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目的探讨弥散加权成像(DWI)、常规磁共振成像(MRI)在新生儿低血糖性脑损伤不同阶段的动态变化。方法回顾分析了2005年9月至2008年9月,中国医科大学附属盛京医院新生儿科收治的经MRI确诊的20例低血糖性脑损伤患儿(病例组)的临床资料,并随机选取同期住院MRI正常的20例单纯性低血糖患儿为对照组。结果病例组平均最低血糖值低于对照组(P<0.01),低血糖持续时间长于对照组(P<0.01)。病例组于低血糖发生后3.8(1～11)d完成首次MRI检查,受累部位主要为枕叶11例、枕顶叶8例,顶叶1例,受累部位在DWI均表现为高信号,常规MRI相应部位12例表现为T1加权成像(T1WI)、T2加权成像(T2WI)正常信号,仅6例表现为T1WI低信号、T2WI高信号;11例于首次检查后11.4(8～15)d完成第2次MRI检查,首次检查受累部位DWI7例转为正常信号,4例低信号,常规MRI均表现为T1WI低信号、T2WI高信号。3例于6个月随访,提示枕叶DWI正常信号,T1WI低信号、T2WI高信号。结论新生儿低血糖性脑损伤早期DWI表现为异常高信号的部位,与晚期常规MRI表现为T1WI低信号、T2WI高信号的部...     

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目的探讨氨溴特罗口服液改善毛细支气管炎患儿气道功能的疗效影响。方法将2009年11月至2010年9月广州市妇女儿童医疗中心93例毛细支气管炎患儿随机分为治疗组(氨溴特罗口服液组)和对照组。观察两组患儿治疗前后潮气呼吸流速-容量环(TBFV)的形态改变以及肺功能各项指标的变化。结果两组患儿治疗前TBFV环均变窄,呼气曲线升枝陡峭,高峰提前,降枝呈波谷样凹陷;治疗后明显好转。两组患儿治疗前各项主要参数比较,差异无统计学意义(P>0.05)。两组患儿治疗前后比较:呼吸频率(RR)、呼气峰流速(PEF)、呼吸系统阻力(Rrs)、每千克体重功能残气量(FRC/kg)均降低(P<0.05或P<0.01);每千克体重潮气量(VT/kg)、吸呼比(TI/TE)、呼气达峰时间(TPTEF)、达峰时间比(TPTEF/TE)、呼气达峰容积(VPTEF)、达峰容积比(PFV)、呼出75%潮气量时的呼气流速/呼气峰流速(25/PF)、潮气呼气中期流速/潮气吸气中期流速(ME/MI)、每千克体重顺应性(Crs/kg)均增加(P<0.05或P<0.01)。其中治疗组与对照组比较,反映大小气道阻塞主要指标PFV、25/PF、ME/MI及肺顺...     

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??Abstract??Objective??To investigate alterations of circulating levels of the inflammatory markers— reflecting brain and adipose tissue inflammation—in the fetal growth restriction??FGR??fetuses and newborns??and explore its possible relation ship with adverse intrauterine development. Methods??Sixty parturients??hospitalized in Shengjing hospital of China Medical University??giving consecutively birth either to 30 appropriate for gestational-age??AGA?? singleton infants ??AGA group ?? or 30 FGR full-term singleton infants ??FGR group????were recruited.Plasm hs-CRP??PAI-1??S100B and leptin levels were determined by enzyme link immune assay??ELISA??in the umbilical cords blood ??UC ?? and venous blood from neonates on postnatal day 1 ??D1?? and day 4??D4??. Results??The birth weight??body length and the body mass index ??BMI?? of the FGR neonates were significantly lower compared with those of AGA group ??P < 0.05??.The leptin levels of UC in the FGR neonates were lower than that in the AGA groups??P < 0.05????and correlated positively with the birth weights and the BMI??P < 0.05??.Plasma hs-CRP levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05??.hs-CRP levels in Umbilical cords blood were significantly decreased when compared with D1 hs-CRP in both AGA and FGR groups ??P < 0.05????and D1 hs-CRP was significantly increasedwhen compared with respective D4 hs-CRP??P < 0.05??.Plasma PAI-1 and S100B levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05????and did not correlated with the birth weights and the BMI. Conclusion??Despite the lower birth weight??BMI and leptin levels in FGRs?? there was no difference for the levels of inflammatory markers hs-CRP and PAI-1 between IUGR and AGA fetuses/neonates.The CRP level in both studied groups fluctuated from fetus to neonate stage might attribute to parturition stress and adaptation recovery.     

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功能性构音障碍(functional articulation disorder,FAD)是最常见的语言障碍[1],患儿常因语音不清造成人际交往困难和一系列情绪及行为问题。目前国内有关FAD的研究较少,对FAD儿童感觉统合能力的研究尚未见报道。为探讨FAD儿童的感觉统合能力发展水平及其在FAD发生中的作用,我们对FAD患儿和正常儿童进行了感觉统合能力的对照研究,现将结果报告如下。1对象和方法1.1对象病例组:以2005-01—2006-06来我院发育儿科就诊的以吐字不清为主诉的6~12岁儿童为研究对象,符合FAD诊断标准者共38例,其中男35例,女3例。FAD的诊断依据日本听力言…     

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??Objective??To study the mixed infections in hospitalized children with community-acquired pneumonia ??CAP??. Methods??We retrospectively reviewed the medical records of CAP patients admitted to Children’s Hospital of Soochow University from January 2015 to December 2015. Samples were tested for multiple pathogens.Results??One or more pathogens was detected in 647??76.5%?? of 846 cases??34.63?? cases were considered mixed infection. The rates of mixed infection in ??6-month????1-year????3-year????5-year?? ≥5-year group were 24.2%??43.5%??43.8%??36.8% and 27.3% respectively. The most frequent combinations of pathogens were those of virus plus bacteria in ??6-month and ??1-year group??virus plus MP in ??3-year and ≥ 5-year group?? and MP plus bacteria in??5-year group??Rhinovirus-H.influenzae was the most commonly found combination of virus and bacteria. The most frequent etiological agent in virus coinfected with MP was rhinovirus. S.pneumoniae was the most important pathogen for bacteria coinfected with MP. No significant difference in clinical characteristics??complications??PICU admission or hospital stay was observed between the patients with mixed infections and those with monomicrobial CAP. Conclusion??Mixed infections account for certain proportion in the cause of CAP. The positivive rate in patients in??1-year and ??3-year groups is significantly higher than that in other age groups. Patients of different ages present with different combinations of pathogens. Mixed infections have no relationship with CAP patients’ mortality.     

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??Objective To investigate the predictive value of lipopolysaccharide binding protein ??LBP?? in early diagnosis of preterm infection with premature rupture of membrane??PROM??. Methods Totally 93 preterm infants with PROM were enrolled in this study?? and were divided into infection group ??45 cases?? and non-infection group ??48 cases?? according to the discharge diagnosis. Their serum LBP levels were detected within 24 hours after birth. High-sensitivity C-reactive protein ??hs-CRP???? procalcitonin ??PCT?? and interleukin-6 ??IL-6?? levels were compared with LBP. Receiver operator characteristic curve ??ROC?? was drawn and the area under the curve ??AUC?? was calculated. Each parameter was evaluated for the diagnosis of early-onset infection in preterm infants with PROM. In addition?? according to the severity of the disease infection group was further divided into severe infection group??21 cases?? and general infection group??24 cases??. LBP levels were detected in two groups of premature infants to assess the value of LBP in the diagnosis of premature infants with premature rupture of membranes. Results The serum levels of IL-6?? PCT and LBP in the infection group were significantly higher than those in the non-infection group. There was no significant difference on serum levels of hs-CRP between the two groups. The level of LBP in the severe infection group was higher than that in the general infection group?? and the difference between the two groups was statistically significant. The AUC of ROC for LBP ??0.974?? in early-onset bacterial infection of preterm infants with PROM was the highest?? PCT ??0.694?? second?? IL- 6 ??0.588?? third?? and hs-CRP ??0.478?? was the lowest. Conclusion Serum level of LBP is superior to hs-CRP and PCT in the diagnosis of early-onset bacterial infection in preterm infants with PROM. LBP can be used as a useful index for the early diagnosis of bacterial infection in preterm infants with PROM. LBP levels can evaluate the severity of premature premature infection in preterm premature rupture of membranes.     

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目的了解儿童乙型肝炎病毒(HBV)基因型与临床分度的关系。方法选择甘肃省人民医院儿科和兰州大学第一医院感染科2008年4月至2010年4月门诊和住院患儿中HBV-DNA阳性的124例乙型肝炎患儿,其中男84例,女40例。HBV携带者65例,慢性乙型肝炎59例(轻度31例、中度18例、重度10例),对以上患儿进行基因分型、同时检测肝功、术前出凝血、HBV-DNA载量。结果 124例肝病患儿中,C基因型62例(50.0%),B基因型48例(38.7%),B/C混合型9例(7.3%),非B/C型5例(4.0%);HBV携带者和轻度组中,以B基因型为主,分别为47.7%和45.2%;中度和重度组中,以C基因型为主,分别为72.2%和80%;在C、B基因型分布方面,HBV携带者和轻度组与中度和重度组比较差异有统计学意义;C基因型患者的HBV-DNA载量、丙氨酸转氨酶(ALT)、天冬氨酸转移酶(AST)、总胆红素(TBIL)均高于B基因型;C基因型患者与B基因型比较,凝血酶原时间(PT)延长、凝血酶原活动度(PTA)下降、纤维蛋白原(FIB)减少。B、C型通过母婴传播的比例差异无统计学意义。结论甘肃省儿童乙型肝炎病毒基因...     

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目的探讨家族史与儿童血脂水平的关系。方法2004年4月至10月营养转型期儿童、成人慢性病综合性防治研究课题组采用整群抽样方法对北京地区6～18岁儿童青少年进行横断面流行病学调查。有效调查对象19306名,其中男9665名,女9641名;按年龄及性别分为男性学龄期组、青春期组,女性学龄期组、青春期组。根据家族史背景分为无家族史、有一级家族史、有二级家族史。对其空腹末梢血总胆固醇(TC)、三酰甘油(甘油三酯TG)进行检测。结果有一级家族史者,各年龄段男童组TC及TG水平均显著高于无家族史者(P<0.05),学龄期女性儿童组TC显著高于无家族史者([4.07±0.41)mmo/L、(4.00±0.33)mmo/L,P<0.05],青春期女性儿童组TG显著高于无家族史者([1.26±0.75)mmo/L、(1.20±0.66)mmo/L,P<0.05];有二级家族史者,各年龄阶段男性儿童组TC及TG均显著高于无家族史者(P<0.05),各年龄组女性儿童TC均显著高于无家族史者(P<0.05)。将肥胖作为混杂因素行协方差分析后,有不同家族史背景的各年龄性别分组儿童TC水平差异仍有统计学意义(P<0.05)。学龄期男性儿...     

心内膜弹力纤维增生症的心功能改变:多普勒组织显像与传统功能指标对比

为探讨心内膜弹力纤维增生症(EFE)的心功能改变及病变部位,采用多普勒组织显像(DTI)及传统超声心动图(UCG)检查了10例EFE和143例正常儿童,结果DTI指标中二尖瓣环收缩期及舒张早期运动速度(MVR-SV及MVR-DeV)、左室后壁心内膜收缩期及舒张期运动速度(LVPW-EnSV、LVPW-EnDV)全部病例显著降低。其异常率高于传统心功能指标。二尖瓣血流E峰与A峰之比在EFE显著降低。结论:DTI为EFE的诊断、病变部位的确定、心功能的了解提供了一个敏感而实用的新方法;E/A对鉴别EFE与扩张型心肌病(DCM)有重要参考价值。     

心肺联合支持治疗心内膜弹力纤维增生症32例临床分析

心内膜弹力纤维增生症(E FE)患儿常因呼吸道感染诱发心力衰竭,病情进展迅速,导致心源性休克与心跳骤停。我们应用心肺联合支持治疗32例心内膜弹力纤维增生症合并心力衰竭,疗效显著,现报道如下。1对象和方法1.1对象我科2000年5月～10月收住的32例心内膜弹力纤维增生症伴发心力衰竭患儿为观察组,其中男18例,女14例;平均年龄1.2岁,0～6个月20例,～12个月6例,～3岁4例,～15岁2例。对照组22例,来自同期我院儿童心血管科,男14例,女8例;平均年龄1.4岁,0～6个月14例,～12个月4例,～3岁2例,～15岁2例。1.2方法心力衰竭、呼吸衰竭的诊断符合《诸福棠…     

MR findings of endocardial fibroelastosis in children

Background Endocardial fibroelastosis (EFE) is characterized by a diffuse white fibrous tissue lining the endocardium. The diagnosis is difficult to establish because clinical symptoms and electrocardiographic findings are nonspecific. Surgical resection of EFE requires the establishment of the diagnosis and delineation of the extent of the fibrotic changes. Objective To describe the use of MRI in the assessment of EFE in children. Materials and methods Three children after surgery for aortic stenosis who were suspected of having EFE were evaluated by echocardiography and MRI. The MR evaluation consisted of black-blood, triple IR, bright-blood, perfusion and myocardial delayed-enhancement sequences. EFE was confirmed at surgery in all patients. Results Echocardiograms demonstrated vigorous systolic function but substantial diastolic dysfunction of the left ventricle in all. Mild endocardial brightening of the anterior septum, anterior wall, or papillary muscles was present in two. No study was thought to be diagnostic of endocardial fibrosis. On MRI EFE manifested at the endocardial surface as a rim of hypointense signal in the perfusion sequences and as a rim of hyperintense signal in the myocardial delayed-enhancement sequences. The black-blood, triple IR, and bright-blood sequences were not diagnostic. Conclusion The diagnosis of EFE is difficult to establish by echocardiography. MRI using perfusion and myocardial delayed enhancement can be useful in establishing the diagnosis.     

心内膜弹力纤维增生症患儿降钙素基因相关肽和内皮素的变化及其临床意义

为探讨降钙素基因相关肽（CGRP）、内皮素（ET）在心内膜弹力纤维增生症（EFE）中的作用。应用放射免疫法测定18例EFE患儿血浆CGRP和ET水平,X线胸片测心胸比率（CTR）,彩色超声心动图检测心脏收缩功能。结果表明：EFE患儿血浆CGRP降低而ET升高,CGRP与ET呈负相关;经治疗病情好转后,血浆CGRP回升而ET下降;EFE患儿血浆CGRP、ET与CTR及心脏收缩功能有关。本研究提示,CGRP降低和ET升高两者协同作用可能是促进EFE心衰发生发展的原因之一。EFE患儿血浆CGRP、ET监测为估计病情、预后和疗效判断提供客观参考依据;治疗EFE时应重视纠正失衡的体液因子水平。     

卡维地洛治疗原发性心内膜弹力纤维增生症的研究

目的 观察原发性心内膜弹力纤维增生症(endocardial fibroelastosis,EFE)患儿血浆脑利钠肽(brain natriuretic peptide,BNP)变化及卡维地洛的临床疗效,探讨治疗剂量、方案及安全性.方法 21例原发性EFE患儿分为2组,常规治疗组(n=10)及卡维地洛治疗组(n=11),治疗前及治疗后6个月进行多普勒超声心动图检测、观察血浆BNP;观察2组治疗前后血浆BNP水平、临床症状、心胸比例、心率的变化、心功能的改善、患儿对卡维地洛的耐受量及不良反应.结果 原发性EFE患儿血浆BNP水平[(865±702)ng/L]明显高于正常对照组[(154±78)ng/L](P＜0.01),且心功能越差升高越明显,心功能Ⅱ、Ⅲ、Ⅳ级分别为(286±125)ng/L、(437±386)ng/L、(1673-s-859)ng/L;卡维地洛治疗后血浆BNP水平[(219±87)ng/L]低于常规组[(403±216)ng/L](P＜0.05),临床症状明显改善,患儿心胸比例降低,心率减慢,射血分数(EF)、短轴缩短率、平均左室周径缩短率显著提高(P＜0.01),左室收缩末期内径(P＜0.05)、左室质量、室间隔收缩末厚度明显降低(P＜0.01).结论 原发性EFE患儿血浆BNP水平显著升高,与EF呈负相关;卡维地洛可以降低血浆BNP水平,明显抑制EFE患儿心室重塑,改善患儿的心功能;心功能Ⅱ～Ⅳ级原发性EFE患儿卡维地洛长期治疗安全有效.     

Anomalous origin of right pulmonary artery from ascending aorta with right ventricular endocardial fibroelastosis

Summary A case of aortic origin of the right pulmonary artery with right ventricular endocardial fibroelastosis is reported. Its diagnostic features, surgical aspects, and postmortem findings are discussed. This is a rare combination. The relevant literature is reviewed.     

原发性心内膜弹力纤维增生症75例远期疗效

目的 总结分析心内膜弹力纤维增生症(EFE)患儿治疗后的临床效果及转归,分析不同治疗方法在改善预后中的作用.方法 回顾性分析1984年8月至2006年6月曾在首都医科大学附属北京安贞医院小儿脏科住院的75例特发性婴幼儿EFE临床及随访资料.结果 本组男40例,女35例,发病年龄20 d～2岁8个月,出院后继续门诊规律治疗及随访69例,随访率92%,门诊随访时间6个月～23年(平均5.7年).随访过程中6例(8.7%)死亡.治愈率46.4%(32/69),好转率40.6%(28/69),总治愈好转率87.0%.全组治疗2年左室射血分数(EF)(55.86%±2.85%)恢复正常,治疗后1、3、5、10年左室EF正常率分别为42.6%(26/61)、64.4%(29/45)、70.7%(29/41)和84.6%(22/26).治疗3年胸部X线心胸比例(C/T)(0.50±0.01)恢复正常.治疗3年左室舒张末径(LVDD)平均值未恢复正常,治疗后1、3、5、10年正常率分别为0%(0/61)、13.3%(6/45)、53.7%(22/41)和84.6%(22/26).EFE患儿首诊评分<22分37例(糖皮质激素组),治疗1年左室EF平均值恢复正常(EF值58.44%±5.10%),治疗2年胸部X线C/T平均值恢复正常(0.50±0.00).EFE患儿首诊评分≥22分29例(糖皮质激素+环磷酰胺组),治疗3年左室EF平均值恢复正常(57.33%±3.43%),治疗3年C/T、LVDD平均值未恢复正常.加用IVIG使应用环磷酰胺治疗病例的百分比下降,选择年龄相当左室EF≤40%的IVIG组21例及非IVIG组19例,临床需加用环磷酰胺的病例分别为7例(33.3%)及11例(57.9%).EFE心内膜厚度恢复正常较慢,平均4年(1～8年).治疗后1、3、5、8年心内膜恢复正常率分别为9.8%(6/61)、22.2%(10/45)、51.2%(21/41)及100%(29/29).结论 对EFE患儿长期规范不间断治疗至痊愈的远期效果良好.重症及难治性EFE需加强免疫治疗,维持治疗时间亦较长.临床治愈的患儿停药后仍应限制活动量并定时复查,及时发现心功能的变化并给予及时治疗可改善远期效果.     

婴幼儿先天性心脏病并心内膜弹力纤维增生症的临床特点

目的研究婴幼儿先天性心脏病(CHD)并心内膜弹力纤维增生症(EFE)的临床及实验室特点,诊断和治疗。方法对本院收治婴幼儿CHD并EFE患儿的临床及实验室检查资料进行回顾性分析、总结。结果3166例CHD中21例(0.66%)并EFE,其中动脉导管未闭(PDA)5例,房间隔缺损(ASD)6例,室间隔缺损(VSD)6例,PDA VSD 1例,ASD VSD 2例.法洛四联症1例。临床有不同程度心力衰竭,多伴肺炎,心脏增大较明显,起病绝大多数较急,病情多较重.预后较差。结论CHD是引起EFE的原因之一,但不除外其他原因尤其是病毒感染导致EFF;疾病预后可能与心脏扩大程度、心力衰竭程度、并发症严重程度及治疗及时与否有关。     

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??Abstract??Objective??To evaluate the diagnostic value of susceptibility weighted imaging ??SWI?? in cerebral vascular malformation of children. Methods??The imaging data of MRI were retrospectively analyzed in all twenty-seven cases?? which included 16 cases of venous angioma?? 8 cases of cavernous angioma and 3 cases of arterio-venous malformation. The comparison of SWI and conventional MR sequences was obtained. Results??The dilated draining veins and medulla veins were displayed well on SWI sequence. More brain cavernous angioma lesions could be detected on SWI than those on conventional MR sequences??P < 0.05??. Conclusion??SWI can detect lesions of venous angioma?? cavernous angioma and arterio-venous malformation more sensitively than other sequences?? which is a reliable diagnostic technique for cerebral vascular malformation of children. SWI has higher clinical value?? and should be the routine sequence in the MRI examination.