巨细胞病毒肝炎婴儿血清白细胞介素-18及肿瘤坏死因子-α测定的临床意义

目的测定婴儿巨细胞病毒(CMV)肝炎治疗前后血清白细胞介素-18(IL—18)及肿瘤坏死因子-α(TNF—α)水平,研究其在婴儿CMV肝炎中的临床意义。方法采用酶联免疫吸附法(ELISA)检测36例CMV肝炎患儿治疗前后及健康婴儿21 例血清IL-18和TNF—α水平。结果CMV肝炎患儿血清IL—18和TNF-α水平明显高于正常对照组(P<0.001),且均与血清ALT呈显著正相关(P<0.01);阴转组治疗结束后血清IL-18和TNF-α水平均较治疗前显著降低(P<0.001),而未阴转组IL-18和TNF-α治疗前后无明显变化(P>0.05)。结论血清IL-18及TNF—α检测可作为婴儿CMV肝炎炎症活动性和肝损害程度的评判指标,并对预测药物抗病毒疗效有重要指导价值。     

婴儿肝炎综合征血清和胆汁成分变化的意义

目的探讨婴儿肝炎综合征（IHS）患儿血清及胆汁成分变化的临床意义。方法采用全自动生化分析仪检测42例IHS患儿及对照组16例婴儿的血清及胆汁中总胆红素（TB）、直接胆红素（DB）、ALT、γ-谷氨酰转肽酶（γ-GT）、总胆汁酸（TBA）水平,采用双抗体夹心ELISA法检测血清及胆汁中白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）的水平。婴儿肝炎综合征患儿分为淤胆型组（18例）和肝炎型组（24例）。结果1.IHS组血清TB、DB、ALT、γ-GT、TBA、IL-6、TNF-α均明显升高（Pa〈0.05）;胆汁中TB、DB、γ-GT、TBA均明显降低（Pa〈0.05）,IL-6、TNF-α高于对照组（Pa〈0.05）。2.淤胆型血清TB、DB、γ-GT、TBA、IL-6、TNF-α均高于肝炎型（Pa〈0.05）;淤胆型胆汁中IL-6、TNF-α高于肝炎型（Pa〈0.05）,γ-GT、TBA则低于肝炎型（Pa〈0.05）。3.IHS患儿胆汁IL-6、TNF-α分别与血清DB、TBA、γ-GT呈正相关（Pa〈0.05）。结论IHS患儿均存在不同程度胆汁淤积,淤胆型IHS胆汁淤积程度更严重,胆汁IL-6、TNF-α可能参与IHS胆汁淤积的发生过程,且与疾病严重程度有关,检测胆汁中TB、DB、γ-GT、TBA、IL-6、TNF-α水平可为判断IHS患儿病情程度及估计预后提供依据。     

支气管哮喘患儿急性发作期血清白细胞介素-25、12的变化及其意义

目的探讨哮喘患儿急性发作期血清IL-25、12水平变化及其在哮喘发病中的作用。方法随机选取于本院就诊的哮喘急性发作期患儿30例作为观察组。男20例,女10例;年龄4～13岁;发作程度：轻度8例,中度17例,重度5例。随机选取同期同年龄组健康体检儿童27例作为健康对照组。男18例,女9例;年龄4～14岁。二组年龄及性别均无统计学差异（Pa〉0.05）。分别抽取各组儿童静脉血4mL,离心后留取血清标本置-70℃冰箱保存,采用ELISA法测定二组儿童血清IL-25、12水平。结果哮喘急性发作期患儿血清IL-25水平[（56.75&#177;11.68）ng/L]显著高于健康对照组[（45.77&#177;10.43）ng/L],差异有统计学意义（t=3.726P〈0.05）;哮喘急性发作期患儿血清IL-12水平[（42.12&#177;12.96）ng/L]显著低于健康对照组[（57.12&#177;14.42）ng/L],差异有统计学意义（t=-4.136P〈0.05）;血清IL-25水平与IL-12水平呈显著负相关（r=-0.420P〈0.01）。结论哮喘患儿急性发作期血清IL-25水平升高和IL-12水平降低与哮喘的发作关系密切。增强IL-2的活性,可为哮喘的治疗提供新的靶点与理论依据。     

病毒性心肌炎患儿血清白细胞介素-18、肿瘤坏死因子-α、干扰素-γ水平及其相关性

目的研究细胞因子白细胞介素-18（IL-18）、肿瘤坏死因子-α（TNF-α）、干扰素-γ（IFN-γ）在病毒性心肌炎（VM）患儿血清中水平及相互关系。方法采用双抗体夹心ELISA方法检测72例VM患儿及25例健康儿童血清IL-18、TNF-α、IFN-γ水平。结果1.VM组血清中IL-18、TNF-α、IFN-γ水平高于正常对照组,均有显著性差异（Pa〈0.05）;2.VM组血清中IL-18与TNF-α呈直线正相关（r=0.35P〈0.05）。结论细胞因子IL-18、TNF-α、IFN-γ参与VM发病免疫过程,IL-18具有抗病毒作用,与TNF-α同样具有心肌免疫损伤可能。     

缺氧缺血性脑病新生儿血清脂联素、白细胞介素-6变化的意义

目的探讨不同时期HIE新生儿血清脂联素与IL-6水平和其相关性，及其与HIE临床分度的关系。方法采用ELISA法对58例HIE患儿（HIE组）及26例非HIE新生儿（对照组）血清脂联素与IL-6水平进行动态检测，并对检测结果采用SPSS 10．0软件进行统计学处理。结果中、重度HIE组急性期血清脂联素水平与轻度组及对照组比较均明湿下降（Pa〈0．001），重度组较中度组明显下降（P〈0．001）；恢复期，中、重度组血清脂联素水平仍明显低于轻度HIE及对照组（Pa〈0．001），重度组明显低于中度组（P〈0．01）；急性期，中、重度HIE患儿血清脂联素水平降低，与恢复期比较均有差异性显著（Pa〈0．001），轻度HIE组和对照组血清脂联素水平在急性期和恢复期比较差异均无统计学意义（Pa〉0．05）。中、重度组HIE患儿急性期血清IL-6水平与对照组及轻度组比较均明显升高（Pa〈0．001），重度组与中度组比较亦明显升高（P〈0．001）；恢复期，中、重度组血清IL-6水平仍明显高于轻度HIE及对照组（Pa〈0．001），重度组明显高于中度组（P〈0．001）；急性期，中、重度HIE患儿血清IL-6水平升高，均明显高于恢复期（Pa〈0．001），轻度HIE组和对照组患儿血清IL-6水平在急性期和恢复期比较差异均无统计学意义（Pa〉0．05）。HIE患儿血清脂联素与IL-6水平呈显著负相关（r=-0．852 P〈0．001）。结论检测血清脂联素和IL-6水平可作为临床HIE病情程度的判断指标之一，对临床诊断及预后的判断具有指导意义。     

肺炎支原体肺炎患儿血清白细胞介素-10、转化生长因子-β1检测的意义

目的探讨肺炎支原体肺炎（MPP）患儿急性期及恢复期外周血IL-10、转化生长因子-β1（TGFβ-1）水平变化的临床意义。方法采用双抗体夹心酶联免疫吸附法（ELISA）测定26例MPP急性期和其中恢复期9例患儿及12例健康儿童血清IL-10、TGFβ-1水平。比较MPP急性期与恢复期IL-10、TGFβ-1的差异。结果MPP急性期及恢复期患儿血清IL-10水平均显著低于对照组（P〈0.01,0.05）,急性期及恢复期MPP患儿血清TGFβ-1均明显高于对照组（Pa〈0.01）。MPP患儿急性期与恢复期IL-10、TGFβ-1无明显差异（Pa〉0.05）。结论IL-10低水平表达与MPP发病可能有关,存在炎症反应失控,同时存在以TGFβ-1高水平表达的抗感染反应占优势。     

中西医结合治疗巨细胞病毒性肝炎患儿血清IL-10及IL-2水平变化

目的：探讨茵栀黄口服液对巨细胞病毒( cytomegalovirus,CMV)性肝炎患儿血清白细胞介素-10(interleukin-10)及IL-2水平的影响。方法60例患儿被分为更昔洛韦组(对照组)和茵栀黄口服液联合更昔洛韦组(治疗组),对照组更昔洛韦5 mg/kg 静脉点滴,2次/d,连用14 d;治疗组给予更昔洛韦剂量同前,加茵栀黄口服液5 ml/次,3次/d,疗程同前;各组给予常规保肝治疗。采用酶联免疫吸附法检测两组治疗前后IL-10、IL-2水平。结果两组治疗后IL-10较治疗前明显降低,IL-2较治疗前明显升高,差异均具有统计学意义( P<0．05),联合用药组治疗后IL-10及IL-2变化较对照组差异有统计学意义( P<0．05)。结论茵栀黄口服液显著降低了CMV肝炎患儿血清IL-10水平,同时显著升高了IL-2的水平,提示其在调节机体免疫功能方面具有一定疗效。     

新生儿缺氧缺血性脑病血清白介素-1β和白介素-18测定及意义

目的 探讨新生儿缺氧缺血性脑病（HIE）血清白介素（IL）-1β和IL-18的变化以及二者与HIE临床分度之间的关系。方法采用酶联免疫吸附法（ELISA）检测了70例HIE患儿（按临床分度分轻、中、重三组）及22例正常对照组足月新生儿第三天血清IL-1β和IL-18的水平。结果（1）HIE组新生儿血清IL-1β和IL-18均明显高于对照组（P〈0．05）；（2）与正常对照组比较，中、重度HIE组血清IL-1β和IL-18水平明显增高（P〈0．01）；轻度HIE组血清IL-1β、IL-18水平则与正常对照组无显著性差异（P〉0．05）。HIE组间血清IL-1β及IL-18两两比较，中度与轻度组比较有显著性差异（P〈0．05）；重度组与其他两组比较均明显升高（P〈0．01）。结论急性期HIE患儿血清IL-1β和IL-18水平与HIE临床分度基本一致。因此，血清IL-1β和IL-18水平可作为辅助诊断HIE的指标，对协助HIE临床分度具有重要价值。     

非甾体抗炎药在小儿全身炎症反应综合征治疗中的作用及其相关机制的研究

目的 探讨非甾体抗炎药在小儿全身炎症反应综合征（SIRS）治疗中的作用及其可能的机制，以期为临床诊治SIRS提供新的措施。方法 选择2004年1月～12月住院的SIRS患儿40例，依据治疗措施分为常规治疗组20例和布洛芬干预组20例，采用免疫化学发光法、酶联免疫吸附测定法检测SIRS患儿治疗前后血清中降钙素原（PCT）、TNF-α，IL-1β、IL-10水平，观察应用非甾体抗炎药后的临床资料及PCT与上述细胞因子水平的变化。结果 布洛芬干预组治疗后，血清PCT水平较常规治疗组降低，但差异无显著性（P〉0．05）；血清TNF—α水平明显下降（P〈0．01）；血清IL-1β及血清IL-10水平下降程度大于常规治疗组，差异无显著性（P〉0．05）；治疗后的临床疗效同常规治疗组比较差异无显著性（P〉0．05）。结论 非甾体抗炎药（布洛芬）可降低SIRS患儿血清中重要致炎因子TNF—α水平，并使PCT、IL-1β、IL-10水平呈下降趋势，提示非甾体抗炎药可能抑制炎症因子的释放，进而缓解因炎症因子聚集引起的炎症反应，从而达到治疗SIRS的目的。     

哮喘患儿血清白细胞介素17、基质金属蛋白酶-9和免疫球蛋白E水平测定的意义

目的探讨哮喘患儿血清IL-17、基质金属蛋白酶-9（MMP-9）和IgE水平测定的意义。方法选取哮喘患儿28例为哮喘组,健康患儿14例为对照组。采用双抗体夹心酶联免疫吸附试验（SELISA）测定二组患儿血清IL-17、MMP-9及IgE水平,并行相关分析。结果哮喘组患儿血清IL-17、MMP-9和IgE水平均显著高于正常对照组（Pa〈0.01）。哮喘组患儿血清IL-17、MMP-9水平均与IgE呈显著正相关（r=0.395,0.940 P〈0.05,0.01）;而IL-17与MMP-9无相关关系（r=0.338 P〉0.05）。结论IL-17与MMP-9均参与哮喘患儿呼吸道炎症反应和呼吸道重建。     

Pubertal growth and development and prenatal and lactational exposure to polychlorinated biphenyls and dichlorodiphenyl dichloroethene

OBJECTIVES: Polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE) are ubiquitous toxic environmental contaminants. Prenatal and early life exposures affect pubertal events in experimental animals. We studied whether prenatal or lactational exposures to background levels of PCBs or DDE were associated with altered pubertal growth and development in humans.Study design: Follow-up of 594 children from an existing North Carolina cohort whose prenatal and lactational exposures had previously been measured. Height, weight, and stage of pubertal development were assessed through annual mail questionnaires. RESULTS: Height of boys at puberty increased with transplacental exposure to DDE, as did weight adjusted for height; adjusted means for those with the highest exposures (maternal concentration 4+ ppm fat) were 6.3 cm taller and 6.9 kg larger than those with the lowest (0 to 1 ppm). There was no effect on the ages at which pubertal stages were attained. Lactational exposures to DDE had no apparent effects; neither did transplacental or lactational exposure to PCBs. Girls with the highest transplacental PCB exposures were heavier for their heights than other girls by 5.4 kg, but differences were significant only if the analysis was restricted to white girls. CONCLUSIONS: Prenatal exposures at background levels may affect body size at puberty.     

Hypokalemia and Hyperkalemia in Infants and Children: Pathophysiology and Treatment

Potassium is the second most abundant cation in the body. About 98% of potassium is intracellular and that is particularly in the skeletal muscle. Electrical disturbances associated with disorders of potassium homeostasis are a function of both the extracellular and intracellular potassium concentrations. Clinical disorders of potassium homeostasis occur with some regularity, especially in hospitalized patients receiving many medications. This article will review the pathophysiology of potassium homeostasis, symptoms, causes, and treatment of hypo- and hyperkalemia.     

Prevention and treatment of overweight and obesity in children and adolescents

Increasing numbers of obese children and adolescents all over the world demand an investment in the primary and secondary prevention of obesity and overweight in this age group. The goal of preventive measures in children is to avoid the negative short- and long-term health problems associated with obesity. Primary prevention aims at establishing a healthy, active lifestyle and keeping children and adolescents within a range of body weight which is considered to be healthy. Constant availability and affordability of palatable and energy-dense food in the affluent society of the western world demands preventive strategies. Universal or public health prevention seems to be the most suitable form because several other cofactors of morbidity and mortality of affluent societies can also be prevented. However, in most European countries there is a lack of awareness of the necessity of prevention programmes, not only among the general population but also among the medical society. More awareness and consciousness to the problem of obesity must be generated in order to lead to effective therapeutic programmes. For those children and adolescents who are already obese, secondary prevention is mandatory. Therapeutic intervention programmes for the obese aim at long-term weight maintenance and normalisation of body weight and body fat. They have to modify eating and exercise behaviour of the obese child and establish new, healthier behaviour and lifestyle. Treatments programmes must include behavioural components in order to permanently change nutrition and physical exercise of the obese children and adolescents. However, long-term results of treatment programmes in European countries are scarce and the reported results, even of multidisciplinary regimens, are not impressive. Conclusion In most European countries there is an urgent need not only for a growing awareness of the problem of obesity in children and adolescents but also for development of new comprehensive approaches in treating this group.