肥胖儿童胰岛素抵抗与血管内皮功能损伤关系的研究

目的判断肥胖儿童胰岛素抵抗与血管内皮功能损伤的关系。方法肥胖176例、超重58例、正常45例三组儿童,B超检测颈动脉内中膜层厚度（TMT）和舒张功能;化验生化指标和血管慢性炎症指标,计算胰岛素抵抗指数和敏感指数。结果三组间比较,动脉粥样硬化危险因素、部分慢性炎症指标、TMT（F=3．209,P=0．046）、颈动脉血管弹性（F=6．576,P=0．002）有显著性差别。胰岛素敏感指数与动脉粥样硬化危险因素、IMT（R=-0．201,P=0．010）、可溶性细胞间黏附分子1（R=-0．197,P=0．010）、脂联素（R=0．419,P=0．000）密切相关;随着胰岛素敏感指数的降低,动脉粥样硬化的危险冈素和血管损伤逐渐增加。多元回归分析IMT与腹型肥胖程度、平均血压,胰岛素抵抗指数、高密度脂蛋白胆固醇有关。结论肥胖儿童早期动脉粥样硬化已经启动,预防成人心脑血管疾病应该从预防儿童肥胖做起。     

Noninvasive assessment of endothelial function in hemodialyzed hypertensive patients by laser Doppler flowmetry

BACKGROUND: End stage renal disease and hypertension are associated with higher cardiovascular mortality. Endothelial dysfunction plays an important role in the pathogenesis of cardiovascular diseases. The authors investigated the endothelium-dependent and -independent vasodilation in the forearm skin microcirculation and the plasma markers of endothelial damage in hypertensive hemodialysed patients and in normotensive control subjects. METHODS: Laser Doppler flowmetry with iontophoresis of acetylcholine and sodium nitroprusside and the postocclusive reactive hyperemia test was performed in 22 normal control subjects and in 21 hemodialysed patients with hypertension. Levels of endothelin-1, big-endothelin, and von Willebrand Factor were measured, as well. RESULTS: The average hyperemic response to the two doses of acetylcholine iontophoresis was 474 +/- 83%; 836 +/- 97% in the control subjects, and 160 +/- 26%; 360 +/- 67% in the hemodialysed patients group (p < 0.05). The vasodilation after the two doses of sodium nitroprusside was 381 +/- 60%, 782 +/- 81% in the control group and 186 +/- 42%; 379 +/- 63% in the dialysed patients group (p < 0.05 compared to control, respectively). The average peak flow during the postocclusive reactive hyperemia test was significantly lower in hemodialysed hypertensives (234 +/- 48%) compared to healthy control subjects (434 +/- 36%, p < 0.05). Levels of endothelin-1, big endothelin, von Willebrand Factor and von Willebrand Factor activity were significantly higher in the patient group compared to the control subjects. CONCLUSIONS: In hemodialysed hypertensive patients, both endothelium-dependent and -independent vasodilation are impaired. Markers of endothelial damage are elevated referring the progression of vascular disease.     

高血压患者内皮微颗粒水平对肱动脉内皮功能的影响

目的 运用彩超评价高血压内皮微颗粒(EMPs)水平对肱动脉内皮功能的影响.方法 采用流式细胞术检测高血压患者30例和健康志愿者30例血浆中EMPs的水平,比较两组对肱动脉内皮功能的影响.结果 2组在年龄、性别、体重指数、总胆固醇、甘油三酯、空腹血糖、吸烟等指标上差异均无统计学意义(P＞0.05).与健康志愿者组相比,高血压患者循环EMPs水平显著升高(P＜0.01);高血压组患者肱动脉内皮舒张功能(FMD)减低(P＜0.01),循环EMPs水平与FMD值呈负相关(r=-0.142,P＜0.01).结论 提示高血压病患者体内较高水平的循环EMPs是肱动脉内皮舒张功能减低的影响因素,彩色多普勒可作为诊断及观察疗效的一项重要手段.     

心肌速度梯度技术评价先天性甲状腺功能减低症患儿左心室心肌局部舒张功能的价值

目的探讨心肌速度梯度技术在评价先天性甲状腺功能低下症(CH)患儿左心室舒张功能方面的应用价值。方法应用QTV I技术分析35例甲状腺功能低下症患儿(CH组)及30例正常婴幼儿(对照组)左心室心肌各节段长轴和短轴方向上的速度曲线,测量舒张早期及晚期峰值速度(Ve、Va),并计算长轴和短轴方向上舒张早期及晚期心肌速度梯度MVG1、MVG2和MVG3等参数。结果 CH组患儿左心室后间隔、后壁、前间隔各节段MVG1、MVG2及MV G3较对照组婴幼儿减低明显,差异有统计学意义(P<0.05);CH组患儿左室侧壁、下壁及前壁各节段MVG1、MV G2、MV G3与对照组婴幼儿比较差异无统计学意义(P>0.05)。结论 CH患儿左心室长轴及短轴方向局部心肌舒张功能在一定程度上存在降低,为临床早期干预的依据。     

The assessment of nutritional status in children

McLaren and Read's widely used nomogram and chart devised for rapid computation of nutritional status in children has been critically evaluated. The nutritional assessment assigned by nomogram and chart was compared to that assigned by direct calculation from standard growth charts. We noted considerable discrepancy between the two methods. When a child's height was above the 50th percentile, the nomogram and chart always underestimated the severity of malnutrition, while severity of malnutrition was overestimated by nomogram and chart when height was below the 50th percentile. Further analysis of both the nomogram and chart revealed they were based on ideal weight for height at the 50th percentile, corrected for age. Thus, the nomogram and chart erroneously assess nutritional status if height is divergent from the 50th percentile. The ideal weight to height ratio (gm/cm) is not only affected by age, but also affected by percentile ranking; the ratio rises with increasing percentile ranking. This variable of percentile ranking for height is not accounted for adequately by either the nomogram or chart. Therefore, we cannot recommend either the nomogram or chart for rapid computation of ideal weight or nutritional status.     

Pre-school assessment of gifted children

The following paper is an analysis of 27 consecutive referrals of children, thirteen boys and fourteen girls, in one health district, for assessment on the grounds of possible giftedness, with a view to early placement in a state-maintained school or nursery school. The assessments were made using the Ruth Griffiths scales of mental development.     

Vestibular function tests in children

Vestibular function tests were performed on a series of 57 children between the ages of 1 and 16 years. Inattention and immaturity of eye movement control created difficulties in the analysis of the electronystagmography traces in some instances. With the eyes closed, spontaneous and positional nystagmus occurred in 20% of asymptomatic children and this was thought to be physiological. Changes in external ear pressure (fistula test) enhanced this spontaneous nystagmus. Smooth pursuit ataxia and optokinetic abnormalities were common in the children with reading disabilities and those with congenital deafness, and were thought to be soft neurological signs of brainstem dysfunction. The torsion swing chair test was acceptable and gave easily readable responses. Caloric abnormalities were very common in children with reading disabilities and provided useful information in those with congenital and acquired disorders of hearing and balance. It was concluded that normal data were required for children of all ages in order to improve our understanding of electronystagmography in children.     

Assessment of inflammatory markers and endothelial function

PURPOSE OF REVIEW: To describe the background and assessment of inflammatory markers and endothelial function in atherosclerosis. RECENT FINDINGS: Recent observations have related several inflammation markers, including cytokines and chemokines, soluble adhesion molecules, and acute-phase reactants, to the pathophysiology of atherosclerosis. Chronic inflammatory states such as rheumatoid arthritis and systemic lupus erythematosus have been identified as independent risk factors for early atherosclerosis. The role of endothelial function in atherosclerosis has been elucidated by clinical studies that have demonstrated that the status of vascular endothelium may modify the effects of risk factors on the development of atherosclerosis. These observations support the response-to-injury theory of atherosclerosis that emphasizes the role of endothelium in atherosclerosis. SUMMARY: Inflammation and endothelial function play significant roles in the pathogenesis of atherosclerosis. Elevations in certain inflammatory mediators as well as evidence of endothelial dysfunction are related to increased risk of future cardiovascular morbidity. The value of measuring inflammatory markers and endothelial function in clinical practice remains to be defined.     

Instrumental methods for evaluation of endothelial function

Endothelial dysfunction is a systemic disorder with a key role in the pathogenesis of atherosclerosis and its complications. Current evidence suggests that endothelial status is not determined solely by the individual risk factor burden but is rather regarded as an integrated index of all atherogenic and atheroprotective factors present in an individual, including known as well as yet-unknown variables and genetic predisposition. Endothelial dysfunction reflects a vascular phenotype prone to atherogenesis and may therefore serve as a marker of the inherent atherosclerotic risk in an individual. Recent advances in the understanding of pathophysiology of early atherosclerosis have opened up new opportunities for development of methods for assessment of the earliest changes in the vessel wall. During the last decade some noninvasive techniques have been introduced in clinical practice among which the ultrasound assessment of flow-mediated vasodilation of the brachial artery is the most widely used. These stimuli induce the endothelium to release nitric oxide which causes vasodilation that can be visualized and measured as an index of the vasomotor activity. This technique is attractive because it is non-invasive, accessible and reproducible in everyday clinical practice.     

16排螺旋CT在先天性心脏病患儿诊断及心功能评估中的临床应用

目的探讨16排螺旋CT在先天性心脏病(CHD)患儿诊断及心功能评估中的临床应用。方法选择2015年6月-2019年6月该院与丽水市中心医院心脏内科收治入院的73例CHD患儿作为研究对象。所有患儿均先进行超声心动图检查再进行16排螺旋CT检查,以病理手术结果作为金标准,比较两种方法对儿童CHD类型诊断价值以及对左右心室功能的评估价值。结果儿童CHD类型诊断中,超声心动图正确率为80.82%,16排螺旋CT正确率为95.89%;16排螺旋CT诊断正确率高于超声心动图(P<0.05);超声心动图对儿童CHD类型诊断的AUC为0.890,16排螺旋CT对儿童CHD类型诊断的AUC为0.966;两种方法测量的左心及右心参数与病理手术结果差异无统计学意义(P>0.05)。结论16排螺旋CT具有图像清晰、成像快、数据处理准确等特点,较超声心动图而言,对儿童CHD类型及心功能评估的临床价值更高,可为临床提供准确数据。