目的 研究血清趋化因子配体18(chemokine ligand 18,CCL18)与四次跨膜蛋白1(transmembrane-4-L-six-family-member-1,TM4SF1)水平检测在卵巢良恶性肿瘤鉴别诊断中的应用价值.方法 收集中国人民解放军联勤保障部队第九八七医院妇产科自2018年7月～2020年7月收治的84例卵巢肿瘤患者作为研究对象,患者均接受血清CCL18和TM4SF1检测.比较良性肿瘤与恶性肿瘤血清CCL18和TM4SF1水平,分析血清CCL18和TM4SF1鉴别良恶性卵巢肿瘤的价值.结果 84例卵巢肿瘤患者中良性和恶性分别为48例和36例.良性肿瘤与恶性肿瘤患者血清CCL18,TM4SF1水平比较,差异均有统计学意义(t=9.05,6.42,均P<0.05).受试者工作曲线(receiver operating characteristic,ROC)分析显示血清CCL18和血清TM4SF1联合预测概率判断卵巢恶性肿瘤的曲线下面积(area under curve,AUC)为0.85,显著高于血清CCL18和血清TM4SF1单项检测,差异有统计学意义(P<0.05).结论 血清CCL18和TM4SF1联合检测有助于鉴别卵巢良恶性肿瘤.

目的 研究妊娠糖尿病(gestational diabetes mellitus,GDM)患者胎盘脂蛋白酯酶(lipoprotein lipase,LPL)基因Hind片段多态性与新生儿发生胰岛素抵抗(insulin resistance,IR)的关系.方法 收集2018年4月～2020年4月84例GDM患者作为观察组,另纳入同期84例健康孕妇作为对照组.比较两组孕妇LPL多态性分布,比较两组新生儿血糖(FPG,HbA1c及2h PG)和血脂(TC,TG,HDL-C及LDL-C)指标水平,计算胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)值.分析胎盘LPL多态性与子代胰岛素抵抗的关系.结果 观察组H+H+基因型48例,H+H-基因型24例,H-H-基因型12例.对照组H+H+基因型32例,H+H-基因型38例,H-H-基因型14例,两组孕妇胎盘LPL基因型分布比较,差异有统计学意义(χ2=6.52,P<0.05).GDM不同基因型患者所生新生儿TC,TG,HDL-C,LDL-C及HOMA-IR水平差异均有统计学意义(F=5.29～16.33,均P<0.05).多元逐步回归分析结果显示胎盘LPL多态性是新生儿HOMA-IR的重要影响因素(t=2.86,P<0.05).结论 胎盘LPL多态性与GDM发病有关,H+H+基因型产妇子代发生胰岛素抵抗的风险更高.

目的 研究抗阻运动+营养膳食运用于妊娠期糖尿病合并高脂血症中的价值.方法 选择我院2017年7月至2019年4月纳入的112例妊娠期糖尿病合并高脂血症患者,遵照随机数字表法分成两组各56例,研究组给予抗阻运动+营养膳食干预,对照组给予常规护理干预,干预前后测定两组的空腹血糖、餐后2h血糖、糖化血红蛋白、总胆固醇、甘油三酯水平,并分别进行生活质量评分(QOL)调查,观察早产、剖宫产、产后出血、切口感染、羊水过多、巨大儿等妊娠结局的发生率,对比两组干预结果.结果 干预前两组的空腹血糖、餐后2h血糖、糖化血红蛋白、总胆固醇、甘油三酯水平相比差异无统计学意义(P＞0.05),干预后研究组的各项指标均低于对照组差异有统计学意义(P＜0.05).研究组早产、剖宫产、产后出血、切口感染、羊水过多、巨大儿的发生率均低于对照组差异无统计学意义(P＜0.05).干预前两组的食欲、精神、睡眠、疲乏、日常生活评分相比差异无统计学意义(P＞0.05),干预后研究组的各项评分均高于对照组差异有统计学意义(P＜0.05).结论 抗阻运动+营养膳食运用于妊娠期糖尿病合并高脂血症中效果显著,可有效控制血糖及血脂水平,同时改善妊娠结局,保障母婴安全,提升生活质量.

Objective To investigate the clinical value of blood β-HCG, progesterone (P)and estradiol (E2) coupled with ultrasonography in the prediction of the outcome of early vaginal bleeding in intrauterine pregnancy .Methods One hundred and fifty patients who were hospitalized from February 2016 to February 2017 and diagnosed as threatened abortion due to vaginal bleeding were enrolled in the study .In accordance with the pregnancy outcome , the patients were divided into the abortion group ( n=64 ) and the continuing pregnancy group (n=87), and another 80 normal pregnant women were selected as the control group .On the day upon ad-mission, the patients received radioimmunoassay to detect blood β-HCG, P and E2, in addition to abdominal ultrasonography , and 48 hours later β-HCG level was reexamined .Results (1) The levels ofβ-HCG, P and E2 in the abortion group were all significantly low-er than those of the continuing pregnancy group and the normal group (P<0.01).But there was no statistical significance in the levels ofβ-HCG, P and E2 in the continuing pregnancy group as compared with those of the normal control group (P>0.05).(2) Abdomi-nal ultrasonography showed that in the abortion group only 21.88%(14/64) of the cases had embryo bud , of which 4 cases could be detected to have fetal heart beat at 7-8 week of pregnancy , but at week 12 missed abortion occurred .For those cases that were detected to have no fetal heart in the primary ultrasonography , fetal heart beat was detected 1-2 weeks later.For those cases with normal fetuses with ultrasonography at 11-13 weeks of pregnancy , they were advised to have medical follow-ups till late pregnancy .Conclusion Dy- namic monitoring should be made in the cases of early vaginal bleeding in intrauterine pregnancy .Detection results of β-HCG, P and E2 coupled with abdominal ultrasonography could be used for accurate evaluation of pregnant outcome .