单纯性肥胖儿童血管内皮分泌功能和内皮依赖性舒张功能障碍的 …

目的 观察肥胖儿童早期血管内皮功能改变的特点。方法 收集７～１４岁单纯性肥胖儿童与正常对照儿童各４０例,分别测定其血浆内皮素（ＥＴ）、６－酮前列环素（６－Ｋ－ＰＧＦ１α）及血清一氧化氮（ＮＯ）水平,并采用高分辨率多普勒超声测定肱动脉在静息、反应性充血和舌下含服硝酸甘油后血管舒张末期内径的变化。结果 肥胖儿童较正常儿童ＦＴ升高,６－Ｋ－ＰＧＦ１α和增加血流介导的血管舒张幅度（ＦＭＤ）均降低。ＦＭＤ与     

儿童单纯性肥胖并高脂血症的早期干预

冠心病（CHD）是动脉粥样硬化（AS）的主要表现形式，脂类代谢紊乱和肥胖是AS和CHD独立危险因素[1]。有研究表明，AS损伤始于儿童[2]，对儿童肥胖和脂代谢紊乱的早期干预，可能逆转和预防AS病变的发生和发展，改变CHD的进程。我科对肥胖并高脂血症患儿进行饮食和脂必妥干预治疗     

超重/肥胖儿童自主神经功能综合评价

目的?评估超重/肥胖儿童的自主神经功能情况。方法 通过研究动态心电图的心率变异性（HRV）及心率减速力（DC）指标,平板运动试验的运动当量、达峰值心率(HR_max)的运动时间、运动终止后第一分钟心率恢复（HRR₁）、恢复至静息心率时间、静息期收缩压、运动峰值收缩压及运动恢复期第三分钟收缩压指标来评估肥胖儿童的自主神经功能。结果 肥胖组儿童31例,男23例、女8例,平均年龄（10.4±2.6）岁;超重组69例,男35例、女34例,平均年龄（10.9±2.7）岁;对照组100例,男57例、女43例,平均年龄（10.2±2.7）岁。超重、肥胖与对照组三组儿童之间正常RR间期标准（SDNN）、相邻RR间期差值的均方根（RMSSD）、5 min均值标准差（SDANN）、NN50占所有NN间期个数的百分数(pNN₅₀)、低频功率（LF）/高频功率（HF）、心率减速力（DC）值的差异均有统计学意义（P<0.05）。超重、肥胖与对照组三组儿童之间达HR_max运动时间、运动当量、HRR₁/...     

单纯性肥胖儿童心血管系统功能的评价

通过对３５例肥胖儿童的运动试验后心率恢复时间、血压和左心功能的观察，分析了其肥胖对心血管系统功能的危害。结果显示肥胖儿童心率恢复时间延长，部分出现心电图ＳＴ段改变或室性早搏，左心功能不全和动脉顺应性改变；血压也明显高于正常儿童。提示肥胖儿童具有心血管疾病的潜在危险。     

对单纯性肥胖儿童心脏结构和功能的研究

近年来单纯性肥胖症发生率有增高趋势。现已证实肥胖是成人心血管疾病的高危因素,但在儿童期单纯性肥胖是否会对心脏结构和功能造成潜在影响,本文对此进行了研究。现报道如下。 对象和方法 一、对象 参加体检的200余名7～9岁学生,经体检无1例发现特殊疾病。根据单纯性肥胖诊断标准,从中选出20名单纯性肥胖男孩作为研究对     

生命早期抗生素暴露与儿童肥胖相关性研究进展

儿童肥胖问题是当今世界最常见的公共卫生问题之一,严重影响儿童健康。近年来儿童普遍暴露于低剂量抗生素中,抗生素问题引起国际关注。国内外研究表明儿童生命早期抗生素暴露与儿童时期肥胖风险有关,但其具体机制尚未完全明确,主要可能与抗生素导致婴幼儿肠道正常菌群定植变化,破坏早期肠道微生物群,从而增加儿童肥胖的风险,但需要进一步的研究来确认该因果机制。     

儿童无创通气的局限性及气管插管介入时机选择

近年来,无创通气在儿童呼吸支持领域有了较快发展。无创通气无需气管插管,操作简便,对部分呼吸道疾病有较为满意的疗效。但是,无创通气不能完全替代有创机械通气。在有些疾病无创通气不仅有着较高的失败率,而且会因气管插管的延误导致病情恶化,增加患儿的病死率。在行无创通气之前需评估患儿是否适宜进行无创通气治疗。对于进行无创通气治疗的患儿需严密监护,动态观察生理指标和监测数据的变化,掌握好气管插管的时机,以免造成有创机械通气治疗的延误。     

不同干预方法对实验性肥胖大鼠早期血管内皮功能障碍作用的比较

目的 观察单纯控制食谱、控制食谱联合有氧运动或降脂药对实验性肥胖大鼠血脂和血管内皮功能的影响。方法 Wistar大鼠随机分为：F组：饲予高脂饲料;N组：饲予基础饲料;A组：高脂饲养8周后予单纯控制食谱12周,B组：高脂饲养8周后予控制食谱联合游泳12周,C组：高脂饲养8周后予控制食谱联合藻酸双酯钠12周。干预12周后,处死全部大鼠,测定Lee指数;血脂指标：总胆固醇（TC）、甘油三酯（TG）;血管内皮因子：血浆内皮素（ET）、血清一氧化氮（NO）,血浆血管性假血友病因子（vWF）,免疫组化法检测腹主动脉细胞间黏附分子1（ICAM-1）蛋白的表达,逆转录-聚合酶链反应（RT-PCR）法检测腹主动脉ICAM-1mRNA的表达。结果 A组的TC、TG、ET低于F组（均P〈0．05）;B、C组的Lee指数、TC、TG、ET、vWF、ICAM-1蛋白和mRNA表达水平均低于F组（均P〈0．05）;A、C两组NO均高于F组（均P〈0．05）,与N组比较差异无统计学意义（均P〉0、05）,B组NO同时高于F组和N组（P〈0．01）。结论 单纯控制食谱能改善血脂和血管舒缩功能,控制食谱联合有氧运动或联合降脂药藻酸双酯钠在减重、降脂和改善血管舒缩、凝血、黏附功能方面均有效,而控制食谱联合有氧运动改善舒缩功能的效果更为显著,因此是单纯肥胖早期血管内皮功能障碍的最佳干预选择。     

无创正压通气辅助治疗儿童慢性肺病的研究进展北大核心CSCD

无创正压通气(NPPV)无需建立有创人工气道,可减少有创通气并发症,减轻患儿痛苦,成为一项逐渐被临床接受的辅助通气技术。目前,儿童慢性肺病在临床病例中逐渐增多,包括支气管肺发育不良、支气管哮喘等,严重影响患儿生长发育及生活质量。随着医学技术的发展,NPPV治疗儿童慢性肺病的使用率逐渐增高,现就NPPV治疗各种儿童慢性肺病的主要模式、不良反应及依从性的研究现状作一综述。     

无创通气支持在儿童急性呼吸窘迫综合征中的应用

急性呼吸窘迫综合征（ARDS）是儿科临床常见危重症,在儿科重症患者中具有较高的发病率和病死率。无创通气因其自身特点已成为ARDS救治的常用支持手段,该文就儿童ARDS无创通气支持研究现状进行综述。     

Arterial intima-media thickening and endothelial dysfunction in obese Chinese children

We studied ultrasonographic signs of early atherosclerosis in relation to established risk factors of cardiovascular disease in 43 obese school-age children compared to 28 non-obese controls. The groups did not show significant differences in age, gender ratio and body height. Mean carotid intima-media-thickness (IMT), carotid haemodynamic parameters, flow-mediated dilatation of the brachial artery (FMD), and biochemical markers of dyslipidaemia were measured and correlated. IMT was significantly increased (0.62 mm vs. 0.46 mm, P <0.001) and FMD was markedly reduced (10.9% vs. 18.8%, P <0.001) in the obesity group. Differences in IMT and FMD persisted after adjustment for Body Mass Index (BMI) and blood pressure on ANCOVA. BMI was highly associated with increased IMT ( r =0.58, P <0.01) and reduced FMD ( r =-0.42, P <0.01), as were blood levels of total cholesterol, LDL cholesterol and Apo B. Conclusion:Childhood obesity seems to contribute to the development and progression of early atherosclerosis, particularly in combination with hypertension and dyslipidaemia. In order to prevent coronary atherosclerosis and other cardiovascular complications, it is vital to control obesity starting from childhood. Ultrasonography of the arterial wall may be used in a clinical setting to identify high-risk patients among severely obese children.     

Gas exchange during exercise in obese children

Twenty-three obese children, aged 9 to 14 years, ranging in percentage overweight from 26% to 83% (median 51.6%±16.3%), and 37 normal-weight children, matched for sex, age and height, performed a maximal exercise test on a treadmill. Cardiorespiratory performance was assessed by determination of the ventilatory anaerobic threshold (VAT) expressed in ml O₂/min per kg and as a percent of maximal oxygen uptake (% VO₂max). VAT and VO₂max related to body weight were significantly lower (P<0.01) in the obese than in the normal-weight children. VAT % VO₂max was similar in the two groups. A significant correlation was found between VAT and VO₂max both in the obese (r=0.85) and in the control groups (r=0.79). The habitual level of physical activity was lower in the obese subjects compared to the control subjects (P<0.001). In conclusion our study shows that physical fitness of overweight children is quantitatively lowered and that it can be assessed by VAT. VAT does not require a maximal test and is particularly useful in the ergometric study of subjects with exercise intolerance.Abbreviations AT anaerobic threshold - HR heart rate - VAT ventilatory anaerobic threshold - VCO₂ carbon dioxide output - VE ventilation - VO₂ oxygen uptake - VO₂max maximal oxygen uptake     

儿童肥胖性哮喘的研究进展

支气管哮喘(简称哮喘)和肥胖是困扰儿童健康的两大慢性疾病,目前两类疾病的患病率仍呈上升趋势,且二者之间相互作用,互为因果。该文对儿童肥胖性哮喘的临床特点、特应性、潜在生物标记物,以及肥胖介导的代谢异常和免疫反应,包括脂肪中的炎症因子和脂肪因子在肥胖性哮喘中的作用进行了综述。     

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目的应用多普勒超声显像法探讨血管迷走性晕厥(VVS)儿童的血管内皮功能。方法研究对象共20例,均为2002年1月至2003年12月在北京大学第一医院儿科就诊儿童,分为VVS组(n=10)及非VVS对照组(n=10),对10例经直立倾斜试验确诊的血管迷走性晕厥儿童,应用多普勒超声测定肱动脉的血流介导的血管舒张反应,并与10例经直立倾斜试验除外VVS的对照组儿童进行比较。结果两组患儿的年龄、性别、身高、体重、基础血压及基础肱动脉血管内径均无显著性差异,但血管迷走性晕厥儿童的血管内皮依赖性舒张功能较对照组显著增强[(11.93±4.46)%vs(8.46±2.18)%,P<0.05]。结论血管内皮依赖性舒张功能增强可能是儿童血管迷走性晕厥发生机制之一。     

Metabolically obese normal-weight children

Non-obese children with elevated serum insulin levels and metabolic disorders such as, hyperglycemia, hypertension, and/or hypertriglyceridemia are a subset of children in high risk of developing cardiovascular disease later in life. Since usually the health policies for the prevention of the obesity associated disorders in children are based on the screening focused on the obese, frequently the metabolically obese normal-weight (MONW) children are not identified in primary care setting. Given that characterization of the MONW children is an important public health issue, and that a large amount of resources might be unnecessarily used in the screening of metabolic risk of nonobese children; we review data regarding criteria for the early recognition of this subset of children in high risk of developing cardiovascular disease. Results of our review suggests that the presence of family history of type 2 diabetes and/or hypertension, the elevated percentage of body fat, and the high birth-weight should be taken into account as criteria of high cardiovascular risk, irrespective of obesity.     

循环内皮细胞和内皮祖细胞与儿童原发性高血压关系的研究进展

近年来,儿童原发性高血压患病率增加迅速.高血压可造成靶器官损害,其中包括心、脑、肾等重要脏器.血管损伤是高血压靶器官损害的核心问题,其机制涉及到肾素-血管紧张素-醛固酮系统的激活、氧化应激反应、血管慢性炎症及内皮细胞功能障碍等.血管内皮细胞损伤可引起血管内皮功能障碍,其本质是内皮损伤和修复之间动态平衡的破坏,是心血管疾病发生发展的始动环节.循环内皮细胞和内皮祖细胞被认为是血管损伤、重塑以及内皮功能障碍的非侵入性标志物.该文通过总结相关文献,阐述原发性高血压患儿血管损伤与内皮细胞损伤之间的关系,深化对儿童原发性高血压的发病机制的认识.     

学龄期肥胖儿童心脏自主神经功能分析

目的对学龄期肥胖儿童的心率减速力(DC)、心率加速力(AC)及心率变异性(HRV)进行分析,并观察肥胖儿童体重指数(BMI)与DC、AC及HRV的相关性。方法选取学龄期肥胖儿童108例,其中血脂正常组75例,血脂异常组33例,另选取103例学龄期健康儿童为对照组。对所有受试者行24 h动态心电图检查,分别将肥胖组与对照组、肥胖儿童中血脂异常组与血脂正常组的DC、AC及HRV进行比较,并将肥胖儿童的BMI与DC、AC及HRV进行相关性分析。结果肥胖组的DC、RR间期总体标准差(SDNN)、RR间期平均值的标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、低频功率(LF)、高频功率(HF)均低于对照组,AC高于对照组(P0.05)。肥胖儿童中血脂异常组的DC、SDNN、SDANN、RMSSD、LF、HF均低于血脂正常组,AC、BMI高于血脂正常组(P0.01)。肥胖儿童BMI与DC、SDNN、SDANN、RMSSD、HF呈明显负相关(P0.05);与AC呈明显正相关(P0.05)。结论学龄期肥胖儿童的自主神经功能受损,表现为迷走神经张力减低,其中合并血脂异常者以上表现尤为突出。肥胖程度越高,迷走神经张力越低,发生心血管疾病的危险性可能越大。     

Self-esteem in a clinical sample of morbidly obese children and adolescents

Aim: To study self-esteem in clinical sample of obese children and adolescents.
Methods: Obese children and adolescents aged 8–19 years (n = 107, mean age 13.2 years, mean BMI 32.5 [range 22.3–50.6], mean BMI z-score 3.22 [range 2.19–4.79]; 50 boys and 57 girls) were referred for treatment of primary obesity. Self-esteem was measured with a validated psychological test with five subscales: physical characteristics, talents and skills, psychological well-being, relations with the family and relations with others. A linear mixed effect model used the factors gender and adolescence group, and the continuous covariates: BMI z-scores, and BMI for the parents as fixed effects and subjects as random effects.
Results: Age and gender, but neither the child's BMI z-score nor the BMI of the parents were significant covariates. Self-esteem decreased (p < 0.01) with age on the global scale as well as on the subscales, and was below the normal level in higher ages in both genders. Girls had significantly lower self-esteem on the global scale (p = 0.04) and on the two subscales physical characteristics (p < 0.01) and psychological well-being (p < 0.01).
Conclusion: Self-esteem is lower in girls and decreases with age. In treatment settings special attention should be paid to adolescent girls.     

Antiphospholipid antibodies and lipoprotein(a) in obese children

Aim: Antiphospholipid (aPL) antibodies, Lipoprotein(a) [Lp(a)] and obesity are considered three independent risk factors for development of cardiovascular diseases. We investigate the presence of aPL antibodies and the Lp(a) concentration in 190 obese and 30 healthy children divided into prepubertal and pubertal, compared with healthy adults.
Results: aPL antibodies were detected in 2.65% of prepubertal and in 2.59% of pubertal obese children. Considering results obtained by Lp(a) test, 4.4% of prepubertal and 5.2% of pubertal obese children and 17.5% of healthy adults were at risk for development of cardiovascular diseases.
Conclusion: The presence of various prothrombotic risk factors increases the probability of developing thrombosis. Considering aPL antibodies there is no statistically significant difference among the different considered groups; therefore each category has the same risk factor. The Lp(a) distribution in adults is significantly different from the Lp(a) distribution in prepubertal (p = 0.012) and pubertal (p = 0.029) obese children. There is no significant difference among prepubertal subjects (p = 0.632) as well as pubertal subjects (p = 0.465), independently from the BMI. These results suggest the control of BMI in young population to avoid the presence of the obesity as another independent prothrombotic risk factor to be added to aPL and Lp(a) in the future adulthood.