中国5~18岁人群遗尿症患病率的横断面调查

目的 了解中国儿童和青少年遗尿症的患病情况。方法 横断面调查,以中国医师协会肾脏专委会中国儿童遗尿疾病管理协作组（简称：协作组）成员与所在省、自治区和直辖市有工作联系的区县为抽样单位。遗尿症诊断标准为年龄≥5岁,3个月内出现尿床事件≥1次;尿床指夜间睡眠中排尿于床上或尿湿衣裤。调查时间为2017年4月20日至2017年5月12日;调查人群为中国5~18岁儿童及青少年,分为幼儿园（5~6岁）、小学（~12岁）,初中（~15岁）和高中（~18岁）。每个区县样本量需＞3 073人。自行设计遗尿症调查问卷,本文主要分析基本人口学信息和尿床事件。由儿童或青少年的家长或照护者在手机或其他安装有微信应用终端设备上填写问卷。结果 24个协作组成员所在省、自治区和直辖市中的34个区县中的225所幼儿园和学校参与了调查,其中幼儿园82所,小学61所,初中49所,高中33所。调查目标样本人群129 952人,进入本文分析的调查问卷100 071份（77.0%）。男52 074份,平均年龄（11.0±3.4）岁,汉族占92.5%,幼儿园、小学、初中、高中人数比例约为1∶5∶2∶1。中国儿童和青少年遗尿症患病率为4.8%（4 821/100 071）;幼儿园、小学、初中、高中遗尿患病率分别为12.1%、5.1%、1.1%和1.4%;各年龄男孩遗尿症患病率均高于同年龄的女孩;中国境内6大行政区（华北、东北、华东、中南、西南、西北）以样本人群年龄构成比进行标准化后,其患病率分别为4.2%,3.7%、4.6%、5.8%、5.1%和4.9%;4 821名遗尿症患儿中,轻、中、重度遗尿症患儿分别占81.4%、13.5%和5.1%;重度遗尿症幼儿园、小学、初中和高中组比例为6.9%、3.7%、5.3%和10.0%。结论 中国幼儿园、小学、初中、高中人群遗尿患病率分别为12.1%、5.1%、1.1%和1.4%,儿童遗尿症患病率总体为4.8%。幼儿园及高中组重度遗尿症的比例较高。     

上海市七区0-14岁儿童哮喘流行病学调查北大核心CSCD

目的了解上海市0～14岁儿童哮喘的患病现状、特点及影响疾病的相关因素。方法采用整群抽样的方法,于2010年9-12月抽取上海7个行政区13500名0～14岁儿童作为调查对象,通过发放问卷及现场问诊、体检的方式完成调查。分析儿童哮喘患病现状及临床特点,并采用Logistic回归方法分析影响哮喘发生的主要因素。结果共发放儿童哮喘初筛问卷13500份,实际回收有效问卷13179份,初筛问卷应答率97．62％,其中男性7054名,女性6125名;最终确诊哮喘患儿998例（7．57％）,其中男性患病率为8．48％（598／7054）,显著高于女性（400／6125,6．53％,x2=17．75,P〈0．001）;患病率较高的年龄段集中在3—8岁,哮喘患儿（545例）占该年龄段儿童（5212例）的10．46％,54．61％（545／998）的患儿首次发病在3岁以内;呼吸道感染（838例,84．97％）是哮喘发作的首位诱因;男性（OR＝0．25,95％CI：0．12～0．45）,有家族过敏性疾病史（OR=2．65,95％CI：1．27～5．55）,有个人过敏性疾病史（OR=9．57,95％CI：4．59～19．97）,早期使用抗生素（OR=0．61,95％CI：0．49～0．83）是儿童哮喘发生的危险因素。确诊患儿中,463例（46．39％）患儿使用过吸人激素,740例（74．15％）患儿使用过支气管舒张剂。结论上海儿童哮喘患病率较10年前的4．52％显著升高,其发病与患儿性别,家族过敏史,个人过敏性疾病史及抗生素的使用有关。     

上海市儿童及青少年慢性头痛的流行病学调查

目的研究上海市儿童及青少年慢性头痛的流行情况及特点,调查慢性头痛的影响状况及就诊情况。方法将上海市中小学生（6～15岁）进行分层整群随机抽样,采用问卷调查及专科随访的方式,调查慢性头痛的患病情况、头痛特点、影响因素及就诊情况。结果（1）患病情况：共调查9857名学生,回收问卷8701份,回收率为88．6％,1481／8701（17％）有过头痛的经历,86．4％头痛原因不明;慢性头痛的患病率为7．8％,性别差异无统计学意义（x^2=0．010,P〉0．05）。（2）慢性头痛的患病率随年龄的增加而增高,12岁前男性高于女性,12岁后女性超过男性。（3）儿童慢性头痛特点：头痛部位单侧、双侧或不详比例相似,颞部居多（35．2％）,额部次之（25．6％）;头痛持续时间短,消化道伴随症状突出;头痛程度,48．5％的患儿认为头痛影响学习、生活;头痛伴随症状以消化道症状最常见。（4）就医情况：24．0％的患儿就诊,其中30．9％的患儿头痛后寻求药物治疗。（5）相关影响因素：慢性头痛的常见诱因为过度疲劳（51．4％）,睡眠不足（40．4％）,情绪改变（38．5％）,学习压力（2,4．1％）;慢性头痛与阳性家族史、学习压力过大有关。结论慢性头痛是儿童常见的临床问题,近半数慢性头痛儿童的学习与日常生活受到影响,但多数患儿未得到医疗指导,此调查结果应引起医学、教育及社会的共同关注。     

2000～2004年北京川崎病住院患儿流行病学调查

目的 进一步了解北京儿童川崎病（KD）的发病率及流行病学特点，并探讨其临床表现和急性期预后。方法 按照日本全国儿童KD调查及北京第1次KD流行病学调查方法，向北京及其郊区所有拥有儿科住院病床的医院发出调查问卷，回顾性记录自2000年1月～2004年12月的所有KD患儿。结果 北京45家有儿科住院病床的医院参加调查，共计报告1107例患儿。5年KD发病率为40．9～55、1／10万5岁以下儿童，平均49．4（95％CI，46、6～52．4）／10万5岁以下儿童。2000～2004年发病率有逐年增高趋势（Pα〈0．05）。发病年龄1个月～13．8岁，中位年龄2．0岁，其中5岁以下占87．4％；男女发病比例为1、83：1；春、夏有2次发病高峰，以夏季最高，2000和2004年在2次高峰基础上冬季还有1次发病高峰。复发15例，复发率1．4％；有家族史2例，占0．2％。发热仍是最常见的临床表现，而多形性皮疹为最少见的临床特征，患儿急性期无死亡。结论 2000～2004年北京KD发病率较前5年升高，但仍低于日本。发病年龄和性别比例与以往报道相似，但季节分布不同，除每年春、夏2次流行高峰外，2000和2004年冬季出现第3个发病高峰。     

南京市儿童过敏性鼻炎及下呼吸道疾病相关性调查

目的研究南京市儿童过敏性鼻炎（AR）及相关下呼吸道疾病流行病学特征。方法2004年3～5月用南京市儿童呼吸道疾病问卷调查表对随机选择的南京市7所小学三年级学生（9～10岁）进行问卷调查。调查分为两阶段，第一阶段向家长发放问卷调查筛选AR可疑患者．第二阶段对可疑患者进行专科检查确诊。对调查结果进行统计学处理。结果 1.共发放问卷调查表1087份．回收989份．应答率91％．有效答卷942份；2．南京市9～10岁儿童AR现患率为5．1％，其中男5．6％（27／484）、女4．6％（21／458），男与女发病率无差异（X^2=0．480 P〉0．05）；按ARIA 2001年分类标准：持续性45．8％（22／48）．其中轻度20.8％（10／48）．中-重度25．0％（12／48）：间歇性54．2％（26／48）．其中轻度45．8％（22／48）、中-重度8．4％（4／48）：3．AR患儿并哮喘．支气管炎、支气管扩张现患率（分别为40．0％、25．0％、2．0％）均较非AR儿童现患率（分别为39％．8．4％、0．1％）高．两组问并哮喘（X^2=75．141 P〈0．001）、气管炎（X^2=10．678 P〈0．001）差异具有统计学意义．而并支气管扩张现患率两组问无显著差异（X^2=0．053 P〉0．05）。结论南京市9～10岁儿童AR现患率为5．1％，与哮喘、支气管炎密切相关．因此应特别关注对上下呼吸道疾病的一致性和治疗的统一性.     

儿童哮喘的管理和治疗的热点问题

申昆玲教授 支气管哮喘是目前儿童慢性呼吸系统疾病中患病率最高的病种之一,流行病学调查显示在世界许多国家和地区儿童哮喘患病率均呈逐年增高趋势。中国大陆在2000年的流行病学调查数据显示,儿童哮喘累积患病率为0．25％～4．63％（平均1．97％）,相比于1990年的累积患病率0．11％～2．03％（平均1．00％）而言,平均上升了64．8％。     

中国六城市学龄儿童代谢综合征流行现状研究北大核心CSCD

目的分析中国汉族学龄儿童代谢综合征（MS）流行现状,比较两种儿童青少年MS定义（中国：简称MS-CHN2012,国际糖尿病联盟：简称MS．IDF2007）在人群中的诊断效率。方法对我国北部地区（北京、天津）、东部（杭州、上海）、中西部（重庆和南宁）六城市2010年22071名（男性11638名,女性10433名）7-16岁中小学生的流行病学调查资料进行分析;分别采用上述两种定义诊断MS并比较两者诊断的一致性。结果（1）7～16岁学龄儿童中,19．9％为超重及肥胖,肥胖占8．9％,男性10．9％,女性6．6％（P〈0．001）。（2）肥胖患病率依次为：北部16．9％、中西部5．9％、东部4．9％,差异有统计学意义（X。=1．007×103,P〈0．001）。（3）两种定义界定的MS,在7～16岁学龄儿童中分别为2．4％和1．4％,在肥胖人群中分别为28．8％和16．8％;不同定义所得的患病率差异有统计学意义（P〈0．001）。（4）两种定义诊断一致率达98．9％（Kappa值为0．711,P〈0．001）。结论7—16岁学龄儿童超重及肥胖已达19．9％,需引起高度重视;MS—CHN2012和MS—IDF2007两种定义在儿童青少年MS诊断上具有较好的一致性,而MS．CHN2012定义能较早检出MS高风险儿童青少年,有利于早期实行防治措施并降低成年期MS的发生风险。     

辽宁省0—14岁儿童中支气管哮喘患病情况及相关因素的研究

目的：探讨辽宁省0－14岁儿童哮喘患病情况及相关因素。方法：采用整群随机抽样调查方法。结果：辽宁省沈阳市和大连市共调查0－14岁儿童20075人，共调查出哮喘儿童241人，患病率为1．20％，其中儿童哮喘175人（72．6％），婴幼儿哮喘21人（8．7％），咳嗽变异性哮喘20人（8．3％），可疑哮喘（喘支）25人（10．4％），儿童哮喘和婴幼儿哮喘196人，患病率为0．98％，沈阳市儿童哮喘患病率为0．76％，大连市为0．82％，男女患病率为1．50％和0．90％，两者差异显著，有74．3％患者3岁以内起病，好发季节以不定期和换季节为主，好发时辰以午夜发作最多，发作诱因主要为感冒和天气变化，82．2％有个人过敏史，一，二级亲属有哮喘史分别为15．8％和26．9％，治疗 以口服支气管扩张剂和静滴激素为主，吸主疗法应用只占34．4％。结论：儿童哮喘患病率明显增加，注意避免诱发哮喘发作的因素，加强对吸入疗法治疗哮喘的推广和普及。     

汉中市儿童、孕妇铁缺乏症流行病学调查研究分析

目的 调查了解儿童、妇女铁减少（ID）、缺铁性贫血（IDA）及铁缺乏症（1DD）患病率。方法 随机抽取汉中市城区7月～7岁儿童532名，30岁以下妊娠38周以内孕妇203名，30岁以下未孕育龄妇女200名为调查对象。检测了血红蛋白（Hb）、锌原卟啉（ZPP）、血清铁蛋白（SF）等指标。结果7个月～7岁儿童ID平均43．80％，IDA平均9．96％。其中7个月～12个月婴儿ID71．67％．IDA22．50％：3个月～36个月幼儿ID33．13％，IDA8．13％；37个月～7岁儿童ID37．30％，IDA5．16％。孕妇ID平均82．17％，IDA平均37．93％。其中早孕组ID75．91％，IDA14．46％，中孕组ID77．14％，IDA51．43％；晚孕组ID100．00％，IDA58．00％。未孕育龄妇女ID49．50％．IDA25．00％。儿童ID、IDA不同年龄组有显著差异（P〈0．01），即年龄越小、患病率越高。孕妇孕龄组之间有显著性差异（P〈0．01）。即孕龄越大，患病率越高。孕妇ID、IDA患病率与育龄妇女有显著性差异（P〈0．01）。孕妇患病率明显高于育龄妇女。不同年龄组儿童、不同孕期孕妇及育龄妇女ID患病率均大于IDA患病率。结论本市儿童、孕妇、育龄妇女铁缺乏症比较普遍，ID、IDA患病率均高于国外和全国平均水平。隐性缺铁十分严重，已成为营养性铁缺乏症的主要问题。婴幼儿和晚期孕妇是铁缺乏症高发人群。     

重庆市一社区0~4 岁儿童便秘患病率和排便情况横断面调查

目的 基于社区调查0~4岁儿童便秘患病率和排便情况。方法 采取整群抽样方法,以在重庆市渝中区大溪沟社区卫生服务中心（调查现场）出生后建立儿童健康体检卡的全部0~4岁儿童家长为问卷调查对象,2013年10~12月对来调查现场的儿童家长指导填写儿童生长发育和营养状况调查问卷;对未来调查现场的儿童家长通过电话指导完成问卷调查,家长按Bristol图确定儿童大便形状。以罗马Ⅲ便秘诊断标准作为本文诊断便秘标准,获得社区儿童便秘患病率;以Bristol大便形状1~3型分别与本文便秘诊断标准主要倚重项目组合,计算敏感度、特异度、阳性似然比和阴性似然比。结果 所在社区建立儿童健康体检卡的0~4岁儿童共1 206名,进入分析972份有效问卷中男535名,女437名;符合本文便秘诊断标准55例,所在社区0~4岁儿童便秘患病率为5.6%。符合本文便秘诊断标准的55例均为Bristol大便形状的1~3型; 0~4和~6月龄组以6型便为主,8月龄以上组以4型便为主。Bristol大便形状1~3型分别与本文便秘诊断标准倚重项目“每周排便2次及以下”和“排便疼痛或排便困难史”组合后诊断便秘的敏感度均为100%,特异度96.8%以上,前者阳性似然比高于后者（142.9 vs 31.3）。结论 0~4岁儿童便秘患病率为5.6%,Bristol大便形状1～3型是儿童发生便秘的警示指标。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Bibliometric data: a disaster for many non-American biomedical journals

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.