降钙素原在新生儿败血症诊断中的价值

目的为探讨血清降钙索原(PCT)对新生儿败血症早期诊断及鉴别诊断的价值。方法采用免疫色谱法对98例不同程度感染的新生儿进行PCT测定。结果败血症患儿PCT阳性(≥0．5ng／ml)率95％(其中75％≥2ng／ml，1例阴性病例为血培养阳性的脓疱疹患儿，临床无炎性反应表现)，局部感染阳性率5．26％，非感染7．69％。所有上呼吸道感染患儿均阴性。新生儿PCT水平在败血症及其他感染患儿间有显著差异。结论PCT是新生儿败血症早期诊断及鉴别诊断有价值的指标。     

组织因子途径抑制物及前降钙素在新生儿败血症诊断中的价值

目的 了解组织因子途径抑制物(TFPI)、前降钙素(PCT)在新生儿败血症诊断中的价值.方法 通过检测48例败血症新生儿及30例健康新生儿血TFPI、PCT、C-反应蛋白(CRP)浓度,比较各炎症指标对诊断败血症的灵敏度、特异度、阳性预测值、阴性预测值和约登指数,评价它们对该病的早期诊断价值.结果 (1)以TFPI≥30μg/L、CRP≥8 mg/L、PCT≥2 ng/ml为阳性标准,三指标对诊断败血症的灵敏度分别为86.92%、89.83%、87.50%,差异无显著性(P＞0.05),其中PCT的特异度96.67%、阳性预测值97.50%、阴性预测值83.32%、约登指数0.84;(2)在败血症组中,20例血培养阳性患儿的TFPI值为(35.5±4.5)μg/L,28例血培养阴性患儿的TFPI值为(34.3±3.2)μg/L,差异无显著性(P＞0.05);但是相对于正常对照组(26.9±5.24)μg/L,败血症组的TFPI值明显升高(P＜0.05).结论 TFP≥30μg/L对诊断新生儿败血症是一个具有较高灵敏度(86.92%)、中度特异度(59.3%)的指标;TFPI对新生儿败血症早期诊断有一定的价值,但均不及PCT及CRP,所有检测指标中PCT特异度、阳性预测值、阴性预测值、约登指数均最高.     

血前降钙素在新生儿败血症中的应用价值探讨

目的探讨血清前降钙素(PCT)检测在新生儿败血症中的应用价值.方法对58例疑似新生儿败血症患儿采用半定量固相免疫测定法测定血清PCT水平,PCT水平分为＜0.5 ng/ml,0.5～2.0ng/ml,2.0～＜10.0 ng/ml和≥10 ng/ml4个等级,血清PCT＞0.5ng/ml为阳性阈值.结果败血症组PCT阳性44例,阳性率75.9%,对照组仅1例阳性,阳性率5.5%,两组有显著差异.结论血清PCT是新生儿败血症的重要诊断标准,可作为败血症预后判断及治疗监测的指标.     

可溶性细胞间黏附分子-1、降钙素原在新生儿败血症诊断中的价值

目的　了解可溶性细胞间黏附分子 1(sICAM 1)、降钙素原 (PCT)在新生儿败血症诊断中的价值。方法　通过检测 5 0例败血症的新生儿及 35例健康新生儿血sICAM 1、PCT、CRP浓度及WBC计数 ,比较各炎症指标对诊断败血症的灵敏度、特异度、阳性预测值、阴性预测值和准确性、约登指数 ,评价它们对诊断该病的价值。结果　 (1)以sICAM 1≥ 30 0ng/ml、CRP≥ 8mg/l、PCT≥ 2ng/ml为阳性标准 ,三指标对诊断败血症的灵敏度分别为 85 %、87 5 %、86 % ,P >0 0 5 ,差异无显著意义 ,但均高于WBC计数 (仅 30 % ,P <0 0 5 ) ,其中PCT的特异度 94 3%、阳性预测值 95 6 %、阴性预测值82 5 %、准确性 89 4 %、约登指数 80 3% ;(2 )sICAM 1浓度在治疗前后差异无显著意义 ,P >0 0 5 ;CRP浓度在两组差异有显著意义 ,P <0 0 5 ;PCT在恢复期全部转阴 ;(3)sICAM 1与CRP呈正相关 ,r =0 339,P <0 0 1;PCT与sICAM 1、CRP浓度的等级相关系数分别为 0 5 6 9、0 4 82 (P <0 0 1)。结论　sICAM 1≥ 30 0ng/ml对于诊断新生儿败血症是一个具有较高灵敏度 (85 % )、中度特异度 (5 4 3% )的指标 ;所有检测指标中PCT特异度、阳性预测值、阴性预测值、准确性、约登指数最高     

降钙素原及C-反应蛋白联合检测在新生儿院内感染早期诊断中的意义

目的：新生儿败血症的早期缺乏特异的临床表现,极易误诊和漏诊,本文通过对新生儿血清降钙素原(procaicltonin,PCT)和C-反应蛋白(C-reactive protein,CRP)水平进行动态监测,阐明联合应用PCT及CRP检测在新生儿院内感染早期诊断中的临床价值。方法采用回顾性分析方法,选取2013年6月至2014年8月中国医科大学附属盛京医院第一新生儿科收治的患儿111例,其中确诊败血症组37例,临床败血症组42例,对照组32例(同期住院的非感染患儿)。败血症组在感染发生时(抗生素治疗前),感染发生(抗生素治疗后)12h、24h,感染控制后3d、7d,对照组在入院后应用抗生素前分别采集血清,采用酶联荧光分析法定量测定PCT、免疫比浊法测定CRP水平。结果与对照组比较, PCT、CRP含量在确诊败血症组和临床败血症组于抗生素治疗前均明显增高(P﹤0.01)。在确诊败血症组和临床败血症组,PCT 于感染发生后12h 达峰值[分别为(15.00±15.51)ng/ml 和(17.93±13.44)ng/ml],感染控制后3d降至正常[分别为(0.49±0.47)ng/ml和(0.42±0.34)ng/ml],CRP于感染发生24h后达峰值[分别为(37.53±30.29)mg/L和(32.41±29.33)mg/L],7d后降至正常[分别为(5.72±2.98)mg/L和(5.06±3.07)mg/L]。当PCT﹥2ng/ml、CRP﹥10mg/L时准确性最好(约登指数分别为76.11%,59.45%),其敏感性分别为88.61%,75.70%;特异性分别为87.5%,83.75%;阳性预测值分别为94.59%,95.65%;阴性预测值分别为75.68%,46.15%。联合检测PCT与CRP时,各诊断效率指标均明显改善。二者受试者工作特征曲线下面积分别为0.964,0.887。结论在感染早期时,CRP和PCT均升高,当CRP﹥10mg/L,PCT﹥2ng/ml时诊断准确性好。但前者在感染后24h达峰值,7d降至正常,而后者在感染后12h达峰值,感染控制后3d恢复正常,联合检测PCT及CRP可提高检测的敏感度、特异度,准确性最佳。     

血前降钙素在新生儿败血症中的应用价值探讨

目的 探讨血清前降钙素(PCT)检测在新生儿败血症中的应用价值。方法 对58例疑似新生儿败血症患儿采用半定量固相免疫测定法测定血清PCT水平,PCT水平分为<0.5 ng/ml,0.5-2.0 mg/ml,2.0-<10.0 ng/ml和≥10 mg/ml 4个等级,血清PCT>0.5 ng/ml为阳性阈值。结果 败血症组PCT阳性44例,阳性率75.9％,对照组仅1例阳性,阳性率5.5％,两组有显著差异。结论 血清PCT是新生儿败血症的重要诊断标准,可作为败血症预后判断及治疗监测的指标。     

核因子-κB及血清降钙素原与新生儿败血症相关性研究

目的探讨核因子-κB(NF-κB)及血清降钙素原(PCT)与新生儿败血症的关系。方法选择我科2008年10月至2010年10月住院的败血症新生儿为败血症组,血培养阴性、确诊感染的病例为普通感染组,同期收住的非感染性疾病新生儿20例为对照组。败血症组患儿分别于入院时和入院后7天,普通感染组和对照组于入院时采集静脉血检测外周血单个核细胞(PBMC)中NF-κB表达和血清PCT水平,所得数值进行组间比较。结果败血症组(29例)NF-κB表达及PCT水平在入院时明显高于入院后7天、普通感染组(26例)及对照组[NF-κB:(19.1±2.4)%比(6.9±2.0)%、(12.7±2.7)%、(4.8±2.1)%,PCT:(20.0±3.0)ng/ml比(1.8±2.1)ng/ml、(11.8±4.1)ng/ml、1.7±0.7)ng/ml,P均<0.05];普通感染组高于对照组和败血症组入院后7天,差异有统计学意义(P均<0.05);对照组与败血症组入院后7天比较差异无统计学意义(P>0.05)。结论 NF-κB和PCT是早期诊断新生儿败血症较好的实验室指标,动态监测其变化可以判断临床疗效。     

降钙素原在新生儿感染中的应用价值

目的为进一步提高新生儿重症感染的早期诊断率 ,探讨一种快速可靠的方法。方法对以新生儿感染为诊断收入我院新生儿科 (包括NICU)的71例新生儿进行降钙素原 (PCT)的测定 ,并与C反应蛋白 (CRP)进行比较 ,将患儿分为重症感染、一般感染和非感染3组进行分析。结果重症感染组PCT阳性率89.29 % ,一般感染组PCT阳性率54.55 % ,非感染组PCT阳性率9.52 % ,重症感染组PCT阳性率明显高于其他两组 ,3组间PCT值差异有极显著性 (P<0.001)。以0.5ng/ml为临界值,PCT诊断重症感染的敏感度为89.29 %,特异度为67.44 %;以2ng/ml为临界值,诊断重症感染的敏感度为71.43,特异度为90.70 %。与CRP相比 ,PCT诊断感染特别是重症感染的敏感性、特异性更高。结论细菌感染时血清PCT水平会升高 ,特别是全身性重症细菌感染时其升高尤为明显 ,可作为新生儿感染的早期检测指标 ,与CRP相比 ,PCT较其优越性更明显 ,特别对新生儿重症感染如败血症等诊断更有价值。     

不同时段血清降钙素原浓度对新生儿早发细菌感染的诊治价值

目的：评估出生早期不同时段血清降钙素原(procalcitonin,PCT)对新生儿早发细菌感染的诊断和治疗价值。方法将195例有宫内感染高危因素的新生儿根据感染结局分为细菌感染组24例及非感染组171例,测定出生2h内,6~12h,12~36h及大于48h新生儿血清PCT、C-反应蛋白(C-reactive protein,CRP)及外周血白细胞含量,分析不同时段PCT诊断早发感染的敏感度、特异度,及其对疗效的判断。结果出生2h内细菌感染组PCT、CRP及白细胞阳性率比较差异均无统计学意义(P﹥0.05);出生6~12h当PCT以2ng/ml为阈值时,其诊断细菌感染的敏感度为91.7%,特异度为86.5%,较CRP及白细胞具有更高的敏感度;出生12~36h是PCT的生理性高峰期,不同阈值的PCT均不能同时有较高的敏感度及特异度,当PCT以0.5ng/ml、2ng/ml以及10ng/ml为阈值时,其敏感度分别为100%、91.7%及75.0%,特异度分别为5.8%、53.8%及95.9%。结论出生6~12h测定PCT,并且以2ng/ml为阈值时,对诊断早发细菌感染有较高的敏感度及特异度,尽量避开PCT的生理性高峰期(出生12~36h)测定PCT浓度,该时期诊断细菌感染的PCT阈值尚需进一步探讨。     

降钙素原及超敏C反应蛋白在新生儿败血症诊断中的价值

目的 探讨降钙素原(procalcitonin,PCT)、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、红细胞沉降率、白细胞计数及中性粒细胞杆状核/分叶核(I/T)比值的测定在新生儿败血症早期诊断中的价值.方法 选取患有败血症的新生儿(42例)和同时期在同病区收治的非感染性疾病患儿(42例,对照组),采集败血症患儿静脉血测定其治疗前的PCT、hs-CRP、红细胞沉降率、白细胞计数及I/T比值,并与对照组进行比较.结果 败血症组PCT、hs-CRP与对照组比较差异有统计学意义(P＜0.05),红细胞沉降率、白细胞计数及I/T比值与对照组相比差异无统计学意义(P＞0.05).PCT诊断新生儿败血症时的临界值为0.5 ng/ml,此时敏感度为73.8％,特异度为80.9％.hs-CRP诊断新生儿败血症的临界值为3 mg/dl,此时敏感度为54.8％,特异度为76.2％.PCT联合hs-CRP在诊断新生儿败血症时敏感度为85.7％,特异度为88.1％.结论 PCT及联合检测PCT、hs-CRP对新生儿败血症的早期诊断具有一定价值,PCT是诊断新生儿败血症价值较高的指标.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Psychopathologie du syndrome d’Asperger et « aspérigisation » de la société contemporaine

The author has attempted here to point out, just for a start, the characteristics of Asperger syndrome from the point of view of psychopathology through a rereading of Hans Asperger's original paper (1944). This thesis merits reevaluation, if for no other reason than to fill the gaps in operational diagnostics based on the DSM. It is found by rereading that Asperger's view of the principal disturbances of autistic psychopathy include a “disturbance of natural evidence” or a “crisis of common sense”. This question of natural evidence that he evokes with regard to autistic psychopathy corresponds to W. Blankenburg's natural evidence, which constitutes a key concept for comprehending schizophrenia in the form poor-symptom (“symptomarme Schizophrenie”) that he observes in the speech of his patient Anne Rau. One can deduce from this that in terms of fundamental disturbances, Asperger syndrome and this “symptom-poor” schizophrenia overlap at the level of loss of natural evidence. It is moreover possible to classify Asperger syndrome among the disturbances of spacing in the sense meant by the evolutionary psychiatry of A. Stevens and J. Price. The author then develops our comprehension of Asperger syndrome from the point of view of the perspective proposed by the notion of resilience in people with Asperger syndrome and of the possibility for them, through these mechanisms of adaptation, to find in the organization of the personality of the “as if” type a position of relative equilibrium. They concur or overlap in the creation of crutches, of borrowed personalities secondarily legitimated by the reaction of the socius. This will end up in the production of inventions and œuvres (works). Clearly, one rarely encounters several cases that one could consider pertinently to be “successful” Asperger syndrome. Finally, the author notes that one can find a sort of isomorphism between Asperger syndrome and contemporary society when he proposes the term “asperigisation” to characterize our society, given that the equilibrium between emotion and logic is strongly disturbed in these patients, in whom logic undergoes hypertrophy while emotion is impoverished. From this perspective, the author hopes to suggest reasons for the increase in the number of cases of Asperger syndrome in the clinical setting and in society in general in our contemporary era.     

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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.