100例IUGR胎儿小脑横径超声测量的价值探讨

本文对１００例临床诊断为ＩＵＧＲ（３０～４０周）的胎儿进行超声测量小脑横径（ＣＤ）、双顶径（ＢＰＤ）和股骨长（ＦＬ），用统计分析得出：ＣＤ、ＢＰＤ和ＦＬ与胎龄的相关系数分别为ｒ＝０．９３１０，ｒ＝６３１６和ｒ＝０．５９８６（Ｐ＜０．０１）。ＣＤ与孕周的相关最密切，其回归方程为ｙ＝８．７９８３＋０．６１１０ｘ（ｘ为ＣＤ，ｙ为孕周）。经临床验证表明：７５％的病例绝对误差在１～６天之间，２５％的病例绝对误差在７～１０天之间。     

老年女性动脉粥样硬化性血栓性脑梗死患者性激素及血脂变化的研究

目的：研究老年女性动脉粥样硬化性血栓性脑梗死（ＡＴＣＩ）患者体内性激素与血脂的变化规律。方法：测定４６例老年女性ＡＴＣＩ患者（Ａ组）、４３例老年健康女性（Ｂ组）和４１例正常育龄行经的年轻健康女性（Ｃ组）的血清雌二醇（Ｅ２）、促卵泡刺激素（ＦＳＨ）和促黄体生成素（ＬＨ）;同时测定了血浆总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬＣ）及高密度脂蛋白胆固醇（ＨＤＬＣ）。结果：Ａ组与Ｂ组、Ｃ组比较显示,Ｅ２、ＨＤＬＣ水平显著降低,ＦＳＨ、ＬＨ、ＴＣ、ＴＧ和ＬＤＬＣ水平则显著增高（Ｐ均＜０．０１）。线性相关分析,Ｅ２与ＦＳＨ、ＬＨ、ＴＣ、ＴＧ、ＬＤＬＣ水平呈显著负相关,而与ＨＤＬＣ水平呈显著正相关。结论：老年女性ＡＴＣＩ患者存在着严重的性激素失调及脂代谢异常,可能为老年女性ＡＴＣＩ患者发病的原因之一     

关于医学名词英文缩写的启事

ＡＣＴＨ促肾上腺皮质激素Ａ／Ｇ白蛋白／球蛋白比值ＡＬＴ丙氨酸转氨酶ＡＳＴ天冬氨酸转氨酶Ｃｃｒ肌酐清除率ＣＯＰＤ慢性阻塞性肺疾病ＣＴ计算机Ｘ线体层扫描ＤＩＣ弥散性血管内凝血ＤＮＡ脱氧核糖核酸ＨＢｃＡｂ乙型肝炎核心抗体ＨＢｅＡｂ乙型肝炎ｅ抗体ＨＢｅＡｇ乙型肝炎ｅ抗原ＨＢｓＡｂ乙型肝炎表面抗体ＨＢｓＡｇ乙型肝炎表面抗原ＨＤＬＣ高密度脂蛋白胆固醇Ｉｇ免疫球蛋白ＬＤＬＣ低密度脂蛋白胆固醇ＭｃＡｂ单克隆抗体ＯＴ旧结核菌素试验ＰＣＲ聚合酶链反应ＰＥＴ正电子发射断层扫描ＲＦ类风湿因子ＳＬＥ系统性红斑狼疮ＳＰＥＣ…     

B超诊断胎儿第四脑室脑积水1例

Ｂ超诊断胎儿第四脑室脑积水１例林路明①孕妇２５岁，孕２产０，现孕３２Ｗ。经Ｂ超检查：宫内胎儿臀位，ＢＰＤ：８．６ｃｍ、ＨＣ３１．０ｃｍ、ＡＣ２８．８ｃｍ、ＨＣ／ＡＣ１．０８、ＦＬ５．２ｃｍ，胎儿脊柱排列整齐。羊水深度６．５ｃｍ、羊水清，ＨＲ２０９次／...     

颅脑损伤患者血清和脑脊液中髓鞘碱性蛋白含量变化及其意义

目的：探讨颅脑损伤患者血清和脑脊液（ＣＳＦ）中髓鞘碱性蛋白（ＭＢＰ）含量变化及其与脑损伤的关系。方法：应用５１４ＭＣ酶标仪，采用酶联免疫吸附法分别测定弥漫性轴索损伤（ＤＡＩ）、颅内血肿（ＩＣＨ）和硬膜外血肿（ＥＤＨ）共６０例颅脑损伤患者（病例组）的血清和ＣＳＦ中ＭＢＰ含量，并与同期腰椎麻醉手术的２０例非脑损伤患者（对照组）作对比。结果：病例组患者血清和ＣＳＦ中ＭＢＰ含量均高于对照组；ＤＡＩ组ＣＳＦ中ＭＢＰ含量与ＩＣＨ组间无显著性差异（Ｐ＞０．０５），但２组间血清ＭＢＰ含量差异显著（Ｐ＜０．０１）；ＥＤＨ组ＣＳＦ和血清ＭＢＰ含量均低于ＤＡＩ组和ＩＣＨ组（Ｐ均＜０．０１），但稍高于对照组（Ｐ＜０．０１，Ｐ＞０．０５）。结论：重型颅脑损伤患者血清和ＣＳＦ中ＭＢＰ含量增高，其上升水平与脑损伤类型及损伤程度有关。     

不同程度冠脉狭窄时血脂、载脂蛋白及纤维蛋白原与红细胞变形性、聚集性的关系

按冠脉主要分支最大狭窄程度不同将冠心病（ＣＨＤ）分为明显狭窄 组（ＯＳ）和杉反狭且（ＭＳ），探讨血脂（ＣＨ、Ｔ Ｇ、ＨＤＬ－ｃｈ）、载脂蛋白（ａｐｏＡＩ、 ａｂｏＢ）及纤维蛋白原（Ｆｇ）对红细胞流变特性的作用。结呆显示：ＣＨＤ两组的红细 胞集率升高与Ｆｇ相关；ＴＧ可能是影响红细胞变形指数（ＤＩ）重要因素之一。随冠 脉狭窄程度加重，ＨＤＬ－ｃｈ、ａｐｏＡＩ、ａｐｏＢ对红细胞流变特性的影响也发生变化。     

关于医学名词英文缩写的启事

ＡＣＴＨ促肾上腺皮质激素Ａ／Ｇ白蛋白／球蛋白比值ＡＬＴ丙氨酸转氨酶ＡＳＴ天冬氨酸转氨酶Ｃｃｒ肌酐清除率ＣＯＰＤ慢性阻塞性肺疾病ＣＴ计算机Ｘ线体层扫描ＤＩＣ弥散性血管内凝血ＤＮＡ脱氧核糖核酸ＨＢｃＡｂ乙型肝炎核心抗体ＨＢｅＡｂ乙型肝炎ｅ抗体ＨＢｅＡｇ乙型肝炎ｅ抗原ＨＢｓＡｂ乙型肝炎表面抗体ＨＢｓＡｇ乙型肝炎表面抗原ＨＤＬＣ高密度脂蛋白胆固醇Ｉｇ免疫球蛋白ＬＤＬＣ低密度脂蛋白胆固醇ＭｃＡｂ单克隆抗体ＯＴ旧结核菌素试验ＰＣＲ聚合酶链反应ＰＥＴ正电子发射断层扫描ＲＦ类风湿因子ＳＬＥ系统性红斑狼疮ＳＰＥＣ…     

ROC曲线评价血清脂类在冠心病及脑血管病患者中的检测意义

测定了６０以上健康老年人６８例，２８例冠心病（ＣＨＤ）和２６例脑血管病（ＣＶＤ）患者血清ＴＧ、ＴＣ、ＨＤＬ－Ｃｈ、ＡｐｏＡＩ、ＡｐｏＢ、Ｌｐ（ａ）、ＬＤＬ－Ｃｈ／ＨＤＬ－Ｃｈ（Ｌ／Ｈ）、ＡｐｏＢ／ＡｐｏＡＩ（Ｂ／Ａ）等九项脂类指标。应用ＲＯＣ曲线对其在ＣＨＤ和ＣＶＤ中的检测意义进行评估。筛选出ＣＨＤ的优选检测指标依次为Ｂ／Ａ〉ＡｐｏＢ〉Ｌｐ（ａ）〉ＡｐｏＡＩ〉ＴＧ；ＣＶＤ的优选指标依次为Ｂ／Ａ〉Ｈ     

关于医学名词英文缩写的启事

ＡＣＴＨ促肾上腺皮质激素Ａ／Ｇ白蛋白／球蛋白比值ＡＬＴ丙氨酸转氨酶ＡＳＴ天冬氨酸转氨酶Ｃｃｒ肌酐清除率ＣＯＰＤ慢性阻塞性肺疾病ＣＴ计算机Ｘ线体层扫描ＤＩＣ弥散性血管内凝血ＤＮＡ脱氧核糖核酸ＨＢｃＡｂ乙型肝炎核心抗体ＨＢｅＡｂ乙型肝炎ｅ抗体ＨＢｅＡｇ乙型肝炎ｅ抗原ＨＢｓＡｂ乙型肝炎表面抗体ＨＢｓＡｇ乙型肝炎表面抗原ＨＤＬＣ高密度脂蛋白胆固醇Ｉｇ免疫球蛋白ＬＤＬＣ低密度脂蛋白胆固醇ＭｃＡｂ单克隆抗体ＯＴ旧结核菌素试验ＰＣＲ聚合酶链反应ＰＥＴ正电子发射断层扫描ＲＦ类风湿因子ＳＬＥ系统性红斑狼疮ＳＰ…     

彩色超声多普勒及OXLDL检查联合诊断颈动脉粥样硬化病变的价值

目的研究彩色超声多普勒（ＣＤＦＩ）及血浆ＯＸＬＤＬ水平在诊断颈动脉粥样硬化（ＣＡＳ）病变中的价值。方法应用ＣＤＦＩ检查１６８例颈动脉（ＣＡ）,以ＣＡ内膜厚度、斑块情况、狭窄程度的超声分级和病理学分型作为评价ＣＡＳ硬化程度的指标。从中筛选出６６例,分为ＣＡＳ组和正常对照组,进行血脂、低密度脂蛋白（ＬＤＬ）及氧化修饰型ＬＤＬ（ＯＸＬＤＬ）水平测定。ＣＡＳ组再分为糖尿病ＤＭ（＋）和ＤＭ（－）组。将所有结果逐一对比分析。结果ＣＤＦＩ检出阳性患者１２５例。ＣＡＳ组ＯＸＬＤＬ水平明显高于对照组（Ｐ＜０００１）,具有显著性差异;ＤＭ（＋）组显著高于ＤＭ（一）组（Ｐ＜００５）。分析表明血浆ＯＸＬＤＬ水平增高是致ＡＳ的危险因素之一。超声检查能发现早期临床无症状的ＣＡＳ,并能够提示ＣＡＳ斑块造成ＣＡ狭窄程度。结论ＣＤＦＩ与ＯＸＬＤＬ检查联合应用可为预防ＣＡＳ的形成,早期发现及治疗提供可靠的依据。     

Determination of gestational age after the 24th week of gestation from fetal kidney length measurements.

OBJECTIVE: To evaluate the application of kidney length measurement to the determination of gestational age between the 24th and 38th weeks and to compare its accuracy with that of other fetal biometric indices. STUDY DESIGN: Seventy-three women with singleton uncomplicated pregnancies underwent standard ultrasound fetal biometry and kidney length measurement every 2 weeks between 24 and 38 weeks' gestation. These measurements were used to date the pregnancies relative to crown-rump length dating between 8 and 10 weeks' gestation. Linear regression models for estimation of gestational age were derived from the biometric indices and kidney length. In addition, stepwise regression models were constructed to determine the best model for determining gestational age between 24 and 38 weeks. Comparisons were then made between the accuracy of these models in the determination of gestational age. RESULTS: The best model for estimating gestational age in late pregnancy included the variables kidney length, biparietal diameter, head circumference, femur length and abdominal circumference. This model accurately predicted gestational age with a standard error of +/- 8.48 days. A model including kidney length, biparietal diameter, head circumference and femur length accurately predicted gestational age with a standard error of +/- 8.57 days. These models were slightly more accurate than models derived from the biometric indices of biparietal diameter, head circumference and femur length (+/- 9.87 days), biparietal diameter, head circumference, femur length and abdominal circumference (+/- 9.45 days) and biparietal diameter and femur length (+/- 9.9 days). Kidney length and femur length were the most accurate single parameters for predicting gestational age using simple linear regression models (+/- 10.29 and 10.96 days, respectively); the abdominal circumference was the least accurate (+/- 14.54 days). CONCLUSION: Kidney length is a more accurate method of determining gestational age than the fetal biometric indices of biparietal diameter, head circumference, femur length and abdominal circumference between 24 and 38 weeks' gestation. When combined with biparietal diameter, head circumference and femur length, the precision of dating is improved by 2 days. This measurement is easy to make and could therefore be easily incorporated into the model for dating pregnancies after 24 weeks of gestation, in particular when measurements of the biparietal diameter and head circumference are difficult.     

Fetal transverse cerebellar diameter measurements in normal and reduced fetal growth.

OBJECTIVES: To establish the increase in fetal transverse cerebellar diameter (TCD) relative to gestational age during normal and restricted fetal growth; to determine the significance of TCD and TCD/AC relationship in predicting fetal outcome as expressed by perinatal mortality. DESIGN: A retrospective cross-sectional study. SUBJECTS: Three hundred and sixty normally developing fetuses between 17 and 34 weeks of gestation and 73 growth-restricted fetuses between 24 and 34 weeks of gestation. METHODS: Ultrasonographic measurements included head circumference (mm), abdominal circumference (mm) and transverse cerebellar diameter (mm). A gestational age-related normal reference chart was produced for TCD. RESULTS: Statistically significant relationships between transverse cerebellar diameter and gestational age, abdominal circumference and head circumference were found. The normal fetal TCD exhibited a more than twofold increase in size during the second half of pregnancy. Twenty-six per cent of the small-for-gestational age (SGA) fetuses displayed a reduced TCD and 82% of the SGA fetuses demonstrated raised TCD/AC values. No statistically significant difference in perinatal mortality or birth weight was found between the subsets of growth-restricted fetuses with reduced or normal TCD; or between the subsets with normal or raised TCD/AC values. CONCLUSIONS: In the normally developing fetus the TCD increases with advancing gestational age. Increased TCD/AC values are suspicious of fetal growth restriction. The perinatal mortality in growth-restricted fetuses with a small cerebellum is increased twofold over that of other fetuses.     

Evaluation of pulsatility index nomograms based on fetal biometry in small for gestational age fetuses.

Reference limits for the PI from the umbilical, middle cerebral, and renal arteries were constructed using BPD, AC, FL, and transverse cerebellar diameter as independent variables and their efficacy tested in a population of SGA fetuses. Therefore, 153 normal fetuses and 90 SGA fetuses with established dates between 20 and 40 weeks of gestation were considered. Normal fetuses showed a linear negative relationship between the PI from all the vessels investigated and all the biometric parameters considered. Although the BPD related better with the PI from the umbilical artery (r = 0.646) and the renal artery (r = 0.765) and the transverse cerebellar diameter related better with middle cerebral artery PI values (r = 0.510), no evident differences in fitting were found among the variables tested. In SGA fetuses the nomograms on BPD, AC, and FL significantly underestimated PI values in all the vessels studied when compared to the nomograms based on gestational age, while a similar ability in identifying abnormal PI values was found for nomograms based on gestational age and transverse cerebellar diameter. These newly developed nomograms based on transverse cerebellar diameter may prove useful in the evaluation of Doppler indices of fetuses with uncertain gestational age.     

Assessment of fetal cerebellar volume using three-dimensional ultrasound

The purposes of this study were to assess the fetal cerebellar volume during normal gestation using three-dimensional (3-D) ultrasound (US) and to establish a normal chart of fetal cerebellar volume using Altman's model of statistics. In total, 231 healthy fetuses were studied for assessment of cerebellar volume using a 3-D US volume scanner. The fetuses to be studied were selected to give a cross-sectional series (i.e., each fetus was examined only once). Polynomial regression analysis was calculated to find the best-fit model using gestational age as the independent variable and cerebellar volume as the dependent variable. Altman's model was used to calculate the age-related reference centiles for the variance of cerebellar volume. In addition, common fetal growth indices, such as biparietal diameter, occipitofrontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight, were also measured for the correlation between cerebellar volume and these indices. Our results indicated that the fetal cerebellar volume was highly correlated with gestational age in normal pregnancies with the best-fit polynomial regression equation of a second-order (r = 0.91, p < 0.0001). In addition, fetal cerebellar volume in normal gestation is also highly correlated with common fetal growth indices, such as biparietal diameter, occipitofrontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight (all p < 0.0001). Following the Altman's model, a normal growth chart of fetal cerebellar volume was established for clinical reference. In conclusion, with 3-D US, the assessment of fetal cerebellar volume becomes feasible. We believe that fetal cerebellar volume assessed by 3-D US may be useful in detecting cerebellar hypoplasia and relevant syndromes prenatally.     

Growth of the fetal gall bladder in normal pregnancies.

Our objective was to obtain dimensions of the fetal gall bladder as a basis, for further studies and to establish normative data to assess deviations in growth. The study group included 183 normal pregnant women from 13 to 40 weeks' gestation. Routine biometric measurements were obtained on all fetuses, including biparietal diameter, head and abdominal circumferences and measurements of the long bones and the two diameters of the fetal gull bladder. The gall bladder area and circumference were calculated for each gestational age.A linear growth function was observed across the gestational age and a first-degree correlation was found to exist between gestational age and both the longitudinal (r = 0.77067; p < 0.00001; y = -0.41060 + 0.0907 x gestational age) and transverse (r = 0.602; p < 0.00001; y = 0.58567 + 0.01925 x gestational age) diameters of the fetal gall bladder. A significant correlation was also found between gull bladder area and gestational age (r = 0.6878; p < 0.00001), biparietal diameter (r = 0.72768; p < 0.00001), abdominal circumference (r = 0.71363; p < 0.00001) and femoral length (r = 0.72190; p < 0.00001). In addition, a significant correlation was found between gall bladder circumference and gestational age (r = 0.76181; p < 0.00001), biparietal diameter (r = 0.80039; p < 0.00001), abdominal circumference (r = 0.78030; p < 0.00001) and femoral length (r = 0.79694; p < 0.00001).These results provide normative data of the fetal gall bladder in various dimensions and across gestational age. In addition, the data offer the potential for prenatal diagnosis of additional lesions in the extrahepatic biliary duct system.     

Transverse cerebellar diameter in small-for-gestational-age fetuses: pregnancy dating is possible only when growth retardation is secondary to uteroplacental insufficiency.

The objective of this study was to establish whether measurement of the transverse cerebellar diameter to determine gestational age differs in small-for-gestational-age fetuses with normal or abnormal Doppler velocity waveforms. Our secondary objective was to compare the efficacy of measurement of transverse cerebellar diameter with that of femur length in pregnancy dating among small-for-gestational-age fetuses. A total of 107 small-for-gestational-age fetuses with established dates and free from structural and chromosomal abnormalities were considered for this study. According to the Doppler results, fetuses were divided into two groups: group A (n = 64), with normal Doppler values as expressed by a ratio of pulsatility indices between the umbilical artery and middle cerebral artery of 95th centile. Measurements of transverse cerebellar diameter and femur length were compared to previously established 95th centile prediction intervals.In both groups of small-for-gestational-age fetuses, the values for transverse cerebellar diameter were lower than in normally grown fetuses after normalization for gestational age. The difference was more evident in group A (p 相似文献   

The fetal cerebellar vermis: anatomy and biometric assessment using volume contrast imaging in the C-plane (VCI-C).

OBJECTIVES: To describe the normal appearance and study the biometry of the fetal cerebellar vermis by three-dimensional (3D) volume contrast imaging in the coronal (C-) plane (VCI-C). METHODS: A total of 203 normally developed fetuses were examined prospectively at 18-33 weeks' gestation. At the level of the view used to measure the transverse cerebellar diameter (TCD), a VCI-C plane was displayed to examine, using a transabdominal probe, the fetal mid-saggital vermis. The volumes acquired were stored for later review and measurement of the anteroposterior (AP) diameter, craniocaudal (CC) diameter and surface area of the cerebellar vermis. Each dataset was evaluated by two independent observers. Measurements as a function of gestational age (GA), biparietal diameter (BPD), head circumference (HC) and TCD were expressed by regression equations. Interobserver variability was evaluated. Nomograms were produced. In order to validate the use of VCI in fetal biometry, datasets from 57 patients were selected arbitrarily for comparison of their VCI-C measurements with those from mid-sagittal sections of a stored 3D multiplanar examination. Intraclass correlation was used to evaluate the agreement between these measurements. RESULTS: The mean maternal age was 32 years. We were able to measure mid-sagittal CC diameter, mid-sagittal AP diameter and cerebellar vermis surface area in all fetuses. Interobserver variability analysis showed no significant differences between the two observers (P > 0.05). Measurements of the cerebellar vermis (AP diameter, CC diameter and surface area) correlated linearly with GA, BPD, HC and TCD (r > or = 0.82, P < 0.0001). CC and AP diameters estimated from the mid-sagittal section of the multiplanar measurements were significantly correlated with VCI-C measurements (r = 0.96, P < 0.00001 and r = 0.95, P < 0.00001, respectively). CONCLUSIONS: VCI-C is a valuable tool, allowing intrauterine assessment of the normal appearance of the fetal cerebellar vermis. The nomograms developed in this study should enable accurate evaluation of the cerebellar vermis.     

三维超声扩展成像检测胎儿小脑蚓部发育的研究

目的 应用三维经腹超声检测胎儿小脑蚓部的发育,为产前筛查胎小儿脑蚓部发育异常提供依据.方法 选择于我院行产前超声检查的孕20～36周正常胎儿共387例.应用经腹三维超声扩展成像技术观察胎儿小脑蚓部发育规律,测量蚓部横径、前后径、上下径,上下蚓部面积之比,蚓部与脑干之间的夹角,并分析它们与孕周的关系.结果 应用经腹三维超声扩展成像多切面同屏显示模式和三维重建矢状切面可以评价蚓部形态的完整性和大小,识别蚓部特征性标志:第四脑室顶点和蚓部裂.正常蚓部与脑干之间几乎平行,夹角随着孕周无明显变化,均值为3.97°±1.65°.上下蚓部面积之比随着孕周无明显变化,均值为0.76±0.06.小脑蚓部横径、前后径、上下径均与孕周呈正相关.结论 应用三维扩展成像多切面同屏显示模式和三维重建矢状切面有助于观察小脑蚓部发育情况,显示小脑蚓部与脑干周围关系,为评价胎小儿脑蚓部的发育提供了新的思路.     

超声测量晚孕期正常双胎生长参数的初步分析

目的拟初步建立孕28-34周的双胎胎儿生长参数超声测量值的正常范围,比较晚孕期单、双胎妊娠胎儿的宫内生长发育模式。方法对2009年5月一2010年4月超声诊断为正常宫内双活胎、单活胎孕妇,采用超声测量胎儿相关生长发育指标,包括双顶径、头围、腹围、股骨长等,测量其中部分双胎的小脑横径并应用虚拟器官计算机辅助分析技术测量其小脑容积,比较晚孕期单、双胎胎儿生长发育的差异。结果①自妊娠30周以后,双胎胎儿的双顶径发育速度比单胎胎儿延缓,单、双胎胎儿平均每周增长分别约2．3、1．7mini②自妊娠32周以后,双胎胎儿的头围的发育速度比单胎胎儿延缓,单、双胎胎儿平均每周增长分别约6．7、5．8Inrn;③自妊娠30周以后,双胎胎儿的腹围的发育速度比单胎胎儿延缓,单、双胎胎儿平均每周增长分别约6．9、5．3mm;④双胎胎儿股骨长从孕28～34周发育速度均较单胎胎儿缓慢,单、双胎胎儿平均每周增长分别约2．0、1．7mml⑤多元分析孕28－34周的双胎胎儿双顶径、头围、腹围和股骨长,相对于单胎胎儿而言,自28周起,双胎妊娠胎儿的生长发育较延缓;⑥自孕28～34周,双胎胎儿小脑横径、小脑容积与单胎胎儿无明显差异。结论双胎妊娠胎儿与单胎妊娠胎儿在晚孕期有着不同的生长发育规律。