摘要：宫内感染可由多种病原体侵入妊娠子宫腔内,引起异常妊娠及新生儿疾病等母婴不良结局,但由于发病机制尚未明确,治疗效果欠佳,预后差。因此,建立稳定、可靠的宫内感染动物模型有助于对其发病机制、药物作用机制及预防等方面进行更深入的研究,对降低母婴不良结局及改善预后有重要的意义。目前国内外建立宫内感染的动物模型主要有:大肠杆菌或脂多糖诱导的宫内感染模型、解脲支原体宫内感染动物模型、念珠菌宫内感染动物模型、巨细胞病毒宫内感染动物模型等,本文主要从实验动物的选择、不同造模方法的实验设计及其优缺点等方面进行综述。

摘要：Objective: The purpose of this study was to evaluate the prevalence of microbial invasion of the amniotic cavity at the time of preterm cesarean delivery for therapy-resistant preterm labor or preterm premature rupture of membranes, which are events that commonly are induced by infection, and to compare this group of patients with a group of patients who underwent preterm cesarean delivery for indications other than preterm labor or preterm premature rupture of membranes. Study design: We studied 207 consecutive women between 23 and 34 weeks of gestation who underwent cesarean delivery. These patients were divided into 3 groups according to the indication for cesarean delivery: patients with preterm labor (group 1), patients with preterm premature rupture of membranes (group 2), and patients with other indications (group 3). In the course of the surgical procedure, amniotic fluid, amniotic membrane, and placental tissue specimens were collected for the detection of pathogens. Results: Ureaplasma urealyticum was detected in 43.9%(58/132) of the patients of groups 1 and 2, with no significant difference between these 2 subgroups. In group 3, which served as the comparison group,Ureaplasma urealyticum was isolated in only 2.7%(2/75) of the patients. Ureaplasma urealyticum as a single pathogen was more frequent than all obligate pathogens together (43.9%vs 39.3%). Conclusion: Our results provide evidence for an association between intrauterine colonization with Ureaplasma urealyticum and both therapy-resistant preterm labor and preterm premature rupture of membranes.

摘要：目的对妊娠晚期使用替比夫定阻断宫内感染的有效性、安全性进行评价。方法按Cochrane系统评价方法,检索从1976至2014年11月Cochrane library、Medline、EMbase、China National Knowledge Infrastructure（CNKI）、China Biomedicine（CBM）相关文献。检索出13篇设有对照组的临床研究。用Rev Man5.0软件进行Meta分析。结果 1试验组分娩前检测孕妇的血清HBV DNA（log10拷贝/m L）低于对照组分娩前血清HBV DNA[WMD=-3.81,95%CI（-4.39,-3.22）,P〈0.01]（差异有统计学意义）。2使用替比夫定治疗前检测孕妇的血清HBV DNA（log10拷贝/ml）高于治疗后（分娩前）检测孕妇的血清HBV DNA[WMD=3.91,95%CI（3.32,4.49）,P〈0.01]。3试验组新生儿6~7个月时的HBV DNA阳性率低于对照组新生儿[OR=0.10,95%CI（0.04,0.22）,P〈0.01]。试验组新生儿12月时的HBV DNA阳性率低于对照组[OR=0.12,95%CI（0.04,0.36）,P〈0.01]。结论对HBV DNA高载量（≥1×106Iu/m L）的孕妇于妊娠晚期（28~32周）使用替比夫定（600mg/日）治疗可有效降低孕妇血清HBV DNA载量及新生儿出生后6~12个月的HBV DNA或HBs Ag阳性率;结合新生儿联合免疫方法,可有效阻断HBV的母婴传播。现有的研究尚不能确定孕期使用替比夫定的安全性,需要更好设计的RCT研究。

摘要：背景:膜联蛋白V是近年来被作为肝细胞膜上存在的与乙型肝炎病毒感染相关受体研究的热点之一,并在胎盘组织中也有表达。目的:探讨膜联蛋白V在HBV宫内感染中的作用;揭示HBV进入胎盘组织细胞的方式,为HBV的宫内感染的机理提供理论依据。设计:随机对照实验。单位:泰山医学院。对象:选择2003-01/2004-12济南市妇幼保健院、泰安市中心医院、泰安市妇幼保健院收集的30例HBsAg阳性孕妇足月分娩的胎盘组织,同时收集母血分离血清。实验经过孕妇知情同意及医院伦理委员会批准。兔抗人膜联蛋白V亲和纯化抗体(第一抗体)、鼠抗人HBs mAb(第一抗体)、生物素化羊抗小鼠IgG(第二抗体)均购自武汉博士德生物工程有限公司。方法:用即用型SABC免疫组织化学染色试剂,检测30例HBsAg阳性的足月胎盘组织中,有18例检测到HBsAg,随机选取10例进行荧光双标染色,其染色主要过程为将待测石蜡切片标本常规脱蜡至水;抗原微波热修复;加入第一种一抗(兔抗人AnV亲和纯化抗体1:60,为单克隆抗体)置湿盒中,4℃冰箱过夜;第二种一抗(鼠抗人HBs mAb1:50),置湿盒中,4℃冰箱过夜;加入与第二种一抗相应的二抗(如生物素化的羊抗鼠IgG1:100):加入以PBS作适当稀释的第一种荧光抗体(如FITC-羊抗兔IgG1:50);加入第二种荧光抗体(Avidin-Cy3);缓冲甘油封固;激光共聚焦显微镜下观察并进行图像分析。用IPP4.5图像分析法,先进入IPP4.5系统的Image Analysis程序,然后调入分析文件进行分析。主要观察指标:乙型肝炎病毒感染的胎盘组织中HBsAg/膜联蛋白V的存在与分布情况。结果:选取10例进行荧光双标染色结合激光共聚焦显微镜检测胎盘组织上滋养层细胞乙型肝炎病毒/膜联蛋白V的存在与分布模式。胎盘组织中存在着丰富的膜联蛋白V,位于绒毛合体滋养层细胞,在基质细胞和血管内皮细胞都有膜联蛋白V的表达。并发现在同一细胞中存在着乙型肝炎病毒和膜联蛋白V的共存现象。结论:乙型肝炎病毒感染胎盘细胞可能是通过与细胞上的受体膜联蛋白V结合,促使病毒进入胎盘细胞,导致宫内感染。

摘要：(上接第22期) 2.全国人口健康素质信息系统的建立及应用的研究 采用现代技术研究建立全国人口健康素质信息系统,及其数据库和应用软件、计算机网络通讯系统结构及其协议规范等。用3年时间完成该系统总体方案设计,并在试点地区试运行;“九五”期末基本完善总体方案。

摘要：目的对28例紧急宫颈环扎术后合并胎膜早破的影响因素进行分析。方法回顾性分析本院妇产科收治的28例紧急宫颈环扎术后合并胎膜早破患者的临床资料,根据孕周分为<28周组(6例)、≥28周组(22例),分析紧急宫颈环扎术后合并胎膜早破的影响因素,并建立预测分娩孕周的数学模型。结果<28周组的平均年龄、经产妇比例高于≥28周组,人工流产次数多于≥28周组,胎膜膨出阴道直径大于≥28周组,平均分娩孕周小于≥28周组,差异有统计学意义(P<0.05);28例孕妇的自然分娩率为89.3%;<28周组产褥感染、新生儿视网膜病变发生率高于≥28周组,差异有统计学意义(P<0.05);产妇分娩孕周和术前C-反应蛋白、分娩时白细胞计数呈不同程度的负相关(P<0.05)。结论高龄、经产妇、人工流产次数多、胎膜膨出阴道直径大是紧急宫颈环扎术合并胎膜早破预后的高危因素,术前C-反应蛋白、分娩时白细胞计数对分娩孕周有预测作用。

摘要：目的分析妊娠糖尿病(gestational diabetes mellitus,GDM)并发早产患者的影响因素。方法回顾性分析在安阳市妇幼保健院产检并完成分娩的40例GDM并发早产患者的临床资料,设为早产组;另收集同期产检并完成分娩的40例GDM未并发早产患者临床资料,设为非早产组;查阅患者病历资料,设计基线资料填写表,记录一般资料,经单因素与多因素检验,分析GDM并发早产患者的影响因素。结果早产组患者妊娠期并发症、宫内感染及白蛋白(ALB)水平与非早产组患者比较,差异有统计学意义(P0.05);将可能的影响因素纳入,经二分类logistic回归分析结果显示,妊娠期并发症、宫内感染均是GDM患者并发早产的危险因素(OR>1,P<0.05);ALB水平升高是GDM患者并发早产的保护因素(OR<1,P<0.05)。结论GDM患者并发早产可能受妊娠期并发症(胎盘早破、胎盘早剥等)、宫内感染及血清ALB水平等因素影响,临床应重点关注上述因素,实施针对性干预。

摘要：目的 构建乙型肝炎病毒（HBV）X基因高效真核表达载体,为进一步研究乙型肝炎病毒X基因的功能及乙型肝炎病毒母婴垂直传播的可能机制奠定基础.方法 设计并合成乙型肝炎病毒X基因的引物,以我国急性肝炎患者血清中获得的全长乙型肝炎病毒序列C基因型作为构建载体X基因序列的母板进行扩增,将扩增产物X基因连接到真核表达载体pcDNA3.1（＋）上,酶切图谱分析、PCR检测和扩增产物序列分析等鉴定所构建的真核表达载体.结果 以重组载体为模板、用乙型肝炎病毒X基因引物PCR扩增得到的目的 片段为500bp,与已知乙型肝炎病毒X基因大小相同,酶切后发现在500bp左右及5kb左右出现两条特异性条带,分别与已知X基因序列相同.结论 成功构建了乙型肝炎病毒X基因真核表达载体,为进一步研究乙型肝炎病毒X基因的功能及宫内感染的可能机制奠定了基础.

摘要：Objective: The purpose of this study was to evaluate whether there is a relationship between the sonographic fetal thymus size and the presence of an intrauterine infection in patients with preterm labor. Study design: Thirty-one women who had been admitted with preterm labor and intact membranes between 24 and 32 weeks of gestation were included. Fetal thymus perimeter was measured sonographically, and amniocentesis for the microbiologic assessment of the amniotic cavity was performed. Placentas and umbilical cords were examined for the presence of chorioamnionitis/funisitis. Results: The prevalence of preterm delivery and intra-amniotic infection was 51.6%(16/31 women) and 32.3%(10/31women), respectively. In all cases with intrauterine infection and in 23.8%of cases without intrauterine infection, the fetal thymus perimeter was below the 5th percentile for gestational age (10/10 women vs 5/21 women; P < .01). Isolated histologic chorioamnionitis and funisitis were found in 22.6%and 25.8%of fetuses, respectively. The fetal thymus was below the 5th percentile for gestational age in 100%, 71.4%, and 12.5%of patients with histologic signs of funisitis and isolated chorioamnionitis and without histologic signs of infection, respectively. Conclusion: Fetal thymus involution in preterm labor patients is strongly associated with funisitis, which is the histologic manifestation of the fetal inflammatory response syndrome.