Retrospective and cost-effective analysis of the result of Changsha Municipal Public Welfare Program by Noninvasive Prenatal Testing / 中华医学遗传学杂志

OBJECTIVE@#To assess the practical and health economical values of non-invasive prenatal test (NIPT) in Changsha Municipal Public Welfare Program.@*METHODS@#A retrospective analysis was carried out on 149 165 women undergoing NIPT test from April 9, 2018 to December 31, 2019. For pregnant women with high risks, invasive prenatal diagnosis and follow-up of pregnancy outcome were conducted. The cost-benefit of NIPT for Down syndrome was analyzed.@*RESULTS@#NIPT was carried out for 149 165 pregnant women and succeeded in 148 749 cases (99.72%), for which outcome were available in 148 538 (99.86%). 90% of pregnant women from the region accepted the screening with NIPT. 415 (0.27%) were diagnosed as high risk. Among these, 381 (91.81%) accepted amniocentesis, which led to the diagnosis of 212 cases of trisomy 21 (PPV=85.14%), 41 cases with trisomy 18 (PPV=48.81%) and 10 cases with trisomy 13 (PPV=20.83%). The sensitivity and specificity of NIPT for trisomy 21, trisomy 18 and trisomy 13 were (97.70%, 99.98%), (97.62%, 9.97%) and (100%, 99.97%), respectively. In addition, 213 and 30 cases were diagnosed with sex chromosomal aneuploidies (PPV=46.2%) and other autosomal anomalies (PPV=16.57%), respectively. For Down syndrome screening, the cost and benefit of the project was 120.79 million yuan and 1,056.95 million yuan, respectively. The cost-benefit ratio was 1: 8.75, and safety index was 0.0035.@*CONCLUSION@#NIPT is a highly accurate screening test for trisomy 21, which was followed by trisomy 18 and sex chromosomal aneuploidies, while it was less accurate for other autosomal aneuploidies. The application of NIPT screening has a high health economical value.

Diagnostic significance of the uric acid in preeclampsia / 中国医师杂志

Objective To explore the diagnostic significance of the uric acid in preeclampsia.Methods The samples were chosen between January 2008 and August 2015 in our hospital maternity clinic,at 24 to 28 weeks of gestation,singletons,1 357 cases of pregnant women,136 cases for the development of preeclampsia,and 1 221 cases of normal pregnancy.the clinical data of 1 357 cases were retrospectively analyzed.Results (1) The maternal age,birth gestational age,body mass index,systolic blood pressure,diastolic blood pressure,urine protein,cholesterol,creatinine,uric acid,and uric acid increased value of the control group of preeclampsia were significandy higher than the normal group (P ＜ 0.05).The incidence of preeclampsia,cesarean delivery rate,fetal growth restriction,small gestational age,and newborn asphyxia rate of high uric acid hematic disease group were significandy higher than the normal group (P ＜ 0.05).(2) Logistic regression analysis showed that systolic blood pressure,urinary protein and uric acid were the predictors,and uric acid was the best predictor.(3) By using receiver operating characteristic (ROC) curve,the growth of uric acid was 112 μmol/L,and the sensitivity was 85.2％,the specificity was 90.1％.Conclusions Uric acid level can be used as an important indicator to monitor the pathophysiology of preeclampsia,and uric acid value can be accurately predicted.

Role of angiogenic T cells and EPC in the pathogenesis of preeclampsia and the relationship between angiogenic T cells and EPC / 中华妇产科杂志

Objectives To investigate the role of angiogenic T cells (Tang) and endothelial progenitor cells (EPC) in the pathogenesis of preeclampsia. To explore the relationship between Tang and EPC. Methods From Mar 2013 to Aug 2014, 40 patients diagnosed preeclampsia (PE) and delivered in Hunan Provincial People′s Hospital. A total of 20 of them were defined as the mild preeclampsia group and the other 20 cases were recruited as the severe preeclampsia group. And 24 healthy pregnant women wererecruited as the control group. The percentage of Tang and EPC in peripheral blood mononuclear cells (PBMC) were determinated by flow cytometry between 28 and 40 gestational weeks. Results (1) There was no significant difference in the age, pre-pregnancy body mass index(Pre-BMI) or gestational age among the three groups (P>0.05). The differences of blood pressure among the three groups were statistically significant (P0.05). (3) The percentage of EPC in maternal peripheral blood was (0.16±0.07)%, (0.09±0.07)%and (0.08±0.05)%in the control group, the mild and the severe preeclampsia group, respectively. Analysis of variance showed that difference among the three groups was significant (F=9.351, P0.05). In the preeclampsia group (including mild and severe cases), there was positive correlation between the Tang level and EPC level (r=0.667, P<0.01). The positive correlation between Tang level and EPC level were proved respectively in the mild preeclampsia group (r=0.803, P<0.01) and the severe preeclampsia group (r= 0.520, P<0.05). Conclusions The number of Tang had some correlation with the pathogenesis of preeclampsia. The percentage of Tang had positive correlation with the level of EPC in women with preeclampsia. Tang might have some influence on the change of EPC′ level. Tang together with EPC were likely to contribute to the angiogenesis in preeclampsia.

Correlation between the myometrial thickness in the second trimester and preterm delivery in a prospective study / 中华妇产科杂志

Objective To investigate the relationship between preterm delivery and anterior myometrial (MA) thickness measured by ultrasound in the second trimester. Methods The general information and pregnancy outcome of singleton pregnant women who had antenatal visit in the Hunan Provincial People′s Hospital between Oct 2010 and Sep 2013 were collected prospectively. The MA thickness was measured at 20-27+6 gestational weeks. The cases were divided into preterm delivery group and term delivery group. Results (1)A total of 1 031 pregnant women were recruited in this study. 147 pregnant women were in the preterm delivery group(14.26%,147/1 031) and 884 women were in the term delivery group(85.74%,884/1 031). The gestation age at delivery of the preterm delivery group was significantly earlier than the term delivery group [(34.57 ± 2.39) vs (39.23 ± 0.92) weeks,P0.05). The incidence of premature rupture of membrane(PROM) in the preterm delivery group and in the term delivery group were 49.0%(72/147) and 15.8%(140/884),respectively, with statistically significant diffrence(P0.05). The mean value of MA thickness in the spontaneous preterm delivery group was(5.15±0.75) mm, and was (5.61±1.38 ) mm in the term delivery group, with statistically significant difference(P0.05). No correlation was found among PROM and MA thickness(r=0.058,P>0.05). However, in the preterm delivery group, the mean value of MA in PPROM was significantly thicker than the spontaneous preterm delivery cases(P<0.01). There was a positive correlation between the MA thickness and PPROM (r=0.457,P<0.01). Conclusion The MA thickness had some correlation with spontaneous preterm delivery and PPROM, while the MA thickness should not be considered as an independent factor of preterm delivery.

Study of the role of nuclear factor-kappa B in preterm birth with subclinical chorioamnionitis / 中华妇产科杂志

Objective To investigate the role of nuclear factor-kappa B(NF-κB) in preterm birth with subclinical chorioamnionitis.Methods From October 2005 to October 2006,111 cases including 36 cases of preterm birth in labor,37 cases of full term gravida with spontaneous labor and 38 cases of full term gravida without threatened labor in the Hunan Province People's Hospital,third Xiangya Hospital of Central South University and Changsha Maternal and Child Care Service Center were enrolled in the study.After delivery,by pathology results of fetal membrane they were divided into two groups:subclinical chorioamnionitis group(subclinical infectious group ) and non-infectious group. Immunohistochemical staining and RT-PCR were used to observe the change of the p65 subunit of NF-κB family in maternal blood and fetal membrane in subclinical infectious group and non-infectious group.Results (1) The incidence of subclinical chorioamnionitis:there were 24 cases of subclinical chofioamnionitis in the 36 cases of preterm birth in labor(67% ),7 cases in the 37 cases of full term gravida with spontaneous labor group (19%)and 3 cases in the 38 cases of full term gravida without threatened labor group(8%).There was a significant difference among the three groups (P＜0.01). In the totally 111 cases,34 eases were classified as subclinical infectious group and 77 cases as non-infectious group.(2) In fetal membrane,the median of the average staining intensity of NF-κB p65 protein was higher in the subclinical chorioamnionitis group (8.0)than those in non-infectious group(4.0).Similarly,the average staining intensity of NF-κB p65 mRNA was higher in the subclinical infectious group (47.5±17.2) than those in non-infectious group(31.3±13.6).There was a significant difference between the two groups (P＜0.01).(3)In maternal blood,the expression of NF-KB p65 protein and mRNA was higher in subclinical chorioamnionitis group (8.0 and 42.6) than these in non-infectious group(4.0 and 23.6).There was a significant difference between the two groups (P＜0.01).(4) The concentration of NF-κB p65 protein in fetal membrane was positively correlated with that of maternal blood(r=0.581,P＜0.01 ) and the concentration of NF-KB p65 mRNA in fetal membrane was positively correlated with that of maternal blood (r=0.571,P＜0.01 ).Condusion The expression of NF-KB in maternal blood and fetal membrane in preterm birth with subclinical chorioamnionitis is higher and the two are correlated with each other.NF-KB p65 could be an accurate biochemical marker in predicting subclinical chorioamnionitis in preterm birth. NF-KB p65 plays an important role in the pathogenesis of subclinical chorioamnionitis in preterm birth.

Clinical Analysis of 85 Cases with Intrahepatic Cholestasis of Pregnancy / 中国医师杂志

Objective To analyse the relationship between hepatic function index and perinatal-prognosis in patients with the intrahepatic cholestasis of pregnancy(ICP). Methods The clinical data of 85 the patients with ICP in our department were retrospectively reviewed. Results The more the serum levels of TBA,SGPT and TBIL in the patients with ICP were, the more incidence of fetal distress, amniotic fluid contamination and asphyxia neonatorum would be (P