先兆子痫患者剖宫产时机的选择

对６年来收治的１２４例先兆子痫，进行剖宫产时机选择分析。其中剖宫产１０３例，先兆子痫剖宫产率８３．０６％，孕周＜３７周者剖宫产率９４．４４％（３４／３６）。结果：母亲全部存活。孕３４－３６周＾＋６者围产儿预后良好，存活率９３．３３％。     

Increased high molecular weight fibrinogen in pre-eclampsia

INTRODUCTION: The major coagulation protein fibrinogen (Fg) is a heterogeneous protein with three main fractions: high molecular weight fibrinogen (HMW-Fg), low molecular weight fibrinogen (LMW-Fg) and low molecular weight' fibrinogen. The clottability of high molecular weight fibrinogen is highest as compared to the other fractions. Pre-eclampsia is associated with a state of hypercoagulability, and with an increase of fibrinogen concentration. The aim of the present study was to examine if the increased total fibrinogen plasma concentration in patients with pre-eclampsia is associated with a change in distribution of the main fibrinogen fractions. MATERIAL AND METHODS: Plasma was collected from 14 patients with pre-eclampsia and from 14 healthy pregnant matched controls. Total fibrinogen concentrations were determined according to Clauss. The percentage high molecular weight fibrinogen was assessed by SDS-electrophoresis and densitometry after isolation of fibrinogen by precipitation. The study groups were compared by the Mann-Whitney U-test. RESULTS: The median (range) total fibrinogen concentration in the pre-eclampsia group was 5.04 (3.25-6.51) g/l and in the control group 4.19 (3.61-5.38) g/l (p<0.05). The median (range) percentage high molecular weight fibrinogen was 76.5 (69.6-84.0)% and 73.0 (69.0-78.9)% in the pre-eclampsia and control group, respectively (p<0.05). CONCLUSIONS: In pre-eclampsia, the concentration of total fibrinogen is increased and the percentage high molecular weight fibrinogen is also slightly higher than in normal pregnancy. These results may be a reflection of the exaggerated inflammatory response, and subsequent endothelial activation, which are currently believed to be the key pathophysiological mechanisms in pre-eclampsia.     

Maternal death in pregnancy from HELLP syndrome. A report of three medico-legal autopsy cases with special reference to distinctive histopathological alterations

Maternal death from HELLP syndrome, a complication of (pre-) eclampsia during pregnancy or postpartum, is rarely encountered in forensic pathology. We report three cases of HELLP syndrome with fatal outcome putting the main focus on the histopathological features of the disease. We found an almost identical histopathological pattern in the liver (periportal coagulation necrosis, hepatic haemorrhages sharply demarcated by an extended fibrin network from the surrounding unaffected liver parenchyma, focal leukostasis in liver sinusoids and swelling of Kupffer’s cells, absence of inflammatory cellular infiltrates in liver plates, lack of fatty transformation of hepatocytes) and kidneys (bloodless glomeruli with swollen and vacuolated intracapillary cells, cigar-shaped capillary loops, enlarged glomerular tufts with herniation of capillary loops into the proximal convoluted tubules, swelling of mesangial cells) in all three cases. The histopathological alterations in the liver and kidneys can be considered characteristic for the disease and their presence may enable the forensic pathologist to establish the definite post-mortem diagnosis of HELLP syndrome in questionable cases. Received: 17 July 2001 / Accepted: 23 October 2001     

十年间重度先兆子癎处理变化与母儿预后(附654例分析)

目的了解10年来我院对重度先兆子癎处理的改变与母儿预后的关系。方法收集我院1999年1月至2003年12月(后5年)重度先兆子癎病例资料305例,将其并发症与处理、分娩方式及围产儿预后,与前5年349例(1994年1月至1998年12月)资料进行对比性分析。结果早发型重度先兆子癎(<34周)后5年占28．9％(88／305),前5年为10．6％(37／349),差异有统计学意义(P<0．01)。后5年中≤34周者行促胎肺成熟治疗占76．5％(78／102),明显高于前5年的11．1％(6／54,P<0．01)。后5年<34周的致死性引产显著减少,分别为30．3％(10／33)和7．9％(7／88),P<0．01。前后5年围产儿死亡率为8．49％(31／365)与10．56％(34／322),差异无统计学意义(P>0．05),但后5年<34周围产儿死亡率明显降低,分别为29．5％(26／88)和69．7％(23／33),P<0．01。外院转来患者平均终止孕周明显小于在本院保健患者(P<0．05),且其母儿并发症明显增多(P<0．05)。结论加强孕期保健、母儿监护,对<34周早发型重先兆子癎可减少致死性引产,促胎肺成熟,适时终止妊娠,密切产儿科合作,有望减少母儿并发症、降低孕产妇和围产儿死亡率。     

杀伤细胞免疫球蛋白样受体基因多态性与子痫前期发病的相关性

目的 探讨杀伤细胞免疫球蛋白样受体(KIR)基因多态性(SNP)与子痫前期发病的相关性.方法 序列特异性引物PCR(PCR-SSP)技术检测子痫前期患者71例(子痫前期组)和正常孕妇100例(对照组)的外周血KIR基因型;实时荧光定量PCR技术检测两组各5例孕妇胎盘组织中KIR2DL4 mRNA的表达情况;DNA直接测序技术检测子痫前期组40例和对照组38例孕妇外周血KIR2DL4基因外显子区及其和内含子交界区的SNP.结果 (1)基因型:对照组共发现50种KIR基因型,子痫前期组共发现40种KIR基因型,两组有16种基因型重合;子痫前期组以基因型42的表达频率最高(15.5%),其次是基因型51(9.9%)和基因型47(7.0%);对照组以基因型47的表达频率最高(22.O%),其次是基因型48(11.O%).两组16种重合的KIR基因型的分布比较,差异有统计学意义(P=0.01).(2)胎盘组织KIR2DL4 mRNA的表达:子痫前期组患者胎盘组织KIR2DL4 mRNA的表达最为14.05±0.25,对照组为12.19±0.85,两组比较,差异有统计学意义(P=0.02).(3)KIR2DL4基因测序:KIR2DL4基因测序发现18个SNP位点,其中有7个为新发现的SNP位点,检测到的所有SNP位点的等位基因、基因型在两组的分布比较,差异无统计学意义(P>0.05).结论 KIR基因型可能与子痫前期的发病相关;KIR2DL4 mRNA表达量下降可能参与子痫前期的病理生理过程.     

Angiogenic factors for the prediction of pre-eclampsia in women with abnormal midtrimester uterine artery Doppler velocimetry

OBJECTIVE: To determine whether assessing uterine perfusion and angiogenic factors concurrently in the second trimester improves the prediction of pre-eclampsia and intrauterine growth restriction (IUGR). METHOD: Plasma levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured for 108 women with abnormal uterine perfusion on Doppler velocimetry in the 23rd week. Later, 33 cases of pre-eclampsia and 9 of IUGR developed. RESULTS: Compared with the plasma levels of the women whose pregnancies remained normal, sFlt-1 levels were significantly higher and PlGF levels significantly lower in the women whose pregnancies became complicated by pre-eclampsia and/or IUGR (P<0.001). The alterations were more pronounced in cases of early-onset pre-eclampsia and in cases of IUGR that necessitated delivery before 34 weeks. Using the sFlt-1/PlGF ratio, these complications could be predicted with 98% sensitivity, 95% specificity, and 93% positive predictive value. CONCLUSION: Measuring uterine perfusion and angiogenic factors concurrently in the second trimester improved the prediction of pre-eclampsia and IUGR.     

妊娠期糖尿病患者血小板参数变化意义的探讨

目的探讨妊娠期糖尿病患者并发子痫前期血小板参数变化的意义。方法分析28例妊娠期糖尿病并发子痫前期患者血小板参数并与86例妊娠期糖尿病患者及92例正常对照组孕妇的血小板参数的比较。结果妊娠期糖尿病并发子痫前期组与妊娠期糖尿病组血小板参数比较血小板计数值下降不明显,但血小板平均体积、血小板压积妊娠期糖尿病并发子痫前期组有明显升高,两组有显著性差异（P〈0.05）。妊娠期糖尿病患者与正常对照组孕妇的血小板参数的比较无差异。结论血小板平均体积、血小板压积可以作为妊娠期糖尿病患者是否可能并发子痫前期的临床监测指标。     

子痫前期保守治疗及终止妊娠时间的探讨

目的:探讨子痫前期保守治疗的临床意义及适时终止妊娠的时间。方法:回顾分析2002年1月～2004年8月该院收治的67例子痫前期的临床资料,按其发病孕周分为:A组<32周6例,B组32～33周2例,C组34～36周16例,D组≥37周43例。主要分析指标包括:发病孕周、终止妊娠孕周、孕周延长时间、严重并发症发生情况、胎儿及新生儿死亡率。结果:A组保守治疗时间平均为(46.2±18.2)天,B组为(19.0±7.1)天,C组为(12.2±9.0)天,D组为(5.2±7.8)天,差异有统计学意义(P<0.01)。C、D组并发症发生率的比较,差异无统计学意义(P>0.05),但与A、B组比较,差异有统计学意义(P<0.01)。A组与B、C、D组胎儿及新生儿死亡率的比较,差异有统计学意义(P<0.05)。孕32周前终止妊娠的子痫前期患者胎儿、新生儿死亡率与孕32周后终止妊娠患者比较差异有统计学意义(P<0.05)。结论:子痫前期发病于32周前,孕妇并发症发生率及胎儿、新生儿死亡率高,采取保守治疗至32周甚至34周后,胎儿及新生儿死亡率降低,而孕妇并发症有所上升。故应严格选择病例,并严密监护,适时终止妊娠。     

内源性一氧化氮合酶抑制物与子痫前期关系的研究

目的:探讨子痫前期患者血浆内源性一氧化氮合酶抑制物-非对称性二甲基精氨酸(asymmetric dimethylarginine,ADMA)及胎盘内皮性一氧化氮合酶(endothelial nitricoxide synthase,eNOS)的表达与子痫前期的关系。方法:2004年1月至2005年1月广州医学院第三附属医院住院分娩的子痫前期孕妇30例,正常晚期妊娠10例,早孕12例。用高效液相色谱法(HPLC)测定血浆ADMA,免疫组化法检测胎盘组织中eNOS。结果:子痫前期组ADMA水平明显高于正常晚期妊娠组,分别为17.97±7.25μg/ml和10.27±1.67μg/ml,两组差异有统计学意义(P<0.01)。而子痫前期组胎盘eNOS表达则明显低于正常晚期妊娠组,两组差异有统计学意义(P<0.05)。结论:子痫前期患者体内eNOS抑制物ADMA升高,胎盘eNOS活性下降,提示ADMA作为eNOS的抑制调节因子在子痫前期病理生理改变中可能起重要作用。     

内毒素调节细胞滋养细胞侵入能力的机制

目的:探讨内毒素(lipopolysacchraride,LPS)对细胞滋养细胞侵入能力的影响。方法:留取正常早孕绒毛,分离细胞滋养细胞,用无血清培养基培养。对照组:培养基中不添加内毒素。实验组:培养基中加入不同浓度的内毒素,其终浓度分别为25、50、100、200ng/m l。Transwell小室检测细胞滋养细胞的侵入能力;采用激光共聚焦-免疫荧光技术检测基质金属蛋白酶-2、9(MMP-2、9)蛋白的表达;RT-PCR检测MMP-2、MMP-9 mR-NA表达水平。结果:内毒素降低细胞滋养细胞侵入Transwell小室的能力,在浓度为0、25、50、100、200ng/m l的LPS作用24h后,细胞滋养细胞侵至滤膜下表面的细胞为145.6±20.7、139.6±18.8、123.1±17、76.5±18、47.9±16,差异有统计学意义(P<0.01);内毒素显著抑制细胞滋养细胞MMP-2、MMP-9蛋白和mRNA的表达。结论:内毒素能够抑制细胞滋养细胞的侵入能力,可能是通过抑制基质金属蛋白酶表达来实现。