妊娠期肝内胆汁淤积症胎盘形态计量改变及围产儿预后的研究

对32例ICP及12例正常胎盘组织进行了组织形态计量学测定,并分析了组织计量学参数与实验室淤胆指标(血甘胆酸、GPT、T-BI、D-BI)、胎儿预后(羊水粪染、胎儿宫内窘迫)的关系.测定表明ICP组胎盘的实质体积百分比、绒毛间腔容积百分比小于对照组,合体结节占绒毛结构容积百分比大于对照组,其中以重症组差异为显著.相关回归分析表明合体结节占绒毛结构容积百分比、绒毛组织容积百分比、绒毛间腔容积百分比与血甘胆酸相关性显著(r=0.521,p<0.01;r=0.401,p<0.05;r=0.328,p<0.05);绒毛间腔容积百分比与羊水粪染程度、胎儿宫内窘迫相关性显著(r=-0.355,p<0.05;r=-0.346,p<0.05);血甘胆酸与羊水粪染程度相关性显著(r=0.402,p<0.05).结论ICP时最主要的胎盘组织形态学异常是绒毛间腔狭窄及合体结节增多,绒毛间腔狭窄可能是绒毛间质水肿所致,血中甘胆酸水平升高对绒毛组织有直接的不良作用,绒毛间腔狭窄可能是导致ICP胎儿宫内缺氧的原因之一.     

未并发IUGR妊娠高血压综合征胎盘的体视学研究

探讨妊娠高血压综合征(妊高征)胎盘的病理形态改变特点及其与妊高征发病机制的关系.利用体视学图像分析系统对轻度妊高征9例(A组),中度妊高征9例(B组),重度妊高征9例(C组),正常同期妊娠9例(D组)的胎盘终末绒毛、绒毛毛细血管进行显微镜下形态学定量分析.发现中度和重度妊高征组纤维素样坏死绒毛体积百分含量显著高于对照组及轻度妊高征组(p＜0.05);轻度妊高征组血管合体膜的厚度显著小于中度妊高征组、重度妊高征组和对照组(P＜0.05);胎盘绒毛和绒毛毛细血管表面密度各级间差异无统计学意义(p＜0.05);各组间的绒毛毛细血管表面积体积比有显著性差异(p＜0.05).上述结果表明,中度和重度妊高征胎盘绒毛纤维素样坏死增加;轻度妊高征血管合体膜变薄;轻度妊高征胎盘血液灌注量增加,绒毛毛细血管管径增大;中度和重度妊高征胎盘灌注量减少,绒毛毛细血管管壁皱缩,管径变小,由此可见,改善胎盘血流灌注是治疗妊高征的关键.     

米非司酮对人中期妊娠胎盘的影响

目的：探讨米非司酮对中期妊娠胎盘绒毛的影响程度，借此评价该药用于足月妊娠引产的安全性。方法：利用体视学原理，对８例胎龄１７～１９孕周妇女服用１５０ｍｇ米非司酮后行水囊引产的胎盘绒毛合体滋养细胞线粒体体视学参数、滋养细胞基底膜和毛细血管屏障厚度进行测算，并与８例胎龄１７～１９孕周水囊引产的胎盘组织对照。结果：米非司酮组合体滋养细胞线粒体的体积密度与对照组间无差异，而其表面积密度、比表面、数密度显著降低，平均体积则明显增大；其次米非司酮组滋养细胞基底膜与对照组相比明显增厚，绒毛间质毛细血管内皮细胞变薄。结论：米非司酮对中期妊娠胎盘组织具较强损伤作用。故在米非司酮用于足月妊娠引产的安全性未充分证实前，不宜将其用于足月妊娠引产中。     

妊娠期肝内胆汁淤积症围生儿血气分析值与胎盘结构变化的相关性研究

目的探讨妊娠期肝内胆汁淤积症(Intrahepatic Cholestasis of Pregnancy,ICP)围生儿出生即刻脐动脉血血气分析值和胎盘绒毛间隙及合体结节面积的变化及其相关性。方法选择ICP晚期妊娠60例,正常晚期妊娠25例,测定围生儿出生即刻脐动脉血血气分析值(PH值、血氧分压PO2及二氧化碳分压PCO2),运用体视学方法测量胎盘绒毛间隙及合体结节的面密度;分析血气分析值与胎盘结构之间的相关性。结果ICP患者胎盘绒毛间隙面密度减小,合体结节面密度增大,围生儿出生即刻脐动脉血pH值、PO2均显著降低,PCO2升高。胎儿脐动脉血pH值、PO2与胎盘绒毛间隙面密度呈正相关,与合体结节面密度呈负相关;PCO2值与绒毛间隙面密度呈负相关,而与合体结节面密度呈正相关。结论ICP患者胎盘血液灌流量减少,绒毛有效交换面积减小,易出现胎儿宫内缺氧。     

过期与延期妊娠的胎盘床血管和胎盘形态计量学

本文应用图像分析技术对过期妊娠２０例（过期组）、延期妊娠１５例（延期组）和正常足月妊娠２９例（正常组）的胎盘绒毛和胎盘床螺旋小动脉进行形态计量学检测。结果：（１）过期组胎盘绒毛具有合体细胞结节、细胞滋养细胞增生、绒毛基底膜增厚和纤维素样坏死的绒毛数高于正常组（均Ｐ＜００５），血管合体细胞膜形成的绒毛数低于正常组（Ｐ＜００５）；延期组与对照组和过期组间均无显著区别。（２）过期组胎盘绒毛直经、周长和面积参数均小于正常组（均Ｐ＜００１）；延期组仅周长和面积参数小于正常组（Ｐ＜００５）。（３）过期、延期组胎盘床螺旋小动脉管壁增厚者高于正常组（Ｐ＜００５），而妊娠生理性改变、管壁纤维素样坏死以及急性动脉粥样化病变与对照组无明显区别。（４）过期、延期组羊水过少和羊水粪染的发生率高于正常组（均Ｐ＜００５），而新生儿低评分者发生率较高，但与正常组无明显区别。提示：过期和延期妊娠的子宫胎盘床血管和胎盘绒毛的形态学病变是导致胎盘功能逐渐低下以及胎儿预后不良的主要原因，尤其过期妊娠者更著     

重度妊高征胎盘组织病理学与形态计量学观察

为探讨妊高征胎盘床血管和胎盘绒毛的组织结构特点及其与妊高征发病机制的关系。本文应用图像分析系统对２９例重度妊高征（妊高征组）和２９例正常妊娠（正常组）的子宫胎盘床血管和胎盘绒毛进行了形态计量学检测。结果显示∶１妊高征组胎盘的重量、大小均显著低于正常组（Ｐ＜００５）。２妊高征组胎盘绒毛具有合体细胞结节、细胞滋养细胞、绒毛基底膜增厚和纤维素样坏死的绒毛数显著高于正常组（Ｐ＜００５），而具有血管合体细胞膜的绒毛数显著低于正常组（Ｐ＜００５）。３妊高征组胎盘的游离绒毛直径、周长和面积均比正常组显著减小（Ｐ＜００５）。４妊高征组子宫胎盘床螺旋动脉妊娠生理性改变缺乏，管壁增生肥厚、纤维素样坏死和动脉粥样硬化的发生率显著高于正常组（均Ｐ＜００５）。提示妊高征子宫胎盘床血管病变在妊高征发病中可能起重要作用，而胎盘绒毛的组织形态学变化是胎盘缺血、缺氧的结果     

胎盘部位滋养细胞肿瘤增殖状况与p21WAF1/CIP1蛋白表达

目的通过观察胎盘部位滋养细胞肿瘤(PSTT)细胞增殖及p21WAF1/CIP1(p21)蛋白表达状态,了解PSTT生物学行为.方法应用免疫组织化学方法对8例PSTT增殖细胞核抗原(PCNA)及p21蛋白表达状况进行观察,并与正常胎盘组织、胎盘部位过度反应、绒毛膜癌比较.结果PSTT的肿瘤细胞阳性细胞指数为(31.25±8.86)%,高于正常胎盘组织及胎盘过度反应(P＜0.01),低于绒癌(P＜0.01);PSTT肿瘤细胞p21蛋白阳性细胞指数为(9.30±6.69)%,高于胎盘过度反应(P＜0.01),低于绒癌(P＜0.05),与正常胎盘比较无显著差异.结论从细胞增殖角度观察PSTT为潜在恶性肿瘤,PCNA可做为评估PSTT恶性潜能的重要指标之一.p21蛋白表达可能与滋养层细胞终末分化有关.     

过熟综合征的胎盘合胞体细胞超微结构定量研究

应用透射电镜对24 例妊娠40 周后伴胎儿过熟综合征的胎盘合成区和运输区合胞体细胞的微绒毛和线粒体进行体视学测试, 并与足月妊娠生理性过期妊娠胎盘进行对照。结果发现从足月妊娠至生理性过期妊娠, 运输区微绒毛表面积密度、体积密度及表面积逐渐增大, 合成区缩小; 病理性过期妊娠, 则两区均明显变小。线粒体的体密度, 表面积密度及数密度在两区均逐渐增加, 至病理性过期妊娠时则显著缩小, 上述改变以运输区变化显著, 平均体积逐渐增大。表明在病理的情况下, 胎盘合胞体细胞损害主要发生在合成区, 运输区则在此时进行功能代偿。失代偿后则发生病理性过期妊娠及胎儿过熟综合征。     

螺旋CT多平面重建支气管壁改变在中心型肺癌诊断中的价值

目的 探讨螺旋CT多平面重建对支气管壁增厚的显示能力及其在中心型肺癌中的诊断与鉴别价值。方法 (1)收集208例正常成人肺的CT横断面及多平面重建(MPR)图像,测量肺段及肺段以上支气管管壁的厚度;(2)对病理证实的58例中心型肺癌患者及12例支气管内膜结核患者进行CT横断扫描并进行相同的后处理,扫描层厚3mm,重建间隔为1.0mm-1.5mm,螺距是1.0,记录肺叶、肺段支气管管壁厚度(T)及管壁增厚长度(L)。结果 (1)正常成人肺段及肺段以上支气管壁厚度平均值为(2.75±0.5)mm;(2)58例中心型肺癌叶、段支气管CT横断扫描管壁厚度平均为8.25mm,管壁增厚长度平均为14.14mm,T/L比值为0.57。MPR管壁厚度平均为14.74mm,管壁增厚长度平均为24.12mm,T/L比值为0.61;(3)中心型肺癌支气管管壁厚度及管壁增厚长度MPR与横断面CT之间差异具有显著性意义(分别为P＜0.01、P＜0.001);(4)12例支气管内膜结核病变支气管管壁厚度平均值为9.13mm,管壁增厚长度平均值为60.52mm,T/L比值为0.15;(5)58例中心型肺癌与12例支气管内膜结核管壁厚度、管壁增厚长度及T/L比值差异有显著性意义(分别为P＜0.01、P＜0.001、P＜0.01)。结论 (1)提供正常成人肺段及肺段以上支气管壁厚度,做为客观量化指标,为支气管增厚疾病提供诊断依据;(2)MPR在横断CT基础上提高了对病变支气管及早期病灶的显示能力;(3)MPR有助于中心型肺癌的诊断与鉴别诊断。     

孕妇特发性血小板减少性紫癜在围产期的治疗:被动免疫性血小板减少症的危险因素

孕妇患特发性血小板减少性紫癜(ITP)并不少见,且常伴严重出血、自发性流产、宫内胎儿发育迟缓(IUGR)、宫内胎儿死亡或胎儿颅内出血(ICH),以致围产期死亡率高达20％。我们主要观察母体ITP的治疗对胎儿被动免疫性血小板减少症(PIT)发生率的影响。 39例(2例为双胎)ITP孕妇治疗主要用类固醇药物、大剂量静脉输注丙种球蛋白、孕前脾切除术,13例虽有血小板减少,但怀孕期间未用药。28例接     

Bone Healing Following Irradiation During Tourniquet Ischaemia

The bone harvest chamber (BHC) methodology, a titanium implant for quantitative evaluations of bone healing, was used in order to investigate the radioprotective function of anoxia, in healing bone tissue. After incorporation of one BHC in each proximal tibial metaphysis of a rabbit it was possible to collect newly formed bone specimens in 3-week-periods without animal sacrifice. The amount of bone was determined by microradiography and densitometry. Ten animals divided into 2 groups were used. One group receiving a single dose of 25 Gy during tourniquet ischaemia was compared with another receiving the same dose during normal blood perfusion. A significantly improved bone healing response was seen in the ischaemic group, with a tendency to further improvement with increasing time after irradiation.     

Inhibition of liver glutathione S-transferase placental form-positive foci development in the rat hepatocarcinogenesis by Porphyra tenera (Asakusa-nori).

The effects of Asakusa-nori, Porphyra tenera (PT), a popular edible seaweed in Japan, on the development of putative preneoplastic lesions, glutathione S-transferase placental form (GST-P)-positive foci, in the male F344 rat liver were examined using a medium-term bioassay system. PT significantly decreased both the number and area of GST-P-positive foci in rat livers initiated with diethylnitrosamine (DEN). To investigate possible mechanisms of inhibition, effects of PT on 5-bromo-2'-deoxyuridine (BrdU) labeling in GST-P-positive foci and the surrounding area of hepatocytes were studied. The ratio of the GST-P-positive foci to surrounding tissue labeling indices was decreased in the PT-treated group as compared with the DEN alone group. Ornithine decarboxylase activity in the liver was slightly increased and spermidine/spermine N'-acetyltransferase activity was slightly decreased in the PT-treated animals. These results suggest that PT possesses chemopreventive effects against DEN-induced hepatocarcinogenesis.     

恶性肿瘤患者体表面积计算方法的比较

目的 探讨不同体重指数（BMI）的恶性肿瘤患者体表面积的计算方法。方法 对227例恶性肿瘤患者在住院当天、第2天和化疗前各测量1次空腹时的身高和实际体重,计算其平均值。按照不同BMI值（≤18.6kg／m²、18.6～23.9kg／m²、24～27.9kg／m²和≥28kg／m²）将患者分为消瘦组（17例）、正常体重组（107例）、超重组（82例）和肥胖组（21例）;计算各组患者的实际和理想体表面积,比较两者间差异。结果 正常体重组患者的实际和理想体表面积分别为1.590m²和1.584m²,差异无统计学意义（P＞0.05）;消瘦组患者的实际和理想体表面积分别为1.523m²和1.641m²（P＜0.05）;超重组患者的实际和理想体表面积分别为1.724m²和1.590m²（P＜0.05）;肥胖组患者的实际和理想体表面积分别为1.813m²和1.570m²（P＜0.05）。结论 不同BMI值患者的实际和理想体表面积有一定的差异,对于超重和肥胖的恶性肿瘤患者实施化疗建议根据理想体表面积计算化疗药物剂量,避免不必要的治疗风险。     

Immunolocalization and quantitation of transforming growth factor alpha in hydatidiform mole.

Complete hydatidiform mole (CHM), a condition related to abnormal gestation, occurs predominantly in the young reproductive age group and has a high prevalence rate in the Trivandrum region, occurring in 1.2% of deliveries. Transforming growth factor alpha (TGF-alpha) is an important growth regulatory molecule, the location and function of which at the human fetomaternal interface in CHM remains to be determined. The present study examined the presence of TGF-alpha in the normal and complete molar placenta and decidua throughout gestation. A total of 149 complete molar placental tissue samples and 96 normal placental tissue samples were evaluated for TGF-alpha expression by immunohistochemistry and 50 each of CHM and normal placental tissue for TGF-alpha concentration by radioimmunoassay. The peptide was localized immunocytochemically with a monoclonal anti-TGF-alpha antibody on paraffin-embedded tissue using the avidin-biotin complex peroxidase technique with aminoethyl carbazole as the chromogen. In molar placenta, villous trophoblast cells (syncytiotrophoblasts and cytotrophoblasts) showed intense cytoplasmic staining at all gestational ages compared to normal placenta of the same gestational age. The tissue concentration of TGF-alpha was highly overexpressed in the molar placenta (10-1000 fold) compared to that in the normal placenta. The results indicate that TGF-alpha is present in trophoblasts throughout human gestation and may provide additional growth advantage to maintenance of the hyperproliferative condition in trophoblastic tumors.     

Inhibitory effect of UFT on rat hepatocarcinogenesis induced by 3'-methyl-4-dimethylaminoazobenzene and phenobarbital promotion]

Inhibitory effect of UFT on hepatocarcinogenesis in rats induced by 3'-methyl-4-dimethylaminoazobenzene (3'-MeDAB) and phenobarbital (PB) promotion was studied. Donryu male rats were divided into four groups. Group A was fed a diet containing 0.06% 3'-MeDAB for 3, 5, or 7 weeks, and then fed normal diet for 2 weeks, subsequently received a diet containing 0.05% PB. Group B was given UFT (20 mg/kg/5 days a week) simultaneously with feeding 3'-MeDAB. Group C was given UFT simultaneously with feeding PB. Group D was given 3'-MeDAB alone. In all groups, the development of hepatocellular carcinoma was investigated 37 weeks later and the number and area per mm2 of induced glutathione S-transferase placental form (GST-P) positive foci were measured using an image processor. The number and area of GST-P positive foci in group B and group C were markedly decreased as compared with those in group A. These results seem to show that the administration of UFT inhibited the production of GST-P positive foci and that stronger inhibitory effect of UFT was observed by simultaneous administration of an initiator than by that of a promoter.     

CT灌注成像对胶质瘤术后监测的临床意义

目的 探讨多层螺旋CT灌注成像在胶质瘤术后随访中的临床意义.方法 对32例胶质瘤术后患者行CT灌注成像,测量术后复发残留病变、术后未复发残留病变及脑组织正常区域的CT灌注参数值,包括脑血容量(CBV)、脑血管表面通透性(PS),以及其各相对参数值(rCBV、rPS).应用SPSS12.0统计软件包,独立样本:检验进行统计学分析.结果 复发残留组16例中,CBV值12例升高,4例接近正常值,PS值均升高.rCBV值>2.6者10例中,最大rCBV值为4.01,平均rCBV值为2.67,平均rPS值为6.32.未复发残留组16例中,CBV值7例接近正常值,2例升高,7例降低;PS值11例接近正常,3例降低,2例升高;rCBV值均<2.6,最大值为2.14,平均rCBV值为0.99,平均rPS值为1.42.复发残留组分别与未复发残留组和脑组织正常区域比较,cT灌注参数值差异均有统计学意义(P<0.01);未复发残留组与脑组织正常区域比较,CT灌注参数值差异均未有统计学意义(P>0.05);复发残留组与未复发残留组rCBV差异及rPS差异均具有统计学意义(P<0.01).结论 CT灌注成像在确定胶质瘤术后是复发、残留还是未复发或残留上有重要价值.