血浆D-二聚体、血清CRP、血清尿酸与妊娠期高血压关系的研究

目的:探讨血浆D-二聚体、血清CRP、血清尿酸与妊娠期高血压关系。方法:随机选取妊娠期高血压孕妇150例,其中轻度子痫前期组75例,重度子痫前期组75例,选取同期同孕周正常妊娠单胎孕妇75例为对照组。对三组患者的血浆D-二聚体、血清CRP、血清尿酸水平进行比较分析,评价其在妊娠期高血压疾病评估中的价值。结果:轻,重度子痫前期组血浆D-二聚体、血清CRP、血清尿酸均明显高于正常妊娠对照组,差异有统计学意义(P<0.01);重度子痫前期组血浆D-二聚体、血清CRP、血清尿酸均明显高于轻度子痫前期组,差异有统计学意义(P<0.01)。结论:血浆D-二聚体、血清CRP、血清尿酸水平可作为监测妊娠期高血压疾病病情严重程度的指标,其检测值越高提示病情越重。     

子痫前期对氧磷酶1活性和代谢综合征变量变化的临床研究

目的:研究子痫前期患者血清对氧磷酶1(PON-1)活性及代谢综合征变量的变化和发生情况。方法:选择年龄、孕周、产次相匹配的轻度子痫前期患者38例(MPE组),重度子痫前期患者45例(SPE组),正常孕妇63例(对照组)为研究对象,测定其血清PON-1活性、丙二醛(MDA)、血脂及空腹血糖水平等指标。结果:子痫前期患者(MPE组+SPE组)血清MDA、总胆固醇、甘油三酯、低密度脂蛋白水平(LDL)均明显高于对照组(P<0.05),而血清PON-1活性及高密度脂蛋白(HDL)较对照组明显降低(P<0.05);SPE组空腹血糖较MPE组和对照组明显升高(P均<0.05)。子痫前期患者血清PON-1活性与MDA、甘油三酯、LDL水平呈负相关(P均<0.05),与HDL水平呈正相关(P<0.05),与BMI及空腹血糖无明显相关性(P>0.05)。对照组、MPE组及SPE组代谢综合征的发生率分别为3.2%,18.4%,33.3%。结论:子痫前期患者有代谢综合征的标志,推断两种疾病相互关联。子痫前期患者血清PON-1活性显著降低,可能为两种疾病相互关联的重要原因之一。     

妊娠期高血压疾病血浆GMP-140水平及Fg含量测定的临床意义

目的探讨血栓前状态与妊娠期高血压疾病发生发展的关系。方法使用流式细胞术(FC)及PT-der法,测定2007年8月至2009年12月吉林大学第二医院及深圳市南山区妇幼保健院收治的妊娠期高血压疾病患者103例(研究组)和正常妊娠晚期孕妇30例(对照组)的产前、产后静脉血浆α-颗粒膜蛋白140(GMP-140)和纤维蛋白原(Fg)水平。将研究组的上述指标与对照组进行比较、将各组产前、产后指标进行比较。结果 GMP-140浓度子痫前期重度组与轻度组相比差异有统计学意义(P0.05);与妊娠期高血压组及正常晚孕组相比差异有统计学意义(P0.01)。子痫前期轻度组与正常晚孕组相比差异有统计学意义(P0.05)。子痫前期重度组Fg含量与妊娠期高血压组相比差异有统计学意义(P0.05);与正常晚孕组相比差异有统计学意义(P0.01)。子痫前期重度组血浆GMP?140及Fg含量产后比产前增高,差异有统计学意义(P0.05)。结论妊娠期高血压疾病患者存在血栓前状态,随妊娠期高血压疾病的病情加重血浆GMP-140水平及Fg含量逐渐增高,产后24小时内仍是血栓病的高发时期。     

孕中期子宫动脉血流多普勒检查预测妊娠期高血压疾病初探

目的:探讨孕中期行彩色多普勒超声检测子宫动脉血流阻力即搏动指数(PI)、阻力指数(RI)值与妊娠期高血压疾病(HDCP)患者围生儿预后的关系.方法:回顾分析在我院行孕期产前检查并资料齐全的HDCP患者78例,分为妊娠期高血压组、轻度子痫前期组和重度子痫前期3组,选择同期无任何妊娠合并症的正常孕妇72例作为对照组,比较4组孕24～28周子宫动脉PI、RI值与母儿预后之间的关系.结果:重度子痫前期患者子宫动脉血流PI、RI值明显高于对照组、妊娠期高血压组和轻度子痫前期组(P<0.01);重度子痫前期患者围生儿预后明显较正常对照组、妊娠期高血压组和轻度子痫前期组差(P<0.01);HDcP中孕期彩色多普勒超声双侧子宫动脉PI、RI值与新生儿出生时体重、分娩孕龄及1分钟Apgar评分呈明显负相关(P<0.01);妊娠24～28周右侧子宫动脉PI、RI在最佳切点预测子痫前期的特异性分别为92.3%、92.0%;敏感性分别为47.4%、56.3%.结论:孕24～28周多普勒超声检测子宫动脉血流阻力是一种有效预测HDCP严重程度及新生儿预后的方法,其预测子痫前期特异性高,敏感性偏低,因此,应用该指标指导I临床进行早期预防性药物干预值得商酌.     

妊娠期高血压疾病子痫前期病变程度对婴幼儿听力情况影响的对比研究

目的探讨不同程度妊娠期高血压疾病子痫前期对婴幼儿听力的影响及意义。方法收集石家庄市第四医院2015年1月至2017年12月母亲在妊娠期有妊娠期高血压疾病子痫前期史的1046例新生儿,按子痫前期的轻重程度,是否早产进行分组,进行听力检查,并与母亲无妊娠期高血压疾病子痫前期史的新生儿13 695例进行对比研究。结果在所研究的14 741例婴幼儿中,共有57例最终被诊断为感音神经性听力损失,总异常率0.39%(57/14 741)。其中母亲无妊娠期高血压疾病子痫前期的婴儿34例,异常率0.25%;母亲有轻度子痫前期的婴儿12例,异常率1.47%(12/815);母亲有重度子痫前期的婴儿11例,异常率4.76%(11/231)。轻度组与对照组、重度组与对照组、重度组与轻度组比较差异均具有统计学意义(P0.01)。在足月儿中,共有33例最终被诊断为感音神经性听力损失,总异常率0.26%。其中母亲无妊娠期高血压疾病子痫前期的足月儿21例,异常率0.18%;母亲有轻度子痫前期的婴儿7例,异常率1.30%;母亲有重度子痫前期的婴儿5例,异常率3.91%。轻度组与对照组、重度组与对照组、重度组与轻度组比较差异均具有统计学意义(P0.01、P0.01、P0.05)。在早产儿中,共有24例最终被诊断为感音神经性听力损失,总异常率1.09%。其中母亲无妊娠期高血压疾病子痫前期的婴儿13例,异常率0.71%;母亲有轻度子痫前期的婴儿5例,异常率1.81%;母亲有重度子痫前期的婴儿6例,异常率5.83%。轻度组与对照组比较差异无统计学意义(P0.05),重度组与对照组、重度组与轻度组比较差异具有统计学意义(分别为P0.01和P0.05)。结论母亲患有重度妊娠期高血压疾病子痫前期的早产儿是听力损伤发生的高危人群,高血压程度越重,听力异常率越高。应重点加强对此类患儿的听力监测及随访,以便及早干预。     

亚临床甲状腺功能减退与妊娠期高血压疾病关系的探讨

目的探讨妊娠合并亚临床甲状腺功能减退(甲减)与妊娠期高血压疾病的关系。方法选择80例妊娠28~34周妊娠期高血压疾病患者(其中子痫前期40例,妊娠期高血压40例)作为研究组,40例正常孕妇作为对照组,比较两组血清促甲状腺激素(TSH)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb)及血脂等指标。结果子痫前期组、妊娠期高血压组患者血清TSH和TPOAb水平均高于对照组(P0.05),FT4水平低于对照组(P0.05);子痫前期组与妊娠期高血压组中亚临床甲减分别占27.5%(11/40)和25.0%(10/40),TPOAb阳性率分别为22.5%(9/40)和20.0%(8/40),均高于对照组(P0.05);妊娠期高血压疾病合并亚临床甲减患者血清总胆固醇(6.40±0.46)mmol/L、甘油三酯(2.42±0.42)mmol/L和低密度脂蛋白(3.80±0.25)mmol/L,均高于单纯妊娠期高血压疾病患者(P0.05)。结论妊娠期高血压疾病的发生可能与亚临床甲减相关,二者可能互为因果,并可能均与血脂代谢异常有关。     

胰岛素样生长因子1及胰岛素样生长因子结合蛋白1表达与妊娠期高血压疾病发病的关系

目的探讨胰岛素样生长因子1(IGF-1)与胰岛素样生长因子结合蛋白1(IGFBP-1)在妊娠期高血压疾病发病中的作用。方法采用酶联免疫吸附法(ELISA)及免疫组化方法检测60例妊娠期高血压疾病患者(妊娠期高血压疾病组,其中妊娠期高血压20例、轻度子痫前期19例、重度子痫前期21例)及18例正常妊娠妇女(对照组)的血清及胎盘组织中IGF-1及IGFBP-1的水平,并分析妊娠期高血压疾病组患者血清中IGF-1水平与胎盘组织中IGFBP-1的相关性。结果(1)血清IGF-1水平:妊娠期高血压疾病组为(229±100)μg/L,明显低于对照组的(336±120)μg/L,两组比较,差异有统计学意义(P<0.01)。妊娠期高血压患者血清中IGF-1水平为(303±80)μg/L,轻度子痫前期患者为(233±77)μg/L,重度子痫前期患者为(155±73)μg/L。3者间比较,差异有统计学意义(P<0.05)。(2)胎盘组织中IGF-1阳性率:妊娠期高血压疾病组为48%(29/60),明显低于对照组的83%(15/18),两组比较,差异有统计学意义(P<0.01);轻、重度子痫前期患者明显低于对照组(P<0.05,P<0.01)。(3)血清中IGFBP-1水平:妊娠期高血压疾病组为(161±90)μg/L,明显高于对照组的(98±75)μg/L,两组比较,差异有统计学意义(P<0.01)。妊娠期高血压患者为(97±73)μg/L,轻度子痫前期患者为(157±69)μg/L,重度子痫前期患者为(225±81)μg/L。3者间比较,差异有统计学意义(P<0.05)。(4)胎盘组织中IGFBP-1阳性率:妊娠期高血压疾病组为77%(46/60),明显高于对照组的39%(5/18),两组比较,差异有统计学意义(P<0.01);轻、重度子痫前期患者明显高于对照组(P<0.05,P<0.01)。(5)相关性:妊娠期高血压疾病组患者血清及胎盘组织中IGF-1水平分别与相应部位的IGFBP-1水平均呈负相关(r=-0.269,P<0.05;r=-0.396,P<0.01)。血清中IGFBP-1水平与胎盘组织中IGFBP-1表达水平呈正相关(r=0.388,P<0.01)。结论孕妇血清及胎盘组织中IGF-1、IGFBP-1水平变化与妊娠期高血压疾病发病及病情发展有关。     

尿液Lipocalin型前列腺素D合酶含量测定在妊娠期高血压疾病中的评估价值

目的:探讨Lipocalin型前列腺素D合酶(L-PGDS)在评估妊娠期高血压疾病肾脏损伤中的临床价值。方法:选择正常健康足月妊娠、妊娠期高血压、轻度子痫前期和重度子痫前期孕妇各20例,分别对其尿液中的L-PGDS浓度进行检测,并与平均动脉压(MAP)和24小时(24 h)尿蛋白进行相关性分析。结果:妊娠期高血压患者尿液中L-PGDS浓度和正常妊娠孕妇比较,差异无统计学意义(P0.05);而轻度子痫前期和重度子痫前期患者尿液中L-PGDS浓度低于正常妊娠女性和妊娠期高血压患者,差异均有统计学意义(P0.01),且重度子痫前期尿液中LPGDS浓度显著低于轻度子痫前期组(P0.01)。Pearson相关分析显示尿液中L-PGDS浓度与MAP、24 h尿蛋白均呈显著负相关关系(P0.05)。结论:尿液L-PGDS水平可以用来评估妊娠期高血压疾病肾脏损伤的程度,能较好地区别妊娠期高血压和子痫前期,在一定程度上反映疾病的严重程度。     

血清胱抑素C在妊娠期高血压疾病中的临床价值

目的探讨血清胱抑素C(Cystatin C,CC)的检测在妊娠期高血压疾病中的临床价值。方法收集北京妇产医院2012年2月至2012年8月妊娠高血压患者22例、轻度子痫前期患者20例、重度子痫前期患者25例,并选择同期孕周相匹配的健康孕妇30例作为对照组。比较妊娠期高血压疾病组间及与健康孕妇组CC、SCr、BUN和UA的差异,比较不良妊娠结局组与无不良妊娠结局组CC、SCr、BUN和UA的差异。结果妊娠期高血压疾病及各亚组患者CC和UA均较健康孕妇明显增高(P0.05),且重度子痫前期患者升高更明显(P0.05)。与正常妊娠组比较,妊娠高血压疾病组CC和UA分别上升了97.4%和47.4%。妊娠高血压疾病各亚组患者中CC和UA超过正常值患者例数重度子痫前期轻度子痫妊娠期高血压。不良妊娠结局组患者的血清CC、SCr和UA均高于无不良妊娠结局组(P0.05)。结论 CC是评价妊娠期高血压疾病患者早期肾脏损害的一项敏感和可靠的指标,其可能作为不良妊娠结局的预测指标。     

miR-574联合miR-1233对妊娠期高血压及子痫前期的预测价值

目的分析miR-574联合miR-1233对妊娠期高血压及子痫前期的预测价值。方法前瞻性收集2017年1月至2019年2月山东省滕州市中心人民医院收治的80例妊娠期高血压患者作为观察组,其中子痫前期38例,非子痫前期42例;同期选择50例正常孕检的孕妇作为本组研究对照组。采用实时荧光定量聚合酶链式反应(PCR)法检测所有受试者血清中miR-574、miR-1233水平;绘制ROC曲线分析miR-574、miR-1233对妊娠期高血压及子痫前期的预测价值。结果观察组血清miR-574、miR-1233水平明显高于对照组(P 0.05);子痫前期血清miR-574、miR-1233水平明显高于非子痫前期(P 0.05);血清miR-574、miR-1233水平是影响患者妊娠期高血压及子痫前期的独立性影响因素(P 0.05);miR-574与miR-1233联合应用对妊娠期高血压及子痫前期预测的敏感度、特异度及曲线下面积(area under the curve, AUC)均明显高于各指标单独应用(P 0.05)。结论联合检测妊娠期女性血清miR-574联合miR-1233可用作评估妊娠期高血压及子痫前期的重要指标。     

Elevated serum uric acid levels in gestational hypertension are correlated with insulin resistance

The purpose of this study was to assess a possible correlation between insulin resistance and uric acid levels in gestational hypertension (GH) and preeclampsia. Fourteen pregnant, nondiabetic women with either GH (n = 7) or preeclampsia (n = 7) and nine pregnant healthy controls in the third trimester were enrolled onto the study. Fasting serum was collected and insulin sensitivity was determined by Homeostasis Model Assessment based on the algorithm developed by Turner and colleagues. Serum samples were also analyzed for creatinine and uric acid levels. Insulin resistance and uric acid levels were compared between hypertensive and control pregnant women, and the association between these two variables was calculated. There were no significant differences in mean age, weight, body mass index, and glucose challenge test between all hypertensive patients and controls. Significant differences were revealed in insulin sensitivity between hypertensive and nonhypertensive pregnant women (45 +/- 31.2% vs. 79.7 +/- 33%; p = 0.018). In our study, uric acid levels were not significantly higher for hypertensive patients (5.46 +/- 0.85 vs. 4.53 +/- 1.4 mg/dL in controls; p = 0.06). The elevated serum uric acid levels were highly correlated to insulin resistance in patients with GH. In contrast, uric acid levels did not correlate with insulin sensitivity in patients with preeclampsia and controls. Insulin resistance is associated with the elevated uric acid levels found in nonproteinuric gestational hypertensive disease.     

Plasma adiponectin concentration in early pregnancy and subsequent risk of hypertensive disorders

OBJECTIVE: Adiponectin is an exclusively adipose tissue-derived protein. Low plasma adiponectin levels have been found in hypertensive men. Our objective was to evaluate whether low first-trimester plasma adiponectin values were predictive of hypertensive disorders later in pregnancy. METHODS: A nested case-control study was carried out on a cohort of 1,842 pregnant women who participated in the first-trimester Down syndrome screening program; 34 developed preeclampsia and 48 gestational hypertension. A control group of 82 nonhypertensive uneventful pregnancies was selected. Plasma adiponectin was determined using an enzyme-linked immunosorbent assay (ELISA). RESULTS: Adiponectin median concentrations in the group which subsequently became hypertensive were significantly lower than those in the control group (7.6 versus 13.0 microg/mL) (P < .001). When the 2 hypertensive subgroups were considered, the plasma adiponectin median value in the preeclampsia group was significantly lower than that in the gestational hypertension group (6.6 versus 9.3 microg/mL) (P = .01). Regression analysis showed an inverse correlation between plasma adiponectin concentrations and maternal age, gestational age, body mass index, systolic blood pressure, and proteinuria. Approximately 34% of hypertensive pregnancies, compared with 7% of controls (P < .001), had plasma adiponectin concentrations less than 6.4 microg/mL (mean value of lower quartile of distribution among control patients). After adjusting for maternal age, all these women experienced a 6.6-fold (95% confidence interval 2.5-17.8) increased risk of pregnancy hypertension, compared with those women who had higher concentrations. CONCLUSION: Our findings suggest a strong association between hypoadiponectinemia and the risk of hypertensive disorders in pregnancy, especially with preeclampsia.     

Neonatal outcome of temporizing treatment in early-onset preeclampsia

OBJECTIVE: To assess the effect of prolongation of pregnancy on neonatal outcome by means of hemodynamic treatment in patients with early-onset preeclampsia. STUDY DESIGN: A retrospective case-controlled study of 222 liveborn infants of patients with early-onset (24--31 weeks) preeclampsia, who underwent temporizing hemodynamic treatment. Of the two control groups of liveborn preterm infants of non-preeclamptic mothers one group was matched with the study group for gestational age on admission (group I), one for gestational age at birth (group II). Primary outcome measures were neonatal and infant mortality and variables of neonatal morbidity. RESULTS: Median gestation in the study group of preeclamptic patients was prolonged from 29.3 to 31.3 weeks. No difference in neonatal or infant mortality was observed between infants from preeclamptic mothers and in the control groups. The study population showed better results than control group I with regard to admission to NICU (P<0.01), mechanical ventilation (P<0.001) and intracranial hemorrhage (P<0.01). Control group II had better results than the study group with respect to birthweight (P<0.001), bronchopulmonary dysplasia (P<0.01), patent ductus arteriosus (P<0.01), and retinopathy (P<0.01). CONCLUSION: Prolongation of gestation in patients with early-onset preeclampsia may reduce neonatal morbidity, but neonates of the same gestational age without a preeclamptic mother still have a better prognosis.     

Postpartum seizure prophylaxis: using maternal clinical parameters to guide therapy

OBJECTIVE: To use individual patient clinical parameters to signal cessation of postpartum magnesium sulfate seizure prophylaxis for the spectrum of pregnancy-related hypertensive disorders. METHODS: This was a prospective study using clinical symptoms (absence of headache, visual changes, epigastric pain) and signs (sustained blood pressure less than 150/100 without need for acute antihypertensive therapy, spontaneous diuresis more than 100 mL per hour for no less than 2 hours) to signal cessation of intravenous magnesium sulfate postpartum in gravidas diagnosed with preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome. Laboratory assessments (including proteinuria) were not used as criteria for drug discontinuation. RESULTS: Five hundred three patients were enrolled and classified according to American College of Obstetricians and Gynecologists criteria (mild preeclampsia, severe preeclampsia, chronic hypertension with superimposed preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome). Maternal age, gestational age, and hours of magnesium therapy before delivery were not statistically different among groups. There was no significant difference in the duration of postpartum magnesium sulfate therapy among groups with the median duration of therapy 4 hours (range 2-77 hours). No eclamptic seizures occurred after magnesium discontinuation. Thirty-eight patients (7.6%) required reinstitution of magnesium therapy for 24 hours because of exacerbation of blood pressure (sustained blood pressure more than 160/110) associated with headache or visual changes. CONCLUSION: Clinical criteria, when compared with arbitrary protocols, can be used successfully to shorten the duration of postpartum magnesium sulfate administration for seizure prophylaxis in patients with pregnancy-related hypertensive disorders.     

Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome

OBJECTIVE: This study was undertake to determine risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. STUDY DESIGN: Maternal medical records of pregnancies complicated by HELLP syndrome managed between July 1, 1992, and April 30, 1999, were reviewed. Risk factors evaluated included maternal age, parity, race, previous preeclampsia, chronic hypertension, gestational age at diagnosis, mean arterial blood pressure, nadir blood platelet count (<50,000 cells/microL vs > or =50,000 cells/microL), and peak serum levels of aspartate aminotransferase and lactate dehydrogenase. Maternal outcome variables analyzed included eclampsia, abruptio placentae, disseminated intravascular coagulopathy, pulmonary edema, pleural effusion, ascites, acute renal failure, liver hematoma, need for transfusion of blood products, cesarean delivery, and death. Statistical analysis was performed with the Student t test, the chi(2) test, and logistic regression analysis. RESULTS: A total of 183 women with HELLP syndrome were studied. Eclampsia was present in 6%, abruptio placentae was present in 10%, and disseminated intravascular coagulopathy was present in 8%. Forty-one women (22%) required transfusion of blood products. Incidence of eclampsia significantly decreased with increasing gestational age, from 16% at < or =28 weeks' gestation to 3% at >32 weeks' gestation (P <.05) and was higher among African American patients than among white patients (12% vs 3%; P <.05). Logistic regression analysis showed an independent relationship between eclampsia and race (P <.05). Incidence of abruptio placentae was higher among women with previous preeclampsia than among women without this clinical history (26% vs 5%; P <.05). Disseminated intravascular coagulopathy was significantly associated with abruptio placentae (P <.0001) and acute renal failure (P <.0001). A nadir platelet count of <50, 000/microL, a peak serum aspartate aminotransferase level of >150 U/L, and a peak serum lactate dehydrogenase level of >1400 U/L were not independent risk factors for adverse outcome. CONCLUSIONS: Among women with HELLP syndrome, African American race is a risk factor for eclampsia. Both acute renal failure and abruptio placentae are associated with disseminated intravascular coagulopathy. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse maternal outcome.     

Hemodynamic Profile of Mild Pregnancy Induced Hypertension

An echocardiographic assessment of hemodynamics was performed in normotensive pregnant women, and in two categories of patients with mild pregnancy-induced hypertension (PIH): those with preeclampsia (PE, proteinuria 0.3g/24 hours) (n=23) and those with gestational hypertension (GH, proteinuria < 0.3g/24 hours) (n=22). The purpose of the study was to establish whether the two subsets of patients with PIH differ in respect to hemodynamics. Patients with PE had significantly lower stroke volume index and cardiac index than patients with GH, and normotensive pregnant women. Despite similar values of mean blood pressure, patients with PE had systemic vascular resistances higher than GH patients. In the PE group mean fetal weight was lower and the incidence of small for gestational age infants was higher than in the GH group.

The differences in hemodynamic profile in patients with preeclampsia and in woman with gestational hypertension suggest that they represent two distinct pathophysiologic entities. PIH with proteinuria, despite “mild” elevation of blood pressure is predominantly associated with high systemic vascular resistance, which may explain poorer fetal outcome in this group of patients.     

妊娠期肾病综合征62例临床特点及围生结局分析

目的:分析妊娠期肾病综合征的临床特点及其围生结局。方法:回顾性分析2009年1月至2010年12月在湘潭市妇幼保健院住院的273例重度子痫前期患者,将62例妊娠期肾病综合征和随机选择的70例重度子痫前期无合并肾病综合征患者分别作为肾病组和对照组,分析两组临床资料,比较血压、低蛋白血症情况、肾功能指标和围生结局。结果:肾病组多为年龄较轻的初产妇,病情重,以舒张压升高为主。肾病组血浆总蛋白和白蛋白低于对照组(P<0.05);24小时尿蛋白定量、尿素氮和肌酐均高于对照组(P<0.05)。肾病组早产率、小于胎龄儿发生率、围生儿死亡率和新生儿并发症发生率高于对照组,差异均有统计学意义(P<0.05)。结论:妊娠期肾病综合征病情重、进展快,对母婴的影响大,适时终止妊娠可减少妊娠期并发症及围生儿发病率和死亡率。     

子痫前期严重并发症的危险因素分析

目的探讨子痫前期患者发生严重并发症的危险因素。 方法回顾性分析805例子痫前期患者及其围产儿临床资料,将发生严重并发症的327例患者作为研究组,478例未发生严重并发症患者作为对照组。 结果(1)子痫前期严重并发症发生率为40.6%(327/805例),327例患者的严重并发症包括138例死胎(42.2%)、71例HELLP综合征(21.7%)、65例胎盘早剥(19.9%)、39例心功能衰竭(11.9%)、39例产后出血(11.9%)、36例肺水肿(11.0%)等。(2)两组患者临床表现进行的比较,发病孕周、收缩压、舒张压、血肌酐、丙氨酸转氨酶、血清白蛋白和期待治疗时间,差异具有统计学意义(P<0.05)。(3)多因素logistic回归分析提示子痫前期严重并发症独立危险因素为：发病孕周早(OR＝0.783,95%CI: 0.745～0.823)、高血肌酐(OR＝1.005,95%CI: 1.001～1.008)、低白蛋白(OR＝0.961,95%CI: 0.929～0.994)。 结论子痫前期严重并发症发生危险因素为发病孕周早、肾功能损害、低蛋白血症。     

细胞外基质金属蛋白酶诱导因子在子痫前期及子痫患者胎盘组织中表达的研究

目的探讨细胞外基质金属蛋白酶诱导因子(EMMPRIN)在子痫前期及子痫患者胎盘组织中的表达及其与子痫前期及子痫发病的关系。方法采用免疫组化链霉菌抗生物素蛋白-过氧化酶连接法和RT-PCR技术检测不同孕周的44例子痫前期(重度)孕妇(子痫前期组)、38例子痫孕妇(子痫组)和49例正常孕妇(正常妊娠组)胎盘组织中EMMPRIN蛋白及mRNA的表达。结果(1)EMMPRIN蛋白阳性表达：子痫前期组EMMPRIN蛋白表达中度阳性率为18%(8/44),强阳性率为9%(4/44);子痫组EMMPRIN蛋白中度阳性率为21%(8/38),强阳性率为13%(5/38),两组分别比较,差异均无统计学意义(P＞0．05)。正常妊娠组EMMPRIN蛋白表达中度阳性率为12%(6/49),强阳性率为82%(40/49),与子痫前期组及子痫组比较,差异均有统计学意义(P＜0．001)。(2) EMMPRIN mRNA表达：子痫前期组孕晚期(37～40周)EMMPRIN mRNA为0．342±0．002,子痫组为0．344±0．023,两组比较,差异均无统计学意义(P＞0．05)。正常妊娠组孕晚期(37～40周) EMMPRIN mRNA为0．872±0．094,分别与子痫前期组及子痫组比较,差异均有统计学意义(P＜0．001)。结论子痫前期及子痫患者胎盘组织中EMMPRIN表达水平下降是子痫前期及子痫发病的重要原因;EMMPRIN可作为子痫前期及子痫发病的一个预测指标。