氟伐他汀对内脂素诱导的内皮细胞基质金属蛋白酶-1表达的影响

目的;探讨他汀类药物降脂外抗动脉粥样硬化的作用机制。方法体外培养人脐静脉内皮细胞,以氟伐他汀和内脏脂肪素共同干预,检测基质金属蛋白酶-1的表达。结果氟伐他汀干预后,基质金属蛋白酶-1的表达较内脏脂肪素组显著降低。结论氟伐他汀可能通过抑制内脏脂肪素的活性,影响血管内皮细胞基质金属蛋白酶-1的表达,由此起到抗动脉粥样硬化的作用。     

产科抗磷脂综合征的诊断和治疗

产科抗磷脂综合征可导致早期复发性流产、死胎、胎盘功能不全和子痫前期等。小剂量阿司匹林和低分子量肝素为一线治疗方案,但仍有30%的病例治疗失败。难治性产科抗磷脂综合征、灾难性抗磷脂综合征的治疗可以使用羟基氯喹、糖皮质激素、静脉免疫球蛋白和血浆置换。抗磷脂综合征妊娠已成为产科研究的一个重要领域,新的治疗方法不断出现。     

非经典抗磷脂抗体在产科抗磷脂综合征的诊断价值研究进展

产科抗磷脂综合征(OAPS)是一种系统性自身免疫性疾病,临床表现为病理妊娠,实验室检查表现为经典抗磷脂抗体(aPLs)持续中高滴度阳性。抗磷脂抗体是一类靶抗原为带负电荷的阴离子磷脂和/或磷脂结合蛋白的自身抗体的总称。临床上表现为OAPS相关病理妊娠的患者体内经典aPLs的检出率较低,近年来有研究报道非经典aPL与OAPS的相关性。非经典抗磷脂抗体主要包括抗磷脂酰乙醇胺抗体、抗凝血酶原抗体、抗膜联蛋白抗体和除抗心磷脂抗体外的抗阴离子磷脂抗体等。加强非经典aPLs的检测有助于改进OAPS的诊断标准,从而积极治疗改善患者妊娠结局。     

小剂量阿司匹林联合低分子肝素治疗时长对产科抗磷脂综合征妊娠结局的影响

目的 探讨小剂量阿司匹林联合低分子肝素治疗时长对产科抗磷脂综合征（obstetric antiphospholipid syndrome,OAPS）妊娠结局的影响。方法 回顾性分析2017年1月至2020年6月大连医科大学附属第一医院收治的115例OAPS患者的临床资料,其中孕早期开始用药至整个妊娠期为全程用药组;≥14周开始用药或仅用阿司匹林或低分子肝素单药治疗或中途停药为部分用药组,妊娠期未使用阿司匹林及低分子肝素为未用药组。分析3组的足月及早产活产率、妊娠丢失情况、妊娠并发症及新生儿评分。结果 3组活产率分别为93.5%、85.7%、50%;足月分娩率分别为79.0%、54.3%、11.1%,两两比较差异均有统计学意义（P<0.05）。3组早产率分别为14.5%、31.4%、38.9%,两两比较差异均有统计学意义（P<0.05）;三组中子痫前期重度和（或）胎儿生长受限发生率分别为17.74%、28.57%、66.67%。3组新生儿5 min Apgar评分及出生体重比较差异有统计学意义（P<0.01）。未治疗组合并慢性高血压比例最高,并与其他两组比较差异均有统计...     

产科抗磷脂综合征诊治中需要探讨的问题

产科抗磷脂综合征(OAPS)的诊疗受到关注,指南及共识成为诊疗的依据.但非典型(NOAPS)、难治性以及伴有血小板减少的OAPS的治疗仍存在着困惑.国内外最新研究结果显示NOAPS的临床表现、实验室检测指标与标准OAPS均有明显不同,干预治疗可以获得相同的妊娠结局.aPLs阳性及不良孕史的NOAPS应按标准OAPS进行...     

抗磷脂综合征对妊娠的影响与治疗

妊娠合并抗磷脂综合征常引起妊娠丢失、胎儿宫内发育迟缓、妊娠高血压综合征等,其发生机理一直有争议。现认为体内产生的抗磷脂抗体诱发血栓的形成特别是胎盘血栓的形成是妊娠失败的主要因素。本文就抗磷脂综合征对妊娠的影响与治疗作一简要综述。     

妊娠合并抗磷脂综合征的诊治

抗磷脂综合征（antiphospholipid syndrome,APS）是一种由抗磷脂抗体引起的非炎症性自身免疫病。妊娠合并APS易发生早期反复自然流产,孕晚期胎死宫内,胎儿生长受限,血小板减少,子痫前期或子痫以及胎盘功能障碍等不良妊娠结局,严重危及母儿健康。临床上应充分重视妊娠合并APS的诊断和治疗。     

低分子肝素治疗抗磷脂综合征疗效及对骨代谢影响的探讨

目的:比较低分子肝素与强的松和阿司匹林治疗抗磷脂综合征(APS)的疗效及对骨代谢的影响,探讨低分子肝素是否能替代强的松和阿司匹林治疗APS.方法:将抗心磷脂抗体(ACA)阳性患者80例(已孕40例,未孕40例)随机分为研究组及对照组,每组为40例.研究组予以低分子肝素(克塞),对照组予以强的松与阿司匹林治疗,观察治疗后两组ACA转阴率,对血液流变学、骨代谢及妊娠结局的影响.结果:①随治疗时间延长,研究组与对照组ACA转阴率均增加,差异无统计学意义(P＞0.05).②研究组治疗前后抗酒石酸酸性磷酸酶(TRAP)浓度,差异均无统计学意义(P＞0.05);对照组治疗前后,差异均有统计学意义(P＜0.05),研究组治疗后TRAP浓度均比对照组上升幅度小,差异均有统计学意叉(P＜0.05).③治疗后研究组与对照组妊娠成功率差异无统计学意义(P＞0.05).结论:低分子肝素治疗抗磷脂综合征,其ACA转阴率、妊娠结局与强的松和阿司匹林相当,降低血浆粘度优于强的松和阿司匹林,对骨代谢影响比强的松和阿司匹林小.     

抗磷脂综合征的围产期抗凝治疗

抗磷脂综合征(APS)是一组以弥漫性动静脉血栓形成、病理妊娠和持续性抗磷脂抗体阳性为特征的综合征。APS能增加复发性流产、早产、死产、子痫前期、胎儿生长受限等妊娠并发症的发生率。不利的妊娠结局和妊娠期血栓形成之间有关联。围产期APS的治疗主要是对症治疗、防止再次发生血栓和病理妊娠。低剂量阿司匹林和肝素能改善APS的妊娠结局。     

维生素E对子(癎)前期血清诱导人脐静脉内皮细胞VCAM-1表达及NF-κB活性的影响

目的探讨子痫前期（pre-eclampsia，PE）血清诱导人脐静脉内皮细胞（human umbilical vascular endothelial cell，HUVEC）血管内皮细胞黏附分子-1（vascular cell adhesion molecules-1，VCAM-1）的表达、核因子-kB（nuclear factor kappa B，NF-kB）活性及维生素E（vitamin E，VitE）对其的影响。方法采用胰酶消化培养法培养正常妊娠HUVEC，传代后待细胞长满至70％～80％，加或不加Vit E作用30min后分别加入正常妊娠及PE血清，培养2h，Western印迹法测定细胞胞浆核因子kB抑制因子（inhibit I kappa B，I-kB）、胞核NF-kB p65含量；培养48h，MTT测定细胞活力，流式细胞学测定细胞凋亡，酶联免疫法测定HUVEC和VCAM-1的表达。结果PE血清培养的HUVEC胞浆I-kB含量明显低于对照组，胞核NF-kBp65含量、VCAM-1的表达、细胞凋亡率明显高于正常妊娠组（P〈O．05），细胞活力明显低于对照组（P〈0．05）。加Vit E预处理后：PE组HUVEC胞浆I-kB含量明显增加；胞核NF-kB p65含量、VCAM-1的表达、细胞凋亡率明显下降（P〈0．05），细胞活力明显增加（P〈O．05）。结论PE血清可促进HUVEC NF-kB活性及VCAM-1的表达，Vit E可抑制PE患者血清诱导HUVEC的NF-kB活性及VCAM-1的表达。     

Plasmapheresis and pregnancy outcome in patients with antiphospholipid syndrome.

OBJECTIVE: To assess plasmapheresis with low dose prednisone on obstetric and neonatal outcomes among unsuccessfully treated pregnant women with documented antiphospholipid syndrome (APS). METHODS: Eighteen pregnant women received prednisone (10 mg/day) and plasmapheresis at 7.08+/-0.6 weeks of gestation, for 3 sessions per week, until lupus anticoagulant activity suppressed and IgG anticardiolipin lowered. Serial pulsatility indexes (PI) of umbilical and uterine arteries were performed. RESULTS: The live birth rate was 100%; mild pre-eclampsia 5.5%; preterm deliveries 22.22%; intrauterine growth restriction 11.11%; thrombocytopenia 5.5%; oligohydramnios and fetal distress 16.6%. There were no perinatal deaths, thrombotic events or lupus flare. Uterine artery PI was reduced and umbilical artery PI was >95th percentile. CONCLUSION: Plasmapheresis and low dose prednisone were associated with a low rate of obstetric and neonatal complications. Plasmapheresis may be used to treat pregnant women with documented APS when first lines (aspirin and/or heparin) fail to prevent pregnancy loss.     

Lack of association between intercellular adhesion molecule-1 (ICAM-1) polymorphisms and polycystic ovary syndrome

Purpose  

This study examined the possible association of G241R and K469E single nucleotide polymorphisms (SNPs) of ICAM-1 gene with the occurrence and clinical/biochemical characteristics of polycystic ovary syndrome (PCOS).     

孕妇血清可溶性细胞间粘附分子-1与亚临床绒毛膜羊膜炎的关系

目的探讨孕妇血清可溶性细胞间粘附分子1(sICAM1)在孕期不同阶段的变化规律及其与早产亚临床绒毛膜羊膜炎的关系。方法2004年4月至2005年1月在中南大学湘雅三医院采用酶联免疫吸附(ELISA)方法,检测48例早产临产孕妇(早产组)及70例正常健康孕妇(其中早孕组15例、中孕组15例、晚孕组20例、足月临产组20例),外周血中sICAM1质量浓度。早产组同时测定血C反应蛋白(CRP)及白细胞(WBC)计数,产后胎膜行病理检测。结果(1)sICAM1质量浓度在正常妊娠各阶段差异无显著性(P>0.05)。(2)早产绒毛膜羊膜炎孕妇sICAM1、CRP质量浓度及WBC计数显著高于非绒毛膜羊膜炎孕妇(P<0.05)。(3)母血清sICAM1质量浓度为247.56μg/L、CRP质量浓度12.75mg/L、WBC计数10.32×109/L可作为绒毛膜羊膜炎的诊断阈值。结论(1)孕妇血清sICAM1质量浓度与孕龄无关。(2)预测早产绒毛膜羊膜炎,sICAM1比CRP和RBC计数更可靠。     

细胞间粘附分子1在亚临床型绒毛膜羊膜炎诊断中的作用

目的　比较胎膜早破 (premature rupture of membranes,PROM)患者血清可溶性细胞间粘附分子 1(soluble intercellular adhesion m olecule1,s ICAM- 1)与 C-反应蛋白 (c- reactive protein,CRP)在亚临床型绒毛膜羊膜炎诊断中的作用。　方法　应用双抗体夹心酶联免疫吸附法测定 5 5例胎膜早破孕妇 [其中足月胎膜早破 (term prem ature rupture of mem brances,TPROM)者 37例 ,早产胎膜早破 (preterm premature rupture of membranes,PPROM)者 18例 ]和 2 0例正常足月孕妇血清s ICAM- 1、CRP浓度 ,并进行胎盘、胎膜病理检查 ,以组织学绒毛膜羊膜炎作为诊断的金标准。　结果　 (1)胎膜早破组患者血清 s ICAM- 1、CRP浓度均显著高于正常足月孕妇 ;(2 )发生绒毛膜羊膜炎患者 ,血清 s ICAM- 1、CRP浓度均高于未发生绒毛膜羊膜炎孕妇 ;(3)血清 s ICAM- 1浓度在 PPROM组与 TPROM组相近 ,血清 CRP浓度在 PPROM却高于 TPROM组 ;(4 )以母血 s ICAM- 1≥ 10 4 .7μg/ L 作为绒毛膜羊膜炎的诊断阈值 ,其敏感性、特异性、阳性预测值、阴性预测值、Kappa指数及ROC曲线下面积分别为 10 0 %、91.2 %、87.5 %、10 0 %、0 .2 0、0 .995 ,明显优于血清 C-反应蛋白指标 ;(5 )亚临床型绒毛膜羊膜组与临床绒毛膜羊膜炎组患者比     

子(癎)前期患者血中氧化低密度脂蛋白及可溶性细胞间黏附分子-1水平的变化及意义

目的探讨子癎前期(preeclampsia,PE)患者血浆中氧化低密度脂蛋白(oxidized low density lipoprotein,oxLDL)和可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1,sICAM-1)水平的变化及其意义。方法采用酶联免疫吸附法(enzyme-linked immunosorbent as-say,ELISA),检测50例PE患者[PE组,其中子癎前期轻度(mild preeclampsea,MPE)及子癎前期重度(severe preeclampsia,SPE)各25例]及25例同期正常孕妇(对照组)血浆中oxLDL和sICAM-1的水平变化。结果PE患者血浆中oxLDL和sICAM-1水平[分别为(30.56±10.29)μg/dl和(703.25±184.21)μg/L]均显著高于对照组[分别为(21.48±10.41)μg/dl和(258.07±67.45)μg/L,P均<0.01]。PE组中,SPE组oxLDL和sICAM-1的水平[分别为(33.74±9.57)μg/dl和(820.02±173.47)μg/L]均显著高于MPE组[分别为(27.39±10.18)μg/dl和(586.48±103.85)μg/L,P<0.05和<0.01]。PE组血浆oxLDL与sICAM-1的水平呈显著正相关(r=0.6175,P<0.01)。结论PE的发病与血清中oxLDL和sICAM-1的水平异常有密切关系。     

Smoking during pregnancy is associated with alterations in markers of endothelial function

OBJECTIVE: Alterations in endothelial function may explain the reduced risk of preeclampsia that is associated with smoking. We hypothesized that markers of endothelial function increase over pregnancy but decrease with smoking. STUDY DESIGN: Plasma samples were obtained throughout pregnancy from 63 primiparous women with normal pregnancies. The samples were assayed for cellular fibronectin, vascular cell adhesion molecule-1, and intracellular adhesion molecule-1. Smoking status was determined by urinary cotinine concentrations. RESULTS: Mean cellular fibronectin concentrations were different by time (P<.001) and smoking status (P=.01); the lowest concentrations were found in smokers. In contrast, intracellular adhesion molecule-1 was different by smoking status (P=.046); the highest concentrations were found in smokers. Vascular cell adhesion molecule-1 was different over time (P<.001), but not by smoking status. CONCLUSION: Smoking during pregnancy is associated with reduced cellular fibronectin and increased intracellular adhesion molecule-1. These differences may be the result of different aspects of endothelial function or the source of the marker. The explanation for reduced preeclampsia in smokers remains elusive.     

Aberrant expression of intercellular adhesion molecule-1 and killer inhibitory receptors induces immune tolerance in women with pelvic endometriosis

OBJECTIVE: To investigate host immunologic response to endometriosis in terms of intercellular adhesion molecule (ICAM)-1 expression by macrophages and killer cell inhibitory receptor (KIR) expression by natural killer (NK) cells. DESIGN: Case-control study of immunologic markers. SETTING: University hospital. PATIENT(S): Twenty-eight Japanese women with endometriosis. Control subjects were 26 women without endometriosis. Diagnoses were made at laparoscopy. INTERVENTION(S): Venipuncture and laparoscopic peritoneal fluid collection. MAIN OUTCOME MEASURE(s): ICAM-1 expression by macrophages and KIR expression by NK cells, measured by flow cytometry. RESULT(S): In women with endometriosis, expression of ICAM-1 by peritoneal macrophages was significantly lower and expression of KIR by NK cells in peritoneal fluid and peripheral blood was significantly higher than in control subjects. CONCLUSION(S): Properties of macrophages and NK cells in women with endometriosis promote immunotolerance to implanted tissue in the peritoneal environment. Increased KIR(+)NK cells in peripheral blood may represent a risk factor for endometriosis.     

肝素配伍阿斯匹林治疗妊娠合并抗磷脂综合征的妊娠结局

目的　探讨肝素配伍小剂量阿斯匹林治疗妊娠合并原发性抗磷脂综合征 (antiphospho lipidsyndrome ,APS)对妊娠结局的影响。　 方法　回顾性分析 32 0例不明原因的反复妊娠丢失的妇女 ,排除其它常见原因后 ,进行抗心磷脂抗体 (anticardiolipinantibody ,aCL)IgG、IgM测定 ,36例阳性者接受肝素配伍小剂量阿斯匹林治疗。　结果　 36例患者中 34例获活婴 ,死胎 1例 ,流产 1例 ,妊娠成功率为 94 .4 % ,孕周 (35 .7± 3.2 )周。新生儿体重为 (2 96 0± 4 5 8)g ,较同期相同孕周新生儿体重(2 6 84± 32 4 ) g明显增加 (P <0 .0 5 )。　 结论　肝素配伍小剂量阿斯匹林治疗APS可明显改善妊娠结局 ,为治疗妊娠合并原发性APS的有效方法。