妊娠糖代谢异常危险因素探讨

目的 探讨妊娠糖尿病和妊娠糖耐量减低妇女的危险因素.方法 采用回顾性多因素分析方法,对妊娠糖尿病(gestational diabetes mellitus,GDM)组105例、妊娠糖耐量减低(gestational impaired glucose tolerance,GIGT)组60例和妊娠糖代谢正常(对照组)153例的临床资料进行单因素和多因素Logistic回归分析,探讨各因素对GDM和GIGT发病的影响.结果 GDM组及GIGT组孕妇平均年龄、孕前体质量指数(body mass index,BMI)糖尿病家族史发生率,恶性肿瘤家族史阳性率均高于对照组(P<0.05);多因素Logistic回归分析显示,孕妇年龄、孕前BMI和糖尿病家族史发生率,恶性肿瘤家族史均为妊娠糖代谢异常的高危因素.结论 有糖尿病家族史、孕前BMI是妊娠糖代谢异常的危险因素.     

维吾尔族和汉族妊娠期糖代谢异常相关因素初探

目的：探讨维吾尔族和汉族妊娠期糖代谢异常的高危因素。方法：采用前瞻性对照研究的方法，对2005年10月王2006年9月门诊产前检查诊断的糖代谢异常孕妇593例，其中GDM260例（汉族172例，维吾尔族88例）、GIGT333例（汉族265例．维吾尔族68例），（OGTT＋组）和糖代谢正常孕妇1425例（汉族1135例，维吾尔族290例）（对照组）的临床资料进行分析，探讨各因素对维吾尔族和汉族妊娠期糖代谢异常发病的影响。结果：（1）糖筛异常发生率，汉族（37．12％）低于维吾尔族（44．25％）（P〈0．005）。糖耐量阳性率，维吾尔族（15．48％）高于汉族（10．32％）（P〈0．005）。维吾尔族GDM发生率（8．73％）明显高于汉族（4．06％）（P〈0．005），而GIGT、发生率（6.75％）和汉族（6．26％）相当（P〉0．05）。（2）孕妇BMI≥25、孕妇孕期增重〉18kg、孕期阴道念珠菌病（WE）、不良孕产史、糖尿病家族史的发生率，维吾尔族和汉族均为OGTT阳性组大于对照组（P〈0．05）；孕妇年龄≥35岁发生率仅在汉族中为OGTT阳性组大于对照组（P〈0．005）；无论在OGTT阳性组和对照组中，孕妇孕期增重〉18kg发生率，均为汉族大于维吾尔族（P〈0.05）；VVC、糖尿病家族史的发生率，维吾尔族大于汉族（P〈0．005）。结论：（1）维吾尔族糖筛查异常、糖耐量试验异常以及GDM发生率均高于汉族。（2）孕前肥胖、孕妇孕期增重〉18kg、VVC、不良孕产史、糖尿病家族史是维吾尔族和汉族糖代谢异常共同的高危因素，而增重〉18kg可能对汉族意义更大；孕妇年龄≥35岁是汉族糖代谢异常的高危因素。     

平顶山市中期妊娠妇女糖尿病患病情况调查

目的：对平顶山市中期妊娠妇女糖尿病情况进行评估,总结妊娠糖尿病的发病原因及危险因素,做好GDM的筛查。方法：对995例中期妊娠的孕妇进行口服葡萄糖耐量试验,筛查出糖代谢异常患者,分为妊娠糖尿病（GDM）组、妊娠糖耐量降低（GIGT）组、糖代谢正常（NIGT）组。结果：995例孕妇中GCT测试呈阳性者为208例（20.9%）,GIGT为43例（4.3%）,GDM为10例（1.0%）。结论：本地区妊娠糖尿病患病率为1.0%,糖耐量低减患病率为4.3%。孕妇年龄过大,具有糖尿病家族史,孕期体重增加过多为GDM的危险因素。     

妊娠期糖代谢异常相关危险因素及对母儿的影响

目的 探讨妊娠期糖代谢异常相关危险因素及对妊娠结局的影响.方法 回顾分析2007年l月～2008年12月于河北大学附属物探医院进行产前检查的孕妇500例,经50 g葡萄糖筛查GCT和75 g糖耐量试验OGT,诊断为妊娠期糖尿病45例,诊断为妊娠期糖耐量受损30例.随机抽取50 g GCT筛查阴性的孕妇150例为对照组.结果 GDM、GIGT发病率分别为9.0%、6.0%、15.0%,GDM组和GIGT组妊高征、羊水过多、巨大儿、新生儿低血糖、新生儿高胆红素血症发生率均较对照组增高,差异有统计学意义(P<0.05).GDM组和GIGT组与对照组年龄超过30岁,孕前体重指数≥24,不良孕产史、糖尿病家族史等高危因素存在差异,其差异有统计学意义(P<0.05).结论 年龄超过30岁,孕前体重指数≥24,不良孕产史、糖尿病家族史均为妊娠期糖代谢异常相关危险因素.妊娠期糖代谢异常可对母儿造成危害,应尽早防治.     

妊娠期糖代谢异常对妊娠结局的影响

目的 探讨妊娠期糖代谢异常对妊娠结局的影响。方法 对70例妊娠期糖代谢异常孕妇进行回顾性分析,其中妊娠期糖尿病（GDM）31例,妊娠期糖耐量受损（GIGT）39例,比较GDM、GIGT与血糖正常孕妇的高危因素和母婴结局。结果 GDM组、GIGT组与对照组年龄〉30岁、体重指数≥24、不良孕产史、糖尿病家族史等高危因素比较,差异有统计学意义（P0.05）。GDM组和GIGT组的新生儿窒息、低血糖、高胆红素血症的发生率均高于对照组,GIGT组新生儿低血糖发生率与对照组比较差异有统计学意义。GDM有3例胎死宫内,而GIGT组与对照组无胎死宫内病例。结论 对GDM和GIGT应同样重视,做到早筛查、早诊断、早治疗,减少母儿并发症的发生。     

赣南地区妊娠期糖尿病危险因素的探讨及特

目的：探讨赣南地区妊娠期糖尿病的危险因素。方法：收集2011年5月-2012年11月我院定期产检、孕前无糖尿病并于我院分娩的孕妇病例,所有孕妇均在孕24-28周进行75 g葡萄糖筛查试验,采用2010年国际妊娠合并糖尿病研究组织（IADPSG）推荐的GDM诊断的新标准进行诊断。结果：两组的年龄大于30岁、孕前体重指数≥25 kg·m-2、多次分娩史、不良孕产史（自然流产、死胎引产）、巨大儿分娩史、家族性遗传病史（特别是糖尿病、高血压史）的发生率相比,差异具有统计学意义（P〈0.05）。结论：孕妇年龄、肥胖、多次分娩史、不良孕产史（自然流产、死胎引产）、家族遗传病史、巨大儿分娩史等是引发GDM发生的高危因素,对此类高危人群早期进行临床干预,从而减少母婴并发症的发生,降低孕产妇及围产儿死亡率。     

体重指数与妊娠并发症和妊娠结局的关系

目的　探讨孕妇孕前体重指数 (BMI)、孕期BMI增加值 (ΔBMI =分娩期BMI -孕前BMI)与妊娠期糖尿病 (GDM )、糖耐量异常 (GIGT)、妊娠高血压综合征 (PIH)及妊娠结局的关系。方法　将 333例单胎孕妇按孕前BMI随机分为消瘦组 (15 8例 )、正常组 (15 2例 )及肥胖组 (2 3例 ) ,对GDM、GIGT、PIH的发生率及妊娠结局作前瞻性分析。结果　肥胖组妊娠期GDM +GIGT及PIH发生率较正常组及消瘦组明显升高 (P值均<0 .0 1) ,肥胖组及消瘦组的GDM发生率较正常组明显升高 (P <0 .0 5 ) ,阴道自然分娩率与剖宫产率的差异无显著性 (P >0 .0 5 ) ,肥胖组巨大儿发生率明显升高 (P <0 .0 5 )。发生GDM、GIGT及PIH孕妇的孕期ΔBMI与无并发症者的差异无显著性 (P >0 .0 5 ) ,阴道分娩与剖宫产终止妊娠者孕期ΔBMI的差异亦无显著性 (P >0 .0 5 ) ,发生巨大儿与未发生巨大儿者孕期ΔBMI的差异有显著性 (P <0 .0 5 )。产后出血的发生与孕前BMI及孕期BMI增加值均无明显关系。结论　孕前BMI与妊娠期GIGT、PIH发生率、巨大儿发生率之间有密切关系 ,孕前控制体重可减少PIH、GDM和巨大儿的发生 ,而控制整个孕期体重增加更可减少巨大儿发生     

妊娠期糖尿病产妇瘦素水平测定及其与新生儿的关系

目的：探讨瘦素与妊娠期糖尿病（GDM）的关系及其对新生儿发育的影响。方法：采用放射免疫法测定GDM孕妇20例,糖耐量低减（IGF）孕妇22例,正常孕妇25例的血清溲索及新生儿脐血瘦素水平,同时测定3组孕妇的孕前体重指数和孕期体重增加指数及胎儿的体重,分析其与瘦素之间的关系。结果;GDM组血清瘦素水平明显高于IGT组及正常组,差异有统计学意义（P〈0．05）。3组孕妇血清瘦素与胎儿体重均无相关性。而3组脐血瘦素水平与胎儿体重呈正相关（r=0．5727,P〈0．05）。GDM组瘦素与孕前体重指数明显相关。（r=0．8277,P〈0．05）．3组孕妇瘦素水平与孕期体重增加指数均无相关。结论：孕妇瘦素水平的增加与GDM的发病有一定的关系。可作为GDM监测指标之一;脐血瘦素水平与胎儿体重有关,但有待于进一步研究。     

影响妊娠期糖代谢异常的临床相关因素分析

目的探讨妊娠期糖代谢异常的发生情况、对母婴结局的影响及妊娠期糖尿病筛查的时机及意义。方法对进行产前检查的孕妇2932例进行50 g葡萄糖负荷试验筛查,试验结果阳性的孕妇再行75g口服糖耐量试验。将诊断为妊娠期糖尿病的孕妇82例作为GDM组;诊断为妊娠期糖耐量受损的孕妇99例作为GIGT组;另将50g糖筛查阳性而75 g糖耐量试验阴性的孕妇366例作为对照组。结果GDM、GIGT组妊高征、羊水过多、胎膜早破、羊水过少等并发症与对照组比较差异有统计学意义（P〈0.05）,GDM、GIGT组巨大儿、新生儿低血糖和高胆红素血症的发生率与对照组比较差异有统计学意义（P〈0.05）。Logistic回归分析显示,体质量指数、年龄、不良孕产史,反复发生霉菌性阴道炎是妊娠期糖尿病的危险因素。结论GDM、GIGT可对母婴造成多种危害,孕期应积极控制血糖并完善围产期保健以减少母婴并发症。     

孕妇血糖筛查结果及临床特征277例分析

对我院营养门诊277例孕妇临床资料进行回顾性分析,其中妊娠糖尿病（GDM）组64例,糖耐量低减（GIGT）组85例,正常组128例（包括糖尿病筛查正常组84例及糖尿病筛查异常且糖耐量试验正常者44例）。结果糖筛查异常孕妇有糖尿病家族史的比例高于糖筛查正常组（P〈0.05）;GDM组年龄高于GIGT组及正常组（P〈0.05）。GIGT组与正常组年龄无差异（P〉0.05）;GIGT组孕前及糖筛查时体重均高于正常组（P〈0.05）;各组孕妇首诊至糖筛查检查时血脂水平均呈上升趋势（P〈0.05）,且首诊时GDM组及GIGT组血脂水平高于正常组（P〈0.01）。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.