孕妇血清AFP、uE3和β-hCG水平与严重胎儿缺陷的关系

①目的 探讨孕中期血清甲胎球蛋白（AFP），游离雌三醇（uF3)和β绒毛膜促性腺激素（β-HCG）水平与严重胎儿缺陷的关系。②方法 用ELISA方法对832例16-21周妊娠妇女血清AFP、UE3和β-hCG进行检测，以筛查阳性病人。③结果 14例胎儿被确诊为异常，其中唐氏综征2例，无脑儿3例，脊柱裂3例，唇腭裂1例，腹裂肠外翻1例，孕中期自然流产2例，死胎1例，葡萄胎1例，总检出率为1.68%，假阳性15例，占被检人数的1.80%。④结论 以上3种生化指标联合检测可作为产前诊断严重胎儿缺陷的有效方法。     

皮肤涂抹雌三醇对裸鼠甲状腺功能和肿瘤影响的效果观察

目的研究经皮涂抹外源性雌三醇(E₃)对裸鼠甲状腺功能及甲状腺移植瘤的影响。方法使用123只4周龄裸鼠,按体质量采用随机数字表法分为9组:①对照组、②低E₃组、③高E₃组、④乳头状甲状腺癌组(PTC组)、⑤乳头状甲状腺癌+高E₃组(PTC+高E₃组)、⑥滤泡状甲状腺癌组(FTC组)、⑦滤泡状甲状腺癌+高E₃组(FTC+高E₃组)、⑧未分化型甲状腺癌组(ATC组)和⑨未分化型甲状腺癌+高E₃组(ATC+高E₃组),均正常饮食饮水。除对照组、PTC组、FTC组和ATC组外,其余5组每日给予皮肤涂抹雌三醇乳膏,低E₃浓度为市售化妆品人均每日使用量中雌三醇含量的25倍、高剂量为100倍。40天后,收集各组裸鼠的24h尿样;尿碘采用砷铈催化分光光度法测定,尿E₃、血清E₃、血清甲状腺激素[游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)]和甲状腺抗体[甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TpoAb)],采用酶联免疫吸附实验[ELISA]测定。在接种肿瘤后的第4日起,每3 d测量肿瘤大小。结果①各组裸鼠血清E₃和尿E₃水平比较差异有统计学意义;其中FTC+高E₃组和ATC+高E₃组的血清E(310.22、14.18 pmol/L)和尿E(36.40、8.18 pmol/L)水平均分别显著低于FTC组和ATC组的血清E(326.52、22.80 pmol/L)和尿E(38.91、11.49 pmol/L)水平;而PTC+高E₃组仅血清E₃水平(12.17 pmol/L)显著低于PTC组(23.05 pmol/L);高E₃组的尿E₃水平显著低于低E₃组(6.92、8.94 pmol/L);低E₃组的尿E₃水平显著高于对照组(8.94、7.17 pmol/L),PTC组、FTC组和ATC组的血清E₃水平显著高于对照组和高E₃组(23.05、26.52、22.80比13.23、14.46 pmol/L)。②各组血清FT3水平比较差异没有统计学意义。各组血清FT4和TSH水平与对照组比较,差异均有统计学意义,其中各实验组的FT4水平均显著低于对照组,TSH水平均显著高于对照组,但PTC组与PTC组+高E₃组、FTC组与FTC+高E₃组、ATC组与ATC+高E₃组分别进行两两比较,FT4和TSH水平并差异无统计学意义。③各组裸鼠血清TgAb和TpoAb水平比较差异均有统计学意义。其中低E₃组、高E₃组、PTC+高E₃组、FTC组、ATC组和ATC+高E₃组的TgAb水平均显著高于对照组;各实验组的TpoAb水平均显著高于对照组。④各组裸鼠尿碘水平比较差异没有统计学意义。⑤各组裸鼠肿瘤体积大小比较差异均有统计学意义,PTC+高E₃组与PTC组比较,在接种肿瘤后的第7 d、16 d、25 d、28 d和37 d,肿瘤体积发生显著性差异(71.54、226.05、730.26、893.34、1242.12比49.87、325.50、551.28、664.38、967.78 mm³);FTC+高E₃组与FTC组比较,在接种肿瘤后的第25 d、28 d、37 d和40 d,肿瘤体积发生显著性差异(392.60、475.70、794.68、943.51比214.82、238.32、422.19、490.00 mm³);ATC+高E₃组与ATC组比较,在接种肿瘤后的第37 d和40 d,肿瘤体积发生显著性差异(217.53、432.10比577.19、1146.66 mm³)。结论外源性雌三醇能够诱导裸鼠发生甲状腺功能减退和抗体水平增高,同时对乳头状甲状腺癌和滤泡状甲状腺癌的生长有着促进作用,对未分化甲状腺癌的生长有抑制作用。     

Second-trimester double or triple screening for Down syndrome: a comparison of Chinese and Caucasian populations.

OBJECTIVES: To compare the performance of double screening (measuring maternal serum levels of alpha-fetoprotein [AFP] and total beta-human chorionic gonadotrophin [hCG] as markers for Down syndrome) with that of triple screening (also measuring levels of unconjugated estriol [uE3]) in the second trimester of pregnancy, and to compare ethnic variance between Chinese and Caucasian populations. METHODS: The study investigated 15096 normal singleton pregnancies and 24 pregnancies affected with Down syndrome. Frequency distributions of AFP, hCG, and uE3 levels were analyzed. Likelihood ratios (LRs) were calculated using the multiple of median value (MoM) of AFP, hCG, and uE3 as variables. After multiplying maternal age risk by the LR values for the markers used in double and triple screening, the specific risks obtained with double and triple screening were estimated. The detection rate (DR) and false-positive rate (FPR) were calculated at different cut-off points. The serum markers' levels were also compared with those of Caucasian women. RESULTS: The median MoM value of hCG was higher in women with affected pregnancies (1.40) than those with unaffected pregnancies (1.00). However, the median MoMs of AFP and uE3 (0.79 and 0.68) were lower in affected than in unaffected pregnancies. At a FPR of 5%, the detection rates reached with double and triple screening were 50% and 66.7%, respectively. Ratios of the 3 serum markers' medians to those in a study with Caucasian women were 1.06 (range=1.04-1.09) for AFP, 1.14 (range=1.10-1.17) for hCG, and 1.28 (range=1.23-1.41) for uE3 for the relevant gestational weeks. CONCLUSION: Triple screening performed better than double screening in the second trimester. Ethnic variance should be taken into account in Down syndrome screening.     

孕中期弓形虫感染对孕鼠血清孕酮及雌三醇含量的影响

目的探讨孕中期弓形虫感染对孕鼠血清孕酮(progesterone)及雌三醇(estriol)含量的影响。方法孕中期BALB/c孕鼠随机分为染虫组和健康对照组,染虫组经腹腔无菌接种纯化的RH强毒株弓形虫速殖子,健康对照组注射等量0.01mol/LPBS。分别于妊娠第10、12、14、16、18d,摘孕鼠眼球取血,经放射免疫法测定血清孕酮和雌三醇含量。结果在孕第10、12、14d,孕鼠血清孕酮和雌三醇含量染虫组与对照组比较差异无统计学意义(P>0.05);在孕第16、18d,两组比较差异有统计学意义(P<0.01)。结论孕中期弓形虫感染可引起孕鼠血清孕酮和雌三醇含量下降,这可能是弓形虫感染致胚胎发育迟缓、胎盘组织炎性病变及滋养层细胞凋亡增加的结果,也可能是胚胎发育迟缓、滋养层细胞凋亡增加的原因。     

米非司酮片配伍欧维婷软膏在绝经后妇女取环中的作用

目的 探讨米非司酮片配伍欧维婷软膏在绝经后妇女取环中的效果。方法 将300例绝经后要求取环的妇女随机分为欧维婷组(实验组一)、欧维婷配伍米非司酮组(实验组二)和米非司酮组(对照组)各100例。实验组一术前7d予以欧维婷软膏0.5g/d,睡前阴道上药;实验组二术前7d予以每日欧维婷软膏0.5g,睡前阴道上药,并于术前3d分别于每日6Am及18Pm各口服米非司酮25mg;对照组仅术前3d在每日6Am及18Pm各口服米非司酮25mg,观察3组术中宫颈软化情况、手术时间、取环成功率、疼痛程度、阴道出血量及药物副反应。结果欧维婷组和欧维婷配伍米非司酮组与单用米非司酮组相比在宫颈软化程度、取环成功率、手术时间、疼痛程度及药物副反应等均有显著性差异(P<0.05)。结论 欧维婷软膏配伍米非司酮片有协同增效作用,应用于绝经后妇女取环安全、有效,成功率高,是一种值得临床推广使用的方法。     

Estriol has different effects from 17β-estradiol in modulating mouse splenocyte function under inflammatory conditions

Estriol (E₃), an endogenous estrogen predominantly produced during human pregnancy, has been suggested to play an important role in modulating the immune system function during pregnancy. The present study sought to investigate the ability of E₃ to alter splenocyte functions in non-immunized naïve BALB/c female mice and also in mice injected with complete Freund’s adjuvant (CFA), and the effect of E₃ was compared with that of 17β-estradiol (E₂). When mice were injected with CFA, their spleen weight index (i.e., wet organ wet/whole body weight) was increased by ~ 300%, but co-administration of E₃ almost completely suppressed splenomegaly. E₃ also reduced cytokine production and reduced ERK and p38 activation in both splenocytes and peritoneal exudate cells from CFA-treated animals. In comparison, while E₂ had a similar but slightly weaker effect than E₃ in reducing splenomegaly, it had a rather different effect from E₃ on cytokine production and ERK activation in splenocytes and peritoneal exudate cells from CFA-treated mice. Under naïve immunological conditions, E₃ and E₂ had very similar effects on splenocyte functions. Both of them transiently increased the percentages of splenic CD4⁺ and CD8⁺ cells. They also increased the proliferation of splenocytes ex vivo, and stimulated production of interferon-γ and interleukin-2. Altogether, these data show that E₃ and E₂ have different effects on splenocyte functions when the animals are under experimentally induced inflammatory conditions.     

高效液相色谱串联质谱法测定血清非结合雌三醇的前处理研究

目的优化高效液相色谱串联质谱法(LC-MS/MS)测定血清游离雌三醇(uE3)的前处理方法。方法以活性炭吸附血清为研究基质,通过加入已知量的雌三醇(E3)标准品及E3-2-3-4-13 C3内标,在LC-20AD XR高效液相色谱系统和API 5500串联四级杆质谱仪上对E3检测的色谱条件、质谱条件及萃取条件等进行优化。结果色谱条件:选用菲罗门Knietex色谱柱(100.0mm×2.1mm,2.6μm);有机相为甲醇,水相为0.1mmol/L氟化铵水溶液,8min梯度洗脱。质谱条件:选用电喷雾(ESI)负离子模式和多反应监测(MRM)模式分析,选择质荷比(m/z)287→m/z 145作为E3的定量离子对,m/z 287→m/z 171作为定性监测离子对;选择m/z 290→m/z 148作为内标的定量离子对,m/z 290→m/z 174作为定性监测的离子对。萃取条件:萃取剂为正己烷/乙酸乙酯(50/50,v/v),样品与萃取剂的比例为1∶2,萃取率可达85.71%。结论 E3检测的色谱条件、质谱条件、萃取条件已得到全面优化,为后续建立LC-MS/MS测定人血中uE3的参考方法打下良好基础。     

游离雌三醇和人胎盘催乳素测定在子痫前期的意义

目的：探讨血清游离雌三醇(uE3)和人胎盘催乳素(hPL)与子痫前期的关系。方法选取2013年6月至2014年6月诊断为子痫前期的孕妇123例纳入观察组,同期健康孕妇150例纳入对照组,两组孕妇均分别在妊娠28~<32周和妊娠32~36周各采血一次,检测血清 uE3和 hPL 水平并进行比较。结果对照组妊娠结局优于观察组。随着孕周增加两组孕妇血清 uE3和 hPL 水平有升高趋势,在相同孕期中对照组血清 uE3和 hPL 水平均较观察组高,差异均有统计学意义(P <0.05)。结论子痫前期孕妇血清 uE3和 hPL 水平下降,与妊娠结局相关。     

Pregnancy estriol,estradiol, progesterone and prolactin in relation to birth weight and other birth size variables (United States)

Objective: Because birth weight has been positively associated with adult life breast cancer risk and pregnancy estrogens have been hypothesized to affect breast cancer risk in the offspring, we have evaluated the association of pregnancy estriol (E3), estradiol (E2), progesterone and prolactin in maternal serum samples collected during the 16th and 27th gestational week with birth size parameters. Methods: Prospective study of 230 Caucasian women who delivered a live singleton after 37–42 weeks of gestation. Results: E3 at the 27th gestational week was significantly positively associated with birth weight, birth length and placental weight. Progesterone at the 27th gestational week was also significantly positively associated with birth weight and placental weight but, after mutual adjustment among the studied pregnancy hormones, these associations weakened considerably. There was also inconsistent evidence that SHBG and prolactin at the 27th gestational week may be respectively positively and inversely related with birth size parameters. Measurements during the 16th gestational week were generally unrelated to birth size parameters. Conclusions: Because E3 is a dominant estrogen during pregnancy, the positive association of it with birth weight allows the use of the latter as a proxy of in utero exposure to estrogens in breast cancer investigations.     

病理性过期妊娠胎盘功能测定的临床意义

目的：研究胎儿过熟综合征（病理性过期妊娠）时母血、脐血及羊水中 Ｆ Ｅ３ 及 Ｈ Ｐ Ｌ 变化的临床意义。方法：采用放射免疫检测方法对 ４０ 例妊娠 ４０ 周后伴胎儿过熟综合征病例及 ４２ 例生理性过期妊娠肘静脉血、脐静脉血及羊水中 Ｆ Ｅ３ 及 Ｈ Ｐ Ｌ 进行检测，同时与５０ 例足月妊娠进行对照。结果：病理性过期妊娠组母血、脐血及羊水中 Ｆ Ｅ３ 浓度显著低于其它组，各样本 Ｈ Ｐ Ｌ 浓度从足月妊娠至病理性过期妊娠急剧下降，各组间有统计学意义。结论： Ｆ Ｅ３ 和 Ｈ Ｐ Ｌ 能准确反映足月妊娠后胎盘功能下降程度，提示病理性过期妊娠时低体重儿发生率高与胎盘 Ｈ Ｐ Ｌ 合成减少有关。