早发型重度子痫前期分娩前后CD28/CTLA-4的相关研究

目的:探讨白细胞分化抗原28/细胞毒性T淋巴细胞相关抗原4(CD28/CTLA-4)与早发型重度子痫前期发病的关系。方法:采用流式细胞技术分别测定30例早发型重度子痫前期患者分娩前后的CD28、CTLA-4、CD28/CTLA-4表达水平,同时测量各组受试者血压及肝肾功能。结果:早发型重度子痫前期患者分娩前CD3+CD4+CTLA-4+、CD3+CD8+CTLA-4+高于分娩后,CD3+CD4+CD28+/CD3+CD4+CTLA-4+、CD3+CD8+CD28+/CD3+CD8+CTLA-4+低于分娩后,差异有统计学意义(均P0.05)。CD3+CD4+CD28+/CD3+CD4+CTLA-4+、CD3+CD8+CD28/CD3+CD8+CTLA-4+两者无直线相关性(r=-0.037,P=0.844)。结论:早发型重度子痫前期患者分娩后较分娩前CTLA-4的表达下降,CD28/CTLA-4上升,可能提示CD28/CTLA-4免疫偏移与子痫前期的发生有关。     

晚期糖基化终产物与子痫前期的研究进展

晚期糖基化终产物（advanced glycation end products,AGEs）是指蛋白质、核酸、脂质等大分子物质的氨基在无酶条件下生成的一组稳定的终末产物,既可直接损伤细胞,也能通过与受体结合发挥生物学效应。研究发现,AGEs与线粒体氧化应激损伤及脂质代谢紊乱关系密切。子痫前期是妊娠期特有的疾病,是孕产妇和围生儿患病及死亡的主要原因,但具体发病机制未明,现普遍认为线粒体氧化应激损伤及脂质代谢紊乱参与子痫前期发病。就AGEs在子痫前期发病中的作用进行综述。     

Maternal outcomes of hypertensive disorders in pregnancy at Korle Bu Teaching Hospital,Ghana

Objective

To determine maternal outcomes of hypertensive disorders in pregnancy at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana.

Methods

A cross-sectional study was conducted between January 1 and February 28, 2013. All women delivering at KBTH whose pregnancies were complicated by hypertensive disorders were identified. A structured questionnaire was administered, and the women were followed up on a daily basis until discharge from hospital. Medical records were also reviewed to identify any complications of hypertensive disorders.

Results

A total of 368 women were analyzed. Of 10 maternal deaths, 3 (30.0%) were due to hypertensive disorders in pregnancy, and specifically pre-eclampsia. Overall, 168 (45.7%) women with hypertensive disorders in pregnancy delivered by cesarean, 16 (4.3%) had placental abruption, 11 (3.0%) had pulmonary edema, 3 (0.8%) had HELLP syndrome, 2 (0.5%) had acute renal failure, 3 (0.8%) had an intracerebral hemorrhage or cerebrovascular accident, 21 (5.7%) were admitted to the intensive care unit, 7 (1.9%) had disseminated intravascular coagulation, and 58 (15.8%) had eclampsia. Cesarean delivery, admission to intensive care unit, and eclampsia were significantly more common in women with pre-eclampsia than in those with other hypertensive disorders.

Conclusion

Hypertensive disorders in pregnancy are associated with high incidences of adverse maternal outcomes in Ghana, with significantly increased frequencies in women with pre-eclampsia.     

Th1/Th2平衡调控对妇产科疾病影响的研究进展

近年来研究发现辅助性T细胞1型（Th1）/Th2的平衡调控与妇产科疾病的发生、发展、治疗和转归有密切的关系。Th1细胞调节细胞免疫,主要促进炎症反应和细胞毒性活动;Th2细胞调节体液免疫,主要刺激细胞的分化与增殖。Th1细胞通过合成γ干扰素（IFN-γ）抑制Th2细胞功能,Th2细胞通过合成白细胞介素4（IL-4）抑制Th1细胞的功能,二者相互作用、相互调节。正常妊娠情况下Th1/Th2细胞应答存在生理性失衡,母体Th2型细胞因子抑制Th1型细胞因子的产生,这种生理性失衡被破坏可导致复发性流产、早产、子痫前期及不孕症等妊娠相关疾病。而宫颈癌、卵巢癌、子宫内膜异位症等妇科疾病与Th1/Th2平衡调控有关,但其确切免疫学机制尚不明确,尚需进一步深入研究,以期为多种妇产科疾病的免疫学治疗开辟新的前景。     

Obstetrical outcome in women with endometriosis including spontaneous hemoperitoneum and bowel perforation: a systematic review

Increasing evidence suggests that pregnant women with endometriosis have a higher risk of adverse obstetrical complications. The aim of this study was to systematically review the existing literature on this aspect. A PubMed/MEDLINE search was performed from its inception until September 2017 for studies on adverse obstetrical complications in pregnant women with endometriosis, including: preeclampsia, preterm birth, small for gestational age (SGA), antepartum hemorrhage, spontaneous hemoperitoneum, spontaneous bowel perforation, preterm birth, cesarean delivery, stillbirth and postpartum hemorrhage. Overall, the results showed an increased risk of preterm delivery, antepartum hemorrhage, delivery by cesarian section, and the rare complications of spontaneous hemorrhage in pregnancy and spontaneous bowel perforation. There is no firm evidence for any increased risk of preeclampsia, having a child born small for gestational age, stillbirth, or postpartum hemorrhage. In conclusion, pregnant patients with endometriosis should be offered special clinical attention.     

葡萄糖酸钙联合卡前列素氨丁三醇对子痫前期产妇剖宫产后出血的临床疗效研究

目的：探讨葡萄糖酸钙联合卡前列素氨丁三醇对子痫前期产妇剖宫产后出血的临床疗效。方法：选取2016年9月-2017年9月我院产科收治的160例子痫前期以剖宫产终止妊娠的产妇为研究对象,按照随机数字表法分为研究组和对照组,各80例。在胎儿娩出后,对照组给予缩宫素和卡前列素氨丁三醇,研究组在对照组的基础上加用葡萄糖酸钙。比较2组产妇手术过程中、手术结束后2 h和手术结束后24 h的出血量、产后出血率、剖宫产前后血清Ca2＋浓度和血红蛋白含量,以及用药后不良反应发生率。结果：2组产妇手术过程中的出血量比较差异无统计学意义（P＞0.05）;手术结束后2 h和24 h,研究组的出血量均少于对照组,差异有统计学意义（均P＜0.05）。研究组产后出血率为15.00%（12/80）,对照组产后出血率为36.25%（29/80）,差异有统计学意义（χ2=9.477,P=0.002）。剖宫产后,2组产妇血清Ca2＋浓度均比剖宫产前升高（均P＜0.05）,血红蛋白含量均比剖宫产前降低（均P＜0.05）。用药后不良反应发生率研究组（16.25%）和对照组（13.75%）比较差异无统计学意义（χ2=0.196,P=0.658）。结论：葡萄糖酸钙联合卡前列素氨丁三醇用于预防子痫前期产妇剖宫产的产后出血具有更好的止血效果且安全,值得临床推广。     

P27基因参与子痫前期发生机制的研究进展

子痫前期(pre-eclampsia,PE)是妊娠期特发疾病,其发生与发展是导致母儿患病率、死亡率增加的重要原因,胎盘中滋养细胞正常的增殖、迁移与分化与其关系密切。P27作为细胞周期蛋白依赖性激酶抑制剂(cyclin dependent kinase inhibitors,CKIs),与细胞周期因子结合调控细胞周期。与正常孕妇相比,PE患者胎盘滋养细胞中P27基因的表达明显增加,这可能与滋养细胞的增殖及侵入障碍有关。P27蛋白与不同蛋白质结合发挥不同作用,其调节主要依靠翻译后修饰及亚细胞定位。Nodal作为转化生长因子β(transforming growth factor β,TGF-β)的成员,在滋养细胞中通过多种机制上调P27 mRNA和蛋白水平,提高了P27蛋白的稳定性并在S10处诱导了P27蛋白的磷酸化,促使P27蛋白和CDK2向细胞质的转移,且加强P27/CDK2/CDK5/Stathmin的结合,从而抑制了细胞增殖、迁移及侵袭。P27蛋白在许多位点被磷酸化,氧化应激、蛋白激酶B(protein kinase B,Akt)、蛋白O-岩藻糖基转移酶1(protein O-fucosyltransferase 1,poFUT1)、磷酸果糖-2-激酶/果糖-2,6-二磷酸酶(PFKFB1-4)等通过使P27蛋白磷酸化,影响其泛素-蛋白酶体降解途径调节细胞周期进程。     

胎盘外泌体在子宫螺旋动脉重铸不全相关妊娠并发症中的作用

子宫螺旋动脉重铸是胎盘滋养细胞与母体血管内皮、平滑肌细胞、免疫细胞等相互作用下完成的,细胞间信息传递在这一过程中起重要作用。外泌体的发现更新了学者们对细胞间信息传递的思考模式。外泌体是细胞主动分泌的直径40~100 nm的囊泡,可由多种细胞分泌并可从多种体液中分离出来,携带多种蛋白质、mRNA、微小RNA(miRNA)等信号分子,在细胞间通讯起重要作用。研究证明,胎盘滋养细胞能分泌外泌体,在母血中能检测并分离出胎盘外泌体,胎盘外泌体携带滋养细胞信息,作用于母体细胞,调节血管形成,重铸子宫螺旋动脉,调节母体免疫,参与胎盘屏障的形成。综述胎盘外泌体的特征、生物学功能及其在螺旋动脉重铸不全相关妊娠并发症中的变化,探讨胎盘外泌体作为诊断妊娠并发症血清标志物的临床价值。     

子痫前期孕妇血清代谢组学分析

目的:比较妊娠子痫前期(PE)患者分娩前后血清代谢轮廓的变化,建立疾病区分模型并筛选出具有潜在临床应用价值的特征代谢物。方法:选取2017年9月-2018年3月天津市第三中心医院收入院的孕妇共45例,其中PE患者(PE组)20例,正常孕妇(对照组)25例,应用超高效液相色谱与质谱联用仪(UPLC-MS)分别检测PE组孕妇分娩前、分娩后以及对照组的血清标本,筛选出差异性特征代谢物并进行分析。结果:构建了妊娠PE组血清代谢轮廓模型,共筛选出溶血磷脂酰胆碱类物质LPC 18:0、LPC 22:6、14-甲基十六烷酸、二十二酸和1,25-二羟基维生素D3-26,23内酯共5种差异性代谢产物,且溶血磷脂酰胆碱类物质LPC 18:0、LPC 22:6和14-甲基十六烷酸3种物质在PE分娩前与分娩后的差异有统计学意义(均P<0.05)。结论:构建代谢轮廓模型具有很强地区分PE患者分娩前后及正常孕妇的能力,筛选出特征代谢物能够反映PE患者代谢水平的变化趋势,为PE的预测、诊治提供参考。