妊娠晚期维生素A缺乏与母婴贫血的相关性分析

目的探讨妊娠晚期孕妇血清维生素A(VA)水平与母婴血红蛋白(HGB)水平及胎儿VA水平的相关性。方法选择于我院分娩的591例孕妇作为研究对象,按照VA浓度将其分为VA正常组(n=452)和VA缺乏组(n=139)。检测两组的空腹静脉血血常规及VA浓度,待分娩时检测脐带血HGB及VA浓度。比较两组孕妇及脐带血红细胞参数、脐带血VA浓度;分析母婴VA浓度与HGB的相关性。结果VA缺乏组孕妇HGB、脐带血HGB以及VA水平均低于VA正常组(P<0.05);Pearson相关分析结果显示,妊娠晚期孕妇VA与孕妇HGB、脐带血HGB及脐带血VA均呈正相关(P<0.05)。结论妊娠晚期VA水平与母婴HGB水平及脐带血VA浓度成正比。因此,可以通过适当提升母体VA水平,以提高母婴HGB及脐带血VA浓度。     

Role of 2‐Dimensional Ultrasound Imaging in Placental and Umbilical Cord Morphometry: Literature and Pictorial Review

Abnormalities of the placenta and umbilical cord have been associated with adverse pregnancy outcomes. Antenatal detection of placental and umbilical cord abnormalities using ultrasound (US) imaging is now gaining popularity with the advancements in obstetric US. This article reviews the use of 2‐dimensional obstetric US as a tool to measure and assess placental and umbilical cord morphometry. It highlights the potential role of placental and umbilical cord morphometry as a valuable component of the screening tool for high risk pregnancies and identifies the need for further research to examine its feasibility.     

Velamentous insertion of the umbilical cord: a first-trimester sonographic screening study.

OBJECTIVE: The purpose of this study was to determine the feasibility of prenatal sonography for detecting velamentous insertion of the umbilical cord in singleton pregnancies at the 11- to 14-week scan. METHODS: The placental umbilical cord insertion site was prospectively examined at the time of the routine first-trimester scan between 11 and 14 weeks as part of ongoing first-trimester sonographic screening for chromosomal abnormalities. RESULTS: Over a 1-year period, 533 consecutive singleton pregnancies were examined by a fetal medicine specialist at a median gestational age of 12 weeks. In 5 cases, a velamentous umbilical cord insertion was diagnosed, with a prevalence rate of 1 (0.9%) per 107. The diagnosis was further confirmed at the second-trimester scan and at the time of delivery in all cases. CONCLUSIONS: The placental umbilical cord insertion site can be readily determined by sonography at the time of the 11- to 14-week scan. Sonographic examination at this early gestational age provides the opportunity for screening for velamentous insertion of the umbilical cord in the first trimester, allowing close surveillance of the pregnancy for potential complications associated with this condition.     

脐带绕颈对胎儿脐静脉血流的影响

目的 探讨妊娠晚期脐带绕颈对胎儿脐静脉血流的影响。方法 随机选择孕龄36~40周,脐带绕颈但尚无产兆的孕妇65例,观察在无胎动、无胎儿呼吸运动时脐静脉血流速度并记录。结果 有脐带绕颈的胎儿,脐静脉血流速度明显低于对照组(P<0.05)。结论 无产兆的胎儿处于静息状态时,脐带绕颈对胎儿脐静脉血流速度有一定影响。其原因是脐带缠绕形成局部环状管道,血流的离心力增加了系统的阻力,导致动能减少,血流速度下降。     

Absence of a relationship between umbilical cord thickness and coiling patterns.

OBJECTIVE: The purpose of this study was to evaluate a relationship between the umbilical cord thickness and cord coiling patterns during the fetal sonographic anatomic survey in the second trimester of pregnancy. METHODS: This was a prospective study of 470 patients with singleton pregnancies who had a fetal anatomic survey with recorded umbilical coiling patterns between 18 and 23 weeks' gestation. The umbilical cord thickness was assessed as an umbilical diameter at the level of the fetal abdominal cord insertion and compared with the antenatal umbilical coiling index (aUCI), calculated as a reciprocal value of the distance between a pair of umbilical cord coils. RESULTS: Three hundred twenty-one patients had adequate sonographic umbilical cord images and maternal demographic, antenatal, and labor data to meet inclusion criteria. The mean aUCI was 0.41 with 10th and 90th percentiles of 0.21 and 0.60, respectively. A total of 10.6% (34/321) and 9.3% (30/321) of patients were categorized as having hypocoiled and hypercoiled umbilical cords, respectively. The mean cord diameter +/- SD was 9.48 +/- 0.97 mm (range 7.0-12.5 mm). There was no statistically significant correlation between aUCI and umbilical cord thickness (P = .1164). CONCLUSIONS: An aUCI, or umbilical coiling pattern, does not correlate with umbilical cord thickness. It appears that a lesser amount of the umbilical supportive tissue, mainly Wharton jelly, is not related to an increased umbilical cord coiling pattern.     

脐带绕颈胎儿脐动脉及大脑中动脉超声血流参数的特点及与胎儿宫内窘迫的相关性分析

目的探讨脐带绕颈胎儿脐动脉(UA)及大脑中动脉(MCA)超声血流参数的特点及与胎儿宫内窘迫的相关性。方法将106例胎儿脐带绕颈孕妇、100例正常孕妇分别纳入脐带绕颈组、非脐带绕颈组。根据不同孕周、是否发生胎儿宫内窘迫对脐带绕颈组孕妇进行再次分组,分别为28~36周组(52例)、≥37周组(54例);宫内窘迫组(28例)、非宫内窘迫组(78例)。比较各组UA、MCA的RI、PI、S/D。分析UA、MCA超声血流参数与胎儿宫内窘迫的相关性。结果脐带绕颈组UA、MCA的RI、PI、S/D均高于非脐带绕颈组(P<0.05)。28~36周组UA、MCA的RI、PI、S/D均低于≥37周组(P<0.05)。宫内窘迫组UA的PI、S/D高于非宫内窘迫组,MCA的RI、PI、S/D高于非宫内窘迫组(P<0.05)。Logistic回归分析结果显示,UA、MCA的PI、RI、S/D与胎儿宫内窘迫存在明显相关性(P<0.05)。结论脐带绕颈胎儿UA、MCA超声血流参数(RI、PI、S/D)均高于非脐带绕颈胎儿,且孕晚期更为突出,UA及MCA的RI、PI、S/D与胎儿宫内窘迫呈高度相关。     

胎盘脐带异常附着对胎儿生长发育的影响及其作用机制

胎盘和脐带在胎儿生长发育中发挥着重要作用。胎盘脐带异常附着(APCI)是诸多妊娠并发症发生的基础,与不良妊娠结局密切相关。本文就APCI对妊娠结局、胎儿生长发育的影响及其机制进行综述。     

彩超评估脐带旋转指数与脐带异常附着的相关性研究

目的：观察脐带旋转指数异常与脐带附着异常是否相关。方法：超声检测350例孕晚期胎儿的脐带旋转指数（1／A）。该指数为脐动脉围绕脐静脉旋转1个周期后占脐静脉的长度的倒数,指数小于0．1考虑为少旋转。分娩后测量脐带附着点到胎盘边缘的距离,将结果分为正常附着、边缘性附着和帆状附着。结果：少旋转组的胎儿脐带约有76．5％为异常附着,正常旋转或高旋转约有2．2％的脐带异常附着,胎儿脐带旋转指数与脐带附着点到胎盘边缘距离之间的相关系数为r=0．953。结论：脐带少旋转与脐带异常附着有显著相关性,若存在脐带少旋转则可提示存在脐带异常附着。     

两种脐带残端处理方法的效果观察

目的探讨彻底清除脐带残端内的血管和华通胶的脐带残端处理方法与传统方法对脐带脱落和脐部感染的影响。方法将800例正常新生儿按出生单双日分为两组,观察组采用彻底清除脐带残端内血管和华通胶的处理方法,对照组采取传统方法,观察并比较两组新生儿脐带脱落时间及脐部感染的情况。结果两组新生儿脐部干湿情况、脐部感染的差异有统计学意义（P〈0．05或P〈0．01）,脐带脱落时间差异有统计学意义（P〈0．01）。结论彻底清除脐带残端内的血管及华通胶的处理方法,缩短了脐带脱落时间,减少了局部渗血、渗液,降低了脐部感染几率,促进脐部愈合。     

三维彩色多普勒超声诊断脐带打结2例

孕妇1,30岁,孕1产0.既往体健,孕早期超声检查及23周系统超声检查胎儿结构均未见异常.孕30+3周超声检查:二维超声显示脐带游离段成襻,局部堆积(图1A),脐动脉血流参数未见异常;三维彩色多普勒超声提示脐带打结(图1B).之后每周例行产检未见异常.孕37+5周超声检查:胎心监护基线变异消失,同时有多发减速,超声监测...     

54例非亲缘脐血造血干细胞移植回顾性分析

本研究对广州市脐血库1998年6月至2003年7月提供的54例非亲缘脐血移植进行回顾性分析,以研究脐血移植的相关影响因素.脐血均采自广州市妇婴医院正常分娩的足月顺产孕妇,脐血分离、冻存、复温方法参照纽约脐血库标准及相关文献;选择脐血的依据是HLA相合程度及有核细胞数量.结果表明1998年6月至2003年7月间,库存脐血3475份,与21家移植中心合作提供脐血99份,治疗患者85例.其中同胞脐血移植11例.对54例非亲缘关系脐血移植病例进行统计分析显示,在54例受者中,恶性病患者43例,占79.6%,非恶性病患者11例,占20.4%,受者中位年龄9.5(1.2-33)岁,中位体重27(10-60)公斤,TNC中位输入量6.82×107/kg,移植后60天植入43例(ANC＞500/μl的中位时间为17天),植入率为79.6%.脐血移植有核细胞重建时间与输入的有核细胞数以及疾病类型相关,同HLA相合程度不相关.急性Ⅲ-Ⅳ度GVHD发生率为21.6%,慢性GVHD发生率为5.4%.6例患者出现自体恢复(11.1%).存活率42.6%.结论非亲缘性脐血造血干细胞移植尤其在治疗小儿白血病方面具有良好的应用前景.     

人脐血单个核细胞和脐带间充质干细胞移植用于大鼠脊髓损伤的实验研究

目的:探讨人脐血单个核细胞和脐带间充质干细胞(MSCs)移植对脊髓损伤功能恢复的影响,寻找一种更适合治疗脊髓损伤的细胞源。方法:采集新鲜人脐带血和脐带,分离培养单个核细胞和MSCs。将脊髓损伤模型随机分成3组:单个核细胞移植组、MSCs移植组和低糖必需培养基(L-DMEM)培养组。采用免疫组化和免疫荧光检测细胞移植后1—4周细胞在脊髓内的存活情况和迁移情况,使用BBB行为学评分评估大鼠脊髓功能恢复情况。结果:L-DMEM培养液组在术后各时间点观察评分无明显差异,而细胞移植组脊髓功能处于逐渐恢复过程,与L-DMEM培养液比较,差异有显著性意义。单个核细胞移植组对损伤脊髓功能的修复作用较MSCs移植组显著,且差异有显著性意义。结论:与MSCs相比较,人脐血单个核细胞更适合作为治疗脊髓损伤的细胞源。     

人脐带和骨髓源间充质干细胞对脐血单个核细胞增殖能力的影响

目的：探讨人脐带间充质干细胞（UCMSCs）与骨髓间充质干细胞（BMMSCs）在体外对造血干细胞的支持作用。方法分别从人脐带和骨髓中分离、培养间充质干细胞,通过免疫细胞化学染色等方法对其进行表型鉴定;采用流式细胞仪测定脐血单个核细胞的周期分布,采用甲基纤维素法测定脐血单个核细胞混合集落形成单位（CFU-Mix）,比较 UCMSCs和BMMSCs对脐血单个核细胞细胞周期、CFU-Mix形成能力的影响。结果成功培养获得 UCMSCs和BMMSCs,鉴定结果符合预期;与非共培养组细胞相比,UCMSCs和 BMMSCs共培养均能促进脐血单个核细胞进入增殖周期,并增加其形成CFU-Mix的能力（P＜0．05）,但UCMSCs和BMMSCs共培养组之间比较差异无统计学意义（P＞0．05）。结论成功从人脐带和骨髓组织中培养获得间充质干细胞,两种来源的间充质干细胞均能提高脐血单个核细胞的体外增殖能力及 CFU-Mix形成能力,均具有造血支持作用。     

混合脐血成人移植定量监测植入状态的实验研究

为了定量监测和研究双份异基因脐血用于成人白血病患者移植后两份脐血的植入状态、嵌合体类型、供者细胞相对数量的动态变化及演变规律 ,采用荧光标记复合扩增短串联重复 (STR)位点嵌合体定量检测技术 ,对 1例急性髓细胞白血病成人患者移植两份 (脐血 1有核细胞数为 2 .5× 10 7/kg ,脐血 2有核细胞数为 1.5 3× 10 7/kg)HLA各 1个位点不相合的异基因脐血前后的序列血样进行 9个STR位点的检测 ;利用供、受者之间的差异位点定性判断脐血是否植入以及嵌合体类型 ;而后根据 377XLDNA测序仪上荧光扫描后两供者差异基因检出峰的峰面积计算脐血植入后患者体内两份脐血的细胞相对数量 ,定量分析供体细胞植入程度及演变规律 ;并与采用HLA差异基因对植入状态的分析结果进行对比。结果表明 :移植后 15天两份脐血同时植入 ,植入状态为完全双份供者嵌合体 ,患者体内脐血 1的相对细胞数量占 5 1.3% ,脐血 2占 4 8.7% ;30天时脐血 1嵌合体细胞上升为 70 .0 % ,脐血2嵌合体细胞下降为 30 .0 %。 5 2天时只检测到脐血 1的基因 ,植入状态转为完全单份供者嵌合体 ,有核细胞数少的一份脐血被排斥 ,有核细胞数多的一份长期植入。结论 :荧光标记复合扩增STR嵌合体定量检测可精确地描述两份脐血的植入程度及变化过程 ,为临床脐     

二维及彩色多普勒超声诊断胎儿脐带扭转的临床分析

目的研究胎儿脐带扭转的二维声像图特征、彩色多普勒血流显像(CDFI)及脐动脉血流S/D值,分析其临床应用价值。方法对335例晚期妊娠妇女随机进行二维超声和CDFI检查。自脐带胎盘端到胎儿脐轮部循踪行多切面扫查,记录脐带扭转声像,脐动脉血流S/D测值,产后进行对照分析。结果CDFI诊断脐带扭转阳性检出率高,漏诊率低,显著优于二维超声。脐带扭转的声像图特征:纵切面呈绳索、麻花或双排对称串珠状;横、斜切面似“鼠眼样”形和“元宝”形。脐带扭转组胎儿窘迫、低Apgar评分发生率明显高于无扭转组(P<0.05)。结论脐带扭转与胎儿宫内窘迫、预后及分娩方式密切相关。CDFI诊断脐带扭转声像特征更直观、准确。脐动脉血流S/D值可提示胎儿缺氧和预后,有重要临床应用价值。     

孕中晚期卵圆孔瓣宫内闭合与脐带扭转的相关性研究

目的卵圆孔瓣宫内闭合是妊娠中晚期胎儿出现右心扩大、缺氧、胎儿水肿,甚至宫内死亡的重要原因之一。应用胎儿超声检查观察孕中晚期卵圆孔瓣闭合与脐带扭转之间的关系。方法 8例中晚期胎儿经超声检查发现胎儿心脏卵圆孔瓣宫内闭合。常规检测胎儿心脏结构,除外结构性心脏发育异常,检测胎儿心脏左、右心比例、卵圆孔径、由于卵圆孔瓣部分闭合剩余交通口径,卵圆孔过隔血流速度,静脉导管阻力指数,动脉导管血流速度。对胎儿进行常规生物学指标检测,重点观察胎儿脐带,计算脐带扭转指数。与出生后脐带状况对照。结果卵圆孔瓣宫内闭合的8例胎儿,右心与左心比例增大,卵圆孔瓣闭合呈瘤样膨隆,剩余交通口径明显减小,卵圆孔血流速度未见明显增快。静脉导管阻力指数轻度增高。部分胎儿动脉导管血流速度增加。脐静脉扭转指数均增加。其中顺产2例,剖宫产6例。出生后发现脐带扭转3例,脐带打真结1例,脐带绕颈极紧1例,球拍状胎盘1例。出生后脐带阳性表现占本研究病例75%。结论脐带宫内异常特别是扭转或打结以及其他因素致通过卵圆孔血流量减少,可能是孕中晚期胎儿卵圆孔瓣宫内闭合的重要原因,是胎死宫内的危险因素。     

胎盘组织及血液中含有丰富的造血干/祖细胞

大量的临床移植表明人脐血 (UCB)可以在造血干细胞移植的儿童中得到造血重建 ,可是在成人中脐血移植 (UCBT)效果并不理想 ,这主要是脐血中所含的细胞数及造血干 /祖细胞数有限 ,而不适宜体重较大的成人。本研究在收集脐血的同时 ,也分别收集胎盘血 (UPB)及胎盘组织 (UPT)中的细胞 ,检测有核细胞数 ,CD34(造血干 /祖细胞的表明标记 )阳性细胞 ,粒单细胞集落 (CFU GM)。结果发现 :来自于胎盘血和胎盘组织中的有核细胞数是脐血细胞的 3- 4倍 ;脐血、胎盘血及胎盘组织细胞的有核细胞数分别为 (8.3± 1.0 4 )× 10 8,(16 .33± 5 .5 4 )× 10 8和(8.0 1± 2 .6 4 )× 10 8;CD34+ 细胞分别为 (0 .77± 0 .0 1)× 10 6,(1.2 5± 0 .5 5 )× 10 6和 (4.2 1± 1.90 )× 10 6;在细胞的长期培养中 ,UPB细胞和UPT细胞能生存更长时间 ,而且这些细胞更易贴壁形成纤维样的细胞 ;冰冻前后UPT细胞活性及回收率无明显差异 ,表明胎盘细胞和脐血细胞一样适合于长期储存 ;而且 ,在UPB和UPT中含有更高比例的T淋巴细胞抑制细胞群 ,可能意味着UPB和UPT具有更强的免疫抑制功能。结论指出 ,有必要建立含有胎盘和脐血细胞的血库 ,以便为大剂量放疗及化疗后的儿童及成年病人进行造血干细胞移植 ,为重建造血创造条件     

Sonographic umbilical vessel morphometry and perinatal outcome of fetuses with a lean umbilical cord

PURPOSE: This study was undertaken to assess whether changes in umbilical cord vessel morphometry are associated with an increased risk of adverse perinatal outcome among fetuses with a lean umbilical cord on sonography. PATIENTS AND METHODS: A total of 160 fetuses with a sonographically lean umbilical cord (cross-sectional area below the 10th percentile for gestational age) after 20 weeks of gestation were enrolled. The cross-sectional areas of the umbilical cord and its vessels were measured. Outcome variables investigated were perinatal death, admission to the neonatal intensive care unit, intrauterine growth restriction, and 5-minute Apgar score. RESULTS: The proportions of perinatal death (1/96 versus 6/64, p < 0.05) and admission to the neonatal intensive care unit (17/96 versus 22/64, p < 0.05) was significantly higher among fetuses with an umbilical vein area below or equal to the 10th percentile for gestational age than among those with an umbilical vein area greater than the 10th percentile. No differences were found in the proportions of perinatal death, neonatal intensive care unit admission, 5-minute Apgar score < 7, and intrauterine growth restriction when fetuses with umbilical vein areas below or equal to the 10th, the 5th, and the 2.5th percentiles for gestational age were compared. No difference was found in the umbilical artery area and Wharton's jelly area among the groups. CONCLUSION: Among fetuses with a sonographically lean umbilical cord, a significant relationship exists between an umbilical vein area below or equal to the 10th percentile and an adverse neonatal outcome.     

异基因脐血干细胞与脐带间充质干细胞联合移植治疗假肥大型肌营养不良症一例的护理

假肥大型肌营养不良又称杜兴肌营养不良（duchenne＇s muscular dystrophy, DMD）,是一种X连锁隐性遗传病,以进行性四肢近端骨骼肌萎缩无力、小腿腓肠肌假性肥大为特征,可同时累及心肌和呼吸肌。DMD目前尚无有效的治疗方法。     

早产儿不同时间二次剪脐效果的临床观察

[目的]分析172例早产儿不同时间二次剪脐的临床效果,探讨最佳的二次剪脐时间。[方法]对住院的早产儿按二次剪脐时间的不同分为3组：A 组二次剪脐时间为出生后48 h~71 h,B 组二次剪脐时间为出生后72 h~96 h,C 组二次剪脐时间为＆gt;96 h,观察不同时间二次剪脐发生脐部出血及脐部炎症的发生率。[结果]B组在剪脐时脐部出血以及剪脐后第2天、第3天发生脐部渗血明显低于 A 组（P〈0.05）,脐部炎症发生率明显低于 C组（P〈0.05）。[结论]早产儿脐部护理二次剪脐的最佳时间为出生后72 h~96 h。