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中华围产医学杂志
北京大学第一医院
中华围产医学杂志

北京大学第一医院

杨慧霞

月刊

1007-9408

zhwc@yahoo.cn

010-66513519

100034

北京市西安门大街1号北京大学第一医院

中华围产医学杂志/Journal Chinese Journal of Perinatal MedicineCSCD北大核心CSTPCD
查看更多>>1998年5月创刊，中国科学技术协会主管，中华医学会主办，北京大学第一医院承办。本刊是围产医学是产科和新生儿科密切合作共同研究的一个新学科，本刊以“提高出生人口素质、保障母婴安全与健康”为办刊宗旨，反映基础、临床与预防医学、遗传学和社会学等相关学科中有关围产医学的新理论、新技术、新进展，旨在为我国广大围产医学工作者提供一个学术交流、信息传递和了解国内外围产医学发展动态的窗口与平台。本刊主要栏目：述评、专家笔谈、论著、实验研究、循证园地、综述、讲座、短篇论著、技术交流、病例报告、临床思维、国外医学动态、指南解读等。
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    脐带挤推对剖宫产分娩新生儿出生后相关结局影响的meta分析

    陈世江陶伏莹付东英田莹莹...
    177-187页
    查看更多>>摘要：目的 评价脐带挤推对剖宫产分娩新生儿出生后相关结局指标的影响。 方法 计算机检索中英文数据库（包括中国知网、万方医学数据库、中国生物医学文献数据库、维普数据库、中华医学期刊全文数据库、PubMed、Embase、CINAHL、Web Of Science、the Cochrane Library、Google Scholar）及临床试验注册平台（ClinicalTrials.gov）中关于剖宫产分娩新生儿脐带挤推的随机对照研究，时间均从建库至2023年7月。纳入标准：研究类型为随机对照研究；研究对象为剖宫产分娩行脐带挤推后断脐的新生儿，种族不限；结局指标为出生后血红蛋白水平、红细胞压积、胆红素峰值、蓝光治疗、脐血pH值、脑室内出血、死亡、红细胞增多症、新生儿坏死性小肠结肠炎、Apgar评分；偏倚风险评估（risk of bias assessment tool 2.0）为低风险或可能存在风险。采用 RevMan5.3进行meta分析，并根据新生儿的胎龄进行亚组分析。采用推荐分级的评价、制订与评估（grades of recommendations assessment，development，and evaluation，GRADE）系统进行证据质量评级。 结果 最终纳入11篇文献，共计2 347例新生儿（包含足月儿1 322例和早产儿1 025例）。meta分析结果显示：（1）与立即断脐相比，脐带挤推能提高新生儿出生后24 h内血红蛋白水平（MD=1.40，95%CI：1.11~1.70，Z=9.32，P<0.01）、48~72 h血红蛋白水平（MD=0.86，95%CI：0.69~1.02，Z=10.02，P<0.01）、24 h内红细胞压积（MD=2.73，95%CI：0.18~5.29，Z=2.09，P=0.04）和48~72 h红细胞压积（MD=3.57，95%CI：2.29~4.85，Z=5.46，P<0.01），但对新生儿胆红素峰值、蓝光治疗、脐血pH值、1 minApgar评分和5 minApgar评分的影响均无统计学意义（P值均>0.05）；（2）与延迟脐带结扎相比，脐带挤推能提高新生儿出生后24 h内血红蛋白水平（MD=0.83，95%CI：0.75~0.91，Z=20.11，P<0.01）和红细胞压积（MD=2.34，95%CI：1.25~3.43，Z=4.20，P<0.01），对出生后48~72 h红细胞压积的影响无统计学意义（MD=－0.38，95%CI：－2.27~1.52，Z=0.39，P=0.70）；对胆红素峰值的影响无统计学意义（MD=－0.65，95%CI：－2.16~1.04，Z=0.69，P=0.49）。通过敏感性分析，足月剖宫产分娩的新生儿脐带挤推组胆红素峰值低于延迟脐带结扎组（MD=－1.30，95%CI：－2.26~0.34，Z=2.66，P<0.01）。脐带挤推对新生儿蓝光治疗、脑室内出血（Ⅰ~Ⅳ级）、死亡、红细胞增多症、新生儿坏死性小肠结肠炎、Apgar 1 min评分和Apgar 5 min评分的影响均无统计学意义（P值均>0.05）。 结论 脐带挤推能提高剖宫产分娩新生儿出生后短期的血红蛋白和红细胞压积水平，可能有益于预防新生儿出生后短期内贫血，但对胆红素峰值、蓝光治疗、红细胞增多症等发生风险影响不大，亦未增加剖宫产分娩新生儿的不良结局。但仍需更多高质量、大样本的随机对照研究进一步证实。 Objective To evaluate the effect of umbilical cord milking (UCM) on neonatal outcomes after cesarean section. Methods Chinese and English databases (including CNKI, Wanfang, China Biology Medicine Disc, VIP, Yiigle, PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, and Google Scholar) and ClinicalTrials.gov were retrieved from the inception to July 2023. Randomized controlled trials regarding UCM in neonates from different races who were born by cesarean section were included. The outcomes were postnatal hemoglobin level, hematocrit value, peak serum bilirubin level, phototherapy, cord blood pH value, intraventricular hemorrhage, death, polycythemia, neonatal necrotizing enterocolitis, and Apgar score. The risk of bias among the included studies was confined to low or possible risk according to the Cochrane Risk of Bias Assessment Tool 2.0. RevMan5.3 was used for meta-analysis, and subgroup analysis was performed among neonates with different gestational ages. The certainty of evidence was evaluated using the grades of recommendations assessment, development, and evaluation (GRADE) framework. Results A total of 11 articles involving 2 347 neonates (1 322 full-term and 1 025 preterm infants) were included. Meta-analysis results showed that: (1) Compared with the immediate cord clamping, UCM increased the hemoglobin level within 24 h and 48-72 h after birth (MD=1.40, 95%CI: 1.11-1.70, Z=9.32 MD=0.86, 95%CI: 0.69-1.02, Z=10.02, both P<0.01), hematocrit value within 24 h and 48-72 h after birth (MD=2.73, 95%CI: 0.18-5.29, Z=2.09, P=0.04 MD=3.57, 95%CI: 2.29-4.85, Z=5.46, P<0.01). However, no significant differences were found in the peak bilirubin level, phototherapy, cord blood pH, and Apgar score at 1 and 5 min (allP>0.05). (2) Compared with delayed cord clamping, UCM increased the hemoglobin level (MD=0.83, 95%CI: 0.75-0.91, Z=20.11, P<0.01) and hematocrit value (MD=2.34, 95%CI: 1.25-3.43, Z=4.20, P<0.01) within 24 h after birth, but not in the hematocrit value at 48-72 h after birth (MD=－0.38, 95%CI:－2.27-1.52, Z=0.39, P=0.70) or the peak bilirubin level (MD=－0.65, 95%CI:－2.16-1.04,Z=0.69, P=0.49). Sensitivity analysis showed that for full-term neonates born by cesarean section, the peak bilirubin level in the UCM group was significantly lower than that in the delayed cord clamping group (MD=－1.30, 95%CI:－2.26-0.34, Z=2.66, P<0.01). Still, the incidence of phototherapy, intraventricular hemorrhage (grade Ⅰ-Ⅳ), death, polycythemia, neonatal necrotizing enterocolitis, and Apgar score at 1 min and 5 min showed no statistical differences (allP>0.05). Conclusions UCM could increase the short-term postnatal hemoglobin and hematocrit levels in neonates born by cesarean section, which might prevent neonatal anemia in the short term without increasing the adverse neonatal outcomes. Little effects were observed on the peak bilirubin level, phototherapy, polycythemia, etc. More high-quality and large-sample randomized controlled trials are needed in the future.

    结扎术脐带剖宫产术婴儿,新生meta分析

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    选择性宫内生长受限中发育正常胎儿围产期特点及生后早期循环功能变化

    张雅慧王丹刘云峰石诗...
    188-195页
    查看更多>>摘要：目的 探讨不同分型选择性宫内生长受限（selective intrauterine growth restriction，sIUGR）的发育正常胎儿（大胎儿）围产期特点及生后早期循环功能的变化。 方法 回顾性纳入2018年2月至2022年8月于北京大学第三医院宫内诊断sIUGR，且生后转入新生儿重症监护病房的sIUGR大胎儿91例。比较不同分型sIUGR大胎儿的围产期情况、临床指标及超声心动图评估的心功能变化。采用单因素方差分析和LSD检验、Kruskal-Wallis H检验、χ2检验及Bonferroni校正检验进行统计学分析。 结果 出生胎龄、出生体重和胎盘重量在Ⅱ型sIUGR大胎儿中分别为（30.6±1.5）周、（1 503.9±286.4）g和（548±120）g，在Ⅲ型中分别为（30.5±2.3）周、（1 523.5±424.4）g和（560±109）g，均小于Ⅰ型患儿［分别为（33.0±1.7）周、（2 022.1±372.3）g和（630±131）g］（LSD检验，P值均<0.05）；Ⅱ型和Ⅲ型患儿生后住院时间均长于Ⅰ型［36.0 d（27.0～43.0 d）和32.0 d（15.0～47.0 d）与17.0 d（9.5～22.0 d）］，因胎儿窘迫导致早产的比例均高于Ⅰ型［63.6%（21/33）和75.0%（15/20）与31.6%（12/38），χ2值分别为7.30和9.93］（Bonferroni校正，all P<0.017）；Ⅱ型生后使用血管活性药物的比例高于Ⅰ型［45.5%（15/33）与18.4%（7/38），χ2=6.04，P=0.014］。室间隔厚度在Ⅲ型大于Ⅰ型和Ⅱ型［（4.4±1.4）与（3.8±0.9）和（3.3±0.9）mm］；Ⅲ型左心室游离壁厚度大于Ⅰ型［（4.6±1.3）与（3.1±0.7）mm］，Ⅰ型大于Ⅱ型［（2.7±0.6）mm］；左心室舒张末期内径、右心室流出道内径、右心室前后径和肺动脉内径在Ⅰ型均大于Ⅱ型和Ⅲ型［左心室舒张末期内径：（15.0±2.1）与（13.4±2.3）和（12.3±3.2）mm；右心室流出道内径：（8.7±1.4）与（7.3±1.4）和（7.1±0.8）mm；右心室前后径：（7.1±1.5）与（6.5±0.9）和（6.4±1.0）mm；肺动脉内径：（6.8±1.1）与（6.3±0.9）和（6.3±0.8）mm］（LSD检验，P值均<0.05）。 结论 与Ⅰ型sIUGR大胎儿相比，Ⅱ型和Ⅲ型sIUGR中的大胎儿出生胎龄及体重小，胎儿窘迫比例高，需加强围产期及生后早期的动态监测和循环支持。Ⅲ型患儿生后早期存在左心室壁及室间隔增厚，可能导致心室舒张功能储备力减低，故应对Ⅲ型患儿生后早期的心肌舒张功能进行重点评估和监测。 Objective To explore the perinatal characteristics and early postnatal circulatory function of the larger fetus in monochorionic diamniotic twin pregnancy complicated with selective intrauterine growth restriction (sIUGR). Methods From February 2018 to August 2022, a total of 91 larger fetuses of the sIUGR pregnancies who were hospitalized in the neonatal intensive care unit of Peking University Third Hospital were retrospectively included. The perinatal factors, clinical monitoring indicators, and echocardiographic data of the larger twins in pregnancies with three types of sIUGR were compared using one-way analysis of variance and LSD test, Kruskal-Wallis H test, Chi-square test, and Bonferroni correction. Results The gestational age, birth weight, and placental weight were (30.6±1.5) weeks, (1 503.9±286.4) g, and (548±120) g in the type Ⅱ sIUGR larger twins and were (30.5±2.3) weeks, (1 523.5±424.4) g, and (560±109) g in type Ⅲ, which were all smaller, lower, and lighter than those in the type Ⅰ[(33.0±1.7) weeks, (2 022.1±372.3) g, and (630±131) g, respectively] (LSD test, all P<0.05). Compared with type Ⅰ sIUGR larger twins, type Ⅱ and Ⅲ sIUGR larger twins had longer hospital stay [36.0 d (27.0-43.0 d) and 32.0 d (15.0-47.0 d)vs. 17.0 d (9.5-22.0 d)], higher proportion of preterm births due to fetal distress [63.6% (21/33) and 75.0% (15/20) vs. 31.6% (12/38), χ2=7.30 and 9.93] (Bonferroni correction, all P<0.017) Compared with type Ⅰ sIUGR larger twins, type Ⅱ sIUGR larger twins had higher proportion of postnatal use of vasoactive drugs [45.5% (15/33)vs. 18.4% (7/38), χ2=6.04, P=0.014]. The interventricular septum thickness was larger in the type Ⅲ sIUGR larger twins than those in the type Ⅰ and Ⅱ twins [(4.4±1.4) vs. (3.8±0.9) and (3.3±0.9) mm] the thickness of left ventricular free wall was the largest in the type Ⅲ larger twins, followed by those in the type Ⅰ and type Ⅱ [(4.6±1.3) vs. (3.1±0.7) vs. (2.7±0.6) mm] the left ventricular end-diastolic diameter, right ventricular outflow tract diameter, right ventricular anteroposterior diameter, and pulmonary artery diameter in type Ⅰ larger twins were increased comparing with those in type Ⅱ and Ⅲ [left ventricular end-diastolic diameter: (15.0±2.1) vs. (13.4±2.3) and (12.3±3.2) mm right ventricular outflow tract diameter: (8.7±1.4) vs. (7.3±1.4) and (7.1±0.8) mm right ventricular anteroposterior diameter: (7.1±1.5) vs. (6.5±0.9) and (6.4±1.0) mm pulmonary artery diameter: (6.8±1.1) vs. (6.3±0.9) and (6.3±0.8) mm] (LSD test, all P<0.05). Conclusion The larger fetuses of type Ⅱ and Ⅲ sIUGR pregnancies had smaller gestational age and lighter birth weight who are more prone to have fetal distress, so it is necessary to strengthen dynamic monitoring and circulatory support for such neonates during the perinatal period and early postnatal period. The thickening of the left ventricular wall and interventricular septum in the early postnatal period of type Ⅲ larger fetuses may lead to the decrease of ventricular diastolic function reserve, thereby the evaluation and monitoring of the myocardial diastolic function of these neonates in the early postnatal period are critical.

    单绒毛膜双羊膜囊选择性宫内生长受限心功能超声心动图

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    持续性有机污染物是否为妊娠期糖尿病的危险因素：系统综述和meta分析

    李晔张馨月
    195页
    查看更多>>摘要：持续性有机污染物（persistent organic pollutant，POP）和妊娠期糖尿病（gestational diabetes mellitus，GDM）之间的关系尚不确定。西班牙学者Kouiti等［1］试图通过一项系统综述和meta分析评估POP暴露与GDM之间的关联强度。该研究2023年12月4日在线发表于《英国妇产科杂志》。
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    硬膜外分娩镇痛对新生儿早期吸吮和母乳喂养的影响

    张洁陈志芳李晔
    196-202页
    查看更多>>摘要：目的 探讨硬膜外分娩镇痛对新生儿吸吮能力和母乳喂养的影响。 方法 采用前瞻性队列研究设计，研究对象为2022年1月至2022年12月在南通大学附属妇幼保健院分娩的产妇。按是否选择硬膜外分娩镇痛，将其分为硬膜外镇痛组和未镇痛组。采用吸吮负压测量仪在新生儿生后3 d内每天测量新生儿吸吮母亲乳头时的口腔负压，记录吸吮负压均值、峰值和谷值。采用中文版婴儿母乳喂养评估工具（Infant Breastfeeding Assessment Tool，IBAT）评估新生儿吸吮姿势。记录并随访产妇在院期间和出院后第1、4、6个月的母乳喂养情况。采用两独立样本t检验、χ2检验（或Fisher精确概率法）及广义估计方程等方法对数据进行统计分析。 结果 共156例产妇纳入最终分析，2组各78例。镇痛组比未镇痛组产妇的总产程、第一产程和第二产程时间更长［M（P25~P75），430 min（353～541 min）与300 min（235～422 min），Z=－5.65；385 min（310～490 min）与260 min（205～347 min），Z=－5.81；40 min（26～67 min）与33 min（18～45 min），Z=－2.33；P值均<0.05］，产前使用催产素和选择导乐分娩者更多［94.8%（74/78）与43.6%（34/78），χ2=48.15；42.3%（33/78）与19.2%（15/78），χ2=9.75；P值均<0.05］。2组产妇的产后疲乏、抑郁和睡眠情况，以及孕期生活事件量表评分的差异均无统计学意义。广义估计方程分析控制混杂因素后，镇痛组新生儿生后3 d内（0~24 h、>24~48 h、>48~72 h）中位吸吮负压均值低于未镇痛组［分别为5.14 kPa（3.39~6.52 kPa）与6.39 kPa（4.95~9.15 kPa）、5.07 kPa（3.94~7.38 kPa）与6.20 kPa（5.08~8.54 kPa）和6.19 kPa（4.64~8.36 kPa）与6.81 kPa（5.88~8.05 kPa），Waldχ2=5.59，P=0.018］；峰值也低于未镇痛组［15.81 kPa（9.74~21.68 kPa）与16.21 kPa（13.58~24.88 kPa）、13.50 kPa（9.83~16.50 kPa）与17.62 kPa（14.01~22.40 kPa）和14.66 kPa（10.47~18.71 kPa）与18.04 kPa（15.33~19.85 kPa），Waldχ2=7.25，P=0.007］；谷值在2组间差异无统计学意义。镇痛组新生儿生后3 d内每天吸吮姿势的IBAT得分低于未镇痛组新生儿［分别为10分（9~10分）与10分（10～11分）、10分（9~11分）与11分（10~11分）和10分（10~11分）与11分（11~12分），Waldχ2=17.05，P=0.001］。镇痛组产后3 d内的纯母乳喂养率［分别为67.9%（53/78）、41.0%（32/78）和38.5%（30/78）］低于未镇痛组［分别为75.6%（59/78）、44.9%（35/78）与55.1%（43/78），Waldχ2=4.21，P=0.040）。2组产后1、4和6个月纯母乳喂养率差异均无统计学意义。 结论 硬膜外分娩镇痛可导致新生儿早期吸吮负压下降，影响新生儿吸吮姿势，降低在院期间的纯母乳喂养率，但与产后6个月内纯母乳喂养率无明显相关性。 Objective To investigate the effects of epidural labor analgesia on neonatal sucking ability and breastfeeding. Methods This was a prospective cohort study. Convenience sampling was used to enroll women who delivered with or without epidural analgesia (epidural analgesia and non-analgesia groups) in the Affiliated Maternity and Child Health Care Hospital of Nantong University from January 2022 to December 2022. Intra-oral negative pressure values during breastfeeding were measured by a pressure measuring instrument within 3 d after birth (0-24 h, >24-48 h, and >48-72 h), and the mean, maximum, and minimum pressure values were recorded. The Infant Breastfeeding Assessment Tool (IBAT) (Chinese version) was used to evaluate sucking posture. Breastfeeding status during hospitalization and within 1, 4, and 6 months after discharge were followed up. Two independent samples t-test, Chi-square (Fisher's exact) test, and generalized estimating equations were used for data analysis. Results A total of 156 mother-infant pairs were analyzed in this study, with 78 pairs in the epidural analgesia group and 78 pairs in the non-analgesia group. The whole, first, and second stages of labor were longer in the analgesia group than those in the non-analgesia group [M(P25-P75), total: 430 min (353-541 min) vs. 300 min (235-422 min), Z=－5.65 first stage: 385 min (310-490 min) vs. 260 min (205-347 min), Z=－5.81 second stage: 40 min (26-67 min) vs. 33 min (18-45 min), Z=－2.33 all P<0.05], and more women in the analgesia group accepted oxytocin and doula before delivery [94.8% (74/78)vs. 43.6% (34/78), χ2=48.15 42.3% (33/78) vs. 19.2% (15/78), χ2=9.75 both P<0.05]. There was no significant difference in scores on the Fatigue Scale-14, Edinburgh Postnatal Depression Scale, Pittsburgh Sleep Quality Index, and Life Events Scale for Pregnant Women between the two groups. After adjusting for confounding factors by generalized estimating equations, the mean intra-oral negative pressure values in the epidural analgesia group were lower than those in the non-analgesia group at 0-24 h, >24-48 h, and >48-72 h after birth [5.14 (3.39-6.52)vs. 6.39 (4.95-9.15) kPa, 5.07 (3.94-7.38) vs. 6.20 (5.08-8.54) kPa, and 6.19 (4.64-8.36) vs. 6.81 (5.88-8.05) kPa, Waldχ2=5.59, P=0.018] the peak value in the epidural analgesia group was also lower than that in the non-analgesia group [15.81 (9.74-21.68) vs. 16.21 (13.58- 24.88) kPa, 13.50 (9.83-16.50) vs. 17.62 (14.01-22.40) kPa, and 14.66 (10.47-18.71) vs. 18.04 (15.33- 19.85) kPa, Waldχ2=7.25, P=0.007] there were no significant differences in the trough value between the two groups. The daily IBAT scores for the sucking position of neonates in the epidural analgesia group were all lower than those in the non-analgesia group in the first three days after delivery [10 (9-10) vs. 10 (10- 11) scores, 10 (9-11) vs. 11 (10-11) scores, and 10 (10-11) vs. 11 (11-12) scores, Waldχ2=17.05, P=0.001]. The rates of early exclusive breastfeeding within postpartum 3 d were also lower in the epidural analgesia group than those in the non-analgesia group [67.9% (53/78) vs. 75.6% (59/78), 41.0% (32/78) vs. 44.9% (35/78), and 38.5% (30/78) vs. 55.1% (43/78), Waldχ2=4.21, P=0.040]. No significant differences were found in the exclusive breastfeeding rates between the two groups at 1, 4, and 6 months after delivery. Conclusion Epidural labor analgesia can lead to decreased early intra-oral negative pressure in neonates, affect neonatal sucking posture, and reduce the rate of exclusive breastfeeding during hospitalization, but has no significant correlation with the exclusive breastfeeding rate within six months after delivery.

    镇痛,硬膜外镇痛,产科吸吮行为自我效能母乳喂养婴儿,新生

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    胎儿梅干腹综合征的病理特征及预后：5例分析

    陶倩郑良楷李晔
    203-208页
    查看更多>>摘要：目的 探讨胎儿梅干腹综合征（prune belly syndrome，PBS）的病理特征及预后。 方法 回顾性分析厦门大学附属妇女儿童医院（厦门市妇幼保健院）2016年12月至2023年1月经病理解剖诊断为PBS的5例胎儿的临床资料。总结PBS胎儿的病理特征，并随访其母亲再次妊娠的情况。对数据资料采用描述性统计分析。 结果 ~ （1）5例胎儿（4例男性，1例女性）均诊断为巨膀胱或膀胱增大，膀胱中位最大径4.4 cm（1.6～8.9 cm）。其中2例合并肾脏发育不良，1例肾脏及输尿管缺如，1例合并双侧输尿管扩张、下尿道闭锁可能，1例合并脑室增宽、腹裂并内脏外翻及脊柱侧弯。引产胎龄为15周+6（12周+519周+4）。（2）5例均表现为腹壁膨隆、腹壁薄弱，伴膀胱过度扩张。其中2例合并腹壁局部缺损，1例伴膈肌发育不良，2例肾脏发育不良伴肾盂、输尿管扩张，2例尿道和肛门闭锁，1例皮肤水肿、腹腔大量积液，1例左肾及左输尿管缺如。镜下可见膀胱壁、腹壁及输尿管管壁内肌层厚薄不一，排列紊乱，部分区域肌层不完整，局部肌层缺如；肾小球、肾小管不同程度地减少，间质增生。免疫组织化学染色可见肌层薄弱、部分区域肌层断裂。（3）遗传学分析发现5例中的1例为DHCR7基因复合杂合变异（c.907G>A/c.461C>T），该变异为致病性。其余4例未见异常。（4）至2023年8月，除1例失访外，其余4例产妇随访了68个月（7～80个月）。3例引产后分别间隔16、24和19个月后再次成功妊娠，1例产妇分娩后尚处于恢复期，未再次妊娠。3例再次妊娠的子代均为足月出生，出生情况良好，随访至3岁，生长发育未见明显异常。 结论 胎儿PBS是一组罕见的以腹壁及膀胱平滑肌层发育不良为特征的先天性畸形，多见于男性。一般不影响母亲再次妊娠的结局。 Objective To investigate the clinicopathological features and prognosis of fetal prune belly syndrome (PBS). Methods This retrospective study collected and analyzed the clinical data of five fetuses with PBS diagnosed through a pathological autopsy in Women and Children's Hospital, School of Medicine, Xiamen University, from December 2016 to January 2023. The clinicopathological features of these cases were summarized, and the subsequent pregnancy outcomes in their mothers were followed up. A descriptive statistical method was used for data analysis. Results (1) Megabladder or enlarged bladder was observed in the five fetuses (four males and one female) with a maximum diameter of 4.4 cm (1.6-8.9 cm). Two fetuses were complicated by renal dysplasia, one by an absence of kidney, and ureters, one by bilateral ureterectasia and possible posterior urethral atresia, and one by the dilated cerebral ventricle, gastroschisis, exposed viscera, and scoliosis. The pregnancies were terminated at the gestational age of 15+6 weeks (12+5-19+4 weeks). (2) The five fetuses exhibited distended and thin abdominal walls with excessive dilation of the bladder. There were two cases with the partially absent abdominal wall, one with diaphragmatic dysplasia, two with renal dysplasia complicated by pyeloureterectasis, two with urethratresia and anal atresia, one with hydroderma and sever seroperitoneum, and one with absent left kidney and left ureter. The muscle layers of the bladder wall, abdominal wall, and ureter tube wall were of varying thickness, and the arrangement of muscle fibers was disordered with incomplete or absent muscle layers in some areas. Moreover, the glomeruli and renal tubules were reduced to varying degrees and fibrous interstitial hyperplasia was observed. Immunohistochemical staining revealed thin muscle layers and broken muscle layers in some regions. (3) One fetus carried a compound heterozygous variant of c.907G>A/c.461C>T in theDHCR7 gene, which was found to be a pathogenic variation. The other four cases had no obvious abnormalities. (4) By August 2023, apart from one case lost to follow-up, the other four were followed up for 68 months (7-80 months). Three women were successfully conceived again after an interval of 16, 24, and 19 months, respectively, and the other one did not conceive due to being in a recovery period. Three neonates were delivered at term in good condition, and no obvious abnormality in growth or development was reported during a three-year follow-up. Conclusions Fetal PBS is a rare congenital malformation characterized by dysplasia of the abdominal wall and the bladder smooth muscle layers. The subsequent pregnancy is generally not affected.

    梨状腹综合征先天畸形尸体解剖病理学,临床

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    生后第1年的脂质、脂蛋白和载脂蛋白水平：前瞻性队列研究

    张馨月夏乐
    208页
    查看更多>>摘要：心血管疾病是全球发病和死亡的主要原因。对生活方式中公认的危险因素进行干预和改善，可预防心血管疾病。在导致动脉粥样硬化的脂蛋白谱中，低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）和其他含有载脂蛋白B（apolipoprotein B，ApoB）的脂蛋白水平升高是动脉粥样硬化性心血管疾病（atherosclerotic cardiovascular disease，ASCVD）发病的危险因素。动脉粥样硬化的发展与含ApoB的脂蛋白水平成正比，因此发生ASCVD的风险会随着时间的推移而增加。做好一级预防，即尽早干预并避免高危因素至关重要。儿童期是预防危险因素避免ASCVD发生的“机会时间窗”。出生时脂蛋白水平能否预测婴幼儿期水平，进而提示远期发生血脂异常的风险，目前尚不清楚。
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    产前超声诊断单纯持续性卵黄动脉1例并文献复习

    刘凤琴周柳英舒娜叶楠...
    209-214页
    查看更多>>摘要：目的 总结分析胎儿持续性卵黄动脉的超声图像特征及预后。 方法 回顾性分析2021年12月电子科技大学医学院附属妇女儿童医院（成都市妇女儿童中心医院）诊断的1例单纯胎儿持续性卵黄动脉病例的产前超声图像特征、遗传学检查结果及预后。以“持续性卵黄动脉”“Ⅱ型单脐动脉”和“产前超声”为关键词，检索中国知网、维普中文期刊数据库、万方数据库和中华医学期刊全文数据库；以“persistent vitelline artery”“type Ⅱ single umbilical artery”和“prenatal ultrasound”为关键词，检索PubMed、Embase和UpToDate数据库。总结胎儿持续性卵黄动脉的产前超声图像特征及预后。对数据资料采用描述性统计分析。 结果 （1）病例报告：本例孕23周超声检查时，腹部可见1条异常粗大的血管起源于腹主动脉近肠系膜上动脉，经脐孔与脐静脉并行进入胎盘，彩色多普勒显示类似脐动脉血流频谱；膀胱横切面未见双侧脐动脉，游离段脐带横切面呈“吕”字形。余胎儿结构未见明显异常。遗传学检测未见异常。出生后该患儿（随访至1岁）生长发育未见异常。（2）文献复习：检索到文献5篇（英文文献3篇，中文文献2篇），共4个病例。结合本研究报道的1例，共5例。这5例中，4例未见明显胎儿结构异常，患儿出生后均生长发育良好；1例产前超声提示左肾缺如，心脏大动脉比值异常，父母选择终止妊娠。3例进行了脐带组织病理学检查，其中2例证实持续性卵黄动脉具有明显内膜弹性层，1例可见卵黄管残留。 结论 胎儿持续性卵黄动脉的产前超声特征为异常血管起源于腹主动脉或肠系膜上动脉，行使脐动脉功能。单纯持续性卵黄动脉预后较好，但目前国内外报道极少。应积累更多病例进一步研究，提高对此类胚胎异常的再认识。 Objective To summarize the ultrasonographic features and prognosis of fetal persistent vitelline artery. Methods The prenatal ultrasound features, genetic testing results, and prognosis of a fetus with an isolated persistent vitelline artery that was diagnosed in our hospital in December 2021 were retrospectively analyzed. Relevant articles were retrieved from CNKI, VIP, Wanfang, Yiigle, PubMed, Embase, and UpToDate databases using the terms "persistent vitelline artery", "type Ⅱ single umbilical artery", and "prenatal ultrasound" in both Chinese and English. Prenatal ultrasound features and prognosis of the persistent vitelline artery in fetuses were summarized using descriptive statistical analysis. Results (1) Case report: In this case, ultrasound at 23 gestational weeks showed that an abnormally large blood vessel deriving from the celiac artery near the superior mesenteric artery entered the placenta through the umbilical opening in parallel with the umbilical vein. Color Doppler showed a blood flow spectrum like that in the umbilical artery. The transverse section image showed that bilateral umbilical arteries were not observed in the bladder and the free segment of the umbilical cord was in the shape of the Chinese character "Lyu". No obvious other structural abnormalities and a negative result of genetic testing were observed in the fetus. Followed up to one year old, the patient showed normal growth and development. (2) Literature review: A total of five articles involving four cases were retrieved (three in English and two in Chinese). Among the five cases, including the present case, one was terminated due to left renal agenesis and abnormal heart arteries ratio revealed by prenatal ultrasound, and the remaining four cases without obvious structural abnormalities in the prenatal ultrasound were born and developed well. Histopathological examination of the umbilical cord was performed in three cases, of which two with persistent vitelline artery had a distinct internal elastic lamina, and one with remained vitelline duct. Conclusions The prenatal ultrasound of fetal persistent vitelline artery is typically characterized by an abnormal vessel that is derived from the abdominal aorta or superior mesenteric artery and plays the function of the umbilical artery. The prognosis of the isolated persistent vitelline artery is good, but a better understanding of such embryonic abnormalities is needed as there are few relevant reports at home and abroad.

    超声检查,产前单脐动脉脐动脉血管畸形卵黄管

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    应注意知情同意的含义

    李晔
    214页
    查看更多>>摘要：在日常编辑工作中发现，有些来稿虽然提到研究对象“签署了知情同意书”，但细读之后发现，该研究对象签署的是医疗工作的知情同意书，而不是临床研究的知情同意书。医疗工作和临床研究的“知情同意”名称虽相同，但含义是有区别的。
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    血清吲哚胺2，3-双加氧酶和犬尿喹啉酸在支气管肺发育不良早产儿中的变化

    陈慧娟孙文强李梦曌杨紫浩...
    215-219页
    查看更多>>摘要：目的 探讨血清吲哚胺2，3-双加氧酶（indoleamine 2，3-dioxygenase，IDO）及犬尿喹啉酸（kynurenic acid，KYNA）在支气管肺发育不良（bronchopulmonary dysplasia，BPD）早产儿中的变化。 方法 采用巢式病例对照研究。建立早产儿队列，纳入2021年12月1日至2022年12月31日生后24 h内收住苏州大学附属儿童医院新生儿科的胎龄<32周的早产儿。诊断BPD者作为BPD组（n=35），按1∶1比例选取与BPD组胎龄相差<1周、出生体重相差<150 g的非BPD早产儿作为对照组（n=35）。检测患儿生后第1、7、14、28天血清IDO及KYNA水平。分析BPD组与对照组间、轻度BPD与中-重度BPD患儿间血清IDO及KYNA水平的差异，以及血清IDO及KYNA水平与BPD严重程度的关系。采用两独立样本t检验和Spearman相关分析进行统计学分析。 结果 与对照组患儿相比，BPD组患儿生后第7、14、28天血清IDO水平［分别为（60.68±9.37）与（50.66±10.46）、（57.81±11.07）与（44.45±8.20）、（50.62±10.77）与（41.31±7.74）pg/ml，t值分别为4.21、5.73和4.15］及第14、28天血清KYNA水平均升高［（439.31±41.22）与（368.99±68.79）、（376.97±45.74）与（325.50±60.07）μmol/L，t值分别为5.18和4.03］，差异均有统计学意义（P值均<0.05）。生后第7、14、28天血清IDO水平与BPD严重程度均呈正相关（r值分别为0.546、0.495和0.502，P值均<0.05），生后第14、28天血清KYNA水平与BPD严重程度也呈正相关（r值分别为0.536和0.458，P值均<0.05）。 结论 BPD患儿血清IDO及KYNA水平升高，提示IDO和KYNA可能在BPD发生和发展中发挥一定作用。 Objective To explore the changes in serum indoleamine 2, 3-dioxygenase (IDO) and kynurenic acid (KYNA) levels in preterm infants diagnosed with bronchopulmonary dysplasia (BPD). Methods A nested case-control study was conducted. The inclusion criteria covered premature infants with less than 32 weeks of gestational age within 24 h post-birth, from December 1, 2021, to December 31, 2022, at Children's Hospital of Soochow University. Those diagnosed with BPD were allocated to the BPD group (n=35). Non-BPD preterm infants matching the BPD cases in terms of gestational age (within one week difference) and birth weight (within a 150 g difference) were selected in a 1∶1 ratio for the control group (n=35). Serum levels of IDO and KYNA were measured on days 1, 7, 14, and 28 postnatally. Differences in serum IDO and KYNA levels were analyzed between the BPD and control groups and among infants with mild BPD versus moderate-to-severe BPD. The association between serum IDO and KYNA levels with the severity of BPD was also assessed. Statistical analysis was conducted using independent samples t-tests and Spearman's correlation analysis. Results Elevated levels of serum IDO on days 7, 14, and 28 postnatally [(60.68±9.37) vs. (50.66±10.46), (57.81±11.07) vs. (44.45±8.20), and (50.62±10.77) vs. (41.31±7.74) pg/ml t=4.21, 5.73, and 4.15, respectively] as well as increased serum KYNA levels on days 14 and 28 [(439.31±41.22) vs. (368.99±68.79), (376.97±45.74) vs. (325.50±60.07) μmol/L t=5.18 and 4.03, respectively] were observed in the BPD group compared to the control group, with all differences being statistically significant (all P<0.05). Furthermore, positive correlations were observed between serum IDO levels and BPD severity on the 7th, 14th, and 28th days (r=0.546, 0.495, and 0.502, allP<0.05), as well as between serum KYNA levels and BPD severity on the 14th and 28th days (r=0.536 and 0.458, both P<0.05). Conclusion Elevated serum levels of IDO and KYNA in infants with BPD suggest these metabolites may play a role in the pathogenesis and progression of BPD.

    支气管肺发育不良色氨酸吲哚胺2,3-双加氧酶犬尿喹啉酸

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    外倒转术成功的影响因素：118例分析

    李根霞赵盼盼程春花谢明坤...
    220-225页
    查看更多>>摘要：目的 探讨影响外倒转术成功的因素。 方法 回顾性选择2015年7月至2021年7月于郑州大学第三附属医院因臀位或横位行外倒转术，且由同一术者操作的产妇作为研究对象（n=118）。应用单因素及logistic回归分析探讨外倒转术成功的临床影响因素；应用受试者工作特征（receiver operating characteristic，ROC）曲线分析手术孕周及羊水指数的最佳界值，评价这些影响因素预测外倒转术成功的价值。 结果 （1）118例中，外倒转术成功77例（65.3%），其中初产妇成功率为49.1%（27/55），经产妇成功率为79.4%（50/63）；56.8%（67/118）经阴道分娩。（2）118例中的19例（16.1%）发生并发症，主要并发症为胎心异常（13例，11.0%）、脐带先露和胎位复转（各2例，分别占1.7%），严重并发症为胎儿宫内死亡和胎盘早剥（各1例，分别占0.8%）。外倒转成功者并发症发生率为7.8%（6/77），低于外倒转失败者的31.7%（13/41）（χ 2=11.33，P=0.001）。（3）多因素分析显示，手术孕周<38周、羊水指数>11.10 cm和经产妇是影响外倒转术成功的因素［OR值（95%CI）分别为0.561（0.351~0.897）、1.173（1.018~1.351）和4.201（1.547~11.404），P值均<0.05］。（4）手术孕周、羊水指数及产次三者联合的ROC曲线下面积为0.744（95%CI：0.640~0.848，P<0.001），其约登指数为0.518，灵敏度为70.0%，特异度为81.8%。 结论 手术孕周、羊水指数及经产妇与外倒转术成功相关。三者联合对手术成功有一定的预测价值。 Objective To investigate the factors influencing the success of external cephalic version. Methods Pregnant women who underwent an external cephalic version due to breech or transverse presentation by the same operator in the Third Affiliated Hospital of Zhengzhou University from July 2015 to July 2021 were selected as the study objects. Univariate analysis and logistic regression analysis were used to explore the clinical factors influencing the success of the external cephalic version. The receiver operating characteristic (ROC) curve was used to analyze the best cut-off value of gestational week and amniotic fluid index at the time of operation and to evaluate the predictive value of the influencing factors on the success of the external cephalic version. Results (1) A total of 118 cases finally entered this study. Among the 118 cases,77 cases (65.3%) succeeded in the external cephalic version, among which the success rate was 49.1% (27/55) for primipara and 79.4% (50/63) for multipara. The vaginal delivery rate was 56.8% (67/118). (2) Complications occurred in 19 (16.1%) of the 118 cases. The main complications were abnormal fetal heart rate (13 cases, 11.0%), umbilical cord presentation, and fetal position reversion (two cases and 1.7% in each), and the serious complications were intrauterine fetal death and placental abruption (one case and 0.8% in each).The complication rate of patients with successful external cephalic version was 7.8% (6/77), which was lower than that of those who failed the external cephalic version [31.7%(13/41)] (χ 2=11.33,P=0.001). (3) Multivariate analysis showed that gestational week at surgery before 38, amniotic fluid index >11.10 cm, and multipara were the factors affecting the success of the external cephalic version [ OR(95%CI)=0.561(0.351-0.897), 1.173(1.018-1.351) and 4.201(1.547-11.404), allP<0.05]. (4) The area under the ROC curve of the combination of the gestational week at surgery, amniotic fluid index, and parity was 0.744 (95%CI: 0.640-0.848, P<0.001), and the Youden index was 0.518, with a sensitivity of 70.0% and a specificity of 81.8%. Conclusion Gestational weeks, amniotic fluid index, and multipara are related to the success of the external cephalic version, and the combination of the three has certain predictive power for the success of the surgery.

    倒转术,胎位臀先露影响因素分析

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