不同参考标准下重庆城区儿童超重／肥胖检出率比较

目的比较3种筛查标准下重庆城区儿童超重/肥胖现况,寻求适宜的儿童肥胖筛查标准。方法按照整群抽样原则抽取本市3个城区的12534名2～18岁儿童作为调查对象,测量其身高及体质量。并分别采用WHO的身高标准体质量法标准(标准1)、国际肥胖工作组(IOTF)的超重/肥胖体质量指数(BMI)标准(标准2)和国立卫生统计中心/疾病预防控制中心(NCHS/CDC)的BMI标准(标准3)评价儿童的超重/肥胖。结果按照标准1、2和3的规定,重庆城区儿童的超重检出率分别为13.0%、9.8%、9.8%;肥胖检出率分别为9.8%、2.9%、6.0%,均有显著性差异(Pa<0.001),且男童超重/肥胖检出率均高于女童。3种标准间,健康儿童、超重儿童或肥胖儿童的BMI均值均有显著性差异(Pa<0.001)。采用标准1和2得到的超重检出率,或采用标准1和3得到的超重检出率均在6岁前和14岁后2个年龄段存在统计学差异(Pa<0.01)。在2～6岁各年龄组,采用标准1和3得到的儿童肥胖检出率比较无显著性差异;在6～18岁各年龄组,采用标准1得到的肥胖检出率均显著高于采用标准2和3得到的肥胖检出率(Pa<0.01);在3～6岁、8～10岁、13岁组采用标准2和3得到的儿童肥胖检出率比较有显著性差异。结论儿童肥胖已经成为重庆城区重要的健康问题之一。采用3种标准筛查的儿童超重/肥胖检出率在2～18岁各年龄组均有所不同,应谨慎使用。     

儿童单纯性肥胖相关性肾病

随着肥胖患者的日益增多,单纯性肥胖相关性肾病(ORG)正在成为一种世界范围的“流行性”疾病.目前人们对单纯性肥胖所导致的肾损害进行了深入的研究,但是临床研究资料几乎均来自于成人,对于儿童ORG的关注程度较低,很少有关儿童ORG的研究报道.儿科医师应加强对ORG的认识,以提高诊断和治疗水平.     

男性单纯性肥胖患儿性发育的变化

目的 探讨男性单纯性肥胖患儿性发育的影响。方法 检测42例8-14岁男性单纯性肥胖儿童睾丸容积、阴茎横径长度、血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）、睾酮（TTT）、泌乳素（PRL）、皮质醇（Cortisol）并与正常对照组比较。结果 患儿睾丸容积、阴茎大小及长度，血清FSH、LH、TTT均低于正常对照组，并与其肥胖程度呈负相关。PRL、E2、Cortisol均高于正常对照组，且与其肥胖程度呈正相关。结论 男性单纯性肥胖儿童具有性发育不良倾向。     

儿童单纯性肥胖血清瘦素水平分析

目的：比较单纯性肥胖儿童与正常健康儿童血清瘦素的水平，分析血清瘦素与空腹胰岛素之间的关系。方法：选择单纯性肥胖儿童30例，健康非肥胖儿童30例作对照组，分别测定其空腹胰岛素与瘦素水平。结果：单纯性肥胖组血清瘦素明显高于对照组（P＜0．001），瘦素与空腹胰岛素呈显著性相关（r=0.854，P＜0．001）。结论：单纯性肥胖儿童体内存在高胰岛素血症，同时存在瘦素抵抗，胰岛素与瘦素的调控是双向的。     

单纯性肥胖儿童的内分泌检测及其临床意义

为进一步探讨单纯性肥胖儿童体内内分泌情况及其临床意义,１９９６年３月至１９９７年１２月我们对３５例单纯性肥胖儿及２０例正常儿进行内分泌检测,报告如下。对象与方法一、对象　３５例单纯性肥胖儿均排除了内分泌及遗传代谢性疾病,按世界卫生组织推荐的标准分型,其中男１９例,女１６例,年龄３～１４ａ。病程５ｍｏ～７ａ。３５例中轻度肥胖４例,中度１３例,重度１８例。二、方法　均于早晨取静脉血３ｍｌ,分离血清后－２０℃冻存。采用放射免疫法,国产放射免疫测定盒分别测定血清三碘甲状腺原氨酸（Ｔ３）,血清甲状腺素（Ｔ…     

单纯性肥胖儿童生长激素及身高的变化

目的：研究单纯性肥胖儿童生长激素水平及身高的变化，探讨发生这种变化的机制。方法：采用双抗体放射免疫法分别对30例单纯性肥胖儿童及23例同龄正常儿童的生长激素（GH）、胰岛素(Ins)及C－肽（CP）水平进行测定，同时对包括上述儿童在内的117例肥胖儿童及正常儿童的身高进行3年的动态观察。结果：肥胖组与对照组比较，GH水平明显下降（P＜0．01），但两组身高变化无明显差异（P＞0．05）。结论：肥胖儿童GH水平明显低于正常儿童，但目前并未发现生长障碍。肥胖儿童GH水平升高与Ins、血脂水平降低三者之间互为因果，与肥胖形成恶性循环。基于GH的融脂作用，近年来应用GH治疗肥胖成为新的探讨途径之一。     

单纯性肥胖儿童血糖水平及相关性探讨

随着现代生活水平的不断提高及生活方式的变更,儿童单纯性肥胖发生率呈上升趋势。肥胖与多种严重危害人类健康的疾病,如糖尿病、冠心病、高血压、高脂血症等密切相关。为了解肥胖儿童糖代谢的特点,我们对118例单纯性肥胖儿童的糖代谢进行了探讨。     

单纯性肥胖儿童生长发育的10年追踪调查分析

单纯性肥胖儿童的生长发育有不同于一般儿童的表现,如身高水平高于同龄儿童,骨龄提前,重度肥胖儿童的人格发育也会受到一定影响。为观察这些发育表现在儿童生长发育过程中的变化,本文以1988年调查的102名单纯性肥胖儿及102名对照儿为观察对象,在1998年进行了追踪调查,兹总结如下。     

Obesity in children

The alarming increase in obesity in children has become a major health problem in the increased incidence of type 2 diabetes as well as other complications including cardiovascular diseases, hepatic disorders, skeletal abnormalities, malignancies and in particular psychological disorders. Mechanisms of appetite and energy metabolism are mediated through hormones leptin and ghrelin, and neuropeptide-Y neurons as well as genetic factors. Control of obesity is largely through appetite control and physical exercise.     

Bodyfat percentage in girls increased steadily with age and percentile rank of body mass index

BACKGROUND: The purpose of the present study was to determine the body composition of elementary school children by bioelectrical impedance analysis (BIA) method with a subject in a standing position. The method is frequently used in Japan. The other aim was to evaluate the relationship between the body composition and percentile rank of the body mass index (BMI) in Japanese children. METHODS: The number of subjects were 1042 children (530 boys and 512 girls aged from 6- to 12-years-old) from an elementary school. The bioelectrical impedance (BI) in the standing position was measured late in the morning before lunch. The fat percentage was derived from the body density according to the formula of Brozek et al. Each percentile value of BMI for each age and sex was determined from the frequency table of height and weight published by the Ministry of Education in Japan. RESULTS: The fat percentage in both boys and girls was significantly correlated with the BMI, however, girls showed a closer linear relation than boys. The fat percentage in girls increased steadily with age and percent rank of the BMI. The fat percentage in boys was scattered in a wide range at each percentile rank of the BMI. CONCLUSIONS: The fat percentage measured by the BIA in the standing position is closely associated with the percentile rank of the BMI in elementary school girls. For boys, it will be necessary to compare data among different types of BI measurement methods.     

综合康复治疗单纯性肥胖儿童阴茎短小30例

目的探索单纯性肥胖儿童阴茎短小的治疗方法。方法单纯性儿童阴茎短小60例分为试验组和对照组各30例。试验组予综合方法减肥和用阴茎短小康复仪治疗,对照组给予行为、饮食、运动指导和阴茎短小康复仪治疗。结果试验组治疗后体质量均有下降,下降幅度(7.75±3.50)kg,体质量指数(BMI)由治疗前(31.10±3.88)下降至(27.82±3.49),两者有显著差异(t=12.68 P<0.01),对照组1个月后BMI(30.89±2.60)明显高于试验组(P<0.01);治疗后试验组阴茎长度由治疗前(1.81±0.76)cm增加至(3.45±1.20)cm,两者比较有显著性差异(t=16.35 P<0.01),其中16例治疗后阴茎长度已达到同龄阴茎的正常范围;对照组阴茎长度由治疗前(1.79±0.70)cm增加至(2.73±1.50)cm,其中3例治疗后阴茎长度已达到同年龄阴茎的正常范围,试验组治疗效果明显优于对照组(t=11.34 P<0.01)。结论在减肥治疗的基础上,配合阴茎短小治疗仪对阴茎进行局部康复治疗是治疗肥胖儿童阴茎短小的较好治疗方法。     

单纯性肥胖儿童临床与血脂成分分析

目的对单纯性肥胖儿童临床与血脂成分进行分析,探讨单纯性肥胖儿童血脂代谢紊乱情况及临床意义。方法对50例2.5~16.0岁单纯性肥胖儿童与40例正常同年龄儿童的临床及血脂成分进行分析,应用生化分析仪检测血脂,包括三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)。应用超声诊断仪进行肝脏检查。结果1.单纯性肥胖与对照组儿童年龄与身高无显著差异,而体质量与体质量指数(BMI)、血压(BP)两组间差异均有非常显著意义(P均<0.001)。2.单纯性肥胖儿童血清TC、TG、LDL的浓度明显高于对照组,差异均有显著性(P均<0.001),HDL浓度两组比较其差异无统计学意义(P>0.05)。3.单纯性肥胖18例(36%)儿童肝脏B超示存在脂肪肝。结论单纯性肥胖儿童存在血脂代谢紊乱,血清TC、TG、LDL浓度均明显升高,预防动脉粥样硬化性心血管疾病必须从儿童时期开始。     

低危骨髓增生异常综合征的诊断和治疗

目的探讨小儿低危骨髓增生异常综合征（MDS）的临床诊疗特点,提高小儿低危MDS诊疗水平。方法分析17例低危MDS的辅助检查特点,监测治疗药物环孢素血药质量浓度,评价治疗效果。结果血常规检查示三系减少11例（64.7%）,二系减少5例（29.4%）,一系减少1例（5.9%）;82.4%（14/17）网织红细胞计数增高,3例正常。17例中骨髓增生活跃14例（82.4%）,增生低下3例（17.6%）。其中一系病态造血8例（47.1%）,二系病态造血7例（41.2%）,三系病态造血1例（5.9%）,无病态造血1例（5.9%）。骨髓细胞遗传学检查示染色体正常10例（58.8%）,异常7例（41.2%）。15例CD59阴性细胞比例在正常范围,占88.2%;2例略高。9例于治疗3周测环孢素血药质量浓度95.3-316.5μg/L。10例于治疗3个月时进行疗效评价。其中血液学改善8例,血液学无改善2例,总改善率80%。结论低危MDS患儿多为学龄期儿童,全血细胞减少最多见。泼尼松、环孢素和司坦唑醇的联合治疗对低危型MDS效果较好。环孢素个体吸收差异较大,临床应用时应定期监测血药质量浓度,并随时调整剂量。     

An update in prevention and treatment of pediatric obesity

Background  Obesity prevalence is growing as well as its severity with increasing morbidity and mortality. This “globesity” also affects developing countries where under nutrition and stunting frequently coexist with overweight and obesity. One third of obese adults began to be so in the pediatric ages. There are two main types of prevention: general one representing greater actions from health authorities and the individual one carried out by the pediatrician and the patient at risk. Once the state of obesity is reached (relative body mass index, rBMI >121%) the longer lasting care becomes more complex and frequently unsuccessful. The treatment of obesity is aimed to care for the present and silent disorders and for preventing its further tracking to adulthood. Data sources  Identification of pediatric population at risk which is the one with an rBMI of 111%–120% plus other risk factors. Specific individual actions include reduction of food intake, increase of energy expenditure, involvement of parents, and the child-adolescent himself in the prevention. Therapy is based on some principles plus the important medical and emotional approach. Results  A Cochrane study based on only 10 appropriate studies showed a predominant poor efficacy of the undergone preventive action. Treatment guides are presented after our own experience with a group of 400 kids with an average follow-up of 7 years and other individual prevention studies. Conclusions  Involving motivated pediatricians with a minimum of time for visits and better follow-up in the frame of a general national preventive programme could be a rational outcome. Treatment of obesity should never be postponed whatever the clinical care is.     

Association between birthweight and body mass index at 3 years of age

BACKGROUND: Obesity in children is one of the risk factors for adulthood obesity, which then leads to the development of chronic diseases such as hypertension, hyperlipidemia and diabetes. In this study, we identified significant factors associating with the body mass index (BMI) at 3 years of age from the perinatal characteristics of children. METHODS: A total of 588 children were included in the study. The BMI at 3 years of age was examined in conjunction with the possible variables such as parents' smoking status during pregnancy, parents' age at birth, gestational age, sibling number and live birth order, sex, birthweight, BMI at 1 month of age, weight gain during the first month of life and feeding method at 1 month of age. RESULTS: Univariate analysis showed that birthweight (P<0.0001), weight gain during the first month of life (P=0.0012) and BMI at 1 month of age (P<0.0001) were significantly associated with the BMI at 3 years of age. Of these factors, birthweight and weight gain during the first month of life were the independent factors correlating with the BMI at 3 years by multivariate analysis (P<0.0001 and P=0.0095, respectively). CONCLUSIONS: Infants with higher birthweight and/or greater weight gain during the first month of life may have a risk of being overweight at 3 years of age.     

单纯性肥胖对儿童肾功能的影响

目的探讨单纯性肥胖对儿童早期肾功能的影响及其发生机制。方法选择70例单纯性肥胖患儿为单纯性肥胖组,50例健康儿童为健康对照组,测量二组儿童身高和体质量,计算体质量指数(BMI);采用放射免疫法检测二组儿童24h尿微量清蛋白(Alb)、β2微球蛋白(β2-MG)和α1微球蛋白(α1-MG)水平,采用SAS8.0软件比较二组BMI、24h尿Alb、β2-MG及α1-MG的差异,分析二组BMI与24h尿Alb的相关性。结果单纯性肥胖组BMI、24h尿Alb水平均显著高于健康对照组(t=15.14,P<0.001;t=4.084,P<0.001),单纯性肥胖组尿β2-MG及α1-MG水平与健康对照组比较差异均无统计学意义(t=1.847,P>0.05;t=1.936,P>0.05),单纯性肥胖组BMI与24h尿Alb水平呈显著正相关(r=0.626,P<0.01)。结论儿童单纯性肥胖可致肾功能损伤,早期主要表现为肾小球功能受损,尿Alb可作为评价单纯性肥胖患儿早期肾功能损害的指标之一,单纯性肥胖患儿肾功能损害程度与肥胖程度有关。