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ГоловнаРізне → Невротичні, особистісні і сексуальні розлади в овдовілих чоловіків без партнерки та їх психотерапевтична корек-ція (автореферат) - Реферат

Невротичні, особистісні і сексуальні розлади в овдовілих чоловіків без партнерки та їх психотерапевтична корек-ція (автореферат) - Реферат

Ключові слова: вагітність, внутрішньоутробна інфекція, природжені вади розвитку, пренатальна діагностика, перинатальна патологія, хромосомні аберації, плацента.

АННОТАЦИЯ

Жадан И.А. Система перинатального прогнозирования, диагностики и профилактики внутриутробных инфекций на основе изучения клинико-генетических особенностей семьи.

Дисертация (рукопись) на соискание ученой степени доктора медицинских наук по специальностям 03.00.15 – медицинская генетика, 14.01.01 – акушерство и гинекология; Институт гигиены и медицинской экологии им. А.М.Марзеева Академии медицинских наук Украины. Киев, 2005.

Определены клинико-генетические, фенотипические, соматогенетические особенности семей с внутриутробной инфекцией (ВУИ). Получены новые данные о частоте и структуре хромосомных аберраций у беременных с инфекциями. Изучено состояние метаболизма соединительной ткани у беременных с внутриутробными инфекциями. Проведено исследование состояния плода при ВУИ на основании количественных и качественных ультразвуковых параметров, данных инвазивных методов пренатальной диагностики, допплерографии. Сопоставлены ультразвуковые и клинико-морфологические характеристики провизорных органов плода при инфекциях различной этиологии. Определены маркерные ультразвуковые признаки внутриутробных инфекций бактериальной, вирусной и бактериально-вирусной этиологии у плода, выделены ранее не описанные эхографические критерии. Найдены общие и дифференциальные ультразвуковые особенности внутриутробных инфекций и врожденных пороков развития. Установлены факторы риска реализации внутриутробных инфекций. Разработана и внедрена система прогнозирования, диагностики и профилактики патологии на основании изучения результатов клинико-генетических, микробиологических, иммуноморфологических, цитогенетических, функциональных показателей, позволившая снизить частоту перинатальных осложнений, самопроизвольных абортов в 2 раза, преждевременных родов в 1,5 раза, уменьшить частоту реализации внутриутробных инфекций в 2 раза.

Ключевые слова: беременность, внутриутробные инфекции, врожденные пороки развития, пренатальная диагностика, перинатальная патология, хромосомные аберрации, плацента.

SUMMARY

Zhadan I.A. The system of perinatal prognosis, diagnostics and prophylaxis of fetal infections based on study of clinical-genetics features of family.

Dissertation (manuscript) for the academic degree of doctor of medicine (M.D.), specialties 03.00.15 – medical genetics, 14.01.01 – obstetrics and gynecology; Institute of Hygiene and Medical Ecology named after of A. M. Morzeyev of the Academy of Medical Sciences of Ukraine, Kiev, 2005.

Dissertation is dedicated to study of pathogenic role of fetal infection in the development of unfavorable course of pregnancy, delivery, postnatal and neonatal stages; ascertainment of clinical-genealogical, fenotypical, microbiological, ultrasound, cytogenetic, and morphological changes in mother-placenta-fetus system; study of the frequencies and types of chromosome aberrations in pregnant with fetal infections; determination of differential prenatal diagnostic criteria of fetal infection and congenital malformations; determination of level oxyrolin excretion in pregnant with violation of exchange of connective tissue and fetal infection; working out and introduction of system of perinatal prognosis, diagnostics and prophylaxis of fetal infections.

Frequency and differential diagnostic characteristics of fetal infections in 233 pregnant were studied. Among examined patients bacterial infections were revealed in 35.6% of pregnant, viral infections in 19.3%, and bacterial-viral infections in 45.1% of pregnant.

It was established that risk factors of fetal infections are not only hard obstetrics anamnesis, chronic urogenital diseases, complicated pregnancy, but also fenotypical features (signs of violation of exchange of connective tissue, mesenchimal dysplasia, high level of stigmatization), and multifactor pathology of parents.

Data about structure and frequency of chromosome aberrations in pregnant with fetal infections was received. In the basic group the medium frequency of chromosome aberrations was significantly different from the control group – 2.360.18* per 100 cells. Total frequency of simple aberrations of chromosome-type in the basic group was 1.000.12* per 100 cells, which is significantly higher then data of the control group (0.640.15 per 100 cells). Medium frequency of chromatyde-type aberrations in the basic group (1.060.09* per 100 cells) was significantly higher then such a parameter of the control group. The increase of aberrations level of both chromosome-type and chromatyde-type points out that damage of chromosome structure takes place at all phases of mitosis cycle.

Cytogenetic examinations of pregnant with bacterial, viral and bacterial-viral infections were carried out with the purpose of analyzing the possible cytogenetic effect depending on etiology of infection process. The frequency of chromosome aberrations of chromatyde-type was significant higher in pregnant with bacterial and bacterial-viral etiology; the level of chromosome damages of chromosome-type was higher in pregnant with bacterial-viral infections; viral infections are accompanied by the tendency of increased damage of chromosomal structure.

The examination of oxyrolin excretion in pregnant with violation of exchange of connective tissue and fetal infection shows that disorganization of basic substance of connective tissue facilitates infection, emphases the role of the pregnant fenotype evaluation (signs of violation of exchange of connective tissue) as a risk factor for total infection, and helps to evaluate changes of collagen's metabolism as a part of pathogenesis mechanism of infection process development.

Ultrasound somatogenetic examination helped to determine the marker ultrasound signs of fetal infections, to distinguish ultrasound criteria which were not described earlier (dolihocefaly form of fetus head – 20.62.6*, unripe placenta – 6.91.7*, high echogenity of chorial layer of placenta – 28.32.2*), to find differential prenatal features of bacterial, viral and bacterial-viral infections.

The common and different ultrasound signs of fetal infections and congenital malformations were found. Specific weight of congenital malformations of polygenic (multifactorial) etiology in pregnant with infections was 65.77.7. This data shows that infection is a basic damaging factor of environment.

The determination of ultrasound markers of fetal infections in pregnant with registration of clinical-genetics features allowed to carry out a timely microbiological examination and adequate treatment.

Discriminator analysis allowed to determine the informative clinical-genetics and ultrasound features, which helps to carry out prognosis of fetal infections. The evaluation of efficiency of this method showed that pregnant with infections were revealed in 79%, without infections – in 89.6% of cases. Prognosis was correct in 82.7 % of cases.

The use of this system allowed to optimize the course of pregnancy, reduce the frequency of postnatal complications, abortions (twice), premature interruptions of pregnancy (1.5 times), and diminish the frequency of clinical manifestations of fetal infections in newborn twice.

Key words: pregnancy, fetal infection, congenital malformations, prenatal diagnostic, perinatal pathology, chromosome aberrations, placenta.

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