遗尿症儿童感觉统合能力的研究

目的：分析原发性夜间遗尿症(PNE)儿童的感觉统合能力,探讨感觉统合失调在原发性遗尿症发生中的作用。方法：采用感觉统合能力发展量表对46例PNE组儿童及46例正常对照组儿童进行感觉统合功能测试,对两组结果采用t检验和χ2检验进行统计分析。结果：PNE组与对照组儿童感觉统合失调的发生率分别为82.6%和43.5%,其中重度失调的发生率分别为36.9%和2.1%,两组间差异有显著性（P﹤0.01）;PNE组所有感觉统合功能因子得分均明显低于对照组,差异有显著性(P﹤0.01)。结论：PNE组儿童存在感觉统合失调现象,感觉统合功能失调在PNE发生中可能有一定作用。     

感觉统合训练治疗孤独症的疗效

目的探讨感觉统合训练治疗孤独症的疗效。方法对23例孤独症患儿进行6个月的感觉统合训练,在训练前后,分别采用感觉统合评定量表和孤独症儿童行为检查量表对孤独症患儿的感觉失调状况和临床症状进行评估,并进行对比分析。结果感觉统合训练治疗后,感觉统合能力有明显改善,其中感觉统合失调的改善以前庭平衡失调、触觉过分防御、本体感觉失调的改善为显著,训练6个月的改善率分别为91.3%、95.7%、69.5%,而学习能力改善较差,为60.8%。通过训练,孤独症儿童的语言、交往、感觉和躯体运动能力较治疗前均显著改善(Pa<0.05),生活自理项改善不明显。结论感觉统合训练对治疗孤独症有一定疗效。     

感觉统合训练对感觉统合失调儿童疗效初步观察

目的观察感觉统合训练对感觉统合失调的疗效。方法对32例确诊为重度感觉统合失调儿童，进行3个疗程感觉统合训练，在训练前以及训练结束后进行感觉统合量表检测，比较训练前以及训练后量表评分，确定疗效。结果训练前以及训练后感觉统合量表评分差异有统计学意义（P〈0．01）。结论感觉统合训练对感觉统合失调儿童有较好的疗效，值得临床推广。     

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目的分析原发性遗尿症(PNE)患儿智力结构,探讨单纯PNE患儿灰质形态学改变状况。方法 2006年10月至2011年8月解放军第463医院儿科就诊的75例右利手PNE患儿(PNE组)及72名正常儿童(对照组),采用中国韦氏儿童智力量表(C-WISC)进行智力测试,计算言语智商(VIQ)、操作智商(PIQ)、总智商(FIQ)、记忆或不分心(M/C)因子等指标;而后进行高分辨率T1WI磁共振成像(MRI)扫描,采用VBM5工具包,对所有被试T1WI图像进行基于体素的形态学分析(VBM),采用t检验进行组间分析,比较单纯PNE患儿脑区激活状况与正常对照组相应脑区灰质密度(GMD)。结果 PNE组FIQ、VIQ和PIQ均正常,与对照组差异无统计学意义(P>0.05)。PNE组M/C因子低于对照组[(100.80±16.83)与(92.73±18.46)],差异有统计学意义(P<0.01);VBM分析表明,PNE患儿小脑左后部及右侧背侧前额叶(dLPFC)灰质密度程度明显低于对照组,差异有统计学意义(P<0.001)。结论 PNE患儿智力结构不平衡,存在注意功能缺陷。左侧小脑及右侧dLPFC功能障碍与其注意功能缺陷有关。     

原发性夜间遗尿症儿童神经心理学特征研究

目的 探讨原发性夜间遗尿症(PNE)患儿的神经心理学特征.方法 采用视听整合持续操作测试(IVA-CPT)和中国韦氏儿童智力量表(C-WLSC)对30例单纯PNE患儿(单纯PNE组)、22例PNE+注意缺陷障碍(ADHD)患儿(PNE+ADHD组)、30例单纯ADHD患儿(单纯ADHD组)以及30例健康儿童(对照组)进行对照研究.结果 IVA-CPT 单纯PNE组与对照组比较,综合控制商数和听觉反应控制商数、听觉谨慎商数、听觉一致性商数差异有统计学意义(P<0.05),综合注意商数、听觉注意力商数、听觉警醒商数和听觉注意集中商数差异有高度统计学意义(P<0.01);单纯PNE组与单纯ADHD组比较,综合控制商数、听觉反应控制商数、综合注意商数,听觉注意力商数差异有统计学意义(P<0.05);单纯PNE组与PNE+ADHD组比较,听觉反应控制商数和视觉速度商数差异有统计学意义(P<0.05),综合注意力商数、听觉注意力商数、视觉注意力商数、听觉警醒商数和视觉警腥商数差异有高度统计学意义(P<0.01).GMsc:单纯PNE组与对照组比较,数字广度、译码、知识与算术分测验量表分差异有统计学意义(P<0.05);单纯PNE组与单纯ADI-ID组比较,数字广度、译码、知识和算术分测验量表分差异有统计学意义(P<0.05);单纯PNE组与PNE+ADHD组比较,数字广度、译码和算术分测验量表分差异有统计学意义(P<0.05).结论 PNE患儿本身即存在注意力的损害,伴有ADHD时损伤更为严重.     

不同类型肺炎支原体肺炎儿童血浆凝血酶调节蛋白和D-二聚体的变化

目的：探讨不同类型肺炎支原体肺炎（MPP）儿童血浆凝血酶调节蛋白（TM）和D-二聚体（D-D）的变化及其在儿童MPP发病机制中的作用。方法：52例MPP患儿,其中表现为大叶性肺炎者30例作为大叶性肺炎组,表现为间质性肺炎者22例作为间质肺炎组;30例健康儿童作为对照组。分别采用酶联免疫吸附法、乳胶增强免疫比浊法测定血浆TM和D-D水平。结果：大叶性肺炎组、间质性肺炎组、对照组血浆TM水平（中位数）分别为23.83、15.56、8.78μg/L,3组比较差异有统计学意义（P<0.01）,其中大叶性肺炎组和间质性肺炎组血浆TM水平均明显高于对照组（P<0.01）,且大叶性肺炎组血浆TM水平高于间质性肺炎组（P<0.05）。大叶性肺炎组和间质性肺炎组血浆D-D水平（中位数）均明显高于参考值中位数（P<0.01）;大叶性肺炎组血浆D-D水平明显高于间质性肺炎组（0.35μg/mL vs 0.13 μg/mL, P<0.01）,且大叶性肺炎组血浆D-D升高比例明显高于间质性肺炎组（87% vs 59%,P<0.05）。结论：血浆TM 和D-D水平在MPP患儿中存在不同程度升高,表现为大叶性肺炎者升高更明显,提示血管内皮细胞损伤和血液高凝状态参与了MPP的发病机制。     

原发性遗尿症患儿治疗前后自我意识变化的初探

目的 分析评估儿童原发性遗尿症（PNE）自我意识评价状况以及遗尿治疗对自我意识的影响。方法 选择2005年7月至2006年1月在复旦大学附属儿科医院确诊的8~16岁PNE患儿为研究对象。排除患有可引起尿床的器质性疾病、治疗前存在高血压、单亲家庭、父母离异、有其他家庭问题及慢性疾病的患儿。指导PNE患儿自己填写Piers Harris儿童自我意识量表(PHCSS)。随后患儿分3组接受不同方法治疗遗尿:生物反馈治疗组、口服醋酸去氨加压素治疗组和口服中药治疗组，疗程均为1个月。治疗结束3个月后再次指导患儿自己填写PHCSS。通过心理分析软件分析两次自我意识评价结果。结果 研究期间共纳入PNE患儿54例，男29例，女25例，平均年龄（10.0±0.6）岁。其中轻度遗尿15例，中度遗尿20例，重度遗尿19例。治疗遗尿前54例患儿自我意识评价结果中焦虑得分显著低于常模（P<0.01）；并且轻、中和重度PNE患儿焦虑得分均显著低于常模（P<0.01），不同遗尿严重程度患儿得分差异无统计学意义。其中12例接受生物反馈治疗，14例接受醋酸去氨加压素治疗，28例接受中药治疗。治疗后有44例接受了自我意识评价随访，治疗遗尿后患儿焦虑得分较治疗前明显增加（P<0.05），其中口服醋酸去氨加压素组治疗后焦虑得分明显提高（P<0.05）。遗尿治疗有效的患儿得分明显高于治疗前（P<0.05），而治疗无效的患儿治疗前、后自我意识各项得分差异无统计学意义。结论 治疗前PNE患儿自我意识评价结果中焦虑得分低下，通过治疗遗尿其自我意识评价也可得到改善，并且临床疗效好的患儿自我意识改善明显。     

剖宫产与学龄前儿童感觉统合失调的前瞻性队列研究

目的 采用前瞻性队列研究,评价剖宫产与学龄前儿童感觉统合失调的关联。 方法 依托上海交通大学医学院附属新华医院和附属国际和平妇幼保健院2012年建立的多中心母婴队列,于2017年采用儿童感觉统合能力发展评定量表,从前庭平衡、触觉防御和本体觉3个维度评价392名学龄前儿童感觉统合功能。剖宫产出生为暴露因素,阴道分娩者作为对照组。采用多因素logistic回归分析评估剖宫产与感觉统合各维度失调的关联。 结果 学龄前儿童感觉统合失调率为21.9%（86/392）,前庭平衡、触觉防御和本体觉失调率分别为5.9%（23/392）、5.4%（21/392）和15.1%（59/392）。调整母亲分娩年龄、母亲受教育程度及儿童出生情况等混杂因素后,剖宫产儿童发生本体觉失调的风险性显著增加（RR=4.16,95%CI：1.41~12.30,P<0.05）。按性别分层分析发现,剖宫产男童本体觉失调的发生风险高于阴道分娩男童（RR=5.75,95%CI：1.26~26.40,P<0.05）。 结论 剖宫产能显著增加学龄前儿童本体觉失调的发生风险,尤其是对男童的影响更为明显。     

影响儿童孤独症感觉统合训练疗效的因素分析

目的：在实践中发现,影响儿童孤独症感觉统合训练疗效的因素很多。该文从信息的感觉处理模式方面来探讨影响儿童孤独症感觉统合训练效果的因素,从而为孤独症儿童的康复训练提供新的方法。方法：对93例1.8～8.3岁孤独症患儿分别进行孤独症行为评定量表（ABC）的评估、Dunn模式的感觉处理分型,以感觉统合评定量表进行感觉统合训练前后的评定来评估疗效,分析性别、年龄、ABC评分以及感觉处理模式对疗效的影响。结果：ABC评分（Wald=6.768,P<0.01）和感觉处理模式（Wald=13.549,P<0.01）对疗效有显著影响,尤以感觉处理模式影响最大,而性别（Wald=1.549,P>0.05）和年龄（Wald=0.010,P>0.05）则无影响。结论：孤独症儿童的感觉处理模式是影响感觉统合训练效果的主要因素。［中国当代儿科杂志,2009,11（2）：124-127］     

儿童过敏性紫癜性肾炎血管内皮生长因子基因多态性的研究

目的：探讨血管内皮生长因子(VEGF)-634G/C基因多态性与汉族儿童紫癜性肾炎(HSPN)的关系。方法：应用聚合酶链反应－限制性内切酶片段长度多态性（PCR－RFLP）技术对100例过敏性紫癜（HSP）汉族儿童进行VEGF -634G/C基因型分析,其中包括合并紫癜性肾炎50例（HSPN 组）,无合并肾炎者 50例（单纯HSP组）。50例年龄、性别匹配的健康汉族儿童作为对照组。并采用酶联免疫吸附试验(ELISA)检测各组血浆VEGF水平。结果：HSPN组VEGF-634CC基因型（32%）和C等位基因频率（56%）均高于对照组（分别为10%和33%）及单纯HSP组（分别为10%和35%,P<0.01）。HSP患儿中,CC基因型者肾炎的发生率比GG基因型者明显增加, 差异有显著性意义（76% vs 31%,P<0.01）。CC基因型者血浆VEGF水平(180.5±40.7 pg/mL)较CG(145.2±48.3 pg/mL)及GG (101.5±26.5 pg/mL)基因型者显著上升, 差异有显著性意义（P<0.05）。结论：VEGF-634G/C基因多态性与儿童HSPN的发生有关。C等位基因可能是儿童HSPN的易感基因。［中国当代儿科杂志,2009,11（6）：417-421］     

家族聚集性原发性夜间遗尿症患儿尿动力学研究

目的 探讨家族聚集性因素对原发性夜间遗尿症(PNE)患儿影响.方法 选取PNE患儿115例,依据PNE先症者三代家族其他成员是否累及,分为家族聚集性(FPNE组,45例)和散发性(SPNE组,70例).填写调查表评估觉醒功能、记录排尿日记和完成白天尿动力学检查.结果 FPNE组重度PNE、非单症状性PNE和小容量膀胱发生率分别为27%、58%和44%,均显著高于SPNE组的7%、21%和21%(P＜0.05),而夜间多尿和觉醒障碍发生率在二组之间的差异无统计学意义.FPNE组逼尿肌过度活跃和尿动力学功能性膀胱出口阻力增加发生率为53%和60%,分别显著高于SPNE组的19%和37%(P＜0.05).最大排尿量和最大膀胱压测定容量在对照组、SPNE组和FPNE组之间逐渐降低,差异有统计学意义(P＜0.05).结论 家族聚集性因素可使PNE发生膀胱功能障碍风险增加,尿动力学检查为其治疗提供客观依据.     

儿童原发性夜间遗尿症尿动力学研究

目的　通过对睡眠中自然充盈状态膀胱尿动力学检测 ,探讨儿童原发性夜间遗尿症(PNE)膀胱病理生理改变。方法　PNE组儿童 5 0例 ,对照组儿童 30例 ,无PNE临床表现。两组均进行下列检查 :晨尿分析、泌尿系B超、尿流率 ,检查结果均正常者列入研究对象 ;连续记录 7d排尿日记 ;在夜间动态脑电图监测下 ,进行自然充盈膀胱的尿动力学检测。结果　夜间总尿量、功能性膀胱容量 (FBC)和排尿潜伏期 :PNE组夜间总尿量与对照组比较差异无显著性意义 (P >0 .0 5 ) ,FBC显著低于对照组 (P <0 .0 1) ,排尿潜伏期显著低于对照 (P <0 .0 1) ;遗尿发生于S2 4期 ;PNE组中膀胱顺应性 (BC)下降 4例 ,对照组 0例 ;PNE组逼尿肌不稳定收缩 (DI) 2 9例 ( 5 8.0 % ) ,对照组 3例( 10 .0 % ) ,差异有显著性意义 (P <0 .0 1) ;DI虽随年龄增加有下降趋势 ,但差异无显著性意义 (P >0 .0 5 ) ;充盈期出现DI伴尿道压下降 ,PNE组 8例 ,对照组 0例 ,排尿期尿道压增高伴盆底肌电活动增强PNE组 4 8例 ( 96 .0 % ) ,对照组 2 8例 ( 93.3% ) ,差异无显著性意义 (P >0 .0 5 )。结论　FBC下降是PNE基本特征 ;DI是PNE重要病理生理改变 ;充盈过程部分PNE可能存在尿道括约肌中枢功能不稳定     

遗尿症患儿智力水平和智力结构分析

目的：有文献报道原发性夜间遗尿症 (PNE) 患儿存在注意力/记忆力缺陷,并认为这种缺陷可能与患儿的智力情况有关,因此该研究对PNE患儿的智力水平和智力结构进行分析。方法：采用中国韦氏儿童智力量表（C-WISC）对40例PNE患儿的智力结构进行测试,并与40例年龄和性别相匹配的正常儿童进行对照研究。结果：PNE组的总智商（FIQ）、言语智商（VIQ）和操作智商（PIQ）均在正常范围,与对照组比较差异无显著性（P＞0.05）,但数字广度、编码、知识与算术分测验量表分与对照组比较差异有显著性 (P＜0.05);记忆/不分心因子（M/C）与对照组比较差异有显著性 (P＜0.05);两组PIQ与VIQ差值比较,差异无显著性（P＞0.05）。结论：PNE患儿智力水平正常,但智力结构中的记忆/不分心因子存在一定缺陷,提示可能与大脑额叶执行功能异常有关。［中国当代儿科杂志,2007,9（5）：433-435］     

Bone age and probable aetiological causes in primary nocturnal enuresis

Aim: To investigate probable aetiological risk factors and to identify whether there are any differences in bone age between normal children and children with primary nocturnal enuresis (PNE). Methods: Ninety children with primary nocturnal enuresis and 40 healthy children were included in the study. Enrolment began in January 2001, and continued through July 2002. Data were obtained via consultation with children and their families, physical examination and laboratory findings. Left hand and wrist graphs of each patient were acquired, and, using Tanner Whitehouse charts (TW-2), bone ages were determined via comparison of 20 hand and wrist bones. Results: Of the total of 90 children with primary nocturnal enuresis participating in the study, 52 (57.8%) were male and 38 (42.2%) were female. Of the control group, 24 (60%) were male and 16 (40%) were female. Differences between chronological ages and bone ages of the PNE and control groups were 0.57±0.59 and 0.54±0.67 y, respectively, and no significant difference was seen (p=0.484). In 90% of the children in the PNE group there was found to be a primary nocturnal enuresis history in the family, whereas in the control group this rate was only 7.5%. Of the children with PNE, 62.2% had very deep sleeping habits, while 7.5% of the control group had this problem.

Conclusion: Our study provides no evidence that bone ages of children suffering from PNE are lower than normal children. We found that a family history of enuresis, male sex and difficulty in waking were risk factors in primary nocturnal enuresis.     

Evaluation of working memory impairment in children with primary nocturnal enuresis: evidence from event-related functional magnetic resonance imaging

Aim: To assess the working memory and explore the differential activations of brain areas in children with primary nocturnal enuresis (PNE) by performing functional magnetic resonance imaging (fMRI) scans using the categorical N‐Back task. Methods: Thirteen right‐handed PNE children (M/F = 7:6, average age 11.4 ± 0.8 years) and 15 age‐matched, right‐handed, healthy controls (M/F = 9:6, 11.3 ± 1.0 years) were recruited for the study. First, intelligence tests were performed using Chinese Wechsler Young Children Scales of Intelligence in PNE children and controls. The full intelligence quotient (FIQ), verbal IQ (VIQ), performance IQ (PIQ) and memory/caution (M/C) factor were measured. After intelligence tests, event‐related fMRI scans were performed using the categorical N‐Back working memory task on a 3.0T MR scanner. The percent of correct responses (PCR) and the mean reaction time to correct response (mRT) were recorded and compared; fMRI data were analysed using SPM2, the differences in activation were compared with the single subject and between‐group levels. Results: The FIQ, VIQ and PIQ in the PNE group were within the normal range and did not significantly differ from the control group (P > 0.05). The M/C factor was statistically significantly lower in the PNE group (P < 0.05). In the N‐Back test, PNE children had lower PCR and longer mRT than controls (P < 0.05). A between‐group analysis of fMRI data revealed significant attenuation in the left posterior cerebellar lobes of PNE children. Conclusion: PNE children had deficits in working memory, and dysfunction in the left cerebella might be associated with their working memory deficits.     

Retarded skeletal maturation in children with primary enuresis

Primary nocturnal enuresis (PNE) is a common paediatric problem of multifactorial aetiology. Growth and skeletal maturation were studied in 35 otherwise healthy children with PNE, 26 boys and 9 girls aged 6–14 years, and comparison was made with a control (CTR) group of 19 boys and 3 girls aged 6–13 years of similar ethnic origin. There was no significant difference between the mean height and weight centiles of the two groups. Bone age (BA) determined by the TW-2 method showed a significant lag behind chronological age (CA); the CA-BA difference being 1.46±1.56 years in the PNE group and -0.08±0.8 years in the CTR group (P<0.001). In 11 of the PNE group (31%) the BA retardation was greater than 24 months: in 4 it was between 24 to 36 months and in 7 the difference was greather than 36 months. In all these children T4 and TSH were found to be normal.It is hypothesised that the retarded bone age in children with PNE may reflect delayed maturation of regulatory CNS functions.Abbreviations PNE Primary nocturnal enuresis - CTR Control group - BA Bone age - CA Chronologic age     

前瞻性随机对照研究生物反馈和口服醋酸去氨加压素治疗儿童原发性遗尿症的疗效

目的: 通过前瞻性随机对照研究比较生物反馈和口服DDAVP两种方法对治疗原发性遗尿症（PNE）的效果。方法：将2005.7-2006.1在复旦大学附属儿科医院确诊为PNE的儿童随机分为DDAVP组和生物反馈组，进行1个月的治疗和其后3个月的随访，指标包括排尿日记，尿流率，尿液AQP2。结果：PNE患儿共50例，男26例，女24例；平均年龄8.4±0.9岁。治疗结束和结束后第3个月时生物反馈组总有效率均高于DDAVP组，两组治愈率和复发率无明显差异。生物反馈组治疗结束时最大尿流率和尿量较治疗前明显提高，正常尿流曲线和逼尿肌-括约肌收缩协调人数较治疗前明显增多。晨尿尿液AQP2主要检测到两个条带，均可见遗尿组灰度显著低于对照组。DDAVP组治疗结束时AQP2与治疗前相比有明显增加。结论：生物反馈和DDAVP均是治疗PNE的有效方法。生物反馈治疗在四个月内的总有效率高于DDAVP，值得在PNE儿童中开展使用。生物反馈治疗对改善膀胱-尿道功能紊乱有帮助，而DDAVP则可以提高尿液中AQP2水平。     

Behavioural problems in children and parenting stress associated with primary nocturnal enuresis in Hong Kong

The aim of this study was to investigate the behavioural problems and parenting stress of enuretic children in the local Chinese community. The study recruited 89 children with primary nocturnal enuresis (PNE) from the paediatric clinics of 9 regional hospitals in Hong Kong, and 131 age- and gender-matched control children without PNE from the Student Health Centres. After adequate instruction, the parents completed the Child Behaviour Checklist (CBCL) and Parenting Stress Index (PSI). A trained interviewer interviewed the parents and children and rated the children on the Global Assessment of Functioning (GAF). The PNE group had worse overall scores in both the Problem and Competence scales of CBCL; in particular, they had more attention problems and aggressive behaviours, and lower social competence and school performance than the control group. Their parents demonstrated more parenting stress as shown by higher PSI scores. Conclusion: In the local Chinese population, PNE was associated with more childhood behavioural problems and greater parenting stress. Attention to the psychosocial functioning of the child and parents may be important in the management of enuresis.