[Clinical features of preeclampsia-eclampsia patients with reversible posterior leukoencephalopathy syndrome].

OBJECTIVE: To investigate the clinical features and specific characteristics of magnetic resonance image (MRI) in preeclampsia-eclampsia patients with reversible posterior leukoencephalopathy syndrome (RPLS). METHODS: The investigators analyzed the combined clinical, laboratory and neuroradiographic features of 20 preeclampsia-eclampsia patients with RPLS and 15 preeclampsia-eclampsia controls with normal MRI findings. RESULTS: Patients with RPLS had more tendency to have headache, seizure, visual disturbance, confusion and altered mental status than controls. Neuroimaging showed diffuse edema predominantly in posterior cerebral white matter bilaterally. Clinical features and neuroradiological alterations disappeared after appropriate treatments were started. Twenty RPLS patients had a significantly higher level of uric acid (442 +/- 77 mmol/L) than those without RPLS (350 +/- 88 mmol/L) (P < 0.05). However no difference was observed for other indices. CONCLUSION: Preeclampsia-eclampsia patients with RPLS have typical clinical and imaging findings, and the syndrome is reversible with appropriate treatment. Perhaps endothelial damage is related to the pathogenesis of RPLS. Monitoring the level of uric acid in patients with preeclampsia-eclampsia is of vital significance to discover RPLS in an early stage.

[Study on the association between gestational diabetes mellitus and tumor necrosis factor-alpha gene polymorphism].

OBJECTIVE: To study allelic frequency of tumor necrosis factor-alpha (TNF-alpha) in gestational diabetes mellitus (GDM) of Han ethnicity in north China and to determine whether there is a specific allele of TNF-alpha associated with GDM susceptibility. METHODS: By using PCR-RFLP, we detected the distribution of TNF-alpha promoter alleles frequency in GDM women and control normal pregnant women. Plasma TNF-alpha levels and insulin levels were measured by radioimmunoassay. RESULTS: (1) There was a significant increase of A alleles frequency of TNF-alpha promoter -308 gene in GDM women compared with control group (61.4% vs 30.0%, P < 0.05) and an increase of the AA + GA genotype was observed in GDM group (71.4% vs 37.1%, P < 0.05). (2) In GDM group, the patients carrying the AA + GA genotype had higher plasma TNF-alpha levels (52 +/- 13 vs 14 +/- 4, P < 0.05) and a lower insulin sensitivity (13.6 +/- 6.5 vs 1.9 +/- 0.2, P < 0.05) compared with those carrying the other genotype (GG). CONCLUSIONS: The 308 G-->A polymorphism of TNF-alpha promoter gene is involved in the pathophysiology of insulin resistance and gestational diabetes mellitus.

[Study on association between gestational diabetes mellitus and sulfonylurea receptor-1 gene polymorphism].

OBJECTIVE: To investigate allelic frequency of sulfonylurea receptor-1 (SUR1) in gestational diabetes mellitus (GDM) women of Han nationality in north China in order to find out susceptible gene associated with GDM, and to assess the association between SUR1 allele and body mass index (BMI) and secretion of insulin. METHODS: Seventy cases of pregnant women were selected. It included 35 cases of pregnant women with GDM (GDM group), 35 cases of normal pregnant women (normal control group). Another 35 women patients with type 2 diabetes in the same period as T2DM group. By using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), we detected the distribution of SUR1 alleles frequency in all individuals of three groups. We also examined BMI, fasting insulin (INS(0)) and 2 h insulin levels (INS(120)). RESULTS: There was significantly increased c alleles frequency of SUR1 in GDM and T2DM women compared with normal pregnancy (70.0%, 71.4% and 52.9%, P < 0.05). Also significantly increased A alleles frequency of SUR1 in GDM and T2DM women was found compared with normal pregnancy (41.4%, 44.3% and 24.3%, P < 0.05). In GDM group, women carrying cc genotype had a higher BMI [(29.2 +/- 5.6) kg/m(2)], INS(0) [(14.9 +/- 8.7) mU/L] and INS(120) [(40.2 +/- 12.1) mU/L] as compared with those in carriers of other genotypes (ct and tt) (all P < 0.05). Also they had a lower insulin sensitivity (HOMA-IR) (3.9 +/- 2.5) as compared with carriers of ct genotype. Women carrying AA genotype had a higher INS(0) as compared with carriers of other genotypes (AG and GG) [(15.4 +/- 3.2), (12.1 +/- 4.5) and (11.5 +/- 4.8) mU/L, both P < 0.05]. Logistic regression analysis showed there was relationship between SUR1 cc genotype and severity of GDM (P = 0.005, RR = 25.128). CONCLUSIONS: There are -3t-->c and A/G polymorphism of SUR1 gene in the Han nationality. Alleles c of SUR1 are significantly implicated in the susceptibility to GDM. It suggests that the defect in SUR1 gene (cc and AA) may contribute to insulin hypersecretion, which might be the cause of increased body weight and decreased insulin sensitivity and genotype cc of SUR1 is connected with severe type of GDM. It might be the predictable index of GDM conversion to type 2 diabetes.