控释地诺前列酮栓在低宫颈评分足月妊娠引产中的应用

地诺前列酮（前列腺素E2，PGE2）阴道控释栓-普贝生自1992年FDA批准用于促宫颈成熟以来在国外临床应用已有多年的经验，国内应用相对较少。为了解普贝生用于足月妊娠引产的有效性及安全性，我院产科对低宫颈评分的单胎足月妊娠孕妇进行了随机前瞻性研究。     

两种雌激素对去卵巢大鼠子宫内膜的影响

目的：探讨戊酸雌二醇和炔雌醇对去卵巢大鼠子宫内膜的作用,为绝经后妇女雌激素补充治疗提供理论依据。方法选用3月龄雌性Sprague-Dawley（ SD）大鼠40只,实验分为Sham组（假手术组）、Ovx组（去卵巢组）、A组（炔雌醇组）、B组（戊酸雌二醇组）。除Sham组外,其余各组均切除双侧卵巢建立骨质疏松动物模型。去势后4周开始A组炔雌醇（0.1 mg·kg-1·d-1）、B组戊酸雌二醇（0.4 mg·kg-1·d-1）灌胃。4组均在90 d对大鼠称重,取大鼠子宫进行称重,子宫内膜行病理切片检查。结果用药12周后各组间大鼠体重无统计学差异。 B 组子宫湿重及子宫指数明显低于A组（P〈0.05）,与Ovx组比较,无显著性差异（P〉0.05）。但A组子宫湿重及子宫指数明显升高,与Ovx组比较差异有统计学意义（P〈0.05）。两组用药组与Ovx组相比均显示子宫内膜增厚,上层单层柱状,肌层肌纤维排列规则一致,浆膜层光滑。 B组可见内膜增厚,但低于A组,两组均未见内膜增生过长、核异性和非典型增生样改变。结论戊酸雌二醇与炔雌醇用于绝经后雌激素补充治疗,虽对子宫内膜均有生长作用,但均未见过度生长及异型性改变。     

母源性抗体及其对新生儿免疫接种的影响

新生儿可通过胎盘获得不同种类的IgG抗体,这些抗体的量及其衰减率因种类不同而存在差异.母源性抗体能保护新生儿和婴幼儿抵御相应病原体的感染,但也严重影响婴幼儿疫苗接种后主动免疫应答,母源性抗体浓度越高,其影响越大.了解母源性抗体对新生儿疫苗接种的影响,有助于母体或新生儿疫苗的研制,对确立有效的免疫方案具有重要的指导意义.     

真两性畸形妊娠足月产病例报告并文献复习

目的探讨真两性畸形的发病机制、临床特点及诊治措施。方法对我院收治的真两性畸形妊娠足月产1例的临床资料进行回顾分析,并复习相关文献。结果患者孕38+4周临产,妇科检查发现外生殖器呈两性畸形,剖宫产娩出一正常男活婴,术中发现右侧卵巢有睾丸样组织,行卵睾切除,术后病理检查提示真两性畸形。染色体核型:46XX。术后6 d痊愈出院。结论临床上对真两性畸形应及时、正确诊断,并进行性别确认,早期手术治疗。     

足月新生儿出生至2岁巨细胞病毒抗体的动态变化

目的:研究足月新生儿巨细胞病毒抗体(antibodies against cytomegalovirus,CMV IgG)的母胎转运和新生儿出生至2岁CMV IgG的动态变化。方法:用固相酶联免疫法定量检测112例单胎足月孕妇及其新生儿脐血的CMV IgG浓度,动态观察41例新生儿1月龄、3.5月龄、8月龄及2岁时体内CMV IgG浓度及IgM的变化。结果:在112例孕妇中108例(96.43%)CMV IgG阳性,其新生儿脐血也阳性;CMV IgG平均浓度新生儿(770.35 IU.ml-1)高于孕妇(654.20 IU.ml-1)(t=5.08,P<0.001);脐血CMV IgG浓度与母体水平呈高度相关(r=0.87,P<0.001)。所有新生儿无CMV感染的临床表现,随访期间也无症状。112例脐血CMV IgM均阴性。41例随访婴儿中,32例(78.05%)8月龄时CMV IgG明显升高,提示CMV感染;其中1月和3.5月龄时分别有4例(13.3%)和21例(70%)CMV IgM转为阳性。另外8例CMV IgG在8月龄时转阴,2岁时仍为阴性;1例CMV IgG阴性母亲分娩的新生儿从出生到2岁时CMV IgG仍为阴性,说明未感染CMV。母源性CMV IgG在新生儿体内半衰期约39 d。结论:母源性CMV IgG可通过胎盘到达胎儿体内;在CMV感染的婴幼儿中,大部分原发感染发生在1～3.5月龄之间,但因存在母源性抗体而无临床表现。     

母源性抗乙型肝炎病毒表面抗原抗体对婴儿乙型肝炎疫苗接种的影响

Objective To investigate whether maternal antibody to hepatitis B surface antigen (anti-HBs)in infants may interfere with the antibody response to hepatitis B vaccine. Methods Infants from singleton pregnant mothers,who delivered at full term at the Affiliated Drum Tower Hospital of Nanjing University Medical School from October 2006 to January 2007,were divided into two groups based on their mothers'status of anti-HBs(43 positive and 29 negative).All infants were vaccinated with hepatitis B vaccine at birth and one month thereafter.Serum anti-HBs were quantitatively determined for the mothers before delivery and for infants in cord blood at delivery and in serum at the age of 1 and 3.5 months. Results Anti-HBs of all 43 newborns in the positive group were positive in cord blood with the coefficiency of 0.98 to the maternal serum anti-HBs level(t=39.05,P<0.01).Forty-two out of the 43 infants remained anti-HBs positive at the age of 1 month.Anti-HBs was negative both at birth and 1 month old in infants of the negative group.However,all infants in both groups were anti-HBs positive at 3.5 months of age,while the average concentration of anti-HBs in infants of the negative group was significantly higher than that of the positive group [(466.9±86.7)mIU/ml vs(151.2±23.1)mIU/ml,t=2.72,P=0.011].Among the 5 infants whose maternal anti-HBs level>1000 mIU/ml,3 did not produce active antibodies against two doses of hepatitis B vaccination. Conclusions Passively acquired maternal anti-HBs in infants can inhibit the active antibody response to hepatitis B vaccine,and the extent of this effect is associated with maternal anti-HBs level.     

母源性抗乙型肝炎病毒表面抗原抗体对婴儿乙型肝炎疫苗接种的影响

Objective To investigate whether maternal antibody to hepatitis B surface antigen (anti-HBs)in infants may interfere with the antibody response to hepatitis B vaccine. Methods Infants from singleton pregnant mothers,who delivered at full term at the Affiliated Drum Tower Hospital of Nanjing University Medical School from October 2006 to January 2007,were divided into two groups based on their mothers'status of anti-HBs(43 positive and 29 negative).All infants were vaccinated with hepatitis B vaccine at birth and one month thereafter.Serum anti-HBs were quantitatively determined for the mothers before delivery and for infants in cord blood at delivery and in serum at the age of 1 and 3.5 months. Results Anti-HBs of all 43 newborns in the positive group were positive in cord blood with the coefficiency of 0.98 to the maternal serum anti-HBs level(t=39.05,P<0.01).Forty-two out of the 43 infants remained anti-HBs positive at the age of 1 month.Anti-HBs was negative both at birth and 1 month old in infants of the negative group.However,all infants in both groups were anti-HBs positive at 3.5 months of age,while the average concentration of anti-HBs in infants of the negative group was significantly higher than that of the positive group [(466.9±86.7)mIU/ml vs(151.2±23.1)mIU/ml,t=2.72,P=0.011].Among the 5 infants whose maternal anti-HBs level>1000 mIU/ml,3 did not produce active antibodies against two doses of hepatitis B vaccination. Conclusions Passively acquired maternal anti-HBs in infants can inhibit the active antibody response to hepatitis B vaccine,and the extent of this effect is associated with maternal anti-HBs level.     

育龄期体检女性脂肪肝发生情况及其对肝功能与血脂影响

目的 探讨育龄期体检女性脂肪肝发生情况及其对肝功能与血脂的影响。方法 选取自2011年1月至2019年12月于南京医科大学附属明基医院体检中心进行体检的97 388例育龄期女性为研究对象。根据超声检查发现有无脂肪肝将其分为脂肪肝组(n=7 654)与非脂肪肝组(n=89 734)。另在非脂肪肝组中选取7 654例育龄期女性设为健康组。记录并比较2011—2019年育龄期女性脂肪肝发生率。比较健康组与脂肪肝组育龄期女性肝功能水平与血脂水平。结果 97 388例育龄期女性中,7 654例超声提示脂肪肝,发生率为7.9%(7 654/97 388)。2011、2012、2013年育龄期女性脂肪肝发生率比较,差异均无统计学意义(P>0.05)。2014—2017年,育龄期女性脂肪肝发生率逐年增加,2018、2019年育龄期女性脂肪肝发生率维持在9.5%。脂肪肝组丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、谷氨酰转移酶、碱性磷酸酶均高于健康组,总胆红素、直接胆红素、白蛋白均低于健康组,差异均有统计学意义(P<0.05)。脂肪肝组甘油三酯、总胆固醇、低密度脂蛋白均高于健康组,高密度脂蛋白低...     

母源性抗乙型肝炎病毒表面抗原抗体对婴儿乙型肝炎疫苗接种的影响

目的 了解母源性抗乙型肝炎病毒表面抗原抗体(anti-hepatitis B surface antigen antibody,抗-HBs抗体)对婴儿乙型肝炎疫苗接种后抗体应答的影响.方法 2006年10月至2007年1月在南京大学医学院附属鼓楼医院产前检查并住院分娩的单胎足月妊娠妇女中,选择抗-HBs抗体阳性孕妇43例(阳性组)和阴性孕妇29例(阴性组),其足月儿出生时和出生后1个月分别接种乙型肝炎疫苗.定量检测孕妇分娩前、脐动脉血及婴儿1月龄和3.5月龄的抗-HBs抗体水平.结果 阳性组43例新生儿脐血抗-HBs抗体也为阳性,与母血清抗体水平的相关系数r=0.98(t=39.05,P<0.01);1月龄时,42例抗体仍阳性.阴性组29例新生儿脐血和1月龄时抗-HBs抗体均阴性.3.5月龄时,两组抗-HBs抗体阳性率均为100%,但阴性组平均抗-HBs抗体浓度高于阳性组[(466.9±86.7)mIU/ml和(151.2±23.1)mIU/ml,t=2.72,P=0.011].母源性抗-HBs抗体>1000 mIU/ml的5例婴儿中,3例在接种2次疫苗后没有产生主动抗体应答.结论 母源性抗-HBs抗体可抑制乙型肝炎疫苗前2次接种后的抗体应答.     

母源性抗-HBs对婴儿乙型肝炎疫苗接种效果的影响

目的 了解母源性抗-HBs对婴儿乙型肝炎疫苗接种后抗体应答的影响.方法 定量检测43例抗-HBs阳性和29例抗-HBs阴性孕妇分娩前及其足月新生儿脐动脉血、第2针乙型肝炎疫苗接种前和接种后2.5个月的抗-HBs水平.结果 43例抗-HBs阳性母亲所生新生儿脐血抗-HBs均阳性,其抗体水平与母体高度正相关(r＝0.98,P＜0.01),1月龄时仍有42例股静脉血抗体阳性;29例抗-HBs阴性母亲的新生儿脐血和1月龄时抗-HBs均阴性.第2针乙型肝炎疫苗接种后2.5个月,两组儿童抗-HBs阳性率均为100%,但母源性抗体阴性组平均抗-HBs活性浓度为163 mIU/ml,明显高于母源性抗体阳性组的94 mIU/ml(P＜0.01);母源性抗-HBs大于1 000 mIU/ml的5名婴儿中,3名在接种第2针疫苗后没有产生主动抗体应答.结论 母源性抗-HBs可抑制乙型肝炎疫苗前两针接种后的抗体应答.