Noninvasive Fetal Lung Maturity Prediction Based on Amniotic Fluid Turbidity Using Ultrasonic Histogram Measurement Function

Background: Amniotic fluid turbidity increases with fetal lung maturation due to vernix and lung surfactant micelles suspended in the amniotic fluid. This study focused on this phenomenon and evaluated the presence or absence of respiratory distress syndrome (RDS)/transient tachypnea of the newborn (TTN) by quantitatively assessing the brightness of the amniotic fluid turbidity using a noninvasive ultrasound histogram measurement function. Methods: We included cases of singleton pregnancies managed at the Niigata University Medical and Dental Hospital between November 2020 and March 2022. Histograms of amniotic fluid turbidity were measured at the center of the amniotic fluid depth, avoiding the fetus, placenta, and umbilical cord, with the gain setting set to 0, and the average value was obtained after three measurements. Histograms of fetal urine in the bladder were measured similarly. The value obtained by subtracting the fetal bladder brightness value from the amniotic brightness value based on histogram measurements was used as the final amniotic fluid brightness value. Results: We included 118 cases (16 of RDS/TTN and 102 of control). The gestational age of delivery weeks was correlated with amniotic fluid brightness (Spearman’s rank correlation coefficient was 0.344;p = 0.00014). Amniotic fluid brightness values were significantly lower in the RDS/TTN group than in the control group (RDS/TTN: 16.2 ± 13.5, control: 26.3 ± 16.3;p = 0.020). The optimal cutoff value of amniotic fluid brightness to predict RDS/TTN was 20.3. For predicting RDS/TTN, the sensitivity, specificity, positive predictive value, and negative predictive value were 91.7%, 69.6%, 26.2%, and 94.1%, respectively. Conclusions: The quantitative value of the amniotic fluid brightness by histogram measurements may provide an easy and objective index for evaluating the presence or absence of RDS/TTN.

Lamellar Bodies Count (LBC) as a Predictor of Fetal Lung Maturity in Preterm Premature Rupture of Membranes Compared to Neonatal Assessment

Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality, affecting approximately 1% of all live births and 10% of all preterm infants. Lamellar bodies represent a storage form of pulmonary surfactant within Type II pneumocytes, secretion of which increases with advancing gestational age, thus enabling prediction of the degree of FLM. Preterm premature rupture of membranes (PPROM) complicates approximately 1/3 of all preterm births. Birth within 1 week is the most likely outcome for any patient with PPROM in the absence of adjunctive treatments. Respiratory distress has been reported to be the most common complication of preterm birth. Sepsis, intraventricular haemorrhage, and necrotizing enterocolitis also are associated with prematurity, but these are less common near to term. Objective: To assess the efficacy of the amniotic fluid lamellar body counting from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Methods: This study was conducted at Ain Shams University Maternity Hospital in the emergency ward from January 2019 to September 2019. It included 106 women with singleton pregnancies, gestational age from 28 - 36 weeks with preterm premature rupture of membranes. This study is designed to assess the efficacy of the amniotic fluid lamellar body counting (LBC) from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Results: The current study revealed a highly significant increase in the lamellar body count in cases giving birth to neonates without RDS compared to that cases giving birth to neonates with RDS. Also, no statistically significant difference between LBC and age, parity and number of previous miscarriages in the mother was found. Gestational age at delivery was significantly lower among cases with respiratory distress. Steroid administration was significantly less frequent among cases with respiratory distress. However, lamellar bodies had high diagnostic performance in the prediction of respiratory distress. Conclusion: Lamellar body count (LBC) is an effective, safe, easy, and cost-effective method to assess fetal lung maturity (FLM). It does not need a highly equipped laboratory or specially trained personnel, it just needs the conventional blood count analyzer. Measurement of LBC is now replacing the conventional Lecithin/Sphyngomyelin L/S ratio. LBC cut-off value of ≤42.5 × 103/μL can be used safely to decide fetal lung maturity with sensitivity of 95.7% and specificity of 97.6%.

Ultrasonographic Segmentation of Fetal Lung with Deep Learning

The morbidity and mortality of the fetus is related closely with the neonatal respiratory morbidity, which was caused by the immaturity of the fetal lung primarily. The amniocentesis has been used in clinics to evaluate the maturity of the fetal lung, which is invasive, expensive and time-consuming. Ultrasonography has been developed to examine the fetal lung quantitatively in the past decades as a non-invasive method. However, the contour of the fetal lung required by existing studies was delineated in manual. An automated segmentation approach could not only improve the objectiveness of those studies, but also offer a quantitative way to monitor the development of the fetal lung in terms of morphological parameters based on the segmentation. In view of this, we proposed a deep learning model for automated fetal lung segmentation and measurement. The model was constructed based on the U-Net. It was trained by 3500 data sets augmented from 250 ultrasound images with both the fetal lung and heart manually delineated, and then tested on 50 ultrasound data sets. With the proposed method, the fetal lung and cardiac area were automatically segmented with the accuracy, average IoU, sensitivity and precision being 0.98, 0.79, 0.881 and 0.886, respectively.

Expression of Lung Surfactant Proteins SP-B and SP-C and Their Modulating Factors in Fetal Lung of FGR Rats

This study investigated the expression of lung surfactant proteins SP-B and SP-C, and their modulating factors TTF-1 and PLAGL2 in the fetal lung of rats with fetal growth restriction（FGR）. The rat FGR model was established by prenatal hypoxia in the first stage of pregnancy, 180 rats for experiment served as hypoxia group, and 197 healthy rats served as normal control group. The FGR incidence in hypoxia was compared with that in normal control group. The histological changes in the fetal lung were observed under the light microscope and electronic microscope in two groups. The SP-B, SP-C, TTF-1 and PLAGL2 proteins were determined in the fetal lung of two groups immunohistochemically. The expression levels of SP-B, SP-C, TTF-1 and PLAGL2 protein and m RNA in the fetal lung of two groups were detected by using Western blotting and RT-PCR respectively. The FGR rat model was successfully established by using hypoxia. Pathologically the fetal lung developed slowly, and the expression levels of SP-B, SP-C, TTF-1 and PLAGL2 protein and mR NA in the fetal lung were significantly reduced in hypoxia group as compared with those in normal control group. It was suggested that maternal hypoxia in the first stage of pregnancy could induce FGR, and reduce the expression of SP-B and SP-C, resulting in the disorder of fetal lung development and maturation.

Evaluation of thalamus echogenicity by ultrasound as a marker of fetal lung maturity

The present study evaluated fetal thalamic echogenicity by ultrasound as a possible marker of fetal lung maturity in comparison with other ultrasound makers. A prospective longitudinal study performed in Al-Elwiya Maternity Teaching Hospital in Baghdad, Iraq during the period from April 2010 to March 2011. One hundred and forty two pregnant women (36 to 42 weeks of gestation) who were admitted for elective cesarean section and referred for an obstetric ultrasound scan at the same day of their elective cesarean section were included. Scanning with linear ultrasound with convex transducer frequency of 3.5 MHz was utilized to measure the biparietal diameter and the state of echogenicity was recorded as echogenic or echolucent, in addition to amniotic fluid vernix and the placental changes. The presence of echogenic thalamus as a sign of fetal lung maturity had a specificity of 86.53% which is higher than the three other signs of lung maturity;the positive predictive value was (89.6%) which is also higher than the three other signs, but the sensitivity was 63.33% and negative predictive value was 57.69% which is lower than the presence of vernix in the amniotic fluid, 86.66 and 67.56 respectively. In conclusion, evaluation of echogenic thalamus is beneficial, and can be considered as a new marker of fetal lung maturity;however, further studies are required to strengthen such idea.

Establish a normal fetal lung gestational age grading model and explore the potential value of deep learning algorithms in fetal lung maturity evaluation

Background:Prenatal evaluation of fetal lung maturity(FLM)is a challenge,and an effective non-invasive method for prenatal assessment of FLM is needed.The study aimed to establish a normal fetal lung gestational age(GA)grading model based on deep learning(DL)algorithms,validate the effectiveness of the model,and explore the potential value of DL algorithms in assessing FLM.Methods:A total of 7013 ultrasound images obtained from 1023 normal pregnancies between 20 and 41+6 weeks were analyzed in this study.There were no pregnancy-related complications that affected fetal lung development,and all infants were born without neonatal respiratory diseases.The images were divided into three classes based on the gestational week:class I:20 to 29+6 weeks,class II:30 to 36+6 weeks,and class III:37 to 41+6 weeks.There were 3323,2142,and 1548 images in each class,respectively.First,we performed a pre-processing algorithm to remove irrelevant information from each image.Then,a convolutional neural network was designed to identify different categories of fetal lung ultrasound images.Finally,we used ten-fold cross-validation to validate the performance of our model.This new machine learning algorithm automatically extracted and classified lung ultrasound image information related to GA.This was used to establish a grading model.The performance of the grading model was assessed using accuracy,sensitivity,specificity,and receiver operating characteristic curves.Results:A normal fetal lung GA grading model was established and validated.The sensitivity of each class in the independent test set was 91.7%,69.8%,and 86.4%,respectively.The specificity of each class in the independent test set was 76.8%,90.0%,and 83.1%,respectively.The total accuracy was 83.8%.The area under the curve(AUC)of each class was 0.982,0.907,and 0.960,respectively.The micro-average AUC was 0.957,and the macro-average AUC was 0.949.Conclusions:The normal fetal lung GA grading model could accurately identify ultrasound images of the fetal lung at different GAs,which can be used to identify cases of abnormal lung development due to gestational diseases and evaluate lung maturity after antenatal corticosteroid therapy.The results indicate that DL algorithms can be used as a non-invasive method to predict FLM.

Prenatal assessment of normal fetal pulmonary grey-scale and lung volume by three-dimensional ultrasonography

Objective To quantitatively analyze the fetal lung echo and right lung volume in the third trimester by real-time three-dimensional ultrasound(3-D US)and evaluate the feasibility of fetal lung maturity.Methods A total of 732 women with normal singleton pregnancies between 28 and 42 weeks of gestation underwent ultrasound examination.The 3-D US equipment with a 3.5-5 MHz transabdominal transducer was used for the fetal biometric measurement.The echogenicity ratio between fetal lung and liver was compared.The fetal lung volume was calculated by the rotational multiplanar technique for volume measurement(VOCAL).Results The right fetal lung volume increased with the increase of gestational age with a linear positive correlation(r=0.884,P<0.01).After 34 weeks,the echogenicity ratio of fetal lung to liver was more than 1.1.Conclusion The echogenicity of lung/liver and fetal lung volume could be used as normal fetal predictable indicators for fetal lung maturity.

Bisphenol A exposure alters release of immune and developmental modulators and expression of estrogen receptors in human fetal lung fibroblasts

Bisphenol A （BPA） has been shown to exert biological effects through estrogen receptor （ER）-dependent and ER-independent mechanisms. Recent studies suggest that prenatal exposure to BPA may increase the risk of childhood asthma. To investigate the underlying mechanisms in the actions of BPA, human fetal lung fibroblasts {hFLFs） were exposed to varying doses of BPA in culture for 24 hr. Effects of BPA on localization and uptake of BPA, cell viability, release of immune and developmental modulators, cellular localization and expression of ERa, ERβ and G-protein coupled estrogen receptor 30 （GPR30）, and effects of ERs antagonists on BPA-induced changes in endothelin-1 （ET-1） release were examined. BPA at 0.01-100 μmol/L caused no changes in cell viability after 24 hr of exposure, hFLFs expresses all three ERs. BPA had no effects on either cellular distribution or protein expression of ERa, however, at 100 μmol/L （or 23 μmol/L intracellular BPA） increased ERβ protein levels in the cytoplasmic fractions and GPR30 protein levels in the nuclear fractions. These paralleled with increased release of growth differentiation factor-15, decreased phosphorylation of nuclear factor kappa B p65 at serine 536, and decreased release of ET-1, interleukin-6, and interferon gamma-induced protein 10. ERs antagonists had no effects on BPA-induced decrease in ET-1 release. These data suggest that BPA at 100 μmol/L altered the release of immune and developmental modulators in hFLFs, which may negatively influence fetal lung development, maturation, and susceptibility to environmental stressors, although the role of BPA in childhood asthma remains to be confirmed in in viuo studies.

<i>Stachybotrys chartarum</i>(<i>atra</i>) spore extract alters surfactant protein expression and surfactant function in isolated fetal rat lung epithelial cells, fibroblasts and human A549 cells

Moulds, notably Stachybotrys chartarum (atra), are constant contributors to air pollution particularly to air quality in buildings. The spores themselves or their volatile organic products are present in variable amounts in almost all environments, particularly in buildings affected by flooding. These moulds and products can account for the sick building syndrome and have been tied to such occurrences as the outbreak of pulmonary hemosiderosis and hemorrhage in infants in Cleveland, Ohio. The present study was designed to investigate the effects of S. chartarum extracts on surfactant protein expression, surfactant quality and cell survival in the developing lung. S. chartarum extracts were incubated with cultures of several cell types;isolated fetal lung type II cells and fetal lung fibroblasts, and human lung A549 cells, a continuously growing cell line derived from surfactant producing type II alveolar cells. MTT formazan assays were employed to test cell viability. The synthesis and release of the predominant surfactant protein A (SP-A), which is involved in the regulation of surfactant turnover and metabolism, and surfactant protein B (SP-B) involved in shuttling phospholipids between surfactant subcompartments was also assessed. Antibodies to these proteins and western blotting results were used to assess the quantity of protein produced by the various cell types. A novel approach utilizing captive bubble surfactometry was employed to investigate the quality of surfactant in terms of surface tension and bubble volume measurements. Electron microscopy was used to examine changes in cellular structure of control and S. chartarum-treated cells. Results of the study showed that exposure to the S. chartarum extracts had deleterious effects on fetal lung epithelial cell viability and their ability to produce pulmonary surfactant. S. chartarum extracts also induced deleterious changes to the developing fetal lung cells in terms of expression of SP-A and SP-B as well as to the surface tension reducing abilities of the pulmonary surfactant. Ultrastructurally, spore toxin associated changes were apparent in the isolated lung cells most notably in the lamellar bodies of fetal rat lung alveolar type II and human A549 cells. This study has demonstrated the potential damage to surfactant production and function which may be induced by inhaling S. chartarum toxins.

Cigarette Smoke Induces Apoptosis by Activation of Caspase-3 in Isolated Fetal Rat Lung Type II Alveolar Ep-ithelial Cells <i>in Vitro</i>

Smoking during pregnancy is a major source of fetal exposure to numerous harmful agents present in tobacco smoke. Lung development involves complex biochemical processes resulting in dramatic changes which continue even after birth. In addition to type I cells which form the blood-air barrier, type II alveolar epithelial (AE) cells have important and diverse functions related to immunological protection and stabilization of the alveolus through synthesis and secretion of the pulmonary surfactant. Apoptosis or programmed cells death is an important physiological process during lung embryogenesis and for the proper maintenance of homeostasis. Caspases are proteases that play important roles in regulating apoptosis. Caspase-3 is the key executioner caspase in the cascade of events leading to cell death by apoptosis. We explored the hypothesis that cigarette smoke extract (CSE) induces apoptosis in fetal rat lung type II AE cells by activation of caspase-3. To analyze these factors, isolated fetal rat lung type II AE cells were used. The cells were exposed to different concentrations of CSE (5%, 10% or 15%) (v/v) for 60 min. The results of the present study showed that CSE induced apoptosis in fetal rat lung type II AE cells with a significant increase (p 0.05) in caspase-3 activity and decrease in cell proliferation at CSE concentrations of 10% and 15% (v/v). These observations indicate that cigarette smoke extract induces apoptosis by activation of caspase-3 in fetal rat lung type II AE cells in a dose-dependent manner and may potentially alter the regulated development of the lung and the appearance of the surfactant-producing type II alveolar cells which are critical for the establishment of adequate gas exchange at birth.

主肺动脉收缩期加速时间/射血时间比值评估重度子痫前期胎儿肺成熟度

目的探讨胎儿主肺动脉收缩期加速时间(AT)/射血时间(ET)比值对重度子痫前期胎儿肺成熟度的预测价值。方法选取2021年1月至2022年12月因重度子痫前期在我院住院并自愿接受超声检查的孕妇65例,根据孕周分为早发型(孕20~33^(+6)周)重度子痫前期组(A组,n=30)和晚发型(孕34~40周)重度子痫前期组(B组,n=35)。选取超声检查孕周与A、B组相匹配的正常孕妇作为各自对照组(分别为30例、35例)。超声多普勒测量胎儿主肺动脉血流参数,包括AT、ET、AT/ET、收缩期峰值流速(PSV)。于分娩即刻采集羊水(约15 mL),检测羊水卵磷脂/鞘磷脂(L/S)值。比较A、B组胎儿主肺动脉血流参数及其与对照组有无差异,分析血流参数与羊水L/S的相关性。结果A组、B组胎儿主肺动脉AT、ET、AT/ET、PSV比较差异有统计学意义(P<0.05),且均小于各自对照组(均P<0.05)。A组、B组胎儿主肺动脉AT/ET比值与羊水L/S均呈正相关(r分别为0.821、0.383,均P<0.05)。受试者操作特征曲线分析显示AT/ET诊断早发型及晚发型子痫前期的曲线下面积分别为0.839、0.833,当假阳性率为5%时,灵敏度分别为0.853、0.912,特异度分别为0.583、0.611,截断值分别为0.185、0.255。结论胎儿主肺动脉AT/ET比值能对重度子痫前期做出初步诊断,并可定量评估胎儿肺成熟度,可为临床提供一种新的简单、无创、可重复的评估方法。

高级别胎儿型肺腺癌并头皮转移1例

胎儿型肺腺癌(fetal adenocarcinoma of the lung,FLAC)是一种罕见的肺部肿瘤。FLAC分为低级别FLAC(low-grade FLAC,L-FLAC)和高级别FLAC(high-grade FLAC,H-FLAC),两者在临床病理特征、生物学行为和临床结局方面有所不同。大多数H-FLAC患者是重度吸烟的中年人。本研究描述了1例罕见的非吸烟年轻男性患者,其最初表现为头顶肿块,最终被诊断为H-FLAC。本文旨在增进对FLAC的了解和认识,提高对该疾病的重视,以防止该疾病漏诊与误诊,加强早期识别、精准诊断,从而推进后续的有效治疗、改善预后。

产前糖皮质激素促胎肺成熟的药物利用评价

目的探讨糖皮质激素在产前促胎肺成熟中应用的合理性。方法2019年至2021年每年按住院号顺序,从电子病历系统中提取前100例应用糖皮质激素促胎肺成熟的患者的用药相关信息,从用药指征、用药时机、使用方法、重复疗程指征、治疗疗程数、各疗程间隔时间等方面评价药物应用的合理性。结果58例患者无指征用药,占所有患者的19.3%;4例患者无指征重复疗程用药,占所有患者的1.3%;168例妊娠24~36^(+6)周者在给药7 d后分娩,占相应孕龄患者的64.1%,132例妊娠24~36^(+6)周者足月分娩,占相应孕龄患者的50.4%;重复疗程中有12例在给药7 d后分娩,占重复疗程者的85.7%。结论该院产前糖皮质激素在促胎肺成熟方面存在过度用药现象,临床应严格用药指征、优化治疗方案,合理应用糖皮质激素以保障用药的有效性和安全性。

新生儿呼吸窘迫综合征相关检查应用进展

新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)是一种由于胎儿肺发育不成熟和/或各种原发、继发性原因引起肺表面活性物质(pulmonary surfactant,PS)分泌不足导致肺泡塌陷、功能障碍,从而使新生儿在出生后不久就出现进行性呼吸困难、发绀乃至呼吸衰竭的肺部疾病,是早产儿尤其是NICU内患儿致死和致病的首要原因。及早诊断和及时采用以肺表面活性物质和机械通气为主的综合性治疗手段是提升本病诊治水平的关键,因此根据临床表现及相关辅助检查进行评估和早期诊断显得尤为重要。目前针对NRDS诊断的辅助检查方法主要包括:胸部X线、肺部超声及肺成熟度检测。本文将主要从胸部X线检查、床旁肺部超声和胎儿肺成熟度三种检查在诊断NRDS方面的应用进展进行综述。

肺胎儿型腺癌临床病理特征分析

目的探讨低级别肺胎儿型腺癌(L-FLAC)和高级别肺胎儿型腺癌(H-FLAC)临床病理特征、诊断及分子遗传学特点异同点。方法回顾性分析华北理工大学附属医院病理科诊断5例FLAC的临床资料、组织学特点、免疫表型、分子特点、随访及预后情况,并复习相关文献。结果3例L-FLAC平均发病年龄37.7岁,与性别和吸烟史无关,常为早期病变(Ⅰ~Ⅱ期);2例H-FLAC均为老年吸烟男性,确诊时多晚期。镜下L-FLAC细胞核轻度异型,伴核上或核下空泡,局灶见桑葚样小体,核分裂象少见。H-FLAC细胞核异型显著伴坏死,核分裂象易见,可与其他类型腺癌混合存在。免疫表型:β-catenin在L-FLAC中呈胞核/质阳性,H-FLAC则呈胞膜阳性;p53在L-FLAC中呈低水平表达,H-FLAC为突变型表达模式;L-FLAC还可灶状表达神经内分泌标记物和SALL-4;Ki-67增殖指数为20%~70%。5例FLAC均行EGFR、KRAS及BRAF基因突变检测,结果为阴性。5例均予手术治疗,随访5.3~43.8个月,无复发及转移。结论FLAC属极为罕见的肺部恶性肿瘤,除了形态学及免疫表型差异外,L-FLAC和H-FLAC在分子遗传学特征方面尚有区别,因此更倾向视H-FLAC为普通型肺腺癌的亚型,而非从属于肺胎儿型腺癌。

产前给药沐舒坦、地塞米松对大鼠胎肺形态发育的影响

目的:比较产前给予沐舒坦(盐酸氨溴索注射液)、地塞米松对大鼠胎肺形态发育的影响。方法:9只孕鼠随机分为生理盐水对照组、沐舒坦治疗组及地塞米松治疗组,每组3只。于孕16、17、18天腹腔注射给药,孕19天每只孕鼠取6只胎鼠肺组织作为早产鼠肺模型,通过光镜观察及电镜技术,分析比较两种药物对胎肺形态发育的影响。结果:光镜下,沐舒坦治疗组、地塞米松治疗组每视野肺泡计数、平均肺泡表面积均高于对照组(P﹤0.01),平均肺泡间隔厚度均低于对照组(P﹤0.01)。地塞米松治疗组每视野肺泡计数、平均肺泡表面积均高于沐舒坦治疗组(P﹤0.01),平均肺泡间隔厚度低于沐舒坦治疗组(P﹤0.01)。透射电镜观察,沐舒坦治疗组、地塞米松治疗组Ⅱ型肺泡上皮内多见板层小体且染色深、致密,胞质内线粒体等细胞器多见,而对照组内难见板层小体、少见细胞器。结论:产前给药沐舒坦、地塞米松均能显著促进胎肺发育,地塞米松效果优于沐舒坦。但考虑到地塞米松的诸多不良反应,沐舒坦可成为临床上促胎肺成熟的更好选择。

天然生物材料壳聚糖支架上人胚肺成纤维细胞的生长

采用不同粒度的硅胶粒子作为致孔剂 ,按硅胶和壳聚糖重量比 9∶1,制备了三组不同孔径的壳聚糖多孔支架 .以无孔壳聚糖支架为参照 ,对多孔支架的有效孔径、吸水性进行了比较 .结果表明 :孔径大小由硅胶尺寸控制 ,吸水性随孔径增大而增大 .为研究支架孔径大小对其生物相容性的影响 ,在系列支架上进行了人胚肺成纤维细胞的培养 .细胞种植 1d后 ,多孔支架上的细胞粘附较多 ,而无孔支架上的细胞伸展情况较好 ;细胞培养 5d后 ,所有支架上细胞伸展情况良好 ,孔径越大的支架上细胞增殖越多 .

羊水板层小体计数预测胎肺生化成熟

目的：探讨羊水板层小体计数（LBC）诊断胎肺生化成熟的价值。方法：测定118例妊娠≥28周羊水标本的LBC,用ROC曲线分析LBC诊断L/S比值、磷脂酰甘油（PG）成熟的界值和价值。结果：LBC与L/S比值、PG、泡沫试验、OD 650密切相关（P〈0.001）;LBC诊断L/S比值≥2.0或PG阳性的ROC曲线下面积为0.959（95%C I=0.929-0.989）,最佳界值为≥86×10^9/L,诊断L/S比值〈2.0及PG阴性的最佳界值为〈40×10^9/L;LBC以≥86×10^9/L为界,诊断胎肺生化成熟的灵敏度为81.08%,特异度为100%,阳性预测价值100%,阴性预测价值为75.86%;以≥40×10^9/L为界,其灵敏度为100%,阴性预测价值为100%。结论：羊水板层小体计数对胎肺生化成熟有较高的诊断价值,可作为首选的胎肺成熟度快速筛选试验。

盐酸氨溴索、地塞米松产前用药对大鼠胎肺形态发育影响的对比

目的比较产前3d给盐酸氨溴索、地塞米松及单次给地塞米松对大鼠胎肺形态发育的影响。方法孕鼠12只随机分为9g/L盐水对照组和产前盐酸氨溴索3d治疗组、地塞米松3d及1d治疗组4组,每组3只。孕d19每只孕鼠取6只胎鼠肺组织,通过光镜观察及电镜技术比较2种药物及不同疗程对胎肺形态发育的影响。结果1.光镜下3个治疗组每视野肺泡计数、平均肺泡表面积均高于对照组(Pa(0.01),平均肺泡间隔厚度均低于对照组(Pa(0.01)。2.光镜下地塞米松3d治疗组每视野肺泡计数、平均肺泡表面积均高于地塞米松1d治疗组,平均肺泡间隔厚度低于地塞米松1d治疗组(Pa(0.01)。3.光镜下地塞米松3d及1d治疗组每视野肺泡计数、平均肺泡表面积均高于盐酸氨溴索治疗组,平均肺泡间隔厚度低于盐酸氨溴索治疗组(Pa(0.01)。4.透射电镜观察:治疗组Ⅱ型肺泡上皮内多见板层小体,尤以地塞米松3d治疗组更为多见,且染色深、致密,线粒体等细胞器多;对照组难见板层小体,少见细胞器。结论产前应用地塞米松、盐酸氨溴索均能显著促进胎肺发育;多次地塞米松优于单次地塞米松治疗;多次及单次地塞米松疗效均优于盐酸氨溴索治疗。

枇杷叶三萜酸对TGF-β_1刺激的人胚肺成纤维细胞转分化及ERK通路的影响

目的研究枇杷叶三萜酸(Triterpene acids of loquat,TAL)对转化生长因子β1(TGF-β1)刺激人胚肺成纤维细胞转分化、胶原合成及ERK通路的影响。方法体外培养人胚肺成纤维细胞(HFL-Ⅰ),MTT比色法测定TAL对HFL-Ⅰ细胞的增殖抑制率。RT-PCR检测每组中结缔组织生长因子(connective tissue growth factor,CTGF)、平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)、Ⅰ型胶原(CⅠ)、Ⅲ型胶原(CⅢ)mRNA的水平,Western blot检测各组细胞中p-ERK1/2和ERK1/2表达水平。结果 TAL呈剂量和时间依赖性抑制HFL-Ⅰ细胞的增殖(P<0.05),并能够降低CⅠ、CⅢ、α-SMA、CTGF的过度表达(P<0.05);Western blot结果显示TAL能降低TGF-β1刺激组p-ERK1/2的表达,而对ERK1/2的表达没有差异。结论 TAL能抑制HFL-Ⅰ的增殖,同时也能使活化后HFL-Ⅰ中的α-SMA生成减少,CTGF、胶原和p-ERK1/2表达降低。