胎痫释微

胎痫的病因病机主要有孕母因素、胎热、风动痰扰及惊痫、客忤,临证须辨证施治。考证古籍及现代医学认识,胎痫为发于围产期及周岁之内的新生儿发作性脑病。

胎痫“禀赋异质,精不化气”病机探析

婴幼儿早发性癫痫性脑病符合古籍中“胎痫”的论述,异质性是其显著特征,结合异质性与禀赋、精气的内在联系,提出其核心病机是禀赋异质、精不化气,主要体现在肾精“量不足”和“质改变”两个方面。认为养胎不慎、胎元受损是重要的致病因素,五脏脏气不平、气化失序、痰气逆乱是发病之始。治疗以补肾培元为主,强调动态辨证施治,佐以健脾、柔肝、涤痰、熄风等法。

Right heart modified myocardial performance index and ductus venosus spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes

Objective To observe the values of changes of right heart modified myocardial performance index(Mod-MPI)and ductus venosus(DV)spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes.Methods Eighty-one pregnant women diagnosed as pre-eclampsia were prospectively enrolled and divided into severe pre-eclampsia(SPE)group(n=39)and mild pre-eclampsia(MPE)group(n=42),while 85 healthy pregnant women were taken as controls(control group).Fetal right heart function parameters,including right ventricular isovolumetric relaxation time(IRT),isovolumetric contraction time(ICT),ejection time(ET),total spent time(TST),Mod-MPI,tricuspid valve peak flow velocity ratio in early and late diastole(TV-E/A),as well as blood flow velocities in each waveform of DV spectrum(S,V,D,and A wave)were obtained,and the pulsatility index(PI)and the ratio of blood flow velocities in each waveform of the DV(S/V,S/D,S/A,V/D,V/A,D/A)were calculated.Intrauterine fetal distress,preterm delivery,neonatal asphyxia and newborn with low weight were considered as adverse pregnancy outcomes.The correlations of right heart Mod-MPI and TV-E/A with DV parameters in pre-eclampsia fetuses were assessed,and their predictive efficacies for adverse pregnancy outcomes were evaluated for right heart Mod-MPI and DV using the receiver operating characteristics(ROC)and the area under the curves(AUC).Results Compared with control group and MPE group,fetal right heart IRT,ICT and Mod-MPI increased and ET decreased in SPE group(all P<0.05).No significant differences of right heart TST and TV-E/A among 3 groups(both P>0.05).Fetal DV A-wave velocity and V/D values progressively decreased but PI progressively increased in control,MPE and SPE groups(all P<0.05).Fetal right heart Mod-MPI in pre-eclampsia was moderately positively correlated with DV PI(r=0.637,P=0.016),while TV-E/A was weakly negatively correlated with DV V/D(r=-0.355,P=0.043).Adverse pregnancy outcomes were noticed in 59 pre-eclampsia cases.The AUC of fetal right heart Mod-MPI and DV PI for predicting adverse pregnancy outcomes in pre-eclampsia cases was 0.897 and 0.848,respectively,without significant difference(Z=0.460,P=0.400).Conclusion Changes of right heart Mod-MPI and DV spectrum parameters in pre-eclampsia fetuses had high value for predicting adverse pregnancy outcomes.

Contribution of placental leptin to the serum levels in preeclampsia and the effect of hypoxia on synthesis of placental leptin

Objective: To investigate the contribution of placental leptin to the serum levels in preeclampsia and the effect of hypoxia on synthesis of placental leptin. Methods: Fifteen preeclamptic women and 20 normotensive pregnant women were recruited in present study. Leptin concentrations in peripheral venous blood samples and uterine venous blood samples were measured by radioimmunoassay. Eight cases of normal human term placental villi were cultured either in normaxia （21%O2） or in hypoxia （2%O2） followed by determining leptin in the culture medium by radioimmunoassay. Results: Leptin concentrations were significantly higher in preeclamptic women than in normotensive pregnant women, both in the peripheral vein （[23.29±12.87] μg/L vs [13.87±5.57] μg/L, P<0.01） and uterine vein （[16.44±8.62] μg/L vs [11.21±4.20] μg/L, P<0.05）. Leptin concentrations were significantly higher in the peripheral vein than in uterine vein, both in the preeclamptic （P<0.01） and in normotensive pregnant women （P<0.01）. Concentrations of leptin in the culture medium were significantly increased in hypoxia than in normoxia （P<0.05）. Conclusion: The pathogenesis of preeclampsia may be associated with an increase of maternal serum leptin and placenta leptin, and hypoxia in placenta may be an important factor that results in preeclamptic placenta to produce more leptin. Placenta is not the principal source of the serum leptin in the preeclamptic women or normotensive pregnant women.

Alteration and potential role of soluble fms-like tyrosine kinase receptor 1 in preeclampsia

Objective:To investigate the alteration of serum soluble fms-like tyrosine kinase receptor 1 (sFlt-1), the possible cause in preeclampsia, the relationship between altered sFlt-1 and the development of pregnancy. Methods: Semi-quantitative RT-PCR was carried out to detect the level of sFlt-1 mRNA in placental tissue of 10 preeclampsia (study group) and 10 normotensive pregnancies (control group); ELISA was used to detect the serum level of sFlt-1 in peripheral venous blood and uterine venous blood in control group (n=35) and study group (n=35), and furthermore to detect the volume of peripheral venous blood sFlt-1 in early, middle and later pregnancies. Results: sFlt-1 mRNA of placental tissue was significantly higher in preeclampsia than that in normal pregnancy. The serum level of sFlt-1 of peripheral vein in preeclampsia was higher than that in normal pregnancy ([ 5639.6±3190.5] pg/ml vs[ 2194.4±635.8 ] pg/ml, P<0.01) , so did the serum sFlt-1 of uterine vein in preeclampsia and control group ([7673.3±2295.8] pg/ml vs[ 3056.6±784.6] pg/ml, P<0.01), indicating that the volume of sFlt-1 of uterine vein blood was significantly higher than that of peripheral venous blood (P<0.01). The serum level of sFlt-1 in early, middle and later pregnancy were (31.7±19.6) pg/ml (n=10), (994.0±302.1) pg/ml (n=10), (2194.4±635.8) pg/ml (n=35), respectively, showing that the level of sFlt-1 in peripheral venous blood increasingly elevated with the development of pregnancy (P<0.01). Conclusion: Preeclampsia is associated with increased level of sFlt-1 which might be largely from placenta during pregnancy.