寒冷气候对正常妊娠和子痫前期胎盘ACE mRNA及蛋白表达的影响

目的:探讨寒冷气候对正常妊娠和子痫前期孕妇胎盘血管紧张素转换酶(ACE) mRNA及蛋白表达的影响;方法:选取2009年9月～2010年5月在该院住院的正常孕妇40例和子痫前期孕妇80例,按照传统节气分为冬季型气候组和过渡季型气候组,各组又分别分为正常妊娠组、轻度子痫前期组和重度子痫前期组.采用半定量RT-PCR及蛋白免疫印迹(Westem-blot)法检测两组孕妇胎盘ACE mRNA及蛋白表达.结果:同季节型中各组胎盘ACE mRNA及蛋白表达量随病情加重呈上升趋势,正常妊娠组＜轻度子痫前期组＜重度子痫前期组,差异均有统计学意义(P＜0.05);冬季型正常妊娠组胎盘ACEmRNA及蛋白表达水平与过渡季型气候正常妊娠组相比,差异无统计学意义(P＞0.05);冬季型轻度子痫前期组胎盘ACE mRNA表达高于过渡季型轻度子痫前期组,差异有统计学意义(P＜0.01);冬季型轻度子痫前期组胎盘ACE蛋白表达高于过渡季型轻度子痫前期组,但差异无统计学意义(P＞0.05);冬季型重度子痫前期组胎盘ACE mRNA及蛋白表达高于过渡季型重度子痫前期组,差异有统计学意义(P＜0.01).结论:寒冷刺激会影响胎盘ACE mRNA及蛋白的表达,使胎盘肾素-血管紧张素系统(RAS)调节异常,从而进一步加重子痫前期的病情,这提示外界不良的气候条件是引发以及加重子痫前期病情的一个重要影响因素,其具体的影响机制还有待于进一步研究.     

正常妊娠和子痫前期孕妇血液流变学的季节性变化

目的:探讨不同季节性气候条件下正常妊娠和子痫前期孕妇的血液流变学变化。方法:检测150例正常妊娠和120例子痫前期孕妇的血液流变学指标,同时根据传统节气将正常妊娠和子痫前期孕妇分为夏季组、冬季组和过渡季组,比较不同组间正常妊娠和子痫前期孕妇的血液流变学变化。结果:与过渡季组相比,正常妊娠妇女冬季组的全血黏度(1/s、5/s)呈升高趋势(P<0.05);与夏季组和过渡季组比较,正常妊娠妇女冬季组的全血黏度(30/s、200/s)升高,但差异无统计学意义(P>0.05);与过渡季组和冬季组比较,正常妊娠妇女夏季组的血浆黏度升高(P<0.05);与过渡季组比较,正常妊娠妇女夏季组和冬季组红细胞聚集指数升高(P<0.05);与夏季组比较,正常妊娠妇女冬季组的红细胞压积升高(P<0.05);夏季组及冬季组子痫前期孕妇的全血黏度(1/s、5/s、30/s、200/s)呈升高趋势,与过渡季组比较,冬季组低切(1/s、5/s)全血黏度显著升高(P<0.05);冬季组子痫前期孕妇的红细胞压积值较夏季组和过渡季组显著升高(P<0.05)。结论:寒冷季节正常孕妇血液有浓缩倾向,冬季子痫前期孕妇全血黏度增高更明显,可能是寒冷季节子痫前期发病率增多、并发严重病例增加的病理生理基础。     

子宫胎盘单位的肾素-血管紧张素系统与子痫前期

子痫前期是妊娠期特有疾病,目前发病机制尚未完全阐明.妊娠激活了循环和子宫胎盘单位肾素-血管紧张素系统(RAS)的许多组分.研究正常妊娠和子痫前期循环及子宫胎盘单位中RAS调节的差异有助于探讨子痫前期的发病机制.就子痫前期循环和子宫胎盘RAS的变化进行综述.与正常妊娠者不同,子痫前期患者循环RAS的许多组分包括Ang Ⅰ、AngⅡ、Ang-( 1-7)及血浆肾素活性下调,血清血管紧张素转换酶(ACE)增加,血清中AT1自身抗体(ATl-AA)增高.胎盘中的总肾素和活性肾素浓度显著升高,AT1受体mRNA、蛋白的表达上调.子宫胎盘床中AngⅡ水平及肾素、ACE mRNA显著升高.     

妊娠期高血压疾病患者血栓素B_2和6-酮-前列腺素水平与季节型气候的关系及其临床意义

目的:探讨妊娠期高血压疾病(HDCP)患者血栓素B2(TXB2)、6-酮-前列腺素(6-keto-PGF1a)水平及6-keto-PGF1a/TXB2值在不同季节型气候的变化及临床意义。方法:收集冬季型组(11～2月)、夏季型组(6～8月)及过渡季型组(3～5月及9～10月)HDCP患者各25例和同期正常孕妇各20例,应用放射免疫分析法测定其血浆中TXB2、6-keto-PGF1a水平并计算6-keto-PGF1a/TXB2(P/T)值。结果:①3个季节型妊娠期高血压组、重度子痫前期组TXB2水平均显著高于相应对照组(P0.05,P0.001),且随病情加重而升高(P0.05);血浆6-keto-PGF1a水平及P/T值均低于相应对照组(P0.05,P0.01),且随病情加重而降低。②冬季型对照组6-keto-PGF1a的水平低于夏季型对照组及过渡季节型对照组(P0.001),而血浆TXB2浓度及P/T值则无组间差异。③冬季型及夏季型妊娠期高血压组及重度子痫前期组TXB2水平高于过渡季节型组(P0.01,P0.05),而6-keto-PGF1a水平及P/T值则低于过渡季节型组(P0.001,P0.01)。结论:HDCP患者血管内皮收缩因子TXB2合成、释放增加,血管舒张因子6-keto-PGF1a分泌减少,P/T值失调。季节性气候变化可以影响正常孕妇的6-keto-PGF1a水平,而对HDCP患者的TXB2、6-keto-PGF1a水平影响更大,可加重病情,应做好防护和监测。     

正常和子痫前期孕妇氧化应激指标上限值的临床研究

目的 评估正常妊娠和妊娠期高血压疾病(子痫前期)初产妇妊娠期间的氧化应激.方法 选择2012年3月至2013年7月在延安大学附属医院孕期检查的105例患者分为三组,其中A组为非妊娠女性(n=35),B组为正常血压的初产妇(n=35),C组为子痫前期初产妇(n=35);对采取的血标本分别测定丙二醛(MDA)、超氧化物歧化酶(SOD)、总抗氧化能力(TAC)和尿酸(UA)水平.结果 正常妊娠孕妇MDA、SOD和UA水平与非妊娠女性相比显著增加(,P＜0.05);子痫前期孕妇MDA(q=15.691,P＜0.001)、SOD(q=4.060,P=0.033)和UA(q=12.095,P=0.001)水平与正常妊娠孕妇相比很大程度增加;正常妊娠孕妇在TAC水平与非妊娠女性相比显著降低(q=3.310,P=0.031),子痫前期孕妇较正常妊娠孕妇有更低的TAC水平(q=6.983,P=0.010);多因素分析显示MDA、SOD、TAC和UA水平是影响子痫前期发生风险的显著性因素(P＜0.05);MDA值为7.89μmol/L可以作为预测子痫前期症状发生的临界值,其敏感性为76.74％,特异度为74.82％.结论 氧化应激是子痫前期发病的高风险因素,应尽可能的避免可导致氧化应激增强的危险因素.     

早发子痫前期患者血浆胎盘生长因子和胱抑素C水平与妊娠结局的关系

目的探讨早期子痫前期患者血浆胎盘生长因子(PLGF)和胱抑素C (Cys C)水平及与妊娠结局的关系。方法选择2017年9月-2018年9月义乌市中心医院收治的早发子痫前期患者47例为早发子痫前期组,另选择同期本院正常妊娠孕妇50例为正常妊娠组,均于入院后第2天抽取孕妇外周静脉血分离血浆,采用荧光免疫分析法测定血浆PLGF含量,采用乳胶颗粒增强的免疫散射浊度法测定血浆胱抑素C含量。结果早发子痫前期组孕妇血浆PLGF水平低于正常妊娠组孕妇,血浆Cys C水平高于正常妊娠组孕妇,差异均有统计学意义(P0.05)。早发子痫前期患者中的重度组血浆PLGF水平低于轻度组,血浆Cys C水平高于轻度组,差异有统计学意义(P0.05)。早发子痫前期患者中的妊娠结局不良组血浆PLGF水平低于妊娠结局良好组,血浆Cys C水平高于妊娠结局良好组,差异有统计学意义(P0.05)。结论早发子痫前期患者血浆PLGF水平降低且与妊娠结局呈负相关,血浆Cys C水平升高与妊娠结局呈正相关。     

血浆高敏C-反应蛋白水平对子痫前期孕妇的评估价值

目的探讨血浆高敏C-反应蛋白(Hs-CRP)水平对子痫前期孕妇病情严重程度评估价值。方法收集106例明确诊断为子痫前期孕妇,依据临床症状及检测指标分为轻度和重度组,同时收集50例正常孕妇作为对照组。评估三组孕妇血浆Hs-CRP的高低,以及血浆Hs-CRP水平高低与子痫前期病情严重程度的相关性。结果①与对照组孕妇相比,合并子痫前期孕妇心率、收缩压、血浆肌酐水平、转氨酶水平以及24h尿蛋白均明显升高;与轻度子痫前期孕妇相比,各指标在重度子痫前期孕妇明显升高,差别具有统计学意义;②与对照组孕妇相比,子痫前期孕妇血浆Hs-CRP水平均呈现出不同程度的升高,与轻度子痫前期孕妇相比,血浆Hs-CRP水平在重度子痫前期孕妇升高更加明显,差别具有统计学意义(P=0.007);③Spearman秩相关分析结果提示子痫前期孕妇严重程度与血浆Hs-CRP水平呈正相关,相关系数r=0.884(P<0.05)。结论检测血浆Hs-CRP水平可用于评估孕妇发生子痫的风险;对于存在子痫前期的孕妇,血浆Hs-CRP水平的高低还能用于评估病情的严重程度。     

蒙古族人肾素-血管紧张素活性与原发性高血压

目的探讨蒙古族人血浆肾素-血管紧张素系统的活性与原发性高血压的关系.方法在现况调查的基础上,分别征集高血压者和血压正常者.先按高血压家系、非高血压家系和家系不清分组,再进一步将人群分为3种家系中的高血压组和血压正常组.用放射免疫法测定血管紧张素Ⅰ(Ang Ⅰ)、血管紧张素Ⅱ(AngⅡ)和血浆肾素活性(PRA).结果 Ang Ⅰ、AngⅡ和PRA在3种家系中总体比较差异均有统计学意义(P＜0.001).Ang Ⅰ和AngⅡ不仅在3种家系的两组中比较差异有统计学意义(P＜0.05),而且在高血压家系中的高血压组和非高血压家系中的正常组、家系不清中的正常组间比较差异也具有统计学意义(P＜0.05).PRA仅在高血压家系的两组中比较差异有统计学意义(P＜0.05).结论在蒙古族人群中,Ang Ⅰ、AngⅡ和PRA与原发性高血压的发生可能有关.PRA与高血压家族遗传史可能有一定的关联.     

蒙古族人群肾素活性和血管紧张素Ⅱ 与平均动脉压的关系

摘要:目的　探讨蒙古族人群血浆肾素活性（PRA）和血管紧张素Ⅱ（AngⅡ）与平均动脉压的（MAP）关系。方法　对2589例蒙古族对象进行人口统计学特征、生活方式等危险因素的调查、身高体重和血压的测量以及PRA和AngⅡ等指标的实验室检测。采用单因素和多因素的分析方法,分析PRA和AngⅡ与MAP的关联关系。结果　蒙古族人群中,PRA与MAP之间呈负相关（r＝-0.125,P＜0.001）。多因素调整后,与最低分位组相比,PRA最高分位组的MAP升高的OR值（95%CI）为0.57（0.42～0.76）。AngⅡ与MAP之间呈正相关（r＝0.119,P＜0.001）。多因素调整后,与最低分位组相比,AngⅡ最高分位组的MAP升高的OR值（95%CI）为2.25（1.71～2.98）。结论　在蒙古族人群中,PRA水平降低和AngⅡ水平增加可增加MAP升高危险。     

慢性收缩性心力衰竭患者血钠水平与血浆肾素、血管紧张素、醛固酮及脑钠肽水平的相关性

目的探索慢性收缩性心力衰竭(CHF)患者血钠水平与血浆肾素-血管紧张素-醛固酮系统(RAAS)及脑钠肽(BNP)水平的关系。方法 125例于本院接受治疗的CHF患者被纳入研究,且按照其血钠水平分为低血钠组和正常血钠组,检测其血浆肾素(PRA)、血管紧张素(AngⅡ)、醛固酮(ALD)及脑钠肽(BNP)水平,并作相关性分析。结果低血钠组患者PRA、AngⅡ及ALD、BNP水平明显高于正常血钠组患者,差异均有统计学意义(P0.05);与NYHAⅡ级患者比较,NYHAⅢ级和NYHAⅣ级患者血钠水平均有明显降低,PRA、AngⅡ及ALD、BNP水平均有明显增加,差异均有统计学意义(P0.05);而与NYHAⅢ级患者比较,NYHAⅣ级患者血钠水平均有明显降低,PRA、AngⅡ及ALD、BNP水平均有明显增加,差异均有统计学意义(P0.05);血钠水平与患者PRA、AngⅡ及ALD、BNP水平均呈显著负相关(r值分别为-0.422、-0.367、-0.499、-0.622,P0.05)。结论慢性收缩性心力衰竭患者低血钠水平可能会促进RAAS及神经内分泌激素激活。     

孕妇对孕妇学校教育模式及课程内容需求

目的:探讨孕妇对孕妇学校授课模式及课程内容需求情况。方法:对在汕头市妇幼保健院孕妇学校听课的200名孕妇进行问卷调查。结果:①对孕妇学校授课的模式需求是多样化的,需求最高的为听讲座,其他依次为观看录像、与医护人员一对一交流、现场示范、模仿操作、参观产房、角色扮演等。②对孕妇学校课程内容需求最高的是新生儿喂养及新生儿的护理方面,其次是分娩知识及产褥期保健知识、胎儿发育过程及自我监护知识、孕产期营养、孕期常见问题应对知识方面。结论:顺应孕妇的需求,多安排孕妇最迫切需求的课程内容,设置多元化的授课方式,更有效地为孕产妇服务。     

Children and pregnant women.

A review of the literature of the 1980s reveals that women living in rural American are at risk for receiving inadequate prenatal and maternal care. Documented risk factors include poverty and concomitant lack of medical insurance, residence in the most restrictive Medicaid states, and loss of local services including the closure of obstetric units of rural hospitals and the decision by local physicians to discontinue obstetrics. A prominent factor in a physician's decision to stop providing maternity care is the escalating cost of medical liability insurance; however, other forces are also at work, including interference with personal and family activities, disruption of other aspects of professional life (e.g., office schedule), inadequate reimbursement, and an inability to keep up with advancing technology. A research agenda for the 1990s should be consistent with previous recommendations and must stimulate the development of new programs that will induce the maximum number of providers to again offer high quality perinatal care to rural women. Other items on the 1990s research agenda include: (1) the clarification of the impact of lost perinatal services in rural areas, (2) the effects of travel time and distance on perinatal outcomes and cost of care, (3) the effect of loss of obstetric services on other health care services for women and children, and (4) comparisons of regionalized versus centralized systems for the provision of perinatal services.     

Pandemic influenza and pregnant women

Planning for a future influenza pandemic should include considerations specific to pregnant women. First, pregnant women are at increased risk for influenza-associated illness and death. The effects on the fetus of maternal influenza infection, associated fever, and agents used for prophylaxis and treatment should be taken into account. Pregnant women might be reluctant to comply with public health recommendations during a pandemic because of concerns regarding effects of vaccines or medications on the fetus. Guidelines regarding nonpharmaceutical interventions (e.g., voluntary quarantine) also might present special challenges because of conflicting recommendations about routine prenatal care and delivery. Finally, healthcare facilities need to develop plans to minimize exposure of pregnant women to ill persons, while ensuring that women receive necessary care.     

Sexuality of pregnant and breastfeeding women

The effect of pregnancy and lactation on the sexual behavior of women was studied, using a retrospective questionnaire answered by a nonrandom sample of 33 women. Sexual functioning was operationally defined by four categories: desire, frequency, enjoyment, and orgasm. Five time periods were studied: the three trimesters of pregnancy, the period of breastfeeding and the period after weaning. Most of the mothers reported that their sexual behavior was about the same during pregnancy as before except for the third trimester, where desire, frequency, and enjoyment decreased. Eighty-two percent of the mothers felt that sex relations should continue throughout all of the pregnancy. Sexual functioning during breastfeeding was reported to be about the same as before pregnancy by 75% of the women. Desire returned for most women by 4 weeks after childbirth, earlier than many of them felt it safe to resume sex relations. Women who had been married longer, with more children and more breastfeeding time, reported an earlier return of sexual interest and felt it safe to resume sex relations earlier. Most women reported their sexual interest after weaning was about the same. No one reported a decrease in sexual interest after weaning. All of the women reported breastfeeding to be enjoyable. Younger marrieds were apt to rate breastfeeding even higher than older marrieds. Also, younger marrieds felt freer about breastfeeding in public. Sexual relations continue when procreatively unfruitful and even when difficult in humans. This underscores the importance of the bonding value of sex.     

孕妇学校对孕妇牙周病治疗依从性的影响

目的了解孕妇学校的宣教对牙周病孕妇治疗依从性的影响。方法回顾性统计2013和2014年度在深圳市福田妇幼保健院门诊产前检查的孕妇数量,统计其中牙周病患病率及诊断为牙周病后到口腔科接受治疗情况。并将2个年度孕妇牙周病患者接受治疗的情况进行比较分析。结果 2013、2014年度门诊建卡产检的孕妇分别为7 260例和8 928例,其中牙周病患者分别为2 824例(38.9%)和3 348例(37.5%),诊断为牙周病后到口腔科接受治疗者分别为1 440例(51.0%)和3 298例(98.5%)。与2013年相比,2014年的牙周病发病率稍低,经比较差异均无统计学意义(均P>0.05),而接受治疗者较2013年明显增多,经比较差异有统计学意义(x^2=565.90,P<0.01)。结论孕妇学校牙周病宣教可明显提高牙周病孕妇治疗的依从性,治疗后可降低流产、早产儿及低出生体重儿的发生率,改善了妊娠结局。     

乙肝孕产妇与正常孕产妇心理变化及比较

目的 分析乙肝孕产妇与正常孕产妇的心理应激的差异.方法 随机抽取69名门诊或住院就诊的HbsAg(+)孕产妇(病例组),随机抽取同期具有可比性的正常妊娠妇女123例(对照组).采用汉密尔顿抑郁量表、汉密尔顿焦虑量表及症状自评量表评定HbsAg(+)孕产妇与正常妊娠妇女的心理状况.结果 病例组抑郁和焦虑的发生率均较对照组高,经比较有显著性差异(χ2抑郁=13.487,P<0.01;χ2焦虑=53.756,P<0.01);病例组与对照组除敌对症状外(t=-2.513,P<0.05),其它各项及整体身心健康水平无显著性差异(均P>0.05).结论 HbsAg(+)孕产妇的心理应激水平比正常孕妇更高,以中度、重度抑郁、焦虑最为显著;其主要心理情绪反应及阶段与正常孕妇基本一致.     

Pica practices of pregnant women

This report summarizes current knowledge about pica practices during pregnancy through a systematic review of the literature for the period 1950 through 1990. Pica behavior was considered in terms of its prevalence, risk factors, clinical profile, and effect on pregnancy outcome. Data on pica practices by pregnant women are limited and inconclusive but reveal several interesting relationships. The prevalence of pica among pregnant women in high-risk groups declined between the 1950s and the 1970s but now remains steady, affecting about one fifth of high-risk women. Women at high risk of pica are more likely to be black, to live in rural areas, and to have a positive childhood and family history of pica. The clinical picture of the disorder during pregnancy is not well described. The evidence suggests that pica during pregnancy results in anemia, but it is not definitive. Pica also has been associated with maternal and perinatal mortality. We conclude that the behavior is more prevalent than commonly believed, shows no sign of further decline, and may have serious effects, particularly anemia, on mother and infant. Dietetic practitioners who counsel pregnant women should ask questions about pica when they conduct nutrition assessments of their clients.     

Salmonella screening of pregnant women

Over a 9-year period all maternity patients were screened by rectal swab for salmonella excretion at the time of delivery. 30,471 mothers were screened and 60 (0.2%) yielded salmonellas, 43 (72%) of whom were symptomless excretors. Seven of the 60 babies (12%) excreted salmonellas, all of which were the same organism as in the mothers. Five had uncomplicated gastroenteritis in the neonatal period, but no mother or child suffered invasive disease and no incidents of hospital cross-infection occurred. These results show that screening is unjustified unless there are problems of cross-infection.     

天津市《职业病防治法》宣传周实施情况以及问题探究

<正>职业卫生健康教育和健康促进工作是从源头上控制和预防职业病的重要措施之一,可显著提升作业工人的职业卫生知识水平~([1])。每年一度的《职业病防治法》宣传周对于进一步落实《职业病防治法》,倡导和动员全体人民共同关注劳动者,督导用人单位认真履行职业病防治的主体责任,广泛宣传职业病防治知识和健康工作方式理念,增强劳动者自我保     

孕妇与非孕妇受血者不规则抗体筛查结果的报告

目的分析在临床安全输血中孕妇与非孕妇受血者不规则抗体筛查的临床价值。方法2017年3月-2019年3月收入深圳市福田区妇幼保健院的120例申请输血女性患者,依据是否怀孕将其分为非孕妇组(n=70例)和孕妇组(n=50例),开展受血者不规则抗体筛查、不规则抗体筛查特异性分布情况,并分析孕妇与非孕妇受血者不规则抗体筛查阳性率。结果120例受血者不规则抗体总筛查率是29.16%,其中抗-M占5.83%,抗-D占5.00%,抗-E占4.16%,抗-C占3.33%,抗-PI占2.50%,抗-Leb占1.67%,抗-Lea占1.67%,抗-H占0.83%,抗-H占0.83%,抗-Fyb占0.83%,抗-N占0.83%,抗-JKa占0.83%;非特异性抗体占1.67%。非孕妇组受血者不规则抗体筛查阳性率21.42%,低于孕妇组阳性率(40.00%),差异有统计学意义(P<0.05)。结论在对女性患者,尤其是孕妇,在输血前有必要实施受血者不规则抗体筛查,明确不规则抗体筛查特异性分布情况,有利于确保输血的整体安全性。