儿童急性白血病 T淋巴细胞嗜银蛋白与亚群的变化和分析

目的通过对急性白血病(AL)患儿T淋巴细胞(T细胞)表示rDNA和rRNA活性的嗜银蛋白的测定,了解患儿T细胞的功能状态,并分析其与T细胞亚群之间的关系。方法应用图象分析法测定31例初发未化疗AL患儿及30例正常儿童(对照组)外周血T细胞核仁组成区嗜银蛋白(银染区)/细胞核面积(I.S%),用流式细胞仪测定T细胞亚群。结果31例AL患儿I.S%值(5.78%±2.66%)较对照组(7.51%±1.06%)下降(P<0.01)。T细胞亚群测定中,CD4 (27.50%±12.56%)较正常值(35%±2.55%)下降(P<0.05);CD8 (26.11%±12.35%)与正常值(25%±2.04%)比较差异无显著性(P>0.05);CD4 /CD8 (1.149±0.51)较正常值(2±0.26)下降(P<0.001)。结论在初发未化疗的AL患儿中,T细胞嗜银蛋白含量下降,代表患儿T细胞免疫功能的CD4 和CD4 /CD8 值降低,显示患儿T细胞活性的改变与T细胞亚群的变化相符,患儿存在T细胞免疫功能降低。     

急性白血病化疗对垂体、性腺、甲状腺激素的影响

目的评价儿童急性白血病(AL)及联合化疗对其垂体、性腺、甲状腺激素的影响。方法测定37例(男23例,女14例)AL患儿化疗前后和20例对照组血清促卵泡激素(FSH)、黄体生成素(LH)、睾酮(T)、雌二醇(E2)、催乳素(PRL)、生长激素(GH)、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平。结果AL患儿FSH、LH、T、E2、GH、FT4、TSH水平化疗前后及对照组各组差异无显著意义(P>0.05),PRL水平治疗前高于对照组(P<0.01),男童PRL水平治疗前后比较差异有显著意义(P<0.01)。FT3治疗前低于对照组(P<0.001),治疗后趋于正常(P>0.05)。结论AL本身及联合化疗对患儿垂体-性腺轴功能及GH水平无明显影响。AL本身可使PRL水平升高,而化疗药物可抑制男童PRL的分泌。联合化疗对甲状腺功能无影响,FT3水平对判断AL患儿病情变化、疗效及预后有一定参考意义。     

细胞外信号调节激酶-1、细胞周期蛋白D1表达与儿童急性白血病关系研究

目的探讨细胞外信号调节激酶_1(ERK1)、细胞周期蛋白D1(cyclinD1)的表达与儿童急性白血病(AL)的关系。方法50例儿童AL(AL组)和26例AL完全缓解(AL_CR组)患儿为病例组,23例非肿瘤性疾病患儿为对照组,采用超敏SP免疫组织化学法,检测各组骨髓细胞中ERK1、cyclinD1的表达情况。结果AL组ERK1、cyclinD1阳性率分别为68.00%和56.00%,明显高于AL_CR组(3.85%,3.85%)和对照组(0,0)(P<0.01);高危AL患儿中阳性率分别为90.91%、86.36%,明显高于标危AL患儿(P<0.01);16例AL患儿化疗前ERK1、cyclinD1阳性率分别为75.00%、68.75%,化疗缓解后阳性率均为0(P<0.01);AL组中ERK1、cyclinD1表达相同(χ2=2.5,P>0.05)。结论AL患儿ERK1、cyclinD1表达率较高,可作为近期疗效的观察指标;ERK1与cyclinD1过度表达相同,可能在AL发生发展过程中有协同作用。     

哮喘患儿血清白细胞介素-4、12与细胞免疫的相关性

目的探讨不同病期哮喘患儿血清IL-12、IL-4水平、细胞免疫功能及其相互关系。方法随机选择哮喘患儿50例。婴幼儿哮喘13例,儿童哮喘37例。发作期30例,经吸入激素治疗后缓解期患儿20例。健康对照组22例。IL-12、IL-4测定采用酶联免疫双抗体夹心法(ELISA)。采用碱性磷酸酶抗碱性磷酸酶桥联酶标试验(APAAP)检测T细胞亚群,采用郭氏法检测红细胞免疫功能。结果1.哮喘患儿发作期、缓解期和对照组IL-12水平分别为(24.44±13.26)、(42.30±12.65)、(44.68±28.28)ng/L,3组比较有显著性差异(F=8.92P<0.01),发作期明显低于其他两组,缓解期与对照组无显著性差异。2.IL-4在发作期、缓解期、对照组阳性率分别为70%、35%、9%,发作期明显高于缓解期(χ2=5.96P<0.05),缓解期仍高于对照组(χ2=4.17P<0.05)。3.哮喘患儿与健康儿童相比,CD3(t=3.18P<0.01)、CD4(t=5.51P<0.01)、CD8(t=10.38P<0.01)均降低,CD4/CD8升高(t=4.28P<0.01),RBC-C3bR降低(t=4.65P<0.01),RBC-IC增高(t=10.22P<0.01)。4.IL-4与IL-12呈显著负相关(r=-0.43P<0.05),与RBC-IC呈显著正相关(r=0.49P<0.05)。结论哮喘患儿存在Th1/Th2类细胞因子失衡和细胞免疫功能紊乱状态,哮喘患儿缓解期IL-12水平恢复至接近健康儿童,IL-4水平仍高于健康儿童。应坚持长期抗感染治疗。     

急性白血病患儿骨髓细胞环氧合酶-2和survivin表达及其意义

目的探讨环氧合酶-2(COX-2)和survivin蛋白在儿童急性白血病(AL)中的表达及意义。方法应用免疫组织化学链霉亲和素-生物素-过氧化物酶(SABC)法检测2006年6～11月收治42例AL患儿骨髓细胞中COX-2和survivin的表达,对照组为10例非恶性血液病且骨髓正常儿童。结果AL患儿COX-2和survivin表达阳性率分别为52.4%和45.2%,与对照组比较差异有显著性(Pa<0.05)。其中32例急性淋巴细胞白血病(ALL)COX-2和survivin的表达阳性率分别为46.9%和40.6%,与对照组比较差异有显著性(Pa<0.05)。ALL高危组和中低危组COX-2阳性表达率分别为54.5%和42.8%,二组比较差异无统计学意义(Pa>0.05)。AL42例COX-2与survivin表达均为阳性16例,均为阴性17例,COX-2和survivin蛋白表达呈正相关(r=0.579P<0.001)。COX-2阴性组初次完全缓解率高于阳性组(93.3%和66.7%),差异有显著性(P<0.05)。结论1.COX-2蛋白在儿童AL中表达增高;2.COX-2与抗凋亡因子survivin共同参与AL发展,二者可能起协同作用;3.COX-2高表达可能与儿童AL预后有关。     

CXCR4在急性白血病细胞中的表达及其意义

目的分析急性白血病(AL)小儿骨髓细胞趋化因子受体CXCR4表达及其与髓外浸润的关系。方法采用流式细胞仪对55例AL进行免疫分型;应用流式细胞仪检测55例小儿急性白血病骨髓细胞CXCR4表达;采用统计学方法分析AL患儿骨髓细胞CXCR4表达与髓外浸润的相关性。结果AL患儿骨髓细胞CXCR4在ALL组表达阳性率明显高于NALL组(P<0.01),my B-ALL组CXCR4表达阳性率较B-ALL组阳性率明显降低(P<0.05);ALL、NALL、B-ALL、my B-ALL组血白细胞计数均数比较无显著差异性(F=0.301 P=0.776),骨髓白血病细胞CXCR4表达的阳性率与外周血白血病细胞数呈正相关(r=0.713 P=0.001)。髓外浸润组白血病细胞CXCR4表达的阳性率为(76.34±11.14)%,非髓外浸润组CXCR4表达的阳性率为(42.65±8.62)%,两组比较有显著差异性(t=2.703 P=0.001)。结论AL小儿骨髓细胞CXCR4的表达与白血病细胞的迁移、浸润密切相关。     

慢性特发性血小板减少性紫癜患儿蛋白激酶C检测的意义

目的 研究慢性特发性血小板减少性紫癜(CITP)患儿外周血T细胞蛋白激酶C(PKC)的活性变化及其与T细胞活化和血小板减少程度之间的关系.方法 无菌采集30例CITP患儿及30例健康对照组外周血各5 mL,T细胞分离富集柱法分离纯化T细胞,采用非放射性核素标记法检测T细胞PKC的活性变化,ELISA检测T细胞活化标志可溶性白细胞介素-2受体(sIL-2R)的表达,血细胞计数仪计数血小板的减少程度.结果 ITP患儿T细胞PKC的活性[(0.94±0.23) mmol/(min·L)]与健康对照组[(0.50±0.17) mmol/(min·L)]比较显著增强(t=8.42P<0.05);CITP患儿T细胞活化标志sIL-2R的表达[(528±124)×103 U/L]与健康对照组[(296±57)×103 U/L]比较显著升高(t=9.31 P<0.05);CITP患儿T细胞PKC的活性变化与T细胞的活化标志物sIL-2R的表达呈正相关(r=0.872 5 P<0.05),与血小板计数呈负相关(r=-0.810 7 P<0.05).结论 CITP患儿外周血T细胞PKC活性增强可能导致T细胞活化,活性T细胞增多可能引起患儿血小板损伤,提示PKC信号传导在CITP的免疫病理机制中发挥重要作用.     

CTLA-4/CD28的表达与儿童急性淋巴细胞白血病临床预后的关系

目的探讨外周血T淋巴细胞表面CTLA-4/CD28的表达与儿童急性淋巴细胞白血病(ALL)发病及治疗转归的相关性。方法采用流式细胞术(FCM)分别检测21例B细胞型ALL患儿初发且未治疗前、经VDLD方案治疗达到完全缓解并持续缓解予CAT巩固停药2~3周后外周血T淋巴细胞表面CTLA-4、CD28的表达。结果(1)治疗前:ALL患儿外周血CD4~+T、CD8~+T淋巴细胞CTLA-4表达显著高于正常水平(P<0.01),CD28表达显著低于正常水平(P<0.01);(2)治疗后:ALL患儿在达到完全缓解时外周血CD4~+T、CD8~+T淋巴细胞CTLA-4的表达显著低于治疗前(P<0.01),与正常对照组比较差异无显著性(P>0.05),CD28的表达显著高于治疗前(P<0.01),与正常对照组比较差异无显著性(P>0.05)。结论(1)T淋巴细胞不能被充分活化,对肿瘤的免疫监视与清除功能降低,可能是ALL的发病因素之一;(2)化疗过程中注重调节T淋巴细胞的免疫功能、刺激T淋巴细胞正常活化可能有助于提高ALL的治疗缓解率。     

细胞周期蛋白A、生存素在儿童急性白血病中的表达及相关性

目的 探讨细胞周期蛋白A、生存素在儿童AL中的表达及相关性.方法 确诊为初治AL患儿47例.将其分为ALL患儿组(标危组,高危组)和急性非淋巴细胞性白血病(ANLL)患儿组;对照组为33例非血液系统恶性疾病儿童;采用密度梯度离心法分离其新鲜骨髓标本单个核细胞,提取细胞总蛋白, 采用蛋白免疫印迹方法 检测其细胞周期蛋白A和生存素的蛋白表达.胶片出现特异性条带为阳性.结果 AL患儿47例细胞周期蛋白A和生存素蛋白阳性表达率均显著高于对照组(P<0.01);ALL高危组细胞周期蛋白A和生存素蛋白阳性率均高于ALL标危组(P<0.05);WBC≥50×109 L-1患儿组细胞周期蛋白A和生存素蛋白阳性率均高于WBC<50×109 L-1患儿组 (P<0.05);周期蛋白A和生存素蛋白的阳性表达率与AL患儿的年龄、性别均无相关性(Pa>0.05);细胞周期蛋白A与生存素在儿童AL中的表达呈正相关(r=0.491 P=0.001);细胞周期蛋白A和生存素蛋白阳性表达率与临床疗效有关.结论 细胞周期蛋白A和生存素与AL儿童发病有关,在儿童AL发生发展过程中可能有协同作用.     

造血干细胞移植治疗儿童白血病

1 造血干细胞(HSCT)治疗儿童急性淋巴细胞白血病急性淋巴细胞白血病(ALL)规范化疗后长期无病生存率高达80%,因此,对于第一次完全缓解(CR 1)的AL患儿原则上选择化疗,但以下情况需选择HSCT.     

Role of nutrients in the regulation of in vivo protein metabolism in humans

Nutrients regulate protein metabolism both in an acute fashion and on a long-term basis. The ingestion of meals is associated with a dramatic switch from an overall catabolic state to a state of net protein anabolism. The acute response of protein metabolism to meal ingestion is mediated, in part, by an increase in insulin secretion, itself a consequence of glucose absorption. Whereas insulin may primarily suppress rates of proteolysis, amino acids are responsible for the stimulation of protein synthesis that follows food intake. In the long run, the effects of nutrition on protein metabolism depend on the energy supply, the source of the energy (carbohydrate versus fat) and dietary protein intake. Finally, specific amino acids, such as glutamine, may play an additional role as protein anabolic agents.     

氨磷汀在儿童肿瘤化疗中的应用

目的研究氨磷汀在儿童肿瘤化疗中的作用及不良反应。方法随机选择肿瘤32例患儿,采用自身对照,观察患儿在同一化疗方案中使用氨磷汀辅助治疗后黏膜损伤、骨髓抑制时间、发热持续时间、抗生素及刺激因子应用时间及氨磷汀的不良反应。结果氨磷汀辅助治疗组发生黏膜溃疡4例,明显低于对照组9例;中性粒细胞<0.5×109/L持续时间缩短,血小板<5×109/L持续时间缩短;发热持续时间、抗生素和刺激因子应用时间缩短。两组化疗过程中均未出现低体温、皮疹、低血压等情况,化疗后肾功能、心电图均正常;对肝功能影响程度相似;氨磷汀组低钙血症尤其是低钙性抽搐发生率高。结论氨磷汀能够有效保护正常组织细胞,不良反应较低,可在儿童肿瘤患者化疗中应用。     

Determinants of pregnancy in adolescents in Nepal

Objective : Social factors and prevalent norms in the community determine the proportion of teenage pregnancy in the community. In the light of high risk associated with teenage pregnancy, the socio-cultural determinants, which influence the conception among teenagers in Nepal, need to be understood. These determinants may be modified by suitable interventions to reduce teenage pregnancy. Aim of this study was to examine the socio-cultural determinants of teenage pregnancy in eastern Nepal.Methods : A case-control study design was selected for comparing the education, economic status, family support and freedom towards conception among teenagers as compared to higher age group women.Result : Seventy adolescent pregnant women were compared with seventy primigravida women in the 20 to 29 years age group. The teenage pregnant women were less educated, had poor economic background, more likely to have accidental pregnancies as compared to the other group and more likely to have love marriages. Husbands were more likely to decide about continuation of pregnancy. They had less psychological and social support from the family.Conclusion : Marriage at young age and pregnancy during teens are associated with less social acceptance and poor support in the family.     

Role of nutrients in the regulation of in vivo protein metabolism in humans

Nutrients regulate protein metabolism both in an acute fashion and on a long-term basis. The ingestion of meals is associated with a dramatic switch from an overall catabolic state to a state of net protein anabolism. The acute response of protein metabolism to meal ingestion is mediated, in part, by an increase in insulin secretion, itself a consequence of glucose absorption. Whereas insulin may primarily suppress rates of proteolysis, amino acids are responsible for the stimulation of protein synthesis that follows food intake. In the long run, the effects of nutrition on protein metabolism depend on the energy supply, the source of the energy (carbohydrate versus fat) and dietary protein intake. Finally, specific amino acids, such as glutamine, may play an additional role as protein anabolic agents.     

他汀类药物在儿童家族性高胆固醇血症治疗中的研究进展

家族性高胆固醇血症(FH)是一种常染色体显性遗传的脂质代谢障碍疾病,由于FH早期就可引起动脉粥样硬化病变,增加患者严重心血管疾病的患病风险和死亡风险,因此目前越来越强调患者自儿童期就使用他汀类药物进行治疗,以改善远期预后。文章综述他汀类药物治疗儿童FH的必要性、有效性和安全性,同时也提出目前存在的一些问题和思考。     

Diagnosis of Chlamydia pneumoniae in community-acquired pneumonia in children in Chile

The incidence of Chlamydia pneumoniae in community-acquired pneumonia in children was studied prospectively in 112 children aged 1 mo to 14 y. Diagnosis of C. pneumoniae was performed by polymerase chain reaction (PCR) on nasopharyngeal aspirates and serology by the microimmunofluorescence test on a single serum specimen. Three (2.7%) cases of pneumonia due to this agent were diagnosed by both PCR and serology. C. pneumoniae was not found in any of 62 children below 5 y of age. In the age group 5-8 y, only 1/30 (3%) was found positive, and in the age group 9-14 y, C. pneumoniae was diagnosed in 2/20 (10%) children. Conclusion: Although the number of enrolled patients is small, and the diagnostic techniques used may have some limitations, the results of this study suggest that C. pneumoniae plays a minor role in the aetiology of pneumonia in children less than 9 y of age in our country. However, it should be considered as a potential agent in pneumonia in older children.     

皮质激素在癫痫治疗中的应用

皮质激素在癫痫中的应用已有近50a的历史，现已证明其对某些癫痫综合征如婴儿痉挛症、Landau—Kleffner综合征、Rassmussen综合征、具有睡眠中癫痫性电持续状态的癫痫综合征等具有肯定的治疗作用，其确切的作用机制尚不清楚。在皮质激素应用过程中应注意其不良反应。     

Efficacy of amphotericin B in multi-drug resistant kala-azar in children in first decade of life

Fifty children in the first decade of life, and suffering from multiple drug resistant kala-azar, confirmed by demonstration of amastigotes in aspirates of bone marrow or spleen were treated with amphotericin B in gradually increasing dosage to a total dose of 20 mg/kg. All patients had classical features of severe kala-azar, and had taken more than one course of antimony and pentamidine, and three patients had taken one additional course of ketoconazole besides many courses of antimony and pentamidine. The clinical response started just after first infusion in 8 patients, and the patients became afebrile. By 5th infusion, all looked better and 18 patients became afebrile. By 15th infusion all patients were afebrile and cheerful. Their spleens became smaller and body weights and total white cell counts increased. Forty eight patients had parasitological cure at the end of treatment, and only 2 patients required an additional 5 infusions for parasitological cure. All patients were ultimately cured. No one relapsed within six months of follow up. All patients had shivering, rigor and rise of temperature on the day of infusion, which could be minimized with prior administration of low dose of hydrocortisone, but could not be eliminated. Eighteen patients had loose motions during treatment, while 14 patients had decrease in appetite which improved quickly when the treatment was over. Fourteen patients had transient rise of blood urea, in six patients serum creatinine also increased and 16 patients had a minor fall in serum potassium. It is concluded that amphotericin B is a very effective drug for multidrug resistant kala-azar in children, and should be used without hesitation in all such cases in children, but under close medical supervision.