产前超声对胎儿肠管扩张的诊断价值

目的：探讨产前超声诊断胎儿肠管扩张的诊断价值.方法：对120例产前超声检查发现胎儿肠管扩张病例进行回顾性分析.结果：（1）在120例肠管扩张的胎儿中,46.7％出生后排便正常,53.3％发生不良妊娠结局.（2）胎儿肠管扩张发生部位越高,预后越差.（3）十二指肠扩张通常伴有羊水增多,而小肠扩张与结肠扩张多不伴有羊水增多.结论：胎儿肠管扩张可导致不良围产期结果,且妊娠结局与肠管扩张发生的部位有关.     

人胎心房和窦房结心房利钠因子的免疫组织化学研究

用免疫组织化学方法对１８例人胎心（１２～４０周胎）进行了心房利钠因子（ＡＮＤ）分布的研究。结果表明，心房利钠因子免疫反应颗粒存在于大部分心房肌细胞内，少部分心房肌细胞无染色颗粒。ＡＮＦ在心房肌细胞中的染色为颗粒状，分布在核周胞浆中，偶尔可见散在胞浆外周。在心房近心内膜侧的心肌细胞可见染色反应增强。免疫反应在左右心房和房中隔无明显不同。左右心耳有很强的免疫反应且右耳强于左耳。窦房结ＡＮＦ免疫反应亦为阳性，但染色较同时期心房肌弱，较心室肌强。窦房结的头、体、尾无免疫染色强度变化。在１２～２０周胎心室肌中有弱的ＡＮＦ免疫反应。从１２～２０周不同胎龄胎心的染色对比看，ＡＮＦ在人胎心有其发展变化规律，随着胎儿增大出现心室免疫染色减弱而心房免疫染色增强的趋势。对心脏作为内分泌器官可能在调节心脏本身的活动和其他生理活动中的意义进行了讨论。     

多普勒超声评价胎儿房性心律失常常压氧治疗的疗效

目的 应用多普勒超声评价常压氧疗法对胎儿房性心律失常的疗效。方法 对多普勒超声确诊193例未合并先天性心脏病的房性心律失常胎儿[其中各类型房性早搏(PAC)165例、室上性心动过速(SVT)28例]行常压氧治疗;对照组63例为单纯房性早搏未行常压氧治疗者。结果 (1)PAC常压氧疗法治疗第二疗程平均转归率97．8％,SVT为85．7%;经治疗后辨膜返流减轻或消失、心包积液减轻或吸收及外周血流频谱明显改善(P＜0．05);(2)对照组PAC63例中12例停止饮用兴奋性饮品早搏消失,11例随孕周发展加重,1例发生短阵房性心动过速。结论 常压氧疗法可明显提高胎儿血氧分压,增加胎儿氧的供应和利用,有效治疗胎儿房性心律失常。     

Molecular Characterization of Hereditary Persistence of Fetal Hemoglobin in the Karen People of Thailand

Hereditary persistence of fetal hemoglobin (HPFH) is the condition whereby a continuously active γ‐globin gene expression leads to elevated fetal hemoglobin (Hb F) levels in adult life [Stamatoyannopoulos G, Grosveld F. Hemoglobin switching. In: Stamatoyannopoulos G, Majerus PW, Perlmutter RM, Varmus H, eds. The Molecular Basis of Blood Diseases. Philadelphia: W.B. Saunders, 2001:135–182; Wood WG. Hereditary persistence of fetal hemoglobin and δβ thalassemia. In: Steinberg MH, Forget BG, Higgs DR, Nagel RL, eds. Disorders of Hemoglobin: Genetics, Pathophysiology, and Clinical Management. Cambridge: Cambridge University Press, 2001:356–388; and Weatherall DJ, Clegg JB. Hereditary persistence of fetal hemoglobin. In: Weatherall DJ, Clegg JB, eds. The Thalassaemia Syndromes. Oxford: Blackwell Scientific Publishers, 1981:450–507]. The condition is caused either by mutation of the β‐ and γ‐globin genes, or the γ‐gene controlled region on other chromosomes. Several families with this condition have been reported from Vietnam, Cambodia and China, and the Southeast Asian mutation (or HPFH‐6), a 27 kb deletion, was demonstrated. Here we report on a mother and her daughter of the Karen ethnic group with high levels of Hb F, living in the Suan Pueng District on the border of Thailand and Myanmar. Genotyping showed a heterozygosity for the 27 kb deletion of the β‐globin gene. Their conditions have been confirmed by gap polymerase chain reaction (PCR) with three oligonucleotide primers recently developed by Xu et al. [Xu X‐M, Li Z‐Q, Liu Z‐Y, Zhong X‐L, Zhao Y‐Z, Mo Q‐H. Molecular characterization and PCR detection of a deletional HPFH: application to rapid prenatal diagnosis for compound heterozygotes of this defect with β‐thalassemia in a Chinese family. Am J Hematol 2000; 65:183–188.], and a DNA sequencing method. Thus far there has been no official report of the HPFH‐6 anomaly from Thailand. The compound heterozygosity of β‐thalassemia (thal) and hereditary persistence of Hb F causes the phenotype of thalassemia intermedia; in contrast, homozygotes for this anomaly show only mild microcytic anemia. Hence, genetic counseling for hereditary persistence of Hb F carriers is needed for family planning.     

Change of Pulsatility Index of the Fetal Middle Cerebral Artery after Auditory Stimulation in No Risk Pregnancies and in Pregnancies with Gestational Hypertension

Purpose: An aim was to determine the degree and the mode of variation of PI of middle cerebral artery in no risk pregnancies and in pregnancies with gestational hypertension, after the constant sound stimuli. Method: Study included 343 patients divided in two groups. Group 1: low risk pregnancies and group 2: gestational hypertension. Ultrasound prenatal auditory screening was performed after the 27th week of gestation. Results: The percentage of fetuses with increase of cerebral blood flow was slightly higher in the pregnancies with hypertension. Conclusion: An average change of PI of median cerebral artery was higher in this group.     

Cholinesterase Activity in Pregnant Women and Newborns

Abstract

Plasma and red blood cell cholinesterase activity in blood samples from 259 pregnant women and cord blood from some of their newborn were compared with samples from 25 nonpregnant female volunteers and with laboratory norms (Ellman method). Plasma cholinesterase was significantly lower (p < 0.05) and red blood cell cholinesterase higher (p < 0.05) in pregnant women than in nonpregnant controls in a repeated measures analysis. By the sixth post-partum week, both plasma and red blood cell cholinesterase were similar to nonpregnant control activity. Fetal cord red blood cell cholinesterase activity was also lower than in nonpregnant women, but plasma levels were not significantly different. When compared with standard laboratory normal ranges, most (98-100%) plasma cholinesterase values in pregnant women and newborn were within range, whereas the majority (59-87%, depending on trimester) of red blood cell levels were above range in pregnancy and below range in 53% of newborns. A low red blood cell cholinesterase in pregnant women is more consistent with a possible overexposure to anticholinesterases than a low plasma cholinesterase. Periods of altered sensitivity to specific cholinesterase inhibiting drugs and environmental agents are suggested by these findings.     

�޻���������ۺ����̥��­��ϸ��ϸ�����ڼ���ֳӰ���о�

目的探讨与胎鼠颅骨细胞共培养时,无机三氧化物聚合物(MTA)对其细胞周期及增殖的影响。方法研究于2012年1月至2013年1月在湖北省十堰市人民医院临床研究所进行。用胰蛋白酶和Ⅱ型胶原酶混合多次消化获得原代胎鼠颅骨细胞,将细胞与MTA共培养(MTA组)4、7、14及21 d,细胞培养加入聚氯乙烯作为对照组。采用流式细胞仪(PI染色)及细胞增殖-毒性试剂盒法(CCK-8法)检测细胞周期中G0/G1、S和G2/M期的细胞数变化及细胞增殖情况。结果 G0/G1期第21天时MTA组细胞明显多于对照组(P<0.05);S期细胞数量在第4、14、21天时MTA组明显少于对照组(P<0.05);G2/M期细胞数量在第4、14天时MTA组明显多于对照组(P<0.05),在第7、21天时MTA组明显低于对照组(P<0.05)。细胞增殖指数(PI):MTA组在第4、7天时均略高于对照组,在第14天时开始降低,第21天时明显低于对照组(P<0.05)。CCK-8检测结果显示实验各组细胞均随培养时间延长而增殖,第14天达到峰值,后开始略有减弱。与对照组比较,MTA组在第4、7天细胞吸光度值略高,随着培养时间继续增加,MTA组吸光度值略低于对照组,但差异均无统计学意义(P>0.05)。结论胎鼠颅骨细胞可以在MTA表面很好地增殖,并且MTA可能通过调节细胞周期来决定细胞的增殖能力,并在7 d后降低细胞增殖速度,这可能对细胞的成骨分化存在一定推动作用。     

早孕期超声检查胎儿颈项透明层厚度 心率及心轴对胎儿先天性心脏病的预测价值

目的 探讨早孕期超声检查胎儿颈项透明层（NT）厚度、心率及心轴对胎儿先天性心脏病的预测价值。方法 选择2015年7月1日至2017年7月1日就诊于安徽医科大学第二附属医院的168例孕龄12～14周孕妇（均为单胎妊娠）,采用彩色多普勒超声测定胎儿NT、心率、心轴,所有孕妇均随访至分娩后1周,统计胎儿发生先天性心脏病的例数,绘制ROC曲线,分析NT厚度、心率及心轴对胎儿先天性心脏病的预测价值。结果 NT预测胎儿先天性心脏病ROC曲线下面积为0.895（P<0.001）,NT预测胎儿先天性心脏病最佳截点为2.995 mm,此时灵敏度为0.882,特异度为0.961;心轴预测胎儿先天性心脏病ROC曲线下面积为0.657（P=0.021）,心轴预测胎儿先天性心脏病最佳截点为50.891度,此时灵敏度为0.643,特异度为0.598;心率预测胎儿先天性心脏病ROC曲线下面积为0.616（P=0.045）,心率预测胎儿先天性心脏病最佳截点为179次/分钟,此时灵敏度为0.556,特异度为0.879。结论 孕早期NT厚度、心率及心轴检查对预测胎儿先天性心脏病及心脏畸形具有一定临床意义,其中NT厚度预测价值最大。