胃肠激素检测在小于胎龄儿变化中的临床意义

目的:对68例小于胎龄儿(其中早产36例;足月32例)生后喂奶前及第7d空腹血中生长抑素(somatostatin, SS)、胃动素(motilin, MOT)、胃泌素(gastrin, Gas)浓度进行测定,并以30例足月新生儿作为对照组.方法:应用放射免疫分析测定SS、MOT、Gas浓度.结果:小于胎龄儿组生后喂奶前及第7d空腹血浆MOT、Gas均明显低于对照组,而SS浓度明显高于对照组,并且与胎龄、开始喂养时间及当日进奶等因素相关.结论:小于胎龄儿消化道机能适应胃肠道营养,在严密观察下应用合理的喂养方式早日开始胃肠道营养,将能促进小于胎龄儿胃肠道的发育和成熟.     

新生儿血清瘦素水平变化与IGF-Ⅰ、生长激素等相关因素的分析

目的探讨新生儿血清瘦素来源及其与胰岛素样生长因子-Ⅰ(IGF-I)和生长激素的关系.方法采用放射免疫法检测80例新生儿静脉血和脐血瘦素水平,根据不同胎龄新生儿出生体重值分为大于胎龄儿组28例,适于胎龄儿组36例,小于胎龄儿组16例;采用Rohrer's指数=出生体重(g)×10/身长(cm)3估测新生儿营养状态.结果早产儿血清瘦素水平明显低于足月儿(0.66±1.03ng/ml vs 3.59±2.16ng/ml,P＜0.01=;适于胎龄儿血清瘦素水平(3.06±0.96ng/ml明显低于大于胎龄儿(4.03±2.22ng/ml),而高于小于胎龄儿(1.13±1.98ng/ml);足月新生儿血清瘦素水平与Rohrer's指数、新生儿体重、胎龄、血清IGF-Ⅰ、生长激素水平呈显著正相关.结论新生儿体内瘦素主要来源于自身脂肪组织,它反映新生儿的生长营养状态,推测瘦素可能通过IGF-Ⅰ、生长激素共同调节新生儿的生长发育,在胎儿和新生儿生长发育中起重要作用.     

新生儿血清瘦素水平变化与IGF—I、生长激素等相关因素的分析

目的　探讨新生儿血清瘦素来源及其与胰岛素样生长因子 -I(IGF -I)和生长激素的关系。方法　采用放射免疫法检测 80例新生儿静脉血和脐血瘦素水平 ,根据不同胎龄新生儿出生体重值分为大于胎龄儿组 2 8例 ,适于胎龄儿组 36例 ,小于胎龄儿组 16例 ;采用Rohrer’s指数 =出生体重 (g)× 10 /身长 (cm) 3 估测新生儿营养状态。结果　早产儿血清瘦素水平明显低于足月儿 (0 .6 6± 1.0 3ng/mlvs 3.5 9± 2 .16ng/ml,P <0 .0 1=;适于胎龄儿血清瘦素水平 (3.0 6± 0 .96ng/ml明显低于大于胎龄儿 (4.0 3± 2 .2 2ng/ml) ,而高于小于胎龄儿 (1.13± 1.98ng/ml) ;足月新生儿血清瘦素水平与Rohrer’s指数、新生儿体重、胎龄、血清IGF -I、生长激素水平呈显著正相关。结论　新生儿体内瘦素主要来源于自身脂肪组织 ,它反映新生儿的生长营养状态 ,推测瘦素可能通过IGF -I、生长激素共同调节新生儿的生长发育 ,在胎儿和新生儿生长发育中起重要作用     

新生儿血清瘦素水平变化与胰岛素和生长激素关系的研究

目的　探讨新生儿血清瘦素来源及其与胰岛素和生长激素的关系。方法　采用放射免疫法检测 80例新生儿静脉血和脐血瘦素水平 ,根据不同胎龄新生儿出生体重值分为大于胎龄儿 (LGA)组 2 8例 ,适于胎龄儿 (AGA)组 36例 ,小于胎龄儿 (SGA)组 16例 ;采用Rohrer′s指数 =出生体重 (g)× 10 0 /身长 (cm) 3 估测新生儿营养状态。结果　早产儿血清瘦素水平明显低于足月儿 (0 6 6± 1 0 3ng/mlvs 3 5 9± 2 16ng/ml,P <0 0 1) ;AGA儿血清瘦素水平 (3 0 6± 0 96ng/m1)明显低于LGA儿(4 0 3± 2 2 2ng/m1) ,而高于SGA儿 (1 13± 1 98ng/m1) ;足月新生儿血清瘦素水平与Rohrer′s指数、新生儿体重、胎龄 ,血清胰岛素、生长激素水平呈显著正相关。结论　新生儿体内瘦素主要来源于自身脂肪组织 ,它反映新生儿的生长营养状态 ,推测瘦素可能通过胰岛素、生长激素共同调节新生儿的生长发育 ,在胎儿和新生儿生长发育中起重要作用。     

低出生体重儿甲状腺功能检测及分析

目的 研究低出生体重新生儿血清甲状腺功能的改变情况；了解早产儿、足月小样儿与足月适于胎龄儿甲状腺激素的变化及关系。方法 采用放射免疫法，对60例低出生体重儿（其中早产儿30例，足月小样儿30例）进行血清甲状腺激素乃、T4、TSH水平检测，并与对照组同期产科30例足月健康新生儿作比较。结果 低出生体重新生儿甲状腺激素水平与对照组比较显著降低（P〈0．01），足月小样儿乃、T4水平明显高于早产儿（P〈0．01）．结论 新生儿甲状腺功能与出生体重和胎龄有关，但无论早产儿还是足月儿垂体一甲状腺的负反馈调节通路都是良好的，早产儿的甲状腺功能低下是暂时的。     

高危新生儿血糖早期监测的临床价值

目的了解高危新生儿低血糖发生情况、探讨低血糖病因和降低低血糖发生率及危害性措施，为临床防治提供依据。方法对住院的1026例高危新生儿在生后3d内进行血糖监测。结果高危新生儿低血糖发生率6．53％；早产儿组较之于足月儿组、低出生体重儿和巨大儿组较之于正常出生体重儿组、小于胎龄儿组较之于适于和大于胎龄儿组，低血糖发生率明显增高（P〈0．01）。结论对高危新生儿进行血糖监测很有必要，并尽旱喂养，及时处置。     

静脉应用小剂量红霉素防治早产儿喂养不耐受的Meta分析

目的对静脉应用小剂量红霉素防治早产儿喂养不耐受的疗效和安全性的相关文献进行Meta分析,为早产儿喂养不耐受的治疗提供参考依据。方法检索Cochrane图书馆、PubMed、EMBASE、在研试验数据库、中国生物医学文献数据库、中国期刊全文数据库、万方数据库和维普中文科技期刊数据库等。检索红霉素防治早产儿喂养不耐受的RCT文献。按Cochrane系统评价方法进行文献质量评价,采用RevMan5．0．17软件进行Meta分析。结果共纳入18篇RCT文献,文献质量评价A级1篇,B级3篇,C级14篇。共纳入1200例早产儿。Meta分析结果显示：①达到全肠内喂养时间：红霉素预防组加权均数差值（WMD）=-4．18（95％CI：-6．29～-2．08）,红霉素治疗组WMD=-4．69（95％CI：-6．38～-3．00）,两组均可较早实现全肠内喂养;胎龄≤32周亚组WMD=-5．15（95％CI：-12．60—2．30）,与对照组差异无统计学意义。剔除低质量文献行敏感度分析,WMD=～5．48（95％CI：-11．66～0．69）,红霉素治疗组与对照组差异无统计学意义。②红霉素预防组住院时间（WMD=-1．10,95％CI：-3．65～1．37）和NEC发生率（OR=1．01,95％CI：0．24～4．22）与对照组差异无统计学意义;红霉素治疗组13均体重增加（WMD=4．29,95％CI：-2．06～10．64）和NEC发生率（OR=0．68,95％CI：0．18—2．56）与对照组差异无统计学意义;红霉素治疗组恢复至出生体重时间（WMD=-2．45,95％CI：-2．87～-2．04）、症状消失时间（WMD=-1．22,95％CI：-1．33--1．11）及住院时间（WMD=-9．70,95％CI：-11．92～-7．49）与对照组差异有统计学意义。结论对于喂养不耐受高危儿及胎龄≤32周的喂养不耐受早产儿,静脉应用小剂量红霉素的证据尚不足;对于胎龄〉32周的喂养不耐受早产儿,今后研究应确定是否存在一个最佳剂量以缩短静脉营养时间及住院时间,在改善喂养不耐受的症状中红霉素可能起一定的作用。     

双胎妊娠合并未足月胎膜早破对新生儿早期结局的影响

目的 调查双胎妊娠未足月胎膜早破对新生儿结局的影响。方法 回顾性分析2010年1月至2018年12月复旦大学附属妇产科医院分娩的1299对胎龄28+0～36+6周双胎儿的临床资料,分析未足月胎膜早破对新生儿结局的影响。结果 胎龄28+0～36+6周双胎胎膜早破发生率为24.2%。胎膜早破组阴道分娩率高于对照组,差异有统计学意义（P<0.05）。胎膜早破组胎龄及出生体质量低于对照组,差异有统计学意义（P均<0.05）。围生儿结局中,胎膜早破组新生儿呼吸窘迫综合征、喂养不耐受、新生儿感染的发生率高于对照组,差异有统计学意义（P均<0.05）。结论 双胎未足月胎膜早破发生率较高,其新生儿发生呼吸窘迫综合征、新生儿喂养不耐受、新生儿感染的风险增加,临床诊疗需警惕这些问题。     

浅析羊水Ⅲ度污染的产科处理方法

目的探讨羊水胎粪污染的产科处理的时机与方法。方法对2006年10月～2008年10月在我院分娩1636例产妇中,羊水有胎粪污染的足月妊娠的产妇431例,进行回顾性分析,其中破膜时羊水粪染（A组）319例,产程中羊水由清亮变为胎粪污染（B组）112例,随机选择对同期产程中羊水清亮的430例足月妊娠的产妇作为对照组。结果羊水胎粪污染的发生率26.34%,粪染组在母体合并症,胎监异常,脐血流异常,新生儿窒息及剖宫产率均高于对照组。A组脐血流异常明显高于B组,B组胎心监护异常及新生儿窒息明显高于A组,A、B两组间母体并发症,剖宫产无明显差异。羊水胎粪污染组中剖宫产与阴道分娩的新生儿窒息率有显著差异。结论重视羊水胎粪污染的临床处理。在伴发母体并发症,脐血流异常,胎心监护异常情况下,及产程中羊水由清亮变为粪染时处理需积极,应该及早剖宫产为宜。如果是经产妇可在严密监护下阴道分娩。     

早产儿喂养不耐受的胃肠内喂养方法研究

目的探讨改良微量胃肠内喂养法对喂养不耐受早产儿的临床效果。结论将符合纳入标准的喂养不耐受70例早产儿随机分为对照组和观察组,对照组采用常规微量胃肠道喂养法,观察组按照3h的间隔分别给予温开水、5%葡萄糖水和稀释奶（根据体重稀释）各喂养6次后,如无不耐受给予全奶喂养,比较两组患儿喂养不耐受各项观察指标的变化以及相关并发症的发病率。结果观察组患儿的黄疸持续时间、恢复出生体重时间、胃潴留消失时间、胎便排尽时间、平均出院时间分别为（14.6±2.5）d、（10.1±1.8）d、（5.1±1.2）d、（14.2±2.3）d、（19.2±2.3）d;对照组分别为（19.5±2.1）d、（13.5±1.3）d、（7.4±1.3）d、（18.7±2.5）d、（25.4±2.1）d,两组比较差异均有统计学意义（P〈0.001）。在吸吮出现时间和坏死性小肠结肠炎（NEC）、吸入性肺炎等并发症发病率方面,两组比较差异均无统计学意义（P〉0.05）。结论与常规微量胃肠道内喂养法相比,改良微量胃肠道内喂养法更能有效地缓解早产儿喂养不耐受症状。     

Extraction and purification of biologically active intestinal trefoil factor from human meconium

Intestinal trefoil factor (TFF3/ITF), a member of trefoil factor family (TFF) domain peptides, is normally expressed by goblet cells and secreted into the lumen of the intestinal tract, and plays an important role in the maintenance and repair of the intestinal mucosal barrier. Significant amounts of TFF3/ITF are present in the meconium of human infants. Here, we describe a relatively simple method for extraction and purification of natural human TFF3/ITF from meconium. The purification methods include acid treatment, ammonium sulfate precipitation, isoelectric precipitation, and iron exchange chromatography. A relatively large amount of natural TFF3/ITF can be purified from meconium of full-term infants and this purified, natural TFF3/ITF is biologically active in an ethanol-induced rat gastric mucosal injury model.     

大鼠视上核、室旁核肠三叶因子表达与实验性胃溃疡的关系

目的探讨大鼠实验性胃溃疡自愈期间肠三叶因子(ITF)在下丘脑视上核(SON)、室旁核(PVN)的表达及其与实验性胃溃疡愈合的关系。方法以免疫组织化学染色、酶联免疫吸附实验分别检测溃疡组(42只)和正常组(6只)大鼠下丘脑和血清及ITF的表达及含量变化,RT-PCR检测ITFmRNA的转录情况。结果 ITF免疫反应阳性物质主要位于视上核和室旁核大细胞部。溃疡1d视上核和室旁核ITF积分吸光度略增高,2d、4d和6d逐渐升高,6d达高峰(P0.01),10～23d均维持在较高水平(P0.05)。血清ITF的变化与免疫组织化学法结果相似;溃疡组ITF/3-磷酸甘油醛脱氢酶(GAPDH)吸光度比值在溃疡2～23d均高于正常组(P0.01,或P0.05)。结论胃溃疡自愈期间可能通过下丘脑和血清ITF的高表达参与溃疡愈合的调节。     

大鼠实验性胃溃疡期间海马肠三叶因子的变化

目的:探讨大鼠实验性胃溃疡自愈期间肠三叶因子(intestinal trefoil factor,ITF)在海马的表达及其与实验性胃溃疡愈合的关系。方法:以免疫组织化学染色和RT-PCR法分别检测溃疡组(n=42)和正常组(n=6)大鼠海马ITF蛋白的表达和mRNA的转录及变化。结果:ITF免疫反应阳性物质主要位于海马的锥体细胞和颗粒细胞的胞浆内,海马内部分神经纤维也显示阳性。与正常组比较,溃疡1 d海马ITF平均灰度值略降低(P>0.05),溃疡后2、4、6 d逐渐降低,6 d达低谷(P<0.01),10、14、23 d均维持在较低水平(P<0.05)。RT-PCR显示海马ITF mRNA转录水平在溃疡1 d开始增高(P>0.05),溃疡后6 d最高,10、14 d略有下降,但仍高于正常组(P<0.01或P<0.05),23 d和1 d水平接近。结论:实验性胃溃疡大鼠海马可能通过ITF的高表达参与实验性溃疡愈合的神经内分泌调节。     

血清BLyS和APRIL水平与非霍奇金氏病关联性的初步研究

目的：研究非霍奇金氏病（NHL）患者血清B淋巴细胞刺激因子（BLyS）和增殖诱导配体（APRIL）蛋白水平，并探讨其与血清乳酸脱氢酶（LDH）的关系。方法：应用酶联免疫吸附试验（ELISA）法检测LDH升高患者组（10例）和LDH正常NHL患者组（12例）NHL患者血清BLyS和APRIL水平，以健康志愿者（23例）作为对照；同时将血清BLyS和APRIL水平与患者血清乳酸脱氢酶（LDH）进行相关性分析。结果：NHL患者组血清BLyS水平显著低于健康对照组（P〈0.05）；NHL患者血清APRIL水平与健康对照组无显著性差异（P〉0.05），但LDH升高患者组血清APRIL水平明显高于LDH正常患者组（P〈0.05）；NHL患者组和LDH升高患者组血清APRIL水平与LDH正相关（r=0.923、0.799，P〈0.05）。结论：NHL患者血清BLyS、APRIL水平与健康对照组差异，提示BLyS和APRIL可能与NHL的预后及恶性程度有关。     

Augmented intestinal trefoil factor (TFF3) and loss of pS2 (TFF1) expression precedes metaplastic differentiation of gastric epithelium

The trefoil peptides spasmolytic polypeptide (SP), intestinal trefoil factor (ITF), and pS2 show lineage-specific expression in the normal gut and are strongly induced after mucosal injury. We assessed the relationship between this induction and the development of the regenerative epithelial lineage over time in the rat stomach and verified these observations in the metaplastic and dysplastic human stomach. Antral or colonic ulcers were induced in Wistar rats by application of serosal acetic acid and tissues harvested 2 hours to 125 days later. Human endoscopic biopsies or gastric resection specimens were also assessed. Tissues were examined by radioimmunoassay, immunoblotting, or immunohistochemistry for ITF, SP, and transforming growth factor alpha (rat) or ITF and pS2 (human) expression. ITF and SP mRNA in antral ulcer margins was localized by in situ hybridization. ITF and SP peptide expression rose steadily in ulcer margins after 4 days, with the rise in ITF being more pronounced. By 40 days, several hundred-fold elevations in ITF levels were present, with a field effect in uninvolved mucosa. Hyperproliferative, elongated glands of undifferentiated cells expressing abundant trefoil peptides and acid sulfomucins were present after day 12 and persisted after ulcer healing. ITF mRNA was aberrantly expressed in basal and mid-regions of these regenerative glands. In contrast, transforming growth factor alpha peptide expression rose promptly after injury then fell to baseline levels with healing. Seven months after injury, gastric atrophy, intestinal metaplasia, and severe dysplasia with conserved ITF expression were seen. ITF was also induced in human intestinal metaplasia and conserved in all gastric cancers, whereas expression of the gastric peptide pS2 was progressively reduced in the progression from metaplasia to dysplasia. Persistent, selective overexpression of ITF, possibly acting in an autocrine fashion, is a feature of regeneration after antral ulceration, and may provide insight into the nature of metaplastic phenotypes arising from chronic gastric injury. The loss of pS2 expression in metaplasia and cancer supports a role for this protein in gastric tumor suppression.     

A single-chain-Fv-based immunofluorometric assay specific for the CEA variant NCA-2

Carcinoembryonic antigen (CEA) is a member of the immunoglobulin gene superfamily. In meconium, a C-terminal truncated form of CEA, denominated NCA-2, is predominant. This molecular variant is present also in sera from adult cancer patients, but no NCA-2-specific assay is yet available, and its possible clinical significance is largely unknown. We have used phage display technology to produce a single-chain antibody (scFv) suitable for an NCA-2-specific assay and compared the NCA-2 results with CEA values in patient sera. A phagemid library with a diversity of 10(7) was constructed from splenic mRNA obtained from a mouse immunized with NCA-2 purified from human meconium. Following phage rescue and three rounds of panning on solid phases coated with NCA-2, several clones were isolated, which displayed high specificity for NCA-2. These were sub-cloned into an Escherichia coli expression vector for high-level expression of soluble scFv. From BIAcore studies a single scFv with low k(off) and a K(D) of 10(-10) mol/l was selected for europium labelling and an immunofluorometric assay with a sensitivity of 0.2 microg/l was established. The assay detects a protein in serum with a molecular weight significantly lower than CEA. For comparison, a routine assay for CEA, which measures both CEA and NCA-2 equivalently, and a CEA-specific assay based on the T84.66 antibody were employed. The difference between serum values measured with the two CEA assays corresponded to the values determined with the NCA-2-specific assay.     

Relationship between extremely low total serum IgE levels and rhinosinusitis.

BACKGROUND: The few studies examining clinical manifestations in adults with serum IgE levels less than 2.0 IU/mL provide conflicting information. OBJECTIVE: To examine self-reported respiratory disease in women with total serum IgE levels less than 2.0 IU/mL to further elucidate previous reports of an association between IgE deficiency and chronic rhinosinusitis. METHODS: In a geographically based cohort of 626 pregnant women, total serum IgE levels were measured using a standard assay with a lower limit of detection of 2.0 IU/mL. Sera with IgE levels less than 2.0 IU/mL were assayed again using a low IgE protocol with a detection limit of 0.02 IU/mL. RESULTS: Twenty-one individuals (3.4%) were found to have IgE levels less than 2.0 IU/mL. On repeated assay, 20 of these individuals with available clinical data were found to have detectable IgE levels ranging from 0.5 to 2.1 IU/mL (geometric mean, 1.2 IU/mL). None of these individuals with low IgE levels had physician-diagnosed sinusitis compared with 19.3% (113/585) of those with IgE levels of 2.0 IU/mL or greater (P = .03). Physician-diagnosed asthma was also less prevalent (1/19, 5.3%) in the low IgE group compared with 20.6% in those with higher IgE levels, but this was not significant (P = .14). The low IgE group reported a higher prevalence of hay fever symptoms than the remaining cohort (31.6% vs 24.4%; P = .43) but had less physician-diagnosed hay fever (5.3% vs 15.8%; P = .34). CONCLUSIONS: Low serum IgE levels were relatively common in these pregnant women. In contrast to previous studies, a low IgE level was not associated with chronic rhinosinusitis.     

Paired measurements of quantitative hepatitis B virus DNA in saliva and serum of chronic hepatitis B patients: implications for saliva as infectious agent.

BACKGROUND: After intensive source and contact tracing 20 % of acute Hepatitis B virus (HBV) infections remain unexplained. Saliva may be an unexpected vehicle of HBV DNA transmission. OBJECTIVE: To further explore this hypothesis we evaluated the quantitative levels of HBV DNA in saliva and compared these with the HBV DNA levels measured in serum. STUDY DESIGN: Serum and saliva were collected from 27 chronic HBV patients attending our outpatient clinic. RESULTS: There were 16 men and 11 women; 15 patients were HBeAg positive, anti-HBe negative and 11 patients were HBeAg negative, anti-HBe positive. One patient was HBeAg and anti-HBe negative. Samples of serum and saliva were collected on the same day. All saliva specimens were clear on inspection. HBV DNA in serum was measured by the Digene Hybrid Capture II microplate assay (Digene Diagnostics), the HBV Monitor assay (Roche Diagnostics) as well as an in-house developed HBV DNA TaqMan assay. The HBV DNA TaqMan assay was used for the quantitative measurement of HBV DNA in saliva. Median HBV DNA levels in serum were 2.10 x 10(5) geq/ml and ranged from 373 genome equivalents per ml (geq/ml) to 4.13 x 10(9) geq/ml; median HBV DNA levels in saliva were 2.27 x 10(4) geq/ml and ranged from 373 geq/ml to 9.25 x 10(6) geq/ml. A clear correlation was shown between HBV DNA in serum and saliva; log HBV DNA in saliva=1.01 + 0.56 x (log HBV DNA in serum). CONCLUSIONS: this is the first report of precise quantitative measurements of HBV DNA levels in saliva and the relationship with HBV DNA levels in serum. Our findings show that saliva is a source of HBV DNA.This finding may have implications in selected patients for the infectivity of saliva and offer further insight in the routes of transmission of HBV infection.     

三种血管内皮损伤指标血清水平与冠心病病变范围的关系

目的:探讨血清可溶性血管细胞黏附分子-1(sVCAM-1)、可溶性细胞间黏附分子-1(sICAM-1)、血管性血友病因子(vWF)水平与冠心病(CHD)病变范围的相关性。方法:根据冠脉造影结果将87例患者分为CHD组(63例)和对照组(24例)。采用ELISA平行检测两组血清sVCAM-1、sICAM-1和vWF水平,酶法测定血脂水平,比较两组患者sVCAM-1、sICAM-1、vWF及血脂水平的差异,并进行相关性分析;以冠脉狭窄支数作为判断CHD病变范围的依据,探讨不同病变范围患者血清sVCAM-1、sICAM-1和vWF的水平变化。结果:CHD组血清sVCAM-1、sI-CAM-1、vWF水平显著高于对照组(P<0.01);血清sVCAM-1、sICAM-1和vWF水平与血脂水平之间无明显相关性(P>0.05);单支冠脉狭窄组血清sVCAM-1、sICAM-1水平显著低于多支冠脉狭窄组(P<0.05)。结论:CHD患者血清sV-CAM-1、sICAM-1和vWF水平升高,sVCAM-1、sICAM-1水平与CHD病变范围有关。