亚高原地区新生儿铁缺乏症研究（附70例）

营养性缺铁性贫血是６个月－３个小儿常见病、多发病,严重威胁着小儿生长、发育和健康,但对新生儿铁营养问题,鲜见报道。本文主西宁地区７０例出生３天之内部生儿进行了血红蛋白（Ｈｂ）、红细胞内游离原卟啉（ＦＥＰ）和ＦＥＰ／Ｈｂ值进行了检测,探索亚高原西宁地区及其郊区（海拔２２６１－２５６０米）,大气压７７．４５－７４．３８ｋＰａ）＾１新生儿缺铁状况及有关因素,结果平均Ｈｂ值２００．５２±２７．４ｇ／Ｌ;Ｆ     

新生儿缺氧缺血性脑病血NSE与ET变化及其与高压氧治疗相关性的研究

目的探讨新生儿缺氧缺血性脑病血清神经元特异性烯醇酶（ＮＳＥ）与血浆内皮素（ＥＴ）变化及高压氧治疗的作用。方法高压氧治疗以纯氧加压,压力０．０５～０．０７ ＭＰ加压 ２０ ｍｉｎ．稳压 ２０ ｍｉｎ,减压 ２０ ｍｉｎ,共历时 １ｈ,每天一次,疗程５～１０ ｄ。ＮＳＥ活性测定采用酶联免疫分析法;ＥＴ活性测定采用放射免疫分析法。结果中度ＨＩＥ患儿血清ＮＳＥ与血浆ＥＴ浓度分别为（１４．７２±４ ２６）μｇ／Ｌ（７６．１±１９．２）ｎｇ／Ｌ;重度ＨＩＥ患儿血清ＮＳＥ与血浆ＥＴ浓度分别为（１５．６４±５．８２）μｇ／Ｌ,（８２．５±２１．６）ｎｇ／Ｌ;中、重度ＨＩＥ患儿血清ＮＳＥ与血浆ＥＴ浓度显著高于对照组（分别为１２．４７± ３．４９ μｇ／Ｌ, ５６．３２± １６．７ｎｇ／Ｌ）。轻度 ＨＩＥ患儿血清 ＮＳＥ（ １３．５８± ４．５７） μｇ／Ｌ,血浆ＥＴ（６２．４± １８．５） ｎｇ／Ｌ与对照组比较无显著差异。中、重度 ＨＩＥ患儿高压氧治疗后,血清 ＮＳＥ,血浆 ＥＴ降低幅度分别为（ １．９２± ０．４６）μｇ／Ｌ,（ １２．７２± ４． ３７）ｎｇ／Ｌ,明显大于常规治疗组（ Ｐ＜ ０．０５）。结论血清 ＮＳＥ和血浆 ＥＴ是ＨＩＥ早期诊断与疗效判     

肺炎患儿血一氧化氮,肿瘤坏死因子检测及其临床意义

为阐明支原体肺炎和腺病毒肺炎时一氧化氮和肿瘤坏死因子的变化,采用比色法、双抗体夹心ＥＬＩＳＡ法对３２例支原体肺炎患儿、１９例腺病毒肺炎患儿和２０例健康儿进行血清ＮＯ、ＴＮＦ测定。结果：支原体肺炎患儿血清ＮＯ、ＴＮＦ为４７．７±１４．４μｍｏｌ／Ｌ、３７．１±９．８μｇ／Ｌ,和腺病毒肺炎患儿为６８．２±１３．９μｍｏｌ／Ｌ、５４．７±１０．１μｇ／Ｌ,均较对照组明显升高,（Ｐ〈０．０１）;而且ＮＯ、     

生长激素神经分泌功能不全患儿夜12小时生长激素分泌相和治疗的…

对生长激素神经分泌功能不全（ＧＨＮＤ）患儿进夜间连续１２小时生长激素（ＧＨ）测定，并与生长激素缺乏症（ＧＨＤ）和正常儿童比较，观察三组儿童ＧＨ均值，峰数和峰值。结果表明：三组ＣＨ平均浓度分别为２．９±１．１，２．５±１．６和５．７±２．０μｇ／Ｌ；峰数分别为１．４±０．５，１．０±１．５和３．３±１．６；最高峰值分别为１６．５±１２．４，１４．３±１６．５和３６．４±１３．７μｇ／Ｌ。ＧＨＮＤ和Ｇ     

氯高铁血红素抗贫血疗效及追踪调查报告

本文报告用氯高铁血红素每天３００ｍｇ／ｋｇ、１５０ｍｇ／ｋｇ、５０ｍｇ／ｋｇ治疗失血性小鼠。治疗后Ｈｂ明显高于阴性对照组；大、中剂量组疗效优于葡萄糖酸亚铁组。对１２０例缺铁性贫血小儿予氯高铁血红素口服液治疗（１－２ｍｇ／ｋｇ·ｄ），治疗后Ｈｂ明显升高，ＦＥＰ明显下降；治愈率达８７．５％，总有效率１００％；治疗结束后３月，６月及１年追踪随访示有８７．５％、７５％、６０％小儿Ｈｂ≥１１０ｇ／Ｌ。提示：     

儿童胰岛素依赖型糖尿病几项凝血指标的研究

用放射免疫法测定２４例ＩＤＤＭ患者血浆６－酮－前列腺素Ｆ１α及血栓素Ｂ２含量，用ＢｅｃｋｍａｎＩＣＳⅡ型手动速率散射比浊法检测血浆纤维结合蛋白含量，并于正常对照组进行比较，其结果为正常对照组６－酮－前列腺素Ｆ１α、血栓素Ｂ２、纤维结合蛋白值分别为２４．９６±４．０９ｐｇ／ｍｌ、８８．４７±９．０５ｐｇ／ｍｌ、０．３０５±０．０４２ｇ／Ｌ；ＬＤＤＭ组上述各项指标分别为２６．８４±１．５８ｐｇ／ｍｌ、１９１±２．８５ｐｇ／ｍｌ、０．２６±０．１１ｇ／Ｌ。本文结果表明ＩＤＤＭ组血浆血栓素Ｂ２（ＴＸＢ２）值明显高于对照组（Ｐ＜０．０１）、Ｆｎ值低于对照组，但无显著性差异（Ｐ＞０．０５），ＴＸＢ２升高与血糖、血脂有正相关倾向，提示儿童ＩＤＤＭ存在发生慢性血管并发症的危险因素。     

氯高铁血红素抗贫血疗效及追踪调查报告

本文报告用氯高铁血红素每天３００ｍｇ／ｋｇ、１５０ｍｇ／ｋｇ、５０ｍｇ／ｋｇ治疗失血性小鼠。治疗后Ｈｂ明显高于阴性对照组；大、中剂量组疗效优于葡萄糖酸亚铁组。对１２０例缺铁性贫血小儿予氯高铁血红素。服液治疗（１—２ｍｇ／ｋｇ·ｄ），治疗后Ｈｂ明显升高，ＦＥＰ明显下降；治愈率达８７．５％，总有效率１００％；治疗结束后３月，６月及１年追踪随访示有８７．５％、７５％、６０％小儿Ｈｂ≥１１０ｇ／Ｌ。提示：氯高铁血红素治疗缺铁性贫血具有良好的疗效。     

美降脂对大鼠实验性肾小球损伤的保护作用

目的　探讨美降脂防治肾小球损伤的作用。方法　１６ 只雄性Ｗｉｓｔａｒ 大鼠阿霉素诱导肾病综合征模型后给予高脂饲料喂养,并随机分为对照组和治疗组。治疗组每日予美降脂４ ｍｇ／ｋｇ。２ 周测１ 次２４ ｈ 尿蛋白,４ 周测１ 次血脂,１２ 周肾组织光镜检查。结果　对照组肾脏病理积分及含有泡沫细胞肾小球百分率分别为１．８１±０．１１％ 和４３ ．２１ ±４ ．８９ ％ ,而治疗组分别为０．９１±０．１７％ 和２１．０９±３．３１％ ,治疗组明显低于对照组（Ｐ＜ ０．０１） 。１０ 周后治疗组２４ ｈ 尿蛋白为２０８．９ ±６０．４ ｇ／Ｌ,１２ 周为１６０．５ ±４８．６ ｇ／Ｌ,明显低于对照组（２７６ ．１±５７ ．３ ｇ／Ｌ;２６２．４±７２．７ ｇ／Ｌ）（Ｐ＜ ０．０５ 和０ ．０１） 。结论　美降脂能明显降低血脂,减轻高脂血症造成的肾小球损伤和减少尿蛋白的排泄量。     

速力菲治疗缺铁性贫血红细胞多项参数的变化

为了解红细胞参数：Ｈｂ、平均红细胞容积（ＭＣＶ）、红细胞容积分布宽度（ＲＤＷ）在速力菲治疗缺铁性贫血（ＩＤＡ）的动态变化，前瞻性观察３６例病儿，现报告如下。对象和方法一、对象　ＩＤＡ病儿３６例，男２３例，女１３例，年龄４ｍｏ～６ａ，均符合小儿ＩＤＡ诊断标准［１］。Ｈｂ６８～８０ｇ／Ｌ４例，～９０ｇ／Ｌ８例，～１００ｇ／Ｌ２４例。Ｈｂ、ＭＣＶ、ＲＤＷ正常参考值为Ｈｂ１１０ｇ／Ｌ、ＭＣＶ８２ｆｌ、ＲＤＷ１４．６％。二、治疗方法　速力菲薄膜衣片为南京第三制药厂生产，生产批号：苏卫药准字（１９９４）第３…     

新生儿血铅水平与环境因素的相关性研究

目的 了解本地新生儿因铅水平现状及其相关的影响因素。方法 采用石墨炉原子吸收光谱法。于１９９８年３～６月，对在我院产科出生的１０３例新生儿进行耳垂微量血血铅含量的测定，并对小儿出生情况及产妇、家庭环境等相关因素进行问卷调查。结果 （１）在１０３例新生儿中，血铅最高值１９７μｇ／Ｌ，最你值２７μｇ／Ｌ，几何均值为７１μｇ／Ｌ，≥１００μｇ／Ｌ者２５例，占２４．３％；（２）早产伴低体重（６例）及窒息史     

同剂量静脉用丙种球蛋白不同方法治疗ABO溶血病的临床观察

为探讨同剂量静脉用丙种球蛋白 (IVIG)不同方法治疗ABO溶血病的疗效。1 7例病人分 2 5gIVIG用 1天组 7例和 1 2 5gIVIG用 2天组 1 0例 ,两组均保持原有的综合治疗。结果显示 ,治疗第二天 ,2 5g组血总胆红素下降 75 2± 1 9 7μmol L ,1 2 5g组下降 2 5 5± 1 1 7μmol L ,P <0 0 0 1。治疗第四天及第七天分别下降 1 2 2 1± 7 4μmol L、81 8± 0 4μmol L及 45 5± 49μmol L、1 1 8 6± 2 1 μmol L(P <0 0 0 1和P <0 0 5)。因此 ,2 5g组 (即IVIG 70 0mg～ 1 0 0 0mg kg)只用 1次疗效优于同剂量分次应用     

Hyperbilirubinemia in healthy neonates with glucose-6-phosphate dehydrogenase deficiency

A cohort study was carried out to assess the association between glucose-6-phosphate dehydrogenase (G6PD) deficiency, diagnosed by quantitative enzyme assay, and neonatal hyperbilirubinemia, defined as serum total bilirubin >/=15 mg/dl, in the well-baby nursery of Chang Gung Children's Hospital. Among 42,110 inborn infants, 757 male (3.54%) and 326 female (1.57%) newborns were G6PD-deficient. Compared to the occurrence of hyperbilirubinemia in G6PD-normal newborns (1.41% in male, 1.44% in female) in the well-baby nursery, a significantly higher incidence was observed in both G6PD-deficient male (11.36%) and female (7.06%) newborns. Further analyses demonstrated that the enzyme activity of G6PD in G6PD-deficient male newborns with hyperbilirubinemia (1.56+/-1.37 U/g Hb) were significantly lower than the subjects without hyperbilirubinemia (2.01+/-1.7 U/g Hb). No significant difference was observed in G6PD-deficient female newborns with hyperbilirubinemia (6.91+/-2.76 U/g Hb) compared to those without hyperbilirubinemia (7.81+/-2.84 U/g Hb). These data suggest that the G6PD-deficient neonates are at increased risk for hyperbilirubinemia even in the nursery free from agents that can potentially cause hemolysis to G6PD-deficient red cells. The lower G6PD enzyme activity was associated with the neonatal hyperbilirubinemia in G6PD-deficient male neonates.     

选择性头部亚低温对新生儿缺氧缺血性脑损伤的治疗作用

目的 探讨选择性头部亚低温对足月新生儿窒息后缺氧缺血性脑损伤（ＨＩＢＤ）的神经保护作用及其安全性。方法 将２２例重度窒息足月新生儿随机分为治疗组（１１例）和对照组（１１例）。治疗组采用选择性头部降温方法,维持鼻咽温度为（３４．０±０．２）℃,持续７２ ｈ;对照组不进行降温治疗。两组均于治疗后６４～７２ ｈ测脑脊液神经元特异性烯醇化酶（ＮＳＥ）,血ＣＫ－ＭＢ,尿β２微球蛋白（β２－ＭＧ）等。于治疗前、生后１０ ｄ和３个月进行常规１６导ＥＥＧ检测,并采用新生儿神经行为评分（ＮＢＮＡ）、婴幼儿发育量表（ＣＤＣＣ）进行神经行为发育评价。结果 治疗组脑脊液ＮＳＥ为（１９．５±２．２）μｇ／Ｌ,明显低于对照组[（２４．６±５．３）μｇ／Ｌ］（Ｐ ＜ ０．０１）;生后２８ ｄ治疗组ＮＢＮＡ评分为（３６±３）分,低于对照组[（３２±２）分］（Ｐ＜０．０１）。治疗前两组ＥＥＧ均异常,生后１０ｄ,３个月治疗组ＥＥＧ均正常,对照组２例持续重度异常。两组患儿血ＣＫ－ＭＢ及尿β２－ＭＧ差异无显著性（Ｐ＞０．０５）。结论 选择性头部亚低温对足月新生儿窒息后ＨＩＢＤ可能具有神经保护作用,临床上具有安全性。     

THE DIAGNOSIS OF IRON DEFICIENCY BY ERYTHROCYTE PROTOPORPHYRIN AND SERUM FERRITIN ANALYSES

ABSTRACT. Free erythrocyte protoporphyrin (FEP) and serum ferritin have been determined in 57 healthy children and in 25 children with varying degrees of iron deficiency. FEP was found to be inversely correlated to the concentration of hemoglobin (r=-0.80) as well as to serum ferritin (r=-0.64). Elevated FEP was found in children with hemoglobin less than 12.5 g/dl, or serum ferritin less than 8 μg/l. In a group of apparently hematologically normal children between the age of 10–14 years (hemoglobin≥ 12.5 g/dl), a 2-month-trial of iron medication resulted in an increase in hemoglobin and ferritin, and a decrease in FEP, indicating suboptimal supply of iron for hemoglobin synthesis before iron medication. In a patient with iron deficiency (FEP 15.3 μmole/l, hemoglobin 5.2 g/dl), iron therapy was followed by a rapid fall in FEP before any changes in hemoglobin, serum iron transferrin saturation and ferritin could be detected. The rapid fall in FEP during start of treatment in iron deficiency makes FEP a sensitive biochemical parameter on iron homeostasis in iron deficiency anemia.     

血常规指标对儿童铁缺乏的预测作用

目的探讨血常规指标在筛查儿童铁缺乏中的预测价值。方法回顾性分析2017年6月至2019年5月浙江大学医学院附属儿童医院1443名6月龄~18岁健康体检儿童(男862名、女581名)的血常规指标及血清铁蛋白(SF)水平。以SF<20μg/L为铁缺乏判断依据,同时伴有贫血(6月龄~5岁血红蛋白<110 g/L,6~18岁血红蛋白<120 g/L)为缺铁性贫血(IDA)组:SF<20μg/L同时排除贫血为无贫血铁缺乏组,SF≥20μg/L合并贫血者为铁状态不明贫血组,SF≥20μg/L无贫血者为健康对照组。定量资料以±s或M(四分位间距)描述,组间比较应用方差分析或非参数秩和检验分析,并应用受试者工作特征曲线(ROC)分析血常规指标及低血红蛋白密度百分比(LHD)对IDA及铁缺乏的预测价值。结果1443名儿童年龄2.1(3.3)岁,健康对照组1061例,无贫血铁缺乏组292例,铁状态不明贫血组43例,IDA组47例。铁缺乏发生率高于贫血发生率[23.5%(339/1443)比6.2%(90/1443),χ2=169.76,P<0.01]。无贫血铁缺乏组LHD、红细胞分布宽度(RDW)均高于健康对照组[0.088(0.093)比0.073(0.068),0.131±0.013比0.126±0.008,P均<0.01],平均红细胞体积(MCV)、平均血红蛋白浓度(MCHC)均低于健康对照组[(80±4)比(83±4)fl,(326±9)比(329±8)g/L,P均<0.01];IDA组LHD[0.322(0.544)]、RDW(0.151±0.018)均高于无贫血铁缺乏组,MCV[(73±6)fl]、MCHC[(309±14)g/L]均低于无贫血铁缺乏组(P均<0.01)。MCHC、LHD、RDW、MCV预测铁缺乏的曲线下面积(AUC)分别为0.63(95%CI:0.60~0.67)、0.63(95%CI:0.60~0.67)、0.67(95%CI:0.63~0.70)和0.73(95%CI:0.69~0.76)。以MCV<80.2 fl、RDW>0.131或MCHC<322 g/L为界值,筛查铁缺乏的灵敏度分别为0.540、0.469和0.336,均高于血红蛋白筛查铁缺乏的灵敏度(0.139,χ2=121.70、87.47、35.56,P均<0.01)。结论血常规中MCV、RDW、MCHC均可作为铁缺乏的筛查指标,简便易于基层推广。     

rhG-CSF在小儿ANLL强烈化疗中的应用

为探讨rhG-CSF对小儿ANLL强烈化疗后粒细胞缺乏的疗效，采用AAE方案（ADM、Ara-C、VP(16)或VM(26)），化疗后当WBC＜1×109/L或ANC＜0．5×109/L时，给予rhG-CSF200μg/m2·d（5～10μg/kg·d），皮下注射，一般连续5～10天。本文15例ANLL，用rhG-CSF30例次。用rhG-CSF前，WBC平均0．78×109/L、ANC0．15×109/L。用rhG-CSF后，平均6．5天WBC升至＞3×109/L、ANC升至＞1×109/L。粒细胞恢复时间与对照组相比明显缩短（P＜0．01）。骨髓复查未见原始细胞增多或复发。rhG-CSF有促进强烈化疗所致骨髓抑制和粒细胞缺乏的恢复，但未见骨髓原始细胞增多和白血病复发。     

Dose–Effect Relationship of Alkylating Agents on Testicular Function in Male Survivors of Childhood Lymphoma

The purpose of our study was to assess the gonadal function in male survivors of childhood lymphoma. We studied 171 male survivors of childhood lymphoma (83 with B-cell non-Hodgkin lymphoma [B-NHL], 32 with T-cell non-Hodgkin lymphoma [T-NHL], 50 with Hodgkin lymphoma [HL], and 6 with anaplastic large-cell lymphoma [ALCL]), measuring follicle-stimulating hormone [FSH] and luteinizing hormone [LH] levels at a median age of 21.1 (17–30.4) years after a median delay of 9.3 (2–22.4) years from treatment. FSH levels were above normal range (≥10 IU/L) in 42.1% and LH levels ≥8 IU/L in only 8.9% of survivors. In multivariate analysis, only the following chemotherapeutic agents were associated with higher FSH or LH levels: cyclophosphamide (P < .0001, .04), lomustine (CCNU; P = .002, 0.04), and procarbazine (P < .0001, .07). No significant correlation was found between FSH or LH levels and age or pubertal status at diagnosis. Mean FSH level was significantly lower in NHL survivors treated more recently: 6 ± 5.1 IU/L in B-NHL survivors treated since 1986 versus 12.3 ± 5.4 IU/L for those treated before 1981 (P = .0001), and 6.8 ± 9.6 IU/L in T-NHL survivors treated since 1989 versus 9.4 ± 5.7 IU/L for those treated before 1989 (P = .035). In HL, mean FSH level was 12.4 ± 9.9 IU/L following procarbazine containing chemotherapy versus 3.4 ± 1.9 IU/L in the absence of procarbazine and increased significantly with the number of MOPP/OPPA (mechlorethamine, Oncovin [vincristine], procarbazine, and prednisone/Oncovin, procarbazine, and prednisone, and Adriamycin [doxorubicin]) courses received, from 6.8 ± 5.7 IU/L for 1–2 MOPP/OPPA to 12.6 ± 7.5 for 3–4 MOPP/OPPA and 19.6 ± 13.3 for more than 4 MOPP/OPPA (P for trend = .006). Testicular toxicity of alkylating agents on childhood lymphoma survivors is dose dependent and not correlated to diagnosis, age, or pubertal status at diagnosis.