重度子痫前期和子痫患者39例的护理

回顾分析39例子痫前期和子痫患者的临床资料、抢救及护理体会，提出加强农村围产期孕妇宣教保健工作是预防重度妊高征的关键，提高护士的抢救技术及加强基础护理对确保母婴的抢救成功非常重要。     

脂代谢相关基因ADRP和LPL在子痫前期胎盘组织表达的改变

目的:研究子痫前期患者胎盘组织中脂代谢相关基因的表达,探讨子痫前期脂肪代谢紊乱的可能原因。方法:利用基因芯片检查4例子痫前期胎盘与4例正常胎盘之间的差异表达基因;采用半定量RT-PCR方法验证子痫前期胎盘组织(研究组)和正常孕妇胎盘组织(对照组)脂代谢相关基因脂肪分化相关蛋白(ADRP)基因和脂蛋白脂酶(LPL)基因mRNA的表达改变。结果:在4轮杂交过程中,共筛选出22条有差异表达的基因,其中表达增高的基因有脂肪分化相关蛋白基因(NM-001122)等13条;表达降低的基因有脂蛋白脂酶基因(NMM-000237)等9条。研究组ADRPmRNA相对表达水平为1·98±0·50,显著高于对照组的1·09±0·20(P<0·01);研究组LPLmRNA相对表达水平为0208±0·067,显著低于对照组的0·524±0·139(P<0·05)。结论:脂代谢相关基因ADRP和LPL在子痫前期胎盘组织的异常表达可能是导致子痫前期发病的原因之一。     

重度子痫前期诊断标准临床意义探讨

目的 从临床实践方面进一步探讨我国最近制定的妊娠期高血压疾病重度子痢前期诊断分类标准的临床意义。方法 收集我院1992年1月至2003年12月诊治的妊娠期高血压疾病493例，其中1992年1月至1997年12月6年内按重度妊高征诊断标准诊断的病例73例(A组)，1998年1月至2003年12月6年内按重度子痫前期诊断标准判断的病例119例(B组)：分析493例按我国过去沿用的妊高征分类标准诊断的各类妊高征患者中有关脏器损害的临床症状及体征的发生率，并比较A、B两组不同标准判断的重度子痈前期的母婴预后。结果 重度妊高征中各项有关脏器损害临床表现的发生率较高，中度妊高征亦有一定的发生率，但较重度妊高征低：B组低体重儿、新生儿窒息、严重并发症及子痫的发生率均较A组低，两组比较差异有显著性意义，两组围生儿死亡率比较差异无统计学意义。结论 我国目前参照世界卫生组织通用标准提出的妊娠期高血压疾病重度子痫前期分类诊断标准体现了有关脏器损害的程度，有一定客观依据和临床价值。包括了过去旧的分类诊断方法中的重度妊高征和部分中度妊高征患者，有利于妊娠期高血压疾病的防治，减少不良妊娠结局。     

重度子痫前期母血FNRBC水平与红细胞免疫黏附调节因子活性的关系

目的:探讨重度子痫前期孕妇外周血胎儿有核红细胞(FNRBC)水平及其红细胞免疫黏附(RCIA)调节因子活性的变化及相关性.方法:采用病例对照研究方法,选择重度子痫前期孕妇34例为研究组,同期18例正常孕妇为对照组,采用单密度梯度离心法,富集计算FNRBC数量;同时采用ELISA法测定孕妇血清RCIA促进因子和抑制因子活性及红细胞受体花环率(RBC-C3bRR)和红细胞免疫复合物花环率(RBC-ICR),分析指标变化及相关性.结果:研究组孕妇外血中FNRBC数量较对照组显著升高(P<0.05);研究组RBC.C3bR花环促进率(RFER)与对照组相比差异无统计学意义(P>0.05),而RBC-C3bR花环抑制率(RFIR)明显高于对照组(P<0.05);研究组RBC-C3bRR明显低于对照组(P<0.05),而RBC-ICR则明显高于对照组(P<0.05).研究组FNRBC水平与RBC.C3bRR呈负相关(r=-0.568,P<0.05)、而与RFIR、RBC-ICR呈正相关(r=0.673,P<0.05;r=0.712,P<0.05).结论:重度子痫前期孕妇外周血中FNRBC数量增多能引起患者红细胞免疫黏附抑制因子活性增加,红细胞免疫功能低下,胎儿物质向母血的渗漏增多,机体免疫调控失衡和紊乱,均可能是重度子痫前期免疫学发病机制中的重要环节.     

不同亚型子痫前期患者母儿结局分析

目的分析不同亚型子痫前期患者的母儿结局。 方法回顾性分析2009年1月1日至2019年12月31日在广州医科大学附属第三医院分娩的2960例单胎子痫前期患者早产组与足月产组、早发型组与晚发型组的临床资料及母儿结局。 结果(1)母亲结局：①早产组与足月产组剖宫产率分别为(80.85% vs 61.67%, χ²＝1.327)、入住重症监护病房率(11.84% vs 2.25%, χ²＝86.844)，P值均<0.05；②早发型与晚发型剖宫产率分别为(77.61% vs 70.30%, χ²＝1.327，P<0.05)、入住重症监护病房率(13.00% vs 4.55%, χ²＝69.158，P<0.05)。(2)新生儿结局：①早产组与足月产组在新生儿出生平均体重[(1472.19±673.50)g与(3067.49±523.92)g，Z＝-42.4]，活产比例(81.35% vs 99.31%, χ²＝2.204)，新生儿窒息率(6.39% vs 0.79%, χ²＝53.51)P均<0.05。②早发型组与晚发型组新生儿出生体重[(1169.53±482.39)g vs(2765.37±683.22)g，Z＝-43.895]，活产比例(74.64% vs 98.31%, χ²＝3.926)，新生儿窒息率(8.71% vs 1.31%, χ²＝86.82)，差异均有统计学意义(P<0.05)。 结论子痫前期患者早产组与足月产组相比，早产组母体及新生儿结局均较差。早发型与晚发型子痫前期相比，早发型母儿结局均较差。     

子痫前期患者血中循环内皮祖细胞数量改变的研究

目的:探讨子痫前期患者与正常同孕周的妇女外周血中内皮祖细胞数量的变化.方法:选择30例子痫前期患者为子痫前期组,30例相同孕周的妇女为对照组,采用Beckman-Coulter Epics XL型流式细胞仪检测两组孕妇外周血中循环内皮祖细胞表达情况.结果:子痫前期组CD34+/CD45+和CD62P+总数占外周有核细胞总数的百分比,明显高于正常相同孕周的妇女,两组比较差异有统计学意义(P＜0.05).结论:子痫前期的发病机制可能与内皮祖细胞数量的改变有关.     

子痫前期的营养管理

子痫前期病因不明,孕期营养在降低子痫前期发病中的作用备受关注。早期防控有利于控制风险,改善母婴预后,产前施行营养干预和评估,保证其孕期各营养物质合理、足量的摄入,对预防子痫前期的发生具有重要临床意义,有待进一步的研究提供更多的证据。     

可溶性CD105与子痫前期

可溶性CD105（sCD105）是一种存在于血液中分子质量为65ku的蛋白质,氨基酸序列对应于CD105蛋白氨基端的可溶性结构,可能是CD105经酶解脱落而成。子痫前期患者循环sCD105显著增高,而且sCD105增高发生在出现子痫前期临床症状前6～10周,其水平与子痫前期发病妊娠周及病情相关。在体外,sCD105可抑制转化生长因子β1（TGF-β1）诱导的人脐静脉内皮细胞的血管生成作用。注射载有sCD105基因的腺病毒可引起小鼠血管通透性增高,导致血管内皮细胞受损,并可使其血压增高,出现蛋白尿和其他类似子痫前期的病理变化。sCD105在子痫前期的变化及其在发病中的作用是子痫前期病因学与病理生理学研究的最新进展之一。     

Dysregulation of maternal and placental vitamin D metabolism in preeclampsia

IntroductionEpidemiology has linked preeclampsia (PET) to decreased maternal serum 25-hydroxyvitamin D3 (25(OH)D3). However, alterations in systemic and placental/decidual transport and metabolism of 25(OH)D3 during pregnancy suggest that other forms of vitamin D may also contribute to the pathophysiology of PET.MethodsIn a cross sectional analysis of normal pregnant women at 1st (n = 25) and 3rd trimester (n = 21), pregnant women with PET (n = 22), and non-pregnant female controls (n = 20) vitamin D metabolites were quantified in paired maternal serum, placental, and decidual tissue.ResultsSerum 25(OH)D3 was not significantly different in sera across all four groups. In normal 3rd trimester pregnant women serum active 1,25-dihydroxyvitamin D3 (1,25(OH)₂D3) was significantly higher than non-pregnant, normal 1st trimester pregnant, and PET women. Conversely, PET sera showed highest levels of the catabolites 3-epi-25(OH)D3 and 24,25-dihydroxyvitamin D3 (24,25(OH)₂D3). Serum albumin was significantly lower in normal 3rd trimester pregnant women and PET relative to normal 1st trimester pregnant women, but there was no change in free/bioavailable 25(OH)D3. In PET placental tissue, 25(OH)D3 and 3-epi-25(OH)D3 were lower than normal 3rd trimester tissue, whilst placental 24,25(OH)₂D3 was highest in PET. Tissue 1,25(OH)₂D3 was detectable in 1st trimester decidua, which also showed 10-fold higher 25(OH)D3 relative to paired placentae. 3-epi-25(OH)D3 and 24,25(OH)₂D3 were not different for decidua and placenta. In normal 3rd trimester pregnant women, total, free and bioavailable maternal 25(OH)D3 correlated with placental 25(OH)D3, but this was not conserved for PET.DiscussionThese data indicate that PET is associated with decreased activation, increased catabolism, and impaired placental uptake of 25(OH)D3.     

The risk of preeclampsia beyond the first pregnancy among women with type 1 diabetes parity and preeclampsia in type 1 diabetes

AimTo estimate the incidence of preeclampsia (PE) among nulliparous and multiparous patients with type 1 diabetes and to study predictors of PE.MethodsWe prospectively collected data on all pregnancies of patients with pregestational type 1 diabetes, followed at our Prenatal Medicine Unit between 1993 and 2008. Medical records were prospectively reviewed by two obstetricians for maternal demographics, pregnancy data, maternal and fetal outcomes. Data were analyzed according to the development of PE and parity.ResultsWe identified and collected data on 291 eligible pregnancies (195 among nulliparae and 96 among multiparae). The incidence of PE was 9.2% (95% CI: 5.6–14.2) among nulliparae and 9.4% (95% CI: 4.4–17.0) among multiparae. Patients who developed PE had higher HbA1c during pregnancy compared to patients who did not (p = 0.026 among nulliparae and p = 0.032 among multiparae). Chronic hypertension [OR 17.12 (3.22, 91.00)], microalbuminuria at the beginning of the pregnancy [OR 3.77 (1.22, 11.61)], weight gain during pregnancy [OR 1.13 (1.04, 1.23)] and HbA1c in the first trimester [2.81 (1.12, 7.05)], but not parity, were significant predictors of PE.ConclusionsAmong patients with type 1 diabetes the incidence of PE was similar among nulliparae and multiparae, unlikely in the general population where PE is a disease of the first pregnancy. An increased risk of PE should be assumed for both nulliparous and multiparous women with pregestational diabetes.     

The association between preeclampsia and the severity of gestational diabetes: the impact of glycemic control

OBJECTIVES: We sought to determine if the rate of preeclampsia is related to the severity of gestational diabetes mellitus (GDM), and if it can be decreased by optimizing glycemic control. STUDY DESIGN: A retrospective analysis of prospectively collective data of 1813 patients with GDM was performed to determine the rate of preeclampsia. Patients were stratified after treatment was begun by level of glycemic control (well controlled was defined as mean blood glucose <95 mg/dL). The extent of hyperglycemia was analyzed by the level of the abnormality in the oral GTT and by the degree of abnormality of daily glucose control after treatment has begun. Severity of GDM was categorized using fasting plasma glucose (FPG) on a 3-hour oral GTT by 10 mg/dL increments. RESULTS: Overall, preeclampsia was diagnosed in 9.6% (174/1813) of diabetic patients. The GDM subjects who developed preeclampsia were significantly younger, had a higher nulliparity rate, were more obese, and gained significantly more weight during pregnancy. However, no difference was found in glycemic profile characteristics between the 2 groups. A comparison between patients with FPG <105 and FPG >105 revealed that the rate of preeclampsia increased significantly, 7.8% vs 13.8%, (O.R 1.81, 95%CI 1.3-2.51). For GDM patients with only mild hyperglycemia (FPG <105 mg/dL), no significant difference was found in the rate of preeclampsia. Preeclampsia rate was further evaluated in relation to level of glycemic control; for the well-controlled patients (mean blood glucose [MBG] <95 mg/dL, n=994), similar rates of preeclampsia were found between each category of FPG severity. In contrast, in poorly controlled patients (MBG >95 mg/dL, n=819), a comparison between severity threshold of FPG <115 and FPG >115 revealed that the preeclampsia rate was 9.8% vs 18% (O.R 2.56, 95%C.I. 1.5-4.3). In a logistic regression model, only prepregnancy BMI (O.R 2.3, 95%CI 1.16-2.30) and severity of GDM (O.R 1.7, 95%CI 1.21-2.38) were independently and significantly associated with an increased risk of preeclampsia. CONCLUSION: The rate of preeclampsia is influenced by the severity of GDM and prepregnancy BMI. Optimizing glucose control during pregnancy may decrease the rate of preeclampsia, even in those with a greater severity of GDM.     

Hypoproteinemia in the second trimester among patients with preeclampsia prior to the onset of clinical symptoms

Objective: To find a risk factor for “uncomplicated” preeclampsia (PE) comparing blood biochemical parameters between women with uncomplicated PE and healthy pregnant women in each trimester of pregnancy. Methods: A retrospective study was performed on 83 cases of uncomplicated PE, selected from 434 patients with PE, disregarding subjects with other complications relevant to hypertension during pregnancy. The study was limited to women with PE occurring in the third trimester, and records of blood biochemical parameters were evaluated. Controls were recruited from 108 healthy volunteers with normal singleton pregnancies. Results: A significant decrease in total protein was observed in the uncomplicated PE group in the second trimester prior to the onset of clinical symptoms. Conclusion: Hypoproteinemia during pregnancy may be a risk factor for this pathophysiology, and the maintenance of sufficient protein in early pregnancy could contribute to prophylaxis for women with uncomplicated PE.     

Calciuria and preeclampsia: a case-control study

OBJECTIVE: The aim of this study was to compare calciuria of preeclamptic cases to normotensive controls among pregnant women hospitalized in the French West Indies obstetrics department. STUDY DESIGN: This case-control study included 47 preeclamptic women and 50 controls. The main outcome was 24h urinary calcium excretion rate. Serum levels of creatinine, calcium and uric acid were also analyzed. A logistic regression analysis has been performed to investigate the relationship between hypocalciuria and preeclampsia after having taken into account prognostic preeclampsia factors and pertinent clinical criteria. RESULTS: Women with preeclampsia had significantly lower calciuria than normotensive patients (1.5 mmol/24h+/-1.0 versus 6.0 mmol/24h+/-4.2, p=0.0001). After taking into account gestational age at hospitalization, body mass index and nulliparity, hypocalciuria was significantly associated with preeclampsia (ORa=21.74; 95% CI, 6.9-66.7). The diagnosis value of a calciuria less than 2.1 mmol/24h is interesting because of its negative predictive value (97%), but its positive predictive value is weak (42%). CONCLUSION: In our population, preeclamptic women had a calciuria significantly lower than controls.     

Endostatin levels and the risk of subsequent preeclampsia

Objective

To evaluate endostatin, an anti-angiogenic factor, in relation to the risk of preeclampsia (PE).

Study design

In this case control study, serum samples were collected at 11–17 weeks and 18–26 weeks’ gestation. Endostatin levels were expressed as adjusted multiples of the median (MoM). Logistic regression was used to calculate adjusted odds ratios (aORs) for the prediction of PE.

Results

A total of 77 women with PE and 150 controls were studied. Endostatin levels were significantly higher in women with PE compared to controls in both the first and the second trimester. At a cut-off level of 75th percentile of endostatin MoMs, the aORs for PE were 1.33 (95% confidence interval [CI], 0.68–2.58) at 11–17 weeks and 1.77 (95% CI, 0.94–3.34) at 18–26 weeks, after adjustment for ethnicity and chronic hypertension. The aORs for early-onset PE were 3.51 (95% CI, 1.18–10.43) at 11–17 weeks and 2.17 (95% CI, 0.67–7.06) at 18–26 weeks.

Conclusions

Higher endostatin levels are associated with an increased risk of early onset PE. Endostatin alone, however, has a poor predictive value for clinical usefulness.     

慢性高血压并发子痫前期的母儿结局分析

目的 了解慢性高血压并发子痫前期与非慢性高血压并发子痫前期患者的临床特征和母儿结局.方法 回顾分析2009年1月1日至2017年12月31日在广州医科大学附属第三医院住院分娩的妊娠≥20周的单胎妊娠诊断为子痫前期的病例资料.按是否为慢性高血压分为慢性高血压并发子痫前期组及非慢性高血压并发子痫前期组,分析两组的临床特征与...     

子痫前期发生和发展过程中的预防

子痫前期的预防策略包括预防发生及预防发展,尤其防止发展成为重症.预防子痫前期的发生包括初级预防和对母体基础疾病的筛查与诊治,更强调对育龄妇女在孕前进行相关知识的教育;还有妊娠期间的管理,包括预警和早发现、早诊断,更重要的是早干预和早处理.在妊娠的任何时段,预防子痫前期发生是一个层面,预防发展到重度子痫前期是一个层面,避...