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。     

内脂素与子痫前期

内脂素(visfatin)是新近发现的一种主要由内脏脂肪细胞分泌的脂肪因子,结构复杂,存在基因多态性,具有调节糖脂代谢作用.内脂索增加胰岛素敏感性、促进血管平滑肌细胞成熟、参与炎症反应及血管生成,与动脉粥样硬化形成及血管内皮细胞受损和功能紊乱密切相关.子痫前期是一种病因不明的病理妊娠,严重危害母要生命,血管内皮细胞损伤...     

牙周疾病与围生结局的研究进展

牙周疾病作为一种亚临床和持续的感染源,可以造成系统性的炎症反应,增加不良妊娠结局。目前很多研究表明,牙周疾病的严重程度与胎儿早产、低出生体质量呈正相关,与死胎及围生儿死亡显著相关,牙周疾病的存在和严重程度显著增加了子痫前期和妊娠期糖尿病的发生风险,积极合理的治疗不会增加胎儿的不良结局,并可能在一定程度上改善母儿预后。     

血清PRO-BNP水平与子痫前期围生期结局关系的回顾性研究

目的：回顾性分析B型脑利钠肽前体（pro B-type natriuretic peptide,PRO-BNP）水平预测子痫前期患者母婴预后的价值。方法：采用荧光免疫法测定111例子痫前期孕妇PRO-BNP水平,根据检测水平分为PRO-BNP正常组（85例）和PRO-BNP异常组（26例）,随访至分娩,比较2组母婴预后的差异。结果：PRO-BNP异常组期待治疗者明显减少,2组比较差异有统计学意义（7.7% vs. 36.5%,χ2＝7.893,P=0.005）。2组孕妇尿蛋白异常情况、胸水发生率比较,差异有统计学意义（均P＜0.05）。2组胎儿窘迫、早产儿和新生儿转儿科发生率、新生儿出生体质量及Apgar评分比较,差异无统计学意义（均P＞0.05）。结论：单一血清PRO-BNP水平与子痫前期患者脏器损伤严重性有一定关系,但与新生儿预后无明显关系。 【关键词】     

Placental Elasticity as a New Non-invasive Predictive Marker of Pre-eclampsia

Point shear wave elastography is an ultrasonography technique used to evaluate tissue elasticity. We examined whether placental elasticity is useful for predicting the onset of pre-eclampsia. Two hundred twenty-one participants were divided into two groups: one group at low risk (n?=?185) and the other at high risk (n?=?36) for pre-eclampsia. The two groups were compared with respect to shear wave velocity (SWV) of the placenta. Use of SWV as a predictor of pre-eclampsia was also investigated by creating a receiver operating characteristic (ROC) curve. The ROC curve was used to set a cutoff SWV value for predicting pre-eclampsia. The SWV of the high-risk group was significantly higher than that of the low-risk group (p < 0.001). Thirteen participants developed pre-eclampsia after SWV measurements, and the SWVs of these participants were significantly higher than those of participants in who pre-eclampsia did not develop. The cutoff value and area under the ROC curve were 1.188 m/s and 0.9118, respectively. Placental elasticity was significantly increased even before the onset of pre-eclampsia onset and, thus, may be a parameter used to predict the onset of pre-eclampsia.     

内皮型一氧化氮合酶运输介导物在子痫前期患者胎盘组织中的定位及定量研究

目的探讨内皮型一氧化氮合酶运输介导物(endothelial n itric oxide synthase traffic inducer,NOSTR IN)在子痫前期(pre-ec lampsia,PE)患者胎盘血管内皮细胞中表达的变化及其在子痫前期发病过程中的作用。方法HE染色后镜下观察胎盘组织及血管的病理变化,免疫组织化学方法及W estern b lot检测子痫前期患者胎盘组织中NOSTR IN的表达。结果HE染色显示子痫前期患者胎盘绒毛血管变细,数目减少,血管合体膜增厚,纤维素样坏死明显多于正常妊娠;免疫组织化学显示正常妊娠和子痫前期患者胎盘血管内皮细胞中都有NOSTR IN的表达,但子痫前期患者胎盘血管内皮细胞胞浆染色较正常妊娠明显增强;W estern b lot显示子痫前期患者胎盘组织中NOSTR IN的表达显著高于正常妊娠(P<0.01)。结论胎盘组织中NOSTR IN表达增加可能是子痫前期发病机制的重要环节之一。     

Exploring knowledge of pre-eclampsia and views on a potential screening test in women with type 1 diabetes

Objectiveto explore knowledge of pre-eclampsia and opinions on potential screening tests for pre-eclampsia in women with type 1 diabetes.Designa qualitative study using semi-structured interviews of women planning a pregnancy, currently pregnant or post-partum with experience of pre-eclampsia.Setting, Participants and Methodseleven women with type 1 diabetes were recruited from a pre-pregnancy planning clinic or antenatal clinic. Semi-structured interviews were conducted with the women, asking a series of open-ended questions about their current knowledge of pre-eclampsia and their views on screening for pre-eclampsia. Data analysis was conducted using inductive thematic analysis.Findingsfour main themes were identified: Information, sources of stress, awareness and acceptability of screening. Generally, women's knowledge of pre-eclampsia was limited. Most did not appear to be aware of their increased risk of developing the disease. Similarly, the majority of women were unaware as to why their blood pressure and urine were checked regularly. The introduction of a screening test for pre-eclampsia was favoured, with only a small number of women raising concerns related to the screening tests.Conclusionshealth care professionals need to raise awareness of pre-eclampsia in this high risk group. The introduction of a screening test for pre-eclampsia appears to be acceptable in this population, however, further research is required to validate these findings and also to explore the views of women in other high risk groups.     

子宫螺旋动脉重铸与病理妊娠

子宫螺旋动脉重铸是妊娠正常进行的关键环节,绒毛外滋养细胞的增殖和侵袭是血管重铸过程的必要条件。滋养细胞生物学功能的完整和调控机制的协调起着至关重要的作用。滋养细胞浸润不足,栓塞螺旋动脉不彻底,母-胎循环的发生提前,使绒毛受到直接的机械损伤,氧化应激作用间接地造成细胞机能障碍和损伤,出现胎盘退化变性;人肿瘤蛋白p53(TP53)介导细胞通路对细胞周期蛋白依赖性激酶抑制剂1A(CDKN1A)和Bax基因的异常表达,微小RNA-520(miR-520)过度调控滋养细胞的凋亡导致母体出现复发性流产。由滋养细胞分泌产生的基质金属蛋白酶9(MMP-9)的异常表达和大量炎性因子的释放造成了胎盘缺血缺氧,表现出子痫前期的相关症状。胎盘绒毛的血管密度、绒毛间隙体积的降低、滋养细胞分化程度下降、微环境缺氧以及突触缺陷因子1(SYDE1)呈低水平表达,可能是造成胎儿生长受限的重要原因。因此研究螺旋动脉重铸过程对病理妊娠的早期诊治有着重要意义。     

子痫前期孕妇的血清尿酸水平对母胎妊娠结局的预测作用

【摘 要】 目的：探讨子痫前期孕妇分娩前1个月内的血清尿酸水平对预测母胎妊娠结局的价值。方法：选取2014年4月-2015年12月在上海市第六人民医院分娩的152例子痫前期孕妇进行回顾性分析。所有入选者根据子痫前期严重程度、发病孕周分别分为重度组（106例）、非重度组（46例）及早发型组（75例）、晚发型组（77例）。收集孕妇分娩前1个月内的血清尿酸,选取病情最严重时对应的数值;妊娠并发症如胸腹腔积液、肝肾功能不全;围生儿健康指标如新生儿出生体质量、Apgar评分。结果：早发型或重度子痫前期孕妇的血清尿酸水平分别比晚发型或轻度子痫前期孕妇的明显升高（P＜0.01）。通过二分类Logistics回归分析发现：血清尿酸水平升高是子痫前期不良母胎结局的危险因素之一。受试者工作特征（receiver operating characteristic,ROC）曲线进一步表明：血清尿酸水平升高达到388～440 μmol/L,对预测子痫前期不良母胎结局的发生差异有统计学意义（P＜0.01）。结论：血清尿酸水平对评估子痫前期孕妇的不良母胎结局、选择评估终止妊娠时机具有重要的预测价值,需要临床医师予以高度重视。     

蜕膜自然杀伤细胞在妊娠并发症中的作用研究进展

蜕膜自然杀伤（dNK）细胞是存在于母胎界面并与胎儿滋养层细胞密切接触的免疫细胞。dNK细胞可能通过分泌相关细胞因子在母胎耐受、螺旋动脉重铸、血管形成以及妊娠期并发症的发生中发挥重要作用。近年来研究发现dNK细胞与正常妊娠的发生及维持密切相关,并发现妊娠期并发症如复发性自然流产、子痫前期等普遍存在dNK细胞细胞学及免疫学等方面的异常改变。综述近年来dNK细胞的最新研究,包括数量、表型、分泌的相关细胞因子及血管生成因子等,以及dNK细胞在妊娠并发症发病中的可能机制。