新生儿窒息后肾血流变化与尿酶的关系

目的 探讨新生儿窒息后肾动脉血流变化与尿酶的关系.方法 采集71例窒息新生儿及20例正常新生儿的新鲜尿液测定尿酶[N-乙酰-β-D氨基葡萄糖苷酶(NAG)、β-半乳糖苷酶(GAL)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)],采集静脉血检测尿素氮(BUN)、肌酐(Cr)及出生后第1、3、7天肾动脉血流参数[收缩期峰值流速(PSFV)、阻力指数(RI)、舒张末血流速度(EDFV)、搏动指数(PI)].结果 窒息新生儿尿中NAG、GAL、ALP、GGT均明显高于正常组(P<0.05),重度窒息组NAG、GAL、ALP、GGT明显高于轻度窒息组(P<0.01).窒息组肾动脉EDFV在日龄第1、3、7天均低于正常组(P<0.05),各日龄组肾动脉RI和PI均高于正常组(P<0.05).EDFV与NAG、GAL、ALP、GGT呈负相关(P<0.01),RI、PI与NAG、GAL、ALP、GGT呈正相关(P<0.01).结论 肾血流检测较尿酶检测省时、方便、影响因素少,且可连续观察,通过肾血流检测可估计尿酶的高低;同样尿酶的高低也可反应肾血流情况,判断有无肾血管痉挛、肾缺血,为早期使用肾血管扩张药物提供依据.     

尿六联微量蛋白对新生儿窒息后早期肾损伤的诊断价值

目的探讨新生儿尿中微量白蛋白（Alb）、α1-微球蛋白（α1-MG）、转铁蛋白（TRF）、视黄醇结合蛋白（RBP）、免疫球蛋白（IgG）、纤维连接蛋白（Fn）对窒息新生儿早期肾损害的临床诊断价值。方法采集39例窒息新生儿及39例正常新生儿的新鲜尿液，用酶联免疫测定法检测微量蛋白含量，并用stat Fax-2100型全自动酶标仪比色分析。检测两组新生儿的血肌酐和尿素氮。结果窒息组新生儿尿中α1-MG、TRF、RBP均明显高于对照组（P〈0．01），Alb、Fn、IgG也高于对照组（P〈0．05）。重度窒息组TRF、RBP明显高于轻度窒息组（P〈0．01），α1-MG亦高于轻度窒息组（P〈0．05），Alb、Fn、IgG两组差异无显著性（P〉0．05）。窒息组血肌酐高于对照组，差异有显著性（P〈0．05）。结论新生儿窒息后肾小球、肾小管均有不同程度损伤，尿液中Alb、TRF、Fn、α1-MG、RBP是诊断肾功能早期损害的敏感指标。其中以TRF和RBP最敏感，联合检测有助于早期诊断肾损害的部位和程度。     

新生儿肾功能损害早期指标分析

目的 探讨血清胱蛋白酶抑制剂C(Cystain C)、尿微量蛋白系列在窒息后新生儿中的变化及意义.评价新生儿肾功能的检测指标.方法 检测2004年9月--2005年9月68例足月窒息新生儿(Apgar评分7分)和40例足月非窒息新生儿的血清Cr、BUN、血β2-微球蛋白(β2-MG)、C、血Cystatin C、尿微量蛋白系列,按不同日龄分3次检测.结果 ①非窒息新生儿血清Cystatin C的平均值为(1.89±0.41)mg/L,血清Cys-tatin C在生后3周内不同日龄间差异无统计学意义,与身高、体重、胆红素之间无相关关系.②窒息组肾小球功能指标中血BUN、Cr、Ccr、Cystatin C、B2-MG明显高于非窒息组;窒息组肾小管功能指标中尿N.乙酰B.D.葡萄糖苷酶(NAG)、α1微球蛋白(α1-MG)明显高于非窒息组.③重度窒息组血BUN、Cr、Ccr、Cystatin C明显高于轻度窒息组;而肾小管功能指标差异无统计学意义.④肾小球功能指标中,尿Alb、IgG与血Cystatin C、血13rMG呈正相关,尿转铁蛋白(TRF)、NAG与Ccr呈正相关;肾小管功能指标中尿NAG、α1-MG与血β2-MG呈正相关.⑤随访发现,血BUN、Cr恢复正常快,尿微量蛋白系列和血β2-MG、血Cystatin C恢复较慢.结论 窒息可引起新生儿肾小球、肾小管功能改变,重度窒息对肾小球功能影响大于轻度窒息,血Cystatin C可作为评价肾小球滤过功能的敏感指标.临床可通过随访尿微量蛋白系列指标来评估肾小管、肾小球损害情况.     

小于胎龄儿肾功能、肾血流改变的观察分析

目的观察小于胎龄儿(SGA)肾功能、肾血流等相关指标,为早期诊治和随访提供依据。方法对87例SGA及20例正常足月新生儿的肾功能、肾血流变化等相关因素进行分析。结果与正常足月新生儿比较,足月SGA的彩超肾动脉血流参数中收缩期峰值流速(PSFV)、舒张末期血流速度(EDFV)在日龄第1天显著减低(P<0.05),而搏动指数(PI)、阻力指数(RI)则显著升高(P<0.05)。与早产SGA相比,足月SGA的PSFV、EDFV在日龄第1天显著减低(P<0.05),而RI则显著增高(P<0.01);第7天各项指标基本恢复,与正常组比较差异无统计学意义。足月SGA尿素氮、肌酐虽在正常范围,但第1天与早产SGA和正常新生儿比较差异有统计学意义(P<0.01),第7天差异无统计学意义。结论SGA早期存在肾血流和肾功能等改变和并发症,临床应予足够的重视。     

过敏性紫癜患儿早期肾损害的实验室检查及干预

目的 探讨过敏性紫癜( Henoch-Schonlein purpura,HSP)患儿早期肾损害诊断的实验室指标及早期干预的临床疗效.方法 对143例多次尿常规检查正常的HSP患儿进一步检测尿微量蛋白[免疫球蛋白G(IgG)、微量白蛋白(MA)、转铁蛋白(TRF)、a1-微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)]以及尿酶[N-乙酰-β-D氨基葡萄糖苷酶(NAG),y-谷氨酰转肽酶(y-GT)]的含量.采用对比研究方法,将131例检查异常的HSP患儿随机分成两组(对照组65例、干预组66例).两组均给予甲氰咪胍、氯雷他定、钙剂等综合治疗,干预组66例在综合治疗的基础上加用小剂量肝素微量泵持续定时静脉滴注及甘利欣口服治疗,对照组65例未给予其他治疗.结果 143例尿常规检查正常的HSP患儿中尿微量蛋白和尿酶异常131例(91.61％),干预组治疗2个月、4个月尿微量蛋白、尿酶各项指标均较治j前降低,差异有统计学意义(P＜0.01).对照组治疗2个月仅尿β2-MG、NAG、y-GT 3项指标降低,差异有统计学意义(P＜0.01),治疗4个月尿微量蛋白、尿酶各项指标均较治疗前降低,差异有统计学意义(P＜0.01).干预组治疗2个月、4个月尿微量蛋白、尿酶各项指标均较对照组低,差异有统计学意义(P ＜0.05或P＜0.01).尿IgG、MA、TRF 、NAG恢复较快,干预组治疗4个月时已基本接近正常,而尿α1-MG、β2-MG、γ-GT恢复较慢,干预组治疗4个月时仍有轻重不一的异常.两组治疗4个月时,对照组尿常规异常率高于干预组(36.92％ vs 6.10％),差异有统计学意义(P＜0.05).结论 尿微量蛋白及尿酶7项指标的联合检测是早期诊断HSP肾损害的良好指标.应用肝素钠、甘利欣对其进行早期干预,能有效预防肾损害,延缓疾病进展.对HSP肾损害须强调早期诊断及早期干预.     

窒息新生儿尿内皮素、尿微量蛋白的变化观察

目的 探讨尿内皮素(ET)、尿微量蛋白(a1-M、TRF、Alb)在新生儿窒息肾脏损害中的意义。方法 窒息组在生后第3天、第7天采用放射免疫法测定尿ET，同时测定其尿微量蛋白水平。对照组健康新生儿同期进行上述检测。结果 发现窒息组第3天尿ET含量明显高于对照组(P＜0．01)。且重度窒息组＞轻度窒息组＞对照组。第7天重度窒息组尿ET平均水平虽高于对照组、轻度窒息组，但统计显示无明显差异(P＞0．05)。尿微量蛋白( a1-M、TRF、Alb)变化与尿ET呈正相关(P＜0．01)。结论 尿ET与尿微量蛋白含量测定可以作为新生儿肾功能损伤的早期指标。新生儿窒息尿ET的增高与肾损害有密切关系。     

母乳性黄疸对肾功能的影响及其早期干预

目的探讨母乳性黄疸(BMJ)患儿肾功能变化及早期干预对肾功能的影响。方法测定50例BMJ患儿入院后12 h内血清胆红素和尿β2-徽球蛋白(β2-MG)、α1-MG、清蛋白(Alb)、IgG及出院前尿β2-MG、α1-MG、Alb、IgG,与20例足月新生儿生理性黄疽(对照组)对比。结果BMJ患儿随血清总胆红素升高,尿微量蛋白有升高趋势,血清胆红素205.2-256.5 μmol/ L时尿β2-MG较对照组明显升高(P<0.05);血清胆红素>256.6-342.O μmol/L,β2-MG、α1-MG显著升高(P均<0.01),Alb 较对照组明显升高(P<0.05)。出院前尿β2-MG、α1-MG、Alb恢复正常。结论BMJ可引起暂时肾功能损害,予早期干预治疗后肾功能很快恢复正常。     

窒息新生儿尿内皮素、尿微量蛋白的变化观察

目的　 探讨尿内皮素 (ET)、尿微量蛋白 (a1 M、TRF、Alb)在新生儿窒息肾脏损害中的意义。 方法 　窒息组在生后第 3天、第 7天采用放射免疫法测定尿ET ,同时测定其尿微量蛋白水平。对照组健康新生儿同期进行上述检测。 结果 　发现窒息组第 3天尿ET含量明显高于对照组 (P <0 0 1)。且重度窒息组 >轻度窒息组 >对照组。第 7天重度窒息组尿ET平均水平虽高于对照组、轻度窒息组 ,但统计显示无明显差异 (P >0 0 5 )。尿微量蛋白 (a1 M、TRF、Alb)变化与尿ET呈正相关 (P <0 0 1)。 结论 　尿ET与尿微量蛋白含量测定可以作为新生儿肾功能损伤的早期指标。新生儿窒息尿ET的增高与肾损害有密切关系     

紫癜性肾炎患儿免疫球蛋白G亚类水平与早期肾损害的相关性

目的探讨紫癜性肾炎(HSPN)患儿免疫球蛋白G(IgG)亚类与尿酶、尿微量蛋白的相关性,分析其在HSPN发生中的作用及其在诊断中的意义。方法采用酶联免疫吸附法检测28例HSPN患儿及20例正常儿童IgG亚类水平;采用免疫散射速率比浊法测定尿4项微量蛋白;采用碱性苦味酸速率法测定尿系列酶,经多元线性回归法分析相关性。结果28例HSPN患儿IgG1和IgG2明显低于正常对照组(P<0.01),其余变化不明显。HSPN组IgG1与尿微量清蛋白(MA)、碱性磷酸酶(ALP)呈明显负相关性,IgG2与转铁蛋白(TF)、α1-微球蛋白(α1-M)呈明显负相关性,IgG4与MA、IgG、α1-M呈明显负相关性。结论IgG亚类失调尤其是IgG1、IgG2下降参与肾炎的发病,与几种尿酶、尿微量蛋白呈明显负相关性,它可反映疾病严重程度,在临床诊断中具有一定的价值。     

肥胖相关性肾小球病小鼠肿瘤坏死因子α表达的变化

目的通过检测肥胖相关性肾小球病(ORG)小鼠血清中TNF-α水平及肾小球中TNF-αmRNA及蛋白表达,探讨ORG的发病机制。方法选取40只清洁级健康35日龄C57BL/6雄性小鼠,按体质量随机分为肥胖组和对照组各20只。肥胖组予高脂高能量饲料喂养,对照组予普通饲料喂养。2组分别于8周末留取尿液,ELISA法检测其尿微量清蛋白(Alb)、转铁蛋白(TRF)、尿视黄醇结合蛋白(RBP)、β2-微球蛋白(β2-MG)等尿微量系列蛋白;留取静脉血,ELISA法检测其血清TNF-α水平;游离其肾脏组织,固定、切片、染色,分别于光镜、电镜下观察肾脏组织病理学改变;提取肾组织RNA,实时定量(RT)-PCR检测TNF-αmRNA表达;提取肾组织,采用Western blot检测TNF-α蛋白表达。结果采用SPSS 13.0软件进行统计学处理。结果与对照组比较,肥胖组尿Alb、TRF、RBP、β2-MG及血清TNF-α水平均明显增高,差异均有统计学意义(Pa<0.01)。肥胖组肾组织TNF-αmRNA及蛋白表达明显增高(Pa<0.01)。肾组织病理学检查发现肥胖组均出现肾小球肥大;电镜下见上皮细胞足突融合,部分肾小管上皮细胞胞质内见较多脂滴,基膜增厚,三层结构消失,节段系膜插入。结论 ORG小鼠早期可出现尿微量蛋白异常;血清及肾组织中TNF-α表达异常可能在ORG的发生发展中扮演重要角色。     

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目的 研究儿童过敏性紫癜(HSP)急性期免疫球蛋白与淋巴细胞亚群的变化,探讨其临床意义.方法 研究对象为2006年1月至2007年8月在苏州大学附属儿童医院住院的HSP急性期患儿40例,根据临床有无肾脏损害分为肾炎(HSPN)组和非肾炎(NHSPN)组,各20例,并以20名正常儿童作为对照组,采用速率散射比浊法测定免疫球蛋白IgA、IgG、IgM,采用流式细胞仪分析技术检测外周血单个核细胞CD3+,CD4+、CD8+、CD4+/CD8+、CD19+、CD19+23+、CD16+56+、CD4+CD25+等淋巴细胞亚群的水平.结果 HSPN组与NHSPN组外周血单个核细胞CD3+、CD4+、CD4+/CD8+、CD4+CD25+、CD16+56+水平明显下降,两组分别与正常对照组比较差异有统计学意义(P<0.01);CD8+、CD19+、CD19+23+水平明显上升,两组分别与正常对照组比较差异有统计学意义(P<0.01);HSPN组与NHSPN组淋巴细胞亚群组间对比无统计学意义(P>0.05);血清免疫球蛋白IgA明显上升,HSPN组与NHSPN组分别与正常对照组比较差异有统计学意义(P<0.01);NHSPN组IgG、IgM变化不大,与对照组比较差异无统计学意义(P>0.05);HSPN组IgG降低与对照组比较差异有统计学意义(P<0.05),IgM变化不大,与对照组比较差异无统计学意义(P>0.05).结论 HSP患儿急性期B淋巴细胞呈多克隆活化,抗体分泌增多,这为临床采取相应的免疫调节治疗提供了理论依据.     

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目的探讨呼吸道合胞病毒(RSV)支气管肺炎患儿外周血单个核细胞(PBMCS)高迁移率族蛋白B-1(HMGB1)mRNA表达,及血浆肿瘤坏死因子-α(TNF-α)水平、T细胞亚群,并探讨HMGB1、TNF-α、T细胞亚群在RSV支气管肺炎免疫发病机制中的临床意义。方法对2007年9月至2009年3月于苏州大学附属儿童医院呼吸科住院治疗的52例RSV支气管肺炎患儿,其中25例为呼吸道合胞病毒(RSV)感染,27例为RSV和细菌混合感染。同时选择23例健康儿童作对照组,应用逆转录聚合酶链反应(RT-PCR)方法对其PBMCS HMGB1mRNA表达进行检测,并应用ELLSA法检测外周血浆TNF-α,流式细胞仪检测T细胞亚群。结果 (1)3组间PBMCS HMGB1mRNA的表达、血浆TNF-α水平差异有统计学意义(P<0.05),RSV感染组和混合感染组HMGB1的表达差异有统计学意义(P<0.05);(2)CD3+、CD3+CD8+、CD3-CD19+、CD19+CD23+、CD3-CD(16+56)+的百分比在3组间差异均有统计学意义(P<0.05);(3)CD3+、CD3+CD8+、CD3-CD(16+56)+亚群:RSV感染组和混合感染组之间差异无统计学意义(P>0.05),但较对照组有明显降低(P<0.05);(4)CD3-CD19+RSV感染组和混合感染组之间差异无统计学意义,但较对照组明显增高(P<0.05);(5)CD3+CD4+、CD4+CD25+在3组间差异无统计学意义(P>0.05);(6)混合感染组CD19+CD23+、CD4+CD25+较对照组明显增高,差异有统计学意义(P<0.05)。结论 HMGB1可能参与了RSV和细菌混合感染支气管肺炎的免疫发病过程,HMGB1与TNF-α作用机制可能不同。     

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??To evaluate the value of combined detection of serum cystatin C ??Cys C?? and urine protein series in predicting renal damage of childhood Henoch-Sch?nlein purpura ??HSP??. Methods??Serum Cys C and urine protein series were tested in 46 child HSP patients??using liquid transmission turbidity and immune nephelometry. Urine protein series included transferrin ??TRF????NAG /UCr??IGGU /UCr??ALBU /UCr and α1MU/UCr. Meanwhile??serum creatinine??urine and serum urea nitrogen were determined. The results were compared with those of healthy control group. Results??The value of serum Cys C and urine protein series in HSP patients were higher than those of control group ??4.28±0.36?? mg/L vs ??0.65±0.43?? mg/L for serum Cys C??P < 0.01????80.43%??37/46?? HSP patients whose routine urinalysis were negative had abnormal tested value of six indexes in complete blood test and urine analysis. The value of serum Cys C had a positive correlation with urine protein series. Conclusion??Six indexes in complete blood test and urine analysis including serum Cys C and urine protein series help to reveal early renal damage in HSP patients??whilst negative urinalysis can’t rule out early renal damage. The sensitivity and specificity of serum Cys C are superior to urine protein series. These six indexes are appropriate indicators in diagnosis of early renal injury in childhood HSP patients.     

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目的 探讨运动、饮食、教育联合干预时单纯性肥胖儿童肾功能的影响.方法 分别对2005年5月至2008年3月浙江省温州市第二人民医院儿科门诊50例单纯性肥胖儿童单纯饮食控制治疗前后和52例单纯性肥胖儿童在饮食控制基础上再制定有计划运动及健康教育联合干预治疗前后肾功能进行测定,并对其疗效进行比较.结果 治疗前单纯治疗组、联合干预组尿白蛋白Alb、IgG、TRF均高于对照组,差异均有统计学意义(P<0.01),而单纯治疗组治疗前与联合干预组治疗前比较差异均无统计学意义(P>0.05).单纯治疗组治疗前后比较:Alb、IgG、TRF差异均有统计学意义(P<0.01).联合干预组治疗前后比较:Alb、IgG、TRF差异均有统计学意义(P<0.01).单纯治疗组治疗后、联合干预组治疗后与对照组比较:单纯治疗组治疗后各项指标差异仍有统计学意义(P<0.01),联合干预组治疗后各项指标差异均无统计学意义(P>0.05).结论 运动、饮食及健康教育联合干预时单纯性肥胖儿童的肾功能改善效果较好,对患儿以后提高生活质量有积极的作用.     

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??Abstracts?? Objective To investigate the expression of RLX in blood and renal tissue of patients with HSP?? and its correlation with clinical indexes and pathological changes?? and explore its effect on the pathogenesis of HSP. Methods Collect 39 cases of Henoch-Schonlein purpura ??HSP?? from Department of Nephrology in Children’s Hospital of Jiangxi province from November 2011 to June 2012?? with complete follow-up data. According to the clinical urine manifestation?? 39 patients with HSP were divided into non-kidney damage group ??n=20?? and kidney damage group ??n=19??. All 39 patients were collected blood samples in the acute and convalescent phase. Nineteen patients from kidney damage group were divided into mild lesions ??n=5???? moderate lesions ??n=9??and severe lesions ??n=5???? according to the degree of pathological changes. RLX concentration was detected with enzyme-labeled immunosorbent assay ??ELISA?? method.RLX protein expression in renal tissue was detected with immunohistochemistry method. Results In the acute phase?? the serum level of RLX in HSP was significantly higher than normal control?? and its concentration was significantly higher in kidney damage group than in non-kidney damage group ??P??0.05??. Compared with acute phase?? the serum level of RLX in HSP in the convalescent phase was significantly lower?? and the level of decline was slower in kidney damage group than in non-kidney damage ??P??0.05??. Weak expression of RLX in renal tissue was found in normal control??while the expression of RLX in renal tissue significantly increased in HSPN ??P??0.05???? with the pathological changes of renal tissue aggravating. The expression of RLX in renal tissue in HSPN was significantly correlated with the serum concentration of RLX ??P??0.05?? and the total urine protein for 24 hours ??P??0.05??. Conclusion There is a modest up-regulation in serum and renal RLX protein expression in HSP?? and the severity of the disease is closely related with RLX expression?? which suggests that RLX may be involved in the pathogenesis of HSP/HSPN?? and it may be an important mechanism that upregulation of RLX may play a defensive role in delaying disease progression of HSP/HSPN.     

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??Objective??To investigate the correlations between plasma monocyte /macrophage chemoattractant protein and related parameters of insulin resisitance in children with simple obesity. Methods??70 children with simple obesity were enrolled as study group??30 healthy children as control group. Body mass index??BMI ??and waist circumference ??WC??were detected as indices of obesity .Plasma levels of macrophage inflammatory protein-1????MIP-1??????monocyte chemoattractant protein-1??MCP-1 ??were measured by ELISA.The rate of CD68 positive cells in blood were detected by flow cytometry??FCM???? Plasma levels of insulin ??adiponectin were measured by RIA?? Insulin resisitance index ??InRI?? were caculated by homeostasis model assessment of insulin resistance ??HOMA-IR??. The associations between MIP-1????MCP-1 levels and adiponectin and related parameters were analyzed with Pearson correlation analysis or partial correlation analysis??Results??The concentration of MIP-1?? and MCP-1 in plasma in children with simple obesity were higher than that in control group. There was a significant difference between the two groups ??P < 0. 05??. The rate of CD68 positive cells in blood of simple obesity had no significant difference between that in control group ??P > 0.05??.The concentration of MIP-1?? and MCP-1 in plasma had positive correlations with BMI and WC and InRI??P < 0. 05??. The concentration of adiponectin in plasma had negetive correlations with BMI and WC and InRI ??P < 0. 05??. The rate of CD68+ cell in blood had no correlation with BMI and WC and InRI??P < 0. 05??.Conclusion??We found that a differential low-grade inflammation is associated with obesity of children .The levels of MIP-1????MCP-1 in blood of obesity were associated with insulin resistance and abdominal obesity. The levels of plasma MIP-1????MCP-1??adiponectin may predict the onset of obesity related complications.     

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??Objective To determine the relationship between clinical features of bronchiolitis in children under 2 years old and lymphocyte subsets ratio. Methods Two hundred and sixty-eight hospitalized children in Children Hospital of Soochow University from January 2014 to September 2015 were enrolled in this study. Peripheral blood was collected and cellular immunity was detected by flow cytometry. Pathogens were tested and patients’ clinical data was collected. Results Bronchiolitis infants were identified in 11.84% of 2264 patients in corresponding period. Prevalence rate of pathogen was 57.84%??whose sequence was??from high to low?? respiratory syncytial virus??RSV??21.27%????mycoplasma pneumoniae??MP??16.42%????Haemophilus influenzae??10.07%????Streptococcus pneumoniae??8.96%??. CD3+??CD3+CD8+ ratio of the children with bronchiolitis and without wheezing patients was lower than healthy control group. The CD4+/CD8+ ratio was the highest in bronchiolitis group??which was the lowest in healthy control group. The CD3- CD19+ ratio was higher in bronchiolitis and no-wheezing group than in healthy control group??P??0.05??. Conclusion Lymphocyte subsets disorder in brochiolitis children was samilar to that in asthma patients. Children between 6 months and 1 year old were more likely to develop bronchiolitis than the other two groups. Bronchiolitis infants may have high expression tendency of B lymphocyte??especially those with allergic symptoms. RSV is still the most common pathogen in bronchiolitis.     

不同给药方法对潮气肺功能支气管舒张试验结果的影响观察

目的　探讨影响潮气肺功能支气管舒张试验参数改善的因素,为婴幼儿哮喘的诊断提供参考依据。方法　选择2017年3月至2018年6月就诊于首都儿科研究所哮喘门诊、经临床明确诊断为支气管哮喘且处于急性发作期（喘息发作≤7 d）的71例婴幼儿,将患儿依就诊顺序分为气雾剂组20例及雾化组51例,前者采用定量气雾剂给予支气管舒张剂,后者采用雾化吸入给予支气管舒张剂。2组患儿均进行潮气肺功能支气管舒张试验,比较两种给药方式对支气管舒张试验结果的影响,主要观察参数包括呼吸频率、潮气量、吸气时间、呼气时间、吸呼比、达峰时间比、达峰容积比、呼气峰流量;随后进行组内分析,进一步探讨各参数改善率的影响因素。结果　给药后,气雾剂组患儿呼吸频率显著下降（P＝0.003）,吸气时间显著延长（P＝0.011）;雾化组患儿潮气量、吸气时间、吸呼比、达峰时间比、达峰容积比显著上升（均P＜0.05）。雾化组患儿吸呼比、达峰容积比上升幅度显著高于气雾剂组（均P＜0.05）。气雾剂组内,与气道轻度阻塞患儿比较,气道重度阻塞患儿给药后,吸呼比、达峰时间比、达峰容积比改善显著（均P＜0.05）;雾化组内,气道重度阻塞患儿给药后,以上参数亦明显改善。雾化组不同年龄组间比较,2岁以上患儿达峰时间比、达峰容积比上升幅度显著高于1岁以下患儿（均P＜0.05）。结论　通过潮气肺功能技术进行支气管舒张试验,雾化吸入给药方式的舒张效果优于定量气雾剂;给药后肺功能参数的改善与气道阻塞程度有关,也与患儿年龄有关。     

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??Objective??To investigate the change of the platelet state and function in acute lymphocytic leukemia. Methods??The changes of platelet indices??PLT??PCT??MPV??PDW????immature platelet fraction??IPF%????immature platelet counts??IPC????granule membrane glycoprotein of platelet ??CD62p?? and PAC-1 were obtained by using automatic blood cell analyzer and whole blood flow cytometry??FCM?? respectively??in children with acute lymphocytic
leukemia??ALL????ALL in first complete remission ??ALL-CR1?? and children undergoing elective surgical procedure??control group??. Results????1??Without addition of platelet agonists ADP??expression of platelet surface activated CD62p and PAC-1 in ALL was higher than that in control group??P??0.05????while expression of platelet surface activated PAC-1 in ALL-CR1 was higher than that in control group??P??0.05????and lower than that in ALL??P??0.05??????2??With addition of platelet agonists ADP??expression of platelet surface activated CD62p and PAC-1 in ALL was lower than that in control group??P??0.05????while expression of platelet surface activated PAC-1 in ALL-CR1 was lower than that in control group??P??0.05????and higher than that in ALL??P??0.05??????3?? PLT??PCT and MPV in ALL was lower than that in control group and ALL-CR1 ??P??0.05??????4?? IPF% in ALL was higher than that in control group and ALL-CR1??P??0.05????and IPC was lower than that in control group and ALL-CR1??P??0.05??. Conclusion??The children who are newly diagnosed with acute lymphocytic leukemia have peripheral platelet reactivity and platelet function defects. Platelet indices and platelet membrane glycoprotein can be used as effective indicators to judge the effect on ALL.     

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??Objective To evaluate the risk factors for retinopathy of prematurity??ROP??for effective prevention.
Methods Studies were identified through literature search in Cochrane Library??PubMed??MEDLINE??Wanfang Periodicals Database??China Science Periodical Database and Chongqing VIP Science and Technology Journal Full-text Database up to October 2015. RavMan 5.3 provided by Cochrane was used for the meta-analysis. Results Ten studies were confirmed to be eligible. The meta-analysis showed as following?? low gestational age??WMD?? -1.76??95%CI?? -1.98—1.54?? P??0.01???? blood transfusion??OR??3.44??95%CI??2.41—4.90??P??0.01????sepsis??OR??2.37??95%CI??1.57—3.57??P??0.01????necrotizing enterocolitis ??OR?? 6.65??95%CI??3.46—12.78??P??0.01????patent ductus arteriosus??OR??2.39??95%CI??1.74—3.29??P??0.01????BPD??OR??4.75??95%CI??3.44—6.56??P??0.01????oxygen therapy??OR??2.72??95%CI??1.83—4.05??P??0.01????RDS??OR??2.53??95%CI??1.70—3.79??P??0.01????asphyxia??OR??2.99??95%CI??1.72—5.19??P??0.01????low birth weight??WMD??-238.19??95%CI??-320.93—155.44??P??0.01??. The differences were all significant statistically. Conclusion Low gestational age??blood transfusion??sepsis??necrotizing enterocolitis??BPD??patent ductus arteriosus??oxygen therapy??RDS??asphyxia??low birth weight are risk factors of ROP.