热性惊厥儿童白细胞介素-1受体拮抗剂基因多态性分析

目的分析白细胞介素-1受体拮抗剂基因(IL-1RN)与儿童热性惊厥(FS)遗传易感性的关系。方法采用病例-对照研究方法收集52例FS病例组和53例对照组外周血样本和流行病学调查资料,提取基因组DNA,采用聚合酶链反应(PCR)方法直接检测IL-1RN基因多态性。结果采自广东省汉族儿童的105例样本中仅发现3种IL-1RN基因型,分别是Ⅰ/Ⅰ、Ⅰ/Ⅱ、Ⅱ/Ⅳ,各基因型在病例与对照组分布无显著性差异。等位基因Ⅰ、Ⅱ和Ⅳ在病例组分布频率分别是95.2%、3.8%、1.0%,在对照组中的分布频率分别是84.9%、10.4%、4.7%,IL-1RN等位基因Ⅰ的频率明显高于对照组(P<0.05)。结论IL-1RN等位基因Ⅰ可能与儿童FS易感性有关。     

Gamma-Aminobutyric Acid Concentration in Lumbar Cerebrospinal Fluid from Patients with Febrile Convulsions and Controls

ABSTRACT. The cerebrospinal fluid (CSF) concentration of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) was analysed in 41 children with febrile convulsions (FC), 41 febrile controls of similar age (control group 1), and 59 controls, who had no fever and/or were outside the age range for FC (control group 2). A significant correlation between CSF-GABA and age was demonstrated for controls (1 + 2) (r= 0.63, p < 0.00001), as well as for patients with FC (r= 0.42, p= 0.003). Patients with FC did not differ significantly from control group 1 in respect to CSF-GABA. Duration of FC was related to both CSF-GABA and age (GABA: r=−0.29, p < 0.05; age: r =−0.32, p < 0.05). For 56 controls (1 + 2) > 1 year of age, a significant negative correlation between CFC-GABA and body temperature was found (r=−0.34, p = 0.01). The low CSF-GABA in the FC-labile age group, the negative correlation of CSF-GABA to body temperature, and the negative correlation of the duration of FC to both CSF-GABA and age, all indicate that GABA could be of importance in the pathophysiology of FC.     

Pre- and Perinatal Factors in Febrile Convulsions

Forsgren, L., Sidenvall, R., Blomquist, H. K:son, Heijbel, J. and Nyström, L. (Departments of Neurology, Paediatrics and Epidemiology and Health Care Research, University Hospital, Umeå, Sweden). Acta Paediatr Scand 80: 218, 1991.
In a community based study, 110 children with febrile convulsions (FC) were identified prospectively. Pre- and perinatal risk factors were compared with 213 age and sex matched controls sampled from the community. During pregnancy, proteinuria and preeclampsia/eclampsia Occurred more often in mothers of cases. Premature birth and bilirubinemia ≥ 200 μmol/l were also more common in cases. There were no differences between cases and controls in Occurrence of chronic illnesses in mothers, parents age at birth, birth order, and factors occurring during delivery such as type of anesthesia, Occurrence of acute or elective cesarean section, use of vacuum extraction, mode of presentation, signs of fetal distress in amnion fluid, umbilical problems, abnormalities of fetal heart rate or duration of delivery. Perinatal asphyxia was uncommon and there was no difference between cases and referents. Occurrence of complications during the first neonatal week did not differ between groups.     

Prophylactic Treatment with Valproic Acid or Diazepam in Children with Febrile Convulsions

ABSTRACT. The purpose of this study was to limit prophylactic treatment of children with febrile convulsions to patients who have the highest risk of recurrence. Two hundred and thirty-one children with a first febrile seizure were divided into high- and low-risk groups according to estimated risk of recurrence. All high-risk children were offered treatment with valproic acid. If this was declined they were offered treatment with diazepam instead. Low-risk children were untreated. Valproic acid and diazepam were found to be equally effective in reducing the risk of recurrence of febrile convulsions. By selecting for prophylactic treatment according to estimated risk of recurrence it is possible to reduce the rate of recurrence of febrile seizures in children at high-risk (60%) to the same level as that of untreated low-risk children (23%). Only about half of all children with febrile convulsions need treatment and follow-up according to these criteria.     

地塞米松对热性惊厥患儿外周血单个核细胞细胞间黏附分子-1及淋巴细胞功能相关抗原-1的干预作用

目的 探讨地塞米松(DXM)对热性惊厥(FS)患儿外周血单个核细胞(PBMC)细胞间黏附分子-1(ICAM-1)及配体淋巴细胞功能相关抗原-1( LFA-1)表达和分泌的影响.方法 FS组患儿16例分为FS对照组和DXM干预组,DXM干预组采用1.0μmol·L-1的DXM进行干预;健康对照组16例,为年龄和性别与FS组患儿相匹配的同期体检健康儿童.常规方法进行FS组和健康对照组的PBMC培养.采用流式细胞仪检测PBMC表面ICAM-1、LFA-1表达水平;采用ELISA法检测培养上清中ICAM-1、LFA-1水平.结果 FS对照组在体外培养的PBMC表面ICAM-1、LFA -1表达水平分别为(19.78±8.93)％和(43.05±15.85)％,明显高于健康对照组[(13.88±6.73)％,(30.43±16.25)％] (Pa＜0.05);DXM干预组的PBMC表面ICAM-1、LFA-1表达水平分别为(17.14±7.98)％和(33.93±19.76)％,与FS对照组比较有下调趋势,但差异无统计学意义(Pa＞0.05).FS对照组PBMC的ICAM-1、LFA-1分泌水平分别为(6.73±3.88)％和(4.84±2.95)％,明显高于健康对照组[(4.24±2.42)％,(2.76±1.36)％](Pa＜0.05);DXM干预组PBMC的ICAM-1、LFA-1分泌水平[(4.34±1.82)％,(3.06±2.81)％]明显低于FS对照组(Pa＜0.05).结论 糖皮质激素DXM干预后ICAM-1、LFA-1的表达被抑制,抑制FS患儿ICAM-1、LFA-1的高表达可作为其治疗的新靶点.     

支气管哮喘患儿外周血辅助性T淋巴细胞17、白细胞介素-17、白细胞介素-21水平变化

目的 检测辅助性T淋巴细胞17(Th17)及细胞因子IL-17、IL-21在支气管哮喘(哮喘)患儿外周血中的表达,探讨其在儿童哮喘发病机制中的作用.方法 以哮喘患儿60例(哮喘组)为研究对象,根据病情分为哮喘发作期(发作期组,n=30)、哮喘缓解期(缓解期组,n=30);以健康儿童30例作为健康对照组.分离外周血单个核细胞,采用流式细胞术检测其Th17细胞百分率.采用ELISA法检测各组IL-17、IL-21表达水平.采用SPSS 13.0软件进行统计学分析.结果 哮喘发作期组患儿外周血中Th17及 IL-17 水平明显高于缓解期组和健康对照组(Pa<0.05);哮喘发作期组患儿血清IL-21表达水平明显低于缓解期组和健康对照组(Pa<0.05);哮喘缓解期组与健康对照组外周血Th17、IL-17、IL-21水平比较,差异均无统计学意义(Pa>0.05).结论 Th17、IL-17通过全身系统性炎症反应参与儿童哮喘的发病,IL-21可作为儿童哮喘的控制指标,亦有望为哮喘的治疗提供新的靶点.     

热性惊厥患儿血淋巴细胞亚群变化的临床意义

目的探讨热性惊厥(FS)患儿外周血淋巴细胞亚群的变化及其临床意义。方法应用流式细胞仪对单纯性FS38例(SFS组)、复杂性FS32例(CFS组)、29例急性上呼吸道感染(上感组)和32例健康儿童(健康对照组)血淋巴细胞亚群CD3 、CD4 、CD8 、CD4 /CD8 、CD1 6CD56 、CD19 进行测定,并进行队列对照研究。结果SFS组血CD3 、CD4 、CD8 、CD4 /CD8 值、CD1 6CD56 、CD19 水平分别为(58.62±13.7)%、(24.54±5.39)%、(29.6±11.39)%、(0.91±0.25)、(12.24±6)%、(18.85±8.22)%;CFS组分别为(55.92±13.43)%、(21.16±5.16)%、(34.24±15.7)%、(0.72±0.26)、(11.94±5.87)%、(21.03±7.85)%;上感组分别为(58.23±12.98)%、(26.72±6.09)%、(23.84±10.56)%、(1.47±0.96)、(14.37±7.39)%、(17.97±8.14)%;健康对照组分别为(60.87±9.59)%、(28.07±6.42)%、(23.62±8.83)%、(1.43±0.85)、(11.94±5.87)%、(21.03±7.85)%。与健康对照、上感组比较,FS组存在CD4 降低,CD8 升高、CD4 /CD8 比值降低,均有统计学意义(Pa<0.05,0.01,0.001);CFS组CD4 、CD4 /CD8 比值较SFS组低,CD8 高,均有统计学意义(P<0.05,0.01)。结论FS患儿体液和细胞免疫均被激活;CFS患儿免疫功能紊乱较SFS更严重。     

Hypocalcemia and Hyperphosphatemia in Severely Dehydrated Children with and without Convulsions

ABSTRACT. Tetanic convulsions are not uncommon among severely dehydrated children in the developing countries. This raises the question whether these children have disturbances in the homeostasis of divalent ions. Serum values are reported of calcium, magnesium, phosphorus, sodium and potassium, as well as blood pH in children below 3 years of age with acute watery diarrhoea and with an estimated weight loss of about 10%. The study was performed on dehydrated children with (DC) or without (D) convulsions. Values were obtained on admission and following rehydration therapy (RT). On admission serum calcium was low in both D and DC children. Serum phosphorus was likewise elevated in both D and DC children. Serum magnesium was slightly elevated in the DC but not in the D group. No patient had Hypernatremia. During RT, serum calcium increased significantly and serum phosphorus decreased significantly in D and DC children. Serum calcium showed a significant inverse correlation with serum phosphorus and a significant direct correlation with blood pH. Treatment of DC children with i.v. calcium and i.m. magnesium had no immediate effect on the convulsions. Our conclusion is that severely dehydrated children will develop hypocalcemia. The cause may be a redistribution of calcium into the cells, parallelled by a redistribution of phosphorus from the intra- to the extracellular space.     

激素敏感型肾病综合征患儿血清、外周血单个核细胞白细胞介素-18表达的意义

目的探讨小儿激素敏感型肾病综合征(SSNS)与白细胞介素-18(IL-18)的关系及地塞米松(DEX)对外周血单个核细胞(PBMC)体外培养表达IL-18的抑制作用。方法单纯型SSNS23例。采用ELISA测定患儿治疗前后血清、尿液IL-18水平和PBMC体外培养上清液中IL-18表达。对照组为相应年龄健康儿童15例;另18例年龄相似的呼吸道感染病例作为感染对照组。结果治疗前后血清、尿液IL-18水平有显著性差异(t=15.072,16.149Pa<0.001)。治疗前PBMC在植物血凝素(PHA)刺激下体外培养上清液中IL-18表达明显高于治疗后和正常对照组(t=6.526,5.585Pa<0.001)。培养液中加入DEX后PBMC表达IL-18水平明显低于未加DEX组(t=4.217P<0.001)。血、尿IL-18与24h尿蛋白定量呈显著正相关(r=0.768,0.638P<0.05)。血清IL-18与PBMC体外培养上清液中IL-18水平呈正相关(r=0.574P<0.05)。结论SSNS的发病与IL-18密切相关;PBMC高表达IL-18可能是其血清IL-18增高原因之一。     

白细胞介素-1与原发性肾病综合征的关系

目的探讨白细胞介素-1(IL—1)与原发性肾病综合征(PNS)间的关系。方法采用ELISA法测定PNS患儿急性期和缓解期血清IL-1水平,分析与24 h尿蛋白定量间的关系。结果PNS患儿急性期和缓解期血清IL-1水平比较有显著差异(P<0.01),急性期肾炎型肾病组(NN)血清IL—1高于单纯型肾病组(SN)(P<0.01)。PNS血清IL-1水平与24 h尿蛋白排泄量间呈明显正相关(r=0 758 P<0.01)。结论PNS患儿血清IL-1水平是升高的,IL-1可能在PNS发病中起部分作用。     

癫痫和热性惊厥患儿脑脊液生长抑素的变化

目的探讨癞痫(EP)和热性惊厥(FC)患儿脑脊液(CSF)生长抑素(SS)含量及其与EP和FC发病机制关系。方法采用放射免疫法(RIA)测定EP和FC患儿CSF中SS含量。结果EP组CSF中SS水平(139.59±45.95)ng/L明显高于FC组(89.71±37.51)ng/L和对照组(77.31±37.10)ng/L(P均<0 05);FC组CSF中sS水平(89 71±37 51)ng/L与对照组比较无显著性差异(P>0.05);严重组EP和FC患儿CSF中SS水平与普通组比较均无显著性差异(P均>0.05)。结论SS参与EP发作,可能有致EP发作作用,而与FC的惊厥发作无关。     

精神分裂症患儿利司培酮治疗前后血清瘦素和白细胞介素-1β变化的意义

目的探讨精神分裂症患儿利司培酮治疗前后血清瘦素和白细胞介素-1β(IL-1β)水平的变化及意义。方法观察组31例精神分裂症患儿,利司培酮治疗前和治疗8周后分别测量身高、体质量以计算体质量指数(BMI),用放射免疫法检测其空腹血清瘦素和IL-1β。选取31例健康儿童作为对照组。结果观察组治疗后BMI、血清瘦素水平均明显上升,与治疗前相比差异均有显著性(P均<0.05);观察组血清IL-1β水平在治疗前与对照组相比明显增高,治疗后明显下降,与治疗前相比差异有显著性(P<0.05)。结论首发精神分裂症患儿血清IL-1β水平明显升高,利司培酮治疗后易出现药源性肥胖,低IL-1β水平可能是瘦素抵抗的原因之一。     

肺炎支原体感染并支气管哮喘发作患儿血清白细胞介素-15的表达

目的研究IL-15在肺炎支原体(MP)感染在支气管哮喘发病中的作用。方法收集2003年6月~2005年4月MP感染并支气管哮喘发作患儿、单纯MP下呼吸道感染患儿、非MP下呼吸道感染患儿和正常对照儿童各30例,采用ELISA方法检测各组患儿外周血IL-15水平。结果外周血IL-15水平在MP感染并支气管哮喘发作组[(2.67±0.93)ng/L]明显高于其他各组,外周血IL-15水平在单纯MP下呼吸道感染组[(2.13±0.64)ng/L]和非MP下呼吸道感染组[(2.10±0.83)ng/L]均显著高于正常对照组[(1.02±0.35)ng/L],单纯MP下呼吸道感染组外周血IL-15水平与非MP下呼吸道感染组相比有所升高,但无显著性差异(P>0.05)。结论MP感染后机体外周血IL-15水平升高可能参与支气管哮喘的发病过程。     

肺炎支原体肺炎患儿血清白细胞介素-10、转化生长因子-β1检测的意义

目的探讨肺炎支原体肺炎（MPP）患儿急性期及恢复期外周血IL-10、转化生长因子-β1（TGFβ-1）水平变化的临床意义。方法采用双抗体夹心酶联免疫吸附法（ELISA）测定26例MPP急性期和其中恢复期9例患儿及12例健康儿童血清IL-10、TGFβ-1水平。比较MPP急性期与恢复期IL-10、TGFβ-1的差异。结果MPP急性期及恢复期患儿血清IL-10水平均显著低于对照组（P〈0.01,0.05）,急性期及恢复期MPP患儿血清TGFβ-1均明显高于对照组（Pa〈0.01）。MPP患儿急性期与恢复期IL-10、TGFβ-1无明显差异（Pa〉0.05）。结论IL-10低水平表达与MPP发病可能有关,存在炎症反应失控,同时存在以TGFβ-1高水平表达的抗感染反应占优势。     

氢质子磁共振波谱在热性惊厥中的临床应用

目的应用氢质子磁共振波谱(1H-MRS)检测热性惊厥(FS)患儿脑组织生化代谢物,了解FS发作后脑损伤情况,探讨1H-MRS在FS中应用的意义。方法对25例FS患儿和6例神经系统正常儿童进行常规头颅MRI和颞叶海马区的1H-MRS检查。25例FS患儿中,15例为单纯性热性惊厥(SFS),10例为复杂性热性惊厥(CFS)。检测指标为N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、谷氨酸-谷氨酰胺复合物(Glx)和乳酸(Lac)的信号强度,计算并比较NAA/(Cho Cr)和Lac/Cr的比值。结果头颅MRI检查结果为FS组及对照组均未显示异常。1H-MRS检测结果为NAA/(Cho Cr)比值,SFS组为0.71±0.05,CFS组为0.65±0.04,对照组为0.73±0.05,CFS组明显低于SFS组及对照组(Pa<0.01),但后二者之间无明显差异(P>0.05)。Lac/Cr比值SFS组(0.32±0.21)和CFS组(0.63±0.30)高于对照组(0.05±0.04)(Pa<0.05),且CFS组高于SFS组(P<0.01)。结论1H-MRS作为一项无创检查,能更敏感地发现FS患儿的早期脑损伤,为FS尤其是CFS患儿的治疗、评估预后提供客观依据。     

热性惊厥患儿血清神经元特异性烯醇化酶与脑损伤的关系

目的检测热性惊厥(FS)患儿血清神经元特异性烯醇化酶(S-NSE)水平,探讨FS是否造成脑组织损伤。方法采用酶标免疫吸附分析法检测49例FS患儿(单纯性FS 32例,复杂性FS 17例)惊厥发生后S-NSE水平,同期住院确诊的呼吸道感染的发热患儿23例作为对照组。结果单纯性FS患儿S-NSE值为(5.17±1.31)μg/L,复杂性FS患儿为(5.84±1.62)μg/L,与对照组(4.98±1.51)μg/L比较均无显著差异(P均>0.05)。结论FS很少造成脑组织的损伤。     

反复热性惊厥大鼠海马白细胞介素-6 和肿瘤坏死因子-α水平的变化

目的探讨反复热性惊厥(FS)大鼠海马IL-6和肿瘤坏死因子-α(TNF-α)的变化。方法将43只SD大鼠随机分为正常对照组(n=10,NC组)、高热对照组(n=12,HC组)和热性惊厥组(n=21,FS组)。分别用酶联免疫吸附法(ELISA)和逆转录酶多聚链反应(RT-PCR)检测大鼠海马IL-6和TNF-α水平及IL-6 mRNA、TNF-αmRNA水平。结果1.FS与HC组大鼠海马IL-6水平[分别为(53.21±8.32)ng/mg、(56.37±2.84)ng/mg]明显高于NC组[(44.55±4.11)ng/mg](P<0.01,0.05),FS与HC组比较差异无统计学意义(P>0.05)。各组大鼠海马IL-6 mRNA水平间比较差异无统计学意义(Pa>0.05)。2.各组大鼠海马TNF-αmRNA及其蛋白水平比较均无统计学意义(Pa>0.05)。结论反复FS对大鼠海马IL-6和TNF-α表达无明显影响,IL-6和TNF-α可能不参与FS相关脑损伤的产生过程。     

Proinflammatory cytokines, prostaglandins and zinc in febrile convulsions

BACKGROUND: Some changes in the levels of proinflammatory cytokines, prostaglandins and zinc (Zn) in peripheral blood and cerebrospinal fluid (CSF) have been suggested to occur for the pathogenesis of febrile convulsions (FC). METHODS: In order to test this hypothesis, the levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 alpha, IL-1 beta and prostaglandins (PGE(2), PGF(2 alpha), PGD(2)) in the CSF and plasma and the levels of Zn in serum and CSF were investigated in children during the acute and late phases of FC. Results were compared with control subjects with meningismus. RESULTS: During the acute phase of FC, children had significantly elevated plasma levels of IL-1 beta, CSF levels of TNF-alpha, plasma levels of PGE(2), PGF(2 alpha) and PGD(2) and CSF levels of PGD(2) (P<0.05). A positive correlation between the degree of fever and plasma IL-1 beta levels was observed in both patients and controls. Three months after the acute phase of FC, plasma levels of IL-1 beta had returned to levels seen in controls. Children with FC also had significantly decreased serum Zn levels during the acute phase (P<0.05). However, there was no significant difference between the groups with respect to CSF Zn levels (P>0.05). CONCLUSIONS: During the acute phase of FC, patients had significantly increased plasma IL-1 beta and prostaglandin levels and decreased serum Zn levels. These changes may be responsible for FC pathogenesis.     

川崎病患儿血清基质金属蛋白酶-1表达的意义

目的 探讨基质金属蛋白酶-1(MMP-1)在川崎病(KD)患儿冠状动脉损伤中的作用.方法 选择KD患儿36例(其中无冠状动脉损伤组15例,冠状动脉损伤组21例),按病程分为急性期、亚急性期和恢复期;10例健康儿童为健康对照组.应用酶联免疫吸附法检测其血清MMP-1蛋白水平.结果 KD急性期患儿血清MMP-1水平明显高于健康对照组(Pa＜0.01),且冠状动脉损伤组较无冠状动脉损伤组升高更显著(P＜0.05);亚急性期、恢复期其MMP-1水平明显降低(各期间比较Pa＜0.01).KD组急性期血清MMP-1水平与外周血白细胞计数呈显著正相关(r＝0.791 P＜0.01).结论 检测血清MMP-1水平对预测和早期诊断KD并冠状动脉病变具有重要意义.