Population pharmacokinetics of ketanserin in pre-eclamptic patients and its association with antihypertensive response

Ketanserin is an antihypertensive drug that is increasingly being used parenterally in the treatment of pre-eclampsia. Because of lack of efficacy in a substantial part of our pre-eclamptic patients, we determined the plasma concentrations of ketanserin in 51 pre-eclamptic patients. Population pharmacokinetic parameters were assessed using the iterative two-stage Bayesian population procedure. The influence of individual pharmacokinetic parameters on antihypertensive response, expressed as the attainment of a diastolic blood pressure 相似文献   

Does plasma L-arginine level play a role in regulation of blood pressure during exercise and autonomic nervous function?

Little is known of L -arginine's role in autonomic nervous regulation and physiological responses to dynamic exercise. We assessed heart rate and blood pressure during a maximal bicycle ergometer test and heart rate variability at rest in 15 healthy male volunteers, age 22–38 years. Venous blood samples for plasma L -arginine measurements were taken when subjects were sitting at rest before and at the end of exercise. The autonomic nervous function was assessed with time and frequency domain analysis of heart rate variability. Plasma L -arginine level decreased during maximal exercise from 71·4 μmol l^?1 to 51·0 μmol l^?1 (P < 0·0001) for all subjects studied. The systolic blood pressure during the maximal exercise test was inversely correlated with plasma L -arginine level at rest (r = ?0·70, P < 0·01). Normalized low frequency band of power spectral analysis of heart rate variability correlated with L -arginine level at rest (r = 0·66, P < 0·01). In conclusion, plasma L -arginine level decreased in physical exercise, and plasma L -arginine level at rest was positively associated with the sympathetic component of power spectral analysis of heart rate variability at rest, and inversely with systolic blood pressure during physical exercise.     

Atrial natriuretic peptide concentrations in umbilical cord plasma from pre-eclamptic women

Summary. Atrial natriuretic peptide (ANP) was measured in arterial and venous umbilical cord plasma at the time of delivery by cesarean section in pre-eclamptic (n= 7) and normal women (n= 6). In addition venous samples were obtained from pre-eclamptic (n= 7) and normal pregnant women (n= 7) near term. ANP plasma levels were higher in pregnant women with pre-eclampsia than in normal pregnant women (27·9±4·4 [mean±SEM] and 14·1 ±2·5 pmol 1^-1, respectively, P<0·05). Immediately after delivery plasma ANP in pre-eclamptic mothers was 66·7 ± 12·8 pmol 1^-1 compared to 13·9 ±2·2 pmol 1^-1 in normal mothers (P<0·01). However, in the pre-eclamptic group the levels of ANP in arterial and venous umbilical cord plasma (19·5 ±4·2 and 16·7±4·3 pmol 1^-1 respectively) were significantly (P<0·01) lower than ANP levels in arterial and venous cord plasma (39·6 ± 1·0 and 31·1±4·2 pmol 1^-1, respectively) from normal mothers. It is concluded that the increased ANP plasma level in pre-eclamptic women originates from a maternal source. In addition, since the ANP level is lower in cord plasma than in maternal plasma in pre-eclampsia, fetoplacental volume homeostasis may also be changed in pre-eclampsia.     

早发型与晚发型帕金森病多巴胺能神经元和脑葡萄糖代谢变化差异

目的 观察早发型帕金森病(EOPD)与晚发型帕金森病(LOPD)多巴胺神经元和脑葡萄糖代谢变化差异。方法 前瞻性纳入45例EOPD患者(EOPD组)、55例LOPD患者(LOPD组)及93名健康对照(HC)者[HC1组(n=47),HC2组(n=46)],行¹¹C-β-CFT 和¹⁸F-FDG PET显像;观察EOPD组与HC1组、LOPD组与HC2组脑¹¹C-β-CFT标准摄取值比值(SUVR)和¹⁸F-FDG葡萄糖代谢网络模式,以回归分析评估脑区¹¹C-β-CFT SUVR与¹⁸F-FDG葡萄糖代谢的关系。结果 EOPD组与HC1组之间,尾状核、壳核和苍白球¹¹C-β-CFT SUVR差异均有统计学意义(P均＜0.05);LOPD组与HC2组之间,伏隔核、尾状核、壳核和苍白球¹¹C-β-CFT SUVR差异均有统计学意义(P均＜0.05)。与HC1组相比,EOPD组双侧尾状核、壳核、苍白球、岛叶、小脑、颞叶、丘脑及额叶葡萄糖代谢明显增高(P均＜0.05);相比HC2组,LOPD组双侧壳核、苍白球、中央旁回、小脑、颞叶及丘脑葡萄糖代谢明显增高(P均<0.05),双侧尾状核和额叶葡萄糖代谢明显减低(P均＜0.05)。尾状核代谢为EOPD组伏隔核¹¹C-β-CFT SUVR减低的影响因素(P＜0.001);尾状核、前额叶、小脑及丘脑代谢均为LOPD组伏隔核¹¹C-β-CFT SUVR减低的影响因素(P均＜0.001)。结论 LOPD患者伏隔核多巴胺神经元受损、尾状核和额叶葡萄糖代谢明显减低,而EOPD患者未见上述表现。     

Maternal plasma levels of vascular endothelial growth factor in normotensive pregnancies and in pregnancies complicated by pre-eclampsia

We have measured the level of vascular endothelial growth factor (VEGF) in maternal plasma during normotensive pregnancy and in pregnancies complicated by pre-eclampsia. VEGF was measured using a competitive enzyme immunoassay. Plasma VEGF was significantly elevated ( P <0.0001) in the pre-eclamptic group (median value 32.7 ng mL⁻¹, range 10.3–64.0), compared with the normotensive group (median value 11.7 ng mL⁻¹, range 6.3–24.3). VEGF is a potent regulator of endothelial cell function. The increased level found in women with pre-eclampsia indicates that VEGF may be involved in the maternal endothelial cell dysfunction associated with this condition. An increase in VEGF, a potent regulator of microvascular permeability, may also contribute to the extravasation of plasma proteins and the subsequent development of proteinuria, both characteristic features of pre-eclampsia.     

L-arginine fails to protect against myocardial remodelling in L-NAME-induced hypertension

BACKGROUND: We investigated whether the substrate for nitric oxide synthesis L-arginine is able to modify hypertension and left ventricular hypertrophy development induced by chronic blockade of nitric oxide synthase activity by NG-nitro-L-arginine-methyl ester (L-NAME). MATERIAL AND METHODS: Four groups of rats were investigated: control, L-arginine 1.5 g kg-1, L-NAME 40 mg kg-1, and L-NAME +L-arginine in corresponding doses. Systolic blood pressure was measured by non-invasive tail-cuff plethysmography each week. After 4 weeks, the animals were sacrificed and hydroxyproline and coenzyme Q9 and Q10 concentrations in the left ventricle, and nitric oxide synthase activity in the left ventricle, kidney and brain were investigated. RESULTS: In the L-NAME group, nitric oxide synthase activity was decreased in the left ventricle, kidney and brain, and hypertension, left ventricular hypertrophy and fibrosis developed. Heart remodelling was associated with the decrease of coenzyme Q9 and Q10 concentrations in the left ventricle. Simultaneous treatment with L-NAME and L-arginine prevented nitric oxide synthase activity diminution in the left ventricle but not in the kidney and brain, and completely failed to prevent hypertension, left ventricular hypertrophy and fibrosis. Nevertheless, l-arginine prevented the diminution of coenzyme Q9 and Q10 concentrations in the left ventricle. CONCLUSIONS: We conclude that L-arginine failed to prevent hypertension, left ventricular hypertrophy and fibrosis development despite restoration of nitric oxide synthase activity in the left ventricle. However, L-arginine prevented the diminution of coenzyme Q levels in the left ventricle.     

l-Arginine administration attenuates airway inflammation by altering l-arginine metabolism in an NC/Nga mouse model of asthma

Changes in l-arginine metabolism, including increased arginase levels and decreased nitric oxide production, are involved in the pathophysiology of asthma. In this study, using an intranasal mite-induced NC/Nga mouse model of asthma, we examined whether administration of l-arginine ameliorated airway hyperresponsiveness and inflammation by altering l-arginine metabolism. Experimental asthma was induced in NC/Nga mice via intranasal administration of mite crude extract (50 µg/day) on 5 consecutive days (days 0–4, sensitization) and on day 11 (challenge). Oral administration of l-arginine (250 mg/kg) was performed twice daily on days 5–10 for prevention or on days 11–13 for therapy. On day 14, we evaluated the inflammatory airway response (airway hyperresponsiveness, the number of cells in the bronchoalveolar lavage fluid, and the changes in pathological inflammation of the lung), arginase expression and activity, l-arginine bioavailability, and the concentration of NOx, the end products of nitric oxide. Treatment with l-arginine ameliorated the mite-induced inflammatory airway response. Furthermore, l-arginine administration attenuated the increases in arginase expression and activity and elevated the NOx levels by enhancing l-arginine bioavailability. These findings indicate that l-arginine administration may contribute to the improvement of asthmatic symptoms by altering l-arginine metabolism.     

新生儿早发型与晚发型败血症临床特征分析

目的分析比较新生儿早发型与晚发型败血症的感染途径、高危因素、临床特点及病原菌分布情况,指导临床早期诊断、治疗与干预。方法根据发病时间对我院2006年1月至2011年12月收治的88例新生儿败血症患儿进行分组,分为早发型组与晚发型组,并进行对照分析。结果在感染途径方面,两组患儿均以呼吸道感染多见（44．7％与46．O％）,两组比较差异无统计学意义（P=0．906）。两组间出生情况相比较,早产、出生体质量低、羊水污染、窒息均是新生儿败血症早期发病的高危因素。两组患儿临床特点相比较,早期发病者多以吃奶差（57．9％,22／38）入院,而晚期发病者易出现发热（42．0％,21／50）。血培养阳性4l例,阳性率46．6％（41／88）,两组血培养阳性标本中均以革兰阳性菌为主,分别是75．0％（15／20）、90．4％（19／21）,而金黄色葡萄球菌及凝固酶阴性葡萄球菌是主要致病菌。结论早产、出生体质量低、羊水污染、窒息均是新生儿败血症早期发病的高危因素。早发型败血症常常表现为吃奶差,而晚发型败血症患儿易出现发热。早发型及晚发型败血症的常见致病菌均为革兰阳性菌,以金黄色葡萄球菌及凝固酶阴性葡萄球菌多见。针对有高危因素的患儿,应结合其临床特点早期行病原学检查,进一步明确诊断,指导临床合理用药。     

Increased lipolytic activity of sera from pre-eclamptic women due to the presence of a lysophospholipase

Endresen MJ, Lorentzen B, Henriksen T. Increased lipolytic activity of sera from pre-eclamptic women due to the presence of a lysophospholipase. Scand J Clin Lab Invest 1993; 53: 733-739.

Sera from pre-eclamptic women exhibit an increased lipolytic activity compared to sera of women with normal pregnancies. The null hypothesis of this study was that the increased release of free fatty acids (FFA) was due to hydrolysis of circulating triglycerides. The nature of the increased lipolytic activity was investigated by incubating sera from pre-eclamptic (PE) and normal pregnant women (C) with various lipid substrates radiolabeled in the FFA position.

The release of FFA in PE-sera was not due to hydrolysis of triglycerides or diglycerides. Lysophosphatidylcholine, however, served as substrate for the enhanced lipolytic activity. By using lysophosphatidylcholine with radiolabeled FFA in the sn-1-position we found that 32±10nmol FFAml^_1h^_1 was released in PE-sera, compared to 10±4nmol FFAmP'h^?1 in C-sera. This lysophospholipase activity appears independent of Ca²⁺ and other divalent cations. The increased release of FFA in sera of pre-eclamptic women can be explained by the presence of a lysophospholipase which releases the remaining fatty acid of lysophosphatidylcholine.     

Inhibition of L-arginine transport by reactive oxygen species in rat anococcygeus muscle

The effect of L-arginine on nitrergic transmission and its alteration with reactive oxygen species (ROS) were investigated. L-arginine potentiated the relaxation response induced by electrical field stimulation in rat anococygeus muscle. This effect was inhibited by L-lysine, a cationic amino acid using y+ L and y+ transport systems in a similar way with L-arginine. The neutral amino acid L-leucine, which uses only y+ L system as a transport mechanism, inhibited this potentiation at only low frequency stimulation. Electrolysis of the physiological solution did not change the responses to electrical field stimulation, but inhibited the potentiation elicited by L-arginine that was prevented in the presence of mannitol and N-acetyl-L-cysteine. In conclusion, L-arginine is transported via y+ system predominantly to potentiate the relaxation response to nitrergic nerve stimulation in rat anococcygeus muscle. ROS, primarily hydroxyl radicals inhibited L-arginine-induced potentiation probably by interacting with the y+ amino acid transport system.     

超声观察晚发型先兆子痫患者子宫动脉血流动力学参数北大核心CSCD

目的评价彩色多普勒超声观察晚发型先兆子痫(PE)患者子宫动脉血流动力学参数的应用价值。方法纳入94例晚发型PE孕妇(观察组)和106名足月妊娠健康孕妇(对照组),观察2组孕妇临床资料及子宫动脉血流动力学参数[阻力指数(RI)、搏动指数(PI)及收缩期峰值血流速度与舒张末期流速的比值(S/D)]。结果观察组孕妇年龄、体质量指数(BMI)、早产率、剖宫产率、胎儿生长受限率及子宫动脉RI、PI、S/D和舒张早期切迹出现率均高于对照组(P均<0.05),而娩出新生儿体质量小于对照组(P<0.05);观察组38例、对照组2名存在子宫动脉舒张早期切迹孕妇的子宫动脉PI均>1.2。结论采用超声监测晚发型PE患者子宫动脉血流动力学参数可为临床及时处置提供依据。     

早发型与晚发型重度子痫前期患者左室舒张功能的评价

摘 要 目的 研究早发型与晚发型重度子痫前期患者左室舒张功能的变化规律。方法 选取确诊的重度子痫前期（左室射血分数均≥50%）患者83例为病例组,依据发病孕周不同分为PE1组（早发型,孕周＜34周）48例和PE2组（晚发型,孕周≥34周）35例,另选同期与PE1组孕周相匹配的36例健康妊娠妇女为对照组N1组,与PE2组孕周相匹配的37例健康妊娠妇女为对照组N2组。均行常规超声心动图检查获取常规参数：二尖瓣口舒张早期峰值流速（E）、二尖瓣口舒张晚期峰值流速（A）并计算E/A比值,二尖瓣环舒张早期间隔侧与侧壁侧运动峰值（eS′、eL′）、舒张晚期运动峰值（aS′、aL′）、等容舒张时间（IVRT）并计算平均e′（eM′）、a′（aM′）、eM′/aM′及E/eM′值;获取左房最大容积（LAVmax）,并用体表面积标化得到左房容积指数（LAVI）。比较分析各组上述参数间的差异。结果 与对照组N1组比较,PE1组E/A、eM′、eM′/aM′均减低,A、E/eM′、IVRT、LAVI均升高,差异均有统计学意义（均P＜0.05）;与对照组N2组比较,PE2组E/A 、eM′、eM′/aM′均减低,A、E/eM′、IVRT、LAVI均升高,差异均有统计学意义（均P＜0.05）;与PE1组比较,PE2组E、E/A、eM′、E/eM′、IVRT、LAVI均减低,A、aM′、eM′/aM′均升高,但差异均无统计学意义;与对照组N1组比较,对照组N2组E、A、eM′、aM′、eM′/aM′均减低,E/A、E/eM′、LAVI、IVRT均升高,但差异均无统计学意义。结论 应用超声心动图测得早发型及晚发型重度子痫前期患者左室舒张功能均减低;早发型与晚发型相比,左室舒张功能有减低的趋势。     

Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre-eclamptic pregnancies.

OBJECTIVES: To calculate the normal range for the fetal middle cerebral artery (MCA)/uterine artery pulsatility index (PI) ratio in the third trimester of pregnancy and to assess its value, compared with that of the MCA/umbilical artery PI ratio, in predicting an unfavorable outcome of pregnancies complicated by pre-eclampsia. METHODS: Doppler blood flow velocimetry of the uterine and umbilical arteries and fetal MCA was performed. We calculated the ratios between 1) the PI of the MCA and the mean PI value of both uterine arteries and 2) the PI of the MCA and the PI of the umbilical artery. All women were examined at or beyond 26 weeks of gestation. A cross-sectional study of 231 normal pregnancies was conducted to construct the reference range. Values below the 5th percentile or an MCA/umbilical artery PI ratio lower than 1.08 were defined as brain-sparing. A further 115 pregnancies with pre-eclampsia (50 mild and 65 severe) were assessed prospectively and the results were related to perinatal outcome. The accuracy of MCA/uterine artery and MCA/umbilical artery PI ratios for prediction of unfavorable pregnancy outcome was compared. RESULTS: Normal MCA/uterine artery PI ratios decreased with advancing gestational age. Redistribution of the fetal circulation indicated by a low MCA/uterine artery PI ratio was seen in 30% of the mild (n=15) and 46% of the severe (n=30) pre-eclamptic cases. There was a significant difference between those without and those with signs of brain-sparing, respectively, in mean birth weight (2456.0 vs. 1424.5 g), gestational age at delivery (35.6 vs. 31.3 weeks) and gestational age at the time of examination (34.9 vs. 30.9 weeks). Furthermore, there was a significantly higher rate of small-for-gestational-age (SGA) neonates (57.8% vs. 25.7%), preterm delivery (100% vs. 81.8%) and Cesarean section (90.7% vs. 66.7%) in cases with an MCA/uterine artery PI ratio below the 5th percentile. However, there was no difference between the groups in the rate of low 5-min Apgar scores, admission to the neonatal intensive care unit, or deliveries before 34 weeks. The MCA/uterine artery and MCA/umbilical artery PI ratios were similar in the prediction of adverse perinatal outcome. Both ratios were better at predicting the outcome of pregnancy than were signs of increased vascular impedance in either the umbilical or uterine arteries. CONCLUSIONS: Normal MCA/uterine artery PI ratio decreases with gestational age. Abnormally low MCA/ uterine artery PI ratios are related to unfavorable pregnancy outcome. The predictive value of the MCA/uterine artery PI ratio is similar to that of the MCA/umbilical artery PI ratio.     

Both early-onset and late-onset ventilator-associated pneumonia are caused mainly by potentially multiresistant bacteria

Objective To compare the causative pathogens of early-onset and late-onset ventilator-associated pneumonia (VAP) diagnosed by bronchoalveolar lavage quantitative cultures. Most previous reports have been based on endotracheal aspirate cultures and gave uncertain findings.Design Prospective evaluation of consecutive patients with clinical suspicion for VAP.Setting Multidisciplinary intensive care unit of a university hospital.Patients and participants During a 3-year period 473 patients with clinical suspicion of VAP entered the study. Diagnosis of VAP was confirmed by cultures of bronchoalveolar lavage (>10⁴ cfu/ml) specimens in 408 patients.Interventions Protected bronchoalveolar lavage samples were taken. Initial antibiotic therapy was modified upon bronchoalveolar lavage culture results.Measurements and results Among 408 patients 191 had early-onset (<7 days mechanical ventilation) and 217 late-onset (7 days) VAP. Potentially multiresistant bacteria, mainly Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA), were the most commonly isolated pathogens in both types of VAP. No difference was noted in the contribution of potentially multiresistant pathogens (79% vs. 85%), P. aeruginosa (42% vs. 47%), or MRSA (33% vs. 30%) between early-onset and late-onset VAP. Initial antibiotic therapy was modified in 58% of early-onset VAP episodes and in 36% of late-onset VAP episodes. No difference in mortality was found between the two types of VAP.Conclusions Both early-onset and late-onset VAP were mainly caused by potentially multiresistant bacteria, most commonly P. aeruginosa and MRSA. Antimicrobial agents against these pathogens should be prescribed empirically, at least in our institution.This article refers to the editorial available at     

Effects of L-arginine and phosphodiesterase-5 inhibitor, sildenafil, on inflammation and airway responsiveness of sensitized BP2 mice

Nitric oxide (NO) levels are elevated in the exhaled breath of asthmatic patients and NO is considered as a biomarker of airway inflammation. However, the functions of NO in the airways are not completely understood. L-arginine, as the substrate of NO synthases, is the precursor of NO which stimulates guanylate cyclase and leads to the formation of cyclic GMP (cGMP). Sildenafil, a phosphodiestérase-5 (PDE-5) inhibitor, prevents the degradation of cGMP. In this study the effects of L-arginine and sildenafil treatment, alone or in combination, were evaluated in ovalbumin-sensitized BP2 mice. These effects concerning the airway responsiveness to inhaled methacholine (MCh) were evaluated by whole-body plethysmography (WBP), the inflammatory response evaluated by bronchoalveolar lavage fluid (BALF) analyses and lung tissue biopsies (eosinophilic inflammation associated with lung remodelling), and NO metabolite measurements (by Griess reaction) in BALF. Ovalbumin sensitization induced: (a) an inflammatory reaction with eosinophil and neutrophil influx in BALF and lung; and (b) an increased bronchial responsiveness to MCh. L-arginine treatment [50 mg/kg intraperitoneally (i.p.), for 7 days] increased the relative amount of eosinophils and neutrophils in BALF, had a tendency to increase the airway responsiveness to inhaled MCh and increased the NO metabolite level in BAL. Sildenafil treatment (20 mg/kg i.p. for 7 days) did not affect the airway responsiveness to MCh and had a lower effect compared with L-arginine on inflammatory reactions. The combination of the two treatments resulted in a dramatic enhancement of the airway responsiveness to inhaled MCh. The relative amount of eosinophils was increased and lung histology showed obvious worsened tissular lesions such as epithelial shedding and hypertrophy, hyperplasia of smooth muscle cells, and fibrosis. These findings are consistent with the notion that NO production plays a role in the development of airway inflammation and hyperresponsiveness of sensitized mice and highlighted the potential risk of the L-arginine dietary complement or PDE5 treatment in asthmatic patients.     

早发型与晚发型重度子痫前期患者左室舒张功能的超声心动图评价

目的应用超声心动图评价早发型与晚发型重度子痫前期患者左室舒张功能的变化。方法选取我院确诊的重度子痫前期(左室射血分数均≥50%)患者83例,依据发病孕周不同分为PE1组(早发型,孕周<34周)48例和PE2组(晚发型,孕周≥34周)35例,另选同期与PE1组孕周相匹配的36例健康妊娠妇女为对照组N1组,与PE2组孕周相匹配的37例健康妊娠妇女为对照组N2组。各组均行常规超声心动图检查获取:二尖瓣口舒张早期峰值流速(E)、二尖瓣口舒张晚期峰值流速(A)并计算E/A比值,二尖瓣环舒张早期间隔侧和侧壁侧运动峰值(eS’、eL’)、舒张晚期间隔侧和侧壁侧运动峰值(aS’、aL’)并计算平均值(eM’、aM’)、eM’/aM’及E/eM’值;获取左房最大容积(LAVmax),并用体表面积标化得到左房容积指数(LAVI)。比较分析各组上述参数间的差异。结果与对照组N1组比较,PE1组E/A、eM’、eM’/aM’均减低,A、E/eM’、IVRT、LAVI均升高,差异均有统计学意义(均P<0.05);与对照组N2组比较,PE2组E/A、eM’、eM’/aM’均减低,A、E/eM’、IVRT、LAVI均升高,差异均有统计学意义(均P<0.05);与PE1组比较,PE2组E、E/A、eM’、E/eM’、IVRT、LAVI均减低,A、aM’、eM’/aM’均升高,但差异均无统计学意义;与对照组N1组比较,对照组N2组E、A、eM’、aM’、eM’/aM’均减低,E/A、E/eM’、LAVI、IVRT均升高,但差异均无统计学意义。结论早发型与晚发型重度子痫前期患者左室舒张功能均减低;与晚发型相比,早发型患者左室舒张功能有减低的趋势。     

Collagen metabolism in normal and complicated pregnancy: changes in the aminoterminal propeptide of type III procollagen in serum

The turnover of type III collagen, a major constituent of the myometrium and the uterine cervix, during pregnancy was evaluated by monitoring serum antigens related to the aminoterminal propeptide of type III procollagen. Their concentration increased markedly towards term in most uncomplicated pregnancies, while their size distribution throughout the pregnancy resembled that seen in the sera of normal healthy persons. In some patients, however, the level remained low, indicating interindividual variation in the release into serum and metabolism of the propeptide. There were no distinct changes during or immediately after vaginal delivery. Values exceeding the reference range for uncomplicated pregnancies were found during weeks 28-37 in patients with pre-eclampsia, essential hypertension, intrahepatic cholestasis of pregnancy or twin pregnancy. Thus, pregnancy should be taken into account when evaluating results of the serum assay for the aminopropeptide and the use of this assay as an indicator of pregnancy complications warrants further study.     

子痫前期患者动态血压节律变化的调查分析与对策

目的调查子痫前期患者24h动态血压节律变化并提出相应的对策。方法对240例子痫前期患者进行24h动态血压监测(ambulatory blood pressure monitoring,ABPM),观察血压水平及昼夜变化规律。结果 240例子痫前期患者中,轻度子痫前期121例,重度子痫前期119例,两组间的24h昼夜均值、日间均值、夜间均值、夜间血压下降率比较,差异具有统计学意义(均P<0.05)。结论通过动态血压监测,护士可了解子痫前期患者不同血压变化曲线,科学监测患者降压治疗的效果,合理安排各项治疗护理操作,减少诱发子痫的因素,从而保证母婴的安全。     

脐血库HLA匹配机率分析

对广州脐血库 1998年以来保存的 30 0 0份脐血和 10 6 0名患者进行回溯分析 ,分析患者在脐血库中搜寻非亲缘脐血的HLA匹配结果 ,以探讨患者找到适于移植的非亲缘脐血的可能性。结果表明 ,6 /6HLA全相合的患者有 119人 (11.2 3% ) ,4 /6以上相合的患者高达 992人 (93.5 8% )。其中 ,分别有 6 1.2 9% ,89.79%的患者可以找到总有核细胞 (TNC)剂量≥ 3.7× 10 7/kg ,≥ 2 .0× 10 7/kg的 4 /6以上HLA相合脐血 ,相应的体重最高者分别为 79kg和 175kg。结论 :脐血库容量在 30 0 0份以上就可以有HLA 93%的匹配率。由于不同体重对脐血TNC数量要求更高 ,广州脐血库能够满足 30 % - 80 %成人患者的需要。在为患者寻找造血干细胞移植非亲缘供者时 ,无论成人或儿童患者 ,在寻找骨髓供者的同时 ,都有必要寻找适宜的脐血供者。     

Pre-eclampsia-induced alterations in IGF-I of human umbilical cord

BACKGROUND: Extracellular matrix (ECM)-components serve as a storage site to concentrate and stabilise growth factors in the vicinity of cells. Human umbilical cord (UC) tissues contain significant amounts of IGF-I and IGF-binding proteins (BPs). IGF-I is known as a stimulator of collagen and sulphated glycosaminoglycans (GAGs) biosynthesis. Pre-eclampsia, the most common pregnancy associated syndrome, is accompanied by an accumulation of collagen and sulphated glycosaminoglycans in the UC. One may expect that IGF-I and BPs play an important role in such a remodelling of the UC tissue. For this reason it was decided to evaluate the alterations in amounts of IGF-I and BPs in UC serum and in the UC arterial wall of newborns delivered by mothers with pre-eclampsia. MATERIALS AND METHODS: Studies were performed on the UCs of 12 control and 12 investigated newborns, delivered by mothers with pre-eclampsia (edema, proteinuria > 500 mg l-1, arterial pressure: systolic > 140 mmHg, diastolic > 100 mmHg). Radioimmunological techniques were employed to determine IGF-I and IGF-BPs (BP-1 and BP-3). RESULTS: It was found that pre-eclampsia is associated with an increase of IGF-I concentration in the UC serum and with simultaneous decrease of its content in the umbilical cord artery (UCA). The decrease of IGF-I content in the UCA wall was accompanied by an increase of BP-3 and BP-1 in this tissue. The increase in BPs content in the UCA wall was not associated with an enhancement of IGF binding by extracts from the homogenates of arterial wall. Heparin drastically decreased the binding of IGF-I by BP-3. CONCLUSIONS: Pre-eclampsia is associated with an increase of IGF-I-concentration in the umbilical cord blood and an elevation of BPs contents in the UCA wall. Despite a high concentration of binding proteins, IGF-I is not accumulated in this tissue. High amounts of sulphated GAGs in the UCA wall may be a factor that prevents the binding of IGF-I by BPs. Free IGF-I can easily bind to cell receptors and stimulate the cells to produce collagen and sulphated GAGs in the arterial wall.