血清CA125、甲胎蛋白及胎盘生长因子在胎盘早剥预测中的初步研究

目的:检测胎盘早剥、重度子痫前期及正常妊娠孕妇的血清CA125、甲胎蛋白和胎盘生长因子水平,探讨其与胎盘早剥的关系,为胎盘早剥的预测及早期诊断提供理论依据。方法:采用微粒酶免疫分析法(MEIA)和双抗体夹心ELISA法检测孕妇血清CA125、甲胎蛋白和胎盘生长因子水平。结果:胎盘早剥组CA125和甲胎蛋白明显高于其他两组,胎盘生长因子明显低于其他两组(P<0.05)。结论:检测外周血CA125、甲胎蛋白和胎盘生长因子水平对于预测胎盘早剥具有一定的临床价值。     

胎盘早剥与重度子痫前期孕妇生化指标的比较

目的 通过比较重度子痫前期诱发的胎盘早剥孕妇血清中CA125、甲胎蛋白和胎盘生长因子水平,探讨其对胎盘早剥早期诊断的临床价值.方法 采用微粒酶免疫分析法和双抗体夹心酶联免疫吸附测定法检测孕妇血清中CA125、甲胎蛋白和胎盘生长因子水平,并对结果 进行比较分析.结果 胎盘早剥组CA125和甲胎蛋白的水平比重度子痫前期组明显升高(174.1±79.4U/mL vs 56.3±13.6U/mL,295.9±83.5ng/mL vs 199.6±43.1ng/mL;t值分别为10.14、6.36,均P<0.01);胎盘生长因子的水平明显降低(64.3±29.2pg/mL vs 96.5±42.7pg/mL;t=15.04,P<0.01).结论 血清中CA125、甲胎蛋白和胎盘生长因子等生化参数作为胎盘早剥的预测及早期诊断的研究有一定的科学依据.     

应用Logistic回归和ROC曲线分析生化指标对胎盘早剥早期诊断价值

目的:建立并利用数学模型,定量分析孕妇血清中CA125、甲胎蛋白和胎盘生长因子水平,探讨其对胎盘早剥早期诊断的价值。方法:采用微粒酶免疫分析法(MEIA)和双抗体夹心ELISA法检测孕妇血清中CA125、甲胎蛋白和胎盘生长因子水平。应用Logistic回归筛选诊断胎盘早剥的相关指标,建立Logistic回归方程,并通过ROC曲线进行分析。结果:CA125和胎盘生长因子两项指标运用回归方程为P=1/〔1+e-(2.329+0.067X1-0.061X2)〕,其灵敏度98.7%,特异度96.7%,ROC曲线下面积99.5%(P<0.01)。结论:运用Logistic回归和ROC曲线综合分析生化指标预测胎盘早剥具有一定的临床价值,有助于提高诊断的科学性和准确性。     

应用ROC曲线分析血清指标联合检测在胎盘早剥早期诊断中的价值

目的探讨采用受试者工作特征曲线(ROC)分析血清指标联合检测在胎盘早剥早期中的诊断价值。方法选取进行产检疑为胎盘早剥的186例孕妇作为观察组,同期体检的52例正常孕妇作为正常对照组,采用电化学发光免疫法测定血清中癌抗原125(CA125)水平,采用酶联免疫法测定血清妊娠相关蛋白(PAPP-A)水平,采用微粒酶免疫法测定血清胎盘生长因子(PLGF)水平,对比血清指标单项诊断与联合诊断准确度、灵敏度、特异度;创建受试者工作特征曲线(ROC),对比单项诊断与联合诊断AUC值。结果病理检查显示112例胎盘早剥(胎盘早剥组),126例无胎盘早剥(无胎盘早剥组)。胎盘早剥组血清CA125水平高于无胎盘早剥组,PAPP-A、PLGF水平低于无胎盘早剥组,差异均有统计学意义(P<0.05)。以手术或产后病理诊断作为金标准,血清CA125、PAPP-A、PLGF诊断准确度为84.45%、76.05%、85.71%。联合诊断阳性108例,阴性130例,联合诊断准确率(90.76%)、灵敏度(88.39%)均高于单项诊断,差异有统计学意义(P<0.05)。ROC曲线显示联合诊断AUC值(0.847)高于CA125、PAPP-A、PLGF单项诊断(0.783、0.586、0.674)。结论孕妇血清中CA125、PAPP-A、PLGF对于胎盘早剥早期诊断均有一定价值,但血清3项指标联合诊断能够提高诊断的准确度与灵敏度。     

血清CA125、AFP和D-二聚体对胎盘早剥早期诊断的临床价值

目的:探讨血清癌胚抗原125(cancer antigen 125,CA125)、甲胎蛋白(alpha-fetoprotein,AFP)和D-二聚体(D-dimer,D-D)对胎盘早剥早期诊断的临床价值。方法:193例孕妇按病情分为胎盘早剥组(n=87)和正常对照组(n=106),采用电化学发光法检测孕妇血清中CA125、AFP水平;采用免疫比浊法检测孕妇血清中D-二聚体水平。结果:胎盘早剥组CA125、AFP和D-二聚体的水平比正常对照组明显升高(P<0.01)。结论:孕妇血清CA125、AFP和D-二聚体在预测早期胎盘早剥中有一定的临床价值。     

CA125与胎盘早剥早期诊断相关性临床研究

目的:研究胎盘早剥患者血清中CA125的水平,探讨胎盘早剥的早期诊断依据。方法:选取胎盘早剥患者52例作为试验组,正常妊娠孕妇40例为对照组,检测孕妇血清中CA125的水平。结果:试验组血清CA125≥39 U/ml 43例,均值为66.7 U/ml;对照组血清CA125≥39 U/ml 2例,均值为20.7 U/ml,两组差异有统计学意义(P<0.05)。血清CA125预测胎盘早剥发生的敏感性为90.3%,特异性为95.0%。结论:孕妇血清中CA125、PLGF的检测值可以作为胎盘早剥早期诊断的指标之一。     

胎盘早剥孕妇血清中CA125、AFP水平的临床研究

目的：比较胎盘早剥与健康孕妇血清抗癌原（CA125）、甲胎蛋白（AFP）两项指标差别,以指导胎盘早剥临床诊疗。方法：选取本院收治的60例胎盘早剥孕妇（观察组）与产检正常的60例健康孕妇（对照组）,取孕妇血标本,系统检测两组血清CA125、AFP。结果：观察组产次更多、剖宫产史和胎盘早剥史更多、孕早期阴道出血比率大、死胎死产及严重妊娠并发症更多、正规孕检比例小、1 minApgar评分更低,与对照组比较差异均有统计学意义（P＜0.05）。观察组血清CA125、AFP两项指标均明显高于对照组,两组比较差异有统计学意义（P＜0.05）。结论：检测血清CA125、AFP两项指标可灵敏反映胎盘早剥,可将两项指标联合检测结果作为胎盘早剥诊疗依据。     

超声结合血清指标诊断胎盘早剥的价值

目的分析超声结合血清指标诊断胎盘早剥的价值,为胎盘早剥的临床诊断提供理论依据。方法选取2017年1月-2018年9月金华市中心医院收治的129例胎盘早剥孕妇为研究对象,同时选取在金华市中心医院进行产前检查的非胎盘早剥孕妇40例为对照组。所有产妇分别采用超声、血清可溶性细胞间粘附分子-1 (SICAM-1)、糖类抗原125 (CA125)进行诊断,以产后诊断结果为金标准,分析超声联合SICAM-1、CA125诊断胎盘早剥的效能。结果超声诊断重度胎盘早剥和轻度胎盘早剥的符合率分别为89.28%和56.16%。重度胎盘早剥的超声诊断符合率高于轻度胎盘早剥,差异有统计学意义(P0.05)。3组产妇血清s ICAM-1和CA125水平比较差异均有统计学意义(均P0.05)。重度胎盘早剥组产妇血清s ICAM-1和CA125水平显著高于轻度胎盘早剥组(均P0.05),轻度胎盘早剥组产妇血清s ICAM-1和CA125水平显著高于对照组(均P0.05)。三者联合诊断胎盘早剥的灵敏度、特异度、漏诊率和误诊率分别为90.70%、88.00%、9.30%、12.00%。结论超声诊断胎盘早剥有一定的临床意义,但如超声诊断出现阴性结果,血清CA125和ICAM-1高于正常水平,应高度警惕胎盘早剥发生。血清CA125和ICAM-1结合临床表现及超声可更早、更准确地诊断胎盘早剥,最大程度改善母婴结局。     

血清孕酮、CA125、hCG表达水平预测先兆流产的价值

目的检测血清孕酮(P)、癌抗原125(CA125)、人绒毛膜促性腺激素(hCG)表达水平,分析先兆流产的价值,探讨先兆流产的影响因素,为临床诊断和治疗先兆流产提供参考。方法选取2015年6月-2016年1月120例单胎孕妇,根据妊娠结局分成对照组(53例正常妊娠孕妇)、观察组1(51例先兆流产孕妇经常规对症治疗后继续妊娠)、观察组2(16例难免流产患者)。采用电化学发光法检测血清P、hCG、CA125水平。应用Logistic回归分析法分析先兆流产的影响因素,分析3个指标的预测价值。结果 3组血清P、hCG、CA125水平比较,差异均有统计学意义(P0.05)。两两比较,血清P、hCG水平表现为对照组观察组1观察组2;CA125水平表现为观察组2观察组1对照组,差异均有统计学意义(均P0.05)。血清P、hCG和CA125均是先兆流产的影响因素。3个指标联合检测的准确度、灵敏度、特异度、阳性预测值及阴性预测值均明显高于各指标单独检测(P0.05)。结论低表达血清P、hCG,高表达血清CA125是先兆流产的危险因素,对于难免流产患者而言,3个指标联合检测可获得更高准确度。     

胎盘生长因子与胎儿生长受限的相关性研究

目的 探讨胎盘生长因子与胎儿生长受限的相关性.方法 采用放射免疫法测定17例胎儿生长受限孕妇(研究组)和20例正常孕妇(对照组)的血清及新生儿脐血胎盘生长因子水平,并对其结果进行相关性研究.结果 研究组孕妇血清胎盘生长因子(38.12±0.91ng/L)低于对照组(40.41±1.77ng/L),差异有统计学意义(t=6.74,P<0.05);研究组新生儿脐血胎盘生长因子(38.35±1.10ng/L)低于对照组(40.45±1.46ng/L),差异有统计学意义(t=2.35,P<0.05).孕妇血清胎盘生长因子水平与新生儿脐血胎盘生长因子水平无相关性(r=0.120,P>0.05),孕妇血清胎盘生长因子水平与新生儿出生体重无相关性(r=0.005,P>0.05).新生儿脐血胎盘生长因子水平与新生儿出生体重呈正相关(r=0.430,P<0.01).结论 胎盘生长因子可能在胎儿生长受限的发病中有重要的作用,并可能为将来诊断和治疗胎儿生长受限提供新的途径.     

A history of placental dysfunction and risk of placental abruption

In a population-based historic cohort study, we assessed the possible association of fetal growth retardation, preterm birth and pregnancy-induced hypertension in the immediately preceding pregnancy with placental abruption in the current pregnancy, which would suggest a shared aetiological factor. We also assessed whether chronic hypertension, diabetes mellitus and a history of Caesarean section are associated with placental abruption. Preterm birth and small-for-gestational-age (SGA) in the immediately preceding delivery were associated with an increased risk of placental abruption with unadjusted odds ratios (ORs) of 2.1 [95% CI = 1.9, 2.4] and 1.6 [95% CI = 1.5, 1.8] respectively. Women with a history of an SGA preterm birth in the immediately preceding delivery and an appropriate-for-gestational-age infant in the current had an adjusted OR of 3.2 [95% CI = 2.3, 4.5]. The adjusted odds ratio of placental abruption in women who had pregnancy-induced hypertension in the previous pregnancy, but not in the current, was 1.4 [95% CI = 1.2, 1.7]. Women who delivered a preterm or SGA infant in the previous delivery and had chronic hypertension or diabetes mellitus in the current had adjusted ORs of 2.3–5.7 and 2.5–6.0 respectively. Caesarean section in the previous delivery increased the risk of placental abruption by 40%. These results suggest that pregnancy-induced hypertension, intrauterine growth retardation, preterm delivery and placental abruption share an aetiological factor or represent different clinical expressions of recurring placental dysfunction. Chronic hypertension and diabetes mellitus may cause or aggravate such dysfunction thus causing placental abruption. A history of Caesarean section is associated with an increased risk of placental abruption.     

胎盘提前钙化的超声征象与胎盘功能的关系

目的:了解胎盘提前钙化的超声征象与胎盘功能的关系。方法:选择15例在36周前B超检查发现Ⅲ级胎盘成熟度的低风险孕妇作为研究组,随机选择同期分娩孕龄与研究对象相匹配的正常孕妇15例作为对照。检测两者的多普勒脐血流、母血游离E3(FE3)浓度,分娩后留胎盘行HPL的免疫组化染色并对染色情况进行定量分析。结果:两组的母血FE3浓度无统计学差异〔8.97(4.7,12.25)ng/ml vs 9.195.54,11.65 ng/ml,P>0.05〕,两组胎盘内HPL的表达强度无统计学差异〔19.85(18.20,19.91)PUvs 20.17(18.01,22.56)PU,P>0.05〕,但胎盘提前钙化组的脐动脉血流的搏动指数(PI)及脐动脉收缩期最大血流速度(S)与舒张期血流速度(D)的比值(S/D)显著高于对照组〔(0.79±0.17)vs(0.71±0.09)P<0.05〕和〔(2.34±0.38)vs(1.99±0.17),P<0.001〕。结论:提前钙化胎盘的分泌功能尚正常,但脐血流受到影响,应引起注意。     

Giant placental chorioangioma

The large placental chorioangioma is a non-trophoblastic vascular tumor of placenta which size is more than 4 cm. It's a rare tumor, the incidence is between 1/3500 and 1/9000 birth. We analyze, on base of our case and from a literature review, the ultrasonography aspects of this tumor: we bring out also the physiological mechanisms of maternal and fetal complications and finally we detail the therapeutic possibilities. Chorioangioma appears in ultrasound scan like a thoroughly limited hypo-echogenic zone The vascular origin of the tumor can be confirmed by color Doppler. A left-right shunt effect results from arterio-venous communications and causes backwardness growth and fetal death in-utero The fetus is exposed to anemia and microangiopathic thrombopenia The maternal complications are: hydramnios, abruption placenta, premature ruptured membrane. Therapeutic possibilities are reduced: In several fetal anemia, blood transfusion can be done. Some techniques for tumor devascularization are be tried by someone.     

Human placental acetylcholine

The human placenta contains both acetylcholine (ACh) and choline acetyltransferase, and in vitro bilaterally perfused placental lobules release ACh. The function of this placental cholinergic system has not yet been clearly defined, although changes occur in it during parturition and it may be linked to placental prostaglandin generation at this time. It has also been suggested that ACh may regulate placental amino-acid transport and/or blood flow. It has been found that ACh release from fetal vessels of bilaterally perfused placental lobules is reduced during preeclampsia but is not necessarily correlated with any change in perfusion pressure or materno-fetal transfer of the nonmetabolizable amino acid alpha-aminoisobutyric acid. However, a correlation has been found between releases from human placental explants of ACh (when inhibited by (2-benzoylethyl)trimethylammonium or vesamicol) and of prostaglandins E2 and F2 alpha. Thus, although the evidence for a role of ACh in the control of placental amino-acid transfer or vascular tone is not conclusive, inhibition of the human placental cholinergic system has been shown to be associated with reduced output of prostaglandins from this tissue.     

Influence of cadmium on placental structure

Placentas of smoking and nonsmoking mothers have been investigated with light microscopical techniques. The cadmium content of the same placentas had been determined in a previous study by means of atomic absorption spectrophotometry (AAS). The cadmium content of the placentas from smokers was found to be elevated, compared to that of nonsmokers. The volume density of the vascular bed in the terminal villi of the placentas of smokers was found to be decreased. Preliminary results of experiments in course with rats exposed to 0.2 mg CdCl₂/kg body wt/day (by subcutaneous injection) seem to indicate that in the placenta of rats, the volume density of the blood vessels in the placental stroma is likewise reduced in the exposed animals.     

胎盘绒毛膜血管瘤的临床病理分析

目的:探讨妊娠合并胎盘绒毛膜血管瘤的产前并发症、临床病理联系和围生期结局。方法:回顾性分析2002年1月～2008年12月广州市妇婴医院诊断的24例胎盘绒毛膜血管瘤患者的病历资料,通过复阅病历和病理切片,获得胎盘绒毛膜血管瘤的临床表现、产前超声图像、临床病理特点和围生期结局。结果:24例胎盘绒毛膜血管瘤中,7例产前彩色多普勒明确诊断,直径均大于4 cm。其中23例单胎妊娠,1例双胎妊娠。23例单胎中,14例有以下并发症:重度子痫前期3例、羊水过少3例、羊水过多4例、胎儿窘迫3例、胎儿生长受限3例、早产儿10例、新生儿窒息3例、新生儿黄疸2例、新生儿死亡2例。1例双胎妊娠伴有胎儿生长受限和双胎输血综合征。无胎儿水肿、心衰和胎儿畸形。结论:胎盘绒毛膜血管瘤与妊娠并发症发生有关,最常见的是早产、羊水异常和胎儿生长受限。建议密切随访,包括对产前诊断时无相关并发症的病例。     

Antenatal diagnosis of placental sulphatase deficiency

A dynamic test for the antenatal diagnosis of placenta sulphatase deficiency was examined in ten patients, selected on the basis of low urinary oestrogen levels (i.e. below the 10th centile at between 30 and 40 weeks gestation). The test consisted of measurement of plasma oestradiol levels over a period of 120 min after an i.v. injection of dehydroepiandrosterone sulphate. The oestradiol response was vigorous in seven patients, absent in two and small, but significant, in one. The three patients with reduced oestradiol response were also found to have raised levels of urinary steroid monosulphates and thus were probably placental sulphatase deficient. The overall clinical importance of placental sulphatase deficiency and the value of the dehydroepiandrosterone sulphate loading test in antenatal diagnosis are discussed.     

胎盘输血技术发展现状

胎盘输血对新生儿的益处已得到广泛证实,既可以补充新生儿血容量,改善生后早期脏器灌注,有利于胎儿血循环向新生儿血循环过渡,也可以减少输血治疗需求,促进新生儿出生时建立适应的生理机制和功能,降低新生儿颅内出血(ICH)、坏死性小肠结肠炎、支气管肺发育不良等并发症发生率。同时,还可增加新生儿血清铁储备,改善神经系统疾病新生儿远期预后,降低新生儿死亡率。本文涉及的胎盘输血措施主要包括新生儿分娩时采取延迟脐带结扎(DCC)和脐带挤压(UCM)。根据世界卫生组织等权威机构推荐,对多数有活力足月新生儿和早产儿应采取DCC措施,达到胎盘输血的目的。笔者拟对胎盘输血的：(1)生理学基础;(2)对新生儿影响;(3)当前对其研究的重点方向等最新研究现状进行阐述。