重度妊高征患者母儿血中降钙素基因相关肽和内皮素浓度…

以探讨降钙素基因要太和内皮素在妊高片发病中的作用为目的，对２０例硬膜外麻醉下行宫产术的产妇，分别于麻醉诱导前、胎儿娩出时采母全静脉血５ｍｌ，胎儿娩出的尚未建立呼吸前采脐动、静脉血各５ｍｌ。和免法测定母儿血浆降钙素基因打关肽和内皮素的浓度。结果：重度妊高征患者母体血浆降钙素基因相关肽的浓度与正常妊娠者相比无明显差异，人皮素的浓度更明显高于正常妊娠。结论：降钙素基因相关肽在妊高生的发病机制中可能不起主     

妊高征患者血浆内皮素与降钙素基因相关肽水平的变化

探讨妊高征患者血浆内皮素与降钙素基因相关肽水平的变化方法采用放射免疫法测定６０例妊高征患者及２３例正常妊娠妇女血浆ＥＴ－１与ＣＧＲＰ的水平。结论ＥＴ－１和ＣＧＲＰ可作为判断妊高征病情程度的指标,ＣＧＲＰ与ＣＴ－１在中,重度妊重高征患者的发病中的起相互作拮抗作用。     

妊高征患者血浆内皮素含量测定

用放射免疫测定法１０例健康未妊娠妇女（未妊娠组）、１０例正常妊娠妇儿（妊娠组）及４１例妊高征患者（妊高征组）血浆内皮素水平。同时测定了妊娠组及妊高征组胎儿脐静血浆内皮素水平。结果表明：未妊娠组与妊娠组间血浆内皮素含量无明显变化（Ｐ＞０．０５）。妊高征组病人血浆内皮素含量显著高于妊娠组（Ｐ＜０．００１）。血浆内皮素水平增程度与妊高征病情严重程度呈正相关。妊娠组脐静脉血浆内皮素含量比母血高４倍，而妊高     

血管活性物质在妊高征发病中的作用

目的探讨一氧化氮(NO)，内皮素－1(ET－1)、前列环素(PGI2)、血栓素A(TXA2)、降钙素基因相关肽(cGRP)多种血管活性物质对妊高征发病的影响。方法应用放射免疫法测定60例妊高征患者，23例正常妊娠妇女血浆ET－1、PGI2，TXA2、cGRP浓度，用Griess法测定NO浓度。结果①妊高征患者血浆NO、PGI2、cGRP浓度降低，NO与妊高征病情呈负相关，PGI2、cGRP与中、重度妊高征病情呈负相关。②妊高征患者血浆ET－1、TXA2浓度增高，ET－1与妊高征病情呈正相关。TXA2与中、重度妊高征病情呈正相关。③上述5种血管活性物质相关分析，NO与ET－1、TXA2与中、重度妊高征呈负相关，NO与PGI2、cGRP呈正相关，ET－1与PGI2、cGRP呈负相关。结论①NO、ET－1、PGI2、TXA2、cGRP可做为判断妊高征病情的指标。②多种血管活性物质在妊高征发病中具有协同和拮抗作用。③妊高征的病因发病机制可能为多途径所致。     

青心酮对妊高征患者胎盘血管壁一氧化氮合成酶和血浆内皮素的影响

目的：观察青心酮（３，４二羟基苯乙酮，ＤＨＡＰ）对妊高征（ＰＩＨ）患者胎盘血管内皮细胞（ＶＥＣ）和平滑肌细胞（ＶＳＭＣ）内一氧化氮合成酶（ＮＯＳ）活性和血浆内皮素（ＥＴ）水平的影响。方法：将２２例ＰＩＨ患者随机分为妊高征组和ＤＨＡＰ治疗组（ＤＨＡＰ每天１６０～２４０ｍｇ），同时取１０例非妊娠妇女（对照组）及１０例正常妊娠妇女（正常妊娠组）作对照。于给药前或（和）剖宫产前采外周静脉血，分离血浆，采用放射免疫法测定ＥＴ；取新鲜胎盘行组织化学分析。结果：正常妊娠组胎盘ＶＥＣ和ＶＳＭＣ内ＮＯＳ活性较高，而妊高征组相应细胞内ＮＯＳ活性明显减弱，并伴有组织和细胞的形态学损伤；ＤＨＡＰ治疗组ＮＯＳ活性较治疗前或未经ＤＨＡＰ治疗的ＰＩＨ患者明显增加，其组织和细胞损伤也减轻；正常妊娠组血浆ＥＴ水平高于对照组而妊高征组血浆ＥＴ水平又高于正常妊娠组，ＤＨＡＰ治疗组血浆ＥＴ水平明显低于妊高征组。结论：ＤＨＡＰ可纠正病理性一氧化氮／内皮素失衡，对改善孕妇及胎儿血液循环有重要作用。     

正常妊娠和妊高征孕妇血浆降钙素基因相关肽的研究

目的探讨降钙素基因相关肽（ＣＧＲＰ）在正常妊娠时的变化及与妊高征发病的关系。方法采用放射免疫法对正常妊娠妇女５９例（正常妊娠组）、妊高征孕妇５７例（妊高征组）和正常非孕妇女１０例（对照组）的血浆ＣＧＲＰ水平进行测定。结果正常妊娠组血浆ＣＧＲＰ水平随孕周的进展而增加,孕晚期达高峰（７６８４±２７７５ｎｇ／Ｌ）;妊高征组其血浆ＣＧＲＰ水平随病情的加重而降低;中度妊高征患者ＣＧＲＰ水平（４９７６±２３１１ｎｇ／Ｌ）和重度妊高征患者ＣＧＲＰ水平（４６３５±２２３２ｎｇ／Ｌ）明显低于轻度妊高征患者（７１２８±２１９８ｎｇ／Ｌ）和正常晚孕妇女（７６８４±２７７５）（Ｐ＜０．０５）。血浆ＣＧＲＰ水平与平均动脉压、新生儿体重均无明显相关关系（Ｐ＞０．０５）。结论ＣＧＲＰ的变化在妊高征的发病过程中可能起重要作用     

妊高征孕妇血中催产素含量变化的研究

应用放射免疫测定法对妊高征和正常妊娠妇女各３８例血浆中催产素含量进行动态观察。结果提示：妊高征初发病者较同孕周正常妊娠组血浆催产素含量相差不显著，妊高征未临产者血浆催产素含量高于正常妊娠组；妊高征临产者血浆催产素含量显著高于正常妊娠组；中、重度妊高征孕妇血浆催产素含量明显高于正常妊娠组；重度妊高征孕妇血浆催产素含量也明显高于轻度妊高征孕妇。说明在临床应用催产素过程中，对于妊高征孕妇催产素的应用要与常规应用有所不同，这一研究为妊高征孕妇催产素的应用提出了理论依据。     

肿瘤坏死因子在妊高征发病中的作用

目的：探讨肿瘤坏死因子（ＴＮＦ）在妊高征发病中的作用及其对胎儿生长的影响。方法：应用放射免疫法对正常晚期妊娠妇女１６例（对照组）及妊高征患者４６例（妊高征组）的血浆、羊水和新生儿脐血中ＴＮＦ进行检测。结果：分娩前妊高征组血浆ＴＮＦ水平较对照组高，以中、重度妊高征者增高显著（Ｐ＜０．０５）；产后７２小时妊高征组血浆ＴＮＦ水平下降，与对照组差异无显著性。对照组及轻度妊高征者新生儿脐血ＴＮＦ水平与母血接近，羊水ＴＮＦ水平明显低于母血（Ｐ＜０．０５）；中、重度妊高征者脐血和羊水ＴＮＦ水平均较母血低（Ｐ＜０．０５；Ｐ＜０．０１）。新生儿脐血、羊水中ＴＮＦ水平在两组间差异无显著性。在中、重度妊高征者中，合并胎儿生长迟缓者其羊水和新生儿脐血ＴＮＦ水平明显高于未合并胎儿生长迟缓者。结论：ＴＮＦ可能作为母体对胎儿抗原的异常免疫反应的重要介质，在妊高征的发病中起一定作用。     

妊高征患者血浆内源性一氧化碳与内皮素一1水平的变化

目的探讨妊高征患者血浆内源性一氧化碳(CO)与内皮素(ET-1)浓度的变化.方法采用Chalmers联二亚硫酸盐还原法和放射免疫法分别测定61例妊高征患者、20例正常晚期妊娠妇女及20例健康非孕妇女(对照组)的血浆CO与ET-1浓度.结果正常妊娠组血浆CO浓度较对照组显著升高(P＜0.01),重度妊高征患者血浆CO浓度显著低于正常妊娠组(P＜0.01);正常妊娠组血浆ET-1浓度较对照组降低,妊高征各组血浆ET-1浓度显著升高,且随病情程度加重而显著增加(P均＜0.05);妊高征各组血浆CO与ET-1浓度呈显著负相关.结论内源性CO可能在妊高征发病中具有重要的生理及病理意义;内源性CO与ET-1在妊高征发病中起相互拮抗作用.     

肿瘤坏死因子在妊高征中的作用

探讨肿瘤坏死因子在妊高征发病中的作用及期 对胎儿生长的影响。方法应用放射免疫法对正常晚期妊娠妇女１６例及妊高患者４６例的血浆、羊水和新生儿脐血中ＴＮＦ进行检测。结果：分娩前妊高征组血浆ＴＮＦ水平较对照组高，以中、重度妊高征者增高显著；产后７２小时妊高征组血ＴＮＦ水平下降，与对照组差异无显著性。     

Plasma and placental levels of interleukin-10, transforming growth factor-beta1, and epithelial-cadherin in preeclampsia

OBJECTIVE: To investigate the plasma and placental levels of interleukin-10 (IL-10), transforming growth factor-beta1 (TGF-beta1), and epithelial-cadherin (E-cadherin) in normotensive and preeclamptic pregnancies. METHODS: The study population consisted of 33 women with normotensive pregnancy and 35 women with preeclampsia. Peripheral venous blood samples were collected before labor (35.3 +/- 1.1 and 34.2 +/- 3.4 weeks' gestation for normotensive and preeclamptic pregnancies, respectively), and placental tissues were obtained after delivery. Maternal plasma and placental homogenate IL-10, TGF-beta1, and E-cadherin levels were determined by enzyme-linked immunosorbent assay. RESULTS: The mean plasma and placental levels of IL-10, TGF-beta1, and E-cadherin were significantly higher in preeclamptic than normotensive patients (P <.001). The plasma and placental levels of IL-10, TGF-beta1, and E-cadherin significantly increased with the increments in diastolic blood pressure (P <.001). CONCLUSION: IL-10, TGF-beta1, and E-cadherin may be involved in the pathologic process of preeclampsia. The pathophysiologic changes associated with preeclampsia may stem in part from the overproduction of these placental mediators.     

Fetal and maternal levels of lipid peroxides in term pregnancies

OBJECTIVE: To examine the relationships between maternal and fetal concentrations of lipid peroxides in term pregnancies before the onset of labor. METHODS: Umbilical cord arterial and venous blood samples were collected from 114 singleton term pregnancies delivered by elective cesarean section. Base excess, oxygen, carbon dioxide and pH were measured in both samples and compared to identify double venous samples. Maternal venous and umbilical cord arterial and venous concentrations of organic hydroperoxides and malondialdehyde were assayed. RESULTS: Maternal plasma malondialdehyde was, on average, double that of cord blood, whereas maternal organic hydroperoxide was only 18% higher. Maternal organic hydroperoxide was correlated with cord arterial and venous levels of organic hydroperoxide but not with pH, carbon dioxide, oxygen or base excess. Maternal malondialdehyde concentration was significantly correlated with both umbilical arterial and venous values of malondialdehyde and with arterial oxygen. Multiple regression shows that 70% of the variation in maternal malondialdehyde can be accounted for by variation in arterial and venous malondialdehyde, and arterial oxygen and base excess. A similar regression analysis with maternal organic hydroperoxide as dependant variable incorporated only umbilical arterial organic hydroperoxide concentration. CONCLUSION: These findings suggest that there is significant trans-placental transport of malondialdehyde from the fetal circulation.     

Maternal plasma calcitonin gene-related peptide levels do not change during labor and are not influenced by delivery route

OBJECTIVE: Calcitonin gene-related peptide (CGRP) circulates in maternal circulation throughout pregnancy, and specific receptors for CGRP (CGRPrs) are expressed by human myometrium. Because CGRP induces a dose-dependent relaxation of human myometrium, we examined a role for CGRP in modulation of myometrial smooth muscle contractility during pregnancy and labor. The aim of the present study was to evaluate the changes of maternal serum CGRP levels during parturition, according to the mode of delivery and in relation to cervical dilatation. METHODS: Circulating CGRP levels were measured in the following groups of healthy women: nonpregnant women, during the follicular phase of the menstrual cycle (n = 19); at term pregnancy (39-40 weeks; n = 24); after elective cesarean delivery (39-40 weeks; n = 20); and at spontaneous vaginal delivery (39-40 weeks; n = 16). In a subgroup of women, blood samples were collected longitudinally throughout labor at various cervical dilatations in the progress of labor (n = 8). RESULTS: Pregnant women at term not in labor had significantly higher CGRP levels than nonpregnant women (P =.021). No significant difference was found between women who delivered vaginally and those who had elective cesarean, and there were no correlations between CGRP plasma levels and cervical dilatation. CONCLUSIONS: Parturition is characterized by no significant changes in maternal serum CGRP levels, and no significant correlation exists between plasma CGRP levels and cervical dilatation during labor.     

妊高征患者血液中内皮细胞因子的表达

目的　探讨妊高征患者血液中内皮细胞因子的表达与妊高征发病和病情严重程度的关系。方法　1999年 1月至 2 0 0 1年 4月采用放射免疫法检测 6 5例不同组别的研究对象血浆中内皮细胞因子水平。结果　内皮素 1(ET 1)在重度妊高征组中显著升高 ,血管内皮生长因子 (VEGF)在各组间无差异 ,神经肽Y(NPY)在妊高征各组中较正常组升高 ,中、重度妊高征组降钙素基因肽 (CGRP)较正常组为低 ,胰岛素样生长因子 (IGF 1)在重度妊高征组显著低于正常组 ,胰岛素样生长因子结合蛋白 (IGFBP 3)水平在各组间差异无显著性意义。各细胞因子间关联性分析发现ET 1与VEGF、NPY及CGRP相关联 (r分别为 - 0 2 87P <0 0 5 ,0 2 6 5P <0 0 5 ,0 5 4 4P <0 0 1)。结论　ET 1和IGF 1在妊高征的发病机制中起重要的作用。ET 1与NPY呈正相关 ,提示妊高征的病理过程与ET 1及NPY等缩血管神经肽有关     

Increased maternal plasma levels of soluble vascular cell adhesion molecule-1 (VCAM-1) in pregnancy induced hypertension (PIH)

One of the reason of PIH problems may be due to the presence of increased circulating levels of cell adhesion molecules, markers of endothelial damage and leukocyte activation. The objective was to evaluate the plasma levels of soluble vascular cell adhesion molecule in maternal peripheral blood of patients with PIH (pregnancy induced hypertension) and compared to those of normal healthy women with uncomplicated pregnancy. Maternal plasma samples were prepared from peripheral venous blood collected from 10 patients with PIH and 10 matched normotensive patients with uncomplicated pregnancies. Samples were assayed for soluble VCAM-1 by specific enzyme-linked immunosorbent assay (ELISA). Women with PIH had significantly higher plasma level of soluble VCAM-1 as compared with healthy pregnant women without PIH (653.50 vs. 456.39 ng/mL, respectively, p < 0.005). Our results on the increased plasma levels of soluble VCAM-1 in patients with PIH provide evidence for endothelial activation of PIH. It suggest that increased plasma level of soluble VCAM-1 could be an early marker of the maternal syndrome of PIH.     

子痫前期患者血浆中sTRAIL、胎盘组织TRAIL及TRAIL受体的变化及意义

目的:研究子痫前期(PE)患者血浆s TRAIL及胎盘滋养细胞上TRAIL/TRAIL-Rs的变化及其与PE发病的关系。方法:选取56例PE患者为研究对象,其中符合重度PE诊断标准者31例(研究组1),未及重度PE 25例(研究组2)。选取同期正常妊娠妇女为对照组,其中28~36周30例(对照组1)、36~(+1)~38周30例(对照组2),因胎膜早破、早产等于28~36周分娩者27例(对照组3),36~(+1)~38周分娩者30例(对照组4)。研究组孕妇留取静脉血及胎盘组织,对照组1、2留取静脉血,对照组3、4留取胎盘组织。ELISA法检测血浆中TRAIL含量,免疫组化法检测胎盘组织中TRAIL和TRAIL-Rs(DR4、DR5、DcR1、DcR2)含量。结果:研究组血浆中sTRAIL含量明显低于对照组(研究组1 vs对照组1,P0.001;研究组2 vs对照组2,P0.005);随着病情加重,s TRAIL含量明显下降(P0.05)。研究组胎盘组织中TRAIL表达明显减少,随着病情加重而加重。研究组中死亡受体DR4、DR5的含量明显高于对照组,而诱骗受体DcR1、DcR2含量明显低于对照组。PE重度组中DR4、DR5含量高于轻度组(P0.05),DcR1和DcR2含量则无显著差异。结论:PE患者血浆中sTRAIL及胎盘组织中TRAIL/TRAIL-Rs含量发生了明显变化,TRAIL/TRAIL-Rs的不平衡性参与了PE的病理过程。     

Maternal circulating nitrite levels are decreased in both normal normotensive pregnancies and pregnancies with preeclampsia.

OBJECTIVE: To evaluate whether maternal nitric oxide synthesis in pregnancies with preeclampsia is different from that in normal normotensive pregnancies. MATERIALS: Maternal circulating combined nitrate and nitrite levels or nitrite level were compared between 10 normotensive nonpregnant women, 30 normotensive pregnant women (10 first-trimester, 10 second-trimester, and 10 third-trimester pregnancies), 20 normotensive postpartum women (10 at 1 week after delivery, and 10 at 4 weeks after delivery), and 13 preeclamptic women (32 to 40 weeks' gestation). End-products of nitric oxide synthesis were measured from maternal venous blood samples using a fluorometric assay. RESULTS: Maternal circulating nitrite levels in nonpregnant women (1.13 +/- 0.22 microM) were significantly higher than those in the first-trimester pregnant women (0.68 +/- 0.13 microM), second-trimester pregnant women (0.65 +/- 0.13 microM), third-trimester pregnant women (0.48 +/- 0.17 microM), first puerperal week women (0.36 +/- 0.16 microM), and fourth puerperal week women (0.67 +/- 0.17 microM), respectively (p < 0.05). Maternal circulating nitrite level was decreased with advancing gestation, still remained low just after delivery, and was increased 4 weeks later. There was no significant difference in maternal circulating nitrite level between preeclamptic women (0.40 +/- 0.17 microM) and third-trimester pregnant women (0.48 +/- 0.17 microM). However, there were no significant differences in maternal circulating combined nitrate and nitrite levels among the groups. CONCLUSION: These results suggest that the maternal nitric oxide synthesis is not changed in normal normotensive pregnancies and pregnancies with preeclampsia. However, plasma nitrite level, which has stronger spasmolytic activity than the activity of the nitrate, was decreased in both normal normotensive pregnancies and pregnancies with preeclampsia.     

分娩对产妇和新生儿免疫状况的影响

应用流式细胞技术检测了共４０例正常孕妇分娩前后和新生儿脐血的白细胞和淋巴细胞亚群。其中阴道分娩组２０例，造反性剖宫产组２０例。结果：分娩前后母体白 数和中性粒细胞，ＮＫ细胞活性以及ＣＤ８、ＣＤ１９亚群均相关不显著，而产后母血ＣＤ４业群升高，ＣＤ３、ＣＤ４／ＣＤ８亦升高，剖宫产或阴道分得母体和新生儿淋巴细胞亚嫩相差不显著，但阴道分娩新生儿的白细胞总数，中性粒细胞比例、单核细胞和ＮＫ细胞显著升高。提示     

Oxidative stress as determined by glutathione (GSH) concentrations in venous cord blood in elective cesarean delivery versus uncomplicated vaginal delivery

OBJECTIVE: To determine whether neonates are subject to oxidative stress by the labor process and the mode of delivery by measuring glutathione (GSH) concentrations in umbilical cord venous blood. STUDY DESIGN: Forty-eight women with singleton term pregnancies were prospectively recruited and classified as follows: 26 women had a spontaneous uncomplicated vaginal delivery (VD), and 22 women had an elective cesarean delivery (CD). GSH concentration in umbilical venous blood samples was determined by a spectroscopic method. RESULTS: Umbilical cord venous blood GSH levels were significantly lower in the elective CD group than in the VD group (2.2 and 2.7 mM, respectively, P = 0.0003). There was a significantly negative correlation between cord blood pO(2) and GSH levels; however, the negative correlation was significantly higher in the elective CD group (P < 0.05). CONCLUSION: Neonates delivered by CD were exposed to a higher oxidative stress as determined by GSH levels compared to those who had an uncomplicated VD.