共查询到20条相似文献,搜索用时 812 毫秒
1.
Sen Y Kandemir N Alikasifoglu A Gonc N Ozon A 《European journal of pediatrics》2008,167(10):1183-1189
The present study was performed to determine the prevalence of metabolic syndrome (MS) and its risk factors in obese children
and adolescents. The study included 352 obese children and adolescents (body mass index [BMI] ≥ 95th percentile) aged between
2 and 19 years. The diagnosis of MS was made according to the criteria adapted from the World Health Organization (WHO) and
the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. BMI z-scores were calculated to assess the degree of obesity. The prevalence of MS and risk factors were determined. Determinants
of MS were examined using regression analysis. The prevalence of MS was 41.8%. The age at onset of obesity, sedentary life-span,
fasting blood levels of glucose, insulin, triglyceride, very-low-density lipoprotein (VLDL) cholesterol, and alanine aminotransferase
(ALT) were higher, while levels of high-density lipoprotein (HDL) cholesterol and the number of actively spent hours were
lower in cases with MS (p < 0.05). The most important determinant of MS was BMI z-score (r = 0.31, p < 0.0001). A one-point increase in BMI z-score yielded a 2-fold increase in the prevalence of MS. The prevalence of MS increased from 27.6% to 60.7% when the BMI
z-score increased from 2.3 to 3.3. The risk of developing MS was 2.6-fold higher in cases with BMI z-score > 3 when compared to those with z-scores between 2 and 3. The results from this study indicate that, although the correlation between MS and the BMI z-score was weak, the BMI z-score may be an effective parameter in identifying obese children and adolescents at risk for MS. Screening the cases with
BMI z-scores ≥ 2 for MS is important for establishing an early diagnosis. 相似文献
2.
Galli-Tsinopoulou A Kyrgios I Maggana I Giannopoulou EZ Kotanidou EP Stylianou C Papadakis E Korantzis I Varlamis G 《European journal of pediatrics》2011,170(7):879-886
Obesity in childhood increases the risk for early adult cardiovascular disease. However, the underlying mechanism is not fully
known. The aims of this study were to measure levels of prothrombotic factors and examine their possible association with
obesity and insulin resistance in obese children and adolescents. A total of 313 obese children and adolescents were recruited.
In a cross-sectional design, we measured anthropometric parameters, plasminogen activator inhibitor-1-antigen (PAI-1-Ag),
von Willebrand factor-antigen (vWF-Ag), fibrinogen (FB), lipids, fasting glucose, and insulin (FI) levels. Insulin resistance
was estimated using the homeostasis model assessment for insulin resistance (HOMA-IR) index. Boys presented significantly
higher PAI-1-Ag levels than girls (82.6 vs. 71.3 ng/ml, p = 0.01). Higher levels of PAI-1-Ag (96.8 vs. 69 ng/ml, p < 0.001), vWF-Ag (123.5 vs. 107.6%, p = 0.004) but not FB (353.1 vs. 337.6 mg/dl, p = 0.137) were found in insulin-resistant (IR) participants after adjusted for age, gender, and pubertal stage. IR patients
were at 2.98 (CI: 1.084–8.193) and 4.86 (CI: 1.119–15.606) times greater risk for high PAI-1-Ag and vWF-Ag levels, respectively.
All three prothrombotic factors were positively correlated with body mass index (BMI) and FI levels (p < 0.05), but only PAI-1-Ag and vWF-Ag were significantly correlated with HOMA-IR index (p ≤ 0.001). After adjustment for confounding factors, both BMI and HOMA-IR indices remained significantly associated with PAI-1-Ag
(r
2 = 0.225, p < 0.001) and vWF-Ag levels (r
2 = 0.077, p = 0.003). Conclusion: This study shows that obesity in youngsters, when accompanied with insulin resistance, is associated with at least threefold
increased risk for elevated levels of prothrombotic factors, contributing to the early development of atherothrombosis. This
impaired prothrombotic state may partially explain the increased risk for developing cardiovascular disease later in adulthood. 相似文献
3.
Assadi F 《Pediatric cardiology》2008,29(3):580-584
Microalbuminuria (MA) and C-reactive protein (CRP) levels are predictors of increased risk for left ventricular hypertrophy
(LVH). Whether the strength of association between CRP and LVH is comparable to that of MA in hypertensive children is unknown.
CRP and MA were measured in 64 children and adolescents with essential hypertension (HTN). In the entire population, CRP and
MA showed positive relations with body mass index (BMI) (r = 0.30, p = 0.04 and r = 0.32, p = 0.04, respectively), systolic blood pressure (SBP) (r = 0.63, p = 0.03 and r = 0.58, p = 0.03, respectively), and LVH (r = 0.86, p < 0.001 and r = 0.81, p < 0.001, respectively). Patients with LVH (n = 23) had significantly higher BMI (p = 0.32), increased SBP (p = 0.031), and higher levels of CRP (p < 0.001) and MA (p < 0.001) compared with those without LVH. Multiple linear regression analysis demonstrated that CRP (r = 2.11, p < 0.001), MA (r = 1.94, p < 0.003), BMI (r = 0.53, p = 0.02), and SBP (r = 0.48, p = 0.04) were significantly associated with LVH. By analysis of covariance, CRP and MA were significantly different between
patients who had LVH and those without LVH after adjustment for age, gender, BMI, SBP, SBP index, and diastolic blood pressure
(p < 0.001 for the two markers). In conclusion, the strength of association between LVH and CRP is comparable to that of MA
in children and adolescents with essential HTN. 相似文献
4.
Nobutaka Noto Tomoo Okada Kensuke Karasawa Mamoru Ayusawa Naokata Sumitomo Kensuke Harada Hideo Mugishima 《Pediatric cardiology》2009,30(3):262-268
The objective of this study was to test the hypothesis that accelerated endothelial dysfunction and the development of premature
atherosclerosis are associated with age in subjects with coronary artery lesions after Kawasaki disease (KD). A case-control
study was performed at a university hospital that included 35 post-KD subjects across a wide age range (range, 8–42 years)
without traditional cardiovascular risk factors and 35 age- and sex-matched healthy control subjects (Cont). Flow-mediated
dilatation (FMD) of the brachial artery-induced by reactive hyperemia, intima media thickness (IMT), and elastic modulus (Ep)
of the common carotid artery were compared between KD and Cont subjects assessed against age. KD subjects had slightly higher
levels of body mass index, lipid profile, and HbA1c than Cont subjects, but the differences were not significant. The mean
IMT (p < 0.001), age-adjusted percentage normal IMT (%N IMT; p < 0.0001), and Ep (p < 0.001) were significantly higher in KD than Cont subjects, and the peak FMD% (p < 0.01) was significantly lower in KD than Cont subjects. There were significant correlations between FMD% and age (r = −0.51 p < 0.0001), IMT and age (r = 0.68, p < 0.001), and Ep and age (r = 0.58, p < 0.01) in KD but not Cont subjects. When the difference in FMD% between KD and matched Cont subjects (ΔFMD%) was plotted
against age, no significant relationship was found, although significant correlations between ΔIMT and age (r = 0.52, p < 0.01) as well as between ΔEp and age (r = 0.46, p < 0.05) were observed. When we defined values that were +2.0 SD over the mean control values (i.e., %N IMT ≥ 120% and/or
Ep ≥ 50 kPa) as markers of subclinical atherosclerosis, 15 subjects met the criteria. Subjects over the age of 22 years were
more likely to have (OR = 16.54, p = 0.0001) subclinical atherosclerosis in this cohort. Our results suggest that endothelial dysfunction and the development
of premature atherosclerosis were accelerated in adult post-KD compared to Cont subjects. 相似文献
5.
Acute phase proteins have been suggested to be increased in patients with type 1 diabetes. The aim of this study was to evaluate
the relationship between serum C-reactive protein (CRP) and intima-media thickness (IMT) and functions of the common carotid
artery (CCA) in children and adolescents with type 1 diabetes. Serum CRP levels were measured in 65 children and adolescents
with diabetes (33 girls and 32 boys; mean age, 12.7 ± 3.8 years; range, 7–18; duration of diabetes, 6.9 ± 3.6 years). Age
and diabetes duration, as well as major cardiovascular risk factors including anthropometric and metabolic parameters, were
matched between girls and boys. The relations of serum CRP levels to CCA structure and functions were measured by ultrasonography
as IMT, cross-sectional compliance, cross-sectional distensibility, diastolic wall stress (DWS), and incremental elastic modulus
(IEM). There was no significant difference for serum CRP levels between girls and boys (3.7 ± 1.3 vs 3.2 ± 0.4 mg/L; p > 0.05). CRP was positively correlated with IMT (r = 0.49, p = 0.001), IEM (r = 0.24, p = 0.05), DWS (r = 0.58, p < 0.001), and body mass index (BMI) (r = 0.28, p = 0.05). In a multivariate regression model, we included CRP and metabolic and anthropometric parameters such as duration
of diabetes, HbA1c, BMI, waist:hip ratio, age, and systolic and diastolic blood pressure as independent variables in the model
for CCA structure and functions. CRP emerged as an independent correlation for mean IMT (β = 0.51, p < 0.001) and DWS (β = 0.61, p < 0.001). According to our findings, CRP was associated with CCA structure and functions in children and adolescents with
type 1 diabetes. 相似文献
6.
Mine Ozkol Betül Ersoy Erhun Kasirga Fatma Taneli Işıl Esen Bostanci Bayram Ozhan 《European journal of pediatrics》2010,169(11):1345-1352
The aims of our study were: (1) to evaluate the frequency of asymptomatic fatty liver disease (FLD) using both Doppler and
B-mode ultrasound (US) in overweight and obese adolescents; (2) to compare metabolic findings of fatty liver (FL) assessed
by two methods; and (3) to evaluate metabolic predictors of FL shown by these methods. Fifty-nine overweight and obese adolescents
aged between 9.0 and 17.0 years and 41 non-obese healthy adolescents were included in this study. B-mode and right hepatic
vein Doppler ultrasonography (US) were performed and anthropometric indices, lipid profiles, and adiponectin levels were evaluated
in all adolescents. HDL-C levels were significantly lower in patients with FL detected by Doppler US compared to patients
without FL (p < 0.05). HDL-C levels were inversely correlated with presence of FL assessed by two methods (r = −0.285, p = 0.004; r = −0.328, p = 0.001, respectively) and adiponectin levels were correlated with presence of FL only detected by B-mode US (r = −0.263, p = 0.008). Adiponectin levels were significantly lower in patients with FL than those without FL assessed by B-Mode US (p = 0.049). Multiple regression analysis revealed that HDL-C levels was the most important predictor of FL assessed by Doppler
US (p = 0.027), while body mass index was the determinant of FL assessed by two methods (p < 0.001) in asymptomatic overweight and obese adolescents. It was found that FLD, identified by both B-mode and Doppler US,
is seen frequently in asymptomatic overweight and obese adolescents. Elevated BMI is associated with increased risk of FL
assessed by two ultrasonographic methods. When using Doppler US, low HDL-C levels can be used as a good predictor for presence
of FLD in overweight and obese adolescents. 相似文献
7.
Fatin Sammour Marcus Haw John Paisey Richard Cope Mike Herbertson Tony Salmon Joseph Vettukattil Mary Rogerson Varvara Karagkiozaki Gruschen Veldtman 《Pediatric cardiology》2009,30(3):282-288
This report characterizes renal dysfunction after total cavopulmonary (TCPC) revision surgery for atriopulmonary Fontan (APF)
circulations, a known risk factor for a poor outcome. The perioperative data for 23 consecutively identified patients were
reviewed. The preoperative mean glomerular filtration rate (GFR) was 101 ± 30 ml/min/1.73 m2, decreasing to 65 ± 41 ml/min/1.73 m2 early in the postoperative period. The preoperative GFR was highly correlated with age at APF (r = −0.5; p = 0.024), age at TCPC (r = −0.5; p = 0.01), and mixed venous saturation (r = 0.6; p = 0.01). Three of four patients requiring renal replacement therapy (RRT) died at a median age of 3 months (range, 18 days
to 9 months). Determinants of early GFR and RRT were preoperative GFR (p = 0.016) and creatinine (p = 0.035). Younger age at primary Fontan (p = 0.008), higher preoperative mixed venous saturation (p = 0.019), and higher preoperative blood pressure (p = 0.006) independently predicted better GFRs at the latest follow-up evaluation. Renal function declines acutely after TCPC
revision, often necessitating RRT. A requirement for RRT marks greater mortality. Higher preoperative creatinine levels identify
those at greatest risk. 相似文献
8.
Kanellopoulos TA Varvarigou AA Karatza AA Beratis NG 《European journal of pediatrics》2007,166(7):685-692
Objectives Postnatal growth in children exposed in utero to tobacco smoke is not well understood. This study investigated growth during
the first 6 years in children whose mothers smoked during pregnancy.
Materials and methods Weight, length, and head circumference were measured annually for 6 years in 100 children in each group of smoking (study)
and nonsmoking (control) mothers.
Results Weight and head circumference were significantly smaller in the neonates whose mothers smoked ≥15 cigarettes/day, but the
difference disappeared by 3 years of life. Length was significantly smaller in the study neonates at birth, followed by increasing
divergence from normality up to 2 years, when the mean difference of children whose mothers smoked ≥15 cigarettes/day from
control children was −3.4 cm (p ≤ 0.0001). Subsequently, they manifested catch-up growth ,and the difference from the controls at 3, 4, 5, and 6 years was
−2.5 cm (p ≤ 0.0001), −2.2 cm (p = 0.005), −2.1 cm (p = 0.013), and −1.9 cm (p = 0.055), respectively.
Discussion The delayed growth was related to smoking per se and appeared to be independent of several confounding factors. At birth,
there was a significant negative correlation between the number of cigarettes smoked per day and the growth parameters studied;
it remained significant up to the 6 year only for length.
Conclusion Length exhibits the most persistent growth delay of the parameters studied, but catch-up growth occurs after the second year
of life, and thus, intrauterine exposure to tobacco smoke seems to have no permanent effect on children’s growth. 相似文献
9.
Schwab KO Doerfer J Krebs A Krebs K Schorb E Hallermann K Superti-Furga A Zieger B März W Schmidt-Trucksäss A Winkler K 《European journal of pediatrics》2007,166(6):541-548
The intentions of our investigation were (1) to search for atherogenic risk factors and signs of incipient atherosclerosis
in children and adolescents with type 1 diabetes (T1DM) in comparison to well-matched control subjects, (2) to evaluate risk
factor associations with carotid intima media thickness (cIMT) in diabetic patients and control subjects, and (3) to acquire
a better knowledge of early atherogenesis in children and adolescents with and without T1DM. 94 diabetic children (age median
12.3 years, HbA1c median 7.7%) and 40 non-diabetic controls (age median 12.3 years) were investigated. Mean cIMT was determined using high-resolution
B-mode ultrasound with an automated contour identification procedure. Compared to controls, subjects with diabetes had significantly
elevated cIMT (p = 0.041) and systolic BP (p = 0.007) but showed a less atherogenic lipid profile. Most markers of inflammation, endothelial function and fibrinolytic
activity were higher in diabetic subjects than in controls. Multiple linear regression analysis revealed a significant relationship
(r = 0.53, p = 0.036) between bilateral mean cIMT and diverse risk factors in patients with T1DM. Spearman rank correlation showed that
diabetes duration (rho = 0.32, p = 0.029), systolic BP (rho = 0.32, p = 0.004), weight (rho = 0.257, p = 0.022), and height (rho = 0.265, p = 0.018) significantly correlated with bilateral mean cIMT in the 94 diabetic patients. In conclusion, in well-controlled
type 1 diabetic children systolic BP may be of greater importance than dyslipidaemia in early atherogenesis. BMI, markers
of sustained inflammation, endothelial dysfunction and fibrinolytic activity are increased in diabetic versus non-diabetic
children but none of them correlates significantly with cIMT. Their prognostic value remains to be determined. 相似文献
10.
Obesity (OB) in adults is associated with insulin resistance, hypertension, and left atrial (LA) enlargement. This study aimed
to determine the association between LA size and (1) different components of the metabolic syndrome (body mass index [BMI],
waist circumference [WC], insulin levels, lipid levels, and blood pressure), and (2) left ventricular (LV) diameters and diastolic
function. Data were collected cross-sectionally from 142 healthy adolescent boys age 16.8 ± 2.0 years in 2009. Measurements
of BMI, WC, blood pressure, lipid profile, and insulin were performed. Mode M, two-dimensional Doppler echocardiography was
performed. Measurements of LA area, LV end diastolic diameter (EDD), end systolic diameter (ESD), posterior wall, interventricular
septum (IVS), and shortening fraction were performed. Tisular Doppler of the diastolic mitral annular E wave (DTE) and A wave
(DTA) and the ratio of maximal early diastolic filling wave velocity to maximal early diastolic myocardial velocity (E/e′)
were recorded. The study group included 38 OB boys (26.8%) and 32 overweight boys (22.5%). Significant univariate association
was found between LA area and BMI (r = 0.61), WC (r = 0.56), systolic blood pressure (r = 0.21), insulinemia (r = 0.28), high-density lipoprotein-cholesterol (HDL-C) (r = –0.24), triglycerides (r = 0.20), EDD (r = 0.25), LV posterior wall (r = 0.25), IVS (r = 0.25), DTE (r = 0.27), DTA (r = 0.30), and E/e′ (r = –0.28). Multiple linear regression analysis showed that LA area was associated with BMI (B = 0.61; R
2 = 0.47) adjusted for confounding variables. In adolescents, BMI and WC were significantly associated with LA, suggesting
that OB could be associated with LA enlargement as early as adolescence. 相似文献
11.
Ana Maria Verçoza Matteo Baldisserotto Carlos Abaeté de los Santos Carlos Eduardo Poli-de-Figueiredo Domingos Otavio d’Avila 《Pediatric cardiology》2009,30(8):1055-1060
Atherosclerosis, beginning in childhood, is dependent on several risk factors and may be predictive of coronary artery disease
in adulthood. The risk factors for subclinical atherosclerosis are similar to those for clinical disease. Carotid intima-media
thickness is a measure of subclinical atherosclerosis and a predictor of subsequent vascular events. This study aimed to examine
the relationships of carotid intima-media thickness with known risk factors in asymptomatic children. Family history of cardiovascular
disease was collected, together with anthropometric, demographic, and clinical data. Body mass index z-scores were calculated. Serum glucose, lipid fractions, fibrinogen, and C-reactive protein were determined. High-resolution
ultrasonography was used to assess intima-media thickness. Associations and relationships of risk factors with composite intima-media
thickness were explored. The study enrolled 93 children (44 girls) ranging in age from 49 to 169 months. The boys had a thicker
intima-media (0.46 ± 0.06 mm) than the girls (0.43 ± 0.06 mm; p = 0.028). The unadjusted triglyceride levels were significantly higher in the overweight and obese children (p = 0.010). Body mass index and overweight/obesity were positively related to intima-media thickness (r = 0.259; p = 0.012 and r
s = 0.230; p = 0.027, respectively), whereas family history of cardiovascular disease was unrelated. Only gender and overweight/obesity
were related to intima-media thickness in a multiple linear regression model (R
2 = 0.125; p = 0.002). Male gender and overweight/obesity were associated with increased intima-media thickness, whereas family history
of cardiovascular disease was unrelated. 相似文献
12.
Albane B. R. Maggio Michaël F. Hofer Xavier E. Martin Laetitia M. Marchand Maurice Beghetti Nathalie J. Farpour-Lambert 《European journal of pediatrics》2010,169(10):1187-1193
We aimed to compare physical activity level and cardiorespiratory fitness in children with different chronic diseases, such
as type 1 diabetes mellitus (T1DM), obesity (OB) and juvenile idiopathic arthritis (JIA), with healthy controls (HC). We performed
a cross-sectional study including 209 children: OB: n = 45, T1DM: n = 48, JIA: n = 31, and HC: n = 85. Physical activity level was assessed by accelerometer and cardiorespiratory fitness by a treadmill test. ANOVA, linear
regressions and Pearson correlations were used. Children with chronic diseases had reduced total daily physical activity counts
(T1DM 497 ± 54 cpm, p = 0.003; JIA 518 ± 28, p < 0.001, OB 590 ± 25, p = 0.003) and cardiorespiratory fitness (JIA 39.3 ± 1.7, p = 0.001, OB 41.7 ± 1.2, p = 0.020) compared to HC (668 ± 35 cpm; 45.3 ± 0.9 ml kg−1 min−1, respectively). Only 60.4% of HC, 51.6% of OB, 38.1% of JIA and 38.5% of T1DM children met the recommended daily 60 min of
moderate-to-vigorous physical activity. Low cardiorespiratory fitness was associated with female gender and low daily PA.
Conclusion: Children with chronic diseases had reduced physical activity and cardiorespiratory fitness. As the benefits of
PA on health have been well demonstrated during growth, it should be encouraged in those children to prevent a reduction of
cardiorespiratory fitness and the development of comorbidities. 相似文献
13.
Annemarie Plaisier Femke Maingay-de Groof Roechama Mast-Harwig Patricia M. J. Kalkman Remi W. Wulkan Renee Verwers Marjolein Neele Wim C. J. Hop Michael Groeneweg 《European journal of pediatrics》2010,169(7):883-886
Acute gastroenteritis is common in childhood. The estimation of the degree of dehydration is essential for management of acute
gastroenteritis. Plasma water was assessed as a diagnostic tool in children with acute gastroenteritis and dehydration admitted
to hospital. In a prospective cohort study, 101 patients presenting at the emergency department with dehydration were included.
Clinical assessment, routine laboratory tests, and plasma water measurement were performed. Plasma water was measured as a
percentage of water content using dry weight method. During admission, patients were rehydrated in 12 h. Weight gain at the
end of the rehydration period and 2 weeks thereafter was used to determine the percentage of weight loss as a gold standard
for the severity of dehydration. Clinical assessment of dehydration was not significantly associated with the percentage of
weight loss. Blood urea nitrogen (r = 0.3, p = 0.03), base excess (r =−0.31, p = 0.03), and serum bicarbonate (r = 0.32, p = 0.02) were significantly correlated with the percentage of weight loss. Plasma water did not correlate with the percentage
of weight loss. On the basis of the presented data, plasma water should not be used as a diagnostic tool in the assessment
of dehydration in children with acute gastroenteritis. 相似文献
14.
15.
Our aim was to identify prognostic factors for an arrhythmic event (AE) in children with hypertrophic cardiomyopathy (HCM)
without a previous AE. One hundred thirty-one nonconsecutive patients (≤20 years) with HCM but no previous AE were evaluated
at the NIH Clinical Center from 1980 to 2001. At a median follow-up of 6.4 years, 22 patients experienced an AE [sudden death
(SD) (n = 12), resuscitated cardiac arrest (n = 3), clinical sustained ventricular tachycardia (VT) (n = 2), and implantable cardiac defibrillator discharge (n = 5)], resulting in a 2% annual AE rate. Baseline factors that were most predictive in univariate risk analysis included
ventricular septal thickness (ST) (P = 0.01), VT induction by programmed ventricular stimulation (PVS) (P = 0.01), age (P = 0.05), and presyncope/syncope (P = 0.05). In multivariate analysis, ST, age, presyncope/syncope, and PVS were not independently predictive of risk for an
AE. However, the 5-year event rates for AE was 15% (95% CI: 5–23%) if ST ≥ 20 mm, 19% (95% CI: 6–31%) when age ≥ 13 years
and ST ≥ 20 mm were combined together, and 23% (95% CI: 3–39%) when PVS and ST ≥ 20 mm were combined together. Of the various
risk factors that were considered in our pediatric HCM cohort, ST and inducible VT were the most significant univariate predictors
of risk for an AE. More traditional risk factors identified in older patients (family history of SD, VT on Holter, and exercise-induced
hypotension) were not predictive of an AE in patients age under 21 years. 相似文献
16.
Vered Molina Hazan Yael Gonen Amir Vardi Ilan Keidan David Mishali Marina Rubinshtein Yusim Yakov Gideon Paret 《Pediatric cardiology》2010,31(7):952-960
This study aimed to examine the association between lactate levels in the first hours after surgery for congenital heart defects
and the results of Risk-Adjusted Classification for Congenital Heart Surgery (RACHS-1) scoring and to evaluate serial lactate
levels over time to determine whether they can serve as a supplementary tool for postoperative assessment within the same
RACHS-1 group of patients. A retrospective cohort study was performed using data retrieved from a clinical database of 255
children who had surgery for congenital heart defects between 1999 and 2001 at Sheba Medical Center. Lactate levels were measured
postoperatively four times (mg/dL units). The last sample was taken at the end of the surgical procedure, and lactate levels
were measured at admission to the pediatrics critical care unit, then 6 and 12 h after admission. The lactate level was measured
via arterial blood gases. A total of 27 deaths occurred, yielding a mortality rate of 7.4% when Norwood operations were excluded
and 10.16% when they were included. The mean initial postoperative lactate level was significantly lower for survivors (42.2 ± 32.0 mg/dL)
than for nonsurvivors (85.4 ± 54.1 mg/dL) (p < 0.01). The serial mean lactate levels decreased progressively for all surviving patients (r
2 = 0.96) compared with nonsurvivors (r
2 = 0.02). The lactate levels correlated with the RACHS-1 subgroups at each time point (r
2 > 0.96 for all). The Pearson correlations between postoperative lactate levels (last lactate measurement taken in the operating
room) and cardiopulmonary bypass (CPB) duration (r = 0.549), clamp duration (r = 0.586), and the inotropic score (r = 0.466) (p < 0.001 for all) were significantly positive. The correlations between the maximum lactate levels (during the first 12 postoperative
hours) and CPB duration (r = 0.496), clamp duration (r = 0.509), and the inotropic score (r = 0.633) (p < 0.001 for all) were extremely positive. The early elevation of lactate levels in RACHS-1 subgroups 1 to 3 were highly correlated
with poor prognosis and death (p < 0.03). In addition, the lactate levels differed significantly between survivors and nonsurvivors within the same RACHS-1
subgroup. The survivors in RACHS-1 subgroups 1 to 3 had lower mean lactate levels than the nonsurvivors in this group (P = 0.011), and this also held true for the survivors and nonsurvivors in RACHS-1 subgroups 4 to 6 (P = 0.026). Lactate levels differed significantly between survivors and nonsurvivors within the same RACHS-1 subgroup. This
combination allows the targeting of appropriately intensive interventions and therapies toward the sickest patients. 相似文献
17.
There are conflicting reports regarding the association of Helicobacter pylori (H. pylori) infection with growth failure. We evaluated the role of H. pylori infection on malnutrition and growth failure in dyspeptic children. The study cases included 108 dyspeptic children and were
evaluated by endoscopic gastric biopsy, while 50 healthy children constituted the control group. The study cases were grouped
as H. pylori [+] (n = 57) and H. pylori [−] (n = 51) by the presence or absence of microorganism in gastric tissue, respectively. Age, gender, height for age (H/A), weight
for height (W/H), body mass index (BMI), weight and height z scores and the daily calorie intake of the children were recorded. Malnutrition and growth failure were evaluated by the
Waterlow criteria and height z score, respectively. Then, the H. pylori [+], H. pylori [−] and control groups were compared in relation to the variables defined above. All groups were similar with respect to
gender and age. The daily calorie intake was lower in dyspeptic children. Although anthropometric variables were similar in
the H. pylori [+] and [−] groups, the control cases had higher W/H compared to both H. pylori [+] (p = 0.030) and H. pylori [−] (p = 0.000) cases, and higher BMI (p = 0.001) and weight z scores (p = 0.014) than those in the H. pylori [−] group. The malnutrition rate was similar in the H. pylori [+] and [−] groups. However, mild acute (p = 0.033) and general malnutrition rates (p = 0.000) were lower in the control cases compared to the study cases. The short stature rate was not different significantly
in all three groups. In conclusion, the results of this study do not support the data that H. pylori infection plays an extra role in malnutrition and growth failure in children presenting with dyspeptic complaints. However,
as a major cause of dyspepsia, H. pylori infection might be considered to cause malnutrition secondary to decreased calorie intake associated with dyspepsia. 相似文献
18.
Kawasaki disease (KD) patients younger than 1 year of age are at especially high risk of developing coronary artery abnormalities
(CAA). To define the clinical characteristics of this group, as well as the risk factors predisposing them to CAA, we reviewed
the medical records of 136 KD patients younger than 1 year of age who were treated at the Korea University Medical Center
from January 2001 to July 2006. Of these patients, 16 developed CAA (11.8%). The CAA(+) group had a longer duration of total
fever than the CAA(−) group (9.1±3.7 days vs. 6.3±2.0 days, p=0.011), but did not differ in the duration of pre- and post-intravenous gamma-globulin (IVGG) fever. The CAA(+) group had
fewer diagnostic symptoms than the CAA(−) group (2.7±1.1 vs. 4.3±1.2, p<0.001). Of the hematological findings, the CAA(+) group only differed from the CAA(−) group in having significantly higher
total white blood cell (19.2±6.0 vs. 14.7±4.7 K/mm3, p=0.007) and platelet (462.9±101.0 vs. 383.6±121.1 K/mm3, p=0.014) levels. Multivariable logistic regression analysis showed that the only factors which were significantly associated
with the development of CAA were the total number of symptoms (OR=0.493, 95% CI=0.293–0.829, p=0.007) and the duration of total fever (OR=1.405, 95% CI=1.092–1.808, p=0.008). Conclusively, incomplete clinical manifestations and a longer duration of total fever are significantly associated
with the development of CAA in KD patients younger than 1 year of age. Therefore, these patients should be monitored for incomplete
KD, especially if unexplained fever continues, and treatment to shorten the duration of total fever should be initiated.
An erratum to this article can be found at 相似文献
19.
Use of near-infrared spectroscopy for estimation of renal oxygenation in children with heart disease
We evaluated whether near-infrared spectroscopy (NIRS) measurement from the flank correlates with renal vein saturation in
children undergoing cardiac catheterization. Thirty-seven patients <18 years of age were studied. A NIRS sensor was placed
on the flank, and venous oxygen saturations were measured from the renal vein and the inferior vena cava (IVC). There was
a strong correlation between flank NIRS values (rSO2) and renal vein saturation (r = 0.821, p = 0.002) and IVC saturation (r = 0.638, p = 0.004) in children weighing ≤ 10 kg. In children weighing > 10 kg, there was no correlation between rSO2 and renal vein saturation (r = 0.158, p = 0.57) or IVC saturation (r = –0.107, p = 0.67). Regional tissue oxygenation as measured by flank NIRS correlates well with both renal vein and IVC oxygen saturations
in children weighing <10 kg undergoing cardiac catheterization, but not in larger children. 相似文献
20.
Clinical presentation of celiac disease and the diagnostic accuracy of serologic markers in children
Lurz E Scheidegger U Spalinger J Schöni M Schibli S 《European journal of pediatrics》2009,168(7):839-845
There has been growing recognition of a changing clinical presentation of celiac disease (CD), with the manifestation of milder
symptoms. Serologic testing is widely used to screen patients with suspected CD and populations at risk. The aim of this retrospective
analysis was to evaluate the clinical presentation of CD in childhood, assess the diagnostic value of serologic tests, and
investigate the impact of IgA deficiency on diagnostic accuracy. We evaluated 206 consecutive children with suspected CD on
the basis of clinical symptoms and positive serology results. Ninety-four (46%) had biopsy-proven CD. The median age at diagnosis
of CD was 6.8 years; 15% of the children were <2 years of age. There was a higher incidence of CD in girls (p = 0.003). Iron deficiency and intestinal complaints were more frequent in children with CD than those without CD (61% vs.
33%, p = 0.0001 and 71% vs. 55%, p = 0.02, respectively), while failure to thrive was less common (35% vs. 53%, p = 0.02). The sensitivity of IgA tissue transglutaminase (IgA-tTG) was 0.98 when including all children and 1.00 after excluding
children with selective IgA deficiency. The specificity of IgA-tTG was 0.73 using the recommended cut-off value of 20 IU,
and this improved to 0.94 when using a higher cut-off value of 100 IU. All children with CD and relative IgA deficiency (IgA
levels that are measurable but below the age reference [n = 8]) had elevated IgA-tTG. In conclusion, CD is frequently diagnosed in school-age children with relatively mild symptoms.
The absence of intestinal symptoms does not preclude the diagnosis of CD; many children with CD do not report intestinal symptoms.
While the sensitivity of IgA-tTG is excellent, its specificity is insufficient for the diagnostic confirmation of a disease
requiring life-long dietary restrictions. Children with negative IgA-tTG and decreased but measurable IgA values are unlikely
to have CD. 相似文献