Short-term Prognostic Indices of Acute Myocardial Infarction

ObjectiveTo determine the prognostic index which will reflect best the short-term outcome of acute myocardial infarction(AMI) in Chi nese patients.Methods340 patients admitted to the hospital with AMI from January 1985 to December 1995 were enrolled in this study.The predictive a bilities of 8 published short-term prognostic indices for AMI were compared wit h each other in 340 AMI patients by receiver-operator characteristic curve(ROC) analysis.Mortality status within 28 days after onset of symptoms was used as th e outcome.ResultsFrom the ROC analysis,the Dubois index was the seco nd best performing index with the ROC of 0.722 1(95% CI0.656 8～0.787 3),and had no significant difference with the best performing indexthe Norris index.Wh en compared with the other indices,Dubois index had the advantage of higher accu racy,easier calculating and less missing data.ConclusionDubois inde x appears to be an appropriate index for the short-term prognosis of AMI in the Chinese population.     

肺癌不同阳性标准痰细胞学筛查方法的灵敏度和特异度分析

目的 探讨改变阳性标准对职业高危人群肺癌痰细胞学筛查灵敏度及特异度的影响.方法 以1992-1999年间至少参加过1次年度性痰细胞学肺癌筛查的云南锡矿工人为研究对象,共9223名.研究对象年龄均40岁以上、井下工龄或冶炼工龄超过10年且无恶性肿瘤史.收集研究对象痰样进行筛查,以筛查阳性且被临床确诊的肺癌患者为真阳性,筛查阴性且在随访期间没有被临床诊断为肺癌的研究对象为真阴性,计算不同阳性标准痰细胞学筛查方法的灵敏度、特异度,并进行受试者工作特征曲线(ROC曲线)分析,利用Hanley和McNeil法计算Z值,比较不同阳性标准ROC曲线下面积的差别.结果 截止到随访终止时间(2001年12月31日),9223名研究对象中共有500例肺癌患者,最常见的细胞类型为鳞癌[55.8%(222/398)],发病部位以中央型肺癌为主[68.5%(316/461)].在筛查过程中,共150例患者有痰细胞学筛查阳性史.阳性标准分别为重度不典型增生及以上、中度不典型增生及以上、轻度不典型增生及以上时,痰细胞学筛查方法灵敏度分别为30.0%(150/500)、36.4%(182/500)、53.0%(265/500);特异度分别为98.9%(8628/8723)、95.1%(8611/8723)、77.9%(7033/8723).3种阳性标准的ROC曲线下面积(由重度到轻度)分别为0.645(95%CI:0.635～0.654)、0.657(95%CI:0.668～0.667)、0.655(95%CI:0.645～0.664);重度与中度、轻度比较,以及中度与轻度比较,差异均无统计学意义(Z值分别为0.780、0.645、0.209,P值均>0.05).结论 随阳性标准的降低,痰细胞学筛查的灵敏度上升而特异度下降,但3种不同阳性标准的准确度并无明显差异.

Abstract：

Objective To discuss the effect of different positive criteria on the sensitivity and specificity of sputum cytology screening for lung cancer among Yunnan tin miners.Methods 9223 Yunnan tin miners who received at least one annual sputum cytology screening for lung cancer during the period between 1992 and 1999 were recruited in the study.At time of enrollment,all participants were aged over 40 years old,had at least 10 years of employment as an underground miner and(or) smelter,and had not been diagnosed with malignancy.In our study,a true positive was categorized as having at least one prior positive sputum screening and a diagnosis of lung cancer,while a true negative,by our definition,signified negative sputum examinations and no diagnosis of lung cancer during the follow up time.Based on different positive criteria,sensitivity and specificity of sputum cytology were computed and receiver operating characteristic(ROC) curve analysis was conducted.Z statistic was used to test the differences of the area under ROC based on Hanley and McNeil method.Results By the end of following up on December 31,2001,a total 500 lung cancer cases were diagnosed among 9223 participants: most were squamous cell carcinoma (55.8% (222/398)) and central lung cancers (68.5% (316/461)).150 lung cancer cases had a previous positive sputum screening result.When positive criteria were taken as grave atypical metaplasia,moderate atypical metaplasia and slight atypical metaplasia,the corresponding sensitivities were 30.0% (150/500),36.4% (182/500),53.0% (265/500) respectively; while the corresponding specificities were 98.9% (8628/8723),95.1% (8611/8723),77.9% (7033/8723) respectively.The areas under ROC curve according to different positive criterias were 0.645(95%CI: 0.635-0.654),0.657(95%CI: 0.668-0.667),0.655(95%CI: 0.645-0.664) respectively.There were no significant differences found in the comparisons between grave and moderate atypical metaplasia,grave and slight atypical metaplasia,moderate and slight atypical metaplasia(Z statistics were 0.780,0.645,0.209 respectively,all P values>0.05).Conclusion While the standard of positive criteria for diagnosis of lung cancer decreased,the sensitivity of sputum cytology screening increased and the specificity decreased.Since there were no significant differences of accuracy for different positive criteria.     

人体肥胖测量指标对非酒精性脂肪性肝病的预测价值CSCD

Objective To investigate the predictive value of different body obesity measures for non‑alcoholic fatty liver disease (NAFLD). Methods It was a cross‑sectional study. The present study was a case‑control study involving 553 subjects who underwent physical examination from January to April 2022. The subjects were divided into NAFLD group (n=321 cases) and control group (n=232 cases) according to abdominal ultrasound imaging parameters. All subjects completed a general information questionnaire, liver ultrasound examination, serum biochemical indices and physical measurements. Logistic regression model was used to analyze the correlation between human obesity measures (neck circumference, triceps skinfold thickness (TSF), body mass index (BMI), waist‑to‑hip ratio, lipid accumulation index (LAP), visceral fat index (VAI), body roundness index (BRI) and a body shape index (ABSI)) and NAFLD. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the predictive value of single and combined measures of obesity for NAFLD. Results The subjects were stratified by gender, and the quartile levels of BMI, neck circumference, TSF, waist‑to‑hip ratio, LAP, VAI and BRI were all correlated with NAFLD in both male and female (all P<0.05). After further adjustment for confounding factors, compared with those in group Q1, group Q4 of the above‑mentioned indexes still had higher odds ratios (P<0.05). The AUC value of LAP in predicting NAFLD was the largest in both men and women, which was 0.836(0.788-0.876) and 0.885(0.839-0.921), and the cut‑off value was 41.93 and 33.27, respectively. There was no significant difference in AUC of ROC predicting NAFLD among LAP, BRI and BMI (P>0.05). The AUC of ABSI in predicting NAFLD was less than 0.7(namely 0.584(0.525-0.641) and 0.679(0.618-0.735) in men and women, respectively), which indicated poor predictive performance for NAFLD. In the pairwise combination index, the AUC of ROC predicting NAFLD with TSF+LAP in male was the largest, which was 0.864(0.819-0.901), and there was statistical significance when compared with BRI (AUC=0.818(0.769-0.860)) and BMI (AUC=0.816(0.767-0.858)) (P<0.05), but there was no statistical significance when compared with LAP (AUC=0.836(0.788-0.876)) (P>0.05). The AUC of ROC predicting NAFLD with VAI+LAP in women was the largest, it was 0.894(0.849-0.928), there was statistical significance when compared with BMI (AUC=0.849(0.799-0.890)) (P<0.05), but there was no statistical significance when compared with LAP (AUC=0.885(0.839-0.921)) and BRI (AUC=0.870(0.822-0.908)) (P>0.05). Conclusion BMI, neck circumference, TSF, waist‑to‑hip ratio, LAP, VAI and BRI all have good predictive value for NAFLD. © 2023 Chinese Medical Association. All rights reserved.     

急性淋巴细胞白血病患儿骨髓间充质干细胞对K562细胞株药物耐受性的影响

Objective To study the effect of acute lymphoblastic leukemia (ALL) children bone marrow mesenchymal stem cells (MSCs) on the resistance of K562cell atd mechanism in vitro.Method MSCs were obtained from AL children bone marrow after derivation, cultivation and identification.The coculture of MSCs and K562 and K562 suspension were established.Effects of MSCs on the growth of K562 cells were investigated in vivo.The two kinds of cells treated with different concentration of adriamycin (ADM) and the rate of apoptosis was evaluated by flow cytometry.Cell cycle was determined by flow cytometry.RT-PCR was used to detect Bcl-2 and Bax in K562 cells.Result Compared with the cell growth curve of K562 alone, the K562 cell co-cultured with MSCs grew slower and the exponential phase of growth was not obvious.The apoptosis index of the K562 cells co- clutured with MSCs was (9.19 ±0.53)% examined by flow cytometry, and that of the K562 cells alone was 4.00 ± 0.37% respectively( P ＜ 0.05 ).The percentage of cells at G0/G1 phase was (50.2 ± 2.26) % and that at S phase was (37.03 ± 3.50) % in the group of K562 alone, but those of the K562 cells co - cultured with MSCs were (80.95 ± 3.83) % and ( 17.40 ± 1.50)% respectively( P ＜0.05).The result of RT-PCR suggested expression of Bcl-2/Bax of the K562 cell co-cultured with MSCs was higher than K562 alone.Conclusion ALL children MSCs suppressed the growth of K562 cell in vitro.Adhesion made K562 depress sensitive to ADM.The mechanism was perhaps caused by adhesion with MSCs, K562 cell cycle was changed and related to Bcl-2 gene high level expression.     

急性淋巴细胞白血病患儿骨髓间充质干细胞对K562细胞株药物耐受性的影响

Objective To study the effect of acute lymphoblastic leukemia (ALL) children bone marrow mesenchymal stem cells (MSCs) on the resistance of K562cell atd mechanism in vitro.Method MSCs were obtained from AL children bone marrow after derivation, cultivation and identification.The coculture of MSCs and K562 and K562 suspension were established.Effects of MSCs on the growth of K562 cells were investigated in vivo.The two kinds of cells treated with different concentration of adriamycin (ADM) and the rate of apoptosis was evaluated by flow cytometry.Cell cycle was determined by flow cytometry.RT-PCR was used to detect Bcl-2 and Bax in K562 cells.Result Compared with the cell growth curve of K562 alone, the K562 cell co-cultured with MSCs grew slower and the exponential phase of growth was not obvious.The apoptosis index of the K562 cells co- clutured with MSCs was (9.19 ±0.53)% examined by flow cytometry, and that of the K562 cells alone was 4.00 ± 0.37% respectively( P ＜ 0.05 ).The percentage of cells at G0/G1 phase was (50.2 ± 2.26) % and that at S phase was (37.03 ± 3.50) % in the group of K562 alone, but those of the K562 cells co - cultured with MSCs were (80.95 ± 3.83) % and ( 17.40 ± 1.50)% respectively( P ＜0.05).The result of RT-PCR suggested expression of Bcl-2/Bax of the K562 cell co-cultured with MSCs was higher than K562 alone.Conclusion ALL children MSCs suppressed the growth of K562 cell in vitro.Adhesion made K562 depress sensitive to ADM.The mechanism was perhaps caused by adhesion with MSCs, K562 cell cycle was changed and related to Bcl-2 gene high level expression.     

Effectiveness of automated machine learning models in predicting the risk of preeclampsia in the first trimesterCSCD

Objective To explore the application value of automated machine learning (autoML) model in predicting the risk of preeclampsia in the first trimester. Methods From January 2017 to October 2020, 2 180 singleton pregnant women who were registered in Jinan Second Maternal and Child Health Hospital and underwent pregnancy examination at 12 weeks of gestation were selected. The pregnant women were divided into preeclampsia group (103 cases) and control group (2 077 cases) according to the occurrence of preeclampsia. The differences in clinical data and hematological indexes in the two groups were compared, and the correlation between each index and the risk of preeclampsia was analyzed too. All the pregnant women were randomly divided into training set and test set according to the ratio of 7∶3, and the autogluon autoML algorithm was used to build a variety of machine learning models, and training and cross‑validation were performed in the training set to compare the accuracy of the different models. The importance of each index in the autoML model was analyzed, and the autoML model and the logistic regression model were used to predict the risk of preeclampsia in pregnant women in the test set respectively, and the receiver operating characteristic (ROC) curve was used to evaluate the prediction performance of the autoML and the logistic regression model. Results The age, pre‑pregnancy body mass index, body mass index at 12 weeks of gestation, waist circumference at 12 weeks of gestation, proportion of drinking history, high‑sensitivity C‑reactive protein (hs‑CRP), triglyceride, low‑density lipoprotein cholesterol (LDL‑C), aspartate aminotransferase (AST), platelet distribution width (PDW), mean platelet volume, thyroid stimulating hormone (TSH) and β‑human chorionic gonadotropin were all significantly higher than those in the control group (all P<0.05), and the free tri‑iodothyronine (free T3), free thyroxine (free T4), placental growth factor (PIGF), soluble fms‑like tyrosine kinase‑1 (sFlt‑1) and pregnancy‑associated plasma protein‑A (PAPP‑A) were all significantly lower than those in the control group (all P<0.05). Correlation analysis showed that the correlation between pre‑pregnancy body mass index, body mass index at 12 weeks gestation, waist circumference at 12 weeks gestation, hs‑CRP, triacylglycerol, AST, TSH, free T3, free T4, β‑HCG, PIGF, sFlt‑1, PAPP‑A and preeclampsia risk were obviously higher; but the correlation between each index were lower. A total of 18 models in 8 categories were constructed with the autoML model algorithm, and the neural network _L2 based on FastAI had the highest accuracy in the training set (0.963) and the validation set (0.971). The TSH, LDL‑C, PDW, waist circumference at 12 weeks of gestation, sFlt‑1, AST were more important in the model, while the free T4, total cholesterol, pregnancy times, drinking history, parity and family history of hypertension were less important indicators. The area under the ROC curve of the autoML model for predicting the risk of preeclampsia in the first trimester was significantly higher than that of the logistic regression model (0.984 vs 0.765, P= 0.002), while there was no statistical difference in the prediction accuracy of the two prediction models in the training set (P>0.05). The prediction accuracy and sensitivity of the autoML model in the test set were both significantly higher than those of the logistic regression model (99.54% vs 98.32%, 93.75% vs 75.00%, both P<0.05). Conclusions Factors such as TSH, LDL‑C, PDW, waist circumference, sFlt‑1 and AST in the first trimester of pregnancy have a certain correlation with the risk of preeclampsia. The autoML model based on the indicators of the first trimester has a high predictive value for the risk of preeclampsia. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

定量感觉检查在糖尿病周围神经病变早期筛查中的灵敏度和特异度研究

目的 探讨定量感觉检查(QST)在糖尿病周围神经病变早期筛查中的临床意义.方法 分别对100例2型糖尿病患者进行神经传导速度检查和QST,以神经传导速度检查结果阳性为诊断糖尿病周围神经病变的金标准,探讨QST用于早期筛查糖尿病周围神经病变的灵敏度和特异度.结果 100例2型糖尿病患者中.神经传导速度检查结果阳性者41例,阴性者59例;同时QST阳性者74例,阴性者26例.QST用于早期筛查糖尿病周围神经病变的灵敏度为97.56%(40/41),特异度为42.37%(25/59).结论 QST在糖尿病周围神经病变的早期筛查中灵敏度较高,但特异度较低,可作为常规肌电图的补充检查.

Abstract：

Objective To evaluate the clinical significance of quantitative sensory testing (QST) in screening diabetic peripheral neuropathy of the early stage. Methods One hundred patients with type 2 diabetes mellitus were examined by nerve conduction velocity (NCV) and QST examination. With the NCV positive as the gold criterion for screening diabetic peripheral neuropathy of the early stage, the sensitivity and specificity of QST was further analyzed for diagnosis of the early stage diabetic peripheral neuropathy. Results Among the 100 patients with type 2 diabetes mellitus,there were 41 cases positive and 59 cases negative in NCV examination. On the other hand,there were 74 cases positive,and 26 cases negative in QST. The sensitivity and specificity of QST for the diagnosis of early stage diabetic peripheral neuropathy was 97.56% (40/41) and 42.37% (25/59). Conclusions In the screening of early stage diabetic peripheral neuropathy,QST shows higher detection sensitivity,but lower specificity than NCV examination. Therefore, QST may be an examination for the supplement of the routine electromyography.     

Analysis of indicators related to visceral fat index based on the random forest modelCSCD

Objective To explore indicators related to visceral fat index by constructing a random forest model. Methods In this cross‑sectional study, the laboratory measures and body composition analysis records of 617 hospital employees (in‑service and retired) who underwent physical examination in Heilongjiang Provincial Hospital Health Management Center from March to September 2021 were selected. The subjects were divided into a training set (n=411) and a test set (n=206) with the ratio of 2∶1. A total of 110 predictors were included in the model. The model was constructed with the training set and was evaluated with the test set. The optimal number of nodes and decision trees were selected to evaluate the prediction performance of the optimal model. And the top 10 relatively important factors were selected for further investigation. The 617 participants were further divided in to groups according to the visceral fat index: the normal or high visceral fat index group, and the differences of the top 10 relatively important factors were further compared between the two groups. Results The optimal number of nodes of the final random forest model was 39 and the number of decision trees was 300. The accuracy, precision, sensitivity and specificity of the model was 83.3%, 73.9%, 89.4% and 78.7%, respectively. The area under the receiver operating characteristic curve and 95% confidence interval of the model was 0.881 (0.832-0.931). The top 10 relatively important factors in the model were body mass index, gender, age, serum uric acid, red blood cell count, monocyte cell count, C‑peptide, carcinoembryonic antigen, glycosylated hemoglobin and glutamyl transpeptidase. There were significant differences in the up‑mentioned 10 indicators between the subjects with normal and high visceral fat index (all P<0.05). Conclusions The random forest model built in this study has good performance in predicting visceral fat index, and visceral fat is related with changes in liver function, pancreas function and immune function. © 2022 Chinese Medical Journals Publishing House Co.Ltd     

重组结核分枝杆菌16ku-38ku-ESAT-6融合蛋白的血清学评价

目的 以重组结核分枝杆菌16 ku-38 ku-ESAT-6融合蛋白(以下简称重组蛋白)为包被抗原,探讨该抗原对结核病的诊断价值.方法 结核组105例、对照组45例(包括非结核病患者25例及健康体检者20例),以重组蛋白作为包被抗原,采用酶联免疫吸附试验(ELISA)检测150例受检者血清中的重组蛋白抗体水平,得出各组之间的吸光度值及阳性率,并与结核分枝杆菌抗体胶体金法诊断试剂盒的检测结果进行比较,以此来评价重组蛋白对结核病的诊断价值,并建立受试者工作特征(ROC)曲线评价系统.结果 重组蛋白检测对照组的阳性率为6.67%(3/45),与试剂盒检测阳性率[51.11%(23/45)]比较差异有统计学意义(P＜0.01),结核组阳性率为59.05%(62/105),与试剂盒检测阳性率[64.76%(68/105)]比较差异无统计学意义(P＞0.05).结核组与对照组的吸光度值分别为2.22±0.58、1.35±0.24,两组比较差异有统计学意义(t=6.06,P＜0.01);重组蛋白检测结核病的敏感度、特异度、阳性预测值及阴性预测值分别为59.05%、93.33%、95.38%、49.41%.应用ROC曲线分析,得出曲线下面积为0.751,cutoff值为2.52,此时敏感度及特异度分别为65.4%、84.8%.结论 重组蛋白检测血清结核抗体具有较高的特异度,可以更好地区分结核病患者群与非患者群,可以作为结核病诊断的备选抗原之一.

Abstract：

Objective To investigate the diagnostic value of 16 ku-38 ku-ESAT-6 protein in tuberculosis (TB). Methods ELISA was used for measuring the level of recombinant 16 ku-38 ku-ESAT-6 protein in 105 TB patients (TB group,26 patients with smear-positive, 79 patients with smear-negative) and 45 controls (control group, 20 healthy volunteers and 25 subjects with pulmonary diseases other than TB). The value of the antigen for diagnosis of TB in serodiagnosis was assessed, and ROC curve evaluation system was established. Results In control group, the positive rate of anti-recombinant 16 ku-38 ku-ESAT-6 protein and commercialization of TB antibody test kit had significant difference [6.67% (3/45) vs. 51.11% (23/45)](P＜0.01);but in TB group, there was no significant difference [59.05%(62/105) vs. 64.76% (68/105)](P＞0.05). The optical density value in TB group and control group was 2.22 ± 0.58 and 1.35 ± 0.24,and there was significant difference(t = 6.06,P＜ 0.01). The sensitivity, specificity, positive predictive value and negative predictive value of the test was 59.05%,93.33%,95.38%,49.41% respectively. Analyzed by ROC curve, the area under the curve was 0.751, the- value of cutoff was 2.52, and sensitivity and specificity was 65.4% and 84.8%. Conclusions Recombinant 16 ku -38 ku -ESAT-6 protein of mycobacterium tuberculosis has higher specificity, and it can significantly distinguish TB and non-TB. So it might be selected as one of diagnosis antigens of TB.     

血栓前体蛋白在急性缺血性脑血管病早期诊断中的价值

Objective To study the value of thromhus precursor protein(TpP)in early diagnosis of acute ischemic cerebrovascular disease.Methods The patients who showed completely or partly anterior circulation infarcts syndrome and were within 6 hours from onset on admission were observed dynamically.All patients were divided into thrombotic cerebral infarction(TCI)group(40 cases),transient ischemic attack (TIA)group(42 cases), and lacunar infarction(LI)group(37 cases).Concentrations of TpP in plasma obtained from three groups on admission were detected by enzyme linked immunosorbent assay(ELISA),then were compared with each other.The diagnostic value of plasma TpP to TCI within 6 hours from onset was analyzed with ROC curve.Results The level of TpP in TCI,TIA and LI group was(24.43±3.21),(15.51±2.65)and(13.52±5.45)mg/L respectively,and was significantly higher than that of healthy people (3.9±2.5)mg/L(P<0.01).The level of TpP was significantly higher in TCI group than that in TIA and LI group(P<0.01).The level of TpP was significantly higher in TIA group than that in LI group(P<0.01).The area under ROC curve for TpP to diagnose TCI was 0.979±0.013(P<0.01).The level of TpP on optimal cutoff was 19.1 mg/L.When the level of TpP was over 19.1 mg/L,TCI was determined with 95% sensitivity and 96%specificity, sum of which was largest of all.Conclusion The level of TpP can differentiate TCI from TIA and LI within 6 hours from onset.     

脑电生物反馈治疗儿童注意缺陷多动障碍疗效观察

目的:探讨脑电生物反馈治疗注意缺陷多动障碍(ADHD)儿童的疗效。方法:对38例年龄7～15岁ADHD儿童进行脑电生物反馈治疗20次,治疗前后进行临床症状评估和认知功能测试,并与正常儿童比较。结果:治疗后与治疗前比较,ADHD儿童的多动因子、多动指数明显改善(P<0.05);短时记忆、Stroop色测验、词义干扰时、数字划消第1、第2段净分和CPT测试的漏按率明显改善(P<0.05),其中短时记忆、数字划消第1、第2段净分、漏按率达到正常对照水平(P>0.05)。结论:脑电生物反馈治疗后,ADHD儿童的认知功能和临床症状部分改善,其中部分认知测试达到正常水平。     

儿童注意缺陷多动障碍视听整合连续性行为测试的应用评价

目的:研究儿童注意缺陷多动障碍(ADHD)视听整合连续性行为测试(IVA-CPT)的临床应用。方法:采用1∶1配对病例对照研究评价IVA-CPT诊断儿童ADHD的应用价值。结果:在100例ADHD儿童中,以注意缺陷为主型占44.0%,以多动冲动为主型占14.0%,混合型占42.0%。病例组综合反应控制商数和综合注意力商数分别为82.71±20.01和67.93±17.17,对照组为107.37±10.57和106.03±10.34,两组间具有非常显著性差异(P<0.001)。结论:IVA-CPT是一种对儿童ADHD具有诊断价值的客观检查方法。     

韦氏儿童智力量表第四版在注意缺陷多动障碍儿童智力结构分析中的应用

【目的】 探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童在韦氏儿童智力量表第四版(Wechsler Intelligence Scale for Children-The Fourth Vision,WISC-IV)测试中的智力结构特征。 【方法】 按照美国《精神障碍诊断和统计手册》第四版(Diagnostic and Statistical Manual,Vision IV,DSM-IV)诊断标准确诊的ADHD儿童55名,按性别匹配以系统抽样的方法收集正常儿童55名作为对照组。使用WISC-IV测量ADHD儿童和正常儿童的智力分布和结构特点并进行比较。 【结果】 ADHD儿童的总智商及四个合成指数的得分均较正常儿童低,差异有统计学意义(P<0.05);各分测验上ADHD儿童的积木、背数、图画概念、字母排序、矩阵推理和符号检索等分测验的得分较对照组低,差异具有统计学意义(P<0.05)。 【结论】 WISC-IV应用于ADHD儿童的临床诊疗工作中,显示出一定的优势和特点,提示在临床工作中可以进行针对性的辅导和训练。     

实时剪切波弹性成像定量评价肥胖儿童脂肪肝的价值

目的 探讨实时剪切波弹性成像(SWE)在定量评价肥胖儿童脂肪肝中的价值,为肥胖儿童脂肪肝的早期诊断、干预和治疗提供更多依据。方法 选取2018年4月-2020年4月西安交通大学第二附属医院儿童青少年肥胖门诊就诊的331例肥胖脂肪肝儿童(脂肪肝组)及100例正常儿童(对照组),以临床诊断为参考标准,分别对两组儿童应用实时剪切波弹性成像测量其肝脏的剪切波速度(SWV)及杨氏模量值(EI),比较两组间的差异,绘制ROC曲线,确定肥胖儿童脂肪肝的最佳诊断界点值。并记录受检儿童一般资料,收集相关血液生化检测结果,比较肥胖脂肪肝儿童SWV值和EI值与临床指标的相关性。结果 肥胖脂肪肝儿童组与正常儿童组在年龄、身高以及丙氨酸转氨酶方面的差异无统计学意义(P>0.05);而在体重、体重指数、腰臀比、血清总胆固醇、甘油三酯方面的差异有统计学意义(t＝3.681、4.010、4.587、3.562、7.015,P<0.05)。脂肪肝组SWV测值为(1.83±0.24)m/s,显著高于对照组(1.01±0.19)m/s,通过绘制ROC曲线确定肥胖儿童脂肪肝SWV的最佳诊断界点值为1.35m/s,灵敏度0.94,特异度0.81,ROC 曲线下面积0.932;脂肪肝组EI测值为(7.11±0.39) kPa,显著高于对照组(5.94±0.26) kPa,通过绘制ROC曲线确定肥胖儿童脂肪肝EI的最佳诊断界点值为6.32 kPa,灵敏度0.96,特异度0.72,ROC曲线下面积0.879。肥胖脂肪肝儿童SWV值和EI值均与体重、体重指数、腰臀比、总胆固醇、血清甘油三酯呈正相关(r_SWV=0.401、0.450、0.488、0.352、0.697, r_EI=0.377、0.463、0.501、0.331、0.611,P<0.05)。结论 实时剪切波弹性成像能够准确无创的定量评价肥胖儿童的脂肪肝情况,对肥胖儿童脂肪肝的早期诊断、干预和治疗具有重要的意义。     

实时剪切波弹性成像定量评价肥胖儿童脂肪肝的价值

目的 探讨实时剪切波弹性成像(SWE)在定量评价肥胖儿童脂肪肝中的价值,为肥胖儿童脂肪肝的早期诊断、干预和治疗提供更多依据。方法 选取2018年4月-2020年4月西安交通大学第二附属医院儿童青少年肥胖门诊就诊的331例肥胖脂肪肝儿童(脂肪肝组)及100例正常儿童(对照组),以临床诊断为参考标准,分别对两组儿童应用实时剪切波弹性成像测量其肝脏的剪切波速度(SWV)及杨氏模量值(EI),比较两组间的差异,绘制ROC曲线,确定肥胖儿童脂肪肝的最佳诊断界点值。并记录受检儿童一般资料,收集相关血液生化检测结果,比较肥胖脂肪肝儿童SWV值和EI值与临床指标的相关性。结果 肥胖脂肪肝儿童组与正常儿童组在年龄、身高以及丙氨酸转氨酶方面的差异无统计学意义(P>0.05);而在体重、体重指数、腰臀比、血清总胆固醇、甘油三酯方面的差异有统计学意义(t＝3.681、4.010、4.587、3.562、7.015,P<0.05)。脂肪肝组SWV测值为(1.83±0.24)m/s,显著高于对照组(1.01±0.19)m/s,通过绘制ROC曲线确定肥胖儿童脂肪肝SWV的最佳诊断界点值为1.35m/s,灵敏度0.94,特异度0.81,ROC 曲线下面积0.932;脂肪肝组EI测值为(7.11±0.39) kPa,显著高于对照组(5.94±0.26) kPa,通过绘制ROC曲线确定肥胖儿童脂肪肝EI的最佳诊断界点值为6.32 kPa,灵敏度0.96,特异度0.72,ROC曲线下面积0.879。肥胖脂肪肝儿童SWV值和EI值均与体重、体重指数、腰臀比、总胆固醇、血清甘油三酯呈正相关(r_SWV=0.401、0.450、0.488、0.352、0.697, r_EI=0.377、0.463、0.501、0.331、0.611,P<0.05)。结论 实时剪切波弹性成像能够准确无创的定量评价肥胖儿童的脂肪肝情况,对肥胖儿童脂肪肝的早期诊断、干预和治疗具有重要的意义。     

基于近红外光谱的注意缺陷多动障碍患儿前额叶皮质功能研究

目的 分析基于近红外光谱成像的注意缺陷多动障碍(ADHD)患儿的前额叶皮质功能,为ADHD的脑功能分析提供参考依据.方法 选取2019年7月-2020年2月就诊于上海市儿童医院儿童保健科ADHD门诊及体检门诊的各100名儿童,由家长填写ADHD评估量表和人口学资料,临床医师进行综合访谈和体格检查,治疗师进行韦氏智力测试...     

中文版Hammersmith婴儿神经学检查量表的信度和效度

目的 检验中文版Hammersmith 婴儿神经学检查量表(HINE)婴儿神经学检查量表的信度和效度。方法 将符合《中国脑性瘫痪康复指南(2015)》脑瘫高危儿诊断2月~1岁的59例患儿(胎龄32~36周和胎龄37~42周)和年龄相匹配的30例正常儿童进行中文版HINE评价。以三组间HINE总分和各因子评分比较确定区分效度;以脑瘫高危儿临床诊断为金标准,以ROC方法确定界限分及灵敏度、特异度;每组随机抽取10例由同一医师在首次检查后1周再次进行检查评估,以检测重测信度;每组随机抽取10例由两组评估医师同时进行HINE的检查和计分,以检测评分者信度。结果 早产脑瘫高危儿组、足月脑瘫高危儿组的量表总分和5个分项目评分均低于正常对照组,差异具有统计学意义(P＜0.01);早产脑瘫高危儿组ROC曲线的线下面积为0.95,界限分为21分时灵敏度0.97,特异度0.93;足月脑瘫高危儿组ROC曲线的线下面积为0.93,界限分为26分时灵敏度0.97,特异度0.95,两组的灵敏度、特异度均≥0.9;量表总分评分者信度组内相关系数(ICC)＞0.8,5个分项目评分者信度ICC＞0.7;该量表总分和5个分项目重测信度r＞0.8。结论 中文版HINE的效度、信度较好,灵敏度、特异度较高,可用于2月~1岁脑瘫高危儿的临床筛查。     

注意缺陷多动障碍儿童睡眠状况的病例对照研究

目的 研究兰州市5~13岁正常儿童和注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)合并睡眠障碍儿童及其血清中促睡眠肽(human delta sleep-inducing peptide,DSIP)的指标进行分析总结。以便实施早期干预治疗的措施。 方法 随机抽取兰州市5个小学和2个幼儿园,对5~13岁的1 100名儿童进行ADHD简化的康奈尔儿童行为量表及睡眠问题的问卷初筛调查,并进行评估打分确定多动指数(Conner's Abbreviated Symptom Questionnaire,ASQ)≥15分为疑似ADHD。由指定的专业技术医师根据美国精神病协会制定的诊断DSM-Ⅳ(1991)标准,进行鉴定确诊。最后测定样本血清DSIP等指标。 结果 1)ADHD组并存的睡眠问题明显高于正常组(P＜0.001),两者有明显的相关性;2)ADHD观察组和正常对照组两组血清中的DSIP 指标分别为:112.12±8.50;338.64±526.02;差异有统计学意义(P=0.019);3)对ASQ与DSIP、常见睡眠问题及学习成绩的相关性采用Pearson分析,结果发现:DSIP与 ASQ呈负相关(P＜0.001);睡眠问题越多的儿童ASQ就越高并且与儿童的学习成绩呈负相关(P＜0.001)。 结论 ADHD的儿童存在着血清DSIP分泌不足的情况,并存着不同程度的睡眠问题,影响学习成绩。     

Sustained performance and regulation of effort in clinical and non-clinical hyperactive children

OBJECTIVE: To study sustained performance and its relation to regulation of effort among four different groups of children: two clinical subgroups of children diagnosed with attention-deficit hyperactivity disorder (ADHD)--one with and one without comorbid oppositional defiant disorder (ODD); a control sample of children without a diagnosis of ADHD but with parental reports of hyperactivity; and a normal control sample. METHODS: Sustained performance was studied (n=64) using a choice reaction time task with long interstimulus intervals, and hyperactive behaviour and regulation of effort was rated throughout the task. RESULTS: The clinical sample differed from the normal controls regarding all measures of overall, but not initial, performance. When studying performance over time, the ADHD group was shown to differ from the normal controls with regard to omissions, mean reaction time and regulation of effort. No significant differences were found between the ADHD children with or without comorbid ODD. The non-clinical hyperactive children differed from the normal controls with regard to reaction time, initially and overall, and regulation of effort overall. CONCLUSIONS: Deficits in sustained performance among ADHD children appear to be evident when long interstimulus intervals are used, and these deficits are related to poor regulation of effort. Further, the observed differences between ADHD children and normal controls do not appear to be a result of comorbid conduct problems. The non-clinical hyperactive children were more similar to the control group than to the ADHD group.     

两种持续性操作测试诊断注意缺陷多动障碍的临床应用

目的:探讨视听持续性操作测试(TOVA)和整合视听连续执行测试(IVACPT)在诊断儿童注意缺陷多动障碍(ADHD)中的应用价值。方法:对门诊疑似ADHD的267例儿童采用精神障碍诊断与统计(DSM-IV)标准进行诊断,分别对152例进行TOVA,115例进行IVACPT,比较两组检测结果并与DSM-IV标准比较。结果:TOVA和IVACPT对ADHD的阳性检出率分别是81.08%和95.24%,都与DSM-IV诊断结果具有相关性,TOVA检测与DSM-IV诊断差异有统计学意义,IVACPT检测与DSM-IV诊断差异无统计学意义。IVA的敏感度显著高于TOVA。结论:IVACPT和TOVA对ADHD的诊断都具有客观的应用价值,IVACPT优于TOVA,对临床诊断ADHD有极高价值。