妊娠期糖尿病与瘦素水平变化的临床研究

目的　探讨瘦素水平与妊娠期糖尿病 (GDM)发病关系以及对其胎儿生长发育的影响。方法　采用放射免疫法测定GDM孕妇 2 0例 ,糖耐量减低 (IGT)孕妇 2 2例 ,正常孕妇 2 5例血清及其新生儿脐血的瘦素水平 ,同时测定这三组孕妇的胰岛素、C肽水平 ,并测量孕前体重指数和孕期体重增加指数 ,分析其与瘦素之间的关系。结果　GDM孕妇血清瘦素、胰岛素和C肽水平明显高于IGT组及正常组 (P <0 .0 0 1)。脐血瘦素水平与胎儿体重呈正相关 (P <0 .0 5 ) 。孕妇血清瘦素水平与胎儿体重无相关。孕妇血清瘦素水平与脐血瘦素水平无相关。GDM孕妇血清瘦素与孕前体重指数明显相关 (P <0 .0 5 ) ,与孕期体重增加指数无相关。结论　 (1)GDM孕妇血清瘦素水平明显高于正常孕妇 ,故瘦素可作为监控GDM的指标之一。(2 )GDM孕妇瘦素水平与脐血瘦素水平虽然不相关 ,提示胎儿瘦素是自身产生 ,但母亲糖尿病也可以影响胎儿产生更多的瘦素。     

母血和脐血瘦素水平与胎儿宫内发育的相关性研究

本研究应用放射免疫分析法对72例正常分娩的产妇母、脐血中瘦素水平进行检测，目的在于探讨母体与胎儿体内的瘦素来源有无不同及与胎儿发育之间的关系。结果显示母血中瘦素水平明显高于脐血，且与孕妇体重、体重指数呈显著正相关关系，而与新生儿出生体重无明显相关性。脐血中瘦素水平与新生儿出生体重呈显著正相关关系，母、脐血中瘦素水平无相关性。说明胎儿体内的瘦素来源于其自身的分泌，且与胎儿宫内发育关系密切，而母体中的瘦素水平与胎儿发育关系不大。     

妊娠期高血压疾病患者瘦素、胰岛素测定及其与新生儿生长发育的关系

目的探讨妊娠期高血压疾病与瘦素、胰岛素的相关性及临床价值.方法1.采用放射免疫法检测62例妊娠期高血压疾病患者及30例正常组患者的母血、脐血瘦素和胰岛素水平,分析在不同程度妊娠期高血压疾病中的差异,及瘦素、胰岛素水平之间的相关性.2.分析脐血瘦素、胰岛素与妊娠期高血压疾病患者的新生儿体重、Ponder指数(PI=体重×100/身长3)的关系.结果妊娠期高血压疾病患者血清瘦素水平明显高于正常妊娠组,瘦素、胰岛素水平呈明显正相关.其中妊娠期高血压组、轻度子痫前期组、重度子痫前期组的新生儿体重、Ponder指数均与脐血瘦素正相关,与母血瘦素无关;而该相关性在子痫组则未发现.结论母血瘦素、胰岛素共同参与妊娠高血压疾病的发病且随病情的加重有逐渐升高的趋势.脐血中瘦素含量可能对新生儿生长发育有重要调节作用,可作为一项预测新生儿体重的指标.     

妊娠期IL-6和皮质醇水平纵向调查及其相关性分析

目的：观察正常妊娠母体各孕期IL-6和皮质醇的血清水平,并分析相关性。方法：利用电化学发光免疫法检测35名孕妇（妊娠组）孕早、中、晚期和32名非孕妇女（对照组）血清IL-6和皮质醇水平,采用直线相关分析法分析两者的相关性。结果：血清IL-6和皮质醇水平在孕早期末开始显著高于对照组,随着孕期的进程而不断升高,在孕晚期达到高峰,各妊娠期血清IL-6和皮质醇水平呈线性正相关。结论：妊娠期血清IL-6和皮质醇水平升高并呈线性正相关,可能在妊娠维持和进展过程中起着重要作用,检测两者的血清水平有助于评价妊娠的健康状态。     

分娩前后血清生长激素变化的观察

目的 :了解女性血清生长激素 (GH)在妊娠期及分娩前后的变化。方法 :采用放射免疫分析 (RIA)检测 76例正常非孕期妇女、6例妊娠晚期妇女、32例临产期妇女和 2 0例产褥期妇女的血清生长激素 (GH)。结果 :妊娠晚期和临产组血清GH含量明显高于正常组和产褥组 ,差异有显著性 (p <0 0 1 ) ;妊娠晚期组与临产组无明显差异 (p >0 0 5 )产褥组与正常组也无明显差异 (p >0 0 5 )。 结论 :GH在妊娠后期和临产期明显升高 ,反映了母体的正常功能 ,为胎儿的正常发育所必需。分娩后迅速恢复正常 ,表明孕期及妊娠期增高的可能主要是母体中胎血GH的含量     

孕早期血清性激素结合球蛋白水平与糖脂代谢的关系

目的了解南京市孕妇孕早期血清中性激素结合球蛋白(SHBG)的平均水平,并探讨SHBG水平与糖脂代谢异常的关系。方法测量105名22~36岁的初产妇孕早期血清中SHBG,孕中期总胆固醇(CHOL)、甘油三脂(TG)、空腹血糖(FPG)、糖化血红蛋白(HA1c)等糖脂代谢指标;记录孕妇的年龄、孕周、孕前身高体重、及产前体重。结果孕早期血清中SHBG为277.75±85.56nmol/L(98.0~454.0nmol/L),P50为284.9nmol/L。SHBG水平孕妇孕周差异无统计学意义,与年龄,孕前体重,与孕期体重增加有相关性,孕早期SHBG与孕中期空腹血糖,餐后两小时糖,糖化血红蛋白,果糖胺等糖代谢指标呈负相关性。与孕中期血清中总胆固醇,甘油三酯,低密度脂蛋白(L-LDL)相关性成负相关,与高密度脂蛋白(H-LDL)呈正相关。结论南京市孕妇孕早期SHBG平均水平为277.75±85.56 nmol/L。早期SHBG水平可能是参与孕期孕妇糖脂代谢紊乱的影响因素。     

足月妊娠妇女静脉血和脐血中瘦素与新生儿体重的关系

目的 研究瘦素(leptin)与新生儿体重和性别的关系，从而探讨其在胎儿生长发育中的调节作用。方法 我们采用放射免疫法(RIA)测定了62例足月妊娠妇女外周静脉血和脐带血中的瘦素浓度，并分析了与新生儿体重的相关性及性别的关系。结果 母亲外周血中瘦素浓度远远高于脐带血中瘦素的含量(P＜0．001)但是仅脐带血中瘦素的含量与新生儿体重呈显著正相关，而母血中瘦素与新生儿体重无相关性(P＞0．05)。不同性别新生儿的脐带血和其母静脉血间瘦素浓度均无显著性差异(P＞0．05，P＞0．05)。结论 母亲外周静脉血中瘦素浓度远远高于脐带血中瘦素浓度。脐带血中瘦素含量可能对新生儿生长发育有重要的调节作用，可用于预测新生儿体重。     

妊高征患者瘦素水平测定及与胎儿发育的关系

目的研究妊高征患者及其新生儿脐血瘦素水平,以探讨瘦素在妊高征发病中的意义及其与胎儿宫内发育的关系.方法正常孕妇,轻、中、重度妊高征患者各10例,分别于入院后抽取肘前静脉血,分娩时抽取脐静脉血测定瘦素水平.结果正常妊娠组,轻、中、重度妊高征组母血瘦素分别为21.07±5.79ng/ml,19.84±6.19 ng/ml,25.31±6.34ng/ml,30.16±6.78ng/ml;脐血瘦素分别为4.20±2.04ng/ml,3.54±1.95ng/ml,6.32±1.60ng/ml,8.51±2.31 ng/ml;胎儿体重分别为3160±368.03g,3140±441.46g,2920±548.33g,2670±539.65g.正常妊娠组与轻度妊高征组母血及脐血瘦素水平比较均无显著性差异(P＞0.05);重度妊高征组较中度妊高征组母血及脐血瘦素水平均增高,差异有显著性(P＜0.01,P＜0.05);中度妊高征组较对照组(轻度妊高征组及正常妊娠组合并)母血及脐血瘦素水平也均增高,差异也有显著性(P＜0.05,P＜0.01).重度妊高征组母血瘦素与脐血瘦素水平呈显著性正相关(r=0.9,P＜0.01),其余各组均无此相关性.重度妊高征组新生儿体重低于正常妊娠组,差异有显著性(t=2.37,P＜0.05),其余各组间比较均无显著性差异.各组脐血瘦素水平均与新生儿体重呈正相关.结论妊高征患者母血、脐血瘦素均有随病情逐渐增高的趋势,瘦素参与妊高征的发病;重度妊高征时胎盘瘦素可能是脐血瘦素的来源之一并有促进胎儿宫内发育的作用.     

妊娠早中晚期甲状腺激素参考值范围

目的 建立本地区健康孕妇早中晚孕期的甲状腺激素参考范围,为诊断、治疗、监测孕妇甲状腺疾病提供参考依据.方法 用化学发光免疫测定方法测定健康妊娠孕妇以及非妊娠妇女甲状腺激素水平,其中孕早期137例,孕中期147例,孕晚期139例,非妊娠妇女130例,分别建立甲状腺激素参考值范围.结果 以中位数（M值）及双侧限值（P2.5和P97.5）表示甲状腺激素在孕早中晚期及非妊娠妇女的参考值范围,孕妇的TSH水平在孕早期明显低于非妊娠妇女（P＜0.01）,孕中期回升,到孕晚期仍低于非妊娠妇女;孕妇的TT4和TT3自孕早期开始即明显升高（P＜0.01）,孕中期到最高;孕妇的FT4和FT3随妊娠时间下降,孕中期和孕晚期均明显低于非妊娠妇女（P＜0.01）.结论 孕妇的甲状腺激素水平与非妊娠妇女存在明显差异,各孕期之间亦存在明显差异,建立各孕期的甲状腺激素参考范围为临床妊娠期甲状腺疾病的诊治提供了较好的临床价值.     

孕中期妇女C-反应蛋白参考区间的建立

目的:建立孕中期妇女C-反应蛋白(CRP)的参考区间。方法:真空促凝管采集正常孕中期妇女全血,取血清冷冻保存,采用乳胶增强散射免疫比浊法,定量检测131例正常孕中期妇女血清CRP浓度。结果:131例正常孕中期妇女的CRP值呈现非正态分布,以百分位数法计算得其95%参考区间为≤7.38 mg/L。以秩和检验统计分析,孕中期妇女CRP水平明显高于正常育龄期妇女(未处怀孕期)CRP(Z=-9.814,P<0.0001),明显低于其产后CRP水平(Z=-11.877,P<0.0001)。妇女孕中期CRP与其体重呈现低度正相关关系(rs=0.264,P=0.001),与其生产前后CRP差值以及产后CRP无相关关系(rs=0.051,P=0.641;rs=0.109,P=0.374)。结论:初步建立了孕中期妇女CRP参考区间。孕中期CRP与正常育龄期妇女(未处怀孕期)CRP比较,其差别有统计学意义,孕中期水平较高。孕中期CRP与其体重呈现低度正相关关系,而与其生产前后CRP差值以及产后CRP无相关关系。     

母血、脐血INS、GLUC、COR RIA及其意义

目的：测定胎龄儿（AGA）母血、脐血胰岛素（INS）、胰高血糖素（GLUC）、皮质醇（COR）水平,探讨AGA体重与孕妇体重指数（BMI）及母血脐血INS、GLUC、COR相关性及意义。方法：随机选取无明显产科并发症的母亲及新生儿,共26对,新生儿分为体重偏低组（A组）及体重偏高组（B组）,采用放射免疫分析测定INS、GLUC、COR含量。结果：新生儿体重与孕妇BMI有明显关系,B组孕妇BMI显著高于A组（P〈0．05）;新生儿GLUC与COR水平与孕妇比较也具重要的统计学意义（P〈0．05,P〈0．01）;B组新生儿COR含量远高于A组水平（P〈0．01）,而GLUC则相反（P〈0．05）。结论：胎儿发育与孕妇BMI及母血、脐血INS、GLUC及COR水平有关,提示母亲营养状况与上述三种代谢激素的分泌水平直接影响胎儿发育。     

子痫前期中IGF—Ⅰ、Ⅱ水平与FGR的相关性研究

目的探讨子痫前期中胰岛素样生长因子Ⅰ、Ⅱ（IGF—Ⅰ、Ⅱ）水平与新生儿出生体重的相关性。方法选择正常晚期孕妇（对照组）32例,轻度子痫前期孕妇20例、重度子痫前期孕妇20例（研究组）,分别于分娩前抽取孕妇静脉血,分娩时留取新生儿脐静脉血和羊水,同时记录新生儿出生体重,应用酶联免疫吸附试验（ELISA）,检测血清及羊水中IGF—Ⅰ、Ⅱ水平,并对检测结果进行分析。结果（1）子痫前期孕妇血及羊水中IGF—Ⅰ、Ⅱ水平与新生儿体重呈正相关。（2）新生儿脐血中IGF—Ⅰ水平与新生儿体重呈正相关,IGF—Ⅱ水平与新生儿体重呈负相关。（3）正常对照组32例均为正常出生体重新生儿,子痫前期孕妇中胎儿生长受限（FGR）总发病率为27．5％,其中轻、重度子痫前期孕妇,FGR发病率分别为5％和50％（P〈0．01）,差异有统计学意义。结论子痫前期状态下IGF—Ⅰ、Ⅱ水平变化与FGR密切相关,重度子痫前期孕妇中FGR发病率较高。     

Establishment of a highly sensitive leptin radioimmunoassay and detection of increased leptin levels in hyperlipidemia and pregnancy

The highly effective antibody has been obtained by immunizing rabbits with recombinant leptin many times. The leptin is iodinated with the chloramine-T method and purified with a Sephadex-G25 chromatography column. The reaction between antigen and antibody is carried out by a one-step balance method and cultured at 4 degrees C for 24 h; the binding and free antigen was then separated by PR reagent. The determining range of this method is about 0.5-24 ng/mL; limited detection level is 0.45 ng/mL, relative standard deviation in a group, and among groups, are less than 5.4% and 8%, respectively. The level of blood leptin in 277 samples of normal persons, in 112 samples of overweight persons (weight/hieght m2 > or = 25) and 224 samples of hyperlipidemic patients have been measured by this method. It is demonstrated that the level of blood leptin in males is much lower than that of the females, and becomes elevated with increased age. Serum leptin level in overweight persons and hyperlipidemic patients is also much higher than that of normal groups (P < 0.01). Serum leptin of 21 workers in our lab at 8:00 AM and 4:00 PM has been tested. It was found that there are no differences between the two time points. The same results are obtained within age groups. Leptin levels of pregnant women's serum is higher than those of the control group (P < 0.001). Leptin in newborn's serum is significantly lower than those of mothers (P < 0.01). There is no obvious correlation between leptin level of mother and newborns by correlation analysis (r = 0.19, P > 0.05). The body weight and body weight index of pregnant women are well correlated with their serum leptin levels (r = 0.33 and 0.35, P < 0.05). The body weight and body weight index of newborns are well correlated with their serum leptin levels (r = 0.54 and 0.49, P < 0.001). The serum leptin level of pregnant women is not correlated with newborn's body weight (r = 0.10). These results have shown that the proposed method is stable, simple, and specific, being sensitive enough to determine leptin levels in human serum or plasma.     

测定GD妊娠妇女TRAb对子代的风险评估

目的：探讨妊娠母体患毒症型弥漫性甲状腺肿（Graves’病,GD）对新生儿及儿童期甲状腺功能的影响。方法：采用放射免疫分析（RIA）测定近几年本院及妇幼保健院妊娠妇女258例及其新生儿259例甲状腺功能及血清促甲状腺素受体抗体（TRAb）含量。观察子代甲状腺机能状况。结果：孕妇甲亢可以直接影响胎儿宫内生长发育,引起宫内发育迟缓,新生儿甲亢与母体甲状腺激素水平相关。结论：对患甲亢的孕妇,不论其临床症状控制得是否满意,均应查TRAb,如果增高则应密切观察新生儿临床表现,定期复查甲状腺功能,及时发现功能异常,以免影响儿童生长发育。     

健康孕妇足月新生儿出生体重相关影响因素研究

目的探讨影响健康孕妇新生儿体重的相关因素。方法本研究为前瞻性研究,选择2013年3-8月在青岛市市立医院检查并决定在本院分娩的早孕妇女480例,排除个别妊娠合并症和并发症,共376例进入研究,追踪调查至孕妇分娩。详细记录孕妇年龄、孕前体质量、身高、分娩孕周、分娩前体质量、孕期体质量增长、新生儿体质量,并检测妊娠32~34周孕妇血脂及血糖水平,分析各因素与新生儿体质量的相关性。结果孕期体质量增长、甘油三酯水平与新生儿体质量呈正相关（r=0.213,P〈0.01;r=0.244,P〈0.001）。甘油三酯与孕前体重指数、孕期体质量增长呈正相关（r=0.172,P〈0.05;r=0.178,P〈0.01）。巨大儿组孕妇甘油三酯水平为（3.82±1.47）mmol/L,正常儿组孕妇为（3.21±1.26）mmol/L,差异有统计学意义（P〈0.05）。巨大儿组孕妇空腹血糖水平为（4.45±0.063）mmol/L,正常儿组孕妇血糖水平为（4.17±0.50）mmol/L,差异有统计学意义（P〈0.01）。结论孕妇血脂、血糖水平及孕期增重显著影响新生儿出生体重,孕期应该平衡膳食、合理增重,并进行血脂、血糖监测,对控制新生儿的体重有重要的临床意义。     

瘦素、RAAS与高血压的关系

目的 探讨瘦素和肾素-血管紧张素-醛固酮系统（RAAS）与高血压的相互关系及病理生理机制.方法 采用放射免疫方法测定91例高血压患者及67名健康志愿者的血清瘦素、血浆肾素活性（PRA）、血管紧张素Ⅱ（AngⅡ）和醛固酮（ALD））水平;同时测量身高、体重,计算体质指数（BMI）.结果 ①同组内女性瘦素水平均显著高于男性（P＜0.01）;高血压组女性瘦素水平显著高于正常组女性（P＜0.01）;高血压组男性瘦素水平也显著高于对照组男性（P＜0.05）.②高血压患者血清瘦素、PRA、收缩压（SBP）和舒张压（DBP）均显著高于对照组（P＜0.01）; AngⅡ水平也明显高于对照组（P＜0.05）,而BMI和ALD水平与对照组比较无明显变化.③直线相关统计分析显示,高血压组患者血清瘦素的升高与PRA、AngⅡ、BMI和SBP呈正相关（PRA：r =0.52,P＜0.01;AngⅡ：r=0.43,P＜0.01;BMI：r =0.55,P＜0.01;SBP：r=0.33,P＜0.05）,而与ALD和DBP无相关性;对照组瘦素仅与BMI呈高度正相关（r=0.54,P＜0.01）,其它指标均无相关性.结论 血清瘦素水平对血压的影响与性别有关,高血压患者存在瘦素抵抗,瘦素可通过影响RAAS的活性使血压升高,主要为收缩压（SBP）的增高.     

弥漫性毒性甲状腺肿患者瘦素水平及临床意义

目的：探讨弥漫性毒性甲状腺肿对人体血清瘦素水平的影响。方法：选取弥漫性毒性甲状腺肿患者51例,并以甲减组、正常组为对照,应用免疫放射分析（IRMA）测定血清瘦素水平,并测甲功,计算体重指数（BMI）和体脂百分数（%Fat）。结果：弥漫性毒性甲状腺肿患者瘦素水平（男性2.05±1.54μg/L,女性7.47±5.08μg/L）显著低于正常组,而且扣除体脂因素后仍很明显（P〈0.01）。甲减组瘦素水平与正常组相比显著升高,但排除体脂因素后,两组差异无显著性。三组瘦素水平均与BMI显著正相关,与游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）呈弱负相关,与促甲状腺激素（TSH）呈弱正相关,但无统计学意义。各组中女性瘦素水平均为男性的（2-3）倍。结论：甲功改变通过体脂含量间接影响瘦素水平。     

Serum levels of inhibin B, unlike inhibin A and activin A, are not altered in women with preeclampsia

PROBLEM: To investigate whether inhibin A, inhibin B, and activin A serum levels are altered in women with preeclampsia. METHOD OF STUDY: Serum samples of 20 women with preeclampsia (study group) and 20 normotensive pregnant women, matched for maternal and gestational age and parity, were assayed for inhibin A, inhibin B and activin A by specific enzyme-linked immunosorbent assay. RESULTS: Median serum concentrations of inhibin A and activin A were significantly higher among women with preeclampsia than in women with normotensive pregnancies, while inhibin B levels were comparable in both groups. Activin A levels were positively correlated with those of inhibins A and B, and inhibin A levels were positively correlated with diastolic blood pressure and inhibin B concentration in the study group. CONCLUSIONS: Inhibin A and activin A, but not inhibin B, serum levels are markedly increased in women with preeclampsia. These hormones might serve as an endocrine marker for preeclampsia.     

Maternal Serum and Cord Blood Leptin Concentrations at Delivery in Normal Pregnancies and in Pregnancies Complicated by Intrauterine Growth Restriction

IntroductionLeptin is a polypeptide hormone, and in pregnancy, it is secreted by the placenta and maternal and fetal adipose tissues. Normal leptin production is a factor responsible for uncomplicated gestation, embryo development, and fetal growth. The study compared maternal serum and cord blood leptin concentrations at delivery in normal pregnancies and in pregnancies complicated by intrauterine growth restriction (IUGR).MethodsThe study was performed in 25 pregnant women with isolated IUGR and in 194 pregnant women without any complications. Leptin concentrations in maternal serum and in cord blood samples collected at delivery were measured by ELISA and subsequently analyzed by maternal body mass index (BMI), mode of delivery, and infant gender and birth weight. For comparative analyses of normally distributed variables, parametric tests were used, that is, the Student t test and a one-way ANOVA. The nonparametric Mann-Whitney test was used when the distribution was not normal. The Pearson correlation coefficient was calculated to assess the correlation between normally distributed variables (p < 0.05).ResultsIn pregnancies complicated by IUGR, the mean maternal serum leptin concentration at delivery was significantly higher (52.73 ± 30.49 ng/mL) than in normal pregnancies (37.17 ± 28.07 ng/mL) (p = 0.01). The mean cord blood leptin concentration in pregnancies complicated by IUGR was 7.97 ± 4.46 ng/mL and significantly lower than in normal pregnancies (14.78 ± 15.97 ng/mL) (p = 0.04). In normal pregnancies, but not in pregnancies complicated by IUGR, a statistically significant correlation was established between maternal serum leptin concentrations and maternal BMI at delivery (r = 0.22; p = 0.00). No statistically significant correlation was found between cord blood leptin concentrations and maternal BMI in either study subjects or controls. In normal pregnancies, but not in pregnancies complicated by IUGR, a strong correlation was observed between cord blood leptin concentrations and birth weight (r = 0.23; p = 0.00).ConclusionsElevated maternal blood leptin concentrations in pregnancies complicated by IUGR may indicate a significant adverse effect of elevated leptin on fetal growth. The differences in leptin concentrations, measured in maternal serum and in cord blood, between the study subjects and controls suggest that deregulated leptin levels may increase the risk of obstetric complications associated with placental insufficiency.