目的 分析妊娠期肝内胆汁淤积症(ICP)孕妇与正常孕妇围产结局及ICP孕妇不同总胆汁酸水平对围产结局及新生儿的影响,为做好ICP孕妇的妊娠期管理及其新生儿预后评估提供参考依据。方法 以2010年3月—2020年3月在我院分娩的ICP孕妇 249例为观察组,同期分娩的249例正常孕妇为对照组,比较2组围产结局相关指标。结果 观察组羊水污染、新生儿黄疸、新生儿呼吸窘迫综合征发生率均高于对照组,根据总胆汁酸水平分组,重度组早产、羊水污染发生率高于轻度组,以上差异均有统计学意义(P＜0.05)。总胆汁酸水平是ICP孕妇发生早产的危险因素(P＜0.05)。结论 ICP孕妇总胆汁酸水平可用于发生早产的预测,及时干预有利于提高其围产期质量。

Objective To analyze the perinatal outcome of women with intrahepatic cholestasis of pregnancy (ICP) and normal pregnant women and the effects of different levels of total bile acid in ICP women on perinatal outcome and newborn. To provide a reference for the management of pregnancy and prognosis of ICP women. Methods From March 2010 to March 2020, 249 women with ICP delivered in our hospital were included as the observation group, 249 normal pregnant women delivered in the same period as the control group, the perinatal outcomes of the two groups were analyzed and compared. Results The incidences of amniotic fluid contamination, neonatal jaundice and neonatal respiratory distress syndrome in the observation group were higher than that in the control group. Grouping by the total bile acid level, the incidences of premature delivery and amniotic fluid contamination in the severe group were higher than that in the mild group, with statistical significance (P<0.05). Total bile acid level was a risk factor for premature delivery in women with ICP (P<0.05). Conclusions The level of total bile acid in women with ICP can be used to predict the occurrence of premature delivery, and timely intervention is beneficial to improve the perinatal quality of ICP women.

目的 分析妊娠中期血清25(OH)D₃水平对妊娠期糖尿病(gestational diabetes mellitus,GDM)的预测价值。方法 选取2019年7月—2020年3月在广州市妇女儿童医疗中心及广东省计划生育专科医院进行产前检查的孕中期妇女,根据孕妇的空腹血糖(FBG)水平和口服糖耐量试验(OGTT)结果分为GDM组(100例)和对照组(320例)。分别测定两组孕妇的年龄、孕前BMI、空腹血糖、服糖后l h血糖、服糖后2 h血糖、空腹胰岛素及25(OH)D₃等指标,进行统计分析与比较。结果 GDM组维生素D不足及缺乏的发病率高于对照组(P＜0.05)。年龄、空腹胰岛素在两组之间无统计学差异(P＞0.05);GDM组25(OH)D₃水平低于对照组(P＜0.05);GDM组空腹血糖、服糖后1 h、2 h血糖及孕前BMI均高于对照组(P＜0.05)。血清25(OH)D₃水平与空腹血糖、服糖后1 h、2 h血糖呈负相关(P＜0.05),而与年龄、BMI及空腹胰岛素无显著相关性(P＞0.05)。25(OH)D₃水平与妊娠期糖尿病发生风险呈负相关。结论 妊娠中期血清25(OH)D₃水平降低可能增加GDM的发生风险,联合检测妊娠中期血清25(OH)D₃水平有助于GDM的早期预测。

Objective To analyze the predictive value of serum 25(OH)D₃ level in the second trimester of pregnancy for gestational diabetes mellitus. Methods From July 2019 to March 2020, pregnant women who had prenatal examinations in Guangzhou Women and Children's Medical Center and Guangdong Family Planning Hospital were selected and divided into GDM group (100 cases) and control group (320 cases) according to FBG level and oral glucose tolerance test (OGTT) results.The age, pre-pregnancy BMI, fasting blood glucose, l h blood glucose after taking sugar, 2 h blood glucose after taking sugar, fasting insulin, 25(OH)D₃ and other indicators of the two groups of pregnant women were measured, respectively, for statistical analysis and comparison. Results The incidence of vitamin D deficiency and deficiency in GDM group was higher than that in control group (P<0.05).There was no significant difference in age and fasting insulin between the two groups (P>0.05).The level of 25(OH)D₃ in the GDM group was lower than that in the control group (P<0.05).Fasting blood glucose, blood glucose at 1 h and 2 h after taking sugar and BMI before pregnancy were all higher in the GDM group than in the control group (P<0.05).Serum 25(OH)D₃ level was negatively correlated with fasting blood glucose and blood glucose at 1 h and 2 h after taking sugar (P<0.05), but not significantly correlated with age, BMI and fasting insulin (P>0.05).The level of 25(OH)D₃ was negatively correlated with the risk of gestational diabetes. Conclusion Reduced serum 25(OH)D₃ levels in the second trimester may increase the risk of GDM, and combined detection of serum 25(OH)D₃ levels in the second trimester is helpful for early prediction of GDM.

目的 分析妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇接受胰岛素治疗对妊娠结局的影响及安全性。方法 将2018年7月—2020年7月接诊且行常规治疗的50例GDM孕妇作为对照组,将同期接诊且在对照组基础上行胰岛素治疗的50例GDM孕妇作为观察组,对组间血糖控制效果、生活质量(SF-36)、治疗效果、不良妊娠结局、不良反应展开分析。结果 (1)组间血糖指标在治疗前无明显差异(P＞0.05);治疗后,观察组血糖控制效果优于对照组(P<0.05);(2)观察组SF-36评分高于对照组,且治疗效果(96.00%)优于对照组(82.00%,P<0.05);(3)观察组出现3例不良妊娠结局(6.00%),对照组出现11例不良妊娠结局(22.00%,P<0.05);(4)观察组发生3例不良反应(6.00%),对照组发生2例不良反应(4.00%,P＞0.05)。结论 对GDM孕妇实施胰岛素治疗,可以改善孕妇血糖水平,减少不良妊娠结局,提高孕妇生活质量,安全可靠,值得推广。

Objective To analyze the effect and safety of insulin therapy on pregnancy outcome in pregnant women with gestational diabetes mellitus (GDM). Methods A total of 50 pregnant women with GDM who received conventional treatment from July 2018 to July 2020 were induded in the control group, and 50 pregnant women with GDM who received insulin treatment on the basis of the control group were induded in the observation group. Results (1) There was no significant difference in blood glucose index between two groups before treatment(P＞ 0.05); after treatment, the blood glucose control effect of the observation group was better than that of the control group(P<0.05); (2) SF-36 score of the observation group was higher than that of the control group, and the treatment effect (96.00%) was better than that of the control group (82.00%,P<0.05); (3) there were 3 cases of adverse pregnancy outcomes (6.00%) in the observation group and 11 cases (22.00%) in the control group; (4) there were 3 cases of adverse reactions (6.00%) in the observation group and 2 cases (4.00%) in the control group(P＞ 0.05). Conclusion Insulin therapy for pregnant women with GDM could improve the blood glucose level of pregnant women, reduced adverse pregnancy outcomes, improved the quality of life of pregnant women, which is safe and reliable, and is worthy of promotion.

目的 探究妊娠期糖尿病(GDM)对母婴分娩结局的影响及导致不良分娩结局的相关影响因素。方法 采用现况调查的方法,通过现场问卷调查的形式,收集2017年9月—2017年11月在广州市妇女儿童医疗中心分娩并且在本院孕检的产妇的临床资料。根据是否患有妊娠期糖尿病,把调查对象分为妊娠期糖尿病组与非妊娠期糖尿病组。定量资料采用t检验或秩和检验,定性资料采用卡方检验或非参数检验,采用logistic回归模型分析不良分娩结局的相关影响因素。结果 在882例调查对象中,GDM孕妇共173例(19.6%)。研究结果表明,GDM孕妇与正常孕妇剖宫产率和住院天数差异有统计学意义(P<0.05),GDM组剖宫产率和住院天数增加,GDM产妇胎儿心脏畸形的风险增加(P<0.05)。Logistic回归分析结果提示孕妇孕次≥3次(OR值为0.399,95%CI为0.189~0.840,P=0.016)、产2次(OR值为0.283,95%CI为0.158~0.507,P<0.001)、产3次或以上(OR值为0.241,95%CI为0.112~0.520,P<0.001)、分娩孕周<37周(OR值为0.380,95%CI为0.180~0.804,P=0.011)是孕妇剖宫产的影响因素;分娩孕周<37周(OR值为16.028,95%CI为7.013~36.629,P<0.001)是孕妇住院天数>5天的影响因素。结论 妊娠期糖尿病可增加孕妇剖宫产率、住院天数以及胎儿心脏畸形的发生率;怀孕3次或以上的孕妇采用剖宫产的可能性与怀孕1次的孕妇相比风险降低;分娩2次或以上的孕妇采用剖宫产的可能性与分娩1次的孕妇相比风险降低;分娩孕周<37周的孕妇采用剖宫产的可能性较分娩孕周≥37周孕妇降低;分娩孕周<37周使孕妇住院天数>5天的风险增加升高。

目的 比较细胞因子TGF-β、IL-10、TNF-α、Th17在不同妊娠结局的妊娠期亚临床甲减孕妇血清中的差异,探索细胞因子在不同妊娠结局中的作用。方法 随机选择2018年1月—2018年12月在我院就诊的66例确诊为因妊娠期亚临床甲减而出现不良妊娠结局的孕妇与同期妊娠结局正常的66例孕妇进行病例对照研究,比较不同妊娠结局孕妇的血清TGF-β、IL-10、TNF-α、Th17的差异;结果 ① 亚临床甲减组的TPOAb、TgAb、TRAb阳性率高于正常妊娠组,同时TNF-α、Th17均高于正常妊娠组,而TGF-β、IL-10均低于正常妊娠组,差异有统计学意义(P<0.05)。② 因子分析发现:在TPOAb、TgAb、TRAb、TGF-β、IL-10、TNF-α、Th17七个影响妊娠期亚临床甲减不良妊娠结局的相关因素中,TGF-β、IL-10、TNF-α、Th17在第1影响因子,特征值达2.347;TPOAb、TgAb、TRAb是次要影响因子,特征值为1.162。结论 TGF-β、IL-10、TNF-α、Th17与妊娠期亚临床甲状腺功能减退症的不良妊娠结局有密切关系,TGF-β、IL-10、TNF-α、Th17是影响妊娠期亚临床甲减不良妊娠结局的主要因子;TPOAb、TgAb、TRAb是影响妊娠期亚临床甲减不良妊娠结局的次要因子。

Objective To compare the serum levels of TGF-β, IL-10, TNF-α and Th17 in pregnant women with subclinical hypothyroidism in different pregnancy outcomes. Methods A case-control study was conducted in 66 pregnant women with adverse pregnancy outcomes due to subclinical hypothyroidism during pregnancy and 66 pregnant women with normal pregnancy outcomes during the same period. The differences of serum TGF-β, IL-10, TNF-α and Th17 among pregnant women with different pregnancy outcomes were compared. Results ①The positive rates of TPOAb, TgAb and TRAb in subclinical hypothyroidism group were higher than those in normal pregnancy group, and TNF-α and Th17 were higher than those in normal pregnancy group, while TGF-βand IL-10 were lower than those in normal pregnancy group (P<0.05). ②Factor analysis found that TPOAb, TgAb, TRAb, TGF-β, IL-10, TNF-α and Th17 were the factors related to adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy. TGF-β, IL-10, TNF-α and Th17 were the main influencing factors with a characteristic value of 2.347; TPOAb, TgAb and TRAb were the second influencing factors,with a characteristic value of 1.162. Conclusion ①TGF-β, IL-10, TNF-α, Th17 are closely related to the occurrence and pregnancy outcome of subclinical hypothyroidism in pregnancy. ②TGF-β, IL-10, TNF-α and Th17 are the main factors affecting the adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy;TPOAb, TgAb and TRAb are the secondary factors affecting the adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy,

目的 了解孕妇妊娠期运动现状及其影响因素,为优化妊娠期运动方案提供依据。方法 采用便利抽样法,使用自编《孕妇妊娠期运动现状及影响因素调查问卷》对广州市某三级甲等妇幼保健院214名孕周＞37周的孕妇进行调查。结果 妊娠期每次运动时长集中在30min~1 h的孕妇占43.0%;91.6%的孕妇选择散步和爬楼梯,仅有8.4%的孕妇接触过孕妇体操和瑜伽等其他运动形式;妊娠合并糖尿病与无合并症孕妇运动量相比,差异无统计学意义(P>0.05);家人朋友为孕妇主要获取妊娠期运动信息来源。认为妊娠期运动不重要、缺乏安全感、家庭及社会支持为妊娠期运动的主要影响因素。结论 孕妇运动量总体处于较低水平,运动形式单一,受认知、心理、生理、社会因素影响;孕妇尤其是患有妊娠合并糖尿病的孕妇对妊娠期运动的重要性和必要性没有给予足够的重视;医护人员对于妊娠期运动的引导作用较弱。

目的 探讨妊娠期高血糖患者母体胰岛β细胞自身抗体对新生儿的影响。方法 选取2014年3月—2016年3月于我院就诊的口服75 g葡萄糖耐量试验(OGTT)异常的孕妇共276例,以60例健康孕妇作为对照组,分别在产前和OGTT试验后空腹抽取静脉血进行检测,检测指标包括谷氨酸脱羧酶抗体(GADA)、胰岛细胞抗体(ICA) )和胰岛素自身抗体(IAA),记录每个出生患儿的体重、Apgar评分、血糖指标进行分析。结果 276例GDM患者中34.41%至少存在一种相关抗体阳性,GDM组GADA阳性、IAA阳性和阴性的搏动指数异常比例均高于健康组(P<0.05),IAA阳性的胎儿生长受限比例比例较GDM组抗体阴性的比例高(P<0.05),妊娠晚期胰岛细胞抗体阳性(OR:6.41,95%CI:1.41~34.13)均为新生儿产后进入ICU进行监护的风险因素,妊娠中、晚期GADA阳性(OR:10.26,95%CI:1.42~75.14) 和妊娠晚期GADA阳性(OR:8.15,95%CI:1.43~46.83)均为新生儿窒息的风险因素 。结论 妊娠晚期胰岛细胞抗体阳性为新生儿产后进入ICU进行监护的风险因素,妊娠中、晚期GADA阳性是新生儿窒息的风险因素。

目的 分析妊娠期慢性乙型肝炎病毒携带者病毒载量与孕妇肝功能、妊娠并发症的相关性。方法 将本院2015年1月—12月间在本院住院并于本院分娩的携带慢性乙型肝炎病毒(HBV)的86例孕妇作为本次研究对象,于住院期间分娩前测定孕妇HBV脱氧核糖核酸(HBV-DNA)定量,依据HBV-DNA定量测定结果将全部患者分为阴性组与阳性组,分别对比2组患者的临床资料、肝功能、妊娠并发症发生率及母婴结局;分析HBV-DNA载量与孕妇妊娠期肝功能及妊娠并发症的相关性。结果 2组孕妇的年龄、BMI、孕次与产次均无差异,P>0.05;阴性组患者妊娠期肝功能指标优于阳性组,P<0.01。阴性组中羊水量异常(偏多或偏少)发生率高于阳性组,P<0.05;其他妊娠期并发症发生率2组均未见差异,P>0.05。2组母婴结局均未见统计学差异,P>0.05。HBV载量与ALT肝功能指标均呈正相关,0<r<1,说明HBV-DNA越高则ALT越高,孕妇的肝功能越差。HBV载量与并发症发生间基本不相关,|r|<0.3,P>0.05。结论 慢性乙型肝炎病毒携带者妊娠期时随着病毒载量的升高,孕妇的肝功能有所下降仍可维持在正常标准,但与妊娠并发症的发生无相关性;提示对HBV-DNA阳性的孕妇给予密切监护,通过临床常规对症治疗能够保证母婴安全。

Objective To analyze the correlation between viral load of chronic hepatitis B virus infection and liver function and pregnancy complications. Methods We selected 86 cases of pregnant women with chronic hepatitis B virus(HBV)in our hospital from January 2015 to December 2015 as the research objects, and then during the hospitalization to test the quality of the HBV deoxyribonucleic acid (HBV-DNA)for them before delivery. According to the HBV-DNA quantitative results, all patients were divided into low dosage group and high dosage group, and then the clinical data, liver function, the incidence rate of pregnancy complications and the outcomes of the two groups were compared; at last we analyzed the correlation among the HBV-DNA load, liver function of pregnant women during pregnancy and pregnancy complications. Results There was no difference between the two groups of pregnant women in the age, BMI, pregnancy and birth time, P>0.05; the low dose group was better than the high dose group in the liver function index during the pregnancy, P<0.01. The incidence of abnormal amniotic fluid volume (more or less) in the low dose group was higher than that in the high dose group, P<0.05; there was no significant difference between the two groups in the incidence of other complications, P>0.05. There was no statistical difference between the two groups in maternal and neonatal outcomes, P>0.05. The HBV load was positively correlated with the two liver function indexes ALT, 0<r<1, indicating that the higher the HBV-DNA, the higher theALT, the worse the liver function of the pregnant women. There was no correlation between HBV load and complications, |r|<0.3, P>0.05. Conclusion Chronic hepatitis B virus carriers during pregnancy with increasing viral load, liver function of pregnant women declined to maintain in normal level, but not associated with pregnancy complications; that of HBV-DNA positive pregnant women given close monitoring of disease through clinical routine treatment can ensure the safety of mother and child.

目的 探讨妊娠期甲亢患者血清甲状腺功能和免疫含量变化及其临床应用价值。方法 分别取妊娠期与非妊娠期甲亢病例各250例,于孕15周、孕25周以及孕35周时测定两组血清甲状腺功能各项指标与免疫含量。结果 与对照组相比,观察组患者整个妊娠期T3、T4水平明显更高(P＜0.05);孕中晚期两组FT3、FT4水平差异并无统计学意义(P＞0.05)。结论 血清T3、T4在妊娠合并甲亢患者整个妊娠过程中呈高水平表达,临床应高度重视TRAb阳性率、FT3、FT4表达水平,以明确诊断。

目的 探究孕妇血清PAPP-A、IR与妊娠期糖尿病的临床相关性。方法 以我院2013年4月—2014年4月期间收治的160例妊娠期糖尿病孕妇作为观察组,以同期收治的妊娠期正常孕妇作为对照组。对比分析两组孕妇血清PAPP-A含量与IR计算值差异。结果 观察组孕妇血清PAPP-A水平低于对照组,而IR计算值明显高于对照组,差异有统计学意义(P<0.05)。结论 孕妇血清PAPP-A与IR水平与妊娠期糖尿病相关性显著,妊娠期糖尿病患者血清PAPP-A明显降低,而IR则明显增加,可为临床诊断提供参考依据。

Objective To explore the clinical relevance of the pregnant women serum PAPP -a, IR and gestational diabetes. Methods The 160 cases of gestational diabetes mellitus were treated in our hospital from April 2013 to April 2014 as the observation group, and the normal pregnant women were treated as the control group. The differences of serum PAPP-A levels and IR values in the two groups were compared and analyzed. Results The serum PAPP-A level of the observation group was significantly lower than that of the control group, while the IR value was significantly higher than that of the control group, the difference was statistically significant (P<0.05). Conclusion The level of serum PAPP-A and IR in pregnant women is significantly related to the gestational diabetes mellitus. The serum PAPP-A of the patients with gestational diabetes is significantly decreased, while the IR is significantly increased, which can provide reference for clinical diagnosis.