HBV携带孕妇与正常孕妇雌激素水平及妊娠结局的对比性研究

目的　探讨HBV携带孕妇与正常孕妇雌激素水平及妊娠结局的差异,为临床HBV携带孕妇正常妊娠提供参考依据。方法　选取2015年1月—2018年1月本院收治的226例孕妇作为研究对象,将其中116例正常孕妇作为对照组,其余110例HBV携带孕妇作为观察组,检测2组体内雌激素水平,并分析对妊娠结局产生的影响。结果　观察组雌酮、雌二醇、雌三醇水平均显著高于对照组（P均＜0.05）。观察组胎儿窘迫、新生儿窒息、剖宫产及早产等妊娠结局的发生率均显著高于对照组,顺产率显著低于对照组（P均＜0.05）。观察组蛋白尿、尿WBC阳性、妊娠期高血压及产后出血等并发症的发生率均显著高于对照组（P均＜0.05）。Logistic多元回归分析结果显示,雌激素水平高、年龄大、携带HBV时间长、有既往治疗史、病毒载量高、ALT水平高均为妊娠不良结局的危险因素（P均＜0.05）。结论　HBV携带孕妇机体分泌的雌激素水平显著升高,进一步增加肝脏的负荷,导致肝功能出现明显异常,增加了妊娠不良结局及妊娠并发症的发生率,临床应加强对HBV携带孕妇相关指标检测,并做好相关并发症的预防。     

妊娠晚期生殖道感染检测分析及对妊娠结局的影响

目的分析妊娠晚期生殖道微生物感染状况及其对妊娠结局的影响,为临床防治提供理论依据。方法选取2015年3月—2019年3月我院收治的286例妊娠晚期妇女为研究对象,入组孕妇均进行生殖道病原微生物感染的检测,分析生殖道微生物感染状况,并观察妊娠晚期生殖道感染对妊娠结局的影响。结果入组286例妊娠晚期妇女,52例(18.18%)出现生殖道病原微生物感染,其中2.10%(6/286)为滴虫感染,11.89%(34/286)为解脲支原体感染,1.40%(4/286)为沙眼衣原体感染,6.64%(19/286)为假丝酵母菌感染,共11例合并有2种或2种以上微生物感染,占3.85%;此外,妊娠晚期生殖道存在微生物感染者早产、胎膜早破、产褥期感染、胎儿窘迫、新生儿窒息和新生儿感染等不良妊娠结局发生率均明显高于无微生物感染者(P均<0.05);多重微生物感染者早产发生率明显高于单一微生物感染者(P<0.05);治愈组不良妊娠结局发生率明显低于无效组(P<0.05)。结论妊娠晚期生殖道微生物感染以解脲支原体、假丝酵母菌较为常见,且妊娠晚期生殖道微生物感染会增加孕妇不良妊娠结局发生风险,多重微生物感染会增加妊娠妇女的早产发生率,临床上可据此为妊娠期妇女制定合理的防治方案,对确保母婴良好结局有重要临床意义。     

妊娠期糖尿病与妊娠期高血压疾病与孕妇体重变化情况和妊娠结局相关性分析

目的探索妊娠期糖尿病与妊娠期高血压疾病与孕妇体重变化情况和妊娠结局相关性研究。方法收集2012年5月—2018年5月在该院做妊娠期检查和分娩的孕产妇1 560例。分为正常妊娠组(1 048例)、HDCP组(250例)、GDM组(216例)、HDCP合并GDM组(46例),比较各组孕妇12、30周的体重变化和妊娠结局。结果 4组孕妇12、30周的体重比较差异有统计学意义。HDCP合并GDM组、HDCP组、GDM组的体重分别都显著高于正常妊娠组(P0.05)。HDCP合并GDM组均显著高于HDCP组、GDM组(P0.05);4组孕妇的胎膜早破、早产、产后出血、新生儿黄疸发生率比较均差异有统计学意义(P0.05)。HDCP合并GDM组、HDCP组、GDM组的不良妊娠结局发生率分别都显著高于正常妊娠组(P0.05)。HDCP合并GDM组均显著高于HDCP组、GDM组(P0.05)。结论孕早期体重增加、孕期体重过多增长的人群易发生GDM和HDCP。GDM组和HDCP组增加了孕产妇和婴儿的不良妊娠结局的风险,所以加强对高危人群合理干预,可以降低并发症的发生率,改善孕产妇健康状况。     

50例妊娠合并糖尿病孕妇的妊娠期管理分析

目的分析妊娠合并糖尿病孕妇的妊娠期管理方法。方法选取该院2013年8月—2014年7月间收治的50例妊娠合并糖尿病孕妇为研究对象(观察组);以同期该院收治的50例正常孕妇作为对照(对照组)。比较两组孕妇的并发症发生率和新生儿病率,分析和总结妊娠合并糖尿病孕妇的妊娠期管理方法。结果两组孕产妇的妊娠期高血压疾病发生率、羊水过多发生率、感染率、胎膜早破发生率、胎儿窘迫率和产后出血率比较差异无统计学意义(P0.05),观察组的早产率和剖宫产率高于对照组,比较差异有统计学意义(P0.05)。两组孕产妇新生儿巨大儿发生率、胎儿生长受限(FGR)发生率、窒息率和高胆红素血症发生率比较差异无统计学意义(P0.05)。结论对妊娠合并糖尿病孕妇加强妊娠期管理,同时给予对症治疗并适时终止妊娠可降低并发症发生率,保障母婴安全。     

妊娠合并糖尿病对妊娠结局的影响评估

目的探讨妊娠合并糖尿病对妊娠结局的影响。方法选取该院2013年5月—2014年5月接收的397例妊娠合并糖尿病患者作为研究对象,将其作为观察组,另选取来该院检查的100例未合并糖尿病者为对照组,对比两组母婴结局情况。结果对照组患者FPG与HbAlc水平明显优于观察组;对照组妊娠期高血压、巨大儿、羊水过多、酮症酸中毒、早产、新生儿呼吸窘迫综合征、新生儿低血糖以及感染等并发症发生率以6.0%明显低于观察组的3 1.7%;观察组治疗不满意组母婴并发症发生率以38.7%明显高于治疗满意组的16.2%(P0.05)。结论妊娠合并糖尿病者母婴并发症发生率明显高于非合并糖尿病者,而给予前者相应治疗后的效果显著,值得推广。     

肝生化指标异常对慢性乙型肝炎病毒感染孕妇胎儿卵泡刺激素的关系

目的分析肝生化指标异常对慢性乙型肝炎病毒(HBV)感染孕妇胎儿卵泡刺激素(FSH)的影响。方法将2012年1月至2016年10月期间在我院产检的103例妊娠伴有慢性HBV感染的孕妇作为研究对象,其中肝生化指标异常组32例(31.07%)为观察组,71例肝生化指标正常者为对照组。观察并对比两组孕妇血清丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)水平、凝血酶原时间(PT)、新生儿脐血FSH水平、孕妇妊娠期间并发症及不良妊娠结局。结果观察组孕妇血清ALT和AST水平以及PT值均高于对照组(均P0.05)。观察组孕妇分娩的新生儿脐血FSH水平高于对照组孕妇分娩的新生儿(P0.05)。观察组孕妇妊娠期高血压和产后出血比例均高于对照组(均P0.05);观察组出现不良妊娠结局早产、宫内发育迟缓(IUGR)和新生儿窒息比例均高于对照组(均P0.05)。两组均无死胎或新生儿出生后死亡病例。结论肝生化指标异常的慢性HBV感染孕妇胎儿脐血FSH水平高于肝生化指标正常孕妇分娩新生儿,慢性HBV感染并肝生化指标异常可增加孕妇不良妊娠结局。     

ALT异常对HBsAg阳性孕妇妊娠过程与结局的影响

目的探讨孕期异常的ALT对HBsAg阳性的孕妇妊娠并发症及妊娠结局的影响。方法将327例HB-sAg阳性孕妇根据孕期ALT水平分为ALT正常组（n=251）和ALT异常组（n=76）,比较两组的妊娠期并发症和最终的妊娠结局。结果与ALT正常组比较,ALT异常组早产、胎儿窘迫和产后出血发生率明显升高（P均〈0.05）;ALT异常组低体重儿发生率高于ALT正常组（P〈0.05）;ALT异常组所分娩新生儿体质量、胎龄、出生后1 min Ap-gar评分均低于ALT正常组（P均〈0.01）。结论 HBsAg阳性的孕妇若妊娠期出现ALT异常,更易增加妊娠期并发症并影响妊娠结局。     

妊娠合并甲状腺功能减退症经激素替代治疗的妊娠结局研究

目的研究激素替代治疗妊娠合并甲状腺功能减退症(甲减)对妊娠结局的影响。方法回顾分析我院妇产科于2013年1月-2015年6月期间收治的妊娠合并甲减患者165例,其中,89例亚临床甲减为SCHO组,76例临床甲减为OH组,均接受规范性甲状腺激素替代治疗,并选择同期健康妊娠孕妇100例作为对照组。比较三组的妊娠结局。结果OH组的胎膜早破率为21.05%,高于对照组的9.00%(P0.05),但与SCHO组的13.48%比较差异无统计学意义(P0.05);OH组的剖宫产率为77.63%,高于SCHO组的52.81%和对照组的50.00%(P0.05);三组妊娠期糖尿病、妊娠期高血压、羊水过少、产后出血发生率比较差异无统计学意义(P0.05)。三组的早产率、新生儿窒息及低出生体重儿发生率比较均无统计学意义(P0.05)。结论规范性激素替代治疗妊娠合并甲减能够有效维持或改善甲状腺功能,减少甲状腺自身抗体对于妊娠结局所致不良影响,争取与健康妊娠孕妇相当的妊娠结局。     

妊娠期肝内胆汁淤积症对乙型肝炎病毒感染孕妇的影响

目的探讨乙型肝炎病毒(HBV)感染合并妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)孕妇的妊娠结局,了解ICP对HBV感染孕妇相关并发症的影响。方法选取2013年1月至2015年7月首都医科大学附属北京地坛医院收治的88例肝功能正常(ALT和AST正常)HBV感染合并ICP的孕妇为研究组,选取同期住院治疗的1206例肝功正常HBV感染孕妇为对照组。回顾性分析两组孕妇孕期合并妊娠期糖尿病的发生率、早产率、胎儿窘迫率、剖宫产率和产后出血率等并发症的发生情况。结果研究组孕妇的早产率为14.80%、剖宫产率为68.18%、产后出血率为7.95%;体外受精-胚胎移植(IVF-ET)的构成比以及双胎的发生率与对照组比较,差异有统计学意义(P值分别为0.004、0.000),早产儿出生体重显著低于对照组。两组妊娠期糖尿病的发生率、胎儿窘迫率差异无统计学意义(P值分别为0.460、0.891)。结论 HBV感染合并ICP易发生早产及产后出血、增加手术产机会和早产儿出生体重降低等情况。     

探讨妊娠期糖代谢异常经过及时诊断和规范处理对母儿预后的影响

目的研究妊娠期糖尿病和糖尿病合并妊娠患者在经过及时诊断处理后,其对母儿结局的影响。方法收集2013年1月—2014年1月期间,在该院诊断并分娩的糖代谢异常妊娠孕妇200例的临床资料,其中包括188例妊娠期糖尿病,12例糖尿病合并妊娠,将这200例孕妇作为研究组。选择同期收治的糖代谢正常的孕妇260名为对照组。对研究组孕妇行临床血糖的控制与处理。结果妊娠期糖尿病组巨大儿发生率为12.70%、妊高征发生率为14.70%,明显高于对照组的7.69%、7.69%,差别有统计学意义（P〈0.05）。糖尿病合并妊娠组孕妇各种并发症的发生率与对照组比较差别无统计学意义（P〉0.05）。结论经过及时诊断和规范处理,妊娠期糖尿病组巨大儿、妊高征发生率仍高于糖代谢正常孕妇;糖尿病合并妊娠孕妇及围生儿结局明显改善。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.