多参数血流频谱评价胎儿宫内缺氧的意义

<正>0前言胎儿在宫内有缺氧现象危及胎儿健康和生命者称为胎儿宫内窘迫(fetal distress)。胎儿宫内窘迫可发生在临产过程,也可以发生在孕期。发生在临产过程中者可以是孕期者的延续和加重。其常见的病因有:1)母体因素:孕妇患心脏病、心力衰竭、高烧急性失血、严重贫血及使用麻醉剂等,均可使孕妇血容量不足而使胎儿缺氧;2)子宫因素:子宫收缩过强、过频,甚至强直性收缩,使子宫血循环受影响,而使胎儿缺氧;3)胎儿因素:胎盘早期剥离、前置胎盘、妊娠高血压综合征、过期妊娠及慢性肾炎等,引起胎盘循环障碍,而使胎儿缺氧;4)脐带方面:脐带打结、脱垂、绕颈、绕体等,使脐血管输送血流功能受阻而引起胎儿缺氧;5)胎儿方面:胎儿心血管系统功能不全、胎儿颅内出血、胎儿     

胎盘缺氧诱导因子表达及绒毛血管变化与胎儿窘迫的关系

目的:通过比较出现胎儿窘迫的孕妇胎盘与正常孕妇胎盘的缺氧诱导因子表达及胎盘的绒毛血管变化情况,探讨胎儿窘迫中胎盘变化及其对胎儿的影响.方法:选取产科门诊定期产检并在产科住院分娩的单胎足月孕妇,临床诊断为胎儿窘迫的孕妇所分娩后的胎盘组织60例作为实验组,再按临床情况分为胎心异常组、羊水污染组、窒息组.选取正常单胎足月妊娠孕妇55例作为对照组.对比两组胎盘中HIF-1α表达水平,胎盘绒毛血管情况及新生儿预后.结果:HIF-1α在实验组与对照组两者的光密度对照有统计学差别,新生儿窒息组的光密度值较高;显微镜下实验组中绒毛血管数目及绒毛体积密度皆较对照组明显增加,实验组中各分组的值较对照组均升高.结论:胎儿窘迫孕妇的胎盘组织HIF-1α因子表达、胎盘绒毛微血管体积密度及绒毛体积密度皆高于未出现胎儿窘迫的孕妇.在排除妊娠合并症及并发症等病理情况下,产时胎儿窘迫的发生与胎盘自身HIF-1α因子表达及胎盘绒毛血管改变有关.     

米索前列醇用于足月妊娠引产安全性分析

观察米索前列醇用于足月妊娠引产的安全性．方法；回顾性分析了72例使用米索前列醇引产和100例使用缩宫素引产的足月妊娠产妇的临床资料．结果：米索组出现过频宫缩14例，而缩宫素组未出现异常宫缩．两组羊水混浊发生率分别为22％、l0％，差异有显著性．剖宫产原因中，胎儿宫内窘迫均为两组主要手术指征，米索组8例占66．7％，缩宫素组7例占44％，差异有显著性，提示：米索前列醇用于足月妊娠引产，对母亲和胎儿有潜在的不安全因素存在．     

妊娠晚期羊水过少对围产儿预后及妊娠结局的影响

目的探讨羊水过少的相关因素及对围产儿预后和妊娠结局的影响。方法采用回顾性分析方法,对152例羊水过少组病例进行分析和总结。结果羊水过少高发于40周后;羊水过少组并发胎盘功能不全、胎儿窘迫、新生儿窒息、羊水污染及剖宫产率显著高于羊水正常组。结论羊水过少导致胎儿窘迫是胎儿窘宫内慢性缺氧的重要标志,对胎儿预后有严重影响,应加强产前监测,及时剖宫产是处理妊娠晚期羊水过少导致胎儿窘迫的重要措施。     

妊娠合并胎盘粘连子宫肌瘤1例

本文是妊娠合并胎盘粘连子宫肌瘤１例的临床报告。原拟诊“孕足月一胎，胎盘后血肿”，术后为胎盘粘连子 宫富细胞平滑肌瘤。母婴平安，７天切口甲级愈合。     

足月妊娠并发羊水过少72例分析

目的：探讨足月妊娠并发羊水过少对母婴的影响，寻找适当的处理方法。方法：对足月妊娠并发羊水过少72例的临床资料进行回顾性分析，并与羊水正常组593例进行对比分析。结果：羊水指数≤5cm组中胎儿窘迫、新生儿窒息率、剖腹产率均高于羊水指数正常组。结论：羊水过少一经确诊应积极引产，羊水指数≤5cm（除胎膜早破）短期内不能经阴道分娩者，宜剖腹产。同时出现脐动脉蛐值、RI指数增高者宜行剖腹产。     

妊娠肝内胆汁淤积症患儿宫内缺氧机理

目的：探讨妊娠肝内胆汁淤积症患儿宫内缺氧机理。方法：应用Medline系统检索资料，并综合评述。结果：妊娠肝内胆汁淤积症患儿宫内缺氧与胎盘病理变化；胆汁酸；羊水胎粪污染；甾体激素代谢障碍等有关。结论：ICP引起胎儿宫内窘迫及死胎的原因及机理仍有待进一步研究。     

过期妊娠胎盘绒毛的初步体视学研究

用英国Ｃａｍｂｒｉｄｇｅｑｕａｎｔｉｍｅｔ５２０（＋）［Ｑ５２０（＋）］图像分析仪分别对４０、４１、４２周各８例胎盘绒毛进行初步体视学研究，测定其结构参数并计算其密度参数，形状参数及分布参数，所得各组结果虽然不同，但其组间差异并无显著性（Ｐ＞０．０５），提示过期妊娠与足月妊娠相比．胎盘绒毛本身形态定量变化只是程度不同，无明显界线。在观察了３组胎盘绒毛内部结构的病理变化基础上，发现过期妊娠并发症与绒毛本身定量的形态改变并无直接关系，而可能与绒毛内部结构的形态变化有关。     

妊娠高血压征人胎盘床的子宫螺旋动脉

本文对20例(6例正常,14例妊高征)胎盘床子宫螺旋动脉进行光镜和电镜观察,发现妊高征的血管与正常妊娠的同类血管在形态上主要不同之处为:1、子宫肌层段血管中膜的平滑肌层保持完整,有时尚可见弹力膜结构。2、血管内膜增生及水肿,并造成血管狭窄或阻塞。3、血管壁的泡沫细胞明显地增多。由于妊高征的子宫螺旋动脉缺乏正常妊娠时血管应有的生理性变化及因内膜增生造成血管腔狭窄或阻塞,子宫对胎盘及胎儿的供血量将较正常妊娠时为少并引起例如胎儿宫内发育迟缓、胎盘梗死、早剥及胎盘后血肿等并发症。     

人胎儿子宫肌层的平滑肌细胞超微结构研究

利用电镜研究胎儿子宫肌层的平滑肌细胞在不同胎龄阶段（6个月、7个月、8个月、足月）的超微结构。结果发现随着胎龄的增长，平滑肌细胞显示下列形态变化：（a)胞质的细胞器减少；（b)核表面的凹陷增加和加深；（c)糖元颗粒聚集，细胞表面的半桥粒状致密斑及带有电子致密体的5nm微丝束逐渐增多；（d)到足月妊娠时，其形态与育龄妇女的子宫肌层的平滑肌细胞极为相似，在任何胎龄到足月妊娠时，其形态与育龄妇女的子宫肌层的平滑肌细胞极为相似，在任何胎龄的子宫肌层里均可见到平滑肌细胞间有间质细胞和一些成熟较差的平滑肌细胞。由于样本取自肌层中间部位，及肌层内间质细胞随着胎龄的增长而减少，歌曲以认为平滑肌细胞增多，可能是由于肌层里间质细胞分化的结果，由于在雌激素作用下，核体大量出现及黄体酮促使糖元颗粒聚集成团，本研究结果提示胎儿子宫肌层平滑肌细胞的成熟可能与雌激素主黄体酮的作用有关。     

人胎盘绒毛合胞体细胞凋亡的电镜观察

利用电镜观察人胎盘绒毛的合肥体时，发现妊娠早期已有代表退化现象的合肥体结形成，此时合胞体结的核染色质分布均匀，近核区的粗面内质风渠扩大，从妊娠中期开始合肥体 的核染色质出现凝缩及边集，近核区粗面内质网渠扩大明显，并可见合胞体结游离面断主绒毛间隙有浓缩细胞核和部分胞南，发现提示合胞体细胞的凋亡是从形成合胞体结开始，再经核染色质凝缩与边集及近核区粗面内质网渠的扩张，最后造成合胞体结游离面断裂及浓缩的核     

米非司酮（RU486）对早孕人滋养细胞超微结构的影响

研究米非司酮（ＲＵ４８６）对早孕人滋养细胞超微结构的影响时，发现ＲＵ４８６可使滋养细胞发生核溶解，粗面内质网渠扩张，线粒体缩小和合体细胞片段脱落等形态改变。虽然ＲＵ４８６可在受体水体拮抗孕酮，但在滋养细胞及在脱膜细胞均无凋亡现象发生。说明ＲＵ４８６对上述组织的影响是继发的，其终止早孕的主要机理可能与子宫螺旋动脉减少供血有关。     

Evidence for local stimulation of ACTH secretion by corticotropin-releasing factor in human placenta

The hypothalamic-pituitary-adrenocortical axis is activated in pregnancy and parturition. Levels of immunoreactive corticotrophin releasing factor (irCRF), immunoreactive adrenocorticotropic hormone (irACTH) and cortisol concentrations in maternal plasma are elevated throughout gestation, increase further during labour and fall precipitously after parturition. The placenta contains biologically active CRF and ACTH and it has been suggested that the placenta produces these peptides during pregnancy. Here we show that irCRF is located in the cytotrophoblast cells of placenta collected at term. Using a monolayer primary culture of human placental cells we have found that CRF stimulates secretion of peptides containing the ACTH sequence in the placenta in a dose-dependent manner, as it does in the pituitary. This effect is reversed by a CRF antagonist and is mimicked by dibutyryl cyclic AMP and forskolin. Glucocorticoids, which suppress the secretion of pituitary ACTH, were found to have no influence on release of irACTH by the placenta. Oxytocin and prostaglandins stimulate irACTH and irCRF secretion from cultured placental cells and the irACTH-releasing activity of two prostaglandins is partially reversed by a CRF antagonist. Thus CRF may be involved in the paracrine regulation of placental irACTH secretion.     

妊娠高血压综合征138例临床分析

本文对138例妊娠高血压综合征进行了分析,结果是:发病率为全年分娩人数的6.52%。子痫发病率为0.56%,25岁至29岁的初产妇发病率高达54.34%;长期的精神紧张是重要的发病因素;中西医结合治疗可以减少分娩时出血。并提出硫酸镁等解痉镇静药物所致的子宫收缩乏力性出血、胎盘滞留大出血,应是产科工作者不可忽视的问题。     

Deficiency in catechol-O-methyltransferase and 2-methoxyoestradiol is associated with pre-eclampsia

Despite intense investigation, mechanisms that facilitate the emergence of the pre-eclampsia phenotype in women are still unknown. Placental hypoxia, hypertension, proteinuria and oedema are the principal clinical features of this disease. It is speculated that hypoxia-driven disruption of the angiogenic balance involving vascular endothelial growth factor (VEGF)/placenta-derived growth factor (PLGF) and soluble Fms-like tyrosine kinase-1 (sFLT-1, the soluble form of VEGF receptor 1) might contribute to some of the maternal symptoms of pre-eclampsia. However, pre-eclampsia does not develop in all women with high sFLT-1 or low PLGF levels, and it also occurs in some women with low sFLT-1 and high PLGF levels. Moreover, recent experiments strongly suggest that several soluble factors affecting the vasculature are probably elevated because of placental hypoxia in the pre-eclamptic women, indicating that upstream molecular defect(s) may contribute to pre-eclampsia. Here we show that pregnant mice deficient in catechol-O-methyltransferase (COMT) show a pre-eclampsia-like phenotype resulting from an absence of 2-methoxyoestradiol (2-ME), a natural metabolite of oestradiol that is elevated during the third trimester of normal human pregnancy. 2-ME ameliorates all pre-eclampsia-like features without toxicity in the Comt(-/-) pregnant mice and suppresses placental hypoxia, hypoxia-inducible factor-1alpha expression and sFLT-1 elevation. The levels of COMT and 2-ME are significantly lower in women with severe pre-eclampsia. Our studies identify a genetic mouse model for pre-eclampsia and suggest that 2-ME may have utility as a plasma and urine diagnostic marker for this disease, and may also serve as a therapeutic supplement to prevent or treat this disorder.     

Effect of ZnO nanoparticles on anti-aging properties of polyurethane coating

Polyurethane nano-coatings were prepared by adding nano-concentrates with nanometer zinc oxide （nano-ZnO） to polyurethane coating. The dispersion state of nanoparticles was observed by TEM images. SEM observation and FT-IR analysis indicate that the nano-coating with 1% ZnO nanoparticles can retain better morphological structure than the nano-coating with 5% ZnO nanoparticles after 500 h accelerated aging. It is known from XPS analysis that the anti-oxidation properties of polyurethane coating are enhanced by 1% ZnO nanoparticles through the nano-network and destroyed by 5% ZnO nanoparticles due to the strong light catalysis. A small change in capacitances of nano-coatings with 1% ZnO nanoparticles before and after accelerated aging indicates that 1% ZnO nanoparticles improve the corrosion resistance of coating, while a large increase in capacitances of nano-coating with 5% ZnO nanoparticles before and after accelerated aging demonstrates that 5% ZnO nanoparticles damage the corrosion resistance of coating.     

成年女性年龄分层与颈总动脉结构重塑相关性研究

应用高频超声技术评估增龄对成年女性颈总动脉形态的影响。3886例成年女性每10岁为一个年龄层组,采用高频超声技术观察成年女性颈总动脉的管径及内-中膜的厚度。年龄分层分析显示女性自20岁起各年龄层的颈总动脉的管径和内-中膜的厚度伴随着年龄的增长而逐渐增加,50岁以后血管老化增速。年龄对女性颈总动脉内-中膜厚度的影响大于颈总动脉管径,血管管径因IMT增长而代偿性扩张的能力随着年龄的增加而呈现下降趋势,增龄可使成年女性颈总动脉发生衰老性结构重塑。     

金针菇多糖对D-半乳糖衰老小鼠学习记忆能力的影响

目的探讨金针菇多糖对衰老小鼠学习记忆能力及大脑皮层形态学的影响.方法 ICR小鼠60只,雌雄各半,按体质量随机分为6组:空白对照组,模型组,脑复康组,金针菇多糖(FVP)低、中、高剂量组.实验动物喂饲6周,末次灌胃后,采用避暗实验检测小鼠的记忆能力,处死小鼠,观察小鼠脑组织形态结构.结果与模型组比较,各组小鼠避暗潜伏期明显延长(P0.05),错误次数明显减少(P0.05);与模型组比较,FVP低、高剂量组小鼠神经细胞数量增多,细胞形态明显改善.结论金针菇多糖对衰老小鼠记忆障碍有一定的改善作用,能维持衰老小鼠神经细胞正常形态结构,对衰老模型小鼠脑组织具有保护作用.