Different Fetal and Neonatal Growth between Early- and Late-Onset Preeclampsia

Preeclampsia is a heterogeneous disease, and there are major differences in severity, fetal growth and poor placentation between early- and late-onset preeclampsia. Here, we examined the effect of onset period on fetal and neonatal growth in preeclampsia with a cross-sectional study including 102 pregnant women with preeclampsia visited Okayama University Hospital from 2009 to 2013. The subjects were retrospectively compared in terms of body mass index (BMI), weight gain during pregnancy, complications, weeks of delivery, neonatal body weight and BMI at birth, fetal growth restriction (FGR), small for gestational age (SGA), pathological findings in the placenta, and infant’s weight at 1 month after birth. Neonatal body weight and BMI at birth were significantly lower and the extent of FGR and the frequency of SGA were higher in early-onset group compared with late-onset group. Mean daily weight gain during the neonatal period was significantly lower in the early-onset group compared with the late-onset group, however the weight gain rate during the neonatal period in the early-onset group was higher than that in late-onset group. In conclusions, there are significant differences in fetal and neonatal growth between early- and late-onset preeclampsia and the catch up for growth might start during neonatal period.

Acute and chronic excitotoxicity in ischemic stroke and late-onset Alzheimer's disease

Stroke and Alzheimer's disease are common neurological disorders and often occur in the same individuals.The comorbidity of the two neurological disorders represents a grave health threat to older populations.This review presents a brief background of the development of novel concepts and their clinical potentials.The activity of glutamatergic N-methyl-D-aspartate receptors and N-methyl-D-aspartate receptor-mediated Ca^(2+)influx is critical for neuronal function.An ischemic insult induces prompt and excessive glutamate release and drastic increases of intracellular Ca^(2+)mainly via N-methyl-D-aspartate receptors,particularly of those at the extrasynaptic site.This Ca^(2+)-evoked neuronal cell death in the ischemic core is dominated by necrosis within a few hours and days known as acute excitotoxicity.Furthermore,mild but sustained Ca^(2+)increases under neurodegenerative conditions such as in the distant penumbra of the ischemic brain and early stages of Alzheimer's disease are not immediately toxic,but gradually set off deteriorating Ca^(2+)-dependent signals and neuronal cell loss mostly because of activation of programmed cell death pathways.Based on the Ca^(2+)hypothesis of Alzheimer's disease and recent advances,this Ca^(2+)-activated“silent”degenerative excitotoxicity evolves from years to decades and is recognized as a unique slow and chronic neuropathogenesis.The N-methyl-D-aspartate receptor subunit GluN3A,primarily at the extrasynaptic site,serves as a gatekeeper for the N-methyl-D-aspartate receptor activity and is neuroprotective against both acute and chronic excitotoxicity.Ischemic stroke and Alzheimer's disease,therefore,share an N-methyl-D-aspartate receptor-and Ca^(2+)-mediated mechanism,although with much different time courses.It is thus proposed that early interventions to control Ca^(2+)homeostasis at the preclinical stage are pivotal for individuals who are susceptible to sporadic late-onset Alzheimer's disease and Alzheimer's disease-related dementia.This early treatment simultaneously serves as a preconditioning therapy against ischemic stroke that often attacks the same individuals during abnormal aging.

Sorl1 knockout inhibits expression of brain-derived neurotrophic factor:involvement in the development of late-onset Alzheimer's disease

Sortilin-related receptor 1(SORL1)is a critical gene associated with late-onset Alzheimer’s disease.SORL1 contributes to the development and progression of this neurodegenerative condition by affecting the transport and metabolism of intracellularβ-amyloid precursor protein.To better understand the underlying mechanisms of SORL1 in the pathogenesis of late-onset Alzheimer s disease,in this study,we established a mouse model of SorI1 gene knockout using cluste red regularly inters paced short palindro mic repeats-associated protein 9 technology.We found that Sorl1-knocko ut mice displayed deficits in learning and memory.Furthermore,the expression of brain-derived neurotrophic factor was significantly downregulated in the hippocampus and co rtex,and amyloidβ-protein deposits were observed in the brains of 5orl1-knockout mice.In vitro,hippocampal neuronal cell synapses from homozygous Sorl1-knockout mice were impaired.The expression of synaptic proteins,including Drebrin and NR2B,was significantly reduced,and also their colocalization.Additionally,by knocking out the Sorl1 gene in N2a cells,we found that expression of the N-methyl-D-aspartate receptor,NR2B,and cyclic adenosine monophosphate-response element binding protein was also inhibited.These findings suggest that SORL1 participates in the pathogenesis of late-onset Alzheimer s disease by regulating the N-methyl-D-aspartate receptor NR2B/cyclic adenosine monophosphate-response element binding protein signaling axis.

A review of clinical practice guidelines on the management of preeclampsia and nursing inspiration

Objectives:To review,evaluate,and synthesize the recommendations of guidelines on preeclampsia(PE)from a nursing perspective.Methods:This is a systematic review of international and national guidelines on PE.Electronic databases and related guideline websites were searched from 2013 to 2023.After systematic retrieval and screening,we used the AGREE II tool to appraise the methodological quality of guidelines that met the eligibility criteria.Then,we analyzed and summarized the recommendations using descriptive analysis and the framework method.Furthermore,we rated the quality of evidence and the strength of the recommendations using the GRADE approach.Results:Ten guidelines were included,among which eight were deemed“clinically useful”and records were extracted.In total,31 recommendations,including 46 items on the nursing management of PE,were summarized from three aspects:1)antenatal care(18 recommendations),including the assessment and regular monitoring of PE,standardized blood pressure(BP)measurement,prevention education for PE,antihypertensive agent monitoring,and magnesium sulfate(MgSO_(4))use;2)intrapartum care(4 recommendations),including childbirth care;3)postpartum care(9 recommendations),including regular nursing monitoring,breastfeeding care and longer-term health counseling.Most of the evidence was rated as“very low”(19/46)or“moderate”(15/46)quality.For the strength of the recommendations,30 items were graded as“strong”and 16 items were rated as“weak”.Conclusions:This study provides professional,evidence-based nursing care resources both for preservice education for nursing staff and health care education for women with PE to help them detect and treat PE in a timely manner.

Low-molecular-weight heparin and preeclampsia—does the sword cut both ways?Three case reports and review of literature

BACKGROUND Low-molecular-weight heparins(LMWH)are the most commonly used anticoagulants during pregnancy.It is considered to be the drug of choice due to its safety in not crossing placenta.Considering the beneficial effect in the improvement of microcirculation,prophylactic application of LMWH in patients with preeclampsia became a trend.However,the bleeding risk related with LMWH in preeclampsia patients has seldomly been evaluated.This current study aimed to identify the potential risks regarding LMWH application in patients with preeclampsia.CASE SUMMARY Herein we present a case series of three pregnant women diagnosed with preeclampsia on LMWH therapy during pregnancy.All the cases experienced catastrophic hemorrhagic events.After reviewing the twenty-one meta-analyses,the bleeding risk related with LMWH seems ignorable.Only one study analyzed the bleeding risk of LMWH and found a significantly higher risk of developing PPH in women receiving LMWH.Other studies reported minor bleeding risks,none of these were serious enough to stop LMWH treatment.Possibilities of bleeding either from uterus or from intrabdominal organs in preeclampsia patients on LMWH therapy should not be ignored.Intensive management of blood pressure even after delivery and homeostasis suture in surgery are crucial.CONCLUSION Consideration should be given to the balance between benefits and risks of LMWH in patients with preeclampsia.

Analysis of risk factors for postpartum depression after cesarean section in women with early-onset preeclampsia

BACKGROUND Early-onset preeclampsia significantly increases maternal and fetal morbidity and mortality.Many pregnant women with early onset preeclampsia choose cesarean section as their delivery method.Although extensive research has explored the association between postpartum depression(PPD)and cesarean section,few studies have investigated the risk factors after cesarean section in women with early-onset preeclampsia.AIM To examine these risk factors through a retrospective,observational analysis of 287 women who underwent a cesarean section for early preeclampsia between June 2014 and March 2024.METHODS Participants were assessed in person during the 32nd week of pregnancy,2 days post-cesarean,and 6 weeks postpartum.According to the Edinburgh Postnatal Depression Scale(EPDS),participants who underwent cesarean section were divided into PPD(n=60)and non-PPD groups(n=227).Furthermore,PPD was diagnosed at 6 weeks postpartum according to depressive symptoms(EPDS score≥11).The demographic and clinical features of PPD were screened.Multivariate logistic regression analysis was used to identify PPD risk factors.RESULTS The prevalence of PPD was 20.9%(60/287)among the 287 women who underwent cesarean section for early-onset preeclampsia.Multivariate logistic regression analyses revealed that advanced age(age>40 years)[odds ratio(OR)=1.93,95%CI:1.31-2.82],previous preeclampsia(OR=7.15,95%CI:5.81-8.85),pre-pregnancy obesity(OR=2.42,95%CI:1.62-3.63),gestational diabetes mellitus(OR=3.52,95%CI:2.51-4.92),preexisting hypertension(OR=1.35,95%CI:1.03-1.89),PPD symptoms(EPDS≥11)at 2 days postpartum(OR=6.15,95%CI:1.32-28.35),high prenatal self-rating anxiety scale score(OR=1.13,95%CI:1.06-1.18),and pain at 6 weeks postpartum(OR=2.16,95%CI:1.28-3.66)were independently associated with PPD.CONCLUSION Risk factors for PPD after cesarean section in women with early-onset preeclampsia include advanced age(age>40 years),pre-pregnancy obesity,previous preeclampsia,gestational diabetes mellitus,preexisting hypertension,PPD symptoms(EPDS≥11)at 2 days postpartum,prenatal anxiety,and pain at 6 weeks postpartum.The early identi-fication of these factors and interventions can mitigate the risk of PPD.

Salivary C-reactive protein and mean platelet volume as possible diagnostic markers for late-onset neonatal pneumonia

BACKGROUND Neonatal sepsis,a formidable threat to newborns,is a leading cause of neonatal mortality,with late-onset sepsis manifesting after 72 hours post-birth being particularly concerning.Pneumonia,a prevalent sepsis presentation,poses a significant risk,especially during the neonatal phase when lung defenses are compromised.Accurate diagnosis of pneumonia is imperative for timely and effective interventions.Saliva,a minimally invasive diagnostic medium,holds great promise for evaluating infections,especially in infants.AIM To investigate the potential of serum C-reactive protein(CRP),salivary CRP(sCRP),and mean platelet volume(MPV)as diagnostic markers for late-onset neonatal pneumonia(LONP).METHODS Eighty full-term neonates were systematically examined,considering anthropometric measurements,clinical manifestations,radiology findings,and essential biomarkers,including serum CRP,sCRP,and MPV.RESULTS The study reveals noteworthy distinctions in serum CRP levels,MPV,and the serum CRP/MPV ratio between neonates with LONP and healthy controls.MPV exhibited a robust discriminatory ability[area under the curve(AUC)=0.87]with high sensitivity and specificity at a cutoff value of>8.8.Correlations between serum CRP,sCRP,and MPV were also identified.Notably,sCRP demonstrated excellent predictive value for serum CRP levels(AUC=0.89),underscoring its potential as a diagnostic tool.CONCLUSION This study underscores the diagnostic promise of salivary and serum biomarkers,specifically MPV and CRP,in identifying and predicting LONP among neonates.These findings advocate for further research to validate their clinical utility in larger neonatal cohorts.

Analysis of the Application Effect and Value of Dydrogesterone in The Treatment of Preeclampsia for Fetal Preservation

Objective: To analyze the application effect and value of dydrogesterone in the fertility preservation treatment of preeclampsia. Methods: Forty cases of patients with preeclampsia admitted to our hospital between January 2023 and January 2024 were divided randomly into a control group and an observation group of 20 cases each. The control group applied progesterone to preserve the fetus, and the observation group applied dydrogesterone. The symptom relief time, hormone levels before and after treatment, as well as adverse drug reactions, and the effect of fetal preservation between the two groups were compared. Results: The time to relieve vaginal bleeding, abdominal pain. and lumbago in the observation group was shorter than that in the control group (P < 0.05). After treatment, the progesterone levels and incidence of adverse drug reactions in the observation group were lower than those in the control group (P < 0.05). The success rate of fertility preservation in the observation group was higher than that in the control group (P < 0.05). Conclusion: In the treatment of fetal preservation of preeclampsia, the application of dydrogesterone positively alleviated vaginal bleeding, abdominal pain, and lumbago, with mild adverse reactions and a good effect on fetal preservation.

超声指导监测液体管理应用于重度子痫前期患者中的价值研究

目的探讨超声指导监测液体管理应用于重度子痫前期患者的价值。方法选取2022年1月至2024年1月九江市妇幼保健院收治的60例重度子痫前期患者作为研究对象,按照随机数字表法分为对照组(30例)与观察组(30例),两组均加强基础治疗,对照组采用常规监护方法,观察组采用超声指导监测液体管理,比较两组的水肿临床疗效、体液管理与体液平衡情况、并发症、术后住院时间。结果观察组的水肿治疗总有效率高于对照组,差异有统计学意义(P<0.05);观察组的冲击试验液体量、总入液量、尿量均低于对照组,差异有统计学意义(P<0.05);观察组的并发症总发生率低于对照组,差异有统计学意义(P<0.05);观察组的术后住院时间短于对照组,差异有统计学意义(P<0.05)。结论对重度子痫前期患者加强超声指导监测液体管理,便于改善水肿症状,降低并发症,缩短住院时间,临床应用价值较高。

中国妊娠期高血压疾病的管理建议:基于《2023年澳大利亚和新西兰产科医学协会妊娠期高血压疾病指南摘要》

妊娠期高血压疾病(HDP)是常见的妊娠期并发症之一,也是导致全球孕产妇死亡的主要原因之一。2023年澳大利亚和新西兰产科医学协会发布了《2023年澳大利亚和新西兰产科医学协会妊娠期高血压疾病指南摘要》,本文围绕其重点内容进行解读,对中国HDP的非药物干预措施、精细化管理流程提出建议,以期为中国HDP的管理提供新的依据。

Elabela is a reliable biomarker for predicting early onset preeclampsia:A comparative study

BACKGROUND Preeclampsia(PE)is a multisystemic metabolic disease with an undetermined etiology.PE is a worldwide cause of maternal and perinatal morbidity,subdivided into early(EoPE)and late-onset(LoPE)according to 34 wk of gestation as a divider.Many researchers investigated biomarkers for predicting PE to halt its consequences on the feto-maternal outcome.Elabela(Ela)is a newly discovered peptide hormone that was implicated in PE pathogenesis.Earlier rodent studies discussed Ela’s role in controlling blood pressure.Moreover,Ela deficiency was associated with PE development.AIM To test whether plasma Ela could serve as a reliable marker for predicting PE based on the time of onset(EoPE vs LoPE)compared to age and body mass matched healthy controls since no definitive treatment exists for PE but to terminate a pregnancy.METHODS This case-control study recruited(n=90)pregnant who fulfilled inclusion criteria;they were allocated into three groups:EoPE(30/90)(<34 wk of gestation);LoPE(30/90)(≥34 wk of gestation);and healthy pregnant(30/90).Demographic criteria;biochemical,hematological,and maternal plasma Ela levels were recorded for comparison.RESULTS Serum Ela was significantly reduced in EoPE compared to LoPE and healthy controls(P=0.0023).The correlation confirmed a strong inverse relationship with mean atrial blood pressure(r=-0.7,P<0.001),while gestational age and platelets count showed a moderate correlation with(r=0.4 with P<0.0001).No correlation was confirmed between the body mass index(BMI)and urine albumin.The predictive ability of 25 centile serum Ela had an Odds ratio of 5.21,95%confidence interval(1.28,21.24),P=0.02 for predicting EoPE.The receiver operator characteristic curve defined the Ela cutoff value at>9.156 with 96.7%and 93.3%sensitivity and specificity,P<0.0001 in predicting EoPE.CONCLUSION A strong correlation of serum Ela with PE parameters with excellent sensitivity and specificity in distinguishing EoPE independent of the BMI,age,and blood pressure which makes Ela a recommendable marker in screening.Further research is warranted to explore prognostic and therapeutic applications for Ela in PE.

妊娠期高血压患者血清miR-488、miR-184表达与子痫前期发生的关系

目的探讨妊娠期高血压患者血清微小核糖核酸(miR)-488、miR-184表达与子痫前期发生的关系。方法选取2022年6月至2023年3月该院收治的妊娠期高血压患者128例,根据是否发展为子痫前期分为单纯妊娠期高血压组55例和合并子痫前期组73例。另选取同期该院46例健康妊娠孕妇为对照组。采用实时荧光定量聚合酶链反应检测各组miR-488、miR-184表达,以及多因素Logistic回归分析妊娠期高血压患者子痫前期发生的影响因素。受试者工作特征(ROC)曲线分析各影响因素对妊娠期高血压患者子痫前期发生的预测价值及Pearson相关性分析血清miR-488、miR-184与胎盘生长因子的相关性。结果与对照组比较,单纯妊娠期高血压组、合并子痫前期组血清miR-488、miR-184表达升高,差异有统计学意义(P<0.05)。与轻度子痫前期组比较,重度子痫前期组血清miR-488、miR-184表达升高,差异有统计学意义(P<0.05)。合并子痫前期组孕产次、收缩压、舒张压、尿蛋白定量及胎盘生长因子水平与单纯妊娠期高血压组比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,孕产次、收缩压、舒张压、尿蛋白定量、miR-488及miR-184均为妊娠期高血压患者子痫前期发生的危险因素(P<0.05),胎盘生长因子为妊娠期高血压患者子痫前期发生的保护因素(P<0.05)。ROC曲线分析结果显示,miR-488+miR-184预测效能显著优于血清miR-488(Z=2.530,P=0.011)、miR-184(Z=2.437,P=0.015)单独预测。血清miR-488、miR-184与胎盘生长因子呈负相关(r=-4.361、-4.288,P<0.05)。结论血清miR-488、miR-184对妊娠期高血压患者子痫前期发生具有预测价值。

血清尿酸/白蛋白比值、乳酸脱氢酶及碱性磷酸酶测定对重度子痫前期的辅助诊断价值研究

目的探讨子痫前期(PE)中肝、肾功能指标参数、血清尿酸/白蛋白比值(sUAR)的水平变化及其辅助诊断重度PE的价值。方法回顾性分析2019年1月至2024年8月于兰州大学第二医院分娩的215例PE孕妇(病例组)及同期100名健康孕妇(对照组)的临床资料,病例组根据病情严重程度分为非重度PE组(100例)、重度PE组(115例)。比较三组一般资料,肝、肾功能指标及sUAR水平。采用logistic回归分析重度PE的影响因素,运用受试者工作特征曲线的曲线下面积(AUC)评估相关指标辅助诊断重度PE的价值。结果非重度PE组和重度PE组收缩压、舒张压、尿素、肌酐、天冬氨酸转氨酶(AST)、尿酸、乳酸脱氢酶(LDH)、sUAR水平高于对照组,且重度PE组高于非重度PE组(P<0.05);重度PE组丙氨酸转氨酶、碱性磷酸酶(ALP)高于非重度PE组和对照组(P<0.05);重度PE组和非重度PE组白蛋白水平低于对照组,且重度PE组低于非重度PE组(P<0.05)。LDH、ALP、sUAR升高是重度PE发生的影响因素(P<0.05)。外周血LDH、ALP、sUAR联合辅助诊断重度PE的价值高于单项指标(P<0.05),其AUC为0.887,灵敏度为80.9%,特异度为85.0%。结论外周血中LDH、ALP、sUAR与PE及病情严重程度有关,且三者联合对重度PE具有较好的辅助诊断价值,一定程度上可评估疾病的进展。

系统性红斑狼疮与子痫前期或子痫风险因果关系的孟德尔随机化研究

目的基于两样本孟德尔随机化(MR)方法探讨系统性红斑狼疮(SLE)与子痫前期或子痫风险的因果关系。方法SLE汇总统计数据来自全基因组关联研究数据库,子痫前期或子痫的汇总统计数据来自芬兰生物库。采用逆方差加权法(IVW)分析SLE与子痫前期或子痫之间的潜在因果关系,以MR-Egger、加权中位数、加权模式和简单模式法4种方法进行补充,并进行多效性、异质性和敏感性分析。结果共有41个单核苷酸多态性(SNPs)作为工具变量。IVW检验结果显示,SLE与子痫前期或子痫之间具有较强因果关系(OR=1.032,95%CI:1.003~1.063,P=0.031),但其他4种方法均未显示出SLE与子痫前期或子痫之间存在因果关系(P>0.05)。MR多效性残差和异常值(MR-PRESSO)分析未发现离群值(P=0.340)。MR-Egger回归分析结果显示不存在水平多效性(Egger_intercept=-0.002,P=0.893)。IVW和MR-Egger法的Q检验结果显示不存在异质性。漏斗图基本对称,表示无显著异质性。留一法分析结果显示,结果可靠。结论SLE和子痫前期或子痫风险存在正向因果关系,临床应对SLE孕妇进行更密集的产前护理和早期干预,以减少不良妊娠结局。

胎盘蛋白13在子痫前期发生中的作用及相关药物治疗研究进展

子痫前期(PE)是导致孕产妇及围生儿病死率和患病率升高的主要原因之一,主要表现为妊娠前血压正常,妊娠20周后发现高血压和蛋白尿。胎盘蛋白13(PP13)是妊娠过程中具有重要作用的蛋白质,由胎盘滋养细胞合成及分泌,参与胎盘种植、维持妊娠,还能调节缩血管/扩血管平衡,影响血管重塑,与PE发生存在一定相关性。PE可导致孕产妇并发心血管疾病、胎儿生长受限、胎儿窘迫等多种不良妊娠结局,随着对PE的不断深入研究,部分药物被证实可用于PE治疗。故现对PP13在PE发生中的作用机制以及相关药物治疗的研究进展进行综述。

初产妇子痫前期发病危险因素的Meta分析

目的:评价初产妇子痫前期发病的危险因素。方法:检索国内外数据库中关于产妇子痫前期疾病危险因素的文献,进行Meta分析,采用敏感性分析方法验证结果的稳健性,采用Egger's检验进行发表偏倚检验。结果:共纳入15篇文献,涉及3 093 792例子痫前期初产妇。Meta分析结果显示:高血压[OR=2.775,95%CI(1.164,6.617)]、糖尿病[OR=2.650,95%CI(1.280,5.487)]、年龄[OR=1.512,95%CI(1.069,2.139)]、体质指数(BMI)[OR=1.949,95%CI(1.497,2.537)]、心脏器质性疾病[OR=2.568,95%CI(2.013,3.276)]是初产妇子痫前期发病的危险因素;饮酒[OR=0.556,95%CI(0.351,0.882)]、吸烟[OR=0.734,95%CI(0.606,0.889)]是初产妇子痫前期发病的保护因素。Egger's检验显示,纳入BMI指标的文献存在发表偏倚(t=2.69,P=0.025)。结论:现有证据显示,高血压、糖尿病、年龄、心脏器质性疾病是初产妇子痫前期发病的确切危险因素。

Effect of hypoxia on expression of placental trophoblast cells SATB1 and β-catenin and its correlation with the pathogenesis of preeclampsia

Objective: To study the effect of hypoxia on the expression of placental trophoblast cells SATB1 and β-catenin and its correlation with the pathogenesis of preeclampsia. Methods: Trophoblastic cell lines HRT8/SVneo were cultured, SATB1 and β-catenin expression and cell biological behavior were determined after hypoxia reoxygenation treatment; cell biological behavior and the expression of related genes were determined after the transfection of SATB1 and β-catenin siR NA; preeclampsia placenta and normal placenta tissues were collected and the expression of SATB1 and β-catenin were determined. Results: OD value, cell migration rate, m RNA contents of SATB1 and β-catenin of H/R group were significantly lower than those of Nor group, cell apoptosis rate was higher than that of Nor group and the number of invasive cells was less than that of Nor group; OD value and bcl-2 mRNA content of SATB1-siRNA group were lower than those of NC group; cell apoptosis rate as well as Bax, Caspase-3, caspase-6 and caspase-9 mRNA contents were higher than those of NC group; cell migration rate as well as CTSB, CTSD, MMP2 and MMP9 mRNA contents of β-catenin-siRNA group were lower than those of NC group; the number of invasive cells was less than that of NC group; the expression levels of SATB1 and β-catenin in preeclampsia placenta tissue were significantly lower than those in normal placenta tissue. Conclusions: Hypoxia can inhibit the expression of SATB1 and β-catenin in the pathogenesis of preeclampsia, which can affect the proliferation, apoptosis, migration and invasion of cells.

血栓弹力图联合凝血指标水平对重度子痫前期患者不良妊娠结局的预测价值

目的:观察血栓弹力图联合凝血指标水平对重度子痫前期患者不良妊娠结局的预测价值。方法:回顾性分析2022年8月至2023年10月于该院就诊的63例重度子痫前期患者的临床资料,作为研究组,选取同期63名孕检正常孕妇作为对照组,比较两组入院时血栓弹力图参数[最大振幅(MA值)、凝固时间(K值)、凝血综合指数(CI值)、反应时间(R值)、α角]水平、凝血指标[D-二聚体(D-D)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)]水平,根据不同妊娠结局将研究组分为良好妊娠结局患者(n=43)和不良妊娠结局患者(n=20),比较不同妊娠结局患者入院时血栓弹力图参数、凝血指标水平,采用受试者工作特征(ROC)曲线分析血栓弹力图、凝血指标水平单项及联合检测对重度子痫前期患者不良妊娠结局的预测价值。结果:研究组R、K值均小于对照组,α角、MA值、CI值均大于对照组,差异有统计学意义(P<0.05);研究组D-D、FIB水平均高于对照组,PT、APTT、TT均短于对照组,差异有统计学意义(P<0.05);不良妊娠结局患者R、K值均小于良好妊娠结局患者,α角、MA值、CI值均大于良好妊娠结局患者,差异有统计学意义(P<0.05);不良妊娠结局患者D-D、FIB水平均高于良好妊娠结局患者,PT、APTT、TT均短于良好妊娠结局患者,差异有统计学意义(P<0.05);ROC曲线分析结果显示,血栓弹力图、凝血指标水平单项及联合检测预测重度子痫前期患者不良妊娠结局的曲线下面积均>0.7,联合检测预测价值最高。结论:血栓弹力图联合凝血指标水平对重度子痫前期患者不良妊娠结局的预测价值高于单项检测。

Implication of Expression of Osteopontin and Its Receptor Integrin αvβ3 in the Placenta in the Development of Preeclampsia

To investigate the expression of osteopontin （OPN） and its receptor integrin αvβ3 in the placental tissue from pregnant women complicated with preeclampsia, the expression of OPN and αvβ3 in the placenta of the pregnant women with preeclampsia and healthy pregnant women was detected by immunohistochemistry, Western blotting and RT-PCR. Our results showed that OPN and αvβ3 protein were expressed in the placenta from normal pregnant woman and those with preeclampsia. OPN was located in the placental syncytiotrophoblasts and the cytoplasm of capillary endothelial cells and integrin αvβ3 was mainly expressed on the surface of trophoblast cells. Expression of OPN and integrin αvβ3 in the placental tissue from preeclampsia subjects was significantly lower than that from the control group （P〈0.05）. Compared with the control group, expression of OPN in the placental tissue from preeclampsia group was significantly lower （P〈0.05） but there was no significant difference in the expression of αv and β3 between the preeclampsia group and the controls. It is concluded that OPN and its receptor integrin αvβ3 may be involved in the pathogenesis of preeclampsia.

Folic acid supplementation attenuates hyperhomocysteinemia-induced preeclampsia-like symptoms in rats

Folic acid participates in the metabolism of homocysteine and lowers plasma homocysteine levels directly or indirectly. To establish a hyperhomocysteinemic pregnant rat model, 2 mL of DL-homocysteine was administered daily by intraperitoneal injection at a dose of 200 mg/kg from day 10 to day 19 of gestation. Folic acid was administered by intragastric administration at a dose of 20 mg/kg during the period of preeclampsia induction. Results showed that systolic blood pressure, proteinuria/creatinine ratio, and plasma homocysteine levels in the hyperhomocysteinemic pregnant rats increased significantly, and that body weight and brain weight of rat pups significantly decreased. Folic acid supplementation markedly reversed the above-mentioned abnormal changes of hyperhomocysteinemic pregnant rats and rat pups. These findings suggest that folic acid can alleviate the symptoms of hyperhomocysteinemia- induced preeclampsia in pregnant rats without influencing brain development of rat pups.