妊娠滋养细胞肿瘤子宫病灶彩色多普勒血流显像动态观察

目的探讨化疗前后妊娠滋养细胞肿瘤(GTT)血流动力学变化.方法利用彩色多普勒血流显像图(CDBFI)动态检测18例GTT患者化疗前及每疗程化疗后子宫动脉,病灶内血流指数,并选取同期20例非孕正常妇女子宫动脉阻力指数作为对照.结果GTT患者化疗前子宫动脉及病灶内血流呈现低阻状态;化疗后随hCG的下降,CDBFI示整个血流逐渐减少,病灶内血流丰富区范围缩小,子宫动脉及病灶内血流参数逐渐恢复正常.化疗前和1～3疗程化疗后子宫动脉处RI明显低于正常非孕妇女(P＜0.01),4疗程化疗后子宫动脉RI与正常非孕妇女相近.结论彩色多普勒血流显像图检查对妊娠滋养叶肿瘤的诊断有帮助,通过动态观察可间接估价患者对化疗的敏感性.     

米非司酮、炔诺酮、三苯氧胺对人早孕绒毛鞘糖脂的影响

应用Ｌａｄｉｓｃｈ分离及微量分析方法，对服米非司酮、炔诺酮、三苯氧胺及正常妊娠妇女的绒毛神经节苷脂（Ｇｇ）和中性鞘糖脂（Ｎ－ＧＳＬ）进行定量分析。结果证明，正常及各服药组Ｇｇ和Ｎ－ＧＳＬ组成相同；各服药组Ｇｇ总量比正常组明显减少（Ｐ＜０．０１）。各服药组绒毛ＧＭ３、ＧＭＩ与ＧＤ３、炔诺酮及三苯氧胺组ＧＴｌｂｔｂ正常组均减少（ＰＭＯ．０１和Ｐ＜０．０５）。米非司酮及三苯氧胺组的Ｎ—ＧＳＬ总量均比正常组升高，其中米非司出组织毛ＣＤＨ、ＣＴＨ增加（Ｐ＜０．０５）；而炔诺酮组则ＰＧ升高明显（Ｐ＜０．Ｏ１）。     

米非司酮对早孕蜕膜与绒毛转化生长因子β基因表达及血清肿瘤坏死因子α的影响

目的:了解米非司酮对早孕蜕膜和绒毛中转化生长因子β基因表达及血清肿瘤坏死因子α水平的影响,探讨来非司酮对母-胎界面及血清中细胞因子的调节作用。方法:应用反转录-聚合酶链反应(RT-PCR)测定正常和服用米非司酮100 mg后的人早孕蜕膜和绒毛中转化生长因子β_1(TGF-β_1)及受体(TGF-β_1R)的基因表达;采用放射免疫法测定米非司酮应用前后血清中肿瘤坏死因子α(TNF-α)的水平。结果:服药组蜕膜中TGFβ_1及受体的基因表达比对照组明显下降(P<0.05),而服药组绒毛中TGFβ_1及受体的基因表达与对照组比较没有显著差异(P>0.05)。服药后血清TNF-α水平明显高于服药前(P<0.05)。结论:米非司酮抗早孕作用是多环节的,可能通过多种机理协同参与促进流产的发生。其中,米非司酮通过降调节蜕膜中TGF-β_1与TGF-β_1R的转录,提高血清TNF-α的水平,从母-胎界面局部至外周,使免疫刺激和抑制失调,导致母体对胚胎排斥而不利于妊娠的维持。     

彩色多普勒超声监测药物流产前后子宫血流变化及其机制探讨

目的　探讨药物流产前后子宫血流的变化及药理作用机制。方法　 1999年 6月至 2 0 0 2年 2月应用彩色多普勒 (CDFI)对 5 8例药物流产患者子宫动脉和滋养层动脉进行检测 ,比较用药前后子宫动脉和滋养层动脉的血流变化 ,同时比较药物流产组与对照组血清NO-2 /NO-3 水平。结果　服药后比服药前子宫动脉和滋养层动脉的阻力指数 (RI)、收缩期与舒张期血流速度比值 (S/D)增高 ,血流峰值速度 (Vmax)和血流量 (PBF)明显减低 ,差异有显著性意义 (P <0 0 5 ) ;孕妇血清NO-2 /NO-3 水平比非孕妇女显著增高 ,服药后比服药前降低 ,差异有非常显著性意义 (P <0 0 1) ;病理检查显示 :药物流产后的蜕膜和绒毛细胞变性 ,其血管内皮细胞向管腔内突起 ,基底膜中断。结论　应用CDFI监测子宫血流变化与药理作用和病理检查结果相符 ,可作为临床观察药物流产效果的可靠手段。     

人早孕滋养细胞通过分泌CXCL16促进蜕膜γδT细胞增殖

目的:探讨人早孕期滋养细胞分泌的CXCL16对蜕膜γδT细胞增殖的影响。方法:收集正常非孕妇女、正常早孕妇女及自然流产妇女的外周血及蜕膜组织各10例,体外分离外周血单核淋巴细胞及蜕膜免疫细胞,使用流式细胞仪检测γδT细胞的比例;采用磁珠分选技术纯化得到的人早孕蜕膜γδT细胞,流式细胞术检测其胞内细胞因子的表达;建立人早孕蜕膜γδT细胞与滋养细胞的共培养体系,流式细胞仪检测γδT细胞中Ki67的表达。结果:正常早孕妇女外周血及蜕膜局部γδT细胞比例明显高于非孕妇女及自然流产妇女,且正常早孕组和自然流产组蜕膜局部γδT细胞比例均高于外周血。人早孕蜕膜γδT细胞内的细胞因子表达依次为IL-10>TGF-β1>TNF-α≥IFN-γ。人早孕滋养细胞或者人重组的CXCL16(rhCXCL16)均能促进γδT细胞的增殖,而在共培养体系中加入CXCL16的中和性抗体后则抵消了此效应。结论:早孕妇女体内γδT细胞数量增多可能与正常妊娠的维持有关,母-胎界面的滋养细胞通过分泌CXCL16促进蜕膜γδT细胞的增殖,蜕膜γδT细胞可能通过分泌IL-10及TGF-β1等细胞因子有利于正常妊娠的维持。     

RU_(486)对早孕妇女蜕膜组织甾体激素受体及内分泌的影响

目的 了解米非司酮及米索对人早孕蜕膜雌激素受体(ER)、孕激素受体(PR)的表达及血清内分泌水平的影响。方法 取正常早孕、服用米非司酮及服米非司酮配伍米索后各20例的蜕膜,应用单克隆抗体链霉素亲生物蛋白——过氧化酶 (SP) 免疫组织化学方法测定 ER、PR 的表达及血清激素水平的变化。结果米非司酮配伍米索使蜕膜组织中 ER、PR 表达下调,正常早孕组、服米非司酮组及服米非司酮配伍米索组之间差异有显著性。血清雌二醇(E_2)、睾酮(T)、泌乳素(PRL)含量上升,孕酮(P)下降;而对 FSH、hCG 的含量无明显影响。结论 大剂量RU_(486)能竞争地结合蜕膜组织孕激素受体,使早孕期高浓度的内源性孕酮与其受体的正常结合受到干扰,从而达到抗早孕的目的。     

早产妇女血清一氧化氮水平测定及研究

目的 探讨一氧化氮（ＮＯ）水平与妊娠及早产的关系。方法 采用Ｇｒｅｉｓｓ法分别测定３５例早产妇女（早产组），６６例妊娠妇女（妊娠组），２５例非妊娠妇女（非妊娠组）静脉血中ＮＯ的含量。早产妇女血清ＮＯ深度显著低于同孕龄及足月妊娠妇女（Ｐ〈０．０１），低于足月妊娠临产妇女，但无显著差异（Ｐ〉０．０５）。足月妊娠临产妇女血清ＮＯ浓度显著低于妊娠期妇女（Ｐ〈０．０１）。非妊娠组血清ＮＯ浓度显著低于早产组及     

VEGF、sFlt-1与药物流产不全的相关性研究

目的:探讨血管内皮生长因子(VEGF)及其可溶性受体(sFlt-1)的变化与药物流产的相关性,及药物流产不全的可能原因。方法:选取因早孕行药物流产的165例患者,其中完全流产者94例,不全流产者42例。采用酶联免疫吸附法(ELISA)测定孕妇血清VEGF及sFlt-1水平,并比较服药前后以及完全流产组与不全流产组服药后的血清VEGF及sFlt-1水平。结果:服米非司酮前后,孕妇血清VEGF及sFlt-1水平比较,差异有统计学意义(P0.05);服米非司酮后,完全流产组与不全流产组的血清VEGF及sFlt-1水平比较,差异均有统计学意义(P0.05)。结论:VEGF及sFlt-1的变化,与药物流产具有相关性,并且可能是药物流产不全的原因之一。     

米非司酮配伍前列腺素终止早孕的子宫颈组织学变化

应用光镜与电镜对２４例早孕妇女在米非司酮配伍前列腺素（ＰＧ）终止早孕过程中宫颈的组织学变化，进行观察。每例于口服单剂米非司酮１５０ｍｇ前、口服后４８小时及胎囊排出后１小时（即放置ＰＧ后６小时内），分别取宫颈活组织进行检查，共３次。结果：与服米非司醇前的早孕宫颈相比，固有层中有明显的胶原纤维溶解，表现为胶原纤维显著减少与不规则及基质无定形物质的大量积聚，并且有多形核白细胞的浸润。胎囊排出后这些变化更     

早孕妇女血清及绒毛组织中表皮生长因子的含量及米非司酮对其的影响

目的探讨表皮生长因子（ＥＧＦ）对早期胚胎发育的影响和米非司酮对胚胎生长及ＥＧＦ的作用。方法采用放射免疫法测定６６例不同孕龄的早孕妇女（研究组）血清及绒毛组织中ＥＧＦ、血雌二醇（Ｅ２）和孕酮（Ｐ）及２０例正常育龄妇女（对照组）血清ＥＧＦ水平，并观察药物流产时米非司酮对绒毛组织中ＥＧＦ含量的影响。结果早孕妇女血清ＥＧＦ水平明显高于非孕妇女（Ｐ＜０．０１）；随孕龄的增长，血清ＥＧＦ、Ｅ２、Ｐ含量明显升高（Ｐ＜０．０５）。用米非司酮后，孕囊的增长幅度减小，血清中ＥＧＦ和Ｐ含量均有轻度下降；药物流产的绒毛中，ＥＧＦ含量明显低于人工流产者（Ｐ＜０．０５）。结论ＥＧＦ对胚胎发育具有重要作用，米非司酮可能通过抑制ＥＧＦ的作用对胚胎发育产生不利影响     

早孕妇女血清及绒毛组织中表皮生长因子的含量及米非司酮对其 …

探讨表皮生长因子对早期胚胎发育的影响和米非司酮对胚胎生长及ＥＧＦ的作用。方法 采用放射免疫法测定６６例不同孕龄的早孕妇女血清及毛组织中ＥＧＦ,血雌二醇和孕酮及２０常育龄妇女血清育龄妇女血清ＥＧＦ水平,并观察药物流产时米非司酮对绒毛组织中ＥＧＦ含量的影响。     

The Comparison of Uterine Artery Doppler Velocimetry with the Histopathology of the Placental Bed

We determined the relationship between the histopathological findings of the placental bed and Doppler flow measurements of the uterine artery in women with preeclampsia and fetal growth retardation. Doppler velocimetry in the uterine artery was evaluated in 17 pregnant women with preeclampsia, 15 of whom had fetal growth retardation, and 20 normal pregnant women, within 14 days of Caesarean delivery and placental bed biopsy. The placental bed biopsies were evaluated in terms of trophoblast migration into the myometrium and physiological changes of the spiral arteries. The results were compared with Doppler velocimetry values. Trophoblast migration and physiological changes were not detected in 10 (59%) cases with preeclampsia and in 4 (20%) with normal pregnancies (p<0.05). In the preeclamptic group, 9 of 15 cases that were complicated with intrauterine growth retardation had no trophoblastic migration into the myometrium. The mean systolic/diastolic ratio, resistance index and pulsatility index of the uterine artery in women with preeclampsia and fetal growth retardation was significantly higher than women with normal pregnancies (p<0.01). The mean resistance index of the uterine artery in the impaired migration group was significantly higher than the migration group (p=0.02). The incidence of impaired trophoblast migration was significantly higher in the group with a high systolic/diastolic ratio (above 2.5) and resistance index (above 0.58) than cases with low systolic/diastolic ratio and resistance index (72%, 23% respectively, p<0.05). The incidence of early diastolic notch in the impaired trophoblast migration group was significantly higher than the migration group (57% versus 13%, p<0.01). Our study supports the hypothesis that high uterine artery flow resistance is related to the reduced trophoblast migration into the myometrium and inadequate physiological changes in the spiral arteries in women with intrauterine growth retardation and preeclampsia.     

Amniotic fluid nitric oxide and uteroplacental blood flow in pregnancy complicated by intrauterine growth retardation

Objective To examine the correlation between placental nitric oxide production and uteroplacental blood flow.
Participants Thirty-one pregnant women with fetuses with intrauterine growth retardation and 27 normal pregnancies as controls.
Design Correlation between amniotic fluid measurements of nitrite metabolite in the third trimester and flow velocimetry waveforms recorded from uterine, umbilical and fetal middle cerebral arteries. Intrauterine growth retarded pregnancies were compared with controls.
Main outcome measures Concentrations of nitric oxide metabolites (NO₂^- and NO₃^-) in amniotic fluid were correlated with flow velocimetry waveforms findings by the determination of correlation coefficient.
Results Overall median nitrite values in amniotic fluid were higher (   P < 0.01  ) in intrauterine growth retarded patients (median 8.6 μmol/mg creatinine) than in controls (5.6 μmol/mg creatinine). Pathologic uterine flow velocimetry waveforms in uterine artery (-2SD) were observed in 12 women of the intrauterine growth retarded group, and the concentration of amniotic fluid nitrite was significantly lower (   P < 0.01  ) in these patients (median 4.45 μmol/mg creatinine) than in those with normal flow velocity waveforms (median 11.43 μmol/mg creatinine). A significant negative correlation was observed between nitrite concentrations and uterine artery resistance index, umbilical artery pulsatility index and umbilical artery pulsatility index:middle cerebral artery pulsatility index ratio.
Conclusions We conclude that placental nitric oxide is significantly associated with uteroplacental blood flow and may be important in maintaining adequate uteroplacental perfusion in intrauterine growth retarded pregnancies.     

正常妊娠及妊高征患者静脉血及新生儿脐血一氧化氮含量的测…

探讨一氧化氮含量与妊娠及妊高征的关系。方法,采用硝酸根还原酶与Ｇｒｉｅｓｓ反应相结合的方法,对４０例妊高征患者、４０例正常晚期妊娠妇女、２０例非孕妇女静脉血及妊高征组和晚孕组各２８例新生儿脐血中的ＮＯ代谢产物亚硝酸基／硝酸基进行测定。     

Impaired uterine artery blood flow at mid gestation and low levels of maternal plasma corticotropin-releasing factor

OBJECTIVE: Corticotropin-releasing factor (CRF) is a placental neuropeptide that plays a role in the control of uteroplacental blood flow regulation. Because CRF has a relaxant effect on uterine vasculature in pregnant rats, we aimed to evaluate mid-gestation plasma CRF levels in women with impaired uterine artery blood flow. METHODS: Maternal plasma CRF was assayed by specific radioimmunoassay, and uterine artery resistance index (RI) was assessed by Doppler evaluation at 22-24 weeks' gestation in 55 healthy pregnant women, of whom 24 showed a unilateral or bilateral uterine artery notch, reflecting resistance. Statistical analysis was performed by the Kruskal-Wallis test followed by the post hoc Dunn's test and the Spearman rank test. RESULTS: The mean uterine artery RI was significantly (P <.001) higher in women with a notch than in healthy controls. Mean +/- standard error of the mean maternal plasma CRF levels were significantly lower in women with a unilateral (168.45 +/- 27.5 pg/mL; P <.01) or bilateral (186.07 +/- 34.5 pg/mL; P <.001) uterine artery notch than in healthy control pregnant women (375.06 +/- 21.77 pg/mL). Although no difference was found in CRF levels between patients with a unilateral or bilateral uterine artery notch, a significant inverse correlation was found between the mean RI and maternal plasma CRF levels (Spearman r = -0.6540; 95% confidence interval, -0.7865, -0.4640; P <.001). CONCLUSION: Reduced levels of circulating CRF were associated with increased uterine artery resistance, which supports the hypothesis that CRF may regulate uterine artery tone at mid gestation.     

Effect of maternal fasting on uterine arterial blood flow

AIM: To determine the effect maternal diet pattern on the uterine artery Doppler flow velocimetry. METHODS: This is a cross-sectional observational study. The uterine artery Doppler flow velocimetry was measured between 20 and 24 weeks' gestation in healthy pregnant women observing Ramadan. For each fasting mother, a non-fasting healthy pregnant woman was recruited as a control. Maternal blood glucose level was measured. RESULTS: A total of 106 pregnant women were studied. The mean hours since last oral intake were significantly longer, and the maternal glucose level was significantly lower in the study group than in the control group. The Mean (95% CI) of the uterine artery pulsatility index, resistance index, peak systolic velocity, end diastolic velocity and systolic/diastolic ratio was similar in both groups. CONCLUSION: Maternal fasting is not associated with significant changes in the uterine artery Doppler flow velocimetry.     

妊娠早期子宫动脉血流的变化及其对妊娠结局的影响

目的:探讨妊娠早期子宫动脉血流的变化及其对妊娠结局的影响。方法:对1 87例妊娠妇女在孕10周、20周和30周分别监测子宫动脉血流动力学参数搏动指数(PI)、阻力指数(RI)和收缩期峰值流速/舒张末期流速(S/D)。结果:157例正常妊娠组孕早期的子宫动脉RI、PI和S/D值和子宫动脉舒张早期切迹数均低于不良妊娠结局组(n=30),其差异有显著性。结论:彩色多普勒超声监测子宫动脉血流动力学参数有助于预测和评估妊娠结局。     

Maternal and fetal serum nitric oxide (NO) concentrations in normal pregnancy, pre-eclampsia and eclampsia.

OBJECTIVES: To measure the maternal and fetal serum concentrations of total nitrites and nitrates (as an index of nitric oxide production) in normal pregnancy, pre-eclampsia and eclampsia. DESIGN: Three groups of women were studied cross-sectionally: late pregnant women with pre-eclampsia and eclampsia (n=31); normal late pregnant women (n=32); and age-matched healthy non-pregnant women (n=21). Venous blood samples were collected from all women and both maternal and umbilical venous samples were collected from pregnant women. METHODS: Blood samples were assayed for nitric oxide (NO) production by Greiss reaction which measures the combined oxidation products of NO (total nitrites and nitrates). RESULTS: There was a significant increase in serum total nitrites and nitrates concentrations in normal pregnant women than in the serum of age-matched normal non-pregnant women (P<0.0001). Significantly higher total nitrites and nitrates levels were found in the maternal sera of the pre-eclamptic and eclamptic women compared with those of normal pregnant women (P<0.0001). Also, fetal blood levels of total nitrites and nitrates were significantly increased in pre-eclampsia and eclampsia compared with those of normal pregnancy (P<0.0001). CONCLUSIONS: (1) Serum nitric oxide (NO) production is increased in normal pregnancy than in the normal non-pregnancy. (2) Maternal and fetal serum NO levels are increased significantly in pre-eclampsia and eclampsia, which possibly represents a compensatory/protective mechanism to maintain blood flow and limit platelets aggregation in the fetal-maternal circulations. (3) The increase in NO production is directly related to the severity of pre-eclampsia; this would be of diagnostic significance for the prediction of the severity of this syndrome.