孕早期睡眠状况对妊娠期糖尿病影响的前瞻性研究

目的 调查分析孕妇孕早期睡眠状况,探讨其对妊娠期糖尿病（GDM）的影响。方法 选取成都市区妇幼医疗机构产前门诊542例孕早期妇女为研究对象进行前瞻性研究,通过问卷调查收集孕妇孕早期睡眠时间、失眠、孕前体质量及其基本信息,于24～28孕周进行糖耐量筛查试验（OGTT）,根据中国妊娠合并糖尿病诊治指南（2014）诊断GDM,并测量体质量。采用多因素非条件logistic回归方法分析孕妇孕早期睡眠状况对GDM发生率的影响。结果 孕早期睡眠不足组、睡眠正常组、睡眠过多组人数分别为16例（2.95%）、268例（49.45%）和258例（47.60%）,GDM发病率分别为62.50%（10/16）、25.75%(69/268)、22.09%(57/258),三组比较差异有统计学意义（χ2=11.280,Pχ2值分别为8.410和11.218,均Pχ2=4.813,P<0.05）。调整可能混杂因素后〔孕妇年龄、文化程度、孕前体质量指数（BMI）、孕早中期增重、孕妇2型糖尿病家族史、孕次、产次、吸烟、饮酒、锻炼、就业〕,多因素非条件logistic回归分析显示:孕妇孕早期睡眠不足是GDM发生的独立危险因素,比值比（95%可信区间）为7.38(2.25~24.17),未观察到孕早期失眠对GDM的影响。结论 孕妇孕早期睡眠状况与GDM发生密切相关,孕早期睡眠不足是GDM发生的危险因素,失眠对GDM的影响有待研究。     

妊娠期糖尿病发病的危险因素及干预措施

目的:分析妊娠期糖尿病发病的危险因素及干预措施,以减少妊娠期糖尿病的发生.方法:选取产检孕妇326例作为研究对象,其中妊娠合并糖尿病54例(病例组),非妊娠合并糖尿病272例(对照组),收集孕妇的临床资料,通过单因素、多因素logistic回归分析法分析妊娠期糖尿病发病的影响因素.结果:孕早期空腹血糖高、空腹胰岛素高、胰岛素抵抗指数高以及年龄≥35岁、孕前体质量大、孕前体质量指数大、糖尿病家族史、孕早期体质量增长多、孕中期体质量增长多为影响妊娠期糖尿病发生的独立危险因素(P<0.05～P<0.01).结论:保健工作中在孕前应对育龄妇女开展饮食管理、控制体质量;孕期除控制体质量外,还应增加对早孕期血脂、空腹血糖等的管理措施.     

妊娠期糖尿病高危孕妇甲状腺功能及甲状腺自身抗体变化

目的 探讨妊娠期糖尿病高危孕妇甲状腺功能及甲状腺自身抗体变化.方法 选取2016年12月至2019年3月本院收治的糖尿病高危孕妇49例作为观察组,并选取同期健康孕妇49名作为对照组,比较孕早期、孕中期、孕晚期、产后抗甲状腺过氧化物酶抗体(TPOAb)阳性发生率及甲状腺功能异常情况.结果 观察组TPOAb阳性发生率显著高于对照组(P<0.05).观察组孕早期、孕中期、孕晚期、产后甲状腺功能异常率均高于对照组(P<0.05).结论 糖尿病高危孕妇发生甲状腺功能异常和甲状腺自身抗体疾病的风险明显高于健康孕妇,因此,在妊娠期对孕妇进行甲状腺功能的检测具有重要意义,值得临床推广应用.     

妊娠期糖尿病筛查及其相关因素

目的　为了解孕妇妊娠期糖尿病的发生情况 ,以及妊娠期糖尿病相关高危因素与无高危因素者葡萄糖耐量试验异常之关系。方法　对孕 2 4～ 2 8周孕妇口服 5 0g葡萄糖行糖筛查 ,血糖≥ 7 8mmol/L者行葡萄糖耐量 (OGTT)试验以明确诊断。结果　妊娠期糖尿病 (GDM)发生率 1 1 8%。妊娠期糖耐量减低 (GIGT)发生率2 86 % ,妊娠期糖尿病相关高危因素中的不良孕产史、DM家族史、孕前肥胖或孕期体重增长过快者与无高危因素者的葡萄糖耐量试验异常之间差异显著 (P <0 0 1 )。结论　对妊娠期所有孕妇行 5 0g糖筛查可减少妊娠期糖尿病的漏诊 ,妊娠期糖耐量减低也应积极治疗 ,伴有高危因素的孕妇应重点监测     

孕早和中期唐氏筛查血清标志物与妊娠期糖尿病的关系研究

目的 探究孕早和中期唐氏筛查血清标志物与妊娠期糖尿病的相关性.方法 选取2015年3月至2020年3月本院产科孕妇400例,根据孕妇是否存在糖尿病分为比对组(n=291)与探究组(n=109),比对组为健康孕妇,探究组为妊娠期糖尿病孕妇.对所有孕妇在孕早期与孕中期实施唐氏筛查,在妊娠24～28周实施口服糖尿量试验,分析唐氏筛查相关血清标志物与妊娠期糖尿病关联性.结果 探究组孕早期妊娠相关蛋白A指标中位数倍数低于比对组(P<0.05);两组孕早期人绒毛膜促性腺激素、孕中期甲胎蛋白、孕中期游离雌三醇与孕中期人绒毛膜促性腺激素中位数倍数比较差异无统计学意义.Logistics单因素分析结果显示,两组孕早期体重指数是否>24 kg/m2、孕早期妊娠相关蛋白A中位数倍数是否<0.8、孕中期甲胎蛋白中位数倍数是否>1、孕中期人绒毛膜促性腺激素中位数倍数是否>1.5比较差异有统计学意义(P<0.05).两组孕早期人绒毛膜促性腺激素中位数倍数是否>1.5、孕中期游离雌三醇是否>1比较差异无统计学意义.Logistics多因素分析结果显示,孕早期是否体重指数>24 kg/m2、孕早期妊娠相关蛋白A中位数倍数<0.8、孕中期甲胎蛋白中位数倍数<1、孕中期人绒毛膜促性腺激素中位数倍数>1.5与妊娠期糖尿病的形成密切相关.结论 孕早期体重指数、孕早期妊娠相关蛋白A、孕中期甲胎蛋白、孕中期人绒毛膜促性腺激素水平与妊娠期糖尿病密切相关,临床医护人员应给予重视.     

妊娠期超声骨密度异常变化及其影响因素探讨

目的探讨妊娠期超声骨密度异常的影响因素。方法选择孕晚期骨密度异常孕妇79例为研究组,选择同期孕晚期骨密度正常孕妇149例为对照组,采用超声跟骨骨密度仪测定孕妇骨密度,采用logistic回归分析影响骨密度异常的相关因素。结果两组孕妇年龄、身高、孕早期体重、收缩压、舒张压、平均动脉压及妊娠期糖尿病发生比例、孕周、孕次、产次比较差异均无统计学意义（均P＞0.05）,但两组孕妇孕早期BMI、孕期日活动时间、是否补充钙和维生素制剂比较差异均有统计学意义（均P＜0.05）。多因素logistic回归分析显示,孕早期BMI较低人群发生骨密度异常的风险为BMI正常人群的2.323倍,P=0.041;日活动时间＜15min人群发生骨密度异常的风险为日活动时间15~60min人群的2.780倍,P=0.020;孕次≥2次人群发生骨密度异常的风险为1次者的2.221倍,P=0.014;同时补充钙和维生素能降低骨密度异常的发生率（OR=0.411,P=0.004）。结论低BMI、日活动时间过少、孕次多以及未补充钙和维生素是骨密度异常的风险因素。     

妊娠早期进行糖脂代谢指标监测对妊娠期糖尿病的临床预测价值

目的 探索妊娠期糖尿病发生的危险因素,分析孕早期血糖血脂及联合检查对妊娠期糖尿病发生的预测价值。方法 将2021年1月-2022年1月期间接受产检的孕妇275例作为研究对象,孕早期(妊娠11～13周)进行了空腹血糖(FPG)和三酰甘油(TG)等相关指标的检查及资料收集,孕24～28周产检时进行口服葡萄糖耐量试验(OGTT),根据测试结果诊断妊娠期糖尿病。其中妊娠期糖尿病孕妇51例作为观察组,其余224例作为对照组。采用多因素Logistic回归分析分析妊娠期糖尿病的危险因素,绘制受试者工作特征(ROC)曲线分析孕早期TG、FPG及联合检查对妊娠期糖尿病预测价值。结果 单因素分析发现两组年龄、孕次、初次分娩、有糖尿病家族史、孕早期BMI、孕早期FPG、孕早期TG、孕期体重增加量、孕早期收缩压、孕早期舒张压、孕早期血红蛋白差异均有统计学意义(P<0.05)。Logistic回归分析结果发现年龄≥35岁、孕早期BMI、孕早期FPG、孕早期TG为妊娠期糖尿病发生的独立危险因素。ROC曲线结果孕早期FPG、TG及联合检测曲线下面积分别为0.695、0.680及0.710。结论 年龄≥35岁...     

妊娠期糖尿病筛查的临床观察(附594例分析)

为了解我院门诊孕妇妊娠期糖尿病的发生情况，以及妊娠期糖尿病相关高危因素与无高危因素者葡萄糖耐量试验异常之关系，对孕24－27^ 6周孕妇晨起空腹口服50g葡萄糖行糖筛查，血糖≥7.8mmol/L者做葡萄糖耐量试验（OGTT）以明确诊断。结果：妊娠期糖尿病发生率1．18％，妊娠期糖耐量减低（GIGT）发生率2．86％，妊娠期糖尿病相关高危因素中的异常分娩史、糖尿病家族史、孕前肥胖或孕期体重增长过快与无高危因素者葡萄糖耐量试验异常之间差异显著（P＜0．01）。提示：对妊娠期所有孕妇行50g糖筛查可减少妊娠期糖尿的漏诊，妊娠期糖耐量减低也应积极治疗，伴有高危因素的孕妇应重点监测。     

妊娠早期血脂水平与妊娠期糖尿病关系研究

目的 探讨妊娠早期血脂水平与妊娠期糖尿病(gestational diabetes mellitus,GDM)发生的关系。方法 选取2018年4~10月期间在首都医科大学附属北京妇产医院入组中国出生人口队列课题的建档并规律产检及分娩的390例孕妇作为研究对象。GDM患者为病例组(n=64),血糖正常者为对照组(n=326)。检测两组孕早期血清总胆固醇(CHO)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C) 的水平,比较两组孕早期血脂水平之间的差异,分析妊娠早期血脂水平与妊娠期糖尿病的关系。结果 与健康对照组孕妇比较,妊娠期糖尿病孕妇孕早期CHO、TG、LDL-C的水平均更高(P＜0.05)。与健康对照组孕妇比较,妊娠期糖尿病孕妇其HDL-C的水平更低(P＜0.05)。Logistic 回归分析的结果显示,CHO的水平较高是导致孕妇罹患妊娠期糖尿病的危险因素(OR=0.575,95%CI:0.358～0.923,P＜0.05);HDL-C的水平较低是导致孕妇罹患妊娠期糖尿病的危险因素(OR=6.765,95%CI:2.078～22.020,P＜0.05)。结论 妊娠早期血脂相关指标异常与妊娠糖尿病的发病有相关性,妊娠期糖尿病孕妇在妊娠早期CHO、TG、LDL-C水平升高,HDL-C水平降低,临床应加强对妊娠早期血脂的监测和干预。     

妊娠期糖尿病筛查及相关因素分析

目的妊娠期糖尿病对母儿危害较大,我国糖尿病的发生率为1％-5％,近年有明显增高的趋势。早期诊断及治疗母儿预后很重要。因此,笔者通过回顾分析探讨妊娠期糖尿病的发生情况,以及妊娠期糖尿病相关高危因素与无高危因素者葡萄糖耐量试验异常的关系。方法对24—28周孕妇口服50g葡萄糖行糖筛查,血糖≥7．8mmol／L者行葡萄糖耐量（OGTF）试验以明确诊断。结果妊娠期糖尿病（GDM）发生率1．26％。妊娠期糖耐量异常（GTGT）发生率2．95％,妊娠期糖尿病相关高危因素中的不良孕产史,DM家族史、孕前肥胖或孕期体重增长过快者与无高危因素者的葡萄糖耐量试验异常之间差异有统计学意义（P〈0．01）。结论对妊娠期所有孕妇行糖筛查可以减少妊娠期糖尿病的漏诊,妊娠期糖耐量减低也应积极治疗,伴有高危因素的孕妇应重点监测。     

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.