窒息新生儿的血浆前列腺素,血栓素变化

窒息新生儿的血浆前列腺素、血栓素变化闵晓华，江澜本组测定２８例出生时有窒息的新生儿血浆前列腺素及血栓素（ＴＸＡ＿２）的最终产物６－酮－前列腺素Ｆ＿（１α）（６－Ｋ－ＰＧＦ＿（１α））、ＴＸＢ＿２，旨在了解其变化及与窒息程度的关系。１．研究对象：窒息组...     

原发性肾病综合征患儿纤溶功能变化及其影响因素初探

本文分别用发色底物法及竞争性ＲＩＡ法对３０例原发性肾病综合征（ＰＮＳ）患儿进行了纤溶系统酶包括组织型纤维酶原激活剂（ｔ－ＰＡ）、纤溶酶原激活物抑制剂（ＰＡＩ）及α２－抗纤溶酶（α２－ＡＰ）及６－酮前列腺素Ｆ１２（６－Ｋｅｔｏ－ＰＧＦ１α）、血栓素Ｂ２（ＴＸＢ２）血浆含量的动态观测,显示病初ｔ－ＰＡ及６－Ｋｅｔｏ－ＰＧＦ１α水平明显降低,α２－ＡＰ水平明显升高;６－Ｋｅｔｏ－ＰＧＦ１α水平与ｔ－ＰＡ     

急性肾小球肾炎患儿血浆TXB2,6—keto—PGF1α的变化：附64例报告

本文用竞争性放射免疫分析法对６４例急性肾炎患儿血浆血栓素Ａ２（ＴＸＡ２）、前列环素（ＰＧＩ２）的稳定代谢产物血栓素Ｂ２（ＴＸＢ２）、６－酮－前列腺素Ｆ１α（６－ｋｅｔｏ－ＰＧＦ１α）进行了测定。结果显示：急性期患儿ＴＸＢ２含量升高，６－ｋｅｔｏ－ＰＧＦ１α下降，有高血压及合并症者改变更著；一般轻症患儿于恢复期上述改变恢复正常，而有高血压及并发症者尚不能完全回到正常水平。作者认为急性肾炎有血压升高、     

新生儿硬肿症及肺出血患儿血拴素A_2、前列环素I_2、蛋白C活性变化及意义

研究新生儿硬肿症５３例，各种原因所致肺出血１２例。检测了ＴＸＢ２（血栓素Ａ２－ＴＸＡ２的稳定衍生物）、６－Ｋ－ＰＧＦ１α（前列环素Ｉ２－ＰＧＩ２稳定衍生物）、ＰＣ－ＡＣＡ（蛋白Ｃ抗凝血活性）。其结果，新生儿硬肿症早期ＴＸＢ２升高，ＰＣ－ＡＣＡ在低体温时活性低，揭示本症存在着高凝趋势。肺出血病人６－Ｋ－ＰＧＦ１α升高，有些病人是在肺出血前检出的，提示此项可做为肺出血早期监测指标，但指标水平及出现时间等应进一步研究。肺出血病人Ｔ／Ｐ（ＴＸＢ２／６－Ｋ－ＰＧＦ１α以下简称Ｔ／Ｐ）比例失调，本研究证明新生儿硬肿症及肺出血存在血小板激活／破坏及血管内皮功能改变，有出凝血功能障碍。     

新生儿硬肿症及脐出血患儿血栓素A2,前列环素I2蛋白C活性变化及意义

研究新生儿硬肿症５３例，各种原因所致肺出血１２例。检测ＴＸＢ２（血栓素Ａ２－ＴＸＡ２的稳定衍生物）６－Ｋ－ＰＧＦ１α（前列环素Ｉ２－ＰＧＩ２稳定衍生物）ＰＣ－ＡＣＡ（蛋白Ｃ抗凝血活性）。其结果，新生儿硬肿症早期ＴＸＢ２升高，ＰＣ－ＡＣＡ在低体温时活性低，揭示本症存在着高凝趋势，肺出血病人６－Ｋ－ＰＧＦ１α升高，有些病人是在肺出血前检出的，提示此项可做为肺出血早期监测指标，但指标水平及出现时间等应时     

肺炎支原体肺炎患儿细胞免疫的研究

采用ＡＰＡＡＰ法和ＥＬＩＳＡ法对３５例肺炎支原体肺炎（ＭＰＰ）患儿急性期和恢复期外周血Ｔ淋巴细胞亚群（ＣＤ３、ＣＤ４、ＣＤ８）及血清可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）进行测定。ＭＰＰ患儿急性期和恢复期ＣＤ４、ＣＤ４／ＣＤ８比值均明显低于对照组（Ｐ均＜０．０１）；ＣＤ８明显高于对照组（Ｐ均＜０．０５）；ＣＤ３与对照组无显著性差异。在ＭＰＰ的急性期和恢复期，ｓＩＬ－２Ｒ水平明显高于对照组（Ｐ均＜０．０１）。急性期ＣＤ８、ＣＤ４与ｓＩＬ－２Ｒ水平呈高度正、负相关。提示Ｔ淋巴细胞功能的紊乱及ｓＩＬ－２Ｒ水平的改变与ＭＰＰ的发生密切相关。     

病毒性肝炎T细胞亚群和几种细胞因子变化的研究

为了探讨小儿病毒性肝炎发病的细胞免疫机制，应用不标记抗体桥联酶标技术（ＡＰＡＡＰ法）检测了５６例病毒性肝炎患儿的外周血Ｔ细胞亚群及膜性白细胞介素２受体（ｍＩＬ－２Ｒ）表达率。应用酶联免疫吸附（ＥＬＩＳＡ）法分别检测了４９例病毒性肝炎患儿单个核细胞培养上清液（ＰＢＭＣｓ）中肿瘤坏死因子α（ＴＮＦα）、白细胞介素６和８（ＩＬ－６、ＩＬ－８）及α干扰素（ＩＦＮ－α）浓度。结果显示：甲型肝炎（简称甲肝）急性期、慢性乙型肝炎（简称乙肝）及丙型肝炎（简称丙肝）组与正常对照比较，ＣＤ４细胞降低，ＣＤ８细胞升高。用植物血凝素（ＰＨＡ）刺激前，甲肝急性期患儿ｍＩＬ－２Ｒ表达率明显高于其他各组，用ＰＨＡ刺激后，各组ｍＩＬ－２Ｒ表达率均显著高于刺激前，但乙肝及丙肝组ｍＩＬ－２Ｒ表达率与正常对照比较则明显降低。甲肝急性期、乙肝及丙肝患儿ＰＢＭＣｓＴＮＦα、ＩＬ－６、ＩＬ－８均较正常对照组升高，而α干扰素（ＩＦＮ－α）均较正常对照组降低。甲肝恢复期ＣＤ４、ＣＤ８和ＰＨＡ刺激前ＰＢＭＣ上ｍＩＬ－２Ｒ表达率以及上述各细胞因子水平均恢复正常。提示细胞免疫功能紊乱与小儿病毒性肝炎的发病及肝损害过程有关。     

癫痫患儿细胞内外钙含量变化及其临床意义

应用密度离心法分离血细胞及火焰原子吸收光谱法同批测定２４例癫痫患儿血清、红细胞（ＲＢＣ）和单个核细胞（ＭＢＣ）内钙含量；应用钙离子选择性电极法检测２８例癫痫患儿脑脊液（ＣＳＦ）－Ｃａ２＋和全血Ｃａ２＋。结果表明：癫痫患儿发作后３天内ＭＢＣ－Ｃａ明显增高（Ｐ＜０．０５），ＣＳＦ－Ｃａ２＋明显降低（Ｐ＜０．０１），血清钙、ＲＢＣ－Ｃａ和全血Ｃａ２＋无显著变化。提示癫痫发作时可能存在钙内流。ＭＢＣ－Ｃａ增高于发作后３小时内最明显（Ｐ＜０．０５），与病因及每日发作次数无关，进一步提示ＭＢＣ－Ｃａ增高与癫痫发作有关。     

抗生素对小儿呼气氢试验的影响

目的探讨抗生素对呼气氢试验（ＢＨＴ）的影响。方法应用ＨＤ１型呼气氢测定仪,检测抗生素应用前后７５例住院患儿空腹呼气氢（ＦＢＨ）值和其中２３例患儿乳果糖氢呼吸试验（ＬＨＢＴ）的结果,并与２３１例健康儿ＦＢＨ比较。结果抗生素应用后ＦＢＨ［（１９５０±１２４）×百万分浓度（１０－６）］较应用前（３５９４±２９８）×１０－６明显降低（ｔ＝４９５,Ｐ＜０００１）;住院患儿抗生素应用前ＦＢＨ（３５９４±２９８）×１０－６与健康儿（１４５２±０１０）×１０－６比较,（ｕ＝４８３,Ｐ＜００１）;应用抗生素患儿口服乳果糖后呼气氢值无明显变化。结论住院患儿抗生素应用前,ＦＢＨ较健康患儿明显升高;抗生素应用后ＦＢＨ较应用前明显降低,ＬＨＢＴ呈假阴性结果。提示肠道氢产生受抑制。     

高脂血症肥胖儿童血小板释放反应的变化及分析

对２１例高脂血症单纯性肥胖儿童血浆前列环素（ＰＧＩ２）代谢产物６－酮－ＰＧＦ１α、血栓素（ＴＸＡ２）降解产物ＴＸＢ２及β－血小板球蛋白（β－ＴＧ）进行了定量分析，结果表明高脂血症肥胖儿较２１例正常儿童血浆６－酮－ＰＧＦ１α明显降低（Ｐ＜０．０１），血浆６－酮－ＰＧＦ１α／ＴＸＢ２比值亦明显变小（Ｐ＜０．０１），血浆β－ＴＧ显著升高（Ｐ＜０．０１）。提示高脂血症肥胖儿童血小板释放反应明显增强，并与体内ＰＧＩ２含量减少及ＰＧＩ２／ＴＸＡ２比值下降有关。     

川崎病患儿外周血单个核细胞基质细胞衍生因子-1和其受体的变化及意义

目的：观察川崎病(KD)患者血浆基质细胞衍生因子1(SDF1)水平及外周血单个核细胞(PBMC)中SDF1的受体CXCR4mRNA表达变化,并分析其与KD及冠状动脉损害的相关关系。方法：采用ELISA方法及荧光定量PCR技术分别测定12例合并冠脉损害和44例无冠脉损害KD患者的急性期与缓解期血浆SDF1浓度及PBMC中CXCR4mRNA表达变化,并与60例正常人比较。结果：KD患者急性期血浆SDF1蛋白水平为1833±395ng/L;PBMC中CXCR4mRNA表达水平为6.57±2.81较对照组升高(P<0.05,P<0.01);缓解期血浆SDF1蛋白和CXCR4mRNA表达水平较急性期下降(P<0.01),但仍显著高于对照组。KD患者合并冠脉损害者PBMC中CXCR4mRNA表达为8.19±2.39,显著高于无冠脉损害者的6.13±2.77(P<0.01)。结论：KD患者血浆SDF1水平及PBMC中CXCR4mRNA表达是增高的,有可能作为判断KD病情活动状态及冠脉损害的免疫学指标。     

Increased levels of BAL cysteinyl leukotrienesinacute [corrected] RSV bronchiolitis

BACKGROUND: Cysteinyl leukotrienes (CysLTs), including LTC4, LTD4 and LTE4, are pivotal mediators in the pathophysiology of asthma. AIM: To determine whether CysLT levels are increased in the lower airways of children with respiratory syncytial virus (RSV) bronchiolitis, as they are in asthmatic children, and to investigate a possible heterogeneity in CysLT levels in children with RSV bronchiolitis. METHODS: Bronchoalveolar lavage (BAL) fluids were obtained from children with acute RSV bronchiolitis (n = 20), from children with acute asthma who had no identifiable virus infection (n = 16) and from control subjects (n = 14). BAL cell counts and differentials were determined, and the concentrations of CysLTs were measured by ELISA. RESULTS: CysLT levels in the asthma (70.6 +/- 52.7 pg/ml, p < 0.001) and bronchiolitis groups (21.9 +/- 23.3 pg/ml, p < 0.05) were significantly higher than in the control group (8.7 +/- 5.2 pg/ml). Among bronchiolitis subjects, the eosinophil-positive subgroup (n = 6) showed significantly higher CysLT levels (49.0 +/- 26.7 pg/ml, p = 0.001) than the control group, but this was not observed in the eosinophil-negative subgroup (n = 14, 10.3 +/- 6.3 pg/ml, p = 0.47). CONCLUSION: CysLT levels are increased in the lower airways during RSV bronchiolitis, although their intensities are lower than those in acute asthma. Among bronchiolitis subjects, high CysLT producers could be distinguished from low CysLT producers by the presence of eosinophilia in BAL fluids, suggesting a pathophysiological heterogeneity in RSV bronchiolitis.     

The release of leukotrienes in the respiratory tract during infection with respiratory syncytial virus: role in obstructive airway disease

Samples of nasopharyngeal secretions from a group of 73 infants with bronchiolitis or upper respiratory illness alone during infection with respiratory syncytial virus were analyzed for leukotriene C4 (LTC4) content using a reverse-phase high-pressure liquid chromatography assay with confirmation by radioimmunoassay. Titers of respiratory syncytial virus (RSV)-specific IgE in nasopharyngeal secretion (NPS) specimens were determined using an enzyme-linked immunosorbent assay. The highest concentrations of LTC4 were found in the first 3 to 8 days after the onset of illness, and LTC4 was detectable in progressively lower concentrations in samples obtained up to 28 days after the onset of illness. LTC4 was detected in samples of NPS obtained in the acute phase of illness from 67% of infants with bronchiolitis due to RSV and in 33% of samples of NPS obtained during the same interval from infants with upper respiratory illness alone (p less than 0.025). Concentrations of LTC4 in children with bronchiolitis were 5-fold higher (1271 pg/ml) than the mean concentration of LTC4 in children with upper respiratory illness (224 pg/ml, p less than 0.02). LTC4 was detected in 83% of the children developing an RSV-IgE response and in 24% of subjects not developing an RSV-IgE response (p less than 0.001). Quantities of LTC4 measured in NPS were directly correlated with the magnitude of the RSV-IgE response in secretions (r = 0.33, p less than 0.02). These studies lend support to previous investigations suggesting that severe bronchiolitis due to RSV results from IgE-mediated hypersensitivity reactions to viral antigens, with release of chemical mediators of airway obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)     

毛细支气管炎患儿尿白三烯E4检测及其意义

目的通过检测毛细支气管炎(毛支)患儿尿白三烯E4(LTE4)水平及特应质对其的影响来探讨毛支患儿预后。方法对47例毛支患儿急性期恢复期及25例对照组进行尿LTE4测定,对急性期患儿同时检测嗜酸性粒细胞计数(EC)。结果毛支急性期尿LTE4水平(62.11±12.23)pmol/L较对照组(22.19±1.50)pmol/L、恢复期(34.86±5.75)pmol/L明显升高(P均<0.01),恢复期较对照组明显升高(P<0.01);与轻度毛支组(59.16±12.25)pmol/L比较,重度组患儿尿LTE4水平(98.04±8.04)pmol/L明显升高(P<0.01);特应质组(88.75±10.45)pmol/L毛支患儿尿LTE4水平较非特应质组(55.28±11.44)pmol/L明显升高(P<0.01);急性期毛支患儿尿LTE4水平与外周血EC计数无相关性(r=0.367,P>0.05)。结论毛支急性期尿LTE4产生增加,恢复期尿LTE4水平仍维持于高水平;重症毛支患儿尿LTE4水平明显升高,提示尿LTE4水平与病情严重程度有关;白三烯是影响特应质毛支患儿预后的重要的炎症介质;外周血EC不能很好的反映...     

Increased laryngeal lavage lipid-laden macrophage index during acute bronchiolitis

AIM: To investigate aspiration risks associated with bronchiolitis in infants using the lipid-laden macrophage index (LLMI) from laryngeal lavages. METHODS: Laryngeal lavages from 29 infants with acute bronchiolitis caused by respiratory syncytial virus were evaluated (acute stage). Repeated studies were then performed at 3-4 weeks after the initial study (remission stage). Lavage cell counts and differentials were determined. The amount of lipid per single macrophage was evaluated and the LLMI was determined by evaluating 100 cells. In addition, 24-h pH monitoring (pHm) was performed in 16 patients. RESULTS: The LLMIs in the acute stage were significantly higher than those in the remission stage (p < 0.05). The neutrophil percentage of the laryngeal lavage correlated significantly with the LLMI (r = 0.707, p < 0.0001) during the acute stage of bronchiolitis. When patients were divided into pHm-positive (n = 5) and pHm-negative (n = 11) subgroups, a significant decrease in LLMI between acute and remission stages was noted among the pHm-positive (p < 0.01) subgroup, but not in the pHm-negative subgroup. CONCLUSION: These findings suggest that there is a transient increased LLMI in patients with bronchiolitis, which could be caused by gastroesophageal reflux.     

哮喘儿童IgE T细胞亚群细胞因子的动态观察及临床意义

目的：探讨哮喘儿童血IgE和T细胞亚群、细胞因子的动态变化及临床意义。方法：应用免疫萤光法及双抗夹心酶联免疫吸附试验(ELISA)分析方法对45例哮喘儿童发作期和缓解期分别测定IgE,T细胞亚群和细胞因子。对照组为20例健康儿童。结果：哮喘发作期、缓解期CD_3~+,CD_4~+ T细胞及CD_4~+/CD_8~+高于对照组,差异有显著性(P<0.05或0.01),CD_8~+ T细胞与对照组比差异无显著性(P>0.05)。发作期CD_4~+ T细胞及CD_4~+/CD_8~+高于缓解期(P<0.05)。发作期IL-2,EFN-γ低于对照组(P<0.01或0.05),IL-4,IL-6,IL-8和IgE高于对照组(P<0.01或0.05);缓解期IL-2,IFN-γ低于对照组(P<0.01),IL-4,IL-8,IgE高于对照组(P<0.05或0.01),缓解期IL-6与对照组比较差异无显著性(P>0.05)。结论：儿童哮喘在发作期和缓解期均存在着免疫功能紊乱,提示儿童哮喘应长期抗变应性炎症治疗。 [中国当代儿科杂志,2003,5(1):23-26]     

毛细支气管炎患儿血内皮素和一氧化氮的监测

目的　 探讨血内皮素 (ET)和一氧化氮 (NO)在毛细支气管炎 (毛支 )中的变化及相互关系。 方法 　用放射免疫分析法和分光光度比色法分别检测毛支患儿血ET和NO ,并与正常儿童进行比较 ;检测重症毛支患儿急性期动脉血氧分压 (PaO2 )和二氧化碳分压 (PaCO2 ) ,并与血ET和NO进行直线相关分析。 结果 　血浆ET在毛支轻症组和毛支重症组 ,急性期均明显高于正常组 (分别 q =14 6 5 4、12 370 ,P均 <0 0 1) ,缓解期均下降 ,与正常组比较无显著差别 (分别 q =0 114、0 6 81,P均 >0 0 5 ) ;毛支轻症组和毛支重症组自身对照比较 ,急性期均高于缓解期 (分别 q =16 2 37、11 413 ,P均 <0 0 1)。与血浆ET一样 ,血清NO在毛支轻症组和毛支重症组 ,急性期均显著高于正常组 (分别q =6 95 5、3 338,P分别 <0 0 1和 <0 0 5 ) ,缓解期则下降 ,与对照组无差别 (分别 q =0 771、0 0 89,P均 >0 0 5 ) ;毛支轻症组和毛支重症组不同阶段NO值比较 ,急性期高于缓解期 (分别 q =8 6 30、2 984,P分别 <0 0 1和 <0 0 5 ) ;两组急性期相比 ,差异无显著性 ( q =2 0 83,P >0 0 5 ) ,但重症组低于轻症组。两组急性期血浆ET和血清NO呈明显正相关 (r =0 6 14 ,P <0 0 1)。血浆ET与PaO2 呈显著负相关 (r =-0 793 ,P <0 0     

缺氧缺血性脑病新生儿血浆内皮素和降钙素基因相关肽水平动态观察

目的探讨内皮素（ＥＴ）和降钙素基因相关肽（ＣＧＲＰ）在新生儿缺氧缺血性脑病（ＨＩＥ）中的变化及临床意义。方法采用放射免疫法对３６例ＨＩＥ患儿和１８例健康足月新生儿血浆ＥＴ和ＣＧＲＰ水平进行了同期动态测定。结果ＨＩＥ患儿急性期血浆ＥＴ和ＣＧＲＰ水平较恢复期明显增高（Ｐ＜０．０１）,并明显高于同期对照组水平（Ｐ＜０．０１）,恢复期与正常对照组无显著性差异。急性期不同程度ＨＩＥ及对照组之间ＥＴ,ＣＧＲＰ水平比较表明,重度组明显高于对照组、轻度组及中度组,中度组高于对照组和轻度组,轻度组与对照组无显著性差异。急性期患儿血浆ＥＴ和ＣＧＲＰ呈直线正相关（ｒ＝０．３８,Ｐ＜０．０５）。结论ＥＴ和ＣＧＲＰ参与了新生儿缺氧缺血性脑病的病理生理过程。ＥＴ的增高可能是促发ＨＩＥ脑损伤的一个重要因素,而ＣＧＲＰ增高在ＨＩＥ病程中对脑损伤可能具有一定保护作用。     

哮喘患儿血浆一氧化氮、环磷酸腺苷/环磷酸鸟苷比值变化的临床意义

目的　研究支气管哮喘患儿血浆一氧化氮 (NO)、环磷酸腺苷 (cAMP) /环磷酸鸟苷 (cGMP)比值变化及其临床意义。方法　采用硝酸还原酶法和放射免疫法测定哮喘患儿 4 0例急性期和缓解期血浆NO3 -/NO2 -、cAMP及cGMP水平与cAMP/cGMP比值变化 ,并设 2 3例健康儿童为对照组。结果　 1.哮喘患儿急性期血浆NO3 -/NO2 -水平显著高于缓解期和对照组 (P均 <0 .0 1)。 2 .哮喘患儿急性期血浆cGMP水平明显高于缓解期 (P <0 .0 5 ) ,显著高于对照组 (P <0 .0 1)。 3.哮喘患儿急性期血浆cAMP明显低于缓解期和对照组 (P均<0 .0 1)。 4 .哮喘患儿急性期cAMP/cGMP比值显著低于缓解期和对照组 (P均 <0 .0 1)。 5 .缓解期血浆NO3 -/NO2 -和cGMP水平下降 ,cAMP水平上升及其cAMP/cGMP比值与对照组相比 ,差异无显著性 (P均 >0 .0 5 )。6 .哮喘患儿急性期血浆NO3 -/NO2 -与cGMP水平呈正相关 (r =0 .4 0 1　P <0 .0 1)。结论　血浆内源性NO、cAMP、cGMP可能参与哮喘的发病机制 ,血浆NO、cAMP/cGMP比值变化可作为监测和指导哮喘患儿疗效和评价哮喘药物疗效的较好生化指标。     

哮喘患儿血IL-16 IL-18免疫球蛋白的动态变化及相关分析

目的：探讨哮喘患儿IL-16,IL-18,免疫球蛋白的动态变化及IL-１６,IL-18与免疫球蛋白之间的关系,为哮喘的发病机制及抗变态反应性炎症治疗提供理论依据。方法：对34例哮喘儿童及21例健康体检儿童（对照组）运用双抗夹心酶联免疫吸附试验（ELISA）法测定IL-16,IL-18,IgE,运用免疫比浊法测定IgG,IgM,IgA。结果：哮喘发作期、缓解期IL-18与对照组比较差异有显著性（P<0.01）;发作期IL-16,IgE,IgG均显著高于对照组（P<0.01或P<0.05）,IgA显著低于对照组（P<0.01）;缓解期IL-16,IgE均显著高于对照组（P<0.01）。发作期及缓解期IL-16,IL-18呈正相关（r=0.70, P<0.01;r=0.70,P<0.05）,发作期IL-16与IgE呈正相关（r=0.624,P<0.01）。结论： 哮喘患儿发作期与缓解期均存在免疫失衡状态,IL-16,IL-18及IgE与哮喘发病机制有关,哮喘患儿在缓解期也应继续抗变态反应性炎症治疗,针对这些细胞因子的治疗具有潜在的价值。［中国当代儿科杂志,2006, 8 (1):6-8］