The Association between Polymorphism of TNF-α Gene and Hypertensive Disorder Complicating Pregnancy

To study whether the development of hypertensive disorder complicating pregnancy is associated with --308G→A, -850C→T mutation at promoter of TNF-α gene, the --308G→A, --850C→T polymorphism was examined in patients and healthy pregnant women by PCR-RFLP technique. The frequencies of genotype and allele were compared between the two groups. The results showed that with-308G→A polymorphism distribution, the allele frequency of TNF2 and the frequency of the genotype TNF2/1 in the patient group was significantly higher in the patient group than in control group （P〈0.05）. A significant difference in genotype distribution of --850C→T polymorphism was observed between the two groups. The allele frequencies of T in patient group was higher in the control group as compared with the patient group. The frequencies of CT and TT genotypes were lower in the patient group. It is concluded that the TNF2 allele of -308 is associated with the occurrence of hypertensive disorder complicating pregnancy, while T allele of--850 may be the protective factor against the development of the disease. TNF2/1 CC may be susceptibility genotype of hypertensive disorder complicating pregnancy.

Endogenous Ouabain in Hypertensive Disorder Complicating Pregnancy

Expression of endogenous ouabain in placenta and the concentrations of serum ET-1 and NO were examined in 30 patients with hypertensive disorder complicating pregnancy （HDCP） and 30 healthy pregnant women to investigate the effect of endogenous ouabain on HDCP. Compared with the healthy pregnant group, the expression of endogenous ouabain dramatically increased in the HDCP groups （P〈0.01）. There was a significantly positive correlation between the expression of en- dogenous ouabain with ET-1 （r= 0.5567, P〈0.01）, while the correlation of endogenous ouabain and NO was significantly negative （r=-0.6895, P〈0.01）. As expected, the correlation between ET-1 and NO was negative （r=-0.7796, P〈0.01）. ET-1 concentrations of maternal and cord sera in HDCP groups were significantly higher in comparison with healthy pregnant group （P〈0.01）. On the contrast, NO concentrations were much lower in the maternal and cord sera of HDCP groups as compared with healthy pregnant group （P〈0.01）. Our data suggest that endogenous ouabain is directly involved in the nosogenesis of HDCP, with accompanying decreased NO and the elevated of ET-1.

The investigation for the relationship among serum leptin, erythrocyte membrane Ca^(2+)-ATPase activity and hypertensive disorder complicating pregnancy

Objective： To study the significance of Leptin and the activity of erythrocyte membrane Ca^2＋-ATPase（EMCA） in the development of hypertensive disorder complicating pregnancy. Methods： Radioimmunoassay was used to test the level of serum Leptin, and the activity of EMCA was determined chemically in 38 pregnant women with hypertensive disorder complicating pregnancy and 36 normotensive pregnant women. Results： The level of serum Leptin in hypertensive disorder complicating pregnancy（gestational hypertension： 13.76 ± 3.46 ng/ml; preeclampsia： 15.76 ± 5.47 ng/ml; eclampsia： 18.32 ± 6.38 ng/ml）was significantly higher than that in normotensive pregnant women （11.33 ± 2.93 ng/ml） ,respectively. The average EMCA activity of patients with hypertensive disorder complicating pregnancy （gestational hypertension： 1.65 ± 0.24 μmol·pi/mg.h ; preeclampsia： 1.37 ± 0.19 μ mol·pi/mg·h;eclampsia：1.12 ± 0.14 μmol·pi/mg·h） was significantly lower than that of normotensive pregnant women（1.83 ± 0.38 μ mol·pi/mg·h）,respectively. There was a negative correlation between the level of serum Leptin and the activity of RMCA in hypertensive disorder complicating pregnancy （r = -0.63）. Conclusion： Inhibition of EMCA activity of erythrocyte in hypertensive disorder complicating pregnancy may increase cytoplasmic free calcium, which contributes to the development of hypertensive disorder complicating pregnancy. The negative correlation between the level of serum Leptin and the activity of EMCA, also suggested that serum Leptin and the activity of EMCA may play a role in the development of hypertensive disorder complicating pregnancy.

Ultrasonic evaluation of central retinal artery hemodynamics in patients with hypertensive disorder complicating pregnancy and the correlation with disease

Objective:To study the correlation between central retinal artery hemodynamic characteristics in patients with hypertensive disorder complicating pregnancy and endothelial injury molecules as well as trophoblast cell apoptosis molecules.Methods: 45 healthy pregnant women, 37 patients with gestational hypertension and 24 patients with preeclampsia who gave birth in Obstetrics Department of our hospital between May 2013 and December 2015 were selected and included in the control group, GH group and PE group respectively. Central retinal artery ultrasonography was done to determine peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI), serum was collected to determine interleukin-6 (IL-6), IL-17, IL-24, chemokine ligand 10 (CXCL10) and cartilage glycoprotein 40 (YKL40) content, and placenta tissue was collected to determine Fas, FasL, Bax, Caspase-3, Caspase-9, XIAP, Survivin and Livin expression.Results: Central retinal artery PSV and EDV as well as XIAP, Survivin and Livin expression in placenta of GH group and PE group were significantly lower than those of control group (P<0.05) while central retinal artery RI, serum IL-6, IL-17, IL-24, CXCL10 and YKL40 content as well as Fas, FasL, Bax, Caspase-3 and Caspase-9 expression in placenta were significantly higher than those of control group (P<0.05). Central retinal artery PSV and EDV as well as XIAP, Survivin and Livin expression in placenta of PE group were significantly lower than those of GH group (P<0.05) while central retinal artery RI, serum IL-6, IL-17, IL-24, CXCL10 and YKL40 content as well as Fas, FasL, Bax, Caspase-3 and Caspase-9 expression in placenta were significantly higher than those of GH group (P<0.05). Serum IL-6, IL-17, IL-24, CXCL10 and YKL40 content as well as Fas, FasL, Bax, Caspase-3 and Caspase-9 expression in placenta were negatively correlated with PSV and EDV, and positively correlated with RI;XIAP, Survivin and Livin expression in placenta were positively correlated with PSV and EDV, and negatively correlated with RI. Conclusions:Central retinal artery blood flow characteristics in patients with hypertensive disorder complicating pregnancy are the significantly increased blood flow resistance and the significantly decreased blood flow volume, and the above blood flow characteristics are associated with maternal endothelial injury and trophoblast cell apoptosis.

Effect of low molecular weight heparin therapy on maternal endothelial injury and placental pathological injury after hypertensive disorder complicating pregnancy

Objective: To study the effect of low molecular weight heparin therapy on maternal endothelial injury and placental pathological injury after hypertensive disorder complicating pregnancy. Methods: A total of 70 patients with hypertensive disorder complicating pregnancy who were treated in the hospital between September 2014 and May 2016 were divided into control group and observation group according to the random number table method, 35 cases in each group. Control group received conventional therapy, the observation group received low molecular weight heparin combined with conventional therapy, and both therapies lasted until delivery. The differences in the levels of endothelial injury indexes in serum as well as the expression of oxidative stress indexes and apoptosis molecules in the placental grinding fluid were compared between the two groups of patients. Results: After treatment, serum ET and VCAM-1 levels of both groups of patients were lower than those before treatment while NO and PGE levels were higher than those before treatment, and serum ET and VCAM-1 levels of observation group were lower than those of control group while NO and PGE levels were higher than those of control group;after delivery, AOPP and MDA levels in placental grinding fluid were significantly lower than those of control group while SOD and GSH-Px levels were higher than those of control group;Fas, p53 and caspase-3 mRNA expression in placental grinding fluid were lower than those of control group while Bcl-2 and bax mRNA expression were higher than those of control group. Conclusion: Adjuvant low molecular weight heparin therapy can help to reduce the maternal endothelial injury, reduce the systemic oxidative stress and suppress the placental cell apoptosis in patients with hypertensive disorder complicating pregnancy.

Ultrasonic evaluation of fetal ventricular systolic function in hypertensive disorder complicating pregnancy and its correlation with the expression of placental hypoxia-related genes

Objective: To discuss the ultrasonic evaluation of fetal ventricular systolic function in hypertensive disorder complicating pregnancy and its correlation with the expression of placental hypoxia-related genes. Methods: A total of 98 late pregnant women with hypertensive disorder complicating pregnancy who were treated in the hospital between December 2014 and February 2017 were selected as hypertensive disorder complicating pregnancy group and 100 normal late pregnant women who received physical examination in the hospital during the same period were selected as normal control group. The ultrasonic parameters of fetal ventricular systolic function in two groups of pregnant women were detected before delivery, and the expression of hypoxia-related genes in placental tissue was detected by fluorescence quantitative PCR. Pearson test was used to assess the correlation between the parameters of fetal ventricular systolic function and placental hypoxia in hypertensive disorder complicating pregnancy. Results: The fetal left ventricular fractional shortening and right ventricular fractional shortening levels of hypertensive disorder complicating pregnancy group were lower than those of normal control group. Angiogenesis-related genes VEGF, netrin-1 and XIAP mRNA expression in placental tissue of hypertensive disorder complicating pregnancy group were lower than those in placental tissue of normal control group while HIF-1α mRNA expression was higher than that in placental tissue of normal control group;oxidative stress-related genes Nrf2, TAC3 and PrxⅡ mRNA expression in placental tissue were lower than those in placental tissue of normal control group;apoptosis genes Fas, p53 and caspase-9 mRNA expression in placental tissue were higher than those in placental tissue of normal control group while Bcl-2 and SFRP2 mRNA expression were lower than those in placental tissue of normal control group. Pearson test showed that the ultrasonic parameter levels of fetal ventricular systolic function in hypertensive disorder complicating pregnancy were directly correlated with the degree of placental hypoxia. Conclusion:Ultrasonic testing of fetal ventricular systolic function in hypertensive disorder complicating pregnancy can be used as a reliable method to measure the degree of placental hypoxia.

Effect of folic acid and vitamin supplement on endothelial injury and placental blood perfusion in patients with hypertensive disorder complicating pregnancy

Objective: To study the effect of folic acid and vitamin supplement on endothelial injury and placental blood perfusion in patients with hypertensive disorder complicating pregnancy. Methods: A total of 62 patients who were diagnosed with preeclampsia in Wuhan Red Cross hospital between March 2015 and February 2017 were selected as the research subjects and randomly divided into two groups, the observation group received folic acid, vitamin and conventional symptomatic treatment, and control group accepted conventional symptomatic treatment. Serum contents of endothelial injury markers and oxidative stress indexes were detected before treatment and 2 weeks after treatment;the expression of apoptosis genes in the placenta were detected after delivery. Results: 2 weeks after treatment, serum ET-1, tTG, sFlt-1, sEng, MPO, IMA, MDA and AOPP levels of both groups of patients were significantly lower than those before treatment, and serum ET-1, tTG, sFlt-1, sEng, MPO, IMA, MDA and AOPP levels of observation group were significantly lower than those of control group;after delivery, Fas, Bax and Caspase-3 mRNA expression levels in placenta tissue of observation group were significantly lower than those of control group while Bcl-2, Survivin and Livin mRNA expression levels were significantly higher than those of control group. Conclusion:Folic acid and vitamin supplement can significantly improve the endothelial injury and placental blood perfusion in patients with hypertensive disorder complicating pregnancy.

Changes in Number and Biological Function of Endothelial Progenitor Cells in Hypertension Disorder Complicating Pregnancy

To examine the changes in number and function of endothelial progenitor cells （EPCs） from peripheral blood （PB） in hypertension disorder complicating pregnancy （HDCP）, 20 women with HDCP and 20 normal pregnant women at the third trimester were studied. Mononuclear cells （MNCs） from PB were isolated by Ficoll density gradient centrifugation. EPCs were identified by positive expression of both CD34 and CD133 under fluorescence microscope and positive expression of factor Ⅷ as shown by immunocytochemistry. The number of EPCs was flow-cytometrically determined. Proliferation and migration of EPCs were measured by MTT assay and modified Boyden chamber assay, respectively. The adhesion activity of EPCs was detected by counting the number of the adherent cells. The results showed that, compared with normal pregnant women, the number of EPCs was significantly reduced in HDCP （4.29%±1.21% vs 15.32%±2.00%, P〈0.01）, the functional activity of EPCs in HDCP, such as proliferation （13.45%±1.68% vs 18.45%±1.67%）, migration （37.25±7.28 cells/field vs 67.10±9.55 cells/field） and adhesion activity （20.65±5.19 cells/field vs 34.40±6.72 cells/filed） was impaired （P〈0.01）. It is concluded that the number and function of EPCs are significantly decreased in HDCP.

Pregnancy complications effect on the nickel content in maternal blood,placenta blood and umbilical cord blood during pregnancy

BACKGROUND Nickel(Ni)may accumulate in the human body and has biological toxicity and carcinogenicity.Ni has an extensive impact on the health of pregnant women and fetuses during gestation.AIM To evaluate Ni exposure in pregnant women in Kunming,Yunnan Province,China;to describe the distribution of Ni in the maternal-fetal system and placental barrier function;and to investigate the effect of Ni exposure on fetal health in mothers with pregnancy complications.METHODS Seventy-two pregnant women were selected using a case-control design.The women were divided into two groups:The control group(no disease;n=29)and the disease group[gestational diabetes(GDM),hypertensive disorder complicating pregnancy(HDCP),or both;n=43].The pregnant women in the disease group were further divided as follows:14 cases with GDM(GDM group),13 cases with HDCP(HDCP group)and 16 cases with both GDM and HDCP(disease combination group).Basic information on the pregnant women was collected by questionnaire survey.Maternal blood,placenta blood and cord blood were collected immediately after delivery.The Ni content in paired samples was determined using inductively coupled plasma mass spectrometry.RESULTS Compared to the control group,age was higher and body mass index was greater in pregnant women in the disease groups(28.14±2.54 vs 28.42±13.89,P<0.05;25.90±3.86 vs 31.49±5.30,P<0.05).The birth weights of newborns in the HDCP group and the control group were significantly different(2.52±0.74 vs 3.18±0.41,P<0.05).The content of Ni in umbilical cord blood in the entire disease group was higher than that in the control group(0.10±0.16 vs 0.05±0.07,P<0.05).CONCLUSION In the maternal-fetal system of women with pregnancy complications,the barrier effect of the placenta against Ni is weakened,thus affecting healthy growth of the fetus in the uterus.

miR-26b、miR-1233-3p、miR-206与妊娠期高血压血管内皮功能关系及三者联合预测HDCP不良妊娠结局的ROC曲线分析

目的 探讨微小RNA-26b(microRNA-26b, miR-26b)、miR-1233-3p、miR-206与妊娠期高血压(hypertensive disorders complicating pregnancy, HDCP)血管内皮功能关系及三者联合预测HDCP不良妊娠结局的价值。方法 选取2019-04/2021-04月作者医院收治的104例HDCP患者的病历资料进行分析。根据是否发生不良妊娠结局分为发生组(n=25)和未发生组(n=79)。比较两组基线资料、肱动脉内皮依赖性舒张功能(flow mediated dilation, FMD)、miR-26b、miR-1233-3p、miR-206。应用Pearson相关分析探讨miR-26b、miR-1233-3p、miR-206与FMD关系。采用多因素Logistic回归分析探讨不良妊娠结局的相关影响因素。采用受试者工作特征(receiver operating characteristic, ROC)曲线及曲线下面积(area under the curve, AUC)分析miR-26b、miR-1233-3p、miR-206预测HDCP不良妊娠结局的价值。结果 发生组患者病情阶段与未发生组比较,差异有统计学意义(P<0.05)。发生组患者FMD、miR-206低于未发生组,miR-26b、miR-1233-3p高于未发生组(P均<0.05)。miR-26b、miR-1233-3p与FMD呈负相关(r=-0.538、-0.588,P均<0.001),miR-206与FMD呈正相关(r=0.653,P<0.001)。调整病情阶段、FMD后,miR-26b、miR-1233-3p、miR-206仍与HDCP不良妊娠结局相关(P<0.05)。miR-26b、miR-1233-3p、miR-206及三者联合预测HDCP不良妊娠结局的AUC分别为0.771(95%CI:0.658~0.884)、0.790(95%CI:0.673~0.907)、0.772(95%CI:0.678~0.856)、0.840(95%CI:0.743~0.936),三者联合预测价值最大。结论 miR-26b、miR-1233-3p、miR-206与HDCP血管内皮功能、不良妊娠结局有关,三者联合检测可作为HDCP不良妊娠结局的一个有效预测方案。

HDCP患者血清miR-181b、PLGF、IL-17与疾病严重程度的关系及其对不良妊娠结局的预测价值

目的:探讨妊娠高血压疾病(HDCP)患者血清miR-181b、胎盘生长因子(PLGF)、白细胞介素17(IL-17)与疾病严重程度的关系及对不良妊娠结局的预测价值。方法:选取126例HDCP孕妇为研究对象,根据HDCP严重程度不同分为妊娠期高血压组(n=61)、子痫前期组(n=37)和重度子痫前期组(n=28);根据妊娠结局分为正常组(n=62)和不良妊娠组(n=64)。比较不同疾病严重程度及不同妊娠结局患者血清IL-17、PLGF、miR-181b水平,分析其与HDCP严重程度的关系及其对不良妊娠结局的预测价值。结果:不同疾病严重程度组患者血清miR-181b、IL-17及PLGF水平差异有统计学意义(P<0.05),且患者血清miR-181b和IL-17水平比较:重度子痫前期组>子痫前期组>妊娠期高血压组;PLGF水平比较:重度子痫前期组<子痫前期组<妊娠期高血压组。miR-181b和IL-17水平与HDCP严重程度正相关(P<0.05),PLGF水平与HDCP严重程度负相关(P<0.05)。早产和产后出血为主要不良妊娠结局,重度子痫前期组不良妊娠结局发生率最高(P<0.05)。不良妊娠组患者miR-181b、IL-17水平高于正常组(P<0.05),PLGF水平明显较低(P<0.05)。miR-181b(AUC=0.725,P<0.05)、IL-17(AUC=0.692,P<0.05)及PLGF(AUC=0.698,P<0.05)对不良妊娠结局均有预测价值,三者联合检测的AUC=0.792,敏感度为85.94%,特异度为64.52%。结论:血清miR-181b、PLGF、IL-17水平与HDCP严重程度相关,对不良妊娠结局有预测价值,联合检测的预测价值更高。

基于血栓弹力图的孕妇HDCP凝血状态分析

目的 分析基于血栓弹力图的孕妇妊娠期高血压疾病(HDCP)孕妇凝血状态。方法 选取2021年11月至2022年10月在我院分娩的孕妇300例作为研究对象,其中250名为正常健康孕妇(纳入对照组),50例为出现HDCP的孕妇(纳入研究组)。所有孕妇均接受凝血指标检测、血小板指标检测以及血栓弹力图检测。比较两组之间以及研究组中不同病情孕妇之间的上述各项检测指标;分析血栓弹力图中各项指标与凝血指标与血小板指标的相关性。结果 研究组的PT、APTT、R、K显著短于对照组(P <0.05),TT显著长于对照组(P <0.05),FIB、D-D、PDW、MPV、Angle、MA、LY30显著高于对照组(P <0.05),PLT显著低于对照组(P <0.05)。研究组孕妇随着病情加重,PT、APTT、R、K逐渐缩短,TT逐渐延长,FIB、D-D、PDW、MPV、Angle、MA、LY30逐渐升高,PLT逐渐降低。R与PT、APTT呈正相关;K与FIB、D-D呈负相关;Angle与FIB、D-D呈正相关;MA与PLT呈负相关,与PDW、MPV呈正相关;LY30与FIB、D-D呈正相关(均P <0.05)。结论 HDCP孕妇的血液处于高凝状态,且随着病情的加重,其血液高凝程度越发严重。血栓弹力图指标与HDCP孕妇的凝血功能指标及血小板指标存在显著相关性,适用于HDCP孕妇的预防、治疗指导。

乌拉地尔联合硫酸镁、阿司匹林治疗妊娠期高血压疾病的效果及对微环境炎症的影响

目的分析乌拉地尔联合硫酸镁、阿司匹林治疗妊娠期高血压疾病的效果及对微环境炎症的影响。方法选择2021年1月至2022年3月我院收治的80例妊娠期高血压疾病患者作为研究对象,以随机数字表法将其分为对照组和观察组,每组40例。对照组给予硫酸镁、阿司匹林治疗,观察组在对照组治疗基础上加施乌拉地尔治疗。比较两组的治疗效果。结果治疗后,观察组的收缩压、舒张压、尿蛋白含量低于对照组(P<0.05)。治疗后,观察组的可溶性白细胞介素-2受体(sIL-2R)、核因子-κB(NF-κB)、高迁移率族蛋白B1(HMGB1)水平低于对照组(P<0.05)。治疗后,观察组的内皮素-1(ET-1)水平低于对照组,血管内皮生长因子(VEGF)、血小板内皮细胞黏附分子-1(PECAM-1)水平高于对照组(P<0.05)。观察组的不良妊娠总发生率显著低于对照组(P<0.05)。结论乌拉地尔联合硫酸镁、阿司匹林治疗妊娠期高血压疾病不仅能改善微环境炎症及血管内皮功能,提高血压控制效果,还能减少不良妊娠结局发生,值得临床进一步推广及应用。

HDP产妇产后发生慢性肾脏病风险因素

目的:分析妊娠期高血压疾病(HDP)发生产后慢性肾脏病(CKD)风险因素。方法:回顾分析2017年7月-2021年6月于本院建档产前检查的孕产妇病例记录共3185例,其中HDP产妇726例纳入观察组,非HDP产妇2459例纳入对照组。收集两组孕前情况、既往史、个人史、家族史、孕产史等临床资料,比较两组及产后发生CKD患者的临床资料,分析HDP产妇发生CKD的风险及相关风险因素。结果:观察组年龄和孕前体质指数高于对照组,初次妊娠、剖宫产及发生分娩并发症的比例高于对照组,CKD发病率(5.0%)高于对照组(1.4%)(均P<0.05)。经分析,观察组发生CKD的风险是对照组的5.54倍(95%CI3.43~10.65);HDP产妇矫正干扰因素后,分娩年龄≥35岁仍是CKD发生的风险因素(OR=2.31,95%CI1.30~3.89),分娩≥2次的HDP产妇发生CKD的风险低于初产妇(OR=0.34,95%CI0.14~0.74)(均P<0.05)。结论:HDP产妇发生CKD的风险较高,特别是年龄≥35岁的高龄产妇,提示临床在分娩后应嘱产妇定期检查肾功能,以便及时干预治疗。

胎儿心脏定量分析技术评估妊娠期高血压疾病胎儿心脏形态及功能的临床价值

目的 探讨胎儿心脏定量分析技术(fetal HQ)评估妊娠期高血压疾病(HDCP)胎儿心脏形态及功能的临床应用价值。方法 选取于山西省儿童医院分娩的HDCP孕妇49例(病例组),以及同期无任何基础疾病及妊娠期合并症且胎儿常规产前超声检查结果无异常的健康孕妇52例(对照组),应用fetal HQ于胎儿四腔心切面获取舒张末期整体球形指数(GSI),以及左、右心室面积变化分数(FAC)、24个节段短轴缩短率(FS)的Z评分及24个节段球形指数(SI),比较两组上述参数的差异。结果 HDCP组GSI及左、右心室FAC与对照组比较差异均有统计学意义(均P<0.05)。HDCP组左心室2~24节段FS的Z评分与对照组比较差异均有统计学意义(均P<0.05),两组左心室1节段FS的Z评分比较差异无统计学意义;HDCP组右心室1~24节段FS的Z评分与对照组比较差异均有统计学意义(均P<0.05)。HDCP组左心室2~16节段SI与对照组比较差异均有统计学意义(均P<0.05),两组左心室1、17~24节段SI和右心室1~24个节段SI比较差异均无统计学意义。HDCP组左、右心室1~11节段SI比较差异均有统计学意义(均P<0.05),左、右心室12~24节段SI比较差异均无统计学意义;对照组左、右心室1~15、22~24节段SI比较差异均有统计学意义(均P<0.05),左、右心室16~21节段SI比较差异均无统计学意义。结论 fetal HQ可用于评估HDCP胎儿心脏形态及功能,具有一定的临床应用价值。

TGF-β1/Smad信号通路在妊娠期高血压疾病中的表达及其与病情严重程度和不良妊娠结局的关系研究

目的探讨转化生长因子β1(TGF-β1)/Smad信号通路在妊娠期高血压疾病(HDP)患者胎盘中的表达及临床意义。方法回顾性选取2021年2月至2023年2月在新疆医科大学第六附属医院妇产科诊断为HDP的单胎孕妇100例,分为轻度组70例,重度组30例。另选正常单胎妊娠孕妇100名作为对照组。采用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶连结(SP)法检测胎盘中TGF-β1、Smad2和Smad3的表达水平,并统计妊娠结局。利用多因素Logistic回归模型来分析TGF-β1/Smad信号通路主要蛋白与HDP以及不良妊娠结局的独立相关性;应用受试者工作特征(ROC)曲线分析TGF-β1/Smad信号通路主要蛋白对HDP的诊断价值以及对妊娠结局的预测价值。结果重度组胎盘组织中TGF-β1、Smad2和Smad3的表达水平分别为(18.10±3.59)%、(4.69±1.01)%、(3.01±0.53)%,轻度组分别为(12.17±3.28)%、(3.16±0.74)%、(2.18±0.47)%,均高于对照组[(9.96±2.42)%、(2.47±0.68)%、(1.77±0.45)%],且重度组高于轻度组,差异均有统计学意义(P<0.05)。100例HDP患者中,妊娠结局良好者81例,妊娠结局不良者19例。妊娠结局不良者胎盘组织中TGF-β1、Smad2和Smad3的表达水平分别为(18.18±3.53)%、(4.77±1.02)%、(3.15±0.54)%,均高于妊娠结局良好者[(12.96±3.32)%、(3.35±0.69)%、(2.26±0.47)%],差异均有统计学意义(P<0.05)。Logistic回归分析显示,TGF-β1、Smad2和Smad3是导致HDP发生的独立危险因素(P<0.05),也是HDP患者不良妊娠结局的独立危险因素(P<0.05)。ROC曲线分析显示,TGF-β1、Smad2、Smad2及三者联合诊断HDP的曲线下面积(AUC)分别为0.823、0.867、0.803、0.966,以三者联合诊断价值最高(敏感度为93.00%,特异度为88.00%);TGF-β1、Smad2、Smad3及三者联合预测HDP患者不良妊娠结局的AUC分别为0.846、0.934、0.820、0.974,以三者联合预测价值最高(敏感度为95.83%,特异度为90.70%)。结论TGF-β1/Smad信号通路参与了HDP的发生与发展,TGF-β1、Smad2和Smad2对诊断HDP及预测HDP患者不良妊娠结局的价值较高,且随着病情的加重,TGF-β1、Smad2和Smad2逐渐升高。

妊娠期糖尿病合并妊娠期高血压疾病患者血清miR-518、炎症因子水平及临床意义

目的分析妊娠期糖尿病(GDM)合并妊娠期高血压疾病(HDP)患者血清miR-518水平与炎症因子的相关性。方法选择2021年8月至2022年8月于该院产科门诊建档并定期产检的孕妇140例为研究对象,其中67例GDM合并HDP患者纳入观察组,53例单纯GDM患者纳入对照组,20例正常妊娠女性纳入健康组。观察组中,GDM合并妊娠期高血压29例,GDM合并轻度子痫前期24例,GDM合并重度子痫前期14例。采用酶联免疫吸附试验检测所有研究对象血清肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-10水平,采用实时荧光定量聚合酶链反应检测所有研究对象血清miR-518水平。结果对照组、观察组miR-518、TNF-α、IL-6、IL-10水平明显高于健康组,且观察组miR-518、TNF-α、IL-6、IL-10水平明显高于对照组,差异均有统计学意义(P<0.05)。与GDM合并妊娠期高血压患者比较,GDM合并轻度子痫前期患者、GDM合并重度子痫前期患者血清miR-518、TNF-α、IL-6、IL-10水平明显升高,差异均有统计学意义(P<0.05)。与GDM合并轻度子痫前期患者比较,GDM合并重度子痫前期患者的血清miR-518、TNF-α、IL-6、IL-10水平明显升高,差异均有统计学意义(P<0.05)。观察组患者血清miR-518水平与血清TNF-α、IL-6、IL-10水平均呈正相关(P<0.05),且疾病越严重,相关系数越大。结论GDM合并HDP患者血清miR-518水平与TNF-α、IL-6、IL-10水平呈正相关,且疾病越严重,相关程度越高,或可通过调控miR-518的表达影响GDM合并HDP患者血清中的炎症因子水平。

中药注射液治疗妊娠期高血压疾病的网状Meta分析

目的:运用网状Meta分析方法比较不同中药注射液治疗妊娠期高血压疾病的疗效。方法:检索PubMed、The Cochrane Library、Embase、Web of Science、万方、维普、中国知网和中国生物医学文献服务系统数据库,搜索建库至2022年2月28日发表的中药注射液治疗妊娠期高血压疾病的随机对照试验,采用RevMan 5.3、STATA 15.1软件进行数据统计分析。结果:最终纳入86项随机对照试验,共涉及8种中药注射液,包括8990例患者。网状Meta分析结果显示:①提高临床总疗效方面,曲线下累积排序概率面积(SUCRA)排名前3位的中药注射液依次为黄芪注射液、脉络宁注射液、参麦注射液;②降低收缩压方面,SUCRA排名前3位的中药注射液依次为黄芪注射液、参麦注射液、川芎嗪注射液;③降低舒张压方面,SUCRA排名前3位的中药注射液依次为黄芪注射液、川芎嗪注射液、丹参川芎嗪注射液;④降低产后出血率方面,SUCRA排名前3位的中药注射液依次为川芎嗪注射液、黄芪注射液、复方丹参注射液;⑤降低新生儿窒息率方面,SUCRA排名前3位的中药注射液依次为黄芪注射液、川芎嗪注射液、丹参注射液。结论:中药注射液联合常规治疗可提高妊娠期高血压疾病临床疗效、降低血压、减少产后出血及新生儿窒息并发症的发生。但鉴于纳入文献的质量及研究数量差异较大,故仍需开展高质量的多中心、大样本、随机双盲试验加以佐证。

三维斑点追踪技术及左室压力-应变环评估妊娠期高血压患者心肌功能的临床价值

目的 探讨三维斑点追踪技术(3D-STI)及左室压力-应变环(LV-PSL)评估妊娠期高血压(HDCP)患者左室心肌功能的临床价值。方法 选取我院确诊的HDCP患者33例(HDCP组)和同期正常孕妇32例(对照组),收集两组临床资料;应用常规超声心动图获得舒张末期左室内径、左室后壁厚度(LVPWTd)、室间隔厚度(IVSTd)、二尖瓣口舒张早期及舒张晚期血流速度峰值、二尖瓣环舒张早期运动速度峰值(e’)及Tei指数;应用3D-STI获得左室整体纵向、径向、圆周、面积应变(GLS、GRS、GCS、GAS),以及左室舒张及收缩末期容积指数(EDVI、ESVI)、每搏量指数(SVI)、射血分数、心输出量(CO);应用LV-PSL获得左室心肌整体做功效率(GWE)、整体有用功(GCW)、整体无用功(GWW)、整体做功指数(GWI),比较两组上述参数的差异。结果 (1)临床资料比较:HDCP组体表面积、收缩压、舒张压均较对照组增大,差异均有统计学意义(均P<0.05)。(2)常规超声心动图参数比较:HDCP组IVSTd、LVPWTd均较对照组增厚,e’较对照组减低,Tei指数较对照组增高,差异均有统计学意义(均P<0.05)。(3)3D-STI参数比较:HDCP组GLS、GRS、GCS、GAS均较对照组减低,EDVI、ESVI、SVI、CO均较对照组增高,差异均有统计学意义(均P<0.05)。(4)LV-PSL参数比较:两组GWE、GCW、GWW、GWI比较差异均无统计学意义。结论 应用3D-STI及LV-PSL可准确评估HDCP患者心肌功能,为临床诊治提供参考依据。

HDCP患者心肌酶谱与血脂指标的关联性研究

目的探讨妊娠期高血压疾病(HDCP)患者心肌酶谱与血脂指标的关联性。方法收集2014年1月1日至6月30日在深圳沙井医院就诊的91例HDCP患者,其中妊娠期高血压20例、轻度子痫前期45例、重度子痫前期26例,选择50例同期在医院正常分娩产妇作为对照组,测量各组血脂指标及心肌酶谱,对两种指标的相关性进行评估。结果妊娠期高血压组、轻度子痫前期组、重度子痫前期组的体质量指数(BMI)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A(Apo-A)、载脂蛋白B(Apo-B)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)及肌酸激酶(CK)与对照组比较差异均有统计学意义(t=1.845-13.482,均P<0.05);轻、重度子痫前期组的BMI、LDL-C、TC、TG、HDL-C、Apo-A、Apo-B、LDH、AST及CK与妊娠期高血压组比较差异均有统计学意义(t=1.663-14.258,均P<0.05);重度子痫前期组的BMI、LDL-C、TC、TG、HDL-C、Apo-A、Apo-B、LDH、AST及CK与轻度子痫前期组比较差异均有统计学意义(t=1.488~16.225,均P<0.05);对照组与各HDCP组脂蛋白a(Lpa)及肌酸激酶同工酶(CK-MB)组间比较差异均无统计学意义(均P>0.05)。多因素相关分析表明,LDL-C、Apo-B均为AST和CK的独立相关因素(r^2分别为0.513、0.497和0.391、0.445,均P<0.05)。结论 HDCP患者血清中LDL-C、TC、TG、Apo-B、AST、LDH及CK均有所升高,HDL-C和Apo-A则明显下降,而且随着病情的加重变化更为明显,心肌酶谱指标AST和CK与LDL-C、Apo-B具有一定的相关性。