影响子痫前期围产儿结局的多因素分析

目的 探讨影响子痫前期围产儿结局的因素.方法 采用单因素和多因素Logistic回归对448例子痫前期患者的围产儿结局进行分析.结果 448例子痫前期发生围产儿不良结局者共94例(21.0%),其中围产儿死亡41例(9.2%).对孕妇的58项变量行单因素分析显示,影响围产儿结局的因素有:发病孕周、分娩孕周、自觉症状、抽搐、尿蛋白、水肿、收缩压、舒张压、白细胞计数、中性粒细胞计数、24 h尿蛋白定量、血浆白蛋白、乳酸脱氢酶(LDH)、肌酐、产检次数、血压升高孕周和水肿孕周等17项变量(P＜0.05);Logistic逐步回归筛选出的多因素依次为:分娩孕周(OR 0.583, 95%CI:0.367～0.926),自觉症状(OR 9.315,95%CI:1.500～57.833)和尿蛋白(OR 3.394,95%CI:1.226～9.397).结论 加强围产期保健,延长分娩孕周,可以减少子痫前期患者围产儿不良结局的发生.     

血单核细胞计数增高影响因素分析

目的 通过分析体检人员血单核细胞增高的影响因素,为检后咨询和健康指导提供科学依据.方法 应用我院体检中心的数据平台,搜索2015年12月-2016年3月在我院体检的成年人(年龄18-65岁)体检资料,将体检资料相对完善的人员纳入分析,有2891人符合标准,女性1468人(占50.78％),男性1423人(占49.22％).体检人员中单核细胞计数增高的有400人,其中女性175人(占43.75％),男性225人(占56.25％).将单核细胞计数增高的人员按体质量、血脂、血尿酸异常进行统计学分析.结果 单核细胞计数增高伴体质量增加与单核细胞计数增高而体质量正常比较,x2=14.28(P<0.01),单核细胞计数增高伴血脂高与单核细胞计数增高而血脂正常比较,x2=83.25(P<0.01),单核细胞计数增高伴血尿酸高与血尿酸正常比较,x2=3.94(P<0.05).结论 体检人员中单核细胞计数增高与受检者体质量增加、血脂增高、血尿酸增高有相关性.血常规检查和身高体质量检查是体检人员必查项目,在出现体质量增加伴单核细胞计数增多时可提示受检者结合自身情况做进一步相关检查,并采取积极干预措施以利身体保持良好的健康状态.     

妊高征患者和正常孕妇妊娠晚期血小板参数的变化

目的　探讨妊高征 (PIH )患者和正常孕妇妊娠晚期血小板参数变化及临床应用价值。方法　采用CD 370 0SL全自动血液分析仪分别对 5 0例妊高征患者 (妊高征组 )、15 0例正常孕妇以及 15 0例正常非孕妇女 (对照组 )血液标本进行血小板计数、平均血小板体积 (MPV)、血小板分布宽度 (PDW )以及红细胞压积 (Hct)检测。结果　妊高征组的MPV、PDW明显高于正常孕妇组 (P <0 0 5 ) ,而此二组又明显高于对照组 (P <0 0 1) ;妊高征组的PLT明显低于对照组 (P>0 0 1)。三组间的Hct无显著性差异 (P >0 0 5 )。结论　妊高征患者妊娠晚期由于血小板消耗和破坏增加 ,导致血小板减少 ,MPV、PDW明显增加。检测血小板参数能为临床预测妊高征的发生提供一定的参考。     

HIV/AIDS剖宫产术后切口愈合与CD4+T淋巴细胞计数关系分析

目的 探讨艾滋病病毒感染者/艾滋病(HIV/AIDS)孕妇剖宫产术后切口愈合与CD4(+)T淋巴细胞计数之间的关系.方法 对在我院实施剖宫产分娩的58例术前2周内曾经检测CD4(+)T淋巴细胞计数的艾滋病病毒(HIV)感染的产妇资料进行分析.结果 剖宫产分娩58例,切口愈合均为甲级愈合.其中50例实施孕期抗反转录病毒药...     

妊娠期母血表皮生长因子和绒毛膜促性腺激素的含量及其意义

目的 了解妊娠期母血表皮生长因了了（ＥＣＧ）和绒毛膜促性腺激素（ＨＣＧ）的浓度变化及其生理学意义。方法 采用放射免疫法测定１８２例不同孕龄的孕妇血清ＥＧＦ和ＨＣＧ含量、２０例健康非孕妇女作为对照组。结果 与非孕妇女比较,妊娠妇女血ＥＧＦ含量明显增高;早孕时ＥＧＦ含量几乎呈直线上升,至孕２４－２７周达高峰,以后迅速下降。早期及晚期妊娠时,ＥＧＦ含量与ＨＣＧ含量呈良好正相关,而中期妊娠时、两者无明显盯     

A Comparison Study of the Effects Injectable Contraceptive Cyclofem on Blood Coagulation and Fibrinolysis

Forty-six healthy women received Cyclofem (25mg medroxyprogesterone acetate with 5mg estradiol cypionate) and other forty-five women, as control, received oral contraceptive pill (Orttm-Novum 1/35, containing norethisterone enantate 1mg and estradiol valerate 35μg) for nine months. Blood samples were taken during the follicular and luteal phases of pre- treatment, and for Cyclofem group, immediately prior to the 3rd and 9th injections and 1 and 3 weeks after the 3rd and 9th injections; for Ortho-Novum group, blood samples were taken on the irst day of the 3rd and 9th pill cycles and 1 and 3 weeks later in both cycles. For both groups after at least 3 months nonhormonal method of contraception, blood sampling was repeated at follicular and luteal phases of a normal mentrual cycle. Coagulation and fibrinolysis parameter were detected including hemoglobin, platelet count, prothrombin time, APTT, fibrinogen, factor Ⅶ, factor Ⅹ, plasminogen, t-PAL AT Ⅲ(functional and immunological assays) and protein C. In the Cyclofem group, hemoglobin, platelet count, fibrinogen and factor Ⅹ were not changed. Factor Ⅶ significantly reduced. Prothrombin time and APTT showed minor changes. Plasminogen and protein C decreased while t-PAI aad AT Ⅲ increased. These changes showed a dynamic balance between coagulation and fibrinolysis. In Ortho-Novum 1/35 group, platelet count, factor Ⅹ and fibrinogen increased and prothrombin time and APTT accelerated. In fibrinolysis and anticoagutation system, plasminogen increased as well as protein C, but AT Ⅲ declined. Those changes showed a tendency of hyper-eoagutability state, fibrinolysis and anticoagulation were enhanced to a certain extent.The result of our study is that there are slight changes on coagulation and fibrinolysis in Cyclofem injectable contraceptive users.     

多囊卵巢综合征孕妇胎盘类固醇的研究

目的  评估多囊卵巢综合征（PCOS）孕妇胎盘类固醇硫酸酯酶（STS）、3β-羟基类固醇脱氢酶1型（3β-HSD-1）和P450芳香化酶（P450arom）活性。方法  研究对象为足月分娩的20例PCOS孕妇和30例健康对照孕妇。分娩后采集胎盘组织和脐带血样本。孕34周时采集母体血液样本。评估胎盘组织中STS、3β- HSD-1和P450arom活性。测定血液样本内孕酮、硫酸脱氢异雄酮（DHEAS）、脱氢表雄酮（DHEA）、雄烯二酮、睾酮、雌酮、雌二醇和总雌三醇含量。结果  与健康对照组孕妇比较,PCOS孕妇胎盘组织中3β-HSD-1含量较高,而P450arom活性较低。此外,PCOS孕妇雄烯二酮和睾酮浓度比对照组孕妇高（P =0.016和0.025）。相较于对照组女性新生儿,PCOS组女性新生儿脐带血内雄烯二酮较低,而雌三醇浓度较高（P =0.038和0.031）。结论  PCOS孕妇胎盘组织内参与类固醇合成的两个重要酶活性发生改变,3β-HSD-1升高,而P450降低,该变化可引起怀孕期间雄激素分泌增加。

     

二维及彩色多普勒超声对孕产妇下肢静脉病变的观察

目的:观察孕、产妇下肢静脉的变化,探讨妊娠期、产褥期下肢静脉血栓形成的病因、发生率及彩色多普勒超声诊断的应用价值. 方法: 利用二维及彩色多普勒超声测量96例孕、产妇不同时期的股静脉及大、小隐静脉的内径,观察血管内血流自显影、有无血栓及彩色多普勒血流显像情况. 结果: 随着孕龄增加,下肢静脉内径逐渐增宽,大隐静脉表现最为显著(P《0.05). 中、晚孕期,股静脉内血流自显影发生率较高(中孕39.1%,晚孕92.5%). 产后3 mo内是下肢静脉血栓最易形成阶段. 结论: 孕妇下肢静脉压的升高导致了下肢静脉扩张,血流淤积,成为静脉血栓形成的易发因素. 超声检查可安全、快速地了解孕妇妊娠期下肢静脉的功能变化,为临床的预防和治疗措施提供有价值的信息.     

多囊卵巢综合征患者白细胞计数的变化特点

目的 探讨多囊卵巢综合征(PCOS)患者外周血白细胞(WBC)计数与体质量指数(BMI)、总睾酮(T)、雌二醇(E2)和促黄体生成素(LH)的关系。方法 对1016例PCOS患者(PCOS组)和1016例正常女性(对照组)的人体测量研究结果和基础内分泌指标进行回顾性分析,比较两组外周血WBC总数及其分类中性粒细胞(N)和淋巴细胞(L)计数,并分析PCOS患者外周血WBC总数及其分类N、L计数与BMI、T、E2、LH的相关性。结果 PCOS患者的外周血WBC总数和L计数明显高于正常女性(P<0.05),WBC总数和L计数的升高与PCOS患者的BMI增加有关,与高水平E2和高水平LH不相关(P＞0.05),WBC总数的升高与T呈正相关性(r=0.073,P<0.05),L计数的升高与T不相关(P＞0.05)。结论 PCOS患者的WBC总数和淋巴细胞计数明显高于正常女性。     

临产孕妇凝血功能指标及血细胞参数变化的研究

目的探讨临产孕妇凝血功能指标、血细胞参数的变化及其临床意义。方法对425例临产孕妇(临产孕妇组)和139例健康非孕妇女(健康对照组)进行凝血功能指标:凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)、D-二聚体(D-D);血细胞参数:血红蛋白浓度(HGB)、红细胞比积(HCT)、红细胞计数(RBC)、红细胞体积分布宽度(RDW)、白细胞计数(WBC)、血小板计数(PLT)、血小板体积分布宽度(PDW)检测和分析。结果 (1)临产孕妇的Fbg、D-D、RDW、WBC、PLT、和PDW高于健康对照组(P0.01),两组差异有统计学意义;(2)临产孕妇的PT、HGB、HCT、RBC低于健康对照组(P0.01),两组差异有统计学意义;(3)临产孕妇的aPTT、TT与健康对照组无明显变化(P0.05),两组差异无统计学意义。结论临产孕妇血液处于高凝状态,可出现不同程度的缺铁性贫血。产前进行凝血功能指标及血细胞参数检测,对预防和冶疗产科一些并发症有极其重要的临床意义。     

妊娠期糖尿病患者血糖及血脂水平与新生儿体质量关系

目的:分析妊娠期糖尿病(GDM)孕妇孕期血糖、血脂水平,探讨GDM孕妇血糖及血脂代谢对新生儿出生体质量的影响,为妊娠糖尿病孕妇的临床管理提供参考.方法:妊娠期糖尿病(GDM)孕妇101例,对照组孕妇112例,记录两组孕妇血糖、血脂水平及孕期体质量增长.结果:与对照组比较,GDM组孕妇在年龄、孕周及孕次方面无显著性差异(...     

Susceptibility to rubella among pregnant women and the serological evidence of congenital rubella in newborn babies at Colombo South Teaching Hospital

OBJECTIVE: To determine the susceptibility to rubella infection in early pregnancy and the incidence of seropositivity of cord blood for rubella specific IgM among the newborn babies at Colombo South Teaching Hospital. METHODS: 1000 cord blood samples and 500 maternal blood samples from pregnant women before the 16th week of gestation were taken from the labour room and the antenatal clinic of the University Unit, Colombo South Teaching Hospital during the period of February 1999 to February 2001. These samples were tested for rubella specific IgM and IgG antibodies by ELISA. A detailed questionnaire was filled during the time of sampling. RESULTS: Of the 500 antenatal blood samples 82% were positive for rubella specific IgG. 373(75%) women gave a history of vaccination against rubella before their present pregnancy. Among the vaccinated 2(0.5%) were negative for IgG antibodies by ELISA. Out of 127 unvaccinated women 12(9%) gave a history of past infection with rubella and of this 3(25%) were seronegative for rubella specific IgG. 18% of pregnant women at 16 weeks of gestation were at risk of giving birth to a baby with congenital rubella syndrome. Among the tested 1000 cord blood samples three were seropositive (0.3%) for rubella specific IgM. CONCLUSIONS: A significant proportion of pregnant women were susceptible to rubella infection in the studied population. The present strategy of selective rubella vaccination should be reconsidered if we are to get closer to eliminating rubella syndrome in Sri Lanka.     

Expectant management of severe preeclampsia presenting before 25 weeks of gestation.

BACKGROUND: The treatment of preeclampsia before 25 weeks of gestation remains controversial. The aim was to evaluate the outcome of expectant management of preeclamptic women presenting prior to 25 weeks of gestation. MATERIAL/METHODS: During a five-year period, 55 women presenting with severe preeclampsia at or before 24 weeks and 6 days of gestation were admitted to a high-care unit for expectant management. Indications for delivery were the development of severe maternal morbidity secondary to preeclampsia. Complications were identified from individual patient and infant records. RESULTS: Mean prolongation of gestation was 4.8+/-4.1 days (range: 1-13 days) and the mean maternal hospitalization period was 10.0+/-8.3 days (range: 2-31 days). Conservative management was associated with a 94.5% (52/55) intrauterine fetal loss rate. Of the three live-born infants, one died secondary to respiratory distress syndrome followed by neonatal sepsis and the other two survived with cognitive and motor developmental delay. HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome was diagnosed in 12 women (21.8%). Nine women (16.3%) required transfusions with blood or blood products. There was 1 case (1.8%) of eclampsia. Overall, 15 women (27.2%) had developed some maternal morbidity without any significant differences between <23 weeks' and >/=23 weeks' gestation. Nulliparity was not associated with stillbirth (p=0.8), HELLP syndrome (p=0.8), or overall maternal morbidity (p=0.7). None of the women died or required any long-term treatment. CONCLUSIONS: Conservative management of severe preeclampsia before 25 weeks of gestation is associated with considerable perinatal mortality and morbidity. Maternal complications are relatively common, but generally short-lived.     

妊娠期糖尿病终止妊娠时机的探讨

目的探讨妊娠期糖尿病的最佳终止妊娠时机,改善母儿结局,提高阴道分娩率。方法回顾性分析我院2012年符合中国卫生部颁布的妊娠期糖尿病诊断标准的孕妇286例,在孕期予饮食营养运动指导后血糖控制满意,空腹血糖（FPG）均在3．3～5．1mmol／L,餐后2h在6．7mmol／L以下排除各种妊娠合并症、并发症,在充分知情同意下,随机分组选择终止妊娠时间,观察组（孕39^＋1～40周）170例,对照组（孕38^＋1～39周）116例,行宫颈评分,予缩宫素、米索前列醇、普贝生三种引产方法引产,比较阴道分娩率、因胎儿窘迫、头盆因素、社会因素、引产失败而行手术的剖宫产率。结果观察组（孕39^＋1～40周）比对照组（孕38^1～39周）阴道分娩率有所提高,因引产失败、社会因素而剖宫产的比率有所下降,差异有统计学意义,在胎儿窘迫、头盆因素而剖宫产方面较无明显差异。结论对于在孕期予饮食营养运动指导后血糖控制满意,无妊娠合并症、并发症的无产兆孕妇,孕39^＋1～40周是妊娠期糖尿病的最佳终止妊娠时机,可提高阴道分娩率。     

正常妊娠与妊高征患者钙调节因子水平的研究

对１４５名健康孕妇（不同孕期及产后）、９０例中、重度妊娠高血压综合征（简称妊高征）患者，以及做为对照的非孕妇女的血清进行钙（Ｃａ）、磷（Ｐ）、碱性磷酸酶（ＡＫＰ）、甲状旁腺素（ＰＴＨ）、降钙素（ＣＴ）、２５羟维生素Ｄ３［２５（ＯＨ）Ｄ３］及骨钙素（ＢＧＰ）等７项检验。并对妊娠中期补钙与未补钙的孕妇的妊高征发生率进行比较。结果：各项检测指标随孕周增加及产后有明显变化。正常妊娠钙代谢调节代偿性平衡，而妊高征患者钙代谢调节失衡。孕中期补钙组的妊高征发生率明显低于对照组。提示妊高征的发生与钙缺乏有着密切的关系，孕中期补钙有利于预防妊高征的发生。     

高危妊娠与胎母输血的相关性分析

目的探讨孕晚期母亲血胎儿红细胞量（KB）与新生儿血红蛋白的相关性。方法运用用红细胞酸洗脱染色试验,监测297例入院待产孕妇的KB值,比较正常孕妇和高危孕妇KB的差异性,并观察其与新生儿出生后24 h内测的血红蛋白值的相关性。结果297例孕妇血中（正常妊娠162例,高危妊娠135例）,234例可测到胎儿红细胞,KB值为0.01%～5.2%,胎儿红细胞检出率占监测人数的78.79%。经非参检验表明,高危妊娠组的KB值明显高于正常组,差异有极显著意义（〈0.001）;母亲KB值与新生儿血色素值的相关性不强,但对母亲KB值进行分层观察发现,以KB≥0.4%为界值,≥0.4%与〈0.4%组间的新生儿Hb值存在差异显著性（=10.406,〈0.01）,KB≥0.4%组新生儿的Hb水平较低。结论大部分高危妊娠孕妇存在胎母输血现象。孕期KB值监测对胎母输血高危孕妇以及高危新生儿的筛选有一定价值。     

异位妊娠自血回输应用价值及安全性分析(附60例分析)

目的:观察异位妊娠自血回输应用价值及安全性。方法:选择适当病例,剖腹探查时回输腹腔游离血,观察术后红细胞变化情况及术后不良反应。结果:输自体血后红细胞及血红蛋白显著提高,未出现明显的不良反应。结论:异位妊娠自血回输是安全有效的,值得临床应用推广,但要严格掌握适应症,注意不良反应出现。     

孕妇血糖与新生儿体重的相关性分析

目的　探讨孕妇空腹血糖与新生儿体重的相关性。方法　对 2 6 1例孕妇 ,均于妊娠 2 4 - 2 8周检测空腹血糖 ,并行葡萄糖耐量试验 (OGTT)。按新生儿体重分为 5组 ,以此分析各组新生儿体重与孕妇血糖之间的相关程度以及分娩方式。结果　孕妇血糖均值 ,各组间差别无显著性意义 (P >0 .0 5 ) ;新生儿体重 ,各组之间差别均有显著性意义 (P <0 .0 5 ) ;孕妇血糖与新生儿体重存在正相关关系r=0 .76 1(P <0 .0 5 )。胎儿体重与分娩方式的结局有关 ,剖宫产率由 1组到 5组逐渐升高 ,1组、2组分别与 3、4、5组间差别均有非常显著性意义 (P <0 .0 1)。结论孕妇血糖与新生儿体重存在正相关关系。为提高围产期保健质量 ,防止巨大儿的发生 ,建议对孕妇进行动态血糖测定分析 ,必要时进行葡萄糖耐量试验     

妊高征患者血液学及生化指标的临床分析

对２２０例妊高征患者细胞计数和因液生化特征进行。结果，妊高征者的红细胞压积（ＨＣＴ），容 转氨酶（ＧＰＴ），谷草转氨酶（ＧＯＴ）、尿 氮（ＢＵＮ）、肌酐Ｃｒ和尿酶（ＵＡ）显著增高，而血小板计数（ＰＬＴ），血浆蛋白（ＡＬＢ、ＧＰ）和血红蛋白（ＨＧＢ）等显著降低，结果表明它们可作为诊断和治疗妊上的重要指标。     

White blood cell count and cardiovascular disease. Insights from the Framingham Study.

OBJECTIVE--To examine the relation of white blood cell (WBC) count to the development of cardiovascular disease (CVD), including coronary heart disease, stroke, peripheral arterial disease, and cardiac failure. Traditional CVD risk factors, hematocrit, and vital capacity were considered. DESIGN--Prospective cohort analysis with one baseline examination of relevant risk factors and 12 years of follow-up for CVD. PARTICIPANTS AND METHODS--A community-based sample (Farmingham Offspring Study) of 1393 men and 1401 women who were free of CVD at the onset of the study and who were between the ages of 30 and 59 years at baseline. Time-dependent multiple variable logistic regression methods were used. RESULTS--There were 180 CVD events in men and 80 in women. The WBC count was correlated most strongly with the number of cigarettes smoked per day, hematocrit, and vital capacity. Among nonsmoking men with WBC counts within the normal range, the age-adjusted WBC count was significantly associated with CVD and coronary heart disease incidence. For each 1.0 x 10(9)/L-cell difference in WBC count, the CVD risk increased 32%. In women, each 1.0 x 10(9)/L-cell increment in WBC count was associated with a 17% increase in CVD risk, but only in smokers, and the relationship was not statistically significant after adjustment for relevant risk factors. CONCLUSIONS--The degree of elevation of WBC count within the normal range is a marker for increased risk of CVD that is partially explained by cigarette smoking. Future studies should include differential WBC determinations to assess their association with CVD.