目的:探讨妊娠早期血清学指标糖化血红蛋白(glycohemoglobin,HbA1c)联合妊娠相关血浆蛋白A(pregnancy-associated plasma protein A,PAPP-A)对妊娠期糖尿病(gestational diabetes mellitus,GDM)的预测意义。方法:随机选取2018年12月1日-2019年7月30日孕11~13+6周于我院门诊产检的妊娠妇女,进行临床资料采集并记录妊娠早期(11~13+6周)空腹血糖(fasting plasma glucose,FPG)、HbA1c、PAPP-A中位数倍数(multiple of the median,MoM)水平,根据孕24~28周进行的75 g口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果将研究对象分为研究组和对照组,统计分析妊娠早期血清学指标预测GDM的最佳截断值并得出最适宜的联合预测方案。结果:多因素Logistic回归分析显示,高水平FPG和HbA1c、低水平PAPP-A、受孕方式采用辅助生殖技术、有家族糖尿病史以及妊娠早期体质量指数(BMI)为超重或肥胖均是GDM发生的独立危险因素。有糖尿病家族史和使用辅助生殖技术受孕发生GDM的风险显著增高(OR分别为7.206和47.512,均P<0.001)。分析不同预测指标的受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)显示,PAPP-A MoM联合HbA1c及FPG诊断时AUC最大(0.728),其后依次为PAPPA MoM联合HbA1c(0.721)、HbA1c联合FPG(0.717),均大于HbA1c(0.707)和FPG(0.647),而PAPP-A MoM的AUC为0.380,对GDM没有诊断意义。结论:具有高风险因素的孕妇,推荐在妊娠早期联合检测HbA1c与PAPPA MoM,以早期预测GDM。 相似文献
Objective Endoscopic third ventriculostomy (ETV) is a standard procedure for the treatment of obstructive hydrocephalus in children.
Main part of the procedure is the perforation of the third ventricle floor (tuber cinereum). This structure is part of the
hypothalamic–pituitary neuronal network of cerebral endocrine regulation. There are no systematic data available about the
endocrine status after ETV in children.
Materials and methods We examined 20 children who had undergone ETV. Examination included laboratory tests (adrenocorticotropic hormone, prolactin,
insulin-like growth factor 1 [IGF-1], IGF-binding protein 3 [IGFBP-3], fT3, fT4, thyroid-stimulating hormone [TSH], serum
osmolarity, electrolytes, glucose, urea, follicle-stimulating hormone [FSH] and luteinizing hormone [LH], and testosterone
in selected patients), measurement of weight, height, and head circumference, and physical examination. The study was approved
by the Ethics Committee of the Medical Faculty of Kiel University.
Results In seven patients, prolactin was moderately elevated. One patient demonstrated a significantly increased prolactin (56.3 ng/ml).
In all eight patients, this was the only laboratory value that was out of the normal range; all other parameters were normal.
Three other patients showed one abnormal parameter (decrease in FSH and LH, increase in TSH, decrease in IGF-1 and IGFBP-3).
In nine patients, weight or height was not within the 3rd to 97th centiles for age.
Discussion and conclusion More patients than expected demonstrated endocrine laboratory abnormalities. However, there was no clinical relevance in any
of the studied patients. It remains inconclusive whether ETV contributes to the abnormalities of prolactin levels or to other
endocrine parameters in pediatric patients. Longitudinal studies are necessary to delineate the effect of ETV on endocrine
regulation.
Presented at the Third World Conference of the International Study Group on Neuroendoscopy (ISGNE), Marburg, Germany, 15–18
June 2005. 相似文献
OBJECTIVE: The outcome of immediate repair of obstetric third-degree tears is poorly documented. Immediate repair may give better functional results than delayed repair because scarring is reduced. This aim of this prospective study was to examine the early outcome of immediate repair of third-degree tears. METHOD: A total of 121 women who had immediate repair of obstetric third-degree tears underwent interview, anal ultrasonography and anorectal physiology. RESULTS: At review, 79 (65%) were completely asymptomatic (score = 0), 23 (19%), had minor flatus incontinence or mild urgency causing no compromise to their quality of life (score 1-4), and 19 (16%) had clinically embarrassing faecal incontinence (score 5-24). Thirty-nine (32%) had an intact internal anal sphincter (IAS) and external anal sphincter (EAS) (i.e. a successful repair), eight (7%) had a defect in the IAS alone but the EAS was intact (i.e. a successful repair but a residual IAS defect), 43 (35%) had a residual defect in the EAS alone (IAS intact) and 31 (26%) had a persistent defect in the IAS and EAS. Residual defects in either or both of the sphincters were associated with a significantly higher incidence of abnormal resting and squeeze anal pressures. Anal manometry had no correlation with symptoms. The highest proportion of severe incontinence was in those with an IAS defect alone (37%) and when there was a residual IAS and EAS defect (24%). Only 2 of 39 (5%) with an intact IAS and EAS had severe incontinence and only 8 of 43 (18%) with a residual EAS defect alone had severe faecal incontinence. CONCLUSION: These results indicate a good outcome following immediate repair of third-degree obstetric tears and emphasize the role of the IAS in providing continence. 相似文献
Background Although there have been reports dealing with ventricular diverticulum (VD) analyzed by cisternography and computed tomography
(CT), those focusing on magnetic resonance imaging (MRI) or neuroendoscopic findings are rare.
Case report We present a case of noncommunicating hydrocephalus caused by aqueductal stenosis with cystic lesion located in supracerebellar
region. Third ventriculostomy was performed on this case. The conventional CT and MRI were compatible with usual VD, but neuroendoscopic
examination suggested otherwise. The endoscopic view inside of the cystic lesion demonstrated passing veins and no membrane.
We diagnosed this cystic lesion as a unique subtype of advanced VD mimicking spontaneous ventriculostomy. Endoscopic observation
of the cyst was very useful for accurate diagnosis and safe treatment. 相似文献
This open multicenter study was performed in 20 hospital gynecological units in the UK. The effects of 600 mg oral mifepristone as pretreatment to vaginal prostaglandin induction of second second trimester abortion was studied in 267 women.
The primary efficacy variable was the abortion induction interval, defined as the time taken to expel the fetus from the time of administration of the first prostaglandin pessary. Induction was commenced 36 to 48 hours following mifepristone intake.
The mean abortion induction interval was 7 h. A total of 81.9% of women aborted within 12 h. There was a significant relationship between abortion induction interval and age of gestation, and a significant inverse relationship between abortion induction interval and parity.
Vomiting, pelvic pain, and nausea were the most frequently reported adverse events. Two patients required transfusion and one patient with a uterine scar from a previous cesarean section suffered a ruptured uterus and hysterotomy. 相似文献