低分子肝素钙治疗川崎病患儿高凝状态的疗效分析

川崎病（Kawasaki disease，KD）患儿的血液呈高凝状态，其程度常与血管炎病变的严重性和活动性相平行，常影响疾病的预后，预防和治疗高凝状态是治疗川崎病的重要措施。低分子肝素钙有强大的抗凝作用，近年来用于辅助治疗原发性肾病综合征、紫癜性。肾炎等疾病，取得了良好的疗效，本研究观察78例川崎病患儿应用低分子肝素钙（LMWH）治疗的疗效，现报告如下。     

小剂量肝素钙治疗小儿原发性肾病综合征疗效评价

目的 探讨小剂量肝素钙在小儿原发性肾病综合征中的治疗作用。方法：对82例原发性肾病综合征合并高凝状态的患儿进行前瞻性研究,所有患儿均常规服用泼尼松每日2 mg/kg (最大量<60 mg/d),其中52例患儿为肝素钙治疗组(每日50 IU/kg,静脉点滴4周),另外30例为对照组。结果：治疗组尿蛋白转阴率与对照组差异无显著性(P>0.05)。尿蛋白转阴病例中,治疗组尿蛋白转阴时间明显短于对照组［(13.08±4.75) d vs (19.33±4.48) d］(P<0.01),开始利尿时间亦明显少于对照组［(9.64±2.65) d vs (17.07±3.99) d］(P<0.01)。治疗组血纤维蛋白原恢复正常率明显高于对照组(93.3% vs 65.4%)(P<0.05)。治疗组尿FDP恢复正常率与对照组差异无显著性(P>0.05)。结论：小剂量肝素钙不能提高原发性肾病综合征患儿尿蛋白转阴率,但可缩短诱导缓解时间,增强利尿效果,且小剂量肝素钙抗凝作用明显。     

黄芪注射液加肝素治疗肾病综合征高凝状态

目的探讨黄芪注射液加肝素在儿童肾病综合征(NS)高凝状态治疗中的作用。方法NS高凝状态患者72例随机分为治疗组和对照组各36例。二组在常规利尿、抗感染、控制血压的同时,均口服足量泼尼松2mg/(kg·d),治疗组予黄芪注射液20mL及肝素100IU/kg加入100g/L葡萄糖液200mL中静脉滴注,1次/d,疗程2～4周,治疗后抽血复检高凝指标。结果治疗组治疗10dPLT计数、纤维蛋白原(Fbg)均降至正常,凝血酶原时间(PT)在正常范围,尿蛋白消失时间(8.9±4.1)d;对照组均在2周以上恢复正常,且尿蛋白消失时间为(12.8±6.2)d。结论黄芪注射液加肝素的治疗NS高凝状态对缩短疗程、减少复发、防治血栓形成等具有重要意义,抗凝疗法可作为NS的常规方案之一。     

低分子肝素治疗儿童原发性肾病综合征高凝状态疗效观察

目的 研究低分子肝素对初发的原发性肾病综合征伴高凝状态的疗效.方法 初发的原发性肾病综合征伴有高凝状态患儿36例,随机分为治疗组和对照组,两组患儿均在开始正规激素治疗的基础上采用抗凝治疗,治疗组给予低分子肝素钙60～100u/(kg·d)皮下注射,连用2周,同时潘生丁2～3 mg/(kg·d)口服3～6个月;对照组只给予潘生丁2～3 mg/(kg·d)口服,3～6个月.两组患儿均至少随访6周.结果 抗凝治疗前两组患儿血小板(PLT)、凝血酶原时间(PT)、部分活化凝血酶时间(APTT)、血浆纤维蛋白原(FB)和血浆D-二聚体(DD)水平差异均无显著性(P＞0.05).治疗1周时治疗组血浆FB和DD明显低于对照组(P＜0.01),治疗2周时两组血浆FB和DD较治疗前均有明显下降,但治疗组血浆FB下降更为明显,两组之间差异有非常显著性(P＜0.01),DD浓度在两组间差别已无显著性(P＞0.05),治疗1周和2周时PLT、PT、APTr在两组间差异均无显著性(P＞0.05).治疗组患儿蛋白尿完全缓解时间(10.15±2.54)d,明显低于对照组(15.06±5.63)d,差异有非常显著性(P＜0.01).结论 短期低分子肝素治疗能够有效缓解原发性肾病综合征的高凝状态,并且对血小板浓度和凝血时间无明显影响,对于初发的激素敏感型肾病患儿可缩短蛋白尿完全缓解所需的时间.     

多靶点免疫抑制治疗儿童难治性肾病综合征的疗效及安全性

目的探讨应用吗替麦考酚酯联合雷公藤多苷多靶点免疫抑制治疗儿童难治性肾病综合征的疗效及安全性。方法 32例难治性原发性肾病综合征患儿,在综合治疗基础上给予吗替麦考酚酯25 mg/(kg.d)、雷公藤多苷1 mg/(kg.d)口服治疗,同期选取30例应用环磷酰胺冲击治疗和27例只应用吗替麦考酚酯的难治性肾病综合征患儿作为对照。治疗期间严密观察各组不良反应的发生,治疗6个月时分别测定比较患儿的24 h尿蛋白定量、血清白蛋白、血肌酐。结果多靶点免疫抑制组患儿24 h尿蛋白均有下降,其中24例尿蛋白<0.5 g/24 h,血清白蛋白恢复正常,肾功能正常,总有效率为75%,与环磷酰胺冲击组及单独应用吗替麦考酚酯组比较,疗效差异有统计学意义(P<0.05)。多靶点免疫抑制组不良事件发生率与环磷酰胺冲击组及单独应用吗替麦考酚酯组之间的差异无统计学意义(P>0.05)。结论吗替麦考酚酯联合雷公藤多苷多靶点免疫抑制治疗儿童难治性肾病综合征有较好的疗效及安全性。     

小剂量肝素治疗肾病综合征高凝状态

肾病综合征（NS）存在高凝状态是产生肾病血栓栓塞的重要因素。因此，及时处理肾病高凝状态有其重要意义［1］。我们应用小剂量肝素治疗肾病综合征高凝状态52例，现报告如下。资料与方法一、临床资料：我院肾脏内科自1995年1月至1997年10月共收治NS148例，选择具有高凝状态的52     

水蛭治疗原发性肾病综合征高粘滞血症

运用中西医结合方法观察水蛙治疗原发性肾病综合征（简称肾病）患儿高粘滞血症的疗效，检测其血液流变学改变、血小板及血浆血栓烷Ａ＿２（ＴｘＡ＿２）、前列环素浓度。结果表明，无论单纯性肾病或肾炎性肾病的高粘滞血症，水蛭加泼尼松治疗组与单独泼尼松治疗组相比，血浆粘度恢复正常无数、尿蛋白消失天数及水肿消失天数均明显减少。单纯性肾病或肾炎性肾病与对照组相比，３．８／ｓ、９．６／ｓ、１９．２／ｓ、３８．３／ｓ、７６．８／ｓ、１９２／ｓ、３８３／ｓ等切变率下的血液粘度、血浆比粘度、红细胞沉降率、红细胞压积、血小板计数、血小板粘附率、最大聚集率、血浆ＴｘＢ＿２浓度及ＴｘＢ＿２／６－酮－前列腺素Ｆ＿１ａ民。的比明显升高。说明肾病患儿存在高凝状态，水蛭具有治疗肾病高粘滞血症的作用。     

静脉滴注小剂量肝素治疗中重度新生儿寒冷损伤综合征疗效探讨

目的探讨静脉滴注小剂量肝素治疗新生儿寒冷损伤综合征的疗效。方法将104例中、重度新生儿寒冷损伤综合征患儿随机分为治疗组52例，对照组52例。两组均给予共同的综合性治疗措施，治疗组加用肝素静脉滴注，剂量：25～37．5u／kg，每日1～2次，疗程3～5d。观察两组临床症状、体征恢复正常时间、治愈率、病死率及肝素不良反应。结果治疗组各项临床症状、体征恢复正常时间均明显早于对照组，差异有非常显著性（P〈0．01）。治疗组治愈率高于对照组，病死率低于对照组，差异均有显著性（P〈0．05）。肝素治疗过程中未发现不良反应。结论静脉滴注小剂量肝素治疗新生儿寒冷损伤综合征可缩短疗程，改善预后，使用安全，利于临床推广应用。     

紫癜性肾炎患儿治疗前后血清D-二聚体检测的意义

目的　了解紫癜性肾炎 (HSP)患儿机体高凝状态及肝素治疗效果。方法　对 2 4例HSP患儿肝素治疗前后测定血清D 二聚体。予肝素钙皮下注射 ,剂量 10 0IU/ (kg·d) ,疗程 2～ 3周 ;同时每周查 2次尿常规 ,观察尿蛋白转阴情况。结果　HSP患儿肝素治疗前血清D 二聚体阳性率 75 % ,正常对照组 15 % ,两者比较差异有显著意义 (P <0 .0 0 5 ) ;HSP患儿肝素治疗后D 二聚体阳性率 17% ,较治疗前下降 ,两者有显著性差异 (P<0 .0 0 5 )。HSP肝素治疗组较非肝素治疗组尿蛋白转阴时间缩短 ,两者比较差异显著 (P <0 .0 1)。结论　HSP患儿体内存在高凝状态 ,肝素治疗HSP疗效确切、安全、方便 ,应做为HSP的常规用药     

小剂量肝素联合尿激酶治疗儿童原发性肾病综合征伴严重高凝状态

多数原发性肾病综合征(PNS)患儿都存在不同程度的高凝状态,应用肝素或尿激酶对PNS合并高凝状态进行治疗已为业界所公认,但临床上发现,有些患儿单用肝素或单用尿激酶疗效欠佳,由此,我们想到联合应用小剂量肝素和尿激酶治疗。本研究对     

Role of nutrients in the regulation of in vivo protein metabolism in humans

Nutrients regulate protein metabolism both in an acute fashion and on a long-term basis. The ingestion of meals is associated with a dramatic switch from an overall catabolic state to a state of net protein anabolism. The acute response of protein metabolism to meal ingestion is mediated, in part, by an increase in insulin secretion, itself a consequence of glucose absorption. Whereas insulin may primarily suppress rates of proteolysis, amino acids are responsible for the stimulation of protein synthesis that follows food intake. In the long run, the effects of nutrition on protein metabolism depend on the energy supply, the source of the energy (carbohydrate versus fat) and dietary protein intake. Finally, specific amino acids, such as glutamine, may play an additional role as protein anabolic agents.     

氨磷汀在儿童肿瘤化疗中的应用

目的研究氨磷汀在儿童肿瘤化疗中的作用及不良反应。方法随机选择肿瘤32例患儿,采用自身对照,观察患儿在同一化疗方案中使用氨磷汀辅助治疗后黏膜损伤、骨髓抑制时间、发热持续时间、抗生素及刺激因子应用时间及氨磷汀的不良反应。结果氨磷汀辅助治疗组发生黏膜溃疡4例,明显低于对照组9例;中性粒细胞<0.5×109/L持续时间缩短,血小板<5×109/L持续时间缩短;发热持续时间、抗生素和刺激因子应用时间缩短。两组化疗过程中均未出现低体温、皮疹、低血压等情况,化疗后肾功能、心电图均正常;对肝功能影响程度相似;氨磷汀组低钙血症尤其是低钙性抽搐发生率高。结论氨磷汀能够有效保护正常组织细胞,不良反应较低,可在儿童肿瘤患者化疗中应用。     

Determinants of pregnancy in adolescents in Nepal

Objective : Social factors and prevalent norms in the community determine the proportion of teenage pregnancy in the community. In the light of high risk associated with teenage pregnancy, the socio-cultural determinants, which influence the conception among teenagers in Nepal, need to be understood. These determinants may be modified by suitable interventions to reduce teenage pregnancy. Aim of this study was to examine the socio-cultural determinants of teenage pregnancy in eastern Nepal.Methods : A case-control study design was selected for comparing the education, economic status, family support and freedom towards conception among teenagers as compared to higher age group women.Result : Seventy adolescent pregnant women were compared with seventy primigravida women in the 20 to 29 years age group. The teenage pregnant women were less educated, had poor economic background, more likely to have accidental pregnancies as compared to the other group and more likely to have love marriages. Husbands were more likely to decide about continuation of pregnancy. They had less psychological and social support from the family.Conclusion : Marriage at young age and pregnancy during teens are associated with less social acceptance and poor support in the family.     

皮质激素在癫痫治疗中的应用

皮质激素在癫痫中的应用已有近50a的历史，现已证明其对某些癫痫综合征如婴儿痉挛症、Landau—Kleffner综合征、Rassmussen综合征、具有睡眠中癫痫性电持续状态的癫痫综合征等具有肯定的治疗作用，其确切的作用机制尚不清楚。在皮质激素应用过程中应注意其不良反应。     

Role of nutrients in the regulation of in vivo protein metabolism in humans

Nutrients regulate protein metabolism both in an acute fashion and on a long-term basis. The ingestion of meals is associated with a dramatic switch from an overall catabolic state to a state of net protein anabolism. The acute response of protein metabolism to meal ingestion is mediated, in part, by an increase in insulin secretion, itself a consequence of glucose absorption. Whereas insulin may primarily suppress rates of proteolysis, amino acids are responsible for the stimulation of protein synthesis that follows food intake. In the long run, the effects of nutrition on protein metabolism depend on the energy supply, the source of the energy (carbohydrate versus fat) and dietary protein intake. Finally, specific amino acids, such as glutamine, may play an additional role as protein anabolic agents.     

他汀类药物在儿童家族性高胆固醇血症治疗中的研究进展

家族性高胆固醇血症(FH)是一种常染色体显性遗传的脂质代谢障碍疾病,由于FH早期就可引起动脉粥样硬化病变,增加患者严重心血管疾病的患病风险和死亡风险,因此目前越来越强调患者自儿童期就使用他汀类药物进行治疗,以改善远期预后。文章综述他汀类药物治疗儿童FH的必要性、有效性和安全性,同时也提出目前存在的一些问题和思考。     

Diagnosis of Chlamydia pneumoniae in community-acquired pneumonia in children in Chile

The incidence of Chlamydia pneumoniae in community-acquired pneumonia in children was studied prospectively in 112 children aged 1 mo to 14 y. Diagnosis of C. pneumoniae was performed by polymerase chain reaction (PCR) on nasopharyngeal aspirates and serology by the microimmunofluorescence test on a single serum specimen. Three (2.7%) cases of pneumonia due to this agent were diagnosed by both PCR and serology. C. pneumoniae was not found in any of 62 children below 5 y of age. In the age group 5-8 y, only 1/30 (3%) was found positive, and in the age group 9-14 y, C. pneumoniae was diagnosed in 2/20 (10%) children. Conclusion: Although the number of enrolled patients is small, and the diagnostic techniques used may have some limitations, the results of this study suggest that C. pneumoniae plays a minor role in the aetiology of pneumonia in children less than 9 y of age in our country. However, it should be considered as a potential agent in pneumonia in older children.     

Efficacy of amphotericin B in multi-drug resistant kala-azar in children in first decade of life

Fifty children in the first decade of life, and suffering from multiple drug resistant kala-azar, confirmed by demonstration of amastigotes in aspirates of bone marrow or spleen were treated with amphotericin B in gradually increasing dosage to a total dose of 20 mg/kg. All patients had classical features of severe kala-azar, and had taken more than one course of antimony and pentamidine, and three patients had taken one additional course of ketoconazole besides many courses of antimony and pentamidine. The clinical response started just after first infusion in 8 patients, and the patients became afebrile. By 5th infusion, all looked better and 18 patients became afebrile. By 15th infusion all patients were afebrile and cheerful. Their spleens became smaller and body weights and total white cell counts increased. Forty eight patients had parasitological cure at the end of treatment, and only 2 patients required an additional 5 infusions for parasitological cure. All patients were ultimately cured. No one relapsed within six months of follow up. All patients had shivering, rigor and rise of temperature on the day of infusion, which could be minimized with prior administration of low dose of hydrocortisone, but could not be eliminated. Eighteen patients had loose motions during treatment, while 14 patients had decrease in appetite which improved quickly when the treatment was over. Fourteen patients had transient rise of blood urea, in six patients serum creatinine also increased and 16 patients had a minor fall in serum potassium. It is concluded that amphotericin B is a very effective drug for multidrug resistant kala-azar in children, and should be used without hesitation in all such cases in children, but under close medical supervision.     

皮质激素在癫(癎)治疗中的应用

皮质激素在癫(癎)中的应用已有近50 a的历史,现已证明其对某些癫(癎)综合征如婴儿痉挛症、landau-Kleffner综合征、Rassmussen综合征、具有睡眠中癫(癎)性电持续状态的癫(癎)综合征等具有肯定的治疗作用,其确切的作用机制尚不清楚.在皮质激素应用过程中应注意其不良反应.