本文選題：重度子癇前期 + sEng蛋白　； 參考：《浙江大學(xué)》2014年碩士論文

【摘要】：子癇前期(pre-eclampsia PE)多發(fā)生于妊娠20周后,以高血壓和蛋白尿為主要臨床表現(xiàn),伴全身多器官功能損害或功能衰竭,嚴(yán)重者可出現(xiàn)抽搐、昏迷,甚至死亡。目前,誘發(fā)子癇前期的病因及病理機(jī)制仍是圍產(chǎn)醫(yī)學(xué)中研究的一個重要課題。因此,子癇前期中胎盤組織內(nèi)蛋白表達(dá)的改變,是PE發(fā)生發(fā)展的關(guān)鍵性環(huán)節(jié)之一。 目前認(rèn)為子癇前期的發(fā)展主要分為兩個階段。第一階段是無臨床癥狀期。其主要特點是孕早期胎盤發(fā)育異常導(dǎo)致胎盤缺血、缺氧并釋放過量的胎盤物質(zhì)進(jìn)入母體血循環(huán)。此階段并無明顯臨床表現(xiàn)。第二階段是臨床癥狀期,其主要表現(xiàn)為高血壓、腎損害、蛋白尿甚至HELLP綜合癥(溶血、肝酶升高、血小板降低)、子癇和其他器官損害。 胎盤是孕期的特殊器官,對胎兒的生長和母體的孕期狀況都有很大的影響。因此,孕期胎盤的病理狀況與胎兒生長受限及子癇前期均有密切相關(guān)。通過大量研究已經(jīng)認(rèn)識到胎盤淺著床和促炎因子的產(chǎn)生在子癇前期發(fā)病中的起到關(guān)鍵作用。其發(fā)病機(jī)制在于胎盤缺氧,異常的抗血管生成因子如sFltl,sEng等從胎盤中釋放,抑制血管內(nèi)皮生長因子(VEGF)、胎盤生長因子(PIGF)的生理作用,從而導(dǎo)致子癇前期的發(fā)生。 此外,對那些嚴(yán)重的重度子癇前期病人,任何疼痛刺激或緊張情緒都可誘發(fā)重度子癇前期患者抽搐,危及母嬰生命安全,因此必須終止妊娠來挽救患者的生命。而在終止妊娠中采用吸入全身麻醉是理想的選擇,在眾多吸入麻醉劑中,七氟醚是一種應(yīng)用于產(chǎn)科麻醉和無痛分娩的吸入麻醉藥。血氣分配系數(shù)小,具有快速誘導(dǎo)和蘇醒的優(yōu)點,能迅速從孕婦和新生兒體內(nèi)清除,對新生兒Apgar評分和臍帶血氣無明顯影響。因此在產(chǎn)科領(lǐng)域具有良好的應(yīng)用前景。我們通過七氟醚干預(yù)重度子癇前期胎盤組織來觀察其對胎盤組織的sEng蛋白表達(dá)有無改善作用。 本研究分成兩個部分：第一部分：七氟醚對離體重度子癇前期胎盤以及外周血中sEng蛋白表達(dá)的影響重度子癇前期是子癇前期的一種,是導(dǎo)致孕婦、胎兒和新生兒死亡的主要原因。本研究通過對重度子癇前期患者胎盤組織的分離培養(yǎng)并通過七氟醚干預(yù)干預(yù)后sEng表達(dá)變化的研究,探討七氟醚對重度子癇前期患者胎盤sEng蛋白表達(dá)的影響。 研究目的： (1)通過酶聯(lián)免疫法(ELISA)檢測重癥子癇前期孕婦外周血漿中sEng水平和臍血sEng水平有無差異；(2)運用3%七氟醚干預(yù)重癥子癇前期產(chǎn)婦的胎盤組織,用酶聯(lián)免疫法(ELISA)檢測檢測胎盤組織干預(yù)在干預(yù)前后的分泌的sEng蛋白的變化,探討吸入七氟醚對重度子癇前期患者胎盤分泌sEng蛋白的影響,為子癇前期的治療及麻醉方案提供一個新的方法和思路。 方法： 1.研究對象為2012年6月至2013年1月間在本院住院行擇期剖宮產(chǎn)術(shù)的重度子癇前期患者48例,重度子癇前期的診斷標(biāo)準(zhǔn)參照《威姆斯產(chǎn)科學(xué)》,納入標(biāo)準(zhǔn)為既往無高血壓、心臟病、腎臟病、糖尿病及甲狀腺功能亢進(jìn)癥等病史的病例。 2.胎盤組織培養(yǎng)24h后干預(yù)于1MAC七氟醚1h,檢測干預(yù)前后胎盤組織分泌的sEng的濃度。sEng的檢測用酶聯(lián)免疫吸附分析法(Elisa) 結(jié)果： 1.臍血的sEng濃度高于母血血清sEng濃度(P0.05) 2.七氟醚干預(yù)前后的sEng表達(dá)有差異,與干預(yù)前相比,干預(yù)后的sEng表達(dá)下降(P0.05)。 結(jié)論： 1.sEng是引起子癇前期的主要因素,由于sEng主要來源于胎盤。而重度子癇前期胎盤組織經(jīng)七氟醚干預(yù)后分泌的sEng減少,由此可以證明七氟醚對重度子癇前期癥狀的改善可能有一定的作用。 第二部分：免疫印跡法分析七氟醚對細(xì)胞骨架蛋白在離體重癥子癇前期患者胎盤中滋養(yǎng)層細(xì)胞中表達(dá)的影響 研究目的：已有研究表明,keratin, type I cytoskeletal-9(細(xì)胞骨架蛋白-9)在子癇前期患者胎盤中的表達(dá)遠(yuǎn)高于正常胎盤組織,而相關(guān)機(jī)制的研究仍鮮有報道,故此實驗旨在研究七氟醚對子癇前期患者胎盤中該蛋白表達(dá)的影響。 方法： 1、研究對象為2012年8月—2013年5月在浙江大學(xué)附屬婦產(chǎn)科醫(yī)院產(chǎn)科住院分娩的孕婦60例,分為重度子癇患者組40例、正常妊娠孕婦(對照)組20例,收集其胎盤組織。 2、將正常胎盤組織設(shè)為A組,重癥子癇前期患者胎盤組織分為B、C兩組。分別用37℃5%CO2-95%O2.37℃5%CO2-95%O2干預(yù)混合七氟醚氣體分別干預(yù)處理。 3、應(yīng)用Western blot檢測A,B,C3組的胎盤組織中cytoskeletal-9表達(dá)的差異；從而觀察七氟醚處理后的重癥子癇前期產(chǎn)婦的胎盤組織內(nèi)cytoskeletal-9表達(dá)的變化。 結(jié)果： 1、在重度子癇前期患者胎盤中,cytoskeletal-9表達(dá)與正常妊娠的胎盤相比顯著升高(P0.01)；用七氟醚處理后,重度子癇前期患者胎盤中cytoskeletal-9的表達(dá)水平較未處理的組明顯降低(P0.01),但和正常妊娠的胎盤相比仍偏高(P0.01)。 結(jié)論： 1、重癥子癇前期患者胎盤組織中keratin, type I cytoskeletal-9(細(xì)胞骨架蛋白-9)表達(dá)量增加。 2、七氟醚能降低重度子癇前期患者胎盤中cytoskeletal-9的表達(dá)水平。
[Abstract]:Preeclampsia (pre-eclampsia PE) occurs more frequently after 20 weeks of pregnancy, with hypertension and proteinuria as the main clinical manifestation, multiple organ dysfunction or functional failure in the whole body. Severe convulsions, coma and even death can occur in severe cases. At present, the etiology and pathological mechanism of preeclampsia in the preeclampsia are still an important subject in perinatal medicine. The change of placental protein expression in preeclampsia is one of the key links in the development of PE.
At present, the development of preeclampsia is mainly divided into two stages. The first stage is no clinical symptom phase. Its main feature is placental ischemia in the early pregnancy, hypoxia and release of excessive placental material into the maternal blood circulation. There is no obvious clinical manifestation in this stage. The second stage is the clinical symptom period, its main manifestation is Hypertension, kidney damage, proteinuria and even HELLP syndrome (hemolysis, elevated liver enzymes, thrombocytopenia), eclampsia and other organ damage.
Placenta is a special organ during pregnancy, which has a great influence on the growth of the fetus and the status of maternal pregnancy. Therefore, the pathological status of placenta during pregnancy is closely related to fetal growth restriction and preeclampsia. Its pathogenesis lies in placenta anoxia. Abnormal antiangiogenic factors such as sFltl, sEng, etc. are released from the placenta and inhibit the physiological role of vascular endothelial growth factor (VEGF) and placental growth factor (PIGF), leading to the occurrence of preeclampsia.
In addition, for severe preeclampsia, any pain irritation or tension can induce convulsions in severe preeclampsia and endanger the safety of mother and infant life. Therefore, it is necessary to terminate pregnancy to save the life of the patient. In the termination of pregnancy, inhalation general anesthesia is an ideal choice, seven fluorine among a large number of inhaled anesthetics. Ether is a inhaled anesthetic used in obstetric and painless delivery. The coefficient of blood gas distribution is small and has the advantages of rapid induction and revival. It can be quickly removed from pregnant women and neonates, and has no obvious influence on the Apgar score of the newborn and the umbilical cord blood gas. Therefore, we have a good application prospect in the field of obstetrics. We use sevoflurane to intervene in the field of obstetrics. Severe preeclampsia placenta tissues were used to observe the effect of placental tissue on the expression of sEng protein.
This study is divided into two parts: the first part: the effect of sevoflurane on the expression of sEng protein in the placenta and peripheral blood of severe preeclampsia in vitro, severe preeclampsia is a preeclampsia, which is the main cause of death in pregnant women, fetus and newborn. This study was conducted by isolation and culture of placental tissue in preeclampsia patients. The effect of sevoflurane on the expression of sEng protein in placenta of severe preeclampsia was studied through intervention of sevoflurane intervention on the expression of sEng.
The purpose of the study is:
(1) detection of sEng level in peripheral plasma and sEng level of umbilical cord blood in pregnant women with severe preeclampsia by enzyme linked immunosorbent assay (ELISA); (2) use 3% sevoflurane to intervene in placental tissue of preeclampsia parturients and detect the changes of sEng protein secreted by placental tissue before and after intervention by enzyme linked immunosorbent assay (ELISA). The effect of sevoflurane on the secretion of sEng protein in placenta of severe preeclampsia patients provides a new method and train of thought for the treatment of preeclampsia and the anesthesia plan.
Method錛，

本文編號：1910168