儿童单纯性肥胖与胰岛素抵抗综合征危险因素的关系

目的 探讨儿童单纯性肥胖与胰岛素抵抗综合征危险因素的关系.方法 单纯性肥胖患儿50例为肥胖组(男23例,女27例),选取同期健康儿童30例为健康对照组(男14例,女16例).对每位对象采用同一磅秤标准方法 测量其身高、体质量,并计算其体质量指数(BMI).血压测定采用儿童标准血压测定法获得.采用发光免疫法、快速测血糖法分别对2组儿童的血糖、血胰岛素、血脂进行检测,计算稳态模型胰岛素抵抗指数(HOMA-IRI)、胰岛素敏感指数(HOMA-ISI),并应用SPSS 12.0软件进行统计学分析.结果 肥胖组儿童HOMA-IRI、舒张压与健康对照组比较均显著增高(t=3.939,3.278 P_＜0.01);收缩压、三酰甘油与健康对照组比较均显著增高(t=2.536,2.573 Pa＜0.05);HOMA-ISI、高密度脂蛋白均显著低于健康对照组(t=-4.750 P＜0.01,t=-2.982 P＜0.05).肥胖组儿童BMI与HOMA-IRI呈显著正相关(r=0.294 P＜0.05).结论 儿童单纯性肥胖与胰岛素抵抗综合征危险因素密切相关,儿童期积极开展对肥胖的干预,对预防和控制成年期诸多慢性疾病的发生有重要意义.     

肥胖伴黑棘皮病儿童代谢综合征的高危因素

目的 探讨肥胖伴黑棘皮病儿童代谢综合征(MS)的高危因素.方法 2006年11月-2007年9月在本院儿科就诊25例肥胖伴黑棘皮病儿童(病例组).男15例,女10例;年龄8.4～16.0岁,平均10.6岁;体质量(72.11±17.66)kg;身高(155±14)cm.32例身高别体质量正常的健康儿童为健康对照组.男18例,女14例;年龄7.6～15.8岁,平均9.8岁.比较二组儿童体质量指数(BMI)、胆固醇(12HO)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、血压、空腹和葡萄糖耐量试验(OGTT)2 h血糖、胰岛素和稳态模型评估法胰岛素抵抗指数(HOMA-IR)的差异,并对所有儿童进行肝脏超声波检查.采用SPSS 12.0软件进行统计学分析.结果 病例组儿童BMI、TG、LDL-C、收缩压和舒张压均显著高于健康对照组(Pa<0.01);空腹和OGTT 2h血糖、OGTT 2h胰岛素和HOMA-IR均显著高于健康对照组(Pa<0.01);BMI与收缩压、舒张压、CHO、TG、LDL-C、空腹血糖(FBG)、空腹胰岛素(FINS)以及HOMA-IR均无相关性(Pa>0.05).病例组患儿中超声诊断脂肪肝发生率为84%,健康对照组儿童肝脏B超检查均未见异常.结论 肥胖伴黑棘皮病儿童BMI增加、胰岛素抵抗、血脂紊乱和血压增高是MS的危险因素,密切随访监测此类患儿有助于早期发现MS.积极治疗肥胖症,阻断儿童血糖、血脂代谢紊乱的发生,有助于减少儿童2型糖尿病和心血管疾病的危险性.     

不同抗癫癎药物治疗对癫癎患儿血脂的影响

目的 探讨癫癎患儿血脂水平的改变及应用抗癫癎药物对血脂水平的影响.方法 采用酶测定法分别测定2009年1月-2011年1月在小儿癫癎专科门诊随访治疗的55例癫癎患儿(全面性发作30例,单纯局限性发作18例,不能分类的发作7例)和30例健康体检儿童(健康对照组)血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白( HDL-C)、低密度脂蛋白(LDL-C)水平,分析癫癎患儿在单药或联合用药至少0.5a后与健康对照组比较血脂水平的变化.结果 癫癎患儿服用抗癫癎药物后引起其血脂水平的改变,与健康对照组血脂水平相比,血清TG、LDL-C显著升高(Pa＜0.01),HDL-C水平显著下降(P＜0.01);丙戊酸钠( VPA)单药治疗的癫癎患儿与健康对照组相比,TG、LDL-C升高及HDL-C降低,其差异有统计学意义(Pa＜0.05,0.01),而单用VPA与联合用药组之间及两个联合用药组间血脂水平改变的差异均无统计学意义(Pa＞0.05);联合用药组与健康对照组比较,其改变幅度VPA＞ VPA+拉莫三嗪＞VPA+左乙拉西坦,但差异均无统计学意义(Pa＞0.05).结论 癫癎患儿服用抗癫癎药物后存在血脂水平的改变,以单用VPA的改变最大.     

瘦素/脂联素值与肥胖儿童体质量指数及糖脂代谢的关系

目的 探讨瘦素/脂联素(L/A)值与单纯性肥胖儿童体质量指数(BMI)、糖脂代谢及肥胖症发病的关系.方法 单纯性肥胖60例和57例健康儿童,采用放射免疫分析(RIA)法测定其血清瘦素水平;ELISA法测定其血清脂联素、空腹胰岛素(FINS)水平;免疫比浊法测定其血脂各成分.分析并比较血清瘦素、脂联素及L/A值与肥胖儿童BMI、糖脂代谢的相关性.结果 1.肥胖儿童血清瘦素、FINS和三酰甘油(TG)水平与健康对照组相比明显增加;脂联素水平降低,差异均有显著性(Pa＜0.05,0.01).2.单纯性肥胖儿童瘦素与BMI、FINS、TG水平均呈显著正相关(r=0.408,0.301,0.301 Pa＜0.05,＜0.01);脂联素水平与BMI、FINS、TG均呈显著负相关(r=-0.360,-0.413,-0.258 Pa＜0.01,＜0.05).3.L/A值与BMI、FINS、TG呈显著正相关(r=0.780,0.764,0.601 Pa＜0.001).结论 血清瘦素和脂联素与肥胖儿童的发病有关,可作为儿童肥胖的监控指标;L/A值较单独瘦素、脂联素更能反映肥胖症儿童的代谢状况,可为肥胖症儿童糖脂代谢提供更为有效的监测指标.     

不同病因急性心力衰竭患儿血清氨基末端脑钠素原水平变化及其与肺动脉压力的关系

目的 探讨先天性心脏病、肺炎并心力衰竭患儿血清氨基末端脑钠素原(NT-proBNP)水平变化及其与肺动脉高压(PH)的关系.方法 采用竞争性酶免疫法检测66例住院心力衰竭患儿(肺炎并心力衰竭25例,先天性心脏病并肺炎心力衰竭22例,先天性心脏病并中重度PH心力衰竭19例)及60例对照组患儿(肺炎、先天性心脏病、健康儿童各20例)外周血NT-proBNP水平.多普勒超声心动图检测心力衰竭患儿心室射血分数(LVEF)、缩短分数(FS),对先天性心脏病患儿估测肺动脉压力.结果 1.肺炎心力衰竭组及先天性心脏病心力衰竭组NT-proBNP水平无显著差异(P＞0.05),但二组均较相应对照组(肺炎对照组、先天性心脏病对照组)显著增高(Pa＜0.001);先天性心脏病并中重度PH心力衰竭组较先天性心脏病无PH或轻度PH心力衰竭组水平亦明显增高(Pa＜0.05).2.三组心力衰竭患儿间LVEF、FS水平比较差异无显著性(Pa＞0.05).3.肺炎对照组、先天性心脏病对照组较正常对照组NT-proBNP水平略高,但无统计学意义(Pa＞0.05).结论 血清NT-proBNP对肺炎心力衰竭、先天性心脏病并心力衰竭均有较敏感而特异的诊断价值,且随肺动脉压力增高而呈增高趋势.     

单纯性肥胖患儿胰岛素抵抗与血脂的关系

目的探讨单纯性肥胖(肥胖)患儿胰岛素抵抗与血脂的关系。方法选取肥胖患儿50例为肥胖组(男23例,女27例),同期健康儿童30例为健康对照组(男14例,女16例)。对每位对象采用同一磅秤标准,测量其身高、体质量,并计算其体质量指数(BMI)。采用儿童标准血压测定法测定2组儿童血压。采用发光免疫法、快速测血糖法分别对2组儿童的血糖、血胰岛素、血脂进行检测,并计算稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(HOMA-ISI)、胰岛素和葡萄糖曲线下的面积比值反映组织对胰岛素的敏感性(AUC)、肝脏组织对胰岛素的敏感性(FINS/FBG),并应用SPSS12.0软件进行统计学分析。结果与健康对照组比较,肥胖组患儿HOMA-IR、AUC、FINS/FBG均显著增高(t=3.939、6.314、3.723,Pa<0.01),空腹三酰甘油(TG)亦显著增高(t=2.573,P<0.05),高密度脂蛋白(HLD)、HOMA-ISI显著低于健康对照组(t=-2.982、-4.75,P<0.05、0.01)。多因素Pear-son相关分析显示,肥胖组TG与HOMA-IR、AUC、FINS/FBG呈显著正相关(r=0....     

母亲妊娠糖尿病及妊高征对新生儿内分泌水平影响的研究

探讨母亲妊娠合并糖尿病及妊高征对高危儿血糖、胰岛素、皮质醇、胰岛素样生长因子1水平(IGF-1)的影响,检测糖尿病组42例,妊高征组144例,健康对照组23例,均于出生24～48小时内采取股静脉血,测定有关内分泌水平.结果显示(1)糖尿病组胰岛素、皮质醇水平较对照组显著增高,P＜0.05;(2)妊高征组皮质醇水平明显高于对照组,P＜0.05;(3)糖尿病与妊高征二组比较,IGF-1有显著性差异,P＜0.05.结论,妊娠合并糖尿病及妊高征均对围产儿内分泌产生影响,可引起血皮质醇水平明显升高,尤其以前者为甚,可发生高胰岛素血症及血中IGF-1水平升高,胎儿柯兴氏面容、RDS及巨大儿的发生显著增高,影响围产儿的质量,应引起重视.     

肥胖儿童非酒精性脂肪肝炎54例

目的 观察不同程度肥胖儿童非酒精性脂肪肝炎(NASH)的发病状况,探讨其可能的发病机制.方法 体质量指数(BMI)≥23的7～16岁单纯性肥胖儿童123例.按BMI分为3组:BMI≥30组34例,25≤BMI＜30组57例,23≤BMI＜25组32例.分别进行肝脏B超检查,并检测血转氨酶、胆固醇、三酰甘油(TG)及空腹血糖/空腹胰岛素比值(FlGIR).将另24例仅有肥胖而无肝脂肪病变者设为对照组.结果 123例患儿中B超发现肝脂肪病变99例(80.49%),其中符合NASH诊断标准者54例(43.90%).所有患儿中,BMI≥30组脂肪肝炎及FGIR＜7的发生率均显著高于其他2组(Pa ＜0.01).相关分析表明,ALT和AST与BMI分级、血胆固醇、TG、FGIR均有相关性(r=0.413,0.290,0.379,-0.477 Pa ＜0.01;r=0.359,0.349,0.348,-0.369 Pa ＜0,01).NASH患儿与对照组血脂、FGIR、BMI比较差异均有统计学意义(X2=9.84,25.59 Pa ＜0.01;t=5.05P＜0.01).结论 BMI ≥30是肥胖儿童发生NASH的高危因素,且脂代谢紊乱和胰岛素抵抗可能与其发病有关.     

不同类型抗精神病药物对精神分裂症患儿血清同型半胱氨酸水平及认知功能的影响

目的 探讨抗精神病药物对精神分裂症患儿血清同型半胱氨酸(Hcy)水平及认知功能的影响.方法 将96例首发精神分裂症患儿分为非经典抗精神病药物治疗组(研究组)和经典抗精神病药物治疗组(病例对照组),分别测定治疗前后2组患儿血清Hcy水平和事件相关电位(ERP),并将检测结果与50例健康儿童(健康对照组)进行比较.结果 与健康对照组比较,治疗前研究组和病例对照组患儿血清Hcy水平明显增高,ERP测定中N2波潜伏期(PL)、P3PL明显延长,P3波幅(amp)明显降低,差异均有统计学意义(Pa＜0.01)；研究组和病例对照组治疗前血清Hcy水平及ERP各指标比较差异无统计学意义.与治疗前比较,治疗后研究组N2PL、P3PL缩短,P3 amp增高,血清Hcy水平降低,差异均有统计学意义(Pa＜0.01)；而病例对照组各指标比较差异均无统计学意义.治疗后与病例对照组比较,研究组N2PL、P3PL缩短,P3 amp增高,血清Hcy水平降低,差异均有统计学意义(Pa＜0.01).结论 儿童精神分裂症患者存在一定程度的高Hcy血症和认知功能损害,非经典抗精神病药物治疗可明显改善精神分裂症患儿的Hcy水平和认知功能.     

风湿性心脏病患儿血浆脑利钠肽水平变化的意义

目的 观察风湿性心脏病患儿血浆脑利钠肽(BNP)水平的变化,探讨其在风湿热(RF)并心脏病变患儿中的诊断价值.方法 选择RF患儿20例(RF组),包括风湿性心脏病患儿11例(心脏病变组),无心脏病变患儿9例(无心脏病变组).同时选择20例健康儿童作为健康对照组.采用ELISA测定各组血浆BNP、肌钙蛋白I(cTnI)水平,并行心脏彩色多普勒超声及ECG检查.健康对照组随机采血1次,测定血浆BNP和cTnI水平.应用SPSS 11.5软件进行统计学分析.结果 RF组患儿血浆BNP、cTnI水平均明显高于健康对照组(Pa＜0.01);心脏病变组血浆BNP水平较无心脏病变组明显升高(P＜0.01),cTnI水平二组比较差异亦有统计学意义(P＜0.05);BNP异常升高率显著高于cTnI(x2=14.19,P＜0.01)及ECG(x2=10.23,P＜0.01),cTnI异常率与ECG异常率比较差异无统计学意义(x2=1.37,P＞0.05).心脏病变组患儿BNP与cTnI水平呈显著正相关(r=0.32,P＜0.05).结论 BNP在风湿性心脏病患儿中异常增高,与cTnI呈正相关,且较cTnI、ECG灵敏度高.BNP、cTnI二者结合对RF并心脏病变的诊断具有重要意义.     

Relation of circulating oxidized LDL to obesity and insulin resistance in children

Kelly AS, Jacobs DR Jr, Sinaiko AR, Moran A, Steffen LM, Steinberger J. Relation of circulating oxidized LDL to obesity and insulin resistance in children. Introduction: Circulating oxidized low‐density lipoprotein (LDL), a marker of oxidative stress, is associated with obesity, insulin resistance, metabolic syndrome, and cardiovascular disease in adults. However, little is known about its relation to insulin resistance and cardiovascular risk factors in children. The purpose of this study was to assess the relation of oxidative stress, measured by circulating oxidized LDL, with measures of adiposity and insulin resistance in children. Methods: Oxidized LDL, measures of body fatness (body mass index: BMI, percent body fat, waist circumference, percent trunk fat, abdominal visceral and subcutaneous fat), insulin resistance with euglycemic insulin clamp (Mlbm), blood pressure, and blood lipids were obtained in 78 children. Oxidized LDL was compared between normal weight children (BMI < 85th percentile) and overweight/obese children (BMI ≥ 85th percentile) and levels were evaluated for associations with body fatness and insulin resistance. Results: Oxidized LDL levels were significantly higher in overweight/obese vs. normal weight children (p < 0.0001). Oxidized LDL was significantly correlated with BMI, percent body fat, waist circumference, percent trunk fat, abdominal visceral fat, and abdominal subcutaneous fat (all p‐values <0.0001). Moreover, oxidized LDL was negatively correlated with Mlbm, even after adjustment for adiposity (p < 0.01). Conclusions: Oxidized LDL is significantly associated with adiposity and with insulin resistance, independent of body fatness, in children. Oxidative stress may be independently related to the development of insulin resistance early in life, especially in obese youth.     

急性白血病X连锁凋亡抑制蛋白的表达及意义

目的探讨儿童急性白血病(AL)X连锁凋亡抑制蛋白(XIAP)的表达和XIAP mRNA水平及其临床意义。方法AL患儿49例,其中初诊未治26例,完全缓解(CR)23例。应用免疫组织化学方法检测其骨髓细胞XIAP表达,对其中24例患儿采用半定量反转录聚合酶链反应(RT-PCR)检测其骨髓单个核细胞XIAP mRNA表达水平。对照组分别为10例和8例非恶性血液病患儿。结果XIAP及其mRNA在初诊未治AL患儿骨髓中表达水平高于缓解期(Pa<0.05)和对照组(Pa<0.05),且缓解期仍高于对照组(Pa<0.05);初诊未治AL患儿骨髓XIAP及其mRNA水平在急性淋巴细胞白血病(ALL)和急性髓系白血病(AML)组比较无显著性差异(Pa>0.05)。结论XIAP及其mRNA在儿童AL治疗前均呈高表达,提示XIAP可能通过抑制肿瘤细胞凋亡参与儿童AL发生发展。     

过敏性紫癜患儿血清可溶性血管细胞黏附分子-1及可溶性细胞间黏附分子-1表达的意义

目的 检测过敏性紫癜(HSP)患儿血清可溶性血管细胞黏附分子-1(sVCAM-1)及可溶性细胞间黏附分子-1(sICAM-1)表达,并探讨其临床意义.方法 酶联免疫吸附法(ELISA)测定53例HSP患儿(其中急性期37例,恢复期16例)及25例健康儿童血清sVCAM-1、sICAM-1水平,分别比较其急性期和恢复期及有或无肾损害HSP患儿上述因子表达水平.结果 HSP急性期患儿血清sVCAM-1和sICAM-1水平明显高于恢复期和健康对照组(Pa＜0.01);肾损害组血清sVCAM-1、sICAM-1明显高于无肾损害组(Pa＜0.01).结论 sVCAM-1、sICAM-1参与HSP病理生理过程,与疾病分期相关;血清sVCAM-1、sICAM-1水平增高可作为儿童HSP肾损害的判断指标之一.     

重症肺炎婴幼儿血浆肾上腺髓质素、内皮素-1水平的变化及其与心功能的关系

目的研究重症肺炎并急性充血性心力衰竭婴幼儿血浆肾上腺髓质素(ADM)、内皮素-1(ET-1)水平的变化,探讨其与心功能的关系。方法选择本院儿科住院肺炎患儿47例,其中支气管肺炎急性期并心力衰竭(无先天性心脏病)患儿15例(A1组);左向右分流先天性心脏病重症肺炎并急性充血性心力衰竭患儿12例(B1组);轻症肺炎患儿20例(C1组)。A2、B2、C2为A1、B1、C1组患儿恢复期。健康儿童20例(D组)。采用特异性放射免疫分析法测定肺炎患儿急性期(治疗前)、恢复期及健康对照儿童血浆ADM、ET-1水平。结果1.急性期血浆ADM水平:A1、B1、C1组均较D组明显升高(Pa<0.01);B1组高于A1、C1组(Pa<0.05),A1组高于C1组,差异有显著性(P<0.05)。2.急性期血浆ET-1水平:A1、B1组均分别高于C1、D组(Pa<0.05),B1组高于A1组,差异有显著性(P<0.05),C1组与D组比较差异不显著(P>0.05)。3.A2、B2组血浆ADM、ET-1均较其急性期明显下降(P<0.05,0.01);C2组血浆ADM较其急性期明显下降(P<0.01),而血浆ET-1急性期与恢复期均无明显改变(Pa>0.05)。结论ADM、ET-1参与重症肺炎并急性充性心力衰竭的病理生理过程。ET-1参与心力衰竭的发生发展,其血浆水平与心力衰竭程度有关。     

Insulin and insulin resistance index are not independent determinants for the variation in leptin in obese children and adolescents

Recent findings have questioned the independent influence of insulin on leptin. We studied whether insulin contributes to leptin in obese children, independent of confounding parameters, such as total adiposity, fasting insulin resistance index, and fat free mass. In 100 obese boys and 103 obese girls, blood levels of leptin, insulin, glucose, and triglycerides were determined. The fasting insulin resistance index (FIRI) was calculated, and body composition was assessed by means of impedance. Leptin and glucose were higher in girls, and all estimates of adiposity were significantly associated with leptin. However, when adjusted for adiposity, the relationship between insulin and leptin, and also between FIRI and leptin, remained significant in boys and girls (p<0.05). Although several regression models were tested, neither insulin nor FIRI were found to contribute significantly and independently to leptin. BMI together with triglycerides and FFM were the main determinants for the variation in leptin in boys (adj. R2=0.46, p<0.0001). In girls, BMI explained a great magnitude of the variation in leptin (adj. R2=0.60, p<0.0001). These findings indicate that in the state of childhood and adolescent obesity, total adiposity but not insulin or insulin resistance index is the main determinant for leptin. In contrast to obese girls, the fat free mass and triglycerides contribute significantly to the variation in leptin in obese boys. The biological significance for these findings should be elucidated in longitudinal studies.     

足月小于胎龄儿脐血血红蛋白氧合酶-1测定的意义

目的 探讨血红蛋白氧合酶/一氧化碳(HO-CO)系统与足月小于胎龄儿(SGA)发病的关系及其机制.方法 2004年11月-2005年11月正常分娩的足月SGA(非匀称型SGA)50例.其中母亲无妊娠高血压综合征(PIH)为SGA 1组(30例),母亲患中重度PIH为SGA 2组(20例),健康足月适于胎龄儿(AGA)20例为对照(AGA组).新生儿娩出后立即采集脐动脉血标本,用双波长分光光度法测定血红蛋白氧合酶-1(HO-1)的活性,用Chalmers血红蛋白结合及连二亚硫酸钠还原法测定血浆碳氧血红蛋白(HbCO)质量分数.单因素方差分析进行多重比较,直线回归法进行相关分析.结果 SGA1组及SGA2组脐血HO-1活性、HbCO质量分数均显著低于AGA组(P<0.01).SGA1组与SGA2组脐血HO-1活性、HbCO水平比较无显著性差异(Pa>0.05).AGA组、SGA1组及SGA2组脐血HO-1活性与新生儿出生体质量均呈正相关(Pa<0.05).结论 SGA脐血HO-1活性显著低于ASA,AGA和SGA脐血HO-1活性水平与出生体质量均呈正相关,说明脐血HO-1活性与胎儿宫内发育及新生儿营养状况有关.     

Plasma visfatin and adiponectin concentrations in physically active adolescent girls: relationships with insulin sensitivity and body composition variables

The purpose of this study was to evaluate the associations of visfatin and adiponectin concentrations with insulin resistance and body composition in regularly physically active pubertal girls. In 129 girls, aged 13-15 years (pubertal stages 3-5), visfatin, adiponectin, insulin resistance measured by homeostasis model assessment (HOMA), and body composition measured by dual-energy X-ray absorptiometry were evaluated. Visfatin concentration was related to HOMA and overall adiposity (body mass index, fat mass) markers, whereas adiponectin concentration was related to overall adiposity (fat mass), central adiposity (trunk fat) and fat free mass values. These relationships remained significant (p < 0.05) after adjusting for pubertal stage. Visfatin was independently related to body mass index (beta = 0.936; p = 0.0001) and HOMA (beta = 0.444; p = 0.039) indices, whereas adiponectin was independently related to fat free mass (beta = 0.889; p = 0.003) and trunk fat (beta = -0.468; p = 0.042) values. In conclusion, visfatin could be related to insulin resistance and overall adiposity indices, whereas adiponectin was related to different body composition values in regularly physically active pubertal girls.     

动脉导管未闭患儿介入治疗前后血浆N末端脑利钠肽水平及心功能变化

目的应用心脏超声技术及检测血浆N末端脑利钠肽（NT-proBNP）水平,探讨经皮动脉导管未闭（PDA）封堵术对心功能影响。方法PDA患儿55例,术前按照小儿心衰改良Ross标准分为无心衰组31例,轻度心衰组14例,中重度心衰组10例（重度心衰1例）。选择年龄、体质量相匹配健康儿童15例作为健康对照组。应用酶联免疫吸附法测定血浆NT-proBNP水平。同时测定左室舒张末期容量指数（LVEDVI）、左室收缩末期容量指数（LVESVI）、左室射血分数（LVEF）、左室缩短分数（LVFS）等反映心室功能及负荷的超声心动图指标。结果1.PDA患儿术前LVEDVI、LVESVI均显著高于健康对照组（Pa〈0.01）,且各组间随着心功能严重程度增加而显著升高（P〈0.01）。2.术前血浆NT-proBNP水平随着心功能严重程度增加而升高,中重度心衰组高于轻度心衰组（P〈0.01）,轻度心衰组高于无心衰组（P〈0.01）,无心衰组与健康对照组比较无统计学差异（P〉0.05）。3.PDA患儿术后3个月血浆NT-proBNP水平、LVEDVI、LVESVI均较术前显著降低（Pa〈0.01）,接近健康对照组水平（P〉0.05）。4.血浆NT-proBNP水平与LVESVI（r=0.653P〈0.01）、LVEDVI（r=0.741P〈0.01）呈正相关,而与LVEF、LVFS等无显著相关性（P〉0.05）。结论PDA堵闭术后3个月在临床症状和反映左室功能超声指标明显改善同时,术前高血流动力学负荷对心室细胞影响也逐渐恢复。     

缺氧缺血性脑病新生儿血浆肾上腺髓质素/内皮素-1值与血清神经元特异性烯醇化酶的相关性

目的 探讨缺氧缺血性脑病(HIE)足月新生儿血浆肾上腺髓质素(AM)/内皮素-1(ET-1)值的变化对血清神经元特异性烯醇化酶(NSE)的影响.方法 2005年1-12月收治HIE新生儿32例.按照HIE的诊断标准分为轻度组18例,中重度组14例.本院同期出生的30例健康新生儿(生后24 h)为健康对照组.采用放射免疫法动态测定HIE新生儿生后1、3、7 d及健康新生儿生后1 d血浆AM、ET-1和血清NSE水平.均数比较采用方差分析及S-N-K检验,双变量资料采用直线相关分析.结果 1.轻、中重度HIE组血浆AM、ET-1水平生后1、3、7 d均增高,与健康对照组比较,轻度组至3、7 d已无显著性差异(Pa＞0.05);中重度组至7 d仍有显著性差异(Pa<0.05).AM/ET-1值在3个时间点均较健康对照组减低,但仅中重度组生后1、3 d与健康对照组比较有统计学意义(Pa<0.05).2.HIE患儿血清NSE水平生后1、3 d增高,与健康对照组比较,仅中重度组有显著性差异(Pa<0.05);7 d,轻度组下降至健康对照组水平(P＞0.05),中重度组与健康对照组比较有显著性差异(P<0.05).且与AM/ET-1值呈显著负相关(r=-0.53 P<0.05).结论 AM和 ET-1共同参与HIE调节局部脑血流量及血脑脊液屏障功能的维护,AM/ET-1值测定对了解不同时期HIE患儿脑血流变化和脑损伤程度有重要意义.     

Waist circumference is an independent predictor of insulin resistance in black and white youths

OBJECTIVES: We examined how well waist circumference (WC) reflects total and abdominal fat and whether WC predicts insulin resistance independent of body mass index (BMI) percentile in youths. STUDY DESIGN: Body composition was measured by dual-energy x-ray absorptiometry and abdominal adiposity by computed tomography. Insulin sensitivity was measured by the hyperinsulinemic-euglycemic clamp. RESULTS: Both BMI percentile and WC were significantly associated (P < .01) with total and abdominal fat and insulin sensitivity. WC remained a significant (P < .01) correlate of total and abdominal fat and insulin sensitivity after controlling for BMI percentile. By contrast, BMI percentile did not remain a significant correlate of visceral fat and markers of insulin resistance after controlling for WC. Without exception, WC explained a greater variance in abdominal fat and metabolic profiles than did BMI percentile. CONCLUSIONS: Our findings suggest that the prediction of health risks associated with obesity in youths is improved by the additional inclusion of WC measure to the BMI percentile. Such observations would reinforce the importance of including WC in the assessment of childhood obesity to identify those at increased metabolic risk due to excess abdominal fat.