孕妇血浆中sCD40及其配体与子痫前期发病及肾功能损害的关系

目的 探讨孕妇血浆中可溶性白细胞分化抗原(sCD40)和sCD40配体(sCD40L)水平变化与子痫前期发病及肾功能损害的关系.方法 选择2008年8月-2010年6月在青岛大学医学院附属医院产科分娩的轻度子痫前期孕妇28例(轻度子痫前期组),重度子痫前期孕妇35例(重度子痫前期组);另选同期妊娠结局良好的健康孕妇30例为对照组.比较3组孕妇分娩孕周及血压变化、血小板计数并检测其血常规、C反应蛋白(CRP)、尿常规、24h尿蛋白定量,以及血清尿酸(UA)、肌酐(Cr)、尿素氮(BUN)等生化指标.采用ELISA法检测3组孕妇血浆中sCD40和sCD40L的水平,并对血浆sCD40和sCD40L的水平与各临床指标的相关性进行分析.结果 (1)血常规及l临床指标:重度子痫前期组和轻度子痫前期组孕妇血浆CRP水平(分别为10.8及7.1 mg/L)均明显高于对照组(3.3 mg/L),前后两者分别比较,差异均有统计学意义(P＜0.05);重度子痫前期组高于轻度子痫前期组,两组比较,差异也有统计学意义(P＜0.05).重度子痫前期组孕妇分娩孕周(32.5周)明显低于轻度子痫前期组(37.2周)和对照组(38.6周),分别与对照组比较,差异均有统计学意义(P＜0.01);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).重度子痫前期组孕妇血小板计数(132×109/L)明显低于轻度子痫前期组(212×109/L)和对照组(216×109/L),分别比较,差异有统计学意义(P＜0.01);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).3组孕妇之间血红蛋白水平及白细胞数分别比较,差异均无统计学意义(P＞0.05).(2)血浆sCD40及sCD40L水平:重度子痫前期组、轻度子痫前期组和对照组孕妇血浆sCD40水平分别为133.6、126.5和90.7 ng/L,sCD40L水平分别为12.5、10.4和4.4 ng/L,24h尿蛋白定量分别为4.5、0.8 g和0,UA水平分别为486、289和162 μmol/L,重度子痫前期组以上各指标均明显高于轻度子痫前期组和对照组,差异均有统计学意义(P＜0.01);轻度子痫前期组也明显高于对照组,差异也有统计学意义(P＜0.01).重度子痫前期组孕妇血浆Cr(89 μmol/L)、BUN(5.32 mmol/L)水平高于轻度子痫前期组(分别为66μmol/L及4.49mmol/L)和对照组(分别为57 μmol/L及3.32 mmol/L),分别比较,差异均有统计学意义(P＜0.05);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).(3)相关性分析:轻、重度子痫前期组孕妇血浆sCD40水平与24 h尿蛋白定量呈正相关(r=0.434,P＜0.05),与UA、CRP呈明显正相关(r=0.536、0.528,P＜0.01),与收缩压、舒张压、分娩孕周、Cr、BUN、血小板计数无明显相关(r分别为0.135、0.183、-0.133、0.190、0.167、-0.221,P均＞0.05).轻、重度子痫前期组孕妇血浆sCD40L水平与24 h尿蛋白定量、UA、CRP均呈明显正相关(r分别为0.591、0.445、0.539,P均＜0.01),与收缩压、舒张压、分娩孕周、Cr、BUN、血小板计数无明显相关(r分别为0.178、0.212、-0.292、0.144、0.135、-0.273,P均＞0.05).轻、重度子痫前期组孕妇血浆sCD40L水平与sCD40呈明显正相关(r均为0.707,P＜0.01).对照组孕妇血浆sCD40、sCD40L水平与各项临床指标均无相关性(P＞0.05).结论 子痫前期孕妇血浆中sCD40和sCD40L水平明显升高,可能参与了子痫前期的发病,并导致肾功能损害.sCD40和sCD40L水平变化也与子痫前期的严重程度相关.

Abstract：

Objective To investigate the variance levels of plasma soluble leukocyte differentiation antigens CD40 (sCD40) and soluble CD40 ligand (sCD40L) in preeclamptic patients with renal damage and its relationship. Methods A total of 63 pregnant women attended the Department of Obstetrics, Affiliated Hospital of Qingdao University Medical College between August 2008 and June 2010. In the present study included 28 pregnant women with mild preeclampsia and 35 patients with severe preeclampsia. Thirty matched normotensive pregnant women were enrolled in the study as the control group. Expression of sCD40 and sCD40L were determined by ELISA. At the same time, the blood routine, C reaction protein ( CRP),urine routine, 24 hours urine protein excretion, and serum uric acid (UA), creatinine (Cr), blood urea nitrogen (BUN) were measured. The correlation analysis was performed between the sCD40/sCD40L and the blood biochemical indexes in 3 groups. Results ( 1 ) The median levels of CRP in severe preeclampsia (10. 8 mg/L)and mild preeclampsia group(7. I mg/L)are significantly higher than that of control group (3. 3 mg/L,P ＜ 0. 05 ); The level of CRP in severe preeclampsia group was also higher than that of mild preeclampsia group ( P ＜ 0. 05 ). The median gestational age at delivery in severe preeclampsia ( 32. 5 weeks)was significantly less than that of mild preeclampsia group ( 37. 2 weeks) and normal group ( 38. 6 weeks,P ＜ 0. 05). However no significant differences were observed between mild preeclampsia group and normal group ( P ＞0. 05 ). The platelet count in severe preeclampsia ( 132 × 109/L) was significantly less than those of mild preeclampsia group (212 × 109/L) and normal group ( 216 × 109/L, P ＜ 0. 01 ), but no significant differences were observed in blood platelet amount between mild preeclampsia group and normal group ( P ＞0. 05 ). There was no significant difference in hemoglobin level and white blood cell in three groups ( P ＞0. 05). (2) The sCD40 plasma concentration in severe, mild preeclampsia and normal group was 133.6,126. 5 and 90. 7 ng/L, respectively. The sCD40 L plasma concentrations were 12. 5, 10. 4 and 4. 4 ng/L respectively in the 3 groups. 24 hours urinary protein quantitative was 4. 5 g/d,0. 8 g/d and 0 in the 3 groups respectively. And the UA level was 486 μ mol/L,289 μmol/L and 162 μmol/L. In the above three groups,the monitoring indicators were significantly higher in women with severe preeclampsia group compared with mild preeclampsia and control groups (P ＜ 0. 01 ), and there were also higher in mild preeclampsia group than that in control groups ( P ＜ 0. 01 ). The level of plasma Cr ( 89 μmol/L) and BUN ( 5. 32 mmol/L) in severe preeclampsia group were higher than those of mild preeclampsia group (66 μmol/L and 4. 49mmol/L) and control group ( 57 μmol/L and 3.32 mmol/L, P ＜ 0. 05 ). There was no significant difference between mild preeclampsia group and normal group (P ＞ 0. 05 ). (3) The correlation analysis indicated that the level of sCD40 has a positive correlation with 24 hours urinary protein quantitative( r = 0. 434, P ＜ 0. 05 ),also significant positive correlation( r =0. 536,0. 528 ,P ＜ 0. 01 ) between the level of sCD40 and UA or CRP in women with preeclampsia. There was no significant correlation between the level of sCD40 and systolic blood pressure, diastolic blood pressure, delivery gestational age, Cr, BUN, and platelet count(r =0. 135,0. 183, -0. 133,0. 190,0. 167, -0. 221 ,all P ＞0. 05 ). There were positive correlation between the level of sCD40L and 24 hours urine protein excretion, either UA or CRP( r =0. 591,0. 445,0. 539 ,all P ＜0. 01 ). No significant correlation was found between sCD40 L and systolic blood pressure, diastolic blood pressure,delivery gestational age, Cr, BUN, and platelet count( r =0. 178,0. 212, -0. 292,0. 144,0. 135, -0. 273,all P ＞0. 05). There was significant positive correlation between plasma sCD40 and sCD40L ( r =0. 707 ,P ＜0. 01 ). There was no relationship between the level of sCD40, sCD40L and the blood biochemical indexes in normotensive pregnant women ( P ＞ 0. 05 ). Conclusions The plasma concentrations of sCD40 and sCD40 L are significantly higher in pregnant women with preeclampsia compared with the control, which may be involved in the development of preeclampsia and contribute to the kidney damage. The variance levels of sCD40 and sCD40L may be also related to the severity of preeclampsia.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

神经激肽B在妊娠期高血压疾病中含量的变化

目的:探讨神经激肽B(NKB)与妊娠期高血压疾病的关系。方法:用酶联免疫吸附法(ELISA)、免疫组化法检测35例妊娠期高血压疾病患者、10例正常孕妇产前及产后,15例正常育龄非孕妇女外周血NKB水平及在胎盘组织中的表达。结果:(1)妊娠期高血压疾病组产前血浆NKB水平明显高于非孕组和正常妊娠组(P<0.01),正常妊娠组高于非孕组(P<0.01)。妊娠期高血压组,子痫前期轻度组、重度组及子痫组产前血浆NKB水平逐渐升高,组间差异有统计学意义(P<0.01)。产后血浆NKB水平迅速下降,与产前比较差异有统计学意义(P<0.01);(2)妊娠期高血压疾病组NKB阳性反应平均灰度值高于正常妊娠组(P<0.01),其合体滋养细胞NKB表达水平随妊娠期高血压疾病的加重逐渐升高(P<0.01)。结论:异常升高的NKB可能参与了妊娠期高血压疾病的发生和发展。     

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.     

人类白细胞抗原G的表达与子痫前期发病的关系

目的 通过检测子痫前期孕妇相关组织中人类白细胞抗原G (HLA-G)的表达,探讨其与子痫前期发病的关系.方法 选择2009年3月至12月在陕西省妇幼保健院产科住院分娩的子痫前期孕妇30例,根据病情分为轻度子痫前期组8例,重度子痫前期组22例.选择同期健康孕妇30例为对照组.3组孕妇均以剖宫产方式分娩.采用ELISA法检测孕妇外周血、脐血及羊水中的可溶性HLA-G(sHLA-G)水平;采用蛋白印迹法检测胎盘、胎膜及脐带组织中HLA-G蛋白的表达.结果 (1)各组孕妇外周血、脐血、羊水中sHLA-G水平:轻、重度子痫前期组孕妇外周血sHLA-G水平分别为(50±14)、(30±6) μg/L,新生儿脐血中sHLA-G水平分别为(34±10)、( 26±8)μg/L,均明显低于对照组的(100±16)、(70±9) μg/L,分别与对照组比较,差异均有统计学意义(P＜0.01);重度子痫前期组与轻度子痫前期组比较,差异也有统计学意义(P＜0.01).重度子痫前期组新生儿脐血中sHLA-G水平虽低于轻度子痫前期组,但差异无统计学意义(P＞0.05).轻、重度子痫前期组孕妇羊水中sHLA-G水平分别为(26±7)、( 25±5) μg/L,均低于对照组的(27±6)μg/L,但分别与对照组比较,差异无统计学意义(P＞0.05);轻度子痫前期组与重度子痫前期组比较,差异也无统计学意义(P＞0.05).(2)各组孕妇胎盘、胎膜及脐带组织中的HLA-G蛋白表达:对照组胎盘组织中HLA-G蛋白表达水平为1.59±0.36,胎膜组织中表达水平为0.42±0.09,胎盘组织中的HLA-G蛋白表达水平明显高于胎膜组织,两者比较,差异有统计学意义(P＜0.05);对照组脐带组织中HLA-G蛋白表达水平为0.24±0.17,分别与胎盘及胎膜组织中的HLA-G蛋白表达水平比较,差异均有统计学意义(P＜0.01).轻度子痫前期组胎盘组织中HLA-G蛋白表达水平为0.78±0.21,重度子痫前期组为0.29±0.17,分别与对照组比较,差异均有统计学意义(P＜0.01).轻、重度子痫前期组孕妇胎膜及脐带组织中均未检测出HLA-G蛋白的表达.结论 与健康孕妇相比,HLA-G在子痫前期孕妇外周血、脐血及胎盘组织中呈明显低表达,HLA-G表达水平的异常可能与子痫前期的发病有关.     

胎盘生长因子与子痫前期发病及一氧化氮关系的研究

目的:探讨胎盘生长因子(PLGF)在子痫前期发病中的作用及其与一氧化氮的关系。方法:选择妊娠期高血压疾病患者45例,其中妊娠期高血压10例,轻度子痫前期12例,重度23例;选择同期正常妊娠妇女20例作为对照组。采用免疫组织化学染色法和逆转录-聚合酶链式反应(RT-PCR)检测两组患者胎盘PLGF蛋白及mRNA的表达。采用硝酸盐还原酶法测定两组胎盘组织NO浓度的变化。结果:(1)免疫组化结果显示,轻度和重度子痫前期的胎盘绒毛合体滋养细胞、绒毛间质PLGF表达均显著低于正常妊娠组(P<0.05),妊娠期高血压组与正常组无差别;PLGF在妊娠期高血压、子痫前期组及正常妊娠组分布范围基本一致,主要分布在绒毛合体滋养细胞和间质细胞胞浆,部分血管合体膜上也有表达;(2)轻、重度子痫前期胎盘组织PLGF mRNA平均灰度分别为3.33±0.39、1.97±0.29,显著低于正常妊娠组的平均灰度4.87±0.60(P<0.01);(3)轻、重度子痫前期胎盘组织中NO浓度分别为8.20±5.56μmol/g、6.46±2.25μmol/g,显著低于对照组18.10±7.12μmol/g(P<0.05);妊娠期高血压组胎盘组织NO浓度与对照组差异无显著性;(4)胎盘组织中胎盘生长因子表达水平与胎盘组织NO浓度呈显著正相关(r=0.54,P<0.05)。结论:子痫前期胎盘组织中胎盘生长因子水平降低,NO浓度下降,可能在子痫前期的发病中起一定作用。     

妊娠合并心脏病患者孕晚期左心室结构及功能与基质金属蛋白酶1及其组织抑制物1水平变化的相关性

目的 探讨妊娠合并心脏病患者左心室结构及功能与血清基质金属蛋白酶1(MMP-1)及其组织抑制物1(TIMP-1)水平的相关性,评价MMP-1及TIMP-1在妊娠合并心脏病患者心脏重新构建过程中的临床价值.方法 收集2007年10月至2008年7月上海交通大学医学院附属仁济医院产科收治的孕晚期妊娠合并心脏病孕妇58例,根据左心室肥大和肺动脉高压情况分为:A组:有心慌、胸闷等临床症状,但无左心室肥大者17例;B组:有心慌、胸闷等临床症状及左心室肥大,但无肺动脉高压者15例;C组:有心慌、胸闷等临床症状及左心室肥大,且有肺动脉高压者26例,其中C组患者根据肺动脉压情况又分为轻度[肺动脉压30～49 mm Hg(1 mm Hg=0.133 kPa)]11例,中度(肺动脉压50-79 mm Hg)9例,重度(肺动脉压≥80 mm Hg)6例.另选同期正常妊娠妇女15例作为对照组.采用多普勒彩色超声心动仪分别测定各组孕妇妊娠晚期的左心室结构和功能指标,包括左心窒重量指数(LVMI)、舒张未期内径(LVEDd)、左心室射血分数(EF)、二尖瓣舒张早期充盈峰(E峰)、舒张晚期充盈峰(A峰)及其比值(E/A);采用酶联免疫法测定各组孕妇血清MMP-1和TIMP-1水平.结果 (1)C组孕妇LVMI为(148±7)g/m~2、LVEDd为(58.9±3.5)mm,E峰为(50±10)cm/s,明显高于对照组及A组、B组(P＜0.01);EF为(51.0±4.4)%,E/A比值为(0.6±0.3),与对照组及A组、B组比较,均显著降低(P＜0.01).(2)C组重度肺动脉高压孕妇LVMI为(150±7)g/m~2、LVEDd为(69.7±3.4)mm,均明显高于轻度及中度孕妇(P＜0.01),A峰[(86±8)cm/s]升高(P＜0.05);E峰[(44±9)cm/s]下降(P＜0.05),EF为(45.6±2.6)%,E/A比值为(0.52±0.17),均明显低于轻度及中度孕妇(P＜0.01).(3)C组孕妇血清MMP-1[(41±10)μg/L]及TIMP-1[(393±37)μg/L]水平与对照组、A组和B组比较,显著升高(P均＜0.01).(4)C组重度肺动脉高压孕妇血清MMP-1[(42±27)μg点/L]及TIMP-1[(411±31)μg又/L]水平较轻度孕妇显著升高(P＜0.01).(5)相关性分析显示,A组、B组及C组孕妇血清MMP-1水平与TIMP-1呈正相关(r=0.587,P＜0.01);MMP-1水平与LVMI、LVEDd呈正相关(r=0.782,P＜0.01;,=0.648,P＜0.01);与EF旱负相关(r=-0.587,P＜0.01).(6)C组重度肺动脉高压孕妇中有3例发生心功能衰竭,其血清MMP-1水平均＞50μg/L,血清TIMP-1水平均＞450μg/L.结论 (1)妊娠合并心脏病孕妇妊娠晚期存在心脏重新构建的特点,并且随着左心室肥大和肺动脉高压严重程度的加重而明显化.(2)血清MMP-1和TIMP-1水平变化与妊娠合并心脏病孕妇的左心室结构、功能及临床症状的严重程度密切相关,并对妊娠合并心脏病孕妇心功能衰竭发生可能有预测价值.     

Neurokinin B levels in maternal and umbilical cord blood in preeclamptic and normal pregnancies

Neurokinin (NK) B has been recently demonstrated to be secreted by the placenta in preeclampsia suggesting it may modulate pathophysiological events of the disease. The aim of this study was to investigate whether NKB is the circulating factor associated with preeclampsia or not. In 22 preeclamptic and normotensive pregnant women, the peripheral and umbilical cord blood NKB levels were measured by radioimmunoassay. The NKB levels in women with preeclampsia were 0.70 (0.53-0.92) nmol/L in peripheral blood and 1.92 (1.42-2.35) nmol/L in umbilical cord blood. In normotensive pregnant women, NKB levels were 0.43 (0.29-0.61) nmol/L and 0.14 (0.07-0.33), respectively. Significantly higher levels of NKB were measured in preeclamptic women compared with normotensive pregnant women in umbilical cord blood. These results suggest that NKB enters both fetal and maternal circulation and may modulate fetoplacental hemodynamics.     

MIF和子痫前期炎症反应机制的关系

目的研究子痫前期胎盘组织炎症反应情况及巨噬细胞移动抑制因子（MIF）的表达,探讨MIF在子痫前期炎症反应中的作用。方法选取住院分娩的子痫前期孕产妇53例,其中轻度子痫前期孕产妇25例（轻度子痫前期组）,重度子痫前期孕产妇28例（重度子痫前期组）。另选取同期正常妊娠晚期孕产妇30例为对照组。采用逆转录（RT）PCR技术检测三组孕产妇胎盘组织中MIFmRNA的表达;采用免疫比浊法检测三组孕产妇血浆中CRP水平;采用ELISA方法检测三组孕产妇血浆中（TNF-α）、IL-6浓度。并对轻度及重度子痫前期组孕产妇血浆中CRP水平与胎盘组织中MIFmRNA表达的相关性进行分析。结果①三组孕产妇胎盘组织中均有MIF的表达,轻度子痫前期组孕产妇胎盘组织中MIFmRNA的水平为（0.84±0.13）,重度子痫前期组为（1.05±0.11）,两组比较,差异有统计学意义（P〈0.01）。对照组孕产妇胎盘组织中MIFmRNA为（0.70±0.12）,明显低于轻度及重度子痫前期组,差异均有统计学意义（P〈0.01）;②轻度子痫前期组孕产妇血浆CRP、（TNF-α）、IL-6浓度分别为（14.99±6.85）mg/L、（14.76±3.67）pg/ml、（24.68±10.13）pg/L,重度子痫前期组孕产妇血浆CRP、（TNF）、IL-6浓度分别为（21.16±8.89）mg/L、（19.66±6.13）pg/ml、（30.91±14.34）pg/L,差异有统计学意义（P〈0.01）;对照组孕产妇血浆CRP、（TNF）、IL-6浓度分别为（4.71±1.76）mg/L、（9.94±2.53）pg/ml、（14.14±5.06）pg/L,明显低于轻度及重度子痫前期组,差异有统计学意义（P〈0.01）;③轻度及重度子痫前期组孕产妇血浆中CRP水平与胎盘组织中MIFmRNA表达水平呈正相关（r=0.67,P〈0.01）。结论子痫前期患者胎盘组织中的MIF的过度表达,可上调血浆中炎性标志物CRP的水平,引起血管内皮损伤,从而参与子痫前期的发病。     

糖代谢异常孕妇体质量及相关因素对新生儿出生体质量的影响

目的 探讨影响糖代谢异常孕妇新生儿出生体质量的相关因素.方法 选择2005年1月-2009年12月在北京大学第一医院分娩的临床资料齐全的妊娠合并糖代谢异常足月单胎孕妇1157例,根据孕前体质指数(BMI)分成4组:53例BMI＜18.5 kg/m2为低体质量组,647例BMI18.5～23.9 kg/m2为理想体质量组,323例BMI 24.0～27.9 kg/m2为超体质量组,134例BMI≥28.0 kg/m2为肥胖组.1157例新生儿按出生体质量分为:出生体质量2500～4000 g为正常体质量儿(987例),其中545例出生体质量3000～3500 g为适宜体质量儿;出生体质量≥4000 g为巨大儿(112例);出生体质量＜2500 g为低体质量儿(58例).记录其孕前体质量、身高、糖代谢异常诊断时间及诊断时体质量、孕期血脂水平、不良产史、糖尿病家族史、分娩孕周、分娩时体质量、新生儿出生体质量.分析孕前BMI、孕期体质量增长(分娩时体质量-孕前体质量)、诊断糖代谢异常的孕周、诊断后孕妇体质量增长(分娩时体质量-诊断糖代谢异常时体质量)、孕期血脂水平、不良产史及糖尿病家族史对新生儿出生体质量的影响及计算孕前不同BMI孕妇分娩适宜体质量儿的孕期体质量适宜增长范围.结果 (1)新生儿平均出生体质量:低体质量组为(3142±333)g,理想体质量组为(3339±476)g,超体质量组为(3381±581)g,肥胖组为(3368±644)g.新生儿出生体质量随孕前BMI增加而增加,低体质量组新生儿平均出生体质量低于其他3组,分别比较,差异均有统计学意义(P＜0.05);但理想体质量组、超体质量组、肥胖组间分别比较,差异均无统计学意义(P＞0.05).(2)分娩正常体质量儿和巨大儿孕妇的孕期体质量增长:分娩正常体质量儿及分娩巨大儿的各组孕妇孕期体质量增长为,理想体质量组分别为(13.5±4.5)及(17.1±5.4)kg,超体质量组分别为(11.6±4.9)及(15.3±6.4)kg,肥胖组分别为(10.3±5.0)及(14.7±7.4)kg,3组分别比较,差异均有统计学意义(P＜0.05);低体质量组分娩巨大儿的孕妇仅1例,无法进行统计学分析.(3)分娩正常体质量儿和巨大儿孕妇的糖代谢异常诊断孕周:理想体质量组分别为(27.8±5.8)及(29.8±5.3)周,超体质量组分别为(26.7±6.8)及(30.2±4.1)周,两者分别组内比较,差异均有统计学意义(P＜0.05);肥胖组分别为(26.2±7.5)及(25.7±9.3)周,差异无统计学意义(P＞0.01);低体质量组分娩巨大儿孕妇例数仅1例,无法进行统计学分析.(4)分娩正常体质量儿与巨大儿孕妇的血脂水平:分娩巨大儿孕妇血清甘油三酯水平[(3.1±1.5)mmol/L]明显高于分娩正常体质量儿的孕妇[(2.7±1.2)mmol/L,P＜0.01];分娩巨大儿孕妇血清高密度脂蛋白胆固醇水平[(1.4±0.3)mmol/L]明显低于分娩正常体质量儿的孕妇[(1.7±0.9)mmol/L,P＜0.05];分娩巨大儿孕妇血清低密度脂蛋白胆固醇及总胆固醇水平[分别为(2.8±0.8)及(5.4±1.1)mmol/L]均低于分娩正常体质量儿的孕妇[分别为(3.0±0.9)及(5.6±1.1)mmol/L],但差异无统计学意义(P＞0.05).(5)影响新生儿出生体质量的相关因素:将年龄、不良产史、糖尿病家族史、孕前BMI、孕期体质量增长、诊断糖代谢异常后孕妇体质量增长、孕期血脂水平、糖代谢异常分类、诊断孕周等因素进行logistic多元回归模型分析,最终进入回归模型的变量中排在前3位的是孕前BMI、孕期体质量增长及高密度脂蛋白胆固醇水平(P＜0.01).结论 妊娠合并糖代谢异常孕妇新生儿出生体质量与孕前BMI、孕期体质量增长、孕期血浆高密度脂蛋白胆固醇水平相关.     

三维能量彩色多普勒超声用于检测子痫前期孕妇胎盘组织血流灌注的价值

目的 探讨三维能量彩色多普勒超声检测子痫前期孕妇胎盘组织血流灌注的临床价值.方法 选择2007年7月至2008年5月在首都医科大学附属北京妇产医院超声科行产前超声检查的正常孕妇及子痫前期孕妇共80例,其中36例正常孕妇为正常孕妇组,44例子痫前期孕妇分为轻度子痫前期组(9例),重度子痫前期组(26例),慢性高血压合并子痫前期组(慢高合并子痫前期组,9例).应用三维能量彩色多普勒超声仪检测各组孕妇胎盘三维直方图血管指数(VI)、血流指数(FI)、血管化血流指数(VFI),应用二维多普勒超声检测脐血流收缩期/舒张期血流速度峰值(S/D值).并记录分娩孕周、新生儿出生体重、低出生体重儿百分比和胎盘重量.结果 (1)VI、FI、VFI及脐血流S/D值:正常孕妇组分别为6.3±2.9、38.6±4.4、2.7±1.3及2.5±0.6;轻度子痫前期组分别为5.7±3.8、36.3±7.2、2.4±2.0及2.4±0.3;重度子痫前期组分别为3.0±2.4、31.7±5.0、1.1±1.0及2.9±1.3;慢高合并子痫前期组分别为2.2±1.6、26.1±4.4、0.8±0.6及3.1±1.6.正常孕妇组孕妇胎盘VI、FI、VFI值与轻度子痫前期组比较,差异均无统计学意义(P>0.05),而重度子痫前期组和慢高合并子痫前期组孕妇胎盘VI、FI 、VFI兀值均明显低于正常孕妇组(P<0.01)及轻度子痫前期组(P<0.05).而各组孕妇脐血流S/D值相互比较,差异均无统计学意义(P>0.05).(2)分娩孕周、新生儿出生体重、低出生体重儿百分比和胎盘重量:正常孕妇组分别为(38.7±1.5)周、(3280±520)g、3%及(568±141)g;轻度子痫前期组分别为(37.9 ±1.0)周、(2971±265)g.0及(576±98)g;重度子痫前期组分别为(33.2±2.6)周、(1820±737)g.58%及(458±154)g;慢高合并重度子痫前期组分别为(32.6±2.6)周、(1497±533)g.7/9及(396±141)g.正常孕妇组与轻度子痫前期组分娩孕周、新生儿出生体重、低出生体莺儿百分比和胎盘重量比较,差异均无统计学意义(P>0.05),而重度子痫前期组和慢高合并重度子痫前期组的分娩孕周、新生儿出生体重、低出生体重儿百分比和胎盘重量均明显低于正常孕妇组(P<0.01)与轻度子痫前期组(P<0.05).结论 (1)重度子痫前期及慢高合并子痫前期孕妇胎盘组织的血流灌注明显减少,临床上相应出现胎盘重量及新生儿出生体重下降、分娩孕周偏低、低出生体重儿数量增加等结果;而脐血流S/D值无明显变化.(2)三维能量彩色多普勒超声对胎盘组织血流灌注的检测有重要的临床诊断意义.     

子痫前期孕妇心脏储备功能变化与妊娠结局

目的 探讨子痫前期孕妇心脏储备功能的变化与妊娠结局的关系.方法 2008年1月至12月,采用随机数字表法选取重庆医科大学附属第一医院产科住院孕妇作为研究对象.其中妊娠期高血压组20例,子痫前期轻度组26例,子痫前期重度组23例,69例正常孕妇分为正常孕妇组1(20例)、正常孕妇组2(26例)、正常孕妇组3(23例),分别与妊娠期高血压组、子痫前期轻度组、子痫前期重度组进行配对对照.采用心音信号处理技术监测各组孕妇心脏储备功能指标,包括心率(HR)、第一心音幅值(S1)与第二心音幅值(S2)比值、舒张期时限(D)与收缩期时限(S)比值,并分析其妊娠结局.结果 (1)子痫前期重度组孕妇S1/S2比值为4.5±3.2,显著高于妊娠期高血压组的2.2±1.1和正常孕妇组3的2.2±1.1,分别比较,差异均有统计学意义(P＜0.01).子痫前期重度组孕妇D/S比值为1.1±0.3,显著低于妊娠期高血压组的1.4±0.3和正常孕妇组3的1.4±0.2,分别比较,差异均有统计学意义(P＜0.01).(2)正常孕女1组1～3的69例孕妇和妊娠期高血压组20例孕妇D/S比值均≥1.00,而子痫前期轻度组26例孕妇中仪1例(1/26,4%)D/S比值(1.00,子痫前期承度组23例孕妇中4例(4/23,17%) D/S比值＜1.00.(3)子痫前期重度组23例孕妇中有2例因病情较重(S1/S2比值均＞5.00,D/S比值均＜1.00),分娩后在重症监护室治疗(其中1例死于心功能衰竭);子痫前期轻度组和子痫前期重度纽的1分钟新生儿Apgar评分≤7分的分别为4例(4/26,15%)和6例(6/23,26%),转新生儿ICU治疗分别为7例(7/26,27%)和6例(6/23,26%),新生儿死亡分别为2例(2/26,8%)和4例(4/23,17%).正常孕妇组1～3和妊娠期高血压组的新生儿均正常.结论 子痫前期孕妇随病情加重,心脏储备功能下降,其孕妇及新牛儿的预后不良.心音信号处理技术对子痫前期孕妇的心脏储备功能检查安全无创、简便有效,值得在临床推广应用.