胆道闭锁Kasai术后自体肝生存良好患儿的营养状况调查

目的回顾性调查胆道闭锁行肝门空肠吻合术(Kasai术)后自体肝生存良好患儿的营养状况,为制定个体化营养方案提供依据。方法收集46例胆道闭锁Kasai手术后1年且自体肝生存良好患儿的临床资料,包括年龄、身高/身长、体重、血清脂溶性维生素(A、D、E、K)水平。以WHO生长曲线软件分别计算患儿年龄别身高Z评分(height-for-age,HAZ)、年龄别体重Z评分(weight-for-age,WAZ)、身高别体重Z评分(weight-for-height,WHZ);以正常参考值为标准,计算营养不良和维生素缺乏的比例。结果46例患儿中男童26例,女童20例,平均年龄(14.5±0.8)个月。患儿HAZ评分为(-0.14±0.86),WAZ评分为(0.21±0.81),WHZ评分为(0.62±1.80),其中生长迟缓2例(4.3%),无低体重及消瘦患儿。25例行脂溶性维生素检查的患儿,其临床和实验室指标与46例自体肝生存良好的患儿均无明显差异(P>0.05)。25例患儿维生素A、D、E、K的水平分别为(290.61±80.26)ng/mL、(30.88±16.15)ng/mL、(7.69±2.77)μg/mL和(1.34±0.98)ng/mL。其中维生素A缺乏4例(16%),维生素D缺乏5例(20%),维生素E缺乏1例(4%),无一例维生素K缺乏者;至少有一种维生素缺乏者有7例(28%)。结论胆道闭锁行Kasai术后1年,自体肝生存良好的患儿营养状况良好;脂溶性维生素A、D缺乏较为常见,应在术后注意监测并补充。     

先天性食管闭锁患儿术后生长发育评估

目的评估先天性食管闭锁(congenital esophageal atresia, CEA)患儿术后生长发育情况, 探讨影响生长发育的危险因素。方法收集2010年9月至2020年1月就诊于首都医科大学附属北京儿童医院新生儿外科的113例CEA患儿的基本临床资料, 其中男68例, 女45例。按CEA分型, Ⅰ型2例, Ⅲ型84例, Ⅳ型2例, Ⅴ型25例。通过门诊及电话进行随访, 同时收集患儿生长发育指标(体重、身高/身长)。根据世界卫生组织标准, 计算年龄别体重Z评分(weight for age Z-score, WAZ)和年龄别身高/身长Z评分(height for age Z-score, HAZ), 评价患儿术后生长发育情况。将WAZ和(或)HAZ小于2个标准差(standard deviations, SD)定义为生长发育障碍。资料采用SPSS 25.0软件进行统计, 比较生长发育障碍组与生长发育正常组间临床特征差异, 通过单因素及多因素Logistic回归分析影响CEA患儿生长发育的危险因素。结果患儿中位随访年龄为81.7(58.0, 105.3)个月, 9例患儿HAZ和...     

高能量密度配方奶粉对紫绀型先天性心脏病患儿术后生长追赶的影响：前瞻性随机对照研究

目的 探讨高能量密度配方奶粉对紫绀型先天性心脏病（CHD）患儿术后生长追赶的影响。方法 前瞻性纳入2017年1~12月行外科手术的紫绀型CHD婴儿100例,随机分配至高能量组（术后给予高能量密度配方奶粉）和常规组（术后给予普通配方奶粉）,每组50例,随访观察6个月。观察指标包括术前、术后脱机拔管时、术后1个月、术后3个月、术后6个月的身高、体重、前白蛋白、N末端B型利钠肽原;计算年龄别身高Z评分（HAZ）、年龄别体重Z评分（WAZ）和身高别体重Z评分（WHZ）;同时记录两组不良反应。结果 术前高能量组和常规组分别有25例（50%）和21例（42%）营养不良,两组营养不良率差异无统计学意义（P > 0.05）。两组患儿术后6个月营养状况均有改善（P < 0.05）。术后6个月高能量组营养不良率低于常规组（18% vs 36%,P < 0.05）;高能量组WAZ < -2的比例低于常规组（P < 0.05）;高能量组营养不良患儿HAZ、WAZ、WHZ均高于常规组（P < 0.05）。两组患儿住院期间均未出现胃肠道不耐受。结论 高能量密度配方奶粉较普通配方奶粉更有助于紫绀型CHD患儿术后生长追赶。     

胆道闭锁Kasai术后近中期疗效及部分影响因素分析

目的 探讨胆道闭锁Kasai术后的近中期疗效及其影响因素.方法 回顾性分析2005年10月至2010年9月在本院行Kasai手术并获得随访的152例胆道闭锁患儿,男68例,女84例,手术时的中位日龄为75 d(31～528 d),平均(82.36±45.17)d,定期门诊复诊并电话随访,平均随访时间(20.11±16.11)个月(2～62个月),对其诊疗过程及随访情况进行分析,对黄疸消退情况、生存率及影响因素采用Kaplan-Meier生存分析、Cox regression分析及x2检验.结果 Kasai术后黄疸消退率为50％(74/149),Ⅰ、Ⅱ、Ⅲ型患儿的黄疸消退率分别为67％、67％、47％,差异无统计学意义(P=0.306);≤60 d、60～≤90d、91～120 d手术组患儿的黄疸消退率分别为54％、53％、46％,≥120 d手术组患儿的黄疸消退率明显降低(25％),但差异无统计学意义(P=0.310);胆管炎发生率57％(85/149),有无胆管炎发作的黄疸消退率分别为31％、75％,差异有统计学意义(P＜0.01).Kaplan-Meier生存分析Kasai术后2、4年的自体肝存活率分别为56％、49％,有胆管炎组和无胆管炎组的2年自体肝存活率分别为43％、77％,差异有统计学意义(P＜0.01).结论 Kasai手术是目前我国治疗胆道闭锁的首要方法,手术年龄和分型与Kasai术后的近中期效果无明显相关,胆管炎是影响Kasai术后效果的重要因素.     

腹腔镜与开放Kasai手术治疗Ⅲ型胆道闭锁中期疗效的对比

目的比较腹腔镜与开放Kasai手术治疗先天性胆道闭锁的中期疗效。方法回顾性分析2010年9月至2011年9月在本院行Kasai手术并获得随访的103例Ⅲ型胆道闭锁患儿,根据手术方式分为腹腔镜辅助Kasai手术组(LP组)和开腹Kasai手术组(OP组)。通过术后12~30个月肝生化ALT和TBil中位数的秩和检验,比较两组Kasai术后中期肝功能情况;应用Kaplan-Meier生存分析比较两组中期生存率;比较两组对二期自体肝移植手术及术后生存情况的影响。结果 103例Ⅲ型胆道闭锁患儿中,LP组55例,OP组48例;两组年龄分布、性别比例、术前肝功能(TBil、ALT、AST)中位数等均无统计学差异。术后12个月、18个月、24个月、30个月两组肝功能(TBil,ALT)恢复情况无统计学差异。Kasai术后LP组和OP组的自体肝生存率,1年生存率分别为78.2%和75%,2年生存率分别为66.9%和55.8%,3年生存率分别为66.9%和55.8%。Kasai术后实施肝移植11例(LP组4例,OP组7例),1例移植术后死亡。结论胆道闭锁患儿实施腹腔镜Kasai手术与开放Kasai手术后中期效果无明显差异。     

肝门肠吻合术治疗胆道闭锁112例报告

目的 评价肝门肠吻合术(Kasai手术)治疗胆道闭锁的效果并总结治疗经验.方法 对2007年1月至2011年12月集中收治并采用统一的治疗方案进行Kasai手术的Ⅲ型胆道闭锁病例进行回顾性分析.结果 进行Kasai手术的126例有112例(89.7％)获得完整随访.术后有70例黄疸清除,总黄疸清除率为62.5％,黄疸清除率在手术年龄≤60 d、60～90 d(包含90d)、90～120 d、＞120 d组分别为72.0％、80.5％、60.0％和19.0％,组间差异有统计学意义(P＜0.05).总胆管炎发生率为30.4％(34/112),黄疸清除组(15例)的胆管炎发生率(21.4％)低于未清除组(19例,45.2),组间差异有统计学意义(P＜0.05).术后68例(60.7％)出现持续肝纤维化,在各因素中分组中手术年龄＞90 d、黄疸未清除和胆管炎发作的病例,出现持续肝纤维化的比率较高(分别为93.5％,100％和50％),组间差异有统计学意义(P＜0.05).本组1年和2年自体肝生存率分别为64.9％和61.8％.单因素生存分析发现,患儿手术年龄、术后黄疸消退与否、胆管炎发作与否以及肝纤维化活动情况是影响自体肝生存的相关因素(P＜0.05).结论 术后黄疸清除和胆管炎发作与否以及自体肝生存时间是胆道闭锁Kasai手术的评价指标,手术年龄≤90d,术后黄疸清除和较少的胆管炎发作有利于术后自体肝生存.     

胆道闭锁术时年龄及肝脏病理与近期预后的相关性研究

目的 研究胆道闭锁患儿Kasai手术术时年龄、肝脏病理与近期预后之间的相关性.方法 对2008年7月至2011年6月收治于我院普外科的胆道闭锁患儿进行Kasai术后6个月的近期预后随访,分为优秀组、良好组和不良组.每组随机抽取20例共计60例作为样本.回顾样本病历资料获取术时年龄.获取样本病例Kasai手术术中取得并保存的肝脏病理标本,应用Masson染色评定肝纤维化程度;应用CK19免疫组化染色和图像分析技术评定胆管反应程度.统计学分析术时年龄、肝脏病理学指标和近期预后之间的相关性.结果 优秀组、良好组和不良组的平均术时年龄分别为(77.55±24.64)d、(90.30±24.13)d和(72.35±24.53)d,无术时年龄＜30d病例;优秀组、良好组和不良组的无肝硬化病例和肝硬化病例分别为11:9、11:9和16:4;优秀组、良好组、不良组平均胆管面积比例分别为(5.62±3.62)％、(8.50±4.08)％和(5.15±3.77)％.不同预后病例术时年龄、肝脏病理学指标均无统计学差异;肝硬化组较无肝硬化组术时年龄无统计学差异,肝硬化组较无肝硬化组胆管反应程度严重;术时年龄与胆管反应呈显著线性正相关.结论 胆道闭锁患儿Kasai术后6个月近期预后和术时年龄、肝纤维化程度、胆管反应程度均无明显相关性,近期预后可能受术者经验和手术技巧影响;术时年龄越大胆管反应越重,胆管反应对肝纤维化有促进作用,尽早手术对改善远期预后有帮助.     

78例胆道闭锁患儿诊疗与近期随访分析

目的 回顾性分析本院78例胆道闭锁患儿的诊疗经验,探讨胆道闭锁患儿的近期预后及影响近期预后的因素.方法 2003年1月至2008年12月本院共收治胆道闭锁患儿78例,对其诊疗过程及随访情况进行分析,影响预后的因素采用卡方检验、秩和检验等进行分析,P＜0.05为差异有统计学意义.结果 黄疸平均发生日龄为（13.00±18.36）d,其中48例行Kasai手术,平均手术日龄为（84.50±34.48）d.中位随访时间为（12.82±11.65）个月.Kasai术后黄疸消退率为45.83%,手术时间＜60d、60～90d、＞90 d的患儿黄疽消退率分别为60.00%、56.67%和15.38%,差异有统计学意义.Ⅰ、Ⅱ型胆道闭锁患儿术后黄疸消退率为66.67%,Ⅲ型胆道闭锁术后黄疸消退率为41.03%,差异无统计学意义.Kasai术后有无胆管炎发生者黄疸消退率分别为40.91%、50.00%,差异无统计学意义.病毒感染、先天性畸形及术前应用中药退黄治疗对预后无显著影响.结论 提高胆道闭锁的疗效是小儿外科的一大难题,手术日龄是决定Kasai手术短期预后的关键因素.     

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目的初步分析3～6岁学龄前儿童血清视黄醇结合蛋白4(RBP4)与儿童身高(HT)、体重(WT)、年龄的身高的Z评分(HAZ)、年龄的体重的Z评分(WAZ)、身高的体重的Z评分(WHZ)、体重指数(BMI)及体重指数Z评分(BMIZ)的关系。方法 2010年10至12月采用整群抽样和分层抽样相结合的方法分别抽取成都市郫县花园镇8所幼儿园481名3～6岁学龄前儿童,测定WT、HT及血清RBP4水平。结果共370名完成检测,其中男188名,女182名;平均年龄(47.1±14.4)个月。偏相关分析显示,血清RBP4分别与WHZ、BMI和BMIZ存在明显正相关,偏相关系数r分别为0.18、0.21和0.20(P均<0.05);而与WT、HT、HAZ和WAZ则无明显相关性(P>0.05)。以各体格指标中位数为界,WHZ、BMI和BMIZ高组血清RBP4显著高于低组(P<0.05),而WT、HT、HAZ和WAZ高组与低组间RBP4差异无统计学意义(P>0.05)。以RBP4浓度的P25、P50及P75为界,仅BMIZ差异有统计学意义(P<0.05)。结论机体体脂成分影响学龄前儿童血清RBP4,而血清RBP4对体脂成分影响较小。     

胆道闭锁肝纤维化与自体肝生存关系的研究进展

胆道闭锁是婴儿期最严重的肝胆系统疾病之一。肝门-空肠吻合术(Kasai手术)是治疗胆道闭锁的主要手段,但术后自体肝长期生存效果不佳,大部分患儿需要通过肝移植来挽救生命。肝纤维化是影响胆道闭锁患儿自体肝生存的重要因素之一,其发生机制复杂,涉及多种信号通路及细胞因子的调控。Kasai手术后胆汁引流不畅、胆管炎发作都会导致肝纤维化进展,进而发生肝硬化。在完善早期诊断、早期手术、通畅引流胆汁及控制胆管炎的同时,还应积极应对患儿肝纤维化的持续进展,以期达到自体肝的长期生存。     

Effect of malnutrition at the time of diagnosis on the survival of children treated for cancer in El Salvador and Northern Brazil

PURPOSE: To investigate the relationship between survival and malnutrition at the time of diagnosis among children treated for cancer in two developing countries. PATIENTS AND METHODS: We studied 443 children treated for cancer between 1995 and 1998 at two centers in San Salvador, El Salvador, and Recife, Brazil. Median age at diagnosis was 4.9 years; 283 children had leukemia and 160 had solid tumors. Z-scores were calculated for weight for age (WAZ), height for age (HAZ), and weight for height (WHZ) at diagnosis. Z scores <-2 indicated malnutrition. Patients were also stratified by low-risk disease (solid tumors: stage I, stage II, or localized; acute lymphocytic leukemia: white blood cell count <25,000/microL, no central nervous system involvement, no mediastinal mass and age >1 and <10 yrs) and high-risk disease (all other patients, including those with acute or chronic myelocytic leukemia). RESULTS: Z-scores indicated malnutrition in 23.5% (WAZ), 22.8% (HAZ), and 15.7% (WHZ) of patients. Z-score was not significantly related to overall survival rates, to survival rates analyzed by type of malignancy or risk status, or to survival rates at the end of the first month of treatment. CONCLUSIONS: We found no relationship between nutritional status and survival in these patients. This implies that future protocols for use in developing countries can be designed to provide optimal treatment intensity despite the high incidence of malnutrition.     

Index for measuring child feeding practices

Objective The present investigation was undertaken with the objective of creating an Infant and Child Feeding Index (ICFI) from a set of complementary feeding (CF) practices and to determine its association with growth of infants and young children (6-23months). Methods A semi-structured interview schedule was used to collect information for 204 children from one large slum (n=104) and two private pediatric clinics (n=100) of urban Vadodara. Results Results revealed that about half (50.5%) of the children were stunted Ht for Age Z score (HAZ<-2SD), nearly one-fourth (25.5%) were underweight Wt for Age Z score (WAZ<-2SD), but wasting (WHZ Wt for Ht Z score<-2SD) was low (3%). Significant associations were revealed between almost all positive CF practices and nutritional status of the children as measured by HAZ and WAZ (p<0.01), but not with WHZ. Good associations were revealed between ICFI and HAZ and WAZ, but not with WHZ. On multivariate analysis of factors affecting the HAZ, WAZ and WHZ scores, ICFI was not found to be significant whereas maternal education was the most significant factor, which was also found to be associated significantly with ICFI. Conclusion It is concluded that the composite index in its present form can reflect the CF practices more holistically than just one or few behaviors studied separately. More research is needed in the direction of constituting a composite index which can then be used for research, monitoring, evaluation and much needed advocacy for complementary feeding.     

Effectiveness of a locally produced ready‐to‐use supplementary food in preventing growth faltering for children under 2 years in Cambodia: a cluster randomised controlled trial

This cluster randomised controlled trial tested the effectiveness of a locally produced, fish‐based, ready‐to‐use supplementary food (RUSF) to prevent growth faltering (decline in z‐scores). Cambodian infants (n= 485), aged 6 to 11 months, were randomised by site to receive the RUSF, Corn‐Soy Blend++ (CSB++), micronutrient powders (MNP), or no supplement (control). The intervention was for 6 months. In unadjusted analysis, the control group had statistically significantly decreased weight‐for‐age z‐scores (WAZ; ‐0.02, 95%CI = ‐0.03 ‐ ‐0.01, P= 0.001) and height‐for‐age z‐scores (HAZ; ‐0.07, 95%CI = ‐0.09 ‐ ‐0.05, P < 0.001), and increased mid‐upper arm‐circumference (MUAC; 0.02cm, 95%CI = 0.01 ‐ 0.04, P = 0.010), but no statistically significant change in weight‐for‐height z‐scores (WHZ). The RUSF group did not differ significantly from the control for WAZ, HAZ or WHZ (in other words, WAZ and HAZ decreased and WHZ did not change), but had increased MUAC in comparison to the control (0.04cm, 95%CI = 0.01 ‐ 0.06, P = 0.008). There were no statistically significant differences between the RUSF group and the CSB++ or MNP groups with respect to WAZ, HAZ, WHZ or MUAC. Interestingly, in adjusted analysis, low consumers of RUSF had increased WAZ, WHZ and MUAC (0.03, 95%CI = 0.01‐0.06, P = 0.006; 0.04, 95%CI = 0.01‐0.08, P = 0.026; and 0.05cm, 95%CI = 0.02‐0.09, P = 0.004, respectively) compared with the control. The novel RUSF, particularly in small quantities, protected against ponderal growth faltering, but the improvements were of limited clinical significance.     

胆道闭锁肝门肠吻合术手术改进的初步探讨

目的 对胆道闭锁(BA)肝门肠吻合术(PE)进行手术改进并评价治疗效果.方法 对2012年3月至2014年2月进行PE的Ⅲ型BA病例的临床资料进行回顾性分析.本研究病例的PE方式分为扩大肝门部病变切除范围PE手术(EPE)、Nakamura的Kasai改进手术(MKPE)和本研究的改进Kasai手术(OMKPE)3种并根据PE方式将病例分组.对病例的术前临床资料、术后黄疸清除率、胆管炎发作率和自体肝生存率按PE方式分组比较,并按不同手术年龄(≤90d和＞90d两组)再进行组间比较.结果 87例获得完整随访,其中EPE 34例,MKPE 19例,OMKPE 34例.各组手术年龄、体重、术前肝功能指标、肝外胆管Ohi亚型和术中肝纤维化Weerasooriya分级比较均无统计学差异(P＞0.05).OMKPE的术后黄疸清除率和自体肝生存率为73.5％和73.5％高于EPE的38.2％和38.2％ (P＜0.05),但MKPE的为57.9％和58.9％,与OMKPE和EPE比较,差异无统计学意义(P＞0.05),其中≤90 d手术年龄组中OMKPE的术后黄疸清除率和自体肝生存率为90.9％和90.9％以及MKPE的为90％和90％,高于EPE的46.2％和38.5％(P＜0.05),但OMKPE与MKPE比较,差异无统计学意义(P＞0.05),＞90 d手术年龄组中OMKPE的术后黄疸清除率和自体肝生存率为65.2％和65.2％,高于MKPE的22.2％和22.2％以及EPE的12.5％和12.5％ (P＜0.05)但MKPE与EPE比较,差异无统计学意义(P＞0.05).胆管炎发作率各组比较差异无统计学意义(P＞0.05).结论 对比EPE和MKPE,OMKPE手术更有利于提高BA术后黄疸清除率和延长自体肝生存,尤其适用于＞90 d大龄患儿.     

Growth of infants during the first 18 months of life in urban and rural areas of southern China

OBJECTIVE: Observe the growth pattern of infants from birth to 18 months. METHODOLOGY: A prospective study was conducted from 1994 to 1996 in urban and township-rural areas of Guangdong Province, southern China, recruiting 568 and 257 newborn infants, respectively. Anthropometric data was collected at birth, 1.5, 4, 5, 6, 8, 10, 12, 15, and 18 months. RESULTS: The urban infants at birth had Z-scores of weight for age (WAZ), height for age (HAZ) and weight for height (WHZ) below the National Center for Health Statistics (NCHS) median (P < 0.01). However, from 1.5 to 4 months, the WAZ and WHZ scores were above (P < 0.01), but by 7 months fell and remained at - 0.7 to - 0.8 SD below the NCHS median (P < 0.01). HAZ scores improved after birth, were at the NCHS median to 8 months (P = NS), and then decreased to 0.2-0.4 SD below the NCHS median (P < 0.01). Compared with the urban infants, the township-rural infants were lighter and shorter throughout the first 18 months of life, and from 8 months of age, were - 1 SD or more below the NCHS median. CONCLUSIONS: Growth retardation was found in this sample of Chinese infants. The magnitude of growth retardation was greater for infants in the township-rural area compared with those in the urban area.     

61例极低出生体重早产儿生后第一年生长发育的随访

目的 探讨极低出生体重早产儿生后第一年生长发育情况及相关影响因素。方法 对61例极低出生体重早产儿进行出生后第一年的生长发育监测。采用Z评分法评价体格指标、丹佛发育筛查测验(DDST)进行发育筛查。结果 61例中小于胎龄儿(SGA)27例(44.3%),适于胎龄儿(AGA)34例(55.7%)。随访1年,年龄别体重(WAZ)、年龄别身长(HAZ)、年龄别头围(HCZ)、身长别体重(WHZ)的Z积分中位数均>-1 SD;年龄别体质指数(BMI)的Z积分(BAZ)以及WHZ的高峰在纠正年龄1个月。纠正胎龄40周时,低体重、生长迟缓、消瘦、小头畸形、超重和肥胖等的生长偏离发生率最高,分别为15%、16%、11%、13%、20%和10%。与纠正胎龄40周比,纠正年龄6个月及9~12个月的超重发生率(3%,3%)明显降低(P P 结论 极低出生体重早产儿在纠正龄3个月以内生长偏离明显。生后第一年DDST筛查异常的比例较高。     

The effectiveness of interventions on nutrition social behaviour change communication in improving child nutritional status within the first 1000 days: Evidence from a systematic review and meta-analysis

This systematic review and meta-analysis aimed to assess the robustness of designs and tools used in nutrition social behaviour change communication (NSBCC) interventions and establish their effectiveness. EBSCOhost as an umbrella database including Medline (Ovid) and CINAHL, EMBASE, and ProQUEST databases were searched for peer-reviewed articles from January 1960 to October 2018. Additional sources were searched to identify all relevant studies including grey literature. Studies' biases were assessed according to Cochrane handbook. Pooled estimate of effectiveness of interventions on infant and young child feeding (IYCF) practices and child nutritional status with 95% confidence intervals were measured using random-effects models. Eighty studies were included in this review: Fifty-one (64%) were cluster randomised controlled trials (RCTs), 13 (16%) were RCTs and 16 (20%) quasi-experimental. Of the included studies, 22 (27%) measured early initiation of breastfeeding, 38 (47%) measured exclusive breastfeeding, 29 (36%) measured minimum dietary diversity, 21 (26%) measured minimum meal frequency, 26 (32%) measured height for age z-scores (HAZ), 23 (29%) measured weight for height z-scores (WHZ), 27 (34%) measured weight for age z-scores (WAZ), 20 (25%) measured stunting, 14 (17%) measured wasting, and 11 (14%) measured underweight. The overall intervention's effect was significant for exclusive breastfeeding (EBF) (odds ratio = 1.73; 95% confidence interval [CI]: 1.35–2.11, p < 0.001), HAZ (standardized mean differences [SMD] = 0.19; 95% CI: 0.17–0.21; p < 0.001), WHZ (SMD = 0.02; 95% CI: 0.004–0.04; p < 0.001), and WAZ (SMD = 0.04; 95% CI: 0.02–0.06; p < 0.001). Evidence shows the effectiveness of NSBCC in improving EBF and child anthropometric outcomes. Further research should test the impact on child nutritional status with clearly specified and detailed NSBCC interventions.