广东籍汉族妇女抗凝血酶Ⅲ和FactorⅤ基因多态性与子痫前期和子痫的相关性研究

目的探讨抗凝血酶III（AT-III）、凝血因子Ⅴ（FactorV）基因多态性与广东籍汉族早孕期妇女子痫前期和子痫发生的关系。方法回顾性分析567例早孕期广东籍汉族妇女AT-III及FactorV基因的突变情况,将其中54例妊娠20周后发生子痫前期和子痫的患者作为观察组,513例正常妊娠者作为对照组。基因突变检测分别采用DdeI和MnlI限制性内切酶片段长度多态性分析。结果观察组ATIIIDdeI＋＋、DdeI＋-及DdeI--基因型频率分别为51.9%、27.8%和20.4%,对照组则分别为66.7%、25.5%和7.8%。观察组AT III DdeI-基因型频率显著高于对照组（34.3%,20.6%,P〈0.01）,AT III DdeI--基因型在子痫前期和子痫发病中的相对风险率为3.025。观察组和对照组均未检出Factor VLeiden突变。结论 ATIII基因多态性可能与广东籍汉族妇女子痫前期和子痫发病相关,而Factor VLeiden突变与其发病无关。     

辛伐他汀治疗子痫前期大鼠的疗效观察

目的探讨辛伐他汀对子痫前期大鼠的治疗效果。方法选取SD雌性孕鼠共30只,随机分为正常组、子痫前期组和辛伐他汀组（每组10只）。于孕14d,分别给子痫前期组和辛伐他汀组大鼠尾静脉注入内毒素（1．0μg／,kg）,建立子痫前期模型,辛伐他汀组大鼠同时给予灌胃给药辛伐他汀片[40mg／（kg·d）]治疗;正常组大鼠尾静脉注入等量生理盐水。孕第8、15、19天测定各组大鼠24h尿蛋白含量;孕第10、15、19天测定各组大鼠心率、血压;孕第21天用硝酸还原酶法测定各组大鼠血浆一氧化氮（NO）浓度。结果①辛伐他汀组、子痫前期组、正常组大鼠24h尿蛋白含量（孕第19天尿蛋白含量-孕第8天尿蛋白含量）分别为（734-20）、（464±57）、（1404-12）μg,3组两两比较,差异有统计学意义（P〈0．01）。②3组大鼠血压（孕第19天血压-孕第10天血压）比较,差异也有统计学意义（P〈0．01）。③3组大鼠心率（孕第19天心率-孕第10天心率）比较,差异无统计学意义（P〉0．05）。④孕第21天,血浆NO浓度正常组为（158±31）mmoL/L,子痫前期组为（49±36）mmol／L,辛伐他汀组为（162±14）mmol／L,子痫前期组分别与其他两组比较,差异均有统计学意义（P〈0．01）。结论辛伐他汀可以提高子痫前期模型大鼠体内NO水平,降低低血压和尿蛋白含量,对心率没有明显影响。     

妊娠期缺血性脑血管意外19例临床分析

目的:探讨妊娠期缺血性脑血管意外与重度子痫前期/子痫的关系,评价凝血相关因子D-二聚体、血小板及纤维蛋白原监测妊娠期缺血性脑血管意外的价值。方法:回顾性分析19例妊娠期缺血性脑血管意外患者的相关致病因素及重度子痫前期/子痫的发病率;与同期正常孕妇比较重度子痫前期/子痫的发病率;比较妊娠期缺血性脑血管意外患者和同期正常孕妇的D-二聚体、血小板、纤维蛋白原的检测值。结果:妊娠期缺血性脑血管意外与重度子痫前期/子痫关系密切,D-二聚体与正常孕妇相比明显升高,有统计学差异(P<0.05),但血小板及纤维蛋白原比较无统计学差异(P>0.05)。结论:防治重度子痫前期/子痫可以减少妊娠期缺血性脑血管意外的发病率,D-二聚体可以预测和动态监测妊娠期缺血性脑血管意外。     

654—2在子痫前期解痉中的应用

目的探讨治疗子痫前期的有效方法，延长孕周以增加新生儿存活率。方法2006年1月至2007年12月收住笔者所在医院的孕28—30周子痫前期患者316例，随机分为两组。研究组：应用654—2（50mg／d）＋硫酸镁（15g／d）；对照组：应用硫酸镁25g／d。结果在延长孕周，增加新生儿存活率，减少蛋白尿等方面研究组较对照组疗效远高于对照组，差异显著（P〈0．01）。结论654—2配伍硫酸镁（15/gd）用于子痫前期解痉，降压治疗对于在延长孕周，增加新生儿存活率有显著作用，且临床使用安全。     

子痫35例临床分析

为探讨降低子痫发生率的方法 ,对 1 988年 1月至 2 0 0 2年 1 2月 1 5年间收治的 3 5例子痫患者的临床资料进行回顾性分析。结果显示 :1 5年来共收治子痫患者 3 5例 ,发生率为 0 .1 8% ,发病率呈下降趋势 ,孕产妇死亡 2例 ,病死率为 5 .71 % ,围生儿死亡 1 0例 ,病死率为 2 6.3 2 %。提示 :加强围生期保健 ,及时诊断、规范治疗妊娠高血压综合征 ,注意产后处理 ,可以有效地降低子痫的发生率 ,多学科的积极介入可以改善对子痫合并严重并发症患者的母婴预后     

Maternal mortality due to arterial hypertension in São Paulo City (1995-1999)

AIM: To describe the case profile of maternal death resulting from hypertensive disorders in pregnancy and to propose measures for its reduction. METHODS: The Committee on Maternal Mortality of S?o Paulo City has identified 609 cases of obstetric maternal death between 1995 and 1999 with an underreporting rate of 52.2% and a maternal mortality rate of 56.7/100,000 live births. Arterial hypertension was the main cause of maternal death, corresponding to 142 (23.3%) cases. RESULTS: Ninety-five (66.9%) of the deaths occurred during the puerperal period and 34 (23.9%) occurred during pregnancy. The time of death was not reported in 13 (9.2%) cases. Seizures were observed in 41 cases and magnesium sulfate was used in four of them. The causes of death were ruled to be cerebrovascular accident (44.4%), acute pulmonary edema (24.6%), and coagulopathies (14.1%). Cesarean section was performed in 85 (59.9%) cases and vaginal delivery in 15 (16.0%). CONCLUSION: Complications of arterial hypertension are responsible for the high rates of pregnancy-related maternal death in S?o Paulo City. Quality prenatal care and appropriate monitoring of the hypertensive pregnant patient during and after delivery are important measures for better control of this condition and are essential to reduce disorders in pregnancy.     

妊娠期高血压和子痫患者血清中髓样分化因子88的表达

目的：探讨髓样分化因子88（MyD88）在妊娠期高血压和子痫患者血清中的表达及意义.方法：选取32例妊娠期高血压孕妇（妊娠期高血压组）,正常孕晚期孕妇32例（正常对照组）以及子痫孕妇30例（子痫组）,分别采用免疫印迹法检测孕妇血清中MyD88蛋白表达水平,酶联免疫吸附法检测血清中白介素-6（IL-6）、白介素-8（IL-8）和肿瘤坏死因子-α（TNF-α）的表达.结果：与正常对照组相比,妊娠期高血压组和子痫组孕妇IL-6、IL-8、TNF-α以及MyD88蛋白表达水平明显升高,差异有统计学意义（P＜0.05）;子痫组孕妇IL-6、IL-8、TNF-α和MyD88的表达水平明显高于妊娠期高血压组,差异有统计意义（P＜0.05）,Myd88的表达水平与IL-6、IL-8和TNF-α水平呈正相关.结论：MyD88与妊娠期高血压的病情程度密切相关,可能是妊娠期发病机制中的重要参与者.     

先兆子痫患者蛋白 Z 水平及其内含子 FG79A 基因多态性的实验研究简

目的探讨先兆子痫患者血浆蛋白z（PZ）水平及其内含子FG79A基因多态性的发生率与先兆子痫之间的相关性和临床意义。方法对先兆子痫组160例和正常妊娠对照组162例检测PZ水平并采用PCR和限制性内切酶片段长度多态性方法并结合基因测序检测PZ内含子FG79A基因多态性,同时检测两组D-D、FDP、AT：A的水平,观察两组各项指标变化情况。结果先兆子痫组PZ水平显著低于正常妊娠对照组（1．57±0．32mg／Lvs2．12±0．35mg/L,P〈0．05）;两组人群均存在PZ内含子FG79A基因多态性。先兆子痫组GG型、GA型和AA型分别占19．38％、53．75％和26．87％,G、A等位基因频率分别为46．25％和53．75％;正常妊娠对照组GG型、GA型和AA型分别占17．90％、54．94％和27．16％,G、A等位基因频率分别为45．37％和54．63％,两组基因型和等位基因频率分布无显著差异（均P〉0．05）;先兆子痫组D-D、FDP水平明显高于正常对照组（5．15±1．03μg／ml vs0．58±1．32μg/ml,P〈0．05;19．46±3．28μg/ml vs 2．93±1．92μg/ml,P〈0．05）,而AT：A水平无显著差异（99．12±13．5％vs100．8±10．6％,P〉0．05）。结论先兆子痫患者存在PZ内含子FG79A基因多态性,但该基因多态性与疾病的发生关联不大,然而该疾病与Pz水平、D-D、FDP水平却有一定的相关性。     

Maternal hepatitis B surface antigen status and incidence of pre‐eclampsia

The relationship between chronic hepatitis B virus (HBV) infection with atherosclerosis and cardiovascular disorders remains unclear, and the impact of maternal HBV infection on the development of pregnancy‐induced hypertension (PIH) and pre‐eclampsia (PE) is also controversial. This retrospective cohort study was conducted to examine the relationship between maternal hepatitis B surface antigen (HBsAg) status with PIH and PE in singleton pregnancies that delivered at 24 weeks of gestation and beyond. Among the 86 537 cases in the cohort, 10% were HBsAg positive, and overall 2.0% had PIH, of whom 56.3% developed PE. HBsAg‐positive women had higher weight and body mass index (BMI), but lower incidences of advanced age, nulliparity, PIH (1.6% vs 2.0%, P = 0.007) and PE (0.8% vs 1.1%, P = 0.005). On multiple logistic regression analysis adjusting for the effects of nulliparity, advanced age, high BMI, and underlying renal, cardiac and autoimmune diseases, HBsAg carriage was associated with significantly reduced incidence of PIH (aOR 0.79, 95% CI 0.66–0.95) and PE (aOR 0.71, 95% CI 0.56–0.91). Our results indicate that maternal HBsAg carriage is independently associated with reduced PE. As chronic HBV infection alters the immune response of the individual, our observation could be related to enhanced maternal immunotolerance of the foetus and hence a reduction in the incidence of PE. The implications of our findings on the long‐term health outcome of the infected women, from cardiovascular morbidity to malignancies, warrant further studies.