目的 应用细胞染色体G显带核型分析和核型BAC-on-BeadsTM (BoBsTM)技术检测早期自然流产胚胎染色体结构和数目异常,探讨核型BoBsTM技术用于诊断绒毛细胞染色体异常的临床价值.方法 采用核型BoBsTM技术对复旦大学附属中山医院闵行分院202例孕6～13周的自然流产胚胎的绒毛组织进行染色体快速检测,并采用经典的细胞染色体G显带核型分析进行常规细胞染色体核型分析.结果 202例绒毛标本,采用核型BoBsTM技术均获得诊断结果,其中结果异常97例,正常105例.在97例异常样本中,发现15号、16号、19号、21号、22号染色体和性染色体(主要是45,XO)的异常类型明显高于其他染色体异常,未发现1号染色体异常.在202例样本中,采用细胞染色体G显带核型分析仅122例获得结果(其中结果异常56例),绒毛培养失败80例.核型BoBsTM技术的检测成功率为100％(202/202),显著高于细胞染色体G显带核型分析的60％(122/202,P＜0.01);核型BoBsTM技术的结果异常率为48％(97/202),与细胞染色体G显带核型分析的46％(56/122)的差异无统计学意义(P＞0.05).在采用G显带核型分析获得染色体核型报告的122例中,仅1例核型为46,XX,der(5)t(5;10)(q31;q21)的标本未被核型BoBsTM技术检出,余121例经两种技术的检测结果完全一致.结论 早期流产的主要原因是染色体数目异常,核型BoBsTM技术是检测绒毛细胞染色体数目异常的可选方法之一.

Objective To investigate the protective effect of propofol pretreatment against hepatic ischemia-reperfusion injury and oxidative stress in rats and the mechanism of the role of GSK-3 β.Methods Sixty SD rats were randomly divided into four groups:sham operation group (S group),ischemia-reperfusion group (I-R group),propofol pretreatment group (P group),TDZD-8 pretreatment group (T group).The hepatic ischemia-reperfusion rat models were established by the method of Nauta.Rats were subjected to 30-min,60-min and 90-min 70％ warm ischemia of liver followed by reperfusion for 120 min,respectively.Propofol (12 mg/kg · h) was injected via femoral vein 30 min before ischemia till the end of reperfusion in P group and TDZD-8 (1 mg/kg) were injected via femoral vein 20 min before ischemia in T group.The animals were killed at 120 min after reperfusion.Blood samples and the liver tissue were obtained.The levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),lactate dehydrogenase (LDH),malondialdehyde (MDA) and superoxide dismutase (SOD) were analyzed.Liver morphological changes were observed using optical microscopy.p-GSK-3β Ser9 and total GSK-3 β expression was determined by Western blot.Results Compared with S group,AST,ALT,LDH and MDA level was increased,SOD level was reduced,and p-GSK-3 β Ser9 expression was significantly reduced in I-R group.Compared with I-R group,the content of AST,ALT,LDH and MDA was reduced significantly,SOD increased significantly,and the content of p-GSK-3β Ser9 increased significantly in P group and T group.There were no significant differences between P group and T group.The hematoxylin-eosin staining of hepatic tissues revealed in I-R group had severe structural damage and periportal inflammatory cells infiltrated,hepatocyte necrosis and sinusoidal congestion.In P group and T group,liver tissues had normal structure,less cell death,edema and inflammatory cell infiltration.Conclusions Propofol can significantly reduce hepatic ischemia reperfusion injury by reducing oxidative stress and lipid hydroperoxides.This protective effect of Propofol may be associated with the inhibition of GSK-3 β by GSK-3 β Ser9 phosphorylation.

目的 了解孕中期外阴阴道念珠菌病(VVC)治疗前后阴道pH值的变化,探讨阴道pH值与治疗效果的关系.方法 选取60例孕14～28周阴道分泌物检查确诊为VVC感染者作为感染组,随机分为两组,每组30例,分别接受克霉唑阴道片和乳酸杆菌胶囊治疗,治疗前后测定阴道分泌物pH值,另选60例阴道分泌物正常的同孕龄孕妇为对照组.结果 感染组阴道pH值4.14±0.12明显高于治疗组(3.83±0.08)及对照组(3.77±0.65)阴道pH值,F=212.99,P<0.05,差异有统计学意义;克霉唑阴道片组(4.14±0.11)和乳酸杆菌组(4.15±0.12)治疗前阴道pH值均高于治疗后(3.77±0.06、3.89±0.05),t值分别为15.59和11.85,均P<0.05,有统计学意义;克霉唑组治疗前后的阴道pH差值高于乳酸杆菌组,t=15.59,P<0.05,两者有显著性差异.结论 pH值可作为孕中期VVC辅助诊断指标,并对治疗效果有一定的预测作用.克霉唑阴道片治疗VVC效果优于乳酸杆菌.

目的 通过比较不同方法 检测假丝酵母菌阴道炎,寻找临床上能快速、准确诊断假丝酵母菌阴道炎的检测方法.方法 对200例假丝酵母菌培养确诊白念珠菌感染的阴道分泌物标本分别进行临床镜检和念珠菌细胞快速处理试剂盒检测.结果 临床镜检和念珠菌细胞快速处理试剂盒检测白念珠菌的检出率分别为25.5%和55.5%,经比较具有显著性差异(χ2=37.35,P<0.05).两种方法 同时检测的检出率为70.0%,一致率为41.0%,临床镜检对临床症状明显的白念珠菌检出率高于念珠菌细胞快速处理试剂盒,但无显著性差异(χ2=3.73,P>0.05).念珠菌细胞快速处理试剂盒对临床症状不明显的的假丝酵母菌检出率高于临床镜检,经比较具有显著性差异(χ2=81.87,P<0.05).结论 念珠菌快速检测试剂盒更适合无明显临床症状的假丝酵母菌阴道炎患者人群.

目的:通过研究细小病毒B19(parvovirus B19,B19)感染孕妇的妊娠结局与血清可溶性白介素-2受体(sIL-2R)的关系,探讨体内的细胞免疫状态对妊娠结局的作用.方法:随访14例B19-DNA阳性孕妇的妊娠结局并检测新生儿脐血血清中的B19-DNA,比较不同妊娠结局孕妇、新生儿脐血血清中的sIL-2R.结果:①B19-DNA阳性孕妇分娩的14例新生儿中,B19-DNA阳性4例,阴性10例,宫内传播率为28.57%;②B19-DNA阳性的新生儿组血清sIL-2R为(642.32±64.51)pg/l,明显高于阴性组(379.96±56.47)pg/ml(p＜0.05);③新生儿脐血B19-DNA阳性的孕妇组血清sIL-2R为(569.48±162.66)pg/ml明显高于新生儿阴性的孕妇组(363.12±86.62)pg/ml(p＜0.05).结论:B19感染孕妇血清sIL-2R升高对胎儿宫内感染有一定的提示作用.B19感染孕妇体内的细胞免疫增强,不利于孕期的细胞/体液免疫平衡,可能是导致不良妊娠结局产生的原因之一.

孕妇体内的生理变化对胃肠道功能造成一定影响,恶心、呕吐是孕期的常见症状,约占妊娠妇女的50%～90%,其中70%在妊娠4～7周时症状最明显,绝大多数于妊娠16周时停止呕吐.严重的恶心、呕吐,并伴有孕妇体重下降、酮血症、酮尿症、电解质紊乱等为妊娠剧吐,发病率为0.3%～2%,一般认为约0.5%.美国的统计资料表明[1],每年有超过50 000名妊娠妇女因为该病需接受住院治疗,平均住院天数为4 d.其发病率与人种有关,新西兰的太平洋海岸、美国的印第安人、巴基斯坦人和非洲裔妇女比欧洲妇女的发病率高.另外,发病率升高与单身母亲、早婚、多胎、妊娠合并滋养细胞疾病、胎儿畸形(包括三体症、胎儿中枢神经系统畸形等)、既往有妊娠剧吐史有关.而当孕妇年龄较大、有吸烟史、孕早期服用维生素和胎儿死亡者发病率下降.本文就妊娠剧吐的病因和营养支持治疗作一综述.