重度子痫前期舒适护理

舒适护理是一种整体化、个体化、创造性、有效的护理模式,使人在生理、心理、社会上达到最愉快的状态,或缩短、降低其不愉快的程度[1].2010年1月～2011年3月,我院自开展优质护理服务活动以来,我产科将舒适护理贯穿于42例重度子痫前期产妇的护理过程中,取得了满意效果,现报告如下.     

重度子痫前期患者外周血NK 细胞功能的研究*

目的:探讨重度子痫前期患者外周血中NK细胞数量、杀伤功能以及相关细胞因子的变化。方法:选择重度子痫前期患者25例(研究组)以及正常妊娠妇女25例(对照组),流式细胞术测定外周血中NK细胞数量,细胞毒实验测定NK细胞的杀伤活性,ELISA法测定血清IFN-γ及IL-2的浓度。结果:研究组患者外周血中NK细胞的数量以及杀伤活性显著高于对照组;研究组外周血中IFN-γ、IL-2的浓度也显著高于对照组。结论:重度子痫前期患者外周血NK细胞数量增多,杀伤活性增强,血清中NK细胞相关细胞因子也增加。这些改变可能参与重度子痫前期的发病机制。     

慢性高血压合并妊娠发生子痫前期的危险因素分析

目的:探讨慢性高血压合并妊娠发生子痫前期的危险因素,为筛查慢性高血压孕妇合并子痫前期提供参考依据。方法:选取2009年3月~2013年7月我院收治的慢性高血压妊娠患者116例,根据是否合并子痫前期分为慢性高血压合并妊娠组(NHDP组)和慢性高血压合并子痫前期组(HDP组),比较两组患者不同孕期的血压、尿蛋白水平以及血液生化检测指标间的差异。结果:两组间年龄、孕次、孕前尿蛋白水平、孕早期及孕中期的平均动脉压、尿蛋白水平间差异均无统计学意义(P0.05)。HDP组孕前体质指数、孕晚期的平均动脉压、尿蛋白水平、Hb、UA、LDH、FDP均较NHPD组显著升高(P0.05),两组间Plt水平差异无统计学意义(P0.05)。logistic回归分析发现Hb、UA及FDP是慢性高血压妊娠患者并发子痫前期的危险因素。结论:凝血状况、血清尿酸水平及肾功能变化是慢性高血压合并妊娠者发生子痫前期的危险因素。     

子痫前期患者肠道微生物特征及益生菌调节

子痫前期(preeclampsia,PE)是妊娠期高血压疾病(hypertensive disorders of pregnancy,HDP)之一,严重损害母婴健康,影响3%～5%的妊娠。随高通量测序技术的发展和普及,肠道微生物与人类健康和疾病的关系逐渐清晰。PE患者肠道微生物群结构变化与疾病的发生发展密切相关,失调的肠道菌群很可能会成为PE早期诊断的生物标志物或干预的靶点。本文总结了以测序技术为基础获得的正常妊娠女性和PE患者肠道微生物分布规律数据,并提出益生菌调理建议,以期为PE的科学预测、精准干预提供理论支持。     

子痫前期患者尿液中足细胞裂孔膜蛋白和标记蛋白的检测及意义

目的：检测子痫前期患者尿液中足细胞裂孔膜蛋白和足细胞标记蛋白的浓度并探讨其临床意义。方法：本实验以62例妊娠期妇女为研究对象,分为三组,其中正常妊娠期妇女25例为正常对照组,慢性高血压的妊娠期妇女17例为高血压组,子痫前期患者20例为子痫前期组。ELISA检测各组妊娠期妇女的尿液中足细胞裂孔膜蛋白和足细胞标记蛋白的表达;Bradford法检测各组妊娠期妇女的尿蛋白。结果：足细胞裂孔膜蛋白和足细胞标记蛋白在正常对照组尿液中含量极少,在高血压组中分泌增加,而子痫前期组患者中明显升高（P〈0．01）,且在子痫前期组尿液中足细胞裂孔膜蛋白和标记蛋白的分泌含量均成正相关（r2=0．79,P〈0．05）。子痫前期组患者中足细胞裂孔膜蛋白和足细胞标记蛋白与尿蛋白浓度成正相关（r2=0．58,P〈0．05;r2=0．79,P〈0．05）。结论：足细胞蛋白脱落主要发生于子痫前期患者,且足细胞蛋白脱落量与尿蛋白成正相关,能直接反映妊娠期患者的肾损伤程度,可作为预测罹患妊娠期高血压的指标。     

子痫前期胰岛素抵抗相关因素研究进展

子痫前期是影响孕、产妇发病率和死亡率的重要原因,但是其发病机制目前仍未完全阐明.胰岛素抵抗在子痫前期临床表现出现之前即可被检测到,并参与其发生发展.近来,一些研究认为视黄醇结合蛋白4,同型半胱氨酸等均与胰岛素抵抗相关,并参与子痫前期的发病机制.本文就相关研究进展作一综述.     

子痫前期患者的舒适护理体会

目的:探讨对子痫前期患者进行舒适护理的作用与意义.方法:对在本院就诊的子痫前期患者随机分成两组,对照组应用常规护理,实验组应用舒适护理,两组孕妇在年龄、孕周、高危病史、产检次数、并发症等方面的差异无统计学意义(P＞0.05),具有可比性.结果:与对照组相比,实验组的孕妇在心理、生理方面都得到了显著的改善,其差异具有统计学意义(P＜0.05).结论:对子痫前期的患者应用舒适护理,能改善临床症状,预防和减少相关并发症的发生,改善母婴预后,降低围产儿死亡率.     

sHLA-G在子痫前期患者的表达及意义

目的：检测子痫前期患者sHLA—G水平,探讨母血sHLA—G的水平和妊娠高血压疾病的关系。方法：采用酶联免疫吸附法检测20例正常孕妇晚期和20例子痫前期患者血清sHLA—G水平。结果：在正常妊娠组sHLA—G血清中的水平为10．72±3.40ng／mL;子痫前期组为9.46±1.5．10ng／mL。子痫前期组sHLA—G水平明显低于正常妊娠晚期组,差异有显著性意义（P〈0．05）。结论：sHLA-G可能与子痫前期患者的发病有关系。     

1例重度子痫前期并发腹水患者的护理体会

重度子瘸前期属妊娠期高血压疾病,是以妊娠20周后高血压、蛋白尿、水肿为特征的妊娠期特有的疾病,并伴有全身多脏器的损害。重度子痫前期并发腹水是病情严重的表现,该病严重威胁着孕产妇及围生儿的生命安全。     

RhoB/ROCK 蛋白分子在重度子痫前期的表达

目的:探讨RhoB/ROCK蛋白分子在重度子痫前期(severe preeclampsia,sPE)患者胎盘组织中表达水平以及意义。方法:取sPE产妇和正常产妇胎盘组织各20例,通过Western blot和免疫组化检测胎盘组织中Rho亚家族蛋白(RhoB、RhoC)及其Rho激酶即ROCK(ROCKI、ROCKII)蛋白的表达水平,应用Spearman等级相关分析法检验RhoB、RhoC与ROCKI、ROCKII蛋白表达水平的相关性。结果:RhoB、ROCKI、ROCKII蛋白在sPE表达水平增加(P<0.05);sPE患者胎盘组织中RhoB与ROCKI、ROCKII蛋白表达水平均呈正相关(r=0.793,r=0.901,P<0.05)。结论:RhoB及其与下游分子ROCKI、ROCKII构成的信号通路,在sPE的发病中可能发挥着重要的作用。     

Function and control of human invasive trophoblast subtypes: Intrinsic vs. maternal control

ABSTRACT

The establishment of a functional placenta is pivotal for normal fetal development and the maintenance of pregnancy. In the course of early placentation, trophoblast precursors differentiate into highly invasive trophoblast subtypes. These cells, referred to as extravillous trophoblasts (EVTs), penetrate the maternal uterus reaching as far as the inner third of the myometrium. One of the most fundamental functions of EVTs is the transformation of spiral arteries to establish the uteroplacental blood circulation assuring an adequate nutrient and gas supply to the developing fetus. To achieve this, specialized EVT subpopulations interact with maternal immune cells, provoke elastolysis in the arterial wall and replace the endothelial cells lining the spiral arteries to induce intraluminal vascular remodeling. These and other trophoblast-mediated processes are tightly controlled by paracrine signals from the maternal decidua and furthermore underlie an intrinsic cell-type specific program. Various severe pregnancy complications such as preeclampsia or intrauterine growth retardation are associated with abnormal EVT function, shallow invasion, and decreased blood flow to the placenta. Hence a better understanding of human trophoblast invasion seems mandatory to improve therapeutic intervention. This approach, however, requires a profound knowledge of the human placenta, its various trophoblast subtypes and in particular a better understanding of the regulatory network that controls the invasive phenotype of EVTs.     

Interactions between trophoblast cells and the maternal and fetal circulation in the mouse placenta

Mammalian embryos have an intimate relationship with their mothers, particularly with the placental vasculature from which embryos obtain nutrients essential for growth. It is an interesting vascular bed because maternal vessel number and diameter change dramatically during gestation and, in rodents and primates, the terminal blood space becomes lined by placental trophoblast cells rather than endothelial cells. Molecular genetic studies in mice aimed at identifying potential regulators of these processes have been hampered by lack of understanding of the anatomy of the vascular spaces in the placenta and the general nature of maternal-fetal vascular interactions. To address this problem, we examined the anatomy of the mouse placenta by preparing plastic vascular casts and serial histological sections of implantation sites from embryonic day (E) 10.5 to term. We found that each radial artery carrying maternal blood into the uterus branched into 5-10 dilated spiral arteries located within the metrial triangle, populated by uterine natural killer (uNK) cells, and the decidua basalis. The endothelial-lined spiral arteries converged together at the trophoblast giant cell layer and emptied into a few straight, trophoblast-lined "canals" that carried maternal blood to the base of the placenta. Maternal blood then percolated back through the intervillous space of the labyrinth toward the maternal side of the placenta in a direction that is countercurrent to the direction of the fetal capillary blood flow. Trophoblast cells were found invading the uterus in two patterns. Large cells that expressed the trophoblast giant cell-specific gene Plf (encoding Proliferin) invaded during the early postimplantation period in a pattern tightly associated with spiral arteries. These peri/endovascular trophoblast were detected only approximately 150-300 microm upstream of the main giant cell layer. A second type of widespread interstitial invasion in the decidua basalis by glycogen trophoblast cells was detected after E12.5. These cells did not express Plf, but rather expressed the spongiotrophoblast-specific gene Tpbp. Dilation of the spiral arteries was obvious between E10.5 and E14.5 and was associated with a lack of elastic lamina and smooth muscle cells. These features were apparent even in the metrial triangle, a site far away from the invading trophoblast cells. By contrast, the transition from endothelium-lined artery to trophoblast-lined (hemochorial) blood space was associated with trophoblast giant cells. Moreover, the shaping of the maternal blood spaces within the labyrinth was dependent on chorioallantoic morphogenesis and therefore disrupted in Gcm1 mutants. These studies provide important insights into how the fetoplacental unit interacts with the maternal intrauterine vascular system during pregnancy in mice.     

Placental membrane-type metalloproteinases (MT-MMPs): Key players in pregnancy

abstract

Membrane-type matrix metalloproteinases (MT-MMPs) are a sub-family of zinc-dependent endopeptidases involved in the degradation of the extracellular matrix. Although MT-MMPs have been mainly characterized in tumor biology, they also play a relevant role during pregnancy. Placental MT-MMPs are required for cytotrophoblast migration and invasion of the uterine wall and in the remodeling of the spiral arteries. They are involved in the fusion of cytotrophoblasts to form the syncytiotrophoblast as well as in angiogenesis. All these processes are crucial for establishing and maintaining a successful pregnancy and, thus, MT-MMP activity has to be tightly regulated in time and space. Indeed, a de-regulation of MT-MMP expression has been linked with pregnancy complications such as preeclampsia (PE), fetal growth restriction (FGR), gestational diabetes mellitus (GDM) and was also found in maternal obesity. Here we review what is currently known about MT-MMPs in the placenta, with a focus on their general features, their localization and their involvement in pregnancy disorders.     

Regulation of proliferation and apoptosis during development of the preimplantation embryo and the placenta

The preimplantation embryo starts as a single cell, the zygote. The first cell divisions do not lead to volume expansion, but rather to an increasing number of small cells. At the morula stage the first two cell lineages differentiate into the trophoblast and the inner cells mass/embryoblast. During development of the preimplantation embryo, apoptosis occurs only after the onset of the embryonic genome. It has become clear that the development of a healthy child requires not only very high rates of proliferation and differentiation, but also apoptosis, which is a crucial mechanism for morphogenesis and the development of the inner organs. Furthermore, the generation of specific cell types, such as lens cells, erythrocytes, and thrombocytes, depends on the apoptosis pathways. This is also true later in gestation, when the trophoblasts form the placenta and provide the epithelial cover of the villous trees of the placenta. This layer is in direct contact with maternal blood and, as do all epithelia, displays a continuous turnover of cells. Thus, apoptosis is a normal constituent of survival in this layer as well, and changes in the regulation and rate of apoptosis have deleterious effects on the trophoblast and consequently the developing embryo or fetus. Here we present a very brief overview of the importance of apoptosis for the development of the preimplantation embryo and the maintenance of placental trophoblasts. Furthermore, we highlight what happens when regulation of proliferation or apoptosis fails in these systems, and attempt to show that apoptosis is only the consequence of poor embryo or trophoblast development -- not its cause.