孕11～14周妊娠相关蛋白A联合子宫动脉搏动指数预测早发型子痫前期的研究

【】目的：探讨孕11-14周妊娠相关蛋白A(PAPP-A)联合子宫动脉搏动指数(PI)预测早发型子痫前期的价值。方法：选择2012年3月至2014年3月孕11-14周时在我院产科门诊建卡产检并于我院分娩的单胎妊娠孕妇176例作为观察组,根据妊娠结局分为正常妊娠和子痫前期,对比正常妊娠孕妇和子痫前期孕妇妊娠相关蛋白A及子宫动脉搏动指数。另选择同期孕8-10周在我院建卡产检并分娩的单胎妊娠孕妇144例作为对照组,分别计算两组孕妇血清PAPP-A联合子宫动脉PI预测子痫前期时的特异度及敏感度。结果：观察组子痫前期发生率为5.95%与对照组的4.35%无统计学差异(P>0.05);观察组和对照组中子痫前期孕妇PAPP-A水平均显著低于正常孕妇(P<0.05);观察组和对照组中子痫前期孕妇子宫动脉(PI)均显著高于于正常孕妇(P<0.05);PAPP-A联合子宫动脉PI检测时,对观察组孕妇的敏感度为85.34%,特异度为81.22%,对对照组孕妇的敏感度为80.64%。特异度为68.18%。结论：子痫前期发病前在孕8-10周、孕11-14周时孕妇血清PAPP-A及子宫动脉PI均有显著变化,但血清PAPP-A联合子宫动脉PI预测子痫前期在孕11-14周具有更高的敏感度和特异度,具有更高的预测价值。     

子宫螺旋动脉的搏动指数与阻力指数对子痫前期的预测价值

目的：探讨彩色多普勒超声检测孕妇子宫螺旋动脉的搏动指数（PI）与阻力指数（RI）对早期子痫前期的预测价值。方法选择120例在我院建卡产检并分娩的孕妇,孕期采用彩色多普勒超声检测子宫螺旋动脉平均搏动指数、阻力指数。根据妊娠经过分为正常组、轻度子痫前期组、重度子痫前期组,分析三组患者子宫螺旋动脉血流动力学的差异。结果孕14～18周、19～23周、24～28周时轻度子痫前期组、重度子痫前期组孕妇子宫螺旋动脉PI、RI值均较正常组升高,差异有统计学意义;重度子痫前期组孕妇升高更为明显,与轻度子痫前期组比,各时段RI比较差异均有统计学意义,19～23周时PI比较差异有统计学意义,另外两时段PI比较差异无统计学意义。结论妊娠早期通过多次检测子宫螺旋动脉的PI、RI 指数能够较准确地预测子痫前期的发生及程度,有利于早期干预治疗,改善预后。     

早孕期联合PP13、PAPP-A、UtA-PI和3D-PDU胎盘血流参数对子痫前期的预防效果

目的分析早孕期联合检测PP13(胎盘蛋白13)、PAPP-A(妊娠相关血浆蛋白A)、Ut A-PI(彩色多普勒子宫动脉搏动指数)和3D-PDU胎盘血流参数对子痫前期(PE)的预防效果。方法选取在早孕期进行唐氏血清筛查和NT超声检查并计划在本院分娩的60孕妇作为研究组(轻度PE、重度PE各30例),另选取60例早孕期健康孕妇作为对照组,检测研究对象血清PP13和PAPP-A浓度,彩色多普勒测量Ut A-PI和三维能量多普勒测量胎盘血流参数,对数据进行统计分析。结果研究组血清PP13、PAPP-A浓度、Ut A-PI均较对照组低,差异有统计学意义(P0.05)。研究组3D-PDU胎盘血流参数VI、FI、VFI均较对照组低,差异有统计学意义(P0.05)。Logistic回归分析结果显示,PP13、PAPP-A表达异常以及Ut A-PI、3D-PDU胎盘血流参数异常改变均与PE的发生存在相关性(P0.05)。结论早孕期检测PP13、PAPP-A、Ut A-PI和3D-PDU胎盘血流参数,可用于评估孕妇发生PE的风险,指导PE预防方案的制定。     

联合检测妊娠早中期孕妇血清PAPP-A、PLGF及子宫动脉血流参数预测子痫前期的临床意义

目的 探讨联合检测妊娠早中期孕妇血清妊娠相关血浆蛋白A(PAPP-A)、胎盘生长因子(PLGF)及子宫动脉血流参数预测子痫前期的临床意义.方法 选取2017年4月—2019年4月于本院行产前检查的孕16周内孕妇180例为研究对象,行PAPP-A、PLGF及超声子宫动脉血流参数[搏动指数(PI)、血流阻力指数(RI)、收...     

正常妊娠孕妇和子痫前期患者妊娠中晚期血清和胎盘中妊娠相关蛋白浓度变化的研究

目的:通过检测正常妊娠孕妇及子痫前期患者血清和胎盘组织中妊娠相关血浆蛋白A(PAPP-A)、妊娠特异性β1糖蛋白(SP1)、人胎盘催乳素(HPL)和胎盘生长因子(PLGF)的浓度,探讨PAPP-A、SP1、HPL和PLGF与子痫前期的关系。方法:选取22例不同孕期健康孕妇(对照组)及23例进行性子痫前期患者(子痫前期组),分别在妊娠17周,25周,33周和37周抽血,采用酶联免疫吸附试验(ELISA)法检测患者血清PAPP-A、SP1、HPL和PLGF浓度,并在妊娠≥37周后产时收集胎盘组织,-80℃保存,经处理后采用特殊酶联免疫吸附试验(ELISA)法检测胎盘组织中PAPP-A、SP1、HPL和PLGF浓度。实验结果应用SPSS 11.0统计软件包进行方差分析。结果:子痫前期组血清中PAPP-A、SP1、HPL和PLGF浓度在第17周时比对照组低,第25周、33周和37周时只有PLGF浓度低于对照组(P<0.05),血清PAPP-A浓度明显高于对照组(P<0.05)。胎盘组织中PAPP-A浓度明显高于对照组(P<0.05),而PLGF、HPL和SP1浓度与对照组相比没有显著差异。结论:在妊娠中期初始(17周),子痫前期患者血清中PAPP-A、SP1、HPL浓度明显低于正常妊娠妇女,提示胎盘存在一定的病理改变;胎盘在子痫前期患者血清中妊娠相关蛋白浓度变化中起了部分的代偿作用,血清中PAPP-A及PLGF的浓度变化可作为诊断子痫前期的参考指标。     

胎盘蛋白13、妊娠相关血浆蛋白-A和胎盘生长因子预测子痫前期的价值

目的 评估孕早期血清标记物胎盘蛋白13 (PP13)、妊娠相关血浆蛋白-A (PAPP-A)、胎盘生长因子(PLGF)的表达对预测子痫前期(PE)的临床价值.方法 前瞻性选择689例单胎孕妇,将其分为未发生妊娠期高血压疾病者620例(对照组)及子痫前期12例(PE组),包括迟发型子痫前期11例,早发型子痫前期1例.孕11～13+6周时检测两组孕妇血清中PP13、PLGF、PAPP-A的水平.结果 对照组血清中PP13、PAPP-A、PLGF的浓度分别为(92.6±33.07) pg/mL、(51.76-±-6.42)ng/mL、(0.176±0.08) ng/mL,PE组血清中PP13、PAPP-A、PLGF的浓度分别为(85.38±31.7) pg/mL、(23.07±4.44) ng/mL、(0.052±0.032) ng/mL.PE组血清PP13浓度与对照组比较,差异无统计学意义(P＜0.05);而PE组PAPP-A、PLGF明显低于对照组,差异有统计学意义(P＜0.05).在单项标志物预测子痫前期的筛查中,PAPP-A的敏感度为65.71％,特异度为47.84％;PLGF的敏感度为68.19％,特异度为47.10％;两种标志物联合对PE的筛查敏感度为69.38％,特异度为50.26％.结论 孕早期母体血清PAPP-A、PLGF可作为预测子痫前期发病的指标,联合这两种指标能使诊断效能提高.目前不能认为孕早期母体血清PP13可应用于迟发型子痫前期的预测.     

子痫前期子宫螺旋动脉血流与孕妇血清血管内皮生长因子表达相关研究

目的应用彩色多普勒超声技术检测子宫螺旋动脉,与孕妇血清血管内皮生长因子(VEGF)检测相结合,分析子痫前期子宫螺旋动脉血流动力学参数改变和其病情严重程度的关系。方法对30例子痫前期孕妇及38名健康孕妇,在未经任何药物治疗前,应用彩色多普勒超声技术检测子宫螺旋动脉,并对结果进行记录和比较。用酶联免疫吸附试验(ELISA)法测定血清VEGF含量。结果①子宫螺旋动脉血流动力学参数子痫前期组较对照组搏动指数(PI)值、阻力指数(RI)值、收缩期峰值流速与舒张末期血流速度之比值(S/D)增高,差异有统计学意义(P<0.01)。子痫前期重度组与轻度组比较各血流动力学参数值均增高,差异有统计学意义(P<0.01)。②血清VEGF含量子痫前期组较对照组降低,差异有统计学意义(P<0.01),子痫前期重度组低于轻度组,差异有统计学意义(P<0.01)。③子痫前期血清VEGF水平分别与子宫螺旋动脉血流动力学参数PI(r=-0.79,P<0.01)、RI(r=-0.78,P<0.01)、S/D(r=-0.83,P<0.01)呈显著负相关。结论①彩色多普勒超声技术检测子宫螺旋动脉血流可以预测子痫前期严重程度。②子痫前期孕妇血清VEGF表达与子宫螺旋动脉血流动力学参数之间呈显著负相关。     

子痫前期孕产妇子宫动脉参数的变化对临床的价值

目的:运用超声多普勒测量子宫动脉血流动力学参数,来探究子痫前期对其参数的影响以及对临床的价值.方法:选取2019-01 ～2020-01在佳木斯大学附属第一医院进行超声产前检查并确诊为子痫前期的孕妇51例,选取同一时期来我院进行产前检查并经随访得知孕晚期至产后无子痫前期及其他妊娠并发症的孕妇30例作为对照组.应用超声多普勒分别测量各组孕妇的子宫动脉血流动力学参数包括阻力指数(RI)、搏动指数(PI)和S/D值.结果:子痫前期组子宫动脉的RI、PI、S/D值高于对照组,差异有统计学意义.故子宫动脉的RI、PI、S/D可以作为预测子痫前期的血流动力学参数,并且有统计学意义(P＜0.05).结论:患有子痫前期的孕妇子宫动脉血流动力学参数发生变化,通过测量孕妇子宫动脉多普勒血流参数并分析其变化,可以提前预测子痫前期及病情的严重程度,以便提供更多的临床价值.     

子痫前期子宫螺旋动脉血流与孕妇血清胎盘生长因子表达的相关研究

目的观察子宫螺旋动脉血流动力学参数与孕妇血清中胎盘生长因子(PLGF)含量,两者结合分析子痫前期的严重程度。方法对30例初诊子痫前期孕妇及154名健康孕妇,通过彩色多普勒超声技术(CDFI)检测子宫螺旋动脉血流动力学参数:搏动指数(PI)值、阻力指数(RI)值、收缩期峰值流速与舒张末期血流速度之比值(S/D)。使用酶联免疫吸附试验(ELISA)法测定孕妇血清中PLGF的含量。结果(1)子痫前期组的PI值、RI值、S/D值较对照组有所增高,差异有统计学意义(P0.01)。子痫前期重度组较轻度组的值增高,差异有统计学意义(P0.001)。(2)子痫前期组的血清PLGF含量较对照组降低,差异有统计学意义(P0.001),子痫前期重度组低于轻度组,差异有统计学意义(P0.001)。(3)子痫前期血清PLGF分别与PI(r=-0.55,P0.05)、RI(r=-0.58,P0.05)、S/D(r=-0.62,P0.05),呈显著负相关。结论 (1)彩色多普勒超声技术检测子宫螺旋动脉血流、孕妇血清PLGF含量都与子痫前期严重程度相关。(2)子宫螺旋动脉血流动力学参数与子痫前期孕妇血清PLGF表达之间呈显著负相关。     

孕妇血清中妊娠相关蛋白-A同型半胱氨酸超敏C反应蛋白和补体C1q水平联合检测在预测子痫前期中的价值

目的评价联合检测妊娠相关蛋白A (PAPP-A)、同型半胱氨酸(HCY)、超敏C反应蛋白(hsCRP)和补体C1q(C1q)水平在子痫前期孕妇患者中的早期诊断价值。方法采用前瞻性的研究方法 ,选取2013年4月至2015年2月在山西医科大学第一医院门诊行常规产前检查并在我院分娩的孕妇共117例,根据随访结果将其分为健康对照组、重度子痫前期组和慢性高血压合并子痫前期组。采用酶联免疫吸附试验定量法检测血清中PAPP-A水平、酶循环法检测HCY水平、免疫比浊法检测hsCRP和C1q,对血清指标和部分妊娠结局的相关性进行分析。结果①117例孕妇中未发生妊娠期高血压疾病42例(健康对照组),重度子痫前期56例(病例A组),慢性高血压合并子痫前期19例(病例B组)。②使用SPSS 22.0软件对数据进行分析,数据不符合正态分布,采用M(QR)进行统计描述,健康对照组孕妇血清中PAPP-A值、HCY值、hsCRP值和C1q值分别是1 504(4 027)ng/ml、6.80(3.25)μmol/L、3(2.70)mg/L、194(26)mg/L;重度子痫前期组分别是1 764(4 167)ng/ml、11.70 (6.60)μmol/L、5.90 (4.24)mg/L、191 (40.50)mg/L;慢性高血压合并子痫前期组分别是1 715 (5 047)ng/ml、9.60 (8.85)μmol/L、5.98(6.43)mg/L、207(52)mg/L;健康对照组产妇血清中PAPP-A值、HCY值hsCRP值和C1q分别是11.16(22.32)ng/ml、9.60(4.45)μmol/L、1.56(2.47)mg/L和206(38.50)mg/L;病例A组产后分别是7.56(26.91)ng/ml、10.60 (6)μmol/L、1.99 (2.78)mg/L和206 (41)mg/L;病例B组产后分别是9.36 (20.52)ng/ml、9.70(5.95)μmol/L、2.75(3.01)mg/L和221(57)mg/L。③经配对计量资料比较的Wilcoxon秩和检验,健康组PAPP-A、HCY、hsCRP和C1q产前产后比较,差异有统计学意义(P<0.05);病例A组PAPP-A、HCY、hsCRP和C1q产前产后比较,差异有统计学意义(P<0.05);病例B组PAPP-A产前产后比较,差异有统计学意义(P<0.05),HCY、hsCRP和C1q产前产后比较,差异均无统计学意义(P>0.05)。④经多个独立样本两两比较的Mann-Whitney U检验,3组孕妇血清PAPP-A分别两两比较,差异均无统计学意义(P>0.05);3组孕妇血清HCY分别两两比较,健康组与病例A组、正常组与病例B组,差异均有统计学意义(P<0.05),病例A组与病例B组,差异均无统计学意义(P>0.05);3组孕妇血清hsCRP分别两两比较,健康组与病例A组、健康组与病例B组,差异均有统计学意义(P<0.05),病例A组与病例B组,差异均无统计学意义(P>0.05);3组孕妇血清C1q分别两两比较,差异均无统计学意义(P>0.05)。3组产妇血清PAPP-A、HCY、hsCRP和C1q分别两两比较,差异均无统计学意义(P>0.05)。结论PAPP-A、HCY、hsCRP和C1q对子痫前期的发病有一定的预测价值。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.