新生儿脐血瘦素水平测定及相关因素分析

目的测定脐血瘦素(leptin)水平并分析其相关因素,以探讨瘦素在胎儿生长发育中的作用.方法采用放射免疫法测定80例新生儿脐血瘦素水平,其中早产儿16例,足月儿64例.足月儿又分为小于胎龄儿11例,适于胎龄儿31例,大于胎龄儿22例.结果早产儿瘦素水平明显低于足月儿(4.25±3.19ng/mlvs9.86±5.50ng/ml,P＜0.001),足月儿中适于胎龄儿瘦素水平(8.91±5.20ng/ml)显著高于小于胎龄儿(5.17±2.46ng/ml)而低于大于胎龄儿(13.56±4.67ng/ml);脐血瘦素与胎龄、出生体重、身长、Kaup指数、头围、胎盘重量、脐血胰岛素、血脂等呈正相关关系;多元逐步回归分析表明体重、性别、胎龄是脐血瘦素的主要相关因素.结论各组新生儿瘦素水平有显著差异,体重、性别、胎龄是其主要相关因素,故瘦素对胎儿生长发育起着重要作用,是胎儿宫内生长发育的重要调控因子.     

新生儿血清瘦素水平与生长发育关系研究

目的：探讨新生儿血清瘦素与生长发育的关系。方法：采用放射免疫法检测80例新生儿静脉血和脐血瘦素水平,其中66例足月儿分为大于胎龄儿(LGA)组18例,适于胎龄儿(AGA)组32例,小于胎龄儿(SGA)组16例。采用Rohrer’s指数=出生体重(g)×100/身长(cm)~3估测新生儿营养状态。结果：早产儿血清瘦素水平明显低于足月儿[(0.66±1.03)ng/ml vs(3.59±2.16)ng/ml],P<0.01;足月儿中AGA血清瘦素水平[(3.06±0.96)ng/ml]明显低于LGA[(4.03±2.22)ng/ml],而高于SGA[(1.13±1.98)ng/ml];足月新生儿血清瘦素水平与Rohrer’s指数、新生儿体重、胎龄呈显著正相关(r=0.61,0.68,0.62,P均<0.01)。结论：新生儿体内瘦素是反映新生儿的发育和营养状态的有用指标。[中国当代儿科杂志,2003,5(1):29-30]     

宫内生长迟缓儿脐血瘦素胰岛素生长激素的水平及临床意义

目的：　探讨脐血瘦素、胰岛素、生长激素在胎儿宫内生长迟缓(IUGR)发病中的作用。方法：　采用放射免疫法测定 31例足月IUGR儿(轻度11例,重度20例)和47例足月适于胎龄儿(正常组)脐血瘦素、胰岛素、生长激素水平。结果：　IUGR儿脐血瘦素、胰岛素、生长激素明显低于正常儿,瘦素(5.55±3.79)ng/ml vs (9.47±5.97)ng/ml,胰岛素(9.75± 4.80)mU/L vs (15.59±9.11)mU/L,生长激素(8.71±4.5 4)ng/ml vs (12.77±4.30)ng/ml,(P<0.01),且IUGR儿的不良生长程度越重,三者水平越低。结论：　瘦素、胰岛素、生长激素分泌不足导致内分泌紊乱,形成一个不利于胎儿生长发育的内环境而至胎儿宫内生长迟缓。     

小于胎龄儿生长相关异常及生长激素治疗

小于胎龄儿(SGA)又称宫内生长迟缓(IUGR)，一般指出生体重低于同胎龄、同性别平均体重的第十百分位以下或同胎龄平均体重2个标准差的新生儿。人群中SGA的发生率约为3％～10％，在中国为7．5％。大部分SGA儿生后出现追赶生长而达到正常范围，但仍有10％～15％不能赶上，其中约半数至成年后身高会低于正常平均身高的2个标准差，对这部分儿童可应用生长激素(GH)，以促进生长，改善最终身高。现主要介绍SGA儿的内分泌、GH治疗对SGA儿的生长发育及代谢的影响。     

足月新生儿脐血ghrelin水平与瘦素、生长激素水平关系研究

目的 探讨ghrelin调节胎儿生长发育的可能的作用机制.方法 采用放射免疫法测定78例足月新生儿脐血ghrelin、瘦素、生长激素水平,分析脐血ghrelin、瘦素、生长激素水平与出生体重的关系及脐血ghrelin水平与瘦素、生长激素水平间的关系.结果 小于胎龄儿(SGA)、适于胎龄儿(AGA)、大于胎龄儿(LGA)三组间新生儿脐血ghrelin、瘦素水平差异均有统计学意义(P均<0.01).脐血ghrelin水平与出生体重呈负相关性(r=-0.339,P=0.002),脐血瘦素水平与出生体重呈正相关性(r=0.373,P=0.001),脐血ghrelin水平与瘦素无相关性(P=0.175).脐血生长激素水平与出生体重、脐血ghrelin水平均无相关性(P=0.267,0.059).结论 Ghrelin及瘦素共同调节胎儿生长发育的机制可能与出生后两者的调节机制有所区别,Ghrelin可能并非通过刺激生长激素分泌而发挥调节胎儿生长发育作用.     

血管内皮生长因子在重度子癎痫前期产妇新生儿脐血中的表达

目的 探讨血管内皮生长因子(VEGF)在重度子癎前期产妇分娩的新生儿脐静脉血、脐动脉血中的表达及其意义.方法 采用放射免疫分析法检测26例重度子癎前期产妇所分娩新生儿(重度子癎前期组)与30例健康产妇所分娩新生儿(对照组)的脐静脉血、脐动脉血VEGF水平.重度子癎前期组新生儿按照其出生体质量-胎龄分类分为小于胎龄儿15例(SGA组)和适于胎龄儿11例(AGA组).结果 (1)重度子癎前期组脐静脉血、脐动脉血VEGF水平[(15.26±5.28)pg/ml、(19.334±4.45)pg/ml]均显著高于对照组[(12.78±3.21)pg/ml、(14.55±2.90)pg/ml](t=2.16,P<0.05;t=4.82,P<0.01).(2)对照组和重度子癎前期组的脐动脉血VEGF水平均显著高于脐静脉血VEGF水平(t=2.24,P<0.05;t=3.00,P<0.01).(3)对照组和重度子癎前期组脐静脉血和脐动脉血VEGF水平与新生儿胎龄或出生体质量均无明显相关性.(4)重度子癎前期SGA组的脐动脉血VEGF水平(21.38±3.68pg/ml)显著高于AGA组(16.53±3.96pg/ml)和对照组(t=3.22,P<0.01;t=6.80,P<0.01).结论 重度子癎前期产妇新生儿脐静脉血和脐动脉血VEGF水平均较健康产妇新生儿明显升高;脐动脉血VEGF水平在一定程度上可反映妊娠期高血压疾病产妇的新生儿宫内损伤程度.     

血管内皮生长因子在重度子癎痫前期产妇新生儿脐血中的表达

目的 探讨血管内皮生长因子(VEGF)在重度子癎前期产妇分娩的新生儿脐静脉血、脐动脉血中的表达及其意义.方法 采用放射免疫分析法检测26例重度子癎前期产妇所分娩新生儿(重度子癎前期组)与30例健康产妇所分娩新生儿(对照组)的脐静脉血、脐动脉血VEGF水平.重度子癎前期组新生儿按照其出生体质量-胎龄分类分为小于胎龄儿15例(SGA组)和适于胎龄儿11例(AGA组).结果 (1)重度子癎前期组脐静脉血、脐动脉血VEGF水平[(15.26±5.28)pg/ml、(19.334±4.45)pg/ml]均显著高于对照组[(12.78±3.21)pg/ml、(14.55±2.90)pg/ml](t=2.16,P<0.05;t=4.82,P<0.01).(2)对照组和重度子癎前期组的脐动脉血VEGF水平均显著高于脐静脉血VEGF水平(t=2.24,P<0.05;t=3.00,P<0.01).(3)对照组和重度子癎前期组脐静脉血和脐动脉血VEGF水平与新生儿胎龄或出生体质量均无明显相关性.(4)重度子癎前期SGA组的脐动脉血VEGF水平(21.38±3.68pg/ml)显著高于AGA组(16.53±3.96pg/ml)和对照组(t=3.22,P<0.01;t=6.80,P<0.01).结论 重度子癎前期产妇新生儿脐静脉血和脐动脉血VEGF水平均较健康产妇新生儿明显升高;脐动脉血VEGF水平在一定程度上可反映妊娠期高血压疾病产妇的新生儿宫内损伤程度.     

脐血可溶性瘦素受体与胎儿生长发育关系探讨

目的：瘦素是肥胖基因的蛋白产物,除参与调节机体能量代谢外,与胎儿的生长发育密切相关,但其作用机制尚不清楚。本研究旨在探讨脐血可溶性瘦素受体与胎儿生长发育的关系及其可能机制。方法：67例足月新生儿根据出生体重分为小于胎龄儿(SGA)组23例,适于胎龄儿(AGA)组44例。采用ELISA法测定脐血和母血中瘦素及可溶性瘦素受体水平,并采用体脂含量估测新生儿营养状态。结果：①脐血可溶性瘦素受体水平与脐血瘦素水平及新生儿出生体重、体脂含量呈负相关(r分别为-0.405,-0.366,-0.356,P均0.05)。③SGA组脐血可溶性瘦素受体明显高于AGA组［(18.24±6.02) ng/ml vs (13.80±4.37) ng/ml］,P<0.01;而SGA组的瘦素含量低于AGA组［(6.79±4.59) ng/ml vs (16.30±11.62) ng/ml］,P<0.01。④脐血可溶性瘦素受体水平男性高于女性［(16.89±4.37) ng/ml vs (13.95±5.29) ng/ml］,P<0.05;而脐血瘦素水平则是男性低于女性［(10.28±8.28) ng/ml vs (15.70±12.11) ng/ml］,P<0.05。结论：可溶性瘦素受体可能通过对血清中游离瘦素水平的调节实现对胎儿生长发育的调控作用。同时测定瘦素和可溶性瘦素受体可能更有利于进一步了解瘦素的病理生理作用机制。     

生长激素缺乏儿童在生长激素治疗中血清瘦素水平的改变

为了观察生长激素对血清瘦素 (leptin)的影响 ,用酶联法测定33例青春期前正常儿童和12例生长激素缺乏(GHD)患儿在治疗前、治疗后血清leptin水平 ;同时观察了患儿BMI与leptin的关系。结果显示 ,正常青春期前儿童血清leptin水平为 (1.22±0.94)ng/ml;治疗前GHD患儿血清leptin水平为 (3.079±2.407)ng/ml,与对照组相比差异无显著性(P>0.05) ;GHD患儿治疗后1、3、6个月血清leptin水平分别为 (1.643±1.367)ng/ml、(1.571±1.397)ng/ml和 (1.349±0.893)ng/ml,与治疗前相比差异有显著性 (P均<0.001)。提示生长激素对leptin的表达有抑制作用     

新生儿脐血脂联素水平及与其他相关激素间关系研究

目的探讨新生儿脐血脂联素水平及与脐血瘦素、胰岛素、甲状腺激素、生长激素间的关系。方法采用放射免疫法检测78例正常足月新生儿脐血脂联素、瘦素、胰岛素、甲状腺激素、生长激素水平,所有新生儿分为小于胎龄儿(SGA)13例、适于胎龄儿(AGA)53例、大于胎龄儿(LGA)12例,并计算体重指数=体重(kg)/身长2(cm2)评估新生儿营养状态。结果新生儿脐血脂联素水平为(24.58±4.26)μg/ml,与体重指数呈正相关(r=0.367,P<0.05);SGA组脐血脂联素为(19.95±4.70)μg/ml,AGA组(24.81±4.15)μg/ml,LGA组(26.57±4.29)μg/ml,3者间差异显著(F=8.871,P<0.05);新生儿不同性别、分娩方式间脂联素水平差异无显著性(t=1.314,0.713,P均>0.05);脐血脂联素与瘦素、胰岛素、FT3、FT4呈正相关(r=0.298~0.453,P均<0.05);与TSH呈负相关(r=-0.487,P<0.05);与生长激素、TT3、TT4无相关性(r=0.072、0.182、0.211,P>0.05)。结论新生儿脐血脂联素水平为(24.58±4.26)μg/ml,在一定程度上反映了胎儿的营养状态,它可能与瘦素、胰岛素、甲状腺激素一起共同调节胎儿的生长发育,它们可以作为评估胎儿体重与生长发育的临床指标。     

胶原成分在儿童系膜增生性肾小球肾炎中的变化

目的观察系膜增生性肾小球肾炎（ＭｓＰＧＮ）系膜区胶原成分的变化。方法应用链菌素亲生物素过氧化酶连接法观察了３０例轻度ＭｓＰＧＮ肾穿刺活组织标本和正常的肾小球系膜区Ⅳ型胶原及其α链（α１、α３、α５链）、Ⅵ型胶原及Ⅰ型胶原的变化。结果（１）正常肾脏组织中，Ⅳ型胶原及其α１（Ⅳ）链分布于系膜区和基底膜，α３（Ⅳ）、α５（Ⅳ）链分布于基底膜，Ⅵ型胶原分布于系膜区、肾小球基底膜和间质，Ⅰ型胶原仅分布于肾间质。（２）在轻度ＭｓＰＧＮ时，系膜区内Ⅳ型胶原及其α１链、Ⅵ型胶原含量较正常对照明显增多（Ｐ＜０．０１）；当系膜区系膜细胞超过４个时，Ⅰ型胶原开始在肾小球内出现，且在硬化肾小球内Ⅰ型胶原均呈阳性；α３（Ⅳ）、α５（Ⅳ）链与正常对照比较无明显变化，硬化肾小球α３（Ⅳ）、α５（Ⅳ）染色呈阳性。结论系膜区胶原成分增多可先于系膜细胞增生，并随系膜细胞增生而增多，间质胶原成分Ⅰ型胶原，不但出现于硬化肾小球内，而且出现于系膜细胞增生较重时     

Breastfeeding perceptions in communities in Mangochi district in Malawi

Aim: To investigate mothers’ perceptions of breastfeeding and influences from their social network. Methods: A cross‐sectional survey was carried out in Mangochi district, Malawi where questionnaire data from 157 rural and 192 semi‐urban mother–infant pairs were obtained. Results: The proportion of mothers who thought that exclusive breastfeeding should last for 6 months and those who reported to have actually exclusively breastfed were 40.1% and 7.5% respectively. Of those who reported practising exclusive breastfeeding for 6 months, 77.5% stated that exclusive breastfeeding should last for 6 months. This opinion was independently associated with giving birth in a Baby‐Friendly facility, OR = 5.22; 95% CI (1.92–14.16). Among the mothers who thought that exclusive breastfeeding should last for less than 6 months, 43.9% reported having been influenced in their opinion by health workers. Infant crying was the most common (62.4%) reason for stopping exclusive breastfeeding. Conclusion: The findings illustrate the positive impact health workers can have, as well as the need to raise awareness of the benefits of exclusive breastfeeding among both health workers and mothers. Furthermore, continued counselling of mothers on how to deal with stressful infant behaviour such as crying may assist to prolong exclusive breastfeeding.     

Cardiomyopathy in children in Ahmedabad

A clinical study and follow up of 20 children with cardiomyopathies upto age of 16 years are presented. The DCM was most common variety followed by RCM and HCM in pediatric age group. SHMD presenting with cardiomyopathy were common in infancy and early childhood. Cardiomyopathies presented most frequently between 2–5 years and 10–16 years age group with DCM having almost equal distribution. Clinical presentation of various types is described, despite of vigorous decongestive and vasodilator treatment in advanced cases, course was rapidly downhill and prognosis is poor in general.     

北京地区2007年儿童A群轮状病毒腹泻的流行病学研究

目的 研究北京地区急性腹泻儿童中A群轮状病毒(RV)感染的流行病学特点.方法 收集2007年4月至12月我院肠道门诊就诊的2039例急性腹泻患儿的粪便标本,采用标记金的A群RV单克隆抗体,以免疫层析双抗体夹心法定性检测A群RV抗原.结果 2039份粪便标本中,621份检测到A群RV,总检出率为30.5%(621/2039),其中男430例(69.2%),女191例(30.8%).RV感染者中,以6个月～2岁年龄段的患儿为最多,共571例(91.9%).检出率以10～12月份最高,均在30%以上,其中高峰出现在11月份,达43.4%.北京地区18个区县的统计数据显示,距市区较近的区县RV抗原检出率较低,边远区县较高.少部分患儿合并肠道细菌感染.结论 A群RV为北京地区2岁以下儿童急性腹泻病的主病原,6个月～2岁婴幼儿是A群RV的易感人群,10～12月份为北京地区的流行高峰.在流行季节对肠道细菌感染患儿常规进行A群RV抗原检测有助于避免漏诊和进行更合理的治疗.     

Achalasia in siblings in infancy

Achalasia is rare in children, more so familial. We report two siblings with familial achalasia who presented in their infancy with vomiting and failure to thrive. Achalasia can be misdiagnosed as upper gastrointestinal obstruction as happened in one of our siblings. Esophageal contrast roentgenography is diagnostic. Both the children were treated successfully by transabdominal esophagomyotomy with fundoplication.     

哮喘大鼠气道重塑中尾加压素-的表达变化

目的：研究哮喘大鼠气道重塑血清和支气管肺泡灌洗液（BALF）中尾加压素 Ⅱ（U-II）含量的变化及其作用。方法：32只雄性Sprague-Dawley大鼠随机分为正常对照组、哮喘2周组、哮喘4周组和哮喘8周组,每组8只。以卵清白蛋白(OVA)致敏与激发建立哮喘大鼠气道重塑模型,图像分析技术测量大鼠支气管壁总面积和平滑肌面积,计算单位基底膜周径(Pbm)的支气管壁厚度(Wat)和平滑肌厚度(Wam),ELISA法测定血清和BALF中U-II的含量。结果：哮喘各组Wat及Wam均明显高于正常对照组（P<0.01）;哮喘组血清和BALF中U-II含量均显著高于正常对照组（P<0.01）,其中哮喘8周组血清和BALF中U-II含量显著高于哮喘4周组和哮喘2周组（P<0.01）,哮喘4周组也显著高于哮喘2周组（P<0.01）。各组大鼠BALF中的U-II含量与Wat及Wam呈正相关,BALF与血清中U-II含量亦呈正相关。结论：哮喘大鼠气道重塑血清和BALF中U-II含量增加;且U-II含量的变化与气道重塑相关。［中国当代儿科杂志,2010,12（4）：287-289］     

Poisoning in children in Japan

The Japan Poison Information Centre (JPIC) received 31510 inquiries about poisoning in children under 6 years old being exposed to poison in the fiscal year 1995. The most frequently implicated products were tobacco (20%) and the peak age for ingestion of household products was 1 year and younger (83.3%). Especially, the inquiries related to children less than 1 year old were 35.7% of the cases. In contrast, the American Association of Poison Control Centers (AAPCC) data showed that the most common poisonings were due to pharmaceutical products and the inquiries related to children less than 1 year old were only 12.1%. The objective of this report was to find out the poison exposure in children in Japan and to compare the data with that of AAPCC.     

转流术治疗小儿精索静脉曲张

目的 采用转流术治疗小儿精索静脉曲张，重新建立精索静脉通道，使静脉回流受阻立即得到改善，消除因睾丸淤血而造成的损害，以利睾丸的正常发育。方法 对28例30侧(左侧26例，双侧2例)精索静脉曲张与腹壁下静脉进行吻合，通过腹壁下静脉，髂静脉转流，手术在放大镜下应用显微外科技术进行，其中28侧用精索静脉主干，2侧结扎一条属支，用另一条静脉进行吻合。结果 通畅率为100％。术后扩张迂曲静脉团消失，阴囊下坠感消失。术后随访24例，时间为3个月-10年。除1例二次手术证实为一条静脉属支漏扎而复发外，另23例全部治愈。结论 精索静脉曲张转流术效果明显优于结扎术，可减少因睾丸淤血对其造成的进一步损害，且术后复发率低。     

Rotavirus infection in children in Japan

Currently, a high morbidity of rotavirus diarrhea has been seen in children in developed and developing countries. Improvement of the vaccines is necessary in order to reduce the burden of diarrhea caused by rotavirus. A survey of rotavirus infection from diarrheal stool specimens in children of seven regions in Japan was conducted from 1984 to 1999. The present study discusses the survey results and reviews the national and international data of more than 23 papers and congress proceedings about rotavirus infection in Japan. We analyze the prevalence of rotavirus infection in acute diarrheal in- and outpatients, the distribution of rotavirus G-serotypes and surveillance data for seasonality and age groups in Japan. The data indicated that rotavirus is the most important cause of diarrhea in Japan among young children, with the prevalence ranging from approximately 9.7 to 88%. The most common rotavirus strains belonged to serotype G1, specifically since 1993. Serotypes G2, G3 and G4 had also been documented to be predominantly based in the area and year before 1992. However, untypeable rotavirus strains had been found each year, with a prevalence up to 56.7% which suggests that rare serotypes (except G1-4) or new serotypes might exist. Unexpectedly, in Tokyo and Sapporo from 1998 to 1999, G9 was found to be the first most prevailing serotype with a high prevalence of 52.9 and 71.4%, respectively. Despite these data from different geographic areas, the year under investigation was relatively clear in respect to seasonality, with a peak of rotavirus activity in late winter (February) through early spring (March). Age distribution had also characterized that the infection was predominant among children aged 1-2 years of age, although it was also common in children of 2-3 years. In addition, mixed infection with bacteria was documented.