目的 探讨与分析Toll受体4(TLR4)、高分子量脂联素(HMW-ADP)水平与妊娠期高血压疾病严重程度的关系.方法 选择在本院诊治的妊娠期高血压患者86例,其中轻度子痫前期60例(轻度组),重度子痫前期26例(重度组),同期选择在本院进行产前检查的正常孕妇86例作为正常组,检测三组血清TLR4、HMW-ADP水平并进行相关性分析.结果 重度组、轻度组的血清TLR4水平高于正常组(P＜0.05),HMW-ADP组低于正常组(P＜0.05),重度组与轻度组对比差异也都有统计学意义(P＜0.05).在86例妊娠期高血压患者中,Spearsman分析显示血清TLR4、HMW-ADP水平与疾病严重程度存在相关性(P＜0.05).多元回归logistic分析显示血清TLR4、HMW-ADP水平都为影响疾病严重程度的重要因素(P＜0.05).ROC曲线显示血清TLR4、HMW-ADP判定妊娠期高血压患者疾病严重程度的曲线下面积为0.898和0.725.结论 妊娠期高血压患者多伴随有血清TLR4的高表达与HMW-ADP的低表达,两者都与疾病严重程度存在相关性,也可预测患者的病情状况.

目的 研究个性化医学营养治疗联合二甲双胍对妊娠期糖尿病患者的疗效.方法 选择2017年1月至2020年12月陕西省人民医院的100例妊娠期糖尿病患者,随机分为两组.对照组采用个性化医学营养治疗,观察组采用个性化医学营养治疗联合二甲双胍.记录两组的并发症(低血糖率、酮症酸中毒率、妊娠期高血压疾病率、早产率、羊水过多率、剖宫产率和蛋白尿率)、餐后2h血糖、空腹胰岛素、空腹血糖;且检测检测胱抑素C(Cys-tatinC,Cys C)和同型半胱氨酸(homocystein,HCY)水平.结果 观察组的有效率明显高于对照组(P＜0.05);观察组的低血糖率(4.00％)、妊娠期高血压疾病率(2.00％)、早产率(4.00％)、剖宫产率(32.00％)、酮症酸中毒率(2.00％)、羊水过多率(6.00％)和蛋白尿率(4.00％)均明显低于对照组(P＜0.05);治疗后,两组的HOMA-β明显升高(P＜0.05),血糖明显降低(P＜0.05),观察组更加明显(P＜0.05);治疗后,两组的血清HCY和Cys C水平明显降低(P＜0.05),且观察组更加明显(P＜0.05).结论 个性化医学营养治疗联合二甲双胍对妊娠期糖尿病患者有显著的疗效,其机制可能与降低血清HCY和Cys C水平有关.

[目的]探讨妊娠期高血压患者血清同型半胱氨酸(Hcy)水平、血压和心肌损伤标志物水平变化及其相关性.[方法]选取2018年10月至2021年10月本院收治的68例妊娠期高血压患者(观察组),另外选取在本院定期产检的68例正常妊娠孕妇.比较两组孕妇的一般资料及Hcy水平、日间收缩压(SBP)、日间舒张压(DBP)、夜间SBP、夜间DBP及肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶(CK-MB)、N末端B型脑钠肽前体(NT-proBNP)、乳酸脱氢酶(LDH)水平,分析Hcy水平、血压与心肌损伤标志物的相关性.[结果]两组孕妇一般资料比较,差异无统计学意义(P＞0.05);观察组Hcy水平、日间SBP、日间DBP、夜间SBP、夜间DBP均显著高于对照组(P＜0.05);观察组cTnI、CK-MB、NT-proBNP、LDH水平均显著高于对照组(P＜0.05);相关性分析显示:Hcy、SBP、DBP与cTnI、CK-MB、NT-proBNP、LDH呈正相关(P＜0.05).[结论]血清Hcy水平及血压与妊娠期高血压患者心肌损伤标志物具有相关性,在妊娠期高血压患者心肌损伤诊断中具有一定参考价值,临床医师需多加关注.

目的 探讨乌拉地尔联合硝苯地平对妊娠期高血压患者乙酰肝素酶(HPA)、晚期糖基化终末产物(AGEs)及母婴结局的影响.方法 选择2017年10月～2018年10月陕西省人民医院收治的妊娠期高血压患者200例进行研究,以简单随机分组法分为观察组(n=105)和对照组(n=95).对照组给予硝苯地平治疗,观察组给予乌拉地尔联合硝苯地平治疗.比较两组患者的临床疗效、血清HPA、AGEs、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)水平、母婴结局及不良反应发生情况.结果 治疗后,观察组总有效率显著高于对照组(P＜0.05);治疗前,两组血清HPA、AGEs水平差异无统计学意义(P＞0.05);治疗后,两组血清HPA、AGEs水平均有所改善,且观察组HPA、AGEs水平均显著低于对照组(P＜0.05);治疗前,两组血压水平比较差异无统计学意义(P＞0.05);治疗后,两组血压水平均有所改善,且观察组SBP、DBP、MAP水平均显著低于对照组(P＜0.05);观察组新生儿死亡、窒息、产后出血及早产总发生率显著低于对照组(P＜0.05);两组不良反应总发生率比较差异无统计学意义(P＞0.05).结论 在妊娠期高血压患者中应用乌拉地尔联合硝苯地平,可有效改善患者HPA、AGEs水平及母婴结局,且不会增加不良反应.

1 病史摘要 患者肖××,女,30岁,经产妇,以"阴道分娩后14小时,阴道出血量多9小时"代诉于2017年4月20日从××县医院转入我院.平素月经规律,孕期产检无异常, 14小时前于××县医院顺利分娩,婴儿体重3350 g,胎盘胎膜自娩完整,检查软产道:会阴I°裂伤,宫颈、阴道壁无裂伤,产程顺利,出血共计200 mL,产房观察2小时无异常,9小时前上厕所时阴道出血量多,含暗红色血块,约600 mL,患者自觉头晕乏力,肛门坠胀疼痛,按摩子宫轮廓不清,质软,考虑子宫收缩乏力,阴道检查:阴道壁3点近穹窿处可触及血肿,大小约7×8 cm,立即给卡前列素氨丁三醇250 ug肌注、补液、抗感染等治疗,同时行阴道壁血肿切开缝合术,清理出凝血块量约600 ml,2块纱布填塞,共计出血量约2000 mL,给予输注红细胞悬液、血浆等对症治疗,另给止血治疗,因病情危重急转我院,转诊途中生命体征平稳,阴道出血不多,入院时查体:T 37.1℃,P 110次/分, R 20次/分,Bp 115/65 mmHg,神志清,精神差,重度贫血貌,心肺腹查体无异常,阴道检查:取出阴道填塞纱布2块,阴道壁3点处可触及血肿,上缘无法触及,张力高,有波动感,双合诊感子宫体位于右侧腹区,轮廓清晰,无压痛.急诊B超提示:子宫大小12.9×9.7×8.3 cm,盆腔内未见明显积液暗区,左侧髂窝相当于阴道后方水平探及一大小约8.5×7.6×7.0 cm低回声区,考虑:血肿.急查血常规示:WBC 20.69×109/L,Neu 96％,HB 90g/L,HCT 0.261,PLT 184×109/L;凝血功能:FDP 11.79 mg/L,DD 3.78 mg/L.

目的 探讨妊娠期糖尿病(GDM)孕妇血清和胎盘组织中转录因子FOXO3a表达水平及其与胰岛素抵抗之间的相关性,旨在为临床诊断及治疗GDM提供胰岛素抵抗相关新靶点.方法 选取2016年1月-2017年1月在陕西省人民医院定期产检并住院分娩的52例GDM孕妇为研究对象(GDM组),另选取同期在该院分娩的52例正常孕妇作为正常组.检测两组孕妇产前体质量指数(BMI)、空腹血糖(FPG)、餐后2h血糖(2hPG)、三酰甘油(TG)、总胆固醇(TC)及空腹胰岛素(FINS),应用胰岛素稳态模型评估法(HOMA)计算胰岛素分泌指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)及胰岛素敏感指数(HOMA-ISI),应用实时荧光定量PCR (qRT-PCR)检测血清中FOXO3a表达水平,应用免疫组织化学法(SP)检测胎盘组织中FOXO3a蛋白表达水平.结果 两组年龄、孕周、收缩压、舒张压比较,差异均元统计学意义(均P＞0.05),GDM组产前BMI明显高于正常组,差异有统计学意义(P＜0.05).GDM组FINS、FPG、2hPG、TG、TC、HOMA-IR明显高于正常组,HO-MA-β、HOMA-ISI明显低于正常组,差异均有统计学意义(均P＜0.05).GDM组血清FOXO3a mRNA表达水平明显高于正常组,差异有统计学意义(P＜0.05);GDM组胎盘组织中FOXO3a蛋白表达阳性率明显高于正常组,差异有统计学意义(P＜0.05).GDM组血清FOXO3a表达与FINS、HOMA-IR呈明显正相关关系(P＜0.05),GDM组胎盘组织中FOXO3a蛋白表达与HOMA-IR呈明显正相关关系(P＜0.05).HOMA-IR是GDM组血清及胎盘组织中FOXO3a表达的独立影响因素(P＜0.05).结论 FOXO3a在GDM血清及胎盘组织中均呈显著高表达,可能是GDM胰岛素抵抗发病机制之一.

Objective To discuss the clinical effect of Kangfuyan Capsules combined with mifepristone in treatment of ectopic pregnancy. Methods Patients (148 cases) with ectopic pregnancy in Xi'an Central Hospital from January 2016 to May 2017 were randomly divided into control (74 cases) and treatment (74 cases) groups. Patients in the control group were po administered with Mifepristone Tablets, 50 mg/time, twice daily. Patients in the treatment group were po administered with Kangfuyan Capsules, 3 grains/time, three times daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, β-HCG levels, the remission time of symptoms and signs, and hormone levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 71.62% and 95.95%, respectively, and there were differences between two groups (P < 0.05). After treatment for 7 and 14 d, the β-HCG level in two groups was significantly decreased (P < 0.05). And the β-HCG in the treatment group was significantly lower than that in the control group (P < 0.05). After treatment, the disappearance time of bellyache, time of recovery of normal menstrual and β-HCG, soak time of pregnancy bag piece in the treatment group was significantly less than that in the control group, with significant difference between two groups (P < 0.05). After treatment for 14 d, the E2, LH and FSH levels in two groups was significantly decreased (P < 0.05). And these indexes in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Kangfuyan Capsules combined with mifepristone has significant clinical effect in treatment of ectopic pregnancy, can effectively promote pregnancy mass absorption,which has a certain clinical application value.

目的 对多囊卵巢综合征者选择达英-35和二甲双胍联合治疗的促排卵效果、体质量指标和激素水平进行分析.方法 取湖北省十堰市铁建医院2016年2月至2017年5月诊治的多囊卵巢综合征78例患者资料加以分析,按照临床所用不同分成2组,将行达英-35医治39例患者设为对照组,将联合二甲双胍医治39例患者设为观察组,对2组促排卵效果、体质量指标和激素水平比较分析.结果 观察组自然排卵、总排卵概率和自然受孕、总受孕概率均比对照组高,且体质量指标(21.20±0.10) kg/m2和体质量(54.10±2.04) kg均比对照组低(P＜0.05);观察组各项激素水平均比对照组优(P＜0.05).结论 多囊卵巢综合征者选择达英-35和二甲双胍联合医治能够优化促排卵效果,提高患者受孕率,降低其体质量,改善其激素水平.

目的:探讨高龄孕妇妊娠晚期异常心电图对新生儿体重及分娩结局的影响.方法:选择110例完整调查资料的妊娠晚期高龄孕妇110例作为研究对象,分为异常组与正常组,采用心电图监测孕妇心功能状况,调查孕妇与新生儿的预后情况.结果:所有孕妇都顺利分娩,产妇与新生儿都存活,异常组的分娩孕周及剖宫产率与正常组对比差异明显(P<0.05).异常组孕妇的胎膜早破、前置胎盘、贫血、产后出血等并发症发生率明显高于正常组(P<0.05).异常组新生儿体重及低出生体重儿发生率与正常组对比差异都有统计学意义(P<0.05).结论:高龄孕妇妊娠晚期异常心电图能增加低体重出生儿发生率,提高孕妇剖宫产率与并发症发生率,要积极进行预防性干预.

Objective It is to observe the effect of intravenous immunoglobulin ( IVIG) combined with decoction for tonify-ing kidney and resoling stasis on unexplained recurrent spontaneous abortion ( URSA) and on prethrombotic state ( PTS) and peripheral blood Th17/Treg immune imbalance.Methods 100 patients with URSA were randomly divided into observation group and control group , 50 cases in each group .The control group was treated with IVIG , and was tracked until the end of pregnancy , the observation group was treated with decoction for tonifying kidney and resoling stasis on the basis of therapy in the control group .The changes of HCG , progesterone , PTS and peripheral blood Th 17/Treg cytokines before and after treat-ment were observed in both groups , and clinical pregnancy outcomes were recorded .Results After treatment the levels of serum HCG, progesterone, antithrombin Ⅲ(AT-Ⅲ) and IL-10, transforming growth factor beta 1 (TGF-beta 1) were significantly increased , while that of serum D-dimer ( D-D) , original tissue fibrinolytic enzyme activation ( t-PA) , fibrinolytic enzyme acti-vation inhibitor-1(PAI-1), IL-17, IL-6 were decreased significantly in both groups (P<0.05), the improvements of these indexes in the observation group were superior to the control group (P<0.05).The survival rate of the pregnancy outcome in the observation group was higher while non -live production rate was lower than that in the control group (P<0.05).No ad-verse drug reactions occurred during treatment in both groups .Conclusion IVIG combined with decoction for tonifying kidney and resoling stasis has determined curative effect on URSA , they can significantly improve the success rate of fetus , improve the clinical outcome and security , its mechanism may be related to inhibit PTS , promote the peripheral blood of Th 17/Treg im-mune balance .

目的 :观察产妇安颗粒联合缩宫素治疗产后子宫复旧不全恶露不绝的临床疗效.方法:将180例产后子宫复旧不全恶露不绝的产妇随机均分为对照组(n=90例)和观察组(n=90例).对照组分娩后给予缩宫素治疗,观察组在对照组基础上给予产妇安颗粒,疗程7d.观察两组子宫下降幅度、恶露排出量、临床预后改善情况;检测两组治疗前后血液流变学指标;并统计临床治疗疗效.结果:观察组治疗后3d、5d、7d的子宫下降幅度、恶露排出量均高于对照组(P均<0.05).观察组小腹痛缓解时间、子宫压痛缓解时间、腰腹坠胀缓解时间、血性恶露持续时间、恶露持续时间、子宫体大小、宫腔积液量均小于对照组(P均<0.05).观察组全血黏度(高、中、低切)、血浆黏度、Fib均显著降低(P均<0.05),观察组以上指标均低于对照组(P均<0.05).观察组临床疗效优于对照组.结论:在缩宫素治疗产后子宫复旧不全恶露不绝基础上,采用产妇安颗粒能够促进产妇子宫收缩,缩短恶露时间,并改善机体血液流变学,提高整体疗效.