新生儿高胆红素血症患儿脑干听觉诱发电位及血清神经元特异性烯醇化酶变化及临床意义

目的通过对新生儿高胆红素血症患儿脑干听觉诱发电位(BAEP)及血清神经元特异性烯醇化酶(NSE)检测,评估高胆红素血症对新生儿听神经损伤。方法 56例血清胆红素大于 220．5μmol／L的新生儿为高胆红素血症组(简称高胆组),血清胆红素小于220．5μmol／L的49例足月儿为对照组,分别进行BAEP、NSE检测。结果高胆组新生儿BAEP的Ⅰ、Ⅲ、Ⅴ波绝对潜伏期(PL)、峰间潜伏期(IPL)均明显延长,与对照组比较,差异有显著性意义(P<0．01);高胆组新生儿NSE明显高于对照组,差异有显著性意义(P<0．01);NSE水平与BAEP的Ⅴ波反应阈值呈正相关(r=0．65,P<0．01)。结论高胆红素血症可导致新生儿听神经损伤;BAEP和NSE对其神经损伤有较高的敏感性,可作为监测指标。     

高胆红素血症新生儿总胆红素/白蛋白比值与脑干听觉诱发电位的关系

目的 探讨总胆红素/白蛋白比值与脑干听觉诱发电位(BAEP)的相关性及其预测高胆红素血症新生儿听力损害的临床价值.方法 检测113例新生儿的总胆红素(TSB)、白蛋白水平,计算总胆红素/白蛋白比值(B/A),将B/A值≥ 3.0 × 10-3的83例新生儿作为观察组,并根据B/A值分4个亚组;另30例B/A ﹤ 3.0 × 10-3的新生儿作为对照组.检测所有新生儿的BAEP,分析TSB水平、B/A值与BAEP异常的相关性.结果 观察组各亚组间新生儿的BAEP异常率差异有统计学意义(P ＜ 0.01),随B/A值增大,BAEP异常率增高;观察组各亚组间新生儿BAEP的Ⅴ波潜伏期及Ⅰ-Ⅴ、Ⅲ-Ⅴ波间期的差异有统计学意义(P均＜ 0.05);TSB水平、B/A值的工作特征曲线(ROC)下面积(AUC)差异也有统计学意义(P ＜ 0.05);BAEP异常与B/A值密切相关(χ2 ＝ 13.489,P ＜ 0.05).结论 B/A值与BAEP异常相关性高,具有预测高胆红素血症新生儿听力损害的临床价值.     

重度高胆红素血症新生儿脑干听觉诱发电位的改变

目的 观察新生儿重度高胆红素血症脑干听觉传导系统的改变.方法 根据血清总胆红素水平把77例新生儿分成3组:A组31例(胆红素342.0～427.5 μmol/L),B组29例(胆红素427.5～513.0 μmol/L),C组17例(>513.0 μmol/L),3组新生儿进行脑干听觉诱发电位检测.结果 3组患儿Ⅰ波及Ⅰ-Ⅲ峰间期异常率随胆红素水平升高而升高,差异有显著性(P<0.01),Ⅲ波、Ⅴ波及Ⅲ-Ⅴ峰间期异常率3组间差异无显著性(P>0.05).3组患儿Ⅴ波反应阈均以轻中度升高为主,A、B两组主要表现为轻度升高,C组主要表现为中度升高,1例患儿重度升高.结论 重度高胆红素血症可导致新生儿听神经损害,血清胆红素水平与脑干听觉诱发电位异常程度有直接关系,主要表现为外周听神经损害,客观听域轻中度升高,应合理干预高胆红素血症以减少神经系统损害.     

新生儿高胆红素血症患儿脑干听觉诱发电位及血清神经元特异性烯醇化酶变化及临床意义

目的通过对新生儿高胆红素血症患儿脑干听觉诱发电位（BAEP）及血清神经元特异性烯醇化酶（NSE）检测，评估高胆红素血症对新生儿听神经损伤。方法56例血清胆红素大于220．5μmol／／L的新生儿为高胆红素血症组（简称高胆组），血清胆红素小于220．5μmol／／L的49例足月儿为对照组，分别进行BAEP、NSE检测。结果高胆组新生儿BAEP的Ⅰ、Ⅲ、Ⅴ波绝对潜伏期（PL）、峰间潜伏期（IPL）均明显延长，与对照组比较，差异有显著性意义（P〈0．01）；高胆组新生儿NSE明显高于对照组，差异有显著性意义（P〈0．01）；NSE水平与BAEP的Ⅴ波反应阈值呈正相关（r=0．65，P〈0．01）。结论高胆红素血症可导致新生儿听神经损伤；BAEP和NSE对其神经损伤有较高的敏感性，可作为监测指标。     

高胆红素血症新生儿血清NSE的变化及意义

目的探讨高胆红素血症新生儿血清神经元特异性烯醇化酶(NSE)和新生儿行为神经测定(NBNA)的变化、两者的相关性及其临床意义。方法应用酶联免疫吸附法检测42例高胆红素血症新生儿和29例正常新生儿血清中NSE浓度,同步测定血清总胆红素(TSB)、白蛋白含量,计算胆红素-白蛋白比值(B/A),并行新生儿NBNA评分。高胆组按TSB≥342μmol/L和171～342μmol/L分为实验组a和实验组b,对照组TSB<85.5μmol/L,结果两实验组血清NSE浓度均较对照组显著升高(P<0.01),两实验组间NSE浓度差异无显著性(P>0.05)。两实验组NBNA评分值均明显低于对照组(P<0.01),两实验组间差异无显著性(P>0.05)。血清NSE浓度与NBNA评分均呈显著性负相关(P<0.01)。结论血清NSE测定比TSB、B/A值能更早期预测新生儿胆红素脑损伤患病风险。     

窒息新生儿脑干听觉诱发电位与血清神经元特异性烯醇化酶的相关性分析

目的：通过研究窒息患儿脑干听觉诱发电位（BAEP）异常与神经元特异性烯醇化酶（NSE）的相关性,探讨NSE对早期了解窒息患儿听神经损害的临床意义和应用前景。方法：选择该院窒息足月新生儿52例作为研究组,根据Apgar评分以及是否合并缺氧缺血性脑病(HIE)分为单纯轻度窒息组23例、单纯重度窒息组15例和窒息合并HIE组14例。采用双盲试验在生后7 d同一时间检测BAEP和NSE,初次BAEP检测异常者在生后3个月同一时间进行第2次BAEP和NSE检测。正常足月新生儿30例作为对照组。结果：窒息患儿两次听力损伤检出率分别为50.0%,21.2%。BAEP两次检出异常率,重度窒息组(63.3%,26.3%)与轻度窒息组(36.9%,5.9%)比较,差异均有显著性意义(P<0.05),HIE组(57.1%,31.3%)与重度窒息组比较差异无显著性意义。各研究组NSE水平均明显高于对照组(P<0.01),重度窒息组为26.70±2.34 μg/L明显高于轻度窒息组的17.18±3.16 μg/L,差异有显著性意义(P<0.01),HIE组为27.00±2.01 μg/L,与重度窒息组比较差异无显著性意义。BAEP异常组NSE水平为25.69±4.12 μg/L高于BAEP正常组的17.15±3.09 μg/L(P<0.01),NSE水平随着V波反应阈值的增高而增高(P<0.05)。结论：血清NSE水平与BAEP密切相关,可作为早期评估窒息患儿听神经损害和判断预后的指标之一。     

妊娠期高血压疾病与新生儿肺出血的关系

目的 了解妊娠期高血压疾病与新生儿肺出血之间的关系.方法 在2005年6月至2007年6月对四家医院收治的正常孕妇(孕A组)、妊娠期高血压孕妇(孕B组)及其所产新生儿(婴A组、婴B组)进行血内皮素(ET)-1和NO水平测定,并比较正常孕妇与妊娠期高血压孕妇所产新生儿肺出血的发生率.结果 孕B组及婴B组分别较孕A组及婴A组血ET-1水平增高[(6.66±2.73)ng/L vs (3.24±1.74)ng/L,(6.42±3.17)ng/L vs (3.91±2.02)?ng/L],NO水平降低[(85.80±46.15)μmol/L vs (110.85±76.56)μmol/L,(82.73±48.51)μmol/L vs(122.23±75.08)μmol/L],差异有非常显著性(P<0.002,P<0.001).婴B组新生儿肺出血发生率为13.3%(20/155例),明显高于婴A组3.9%(5/128例),差异有显著性(χ2=5.9,P=0.01).结论 妊娠期高血压孕妇NO生成减少及ET-1异常升高,导致胎盘血管强烈收缩,胎儿发生缺血缺氧,可最终引起新生儿肺出血.及早防治妊娠期高血压,可降低新生儿肺出血发生率.     

新生儿高胆红素血症患儿NBNA与BAEP评价

目的　 探讨新生儿高胆红素血症患儿脑损伤的早期预测方法。 方法 　对 38例高胆患儿分别进行新生儿神经行为评分 (NBNA)和脑干听觉诱发电位 (BAEP)检测。 结果 　高胆组BAEP异常率明显高于对照组 (P <0 0 1) ,Ⅰ、Ⅴ波潜伏期与对照组比较差异显著 (P <0 0 1,P <0 0 5 )。高胆组NBNA评分明显低于对照组 (P <0 0 0 1) ,主要失分项目为行为能力和主动肌张力。在血清胆红素≥ 2 0 4μmol/L时 ,胆红素水平与NBNA评分呈显著负相关 (P <0 0 1) ,血清胆红素浓度≤ 2 5 6 5 μmol/L时 ,部分高胆患儿NBNA评分即有降低 ,BAEP异常率增高 ,黄疸消退后NBNA评分全部恢复正常。 结论 　NBNA和BAEP是早期诊断新生儿胆红素脑病敏感而有效的方法 ,有助于判断病情及指导治疗。     

新生儿ABO溶血高胆红素血症血尿胱抑素C测定及临床价值探讨

目的 探讨新生儿ABO溶血高胆红素血症血、尿胱抑素C(Cys C)变化及其临床价值.方法 2008年1月至2010年1月本科确诊为ABO溶血症引起高胆红素血症(TBil≥220.6μmol/L)的新生儿为观察组,根据胆红素水平分为轻度组(TBil<256.5 μmol/L)和中重度组(TBil≥256.5 μmol/L).同期自然分娩、无黄疸的新生儿为对照组.测定观察组入院24 h内及黄疸消退期、对照组生后2～3 d血清胆红素、血尿Cys C、β2-微球蛋白(β2-MG)、BUN、Scr值,并对资料进行统计学分析.结果 轻度组18例,中重度组22例,对照组20例.中重度组血清Cys C、β2-MG值高于对照组(P<0.05);轻度组、中重度组尿Cys C、β2-MG值均高于对照组(P<0.05);中重度组血、尿Cys C、β2-MG值均高于轻度组(P<0.05);血清胆红素与血、尿Cys C水平呈正相关(r=0.627、0.538,P<0.01);血、尿Cys C水平分别与血、尿β2-MG水平呈正相关(r=0.385、0.368,P<0.05).观察组治疗后,血、尿Cys C值较治疗前明显下降(P<0.01).结论 高胆红素血症对新生儿肾功能有不同程度的损害,且对肾小管的损害早于肾小球,但肾损伤短暂、可逆;血、尿CysC测定时新生儿早期肾功能损害的诊断、治疗及疗效判断均具有十分重要的临床指导价值.     

儿童脑损伤血清S-100B、神经元特异性烯醇化酶检测的意义

目的　研究不同程度脑损伤儿童血清S 10 0B、神经元特异性烯醇化酶 (NSE)浓度及其与格拉斯格昏迷评分法 (GCS)评分的相关性。方法　选择 2 0 0 1年 4月～ 2 0 0 2年 1月我院收治脑损伤后 2 4h内患儿 36例 ,按GCS评分标准将其分为重度脑损伤组 (组 1) 18例 ,GCS <8分 ;轻度脑损伤组 (组 2 ) 18例 ,GCS >12分 ;健康对照组 16例。脑损伤组于伤后 12～ 2 4h内均采集脑损伤组、健康对照组肘静脉血 4ml。分别用免疫荧光法和双抗体夹心免疫荧光法测定NSE及S 10 0B浓度。 6 2 0nm的酶标仪检测吸光度 ,通过标准曲线计算血清S 10 0B、NSE浓度。结果　组 1血清S 10 0B为 1.0 5± 0 .5 2 μg/L ,NSE为 6 9.13± 37.86 μg/L ;组 2S 10 0B 0 .4 7± 0 .2 1μg/L ,NSE为 2 6 .14± 13.4 6 μg/L ;对照组血清S 10 0B血清 0 .19± 0 .0 9μg/L ,NSE为 14 .4 3± 7.70 μg/L。S 10 0B组 1与组 2比较t=4 .5 7　P <0 .0 1;NSE组 1与组 2比较t =4 .5 4　P <0 .0 1;组 2与对照组比较S 10 0B :t=4 .72　P <0 .0 1,NSE :t=3.0 6　P <0 .0 1;组 1与对照组比较S 10 0B :t=6 .5 7　P =0 .0 0 ,NSE :t=5 .6 7　P =0 .0 0。S 10 0B与GCS评分的相关系数r =- 0 .86 9,F =12 6 .6 6　P =0 .0 0 0 ;r =- 0 .86 9,t =- 11.2 2 5　P =0 .0     

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.