妊娠高血压综合征患者血浆血管性假血友病因子及内皮素水平的变化

目的　探讨孕妇血浆血管性假血友病因子(vWF)及内皮素(ET-1)水平变化与妊娠高血压综合征(妊高征)发病的关系。方法　应用酶联免疫吸附试验和放射免疫分析法,分别测定36例妊高征患者(妊高征组)及18例正常妊娠妇女(正常妊娠组)血浆中vWF及ET-1水平,并以19例健康未孕妇女(正常未孕组)为对照。结果　正常妊娠组vWF为（131.6±39.2）%,轻度妊高征患者血浆vWF为（135.9±30.9）%,二者比较,差异无显著性(P>0.05);正常妊娠组ET-1为（47.1±4.7）pg/L,轻度妊高征患者为（63.7±4.8）pg/L,二者比较,差异有极显著性(P<0.01)。中、重度妊高征患者血浆vWF为（174.4±35.4）%,ET-1为（92.6±19.1）pg/L,与正常妊娠组比较,差异均有极显著性(P<0.01)。妊高征患者血浆vWF与ET-1呈明显正相关。结论　vWF和ET-1可作为判断妊高征病情程度的指标;vWF和ET-1在妊高征发病中起相互协同作用。     

1型糖尿病患儿血清维生素A和维生素D水平及其临床意义

目的分析1型糖尿病(T1DM)患儿血清维生素A和维生素D水平变化及其临床意义。方法 2012年2月至2015年1月南阳市中心医院儿科收治住院的T1DM患儿45例,为T1DM组,其中27例合并酮症酸中毒(DKA)。同期选取本院健康体检儿童38例,为对照组。采用酶联免疫吸附法测定血清维生素A和维生素D水平。结果 T1DM患儿血清维生素A和维生素D水平均低于对照组,差异有统计学意义(P0.05)。单纯T1DM患儿血清维生素A和维生素D与T1DM合并DKA患儿比较差异均无统计学意义(P0.05)。结论及时、足量补充维生素A和维生素D可能降低或延迟儿童T1DM发病。     

儿童1型糖尿病动态血糖监测的临床意义

目的应用动态血糖监测系统(CGMS)观察1型糖尿病患儿血糖控制情况，寻找评价和改善血糖控制的方法。 方法收集复旦大学附属儿科医院2003年10月至2004年6月内分泌科门诊随访的儿童1型糖尿病患者28例，男16例，女12例，年龄(131±45)岁，病程(55±34)年，其中21例采用每天多次胰岛素注射(MDI),另7例使用胰岛素泵连续胰岛素输注(CSII)治疗。动态监测血糖3d，同时指尖血糖监测≥4次/d。 结果(1)研究对象体重指数(BMI)为(194±30)kg/m2,糖化血红蛋白(HbA1c)为(84±16)%。CSII组HbA1c(82±10)%,MDI组HbA1c(85±18)%,差异有显著性意义(P<005);(2)CGMS发现22例77次餐后2h高血糖，CSII组4例(571%),每例出现1次，MDI组18例(857%),每例出现(41±25)次,差异显著(P<001)；(3)CGMS发现17例79次低血糖，持续时间(766±928)min,而指尖血糖监测仅发现19次低血糖;白天低血糖持续时间(415±391)min，夜间(1124±1171)min，夜间低血糖持续时间显著长于白天(P<001)。(4)HbA1c≤8%组餐后高血糖发生率低于HbA1c>8%组(P<005)，而低血糖的发生率显著升高(P<001)。 结论1型糖尿病患儿多数存在低血糖和餐后高血糖；动态血糖监测系统是发现血糖异常波动的有效工具。动态血糖监测对指导1型糖尿病治疗，调整胰岛素剂量，从而改善血糖控制有着重要的临床意义。     

阻塞性睡眠呼吸暂停综合征患儿血浆内皮素 1与血管紧张素Ⅱ水平的检测及分析

目的探讨儿童阻塞性睡眠呼吸暂停综合征(OSAS)患儿血浆内皮素 1(ET 1)和血管紧张素Ⅱ(AngⅡ)水平的变化及临床意义。 方法选择广州市2004年2月至2004年11月在儿童医院住院治疗的80例OSAS患儿及30例正常儿童，测定血浆ET 1及AngⅡ水平。 结果与正常儿童相比，OSAS患儿血浆ET 1及AngⅡ水平明显增高，差异有统计学意义(P<0.05)。ET 1水平对多导睡眠图(PSG)结果无明显影响；AngⅡ浓度与最低SaO2相关。 结论血浆ET 1和AngⅡ水平增加与OSAS发病有一定的关系。     

尿型纤溶酶原激活因子及其1型抑制因子mRNA表达与卵巢癌临床病理及预后的关系

目的 研究卵巢组织中尿型纤溶酶原激活因子（uPA）及其1型抑制因子（PAI-1）的表达，探讨其表达与卵巢肿瘤恶性程度的关系。方法 采用逆转录-聚合酶链反应（RT—PCR）方法检测uPA、PAI-1在40例卵巢恶性肿瘤、20例卵巢良性肿瘤及20例正常卵巢组织中的表达。结果 uPA、PAI-1在卵巢恶性肿瘤组织中的阳性表达率明显高于卵巢良性肿瘤组织和正常组织，Ⅲ～Ⅳ期卵巢恶性肿瘤患者其卵巢肿瘤组织中uPA、PAI-1阳性表达率明显高于Ⅰ～Ⅱ期，uPA、PAI-1在低分化、淋巴结转移、残存灶〉2cm的表达率均明显高于高、中分化、无淋巴结转移、残存灶〈2cm者，uPA在有大网膜转移患者的表达率高于大网膜正常者，预后差者uPA表达明显高于预后好者，P值均〈0．05。结论 uPA、PAI-1表达与卵巢恶性肿瘤的侵袭、转移关系密切，有望在临床上成为判断侵袭、转移和预后指标之一。     

缺氧缺血性脑病患儿血浆内皮素1与降钙素基因相关肽变化及其对脑血流动力学的影响

目的　研究新生儿缺氧缺血性脑病 (HIE)时血浆内皮素 1(ET- 1)、降钙素基因相关肽(c GRP)的变化及其对脑血流动力学的影响。　方法　用放射免疫法检测了 4 0例 HIE患儿和 4 0例正常新生儿脐血及生后 1、3、7d外周血 ET- 1与 c GRP的动态变化 ,并于生后 2 4 h取内外周静脉血后即刻应用脉冲多谱勒超声检测 HIE患儿大脑中动脉的血流动力学参数。　结果　 (1) HIE患儿脐血与生后第 1天血浆 ET- 1水平分别为 (70± 2 5 ) ng/ L、(5 7± 14 ) ng/ L ,对照组分别为 (38± 19)ng/ L、和 (35± 99) ng/ L (P值均 <0 .0 0 1) ;c GRP水平分别为 (2 86± 14 3) ng/ L、(2 91± 15 4 ) ng/ L ,对照组分别为 (186± 87) ng/ L、(196± 10 4 ) ng/ L (P值均 <0 .0 0 1) ;至生后 1周末时 ET- 1可恢复正常 ,而 c GRP仍显著高于对照组。 (2 )多谱勒超声显示 HIE患儿脑血流阻力增加、血流速度减慢。 (3)直线相关回归分析表明 ,HIE脑血流阻力指数 (RI)与 ET- 1呈正相关 (r=0 .72 4 ,P<0 .0 1) ,与 c GRP呈负相关 (r=- 0 .719,P<0 .0 1)。　结论　新生儿窒息后 ET- 1、c GRP参与了 HIE的病理生理过程 ,其平衡失调可能是 HIE脑血流动力学紊乱的原因之一。窒息新生儿早期使用 c GRP或 c GRP活性样药物 ,对防止或减轻缺氧缺血性     

妊娠合并暴发性1型糖尿病的研究进展

暴发性1型糖尿病（fulminant type 1 diabetes,FT1DM）最早由日本学者Imagawa等[1]于2000年首次报道,目前暂归于特发型1型糖尿病（1B型）。本病起病急骤,病情凶险,大多于妊娠中晚期或分娩后立即发病[2],如未及时诊断和治疗,不但自身危害大,而且常导致胎儿死亡。     

神经激肽B和内皮素1与妊娠期高血压疾病发病的关系

目的 探讨神经激肽B(NKB)和内皮素1(ET-1)与妊娠期高血压疾病(HDCP)发病的关系.方法 选择2005年3-7月在华中科技大学同济医学院附属协和医院妇产科行产前检查的22例HDCP孕妇作为研究对象,其中,妊娠期高血压12例为妊娠期高血压组,子痫前期10例为子痫前期组;同期22例正常孕妇为对照组.分别采用酶联免疫吸附试验测定3组不同孕周孕妇血浆中NKB和ET-1的水平,采用免疫组化链霉菌抗生物素蛋白-过氧化物酶连接法(SP)检测NKB在胎盘组织中的定位和表达,采用RT-PCR技术检测胎盘组织中的NKB mRNA和ET-1 mRNA表达.结果 (1)子痫前期组孕10～14周、孕20～24周、孕30～34周孕妇血浆中NKB和ET-1的水平分别为(35.6±5.2)、(17.9±4.3)μg/L,(39.5±4.3)、(22.7±3.6)μg/L,(47.1±3.3)、(27.5±3.5)μg/L;对照组分别为(22.9±3.3)、(10.7±5.3)μg/L,(30.2±3.4)、(13.2±4.1)μg/L,(34.6±4.3)、(16.6±4.8)μg/L,两组分别比较,差异均有统计学意义(P<0.05);妊娠期高血压组与对照组比较,差异均无统计学意义(P>0.05).(2)各组孕妇胎盘组织中的绒毛合体滋养细胞、绒毛血管内皮细胞及间质细胞的胞质内均可观察到NKB蛋白阳性染色颗粒,其中以合体滋养细胞的分布为主.子痫前期组胎盘组织中的NKB蛋白表达水平(0.244±0.020)显著高于对照组(0.160±0.012),两组比较,差异有统计学意义(P<0.05).而妊娠期高血压组NKB蛋白表达水平(0.162±0.019)与对照组比较,差异无统计学意义(P>0.05).(3)子痫前期组孕妇胎盘组织中的NKB mRNA(0.97±0.36)和ET-1 mRNA(0.90±0.36)表达水平显著高于对照组(分别为0.78±0.54、0.65±0.47),两组比较,差异有统计学意义(P<0.05);而妊娠期高血压组(分别为0.80±0.40、0.70±0.32)与对照组比较,差异无统计学意义(P>0.05).(4)子痫前期组孕妇血浆中NKB水平与ET-1水平呈正相关关系(r=0.79,P<0.05).结论 子痫前期患者在孕早期(孕10～14周)临床症状出现之前,其血浆中NKB和ET-1水平即已显著升高,胎盘组织中NKB和ET-1表达水平也明显升高.子痫前期患者体内NKB和ET-1水平变化与HDCP的发病密切相关.     

血管紧张素Ⅱ-1型受体基因多态性及血浆内皮素与妊娠高血压综合征关系的研究

目的　研究血管紧张素 - 1型受体 (Angiotensin Type1Receptor,AT1 R)基因116 6位点多态性及血浆内皮素 (Endothelin,ET)在妊娠高血压综合征 (简称妊高征 )发病中的相关性。　方法　应用聚合酶链反应、限制性内切酶酶解及电泳分型的方法对 AT1 R基因 116 6位点的多态性进行分析 ,放射免疫法测定两组血浆 ET值。　结果　 (1)妊高征组 AT1 R基因 116 6位点变异体(AC、CC)频率明显高于正常妊娠组 (χ2 =11.0 6 ,P<0 .0 1) ,两组间 C等位基因频率比较差异也非常显著 (χ2 =9.73,P<0 .0 1)。 (2 )妊娠妇女 AT1 R基因 116 6位点变异型与野生型发生妊高征的比值比(OR)为 4.95 ,95 %可信限为 1.93～ 12 .72。 (3)随着妊高征病情加重 ,AT1 R基因变异频率无增高趋势。(4)妊高征组与正常妊娠组间 ET值比较差异非常显著 ,(t=5 .5 8,P<0 .0 1)。(5 )正常妊娠组中不同基因型之间 ET水平比较差异无显著性 (t=0 .83,P>0 .0 5 ) ;妊高征组变异型 ET水平较野生型增高 (t=2 .5 3,P<0 .0 5 )。　结论　 (1) AT1 R基因 116 6位点的变异与妊高征发病有关 ,C等位基因可能是妊高征的易感基因。 (2 )妊高征患者 AT1 R基因 A 116 6 C变异与血浆 ET的升高有一定相关性。     

HIF-1α、VEGF在妊娠期糖尿病胎盘组织中的表达及其与胎儿缺氧的关系

目的:探讨缺氧诱导因子-1α(HIF-1α)和血管内皮生长因子(VEGF)在妊娠期糖尿病(GDM)胎盘中的表达及其与血糖控制效果和胎儿缺氧的关系。方法:选取GDM孕妇64例,其中血糖控制不良组(A组)22例,血糖控制良好组(B组)42例,同期分娩正常孕妇27例为对照组(C组)。采用Giemsa染色法计数脐血中胎儿有核红细胞(FNRBC);免疫组化SP法和RT-PCR技术测定HIF-1α和VEGF蛋白和mRNA在胎盘中表达;分析GDM组FNRBC水平与HIF-1αmRNA及VEGFmRNA表达的相关性。结果:①3组胎盘中均有HIF-1α和VEGF蛋白的表达,A、B组胎盘中HIF-1α和VEGF蛋白的表达呈较强阳性和强阳性。②A、B、C组胎盘组织中HIF-1α和VEGF蛋白阳性表达率两两比较差异均有高度统计学意义(P<0.01)。③A、B、C组胎盘组织中HIF-1α及VEGFmRNA表达水平两两比较差异均有高度统计学意义(P<0.01)。④A、B、C组脐血FNRBC计数水平两两比较差异均有高度统计学意义(P<0.01)。⑤A、B组脐血FNRBC水平与胎盘组织中HIF-1α、VEGFmRNA表达均呈正相关关系(P<0.01);A、B组胎盘组织中HIF-1α与VEGFmRNA表达亦呈正相关关系(P<0.01)。结论:GDM胎盘中HIF-1α和VEGF的高表达可能参与了GDM的发病过程,其表达水平与孕妇血糖控制效果有关,且能导致胎儿缺氧和不良后果。     

Oligomenorrhoea in adolescents with type 1 diabetes mellitus: relationship to glycaemic control

Objective

To investigate oligomenorrhoea in adolescents with type 1 diabetes and the possible relationship with glycaemic control.

Study design

The study group consisted of 81 female adolescents with type 1 diabetes whose mean age was 15.0 years (range 12-18). The control group consisted of 205 healthy adolescents with a mean age of 15.5 years (range 12-18). Data on menstruation were collected by two parallel self-administered questionnaires. Oligomenorrhoea was defined as having a menstrual cycle longer than 36 days throughout the past year (5-6/year). The metabolic control of diabetes was evaluated by calculating the mean value of HbA1c during the past year.

Results

Age of menarche was greater for adolescents with type 1 diabetes (12.2 ± 1.4 vs. 11.7 ± 1.2, p < 0.000) compared to healthy age-matched controls. Logistic regression analysis with oligomenorrhoea as the dependent binary variable revealed an odds ratio equal to 7.8 (95% CI 3.411-17.853) for adolescents with type 1 diabetes (p < 0.000). Finally, a second logistic regression analysis, concerning only adolescents with type 1 diabetes and with the same binary variable, estimated an odds ratio of 4.8 (95% CI 1.784-13.057, p < 0.002) for HbA1c, and an odds ratio of 5.3 (95% CI 1.821-15.130, p < 0.002) for the frequency of hypoglycaemia.

Conclusion

In adolescents with type 1 diabetes, menarche occurs later and oligomenorrhoea is more frequent. The relative risk of having oligomenorrhoea is greater when there is an increased value of HbA1c or when hypoglycaemia is more frequent.     

Factor VIII: von Willebrand factor patterns in the plasma of patients with pre-eclampsia

Elevation of the factor VIII protein to coagulant ratio previously has been reported to predict the severity of pre-eclampsia. Abnormal levels and patterns of factor VIII: von Willebrand factor (VIII/vWF) have been reported in thrombotic thrombocytopenia purpura (TTP). Severe pre-eclampsia shares many features with this syndrome. Nine primigravid patients with pre-eclampsia were evaluated by assays for factor VIII/vWF protein and coagulant activity and were compared to nine normal primigravid (controls). The patients and controls were indistinguishable by factor VIII antigen/coagulant activity ratios. Pre-eclamptic patients also had unremarkable factor VIII patterns on crossed immunoelectrophoresis. The evaluation of factor VIII/vWF multimeric patterns showed four patients with abnormal patterns in the pre-eclamptic patients and three abnormal patterns in the controls. These patterns were not analogous to the factor VIII abnormalities found in TTP.     

Evaluation of relationship between HbA1c levels and ovarian reserve in patients with type 1 diabetes mellitus

Abstract

In organ or non-organ-specific autoimmune disorders, human ovary is usually the target of the autoimmune attack. We aimed to demonstrate the correlation between ovarian reserve and DM1, based on the view that women with type-1 diabetes mellitus (DM1) will have lower AMH levels secondary to poor glycemic control and autoimmune attacks. Ovarian functions of 42 patients diagnosed with DM1 who use insulin and 65 healthy volunteers were analyzed. Basal hormone and AMH levels were measured during the follicular phase. Fasting and postprandial blood glucose concentrations, HbA1c and C-peptide levels were evaluated. The mean antral follicle count (AFC) was significantly lower in DM1 patients than in healthy controls (p?=?.001). The AMH levels were lower in women with DM1 than in the controls (p?=?.001). The HbA1c values of DM1 patients, who formed the study group, was significantly higher than the control group. Ovarian reserve that is evaluated with serum AMH level is affected by poor glycemic control in type 1 diabetes. Due to the time of the autoimmune damage in the ovaries and the observable effects of this damage, more comprehensive and longer-term studies are needed to be conducted for the follow-up of reproductive abnormalities.     

Serum leptin levels in pregnant women with type 1 diabetes mellitus.

BACKGROUND: Leptin is an important weight regulator and during pregnancy leptin is not only synthesized in adipose tissue but also in the placenta. AIM: To examine changes in serum leptin levels in women with type 1 diabetes mellitus during pregnancy and post delivery in relation to concomitant changes in maternal body weight, birth weight, glycemic control, and blood pressure. METHODS: Non-fasting serum leptin from 45 women with type 1 diabetes mellitus were studied consecutively throughout pregnancy and 3 months post partum. RESULTS: Serum leptin was positively associated with HbA1c in week 18, 22 and 30 (r=0.38, 0.41, and 0.54, respectively, p<0.05, adjusted for body weight). Moreover, serum leptin correlated positively with maternal body weight and BMI (0.4525 kg/m2), the changes during pregnancy and the level of serum leptin were significantly greater compared to lean women (p<0.05). The women with low ambulatory blood pressure (lower tertile, mean arterial blood pressure <83.4 mmHg) showed the lowest level of serum leptin throughout pregnancy and it changed significantly differently from the women with higher blood pressure (p<0.05). CONCLUSION: Changes in serum leptin levels of pregnant women with type 1 diabetes mellitus were associated with parallel changes in maternal body weight and glycemic control. Women with low blood pressure had the lowest serum leptin levels throughout pregnancy.