不同妊娠期骨代谢状况的研究

测定不同妊娠期孕妇血清及新生儿脐血游离钙（Ｃａ〕、骨型酸性磷酸酶（ＴＲ－ＡＣＰ）及碱性磷酸酶（ＡＬＰ），并与非妊娠妇女进行对照。结果显示：对照组、妊娠早中期组、妊娠晚期组及新生儿组游离Ｃａ分别为１．１６±０．０７、１．１３±０．０７、１．０９±０．１１、１．２５±０．０６ｍｍｏｌ／Ｌ，并随孕周增加而明显下降。新生儿组游离Ｃａ值显著高于妊娠晚期组（Ｐ＜０．０１）。提示：胎盘逆浓度主动转运游离Ｃａ，同时ＴＲ－ＡＣＰ、ＡＬＰ活性随孕周增加而升高，说明孕妇骨代谢非常活跃。     

继发性高促性腺激素性闭经妇女的骨代谢状况

目的：探讨继发性高促性腺激素性闭经妇女的骨代谢状况。方法：对１２例继发性高促性腺激素性闭经妇女，１２例同龄正常妇女及８例自然绝经妇女的空腹２小时尿钙与肌酐比值（Ｃａ／Ｃｒ）、尿羟脯氨酸与肌酐比值（ＯＨＰｒ／Ｃｒ）、血碱性磷酸酶（ＡＫＰ）、血骨钙素（ＢＧＰ）、血降钙素（ＣＴ）、血白细胞介素Ⅵ（ＩＬ－６）及血雌二醇（Ｅ２）水平进行测定与比较。结果：继发性高促性腺激素性闭经组与正常对照组相比，＜Ｅ２血ＣＴ水平显著降低（Ｐ＜００１），尿Ｃａ／Ｃｒ、尿ＯＨＰｒ／Ｃｒ比值及血ＡＫＰ、血ＢＧＰ、血ＩＬ－６水平均明显增高（Ｐ＜００１）。继发性高促性腺激素性闭经组与自然绝经组相比，尿Ｃａ／Ｃｒ比值及血ＢＧＰ水平明显低于自然绝经组（Ｐ＜００５），血Ｅ２水平，尿ＯＨＰｒ／Ｃｒ比值、血ＡＫＰ、血ＣＴ及血ＩＬ－６水平无明显统计学差异（Ｐ＞００５）。结论：继发性高促性腺激素性闭经妇女与同龄正常妇女相比，骨代谢呈高转换负钙平衡状态，此状态的出现与其ＣＴ分泌减少、ＩＬ－６产生增多有关     

过期妊娠孕妇机体过氧化与胎盘功能关系的研究

测定足月妊娠及过期妊娠红细胞超氧化物歧化酶（ＳＯＤ）和全血谷胱甘肽过氧化物酶（ＧＳＨ－Ｐｘ）活力，血清脂质过氧化物（ＬＰＯ）及血清Ｅ３，ｈＰＬ及血浆ＴＸＢ２和６－ｋｅｔｏ－ＰＧＦ１α（６ＫＰ）水平。结果显示过期妊娠者ＳＯＤ，ＧＳＨ－Ｐｘ活力明显低于正常足月妊娠，Ｐ〈０．００１，ＬＰＯ明显高于正常足月妊娠，Ｐ〈０．０５，同时Ｅ３，ｈＰＬ下降，Ｐ〈０．００１，６ＫＰ亦降低，Ｐ〈０．０５。在过期妊娠期中     

应用静脉血流阻抗图测定妊娠妇女血液动力学的变化

分析３１例健康非妊娠妇女和３２例妊娠妇女分娩前后的静脉血流阻抗图，对静脉最大排出量（ＭＶＯ）、静脉三秒回流量（ＶＯ）、静脉容量（ＶＣ）、动脉血流量（ＡＢＦ）进行了检测。结果表明：妊娠晚期和分娩后各项参数均低于健康非妊娠妇女，差异有显著意义（Ｐ＜０．０１）。分娩后较妊娠晚期各项参数均有所增加，尤以ＶＣ为著。提示：静脉血流阻抗图对早期诊断产后下肢静脉血栓形成一定价值。     

硫酸普拉酮钠用于中期妊娠引产的疗效观察

对５０例利凡诺引产的中期妊娠妇女应用硫酶普拉酮钠（硫酸去氢表雄酮，ＤＨＡＳ）促宫颈成熟（用药组），并与同期５０例单纯利凡诺引产的中期妊娠妇女（对照组）进行比较。结果表明：用药组５０例宫颈Ｂｉｓｈｏｐ评分均有升高，显效率为８６％；总有效率为９８％；与对照组比较差异有显著性（分别为Ｐ＜０．００１及Ｐ＜０．０１）；用药组平均引产时间比对照组缩短１３．４小时，差异有显著性（Ｐ＜０．０１）。     

妊高征患者外周血清及单核细胞内镁,钙含量测定

目的：探讨镁、钙代谢在妊高征病理生理变化中的作用。方法：采用原子吸收分光光度测定法（火焰原子化法），测定了２６例妊高征患者（妊高征组）产前外周血清及单核细胞内镁、钙含量，以２７例同期住院的正常晚期妊娠妇女作对照（对照组）。结果：妊高征组与对照组比较：（１）妊高征组外周血清镁、钙含量显著降低（Ｐ＜０．０１及Ｐ＜０．０５）；（２）中、重度妊高征患者外周血单核细胞内镁含量显著降低（Ｐ＜０．００１及Ｐ＜０．０１）；（３）中、重度妊高征患者外周血中单核细胞内的钙含量显著降低（Ｐ＜０．０１及Ｐ＜０．０５）。结论：镁、钙含量降低可能在妊高征病理生理变化中起重要作用。     

胎儿胰岛素样生长因子-Ⅰ的检测及意义

目的评估胰岛素样生长因子Ⅰ（ＩＧＦⅠ）在胎儿、胎盘生长发育中的作用。方法用放射免疫分析法（ＲＩＡ）测定大于胎龄儿（ＬＧＡ）组３０例,适于胎龄儿（ＡＧＡ）组３６例及小于胎龄儿（ＳＧＡ）组３６例的脐血清ＩＧＦⅠ的水平。用线性相关分析法分析各组变量之间的相关关系。结果３组胎儿脐血清ＩＧＦⅠ与胎龄、胎儿体重、胎盘重量均呈显著正相关（ｒ＝０．３２,Ｐ＜０．００１;ｒ＝０．６８,Ｐ＜０．００１;ｒ＝０．７５,Ｐ＜０．０１）,其中与胎盘重量呈高度正相关。脐血清ＩＧＦⅠ水平,ＡＧＡ组为１４４５９±４６．７３μｇ／Ｌ;ＳＧＡ组为９０．８０μｇ／Ｌ（ｔ＝４．７,Ｐ＜０．００１）,ＬＧＡ组为２０９１７μｇ／Ｌ（ｔ＝７．９７,Ｐ＜０．００１）。结论ＩＧＦⅠ是胎儿、胎盘生长发育的重要调节因子,对巨大儿、小于胎龄儿的形成有重要作用。     

花生四烯酸的代谢产物在兔羊水栓塞中的作用

目的：研究不同性质的羊水注入兔血循环后血中花生四烯酸的代谢产物血栓素Ａ２（ＴＸＡ２）、前列环素Ｉ２（ＰＧＩ２）和白三烯Ｃ４（ＬＴＣ４）的变化。方法：新西兰孕兔２９只,随机分为４组：兔原羊水、胎粪液、胎盘组织提取液和生理盐水,分别在注入前、注入后５ｍｉｎ,、４５ｍｉｎ从兔耳动脉抽血２ｍｌ,用放射免疫分析（ＲＩＡ）检测血中ＴＸＡ２和ＰＧＩ２的代谢物６－酮前列腺素（６－Ｋｅｔｏ－ＰＧＦ１α）和血栓素Ｂ２（ＴＸＢ２）,用酶联免疫法（ＥＩＡ）检测ＬＴＣ４。结果：注入胎粪液、胎盘组织提取液后６－Ｋｅｔｏ－ＰＧＦ１α明显增加（Ｐ＜０．０１）,兔原羊水组轻度增加,但差异无显著性（Ｐ＞０．０５）;生理盐水组无明显变化（Ｐ＞０．０５）;除生理盐水组外,其余各组的ＴＸＢ２和ＬＴＣ４在注入后增加显著（Ｐ＜０．０１）;ＴＸＢ２、６－Ｋｅｔｏ－ＰＧＦ１α和ＬＴＣ４的组间对比以胎盘组织提取液组增加显著（Ｐ＜０．０１）。结论：羊水进入兔血循环能刺激机体产生ＴＸＡ２、ＬＴＣ４和ＰＧＩ２等花生四烯酸的代谢产物,在羊水栓塞的发生、发展过程中起重要作用。     

消炎痛Vcu200 IUD减少月经过多的机理

自１９９２年１１月至１９９５年６月，对４６例放置无消炎痛ＶＣｕ２００ＩＵＤ及２４例含消炎痛ＶＣｕ２００ＩＵＤ妇女的子宫内膜中６－ｋｅｔｏ－ＰＧＦ１α、ＴＸＢ２及纤溶指标包括ｔ－ＰＡ、ＰＡＩ、ＰＫ、ＰＬＧ、Ｄ－Ｄ及ＦＤＰ的水平进行测定，同时作光、电镜观察置器后ＩＵＤ对子宫内膜的影响。结果：１．无消炎痛ＶＣｕＩＵＤ３月组置器后６－ｋｅｔｏ－ＰＧＦ１α／ＴＸＢ２比值明显高于置器前（Ｐ＜０．０５），ｔ－ＰＡ、ＰＫ、ＰＬＧ、Ｄ－Ｄ及ＦＤＰ均非常明显低于置器前水平（Ｐ＜０．ｏ１～０．００１）。２．无消炎痛ＶＣｕＩＵＤ＞６月组置器后只ｔ－ＰＡ、ＰＫ、ＦＤＰ明显低于置器前水平（Ｐ＜０．０１～０．００１），其余指标均无统计学差异。３．放置合消炎痛ＶＣｕＩＵＤ３个月后６－ｋｅｔｏ－ＰＧＦ１α、ＴＸＢ２及各项纤溶指标与置器前比均无统计学意义。４．子宫内膜形态学变化与置器前相比，表现为血管内血栓形成减少及末梢小血管腔扩大。根据上述结果，置器后内膜中６－ｋｅｔｏ－ＰＧＦ１α／ＴＸＢ２值升高，与ｔ－ＰＡ水平下降可能是置器后月经过多的主要原因，尤以前者起主导作用。本文并对消炎痛ＩＵＤ减少月经过多的作用机理进行了讨论。     

妊娠高血压综合征患者血浆内皮素降钙素基因相关肽的测定

目的探讨内皮素、降钙素基因相关肽在妊娠高血压综合征发病中的作用。方法应用放射免疫分析法对５８例ＰＩＨ患者、５０例晚期妊娠妇女和５２例对照组血浆ＥＴ、ＣＧＲＰ含量进行测定。结果妊娠组ＥＴ水平较对照组升高（Ｐ＜００５）；ＰＩＨ组ＥＴ水平较妊娠组增高显著（Ｐ＜００１），轻、中、重度ＰＩＨ患者各组间比较有显著差异（Ｐ＜００１）。ＰＩＨ组血浆ＥＴ水平与舒张压呈正相关，ｒ＝０５４２，Ｐ＜００１。妊娠组ＣＧＲＰ水平较对照组无显著性差异（Ｐ＞００５）；ＰＩＨ组较妊娠组降低显著（Ｐ＜００１），轻、中、重度ＰＩＨ各组间比较均有显著差异（Ｐ＜００５）。结论妊娠状态下，ＥＴ、ＣＧＲＰ参与体内血压的调节，两者平衡失调可能与ＰＩＨ的发生、发展有关。因此，测定血浆ＥＴ、ＣＧＲＰ浓度有助于ＰＩＨ的诊断和治疗。     

绝经后妇女血清骨钙素水平及其它相关因素与骨质疏松关系的研究

应用放射免疫法和单光子骨密度测定法测定了１１３例绝经前后妇女的血清骨钙素水平（ＢＧＰ）、尺桡骨平均骨密度（ＢＭＤ），并测定了甲状旁腺激素（ＰＴＨ）、降钙素（ＣＴ）、雌二醇（Ｅ２）等多种骨代谢参数。结果：绝经后妇女血清ＢＧＰ升高，绝经５年内升高最为明显，ＢＭＤ逐渐下降，ＢＧＰ与ＢＭＤ呈正相关，骨转换水平升高。提示绝经后妇女因缺乏雌激素存在骨质丢失。这一过程可能是在多种因素参与下，骨形成和骨吸收之间不平衡所致。     

Bone remodeling and bone mineral density during pregnancy

INTRODUCTION. The effect of pregnancy upon the maternal skeleton is not fully understood. The information that has been gathered by recent studies is conflicting with regard to overall loss or gain of bone during pregnancy. The aim of the present longitudinal, controlled study, therefore, was to investigate the effect of pregnancy on lumbar spine, wrist, and hip bone mineral density, and to describe bone remodeling during pregnancy as indicated by biochemical markers of both bone resorption and formation. MATERIALS AND METHODS. Thirty healthy women (15 subjects seeking pregnancy and 15 non-pregnant controls) were studied. Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry before conception and within 2 weeks after parturition. Markers of bone resorption (urinary cross-linked type I collagen N-telopeptides, serum type I collagen C-telopeptides) and bone formation (total and bone specific alkaline phosphatase, osteocalcin), and total serum calcium were analyzed before, during (once in each trimester), and after pregnancy. RESULTS. During pregnancy, BMD decreased significantly by 3.4+/-4.1% at the lumbar spine and 4.3+/-3.9% at the trochanter, while there was a slight but significant increase in BMD at the proximal 1/3 of the forearm (1.3+/-1.9%). Total hip and femoral neck BMD did not change significantly, nor did total and ultradistal forearm BMD. Bone resorption increased during pregnancy with peak levels in the third trimester (N-telopeptides) or post partum (C-telopeptides), respectively. The increase in bone resorption was accompanied by a significant decrease in serum calcium in the third trimester. Markers of bone formation showed a biphasic pattern with decreases from baseline to the first (total and bone specific alkaline phosphatase) or second trimester (osteocalcin), respectively, followed by a significant increase in the third trimester and post partum. There was no change in any parameter in the control group throughout the study. CONCLUSION. In conclusion, pregnancy is characterized by high bone turnover with resorption preceding formation. During the first and second trimester bone remodeling is uncoupled. Serum calcium decreases as bone resorption peaks in late pregnancy. There are significant decreases in bone mineral density at sites rich in trabecular bone, such as the lumbar spine and the trochanter.     

南昌地区正常孕产妇血清免疫球蛋白与补体3水平的观察

目的 了解正常妊娠孕产妇血清ＩｇＧ、ＩｇＡ、ＩｇＭ及Ｃ３水平。方法 采用单相免疫扩散法对２７３例正常孕产妇三种血清免疫球蛋白（Ｉｇ）和补体３（Ｃ３）水平进行了测定,并与２１例非妊娠妇女作比较。结果 正常妊娠组与非妊娠组比较,血清ＩｇＧ水平降低明显,差异有显著性（Ｐ〈０．０１）。早、中、晚孕及产后分别下降４４．０３％、１８．４６％、３５．４５％和３５．７７％。除中孕组外,其它各组差异均有显著性（Ｐ〈     

绝经前全子宫切除保留卵巢对妇女骨代谢及骨密度的影响

目的 :追踪观察绝经前妇女全子宫切除保留卵巢对远期骨代谢及骨密度的影响。方法 :对比观察绝经前行全子宫切除保留单侧卵巢 4 8例、全子宫切除保留双侧卵巢 15例和正常妇女 30例的血清钙 (Ca)、血清磷 (P)、血清碱性磷酸酶 (AKP)、血清骨钙素(BGP)、空腹尿Ca Cr及尿HYP Cr值、骨密度值的变化和差异。结果 :全子宫切除保留单侧卵巢组血AKP值、BGP值、空腹尿Ca Cr和尿HYP Cr均显著高于对照组 (P <0 0 5 ) ,而骨密度值则显著低于对照组 (P <0 0 5 )。保留双侧卵巢组尿HYP Cr显著高于对照组 (P <0 0 5 )。结论 :子宫全切除保留单侧卵巢者远期骨转换加快 ,导致骨丢失及骨密度下降 ,双侧卵巢保留者骨吸收亦加快 ,但骨密度无下降     

The Concentrations of Markers of Bone Turnover in Normal Pregnancy and Preeclampsia

Background. The purpose of our study was to investigate the concentrations of markers of bone turnover in normal pregnancy and preeclampsia. Material and Methods. Forty-five pregnant patients with preeclampsia, 78 healthy pregnant women (26 in first, 26 in the second, and 26 in third trimester of pregnancy), and 20 nonpregnant women were included in the study. Serum concentrations of osteoprotegrin (OPG), receptor activator of nuclear factor kappa B ligand (sRANKL), and the markers of bone turnover, osteocalcin and CrossLaps—degradation products of type I collagen, were determined using the ELISA method. Statistical analysis was performed using Mann–Whitney U-test. Results. The concentrations of sRANKL and OPG were significantly higher in the second trimester of normal pregnancy when compared to the first and the third trimesters and to nonpregnant controls. The concentrations of osteocalcin were significantly higher in the first trimester of physiological pregnancy in comparison with nonpregnant women and with second and third trimesters of pregnancy. The concentrations of CrossLaps were significantly higher in the second trimester of normal pregnancy when compared to the first and third trimester. In preeclampsia, the sera concentrations of osteocalcin and CrossLaps were significantly higher when compared to the third trimester of normal pregnancy. Conclusion. The results suggest that the bone formation is increased in the first trimester, whereas the bone resorption is increased in the second trimester of normal pregnancy. Furthermore, the results suggest that the bone turnover is increased in patients with preeclampsia when compared to healthy normotensive pregnant women.     

Changes in bone density and metabolism in pregnancy

OBJECTIVE: The impact of pregnancy on maternal bone density remains unclear. As a prerequisite to investigate the pathophysiology of gestational bone metabolism, we sought to document the changes in bone metabolism biochemistry in conjunction with those in selective trabecular/cortical osteodensitometry between early and late pregnancy. METHODS: A prospective, controlled study in a university hospital was conducted with 43 healthy women, 34 of them during uneventful pregnancy. The main outcome measures are trabecular and cortical bone density measured in the first and third trimesters using peripheral quantitative computed tomography in conjunction with a panel of bone metabolism parameters, including blood parathyroid hormone, calcitonin, osteocalcin, skeletal alkaline phosphatase, and the urinary desoxypyridinoline/creatinine ratio. RESULTS: Cortical bone density was unaffected by pregnancy. Trabecular bone density changes showed wide interindividual variation, ranging from +1.3 to -20.7% per year, identified as fast losers (less than -3%) and slow losers (more than -3%). Serum osteocalcin levels were lower in slow versus fast bone losers in both trimesters (first: P=0.02, third: P=0.02) and were the only independent parameter to differentiate between fast and slow losers. CONCLUSIONS: Our data suggest that wide interindividual variation and the failure to provide a separate measure of trabecular bone density account for the conflicting evidence in earlier reports. Serum osteocalcin concentration during the first trimester distinguishes between fast and slow losers of trabecular bone and should be evaluated in future studies as predictor for later bone loss (osteoporosis).     

Bone mineral content in premenopausal women treated with gonadotropin-releasing hormone analogue]

To assess bone metabolism during treatment with gonadotropin-releasing hormone analogue (GnRHa), serum osteocalcin (BGP), alkaline phosphatase (ALP), parathyroid hormone (PTH), calcitonin (CT), calcium (Ca) and phosphorus (P) were determined before and after 6 months of GnRHa treatment in 15 premenopausal women with clinically diagnosed endometriosis. The bone mineral content (BMC) of the lumbar spine (L3) was measured by single energy quantitative computed tomography in 9 women, and in 6 of these 9 women microdensitometry was performed simultaneously during the treatment. BMC decreased significantly to 92.5 +/- 6.8% (mean +/- SD) of the pretreatment value after 6 months of treatment. On the other hand, microdensitometry revealed no significant change during treatment. Serum BGP and ALP were significantly higher after 6 months of treatment than before treatment, indicating an increase in bone formation. These data indicate that the GnRHa treatment induces an increase in bone turnover and a significant bone loss.     

Changes in hepatobiliary enzymes and its isoenzymes in intrahepatic cholestasis in pregnancy]

Serum alkaline phosphatase (AKP), gamma-glutamyl transpeptidase (gamma-GT), 5'-nucleotidase (5'-NT), leucine aminopeptidase (LAP), AKP gamma-GT isoenzymes, and lipoprotein-X (LP-X) were measured in 97 normal pregnant women and 40 patients with intrahepatic cholestasis of pregnancy (ICP). It was found that in ICP the changing patterns in the four hepatobiliary enzymes were different in different gestational weeks of 3 rd trimester. The changes of gamma-GT and 5'NT were more significant, especially the latter. Six bands were found both in serum AKP and gamma-GT isoenzymes. In ICP the rate of occurrence of AKP1 and AKP2 isoenzymes were elevated. Thus, gamma-GT, 5'-NT, AKP and gamma-GT isoenzymes might be more sensitive parameters for monitoring intrahepatic cholestasis of pregnancy.     

手术后口服小剂量米非司酮治疗子宫内膜异位症的近期疗效和副作用的初步观察

目的探讨保留生育功能或保留卵巢功能手术后服用小剂量米非司酮治疗子宫内膜异位症(内异症)的临床疗效、副反应及对生殖激素水平和骨代谢的影响.方法米非司酮组31例,予米非司酮10 mg口服,每日1次;达那唑组30例,予达那唑200 mg口服,每日2～3次,均连续用药3个月.观察两组症状、体征改善情况,用药后的副反应及用药3个月时血清生殖激素水平和骨代谢生化指标的变化.结果两组症状、体征缓解率相似.米非司酮组潮热、阴道出血、腰背疼痛、体重增加、痤疮等副反应发生率显著低于达那唑组(P<0.05).用药3个月时,米非司酮组血清促卵泡激素和黄体生成激素与达那唑组比较,差异无显著性(P>0.05);米非司酮组雌二醇(E2)为(204.9±45.3) pmol/L,保持在卵泡期水平,达那唑组为(94.3±33.0) pmol/L,为绝经后水平,两组比较,差异有极显著性(P<0.01).停药13～15 d,米非司酮组E2水平为(1 221.6±384.2) pmol/L,较用药前排卵期下降,但差异无显著性(P>0.05),达那唑组为(815.1±376.0) pmol/L,明显下降(P<0.05).停药当月黄体高峰期孕酮水平,米非司酮组为(33.1±5.6) nmol/L,与治疗前相似,而达那唑组为(27.4±4.9) nmol/L,显著降低(P<0.01),两组间差异有显著性(P<0.05).用药3个月时,米非司酮组尿脱氧吡啶啉/尿肌酐(UDpd/Cr)、血碱性磷酸酶(AKP)和骨钙素(BGP)与用药前比较,差异均无显著性(P>0.05);达那唑组血AKP为(54.0±10.7) U/L,BGP为(7.7±1.9) μg/L,较用药前明显升高(P<0.01),而UDpd/Cr水平无显著变化(P>0.05).米非司酮组停药后基础体温上升和月经复潮时间较达那唑组为短.结论手术后加用米非司酮可明显改善患者症状和体征,疗效与达那唑类似,但副反应明显减少.10 mg/d米非司酮3个月治疗可使血清E2保持在卵泡期水平,且对骨代谢无明显影响.     

Clinical significance of serum AKP, HSAP, LAP and gamma-GT determination in high-risk pregnancy

Serum levels of alkaline phosphatase (AKP), heat stable alkaline phosphatase (HSAP), leucine aminopeptidase (LAP) and gamma-glutamyl transferase(gamma-GT) were determined in 249 blood samples from 202 women with normal or high-risk pregnancy at 30-42 weeks. The results showed that AKP and HSAP increased with the advance of gestational weeks (r = 0.9 259, P less than 0.01), reaching their plateau at 37-38th week. In severe hypertensive pregnant woman, AKP and gamma-GT were significantly elevated, while HSAP remained in consistent low level. A "dissociation phenomenon" between AKP and HSAP was discovered. In cases of prolonged pregnancy, oligohydramnios and IUGR with fetal distress and neonatal asphyxia, both AKP and HSAP were lower than those in normal pregnancies of same gestitional age. Serum level of HSAP might reflect the placental function, while combined with AKP and gamma-GT could also be helpful in assessing the severity of hypertension in pregnancy and in predictive feto-maternal prognosis.