婴幼儿佝偻病血清诊断指标探讨

应用竞争蛋白结合法测定佝偻病血清２５（ＯＨ）Ｄ３浓度，同时测定了血清钙（Ｃａ）、磷（Ｐ）、碱性磷酸酶（ＡＬＰ）、尿羟脯氨酸与肌酐比值（ＴＨＰ／Ｃｒ）。结果显示：佝偻病患儿血清２５（ＯＨ）Ｄ３值降低，ＡＬＰ、尿ＴＨＰ／Ｃｒ值增高。相关分析显示，血清２５（ＯＨ）Ｄ３与Ｃａ、Ｐ无相关性（Ｐ＞００５）；与ＡＬＰ、ＴＨＰ／Ｃｒ呈负相关（Ｐ＜００１，Ｐ＜００５）。说明血清２５（ＯＨ）Ｄ３、ＡＬＰ、ＴＨＰ／Ｃｒ对佝偻病有诊断价值，血清Ｃａ、Ｐ对佝偻病诊断有参考价值。     

CCHD的血液粘度与红细胞压积以及动脉血氧饱和度的关系

对２０例紫绀型先天性心脏病（ＣＣＨＤ）和１８例对照组检测血液流变学有关指标。观察组全血粘度（ＷＢＶ）和红细胞压积（ＨＣＴ）明显高于对照组，差异显著，Ｐ〈０．０１。观察组ＨＣＴ与ＷＢＶ有明显正相关（ｒ＝０．７３２）观察组动脉血氧饱和度（ＳＡＴ）０．８±０．０６，明显低于正常值，而ＳＡＴ与ＷＢＶ有明显负相关（ｒ＝－０．８９），本研究提示，ＳＡＴ和ＨＣＴ可做为ＣＣＨＤ患儿可能出现高粘综合征（ＨＶＳ），脑     

反复呼吸道感染患儿血清β－胡萝卜素、维生素A、E含量测定及分析

用高效液相色谱测定３４例反复呼吸道感染患儿血清β－胡萝卜素、维生素Ａ（ＶｉｔＡ）与维生素Ｅ（ＶｉｔＥ）的含量。同时测定了血清免疫球蛋白水平。结果显示：①患儿组β－胡萝卜素及ＶｉｔＡ含量明显低于对照组（Ｐ＜０．０５及Ｐ＜０．０１），两组ＶｉｔＥ则无显著性差异。②亚临床型ＶｉｔＡ缺乏在患儿组为２４例（２４／３４例，７０．５％），对照组中为１３例（１３／４０例，３２．５％），有显著性差异（Ｘ２＝１０．６６，Ｐ＜０．００５）。临床型ＶｉｔＡ缺乏则在两组均未见到。③患儿组ＩｇＡ水平与β－胡萝卜素、ＶｉｔＡ的相关系数ｒ分别为０．３５４（ｔ＝２．２５，Ｐ＜０．０５）及０．３２２（ｔ＝１．９２４，Ｐ＜０．０５），均显著相关。ＩｇＧ及ＩｇＭ则与两种维生素之间均无显著相关。提示，β－胡萝卜素和ＶｉｔＡ缺乏时ＩｇＡ水平降低，与呼吸道易受感染可能有关。防治反复呼吸道感染时宜服用β－胡萝卜素及／或ＶｉｔＡ，以前者防治效果为优。     

99mTc-DMSA肾静态显像对上尿路感染诊断的评价

目的 评价＾９９ｍＴｃ－ＤＭＳＡ肾静态显像对上尿路感染的诊断价值。方法 对３０例发热（体温≥３８．５℃）,尿培养阳性和尿路感染患儿进行＾９９ｍＴｃ－ＤＭＳＡ肾静态显像检查,并与泌尿系统Ｂ超检查结果和尿视黄醇结合蛋白与肌酐测定比值（ＲＢＰ／Ｃｒ）进行对比分析。     

心肌疾病抗ADP/ATP载体抗体与粒细胞-巨噬细胞集落刺激因子的临床研究

目的探讨病毒性心肌炎（ＶＭＣ）和扩张型心肌病（ＤＣＭ）的自身免疫发病机制。方法采用免疫印转和放射免疫技术检测了３０例ＶＭＣ、１４例ＤＣＭ患儿血浆中抗心肌线粒体ＡＤＰ／ＡＴＰ运载蛋白（ＡＮＴ）抗体和粒细胞－巨噬细胞集落刺激因子（ＧＭ－ＣＳＦ）。结果ＶＭＣ和ＤＣＭ患儿抗ＡＮＴ抗体和ＧＭ－ＣＳＦ的阳性率分别为７３％和５７％，而２５例正常健康儿分别为０和１２％（Ｐ均＜０．０１），且抗ＡＮＴ抗体与ＧＭ－ＣＳＦ的血浆水平呈正相关（ｒ＝０．４０９１，Ｐ＜０．０５）。结论小儿ＶＭＣ和ＤＣＭ的发病与心肌的自身免疫损伤有关，抗ＡＮＴ抗体和ＧＭ－ＣＳＦ均参与了这一过程。抗ＡＮＴ抗体可作为小儿ＶＭＣ和ＤＣＭ的一种特异性诊断指标。     

泛影葡胺对先天性心脏病患儿肾功能的影响

本文观察了造影剂泛影葡胺对先天性心脏病（ＣＨＤ）患儿肾脏功能的影响。结果发现，虽然造影后血清肌酐，尿素氮、β２—微球蛋白（β２—Ｍ）无明显改变，但尿β２—Ｍ、／血β２—Ｍ比值明显升高（Ｐ＜０．０１），特别是当造影剂总量超过４．５ｍｌ／ｋｇ时，二者的升高更为明显，对紫绀型ＣＨＤ患儿尤其如此。本文讨论了泛影葡胺对ＣＨＤ患儿肾脏功能的损伤作用及其与剂量的关系。     

长期吸入丙酸倍氯松的哮喘儿童肾上腺皮质功能的观察

为了解长期吸入激素对儿童肾上腺皮质功能的影响，随机选取吸入丙酸倍氯松（ＢＤＰ）治疗６个月以上（最长５１个月，平均２４个月）的哮喘患儿３０例，通过放射免疫法进行２４小时尿游离皮质醇（２４ｈｒ－ＵＦＣ）测定，并对其中９例进行ＡＣＴＨ刺激试验。选择未经吸入治疗的哮喘患儿及正常儿童各３０例作为对照组。结果：吸入丙酸倍氯松每天２００～４００μｇ的３０例哮喘患儿２４ｈｒ－ＵＦＣ中位数为２２．４μｇ／２４ｈ，未经吸入组与正常对照组儿童２４ｈｒ－ＵＦＣ中位数分别为２１．０μｇ／２４ｈ与２４．９μｇ／２４ｈ，各组之间经秩和检验，差异均无显著意义；吸入治疗的３０例患儿中，９例做了ＡＣＴＨ刺激试验，结果正常。提示：哮喘儿童每天吸入ＢＤＰ２００～４００μｇ是一个比较安全的剂量。     

视觉运动整合发育测验和团体儿童智力测验的相关研究

为了进一步明确视觉－运动整合发育测验（ＶＭＩ）对儿童智能发育评估的应用价值，采用ＶＭＩ测验和团体儿童智力测验（ＧＩＴＣ），对２１０名９～１８岁的被试者进行测查。结果表明：（１）ＶＭＩ测验得分与ＧＩＴＣ各分测验均有较好的相关性（ｒ＝０．２６～０．６３，Ｐ＜０．０１），与空间分测验的相关性最好（ｒ＝０．６３，Ｐ＜０．０１）；在多元逐步回归分析中，与ＶＭＩ测验得分偏相关系数最大的亦是ＧＩＴＣ中的空间分测验。（２）随着父亲文化程度的提高，儿童的ＶＭＩ测验得分依次增高，其差值有显著意义。提示ＶＭＩ测验具有较好的平行效度；父亲的文化程度对儿童视觉运动整合能力的发展有明显的影响作用。     

407例新生儿抗—HCV调查

４０７例血清ＨＢｓＡｇ阳性母亲分娩的婴儿，于出生后２４－３６小时内用ＥＬＩＳＡ法检测其血清的抗－ＨＣＶ，阳性率为４．６７％（１９／４０７），其中１０５例母亲产前检测血清抗－ＨＣＶ，９例阳性，检出率为８．５７％。此９例抗－ＨＣＶ阳性的母亲所生婴儿有４例抗－ＨＣＶ阳性，而９６例抗ＨＣＶ阴民生的母亲所生婴儿只有３例抗－ＨＣＶ阳性，差异非常显著（ｘ＾２＝２２．５７，Ｐ〈０．００１），提示ＨＣＶ存在母婴生趣     

套式聚合酶链反应加限制酶分析检测母婴巨细胞病毒感染

为评价套式聚合酶链反应（套式ＰＣＲ）加限制酶分析在孕妇巨细胞病毒感染及其母婴宫内传播检测中的应用，采用套式ＰＣＲ加限制酶分析，病毒分离、电镜观察和特异性抗体测定，对各孕期孕妇外周血，脐血及死胎组织进行人巨细胞病毒（ＨＣＭＶ）检测。结果：３６７名孕妇ＨＣＭＶ阳性检出率为５．５％，其中，套式ＰＣＲ检出率（４．９％）高于病毒分离（３．０％，Ｐ＜０．０５）。６份ＨＣＭＶＤＮＡ阳性母血中，３份配对脐血ＨＣＭＶＤＮＡ也阳性，母－脐传播率为３／６。３对被证实为母－婴宫内传播ＨＣＭＶ的标本中，２对套式ＰＣＲ，病毒分离及特异性ＩｇＭ、ＩｇＡ均阳性，１对套式ＰＣＲ、病毒分离、特异性ＩｇＡ阳性，ＩｇＭ阴性。提示：套式ＰＣＲ能提高诊断ＨＣＭＶ的特异性与敏感性，对孕妇及胎儿／新生儿ＨＣＭＶ感染的研究有重要意义。     

高效液相色谱法检测尿中儿茶酚胺代谢产物含量在神经母细胞瘤早期诊断中的价值

目的　尿中香草扁桃酸 (VMA)及高香草酸 (HVA)的检测是目前早期诊断神经母细胞瘤 (NB)的重要指标 ,以前的检测方法干扰因素多 ,结果不够准确。该文探讨高效液相色谱法 (HPLC)检测随机尿中VMA、HVA的含量在NB诊断和早期诊断中的价值。方法　用HPLC方法 (流动相 pH4 .3,甲醇含量 2 % ,正辛烷磺酸钠溶液 3.0mmol/L)检测 5 0例正常儿童 (正常对照组 )、2 7例NB患儿 (NB组 )及 1 5例急性淋巴细胞性白血病患儿(ALL组 )随机尿中VMA、HVA浓度。用比色法测定同一样品中肌酐浓度。以VMA、HVA与肌酐的比值表示VMA、HVA含量。结果　NB组患儿随机尿VMA/Cr及HVA/Cr的含量 (5 1 .6 0± 4 .5 3μmol/ μmolCr,5 8.0 0±3.75 μmol/ μmolCr)明显高于正常对照组 (8.4 2± 3.6 1 μmol/ μmolCr,1 0 .1 2± 3.88μmol/ μmolCr)及ALL组患儿(8.78± 3.5 0 μmol/ μmolCr,1 1 .5 0± 2 .6 8μmol/ μmolCr) ,其差异均有显著性 (P <0 .0 5 )。以正常对照组儿童随机尿中VMA/Cr及HVA/Cr均值加 2 .5个标准差为异常判定值 ,分别为 1 7.5、1 9.8μmol/ μmolCr,超过此值为异常 ,则尿VMA/Cr或HVA/Cr异常对NB的诊断效率为 96 .3%。结论　HPLC同时测定随机尿中VMA、HVA含量 ,能为NB的早期诊断提供可靠的实验依据 ,并且可用于NB的诊断     

库仑阵列电化学测定尿儿茶酚胺代谢物方法的建立及其在神经母细胞瘤诊断中的应用

目的 建立以反相液相色谱-库仑阵列电化学联用紫外检测法同时测定随机尿液中儿茶酚胺代谢产物方法,并应用于0～10岁儿童正常值范围的确立及神经母细胞瘤的诊断.方法 反相液相色谱梯度洗脱法分离样品,库仑阵列电化学定量检测VMA和HVA的浓度,紫外检测器检测Cr的浓度.以VMA/Cr和HVA/Cr表示尿儿茶酚胺代谢物的含量.对该法进行系统性评价后应用于120例健康儿童和15例神经母细胞瘤患儿随机尿样的测定中.结果 VMA、HVA和Cr的日内变异系数和日问变异系数均小于5%,线性相关系数均大于0.9990.回收率均大于95%.健康儿童VMA/Cr(2.99±1.77)μg/mg和HVA/Cr(3.40±1.50)μg/mg与年龄有显著相关性(P＜0.001),0～2岁组[VMA/Cr(4.04±1.24)μg/mg,HVA/Cr(4.87±1.81)μg/mg]与其他年龄组[2～4岁:VMA/Cr(3.02±0.81)μg/mg,HVA/Cr(3.46±1.06)μg/mg;4～6岁:VMA/Cr(2.68±0.95)μg/mg,HVA/Cr(2.75±1.04)μg/mg;6～10岁:VMA/Cr(2.32±0.95)μg/mg,HVA/Cr(2.61±0.84)μg/mg]差异均有统计学意义(P＜0.001).以低于(-x)+3s作为正常值,超过此范围诊断为神经母细胞瘤,对患儿诊断的符合率达93%.结论 本研究建立了同时快速准确检测随机尿样VMA、HVA和Cr的方法,并分年龄组建立了0～10岁儿童的正常值范围,为神经母细胞瘤的诊断和筛查提供了有效的参考指标和简单易行、准确灵敏的生化检验手段,也可用于与儿茶酚胺异常分泌相关的其他研究领域.     

Value of random urinary homovanillic acid and vanillylmandelic acid levels in the diagnosis and management of patients with neuroblastoma: comparison with 24-hour urine collections

Urinary homovanillic acid (HVA) and vanillylmandelic acid (VMA) levels were determined in random samples and in 24-hour collections from 13 patients with neuroblastoma and 22 patients without neuroblastoma. Random sample levels were compared with levels in 24-hour collections and showed a positive correlation of 95% for HVA (N = 59) and 93% for VMA (N = 52). No false positives or false negatives occurred using random samples for diagnosis. Nonneuroblastoma (normal) HVA (N = 126) and VMA (N = 119) levels are reported for different age groups. Sequential random HVA and VMA determinations in patients with neuroblastoma during and after therapy are shown. Random urinary HVA and VMA levels are shown to be adequate for utilization in the diagnosis of neuroblastoma and sequential determinations of random HVA and VMA are shown to be helpful in the follow-up of those patients.     

Optimising urinary catecholamine metabolite diagnostics for neuroblastoma

Introduction

The analysis of urinary catecholamine metabolites is a cornerstone of neuroblastoma diagnostics. Currently, there is no consensus regarding the sampling method, and variable combinations of catecholamine metabolites are being used. We investigated if spot urine samples can be reliably used for analysis of a panel of catecholamine metabolites for the diagnosis of neuroblastoma.

Methods

Twenty-four-hour urine or spot urine samples were collected from patients with and without neuroblastoma at diagnosis. Homovanillic acid (HVA), vanillylmandelic acid (VMA), dopamine, 3-methoxytyramine, norepinephrine, normetanephrine, epinephrine and metanephrine were measured by high-performance liquid chromatography coupled with fluorescence detection (HPLC-FD) and/or ultra-performance liquid chromatography coupled with electrospray tandem mass spectrometry (UPLC-MS/MS).

Results

Catecholamine metabolite levels were measured in urine samples of 400 neuroblastoma patients (24-hour urine, n = 234; spot urine, n = 166) and 571 controls (all spot urine). Excretion levels of catecholamine metabolites and the diagnostic sensitivity for each metabolite were similar in 24-hour urine and spot urine samples (p > .08 and >.27 for all metabolites). The area under the receiver-operating-characteristic curve (AUC) of the panel containing all eight catecholamine metabolites was significantly higher compared to that of only HVA and VMA (AUC = 0.952 vs. 0.920, p = .02). No differences were observed in metabolite levels between the two analysis methods.

Conclusion

Catecholamine metabolites in spot urine and 24-hour urine resulted in similar diagnostic sensitivities. The Catecholamine Working Group recommends the implementation of spot urine as standard of care. The panel of eight catecholamine metabolites has superior diagnostic accuracy over VMA and HVA.     

Catecholamine metabolites in ganglioneuroma

With rare exception, ganglioneuroma (GN) is a benign lesion which presents as a localized mass without metastatic potential and which is chemotherapy resistant. Thus, its distinction from neuroblastoma (NB) may be important. The diagnosis of GN implies the absence of neuroblastic elements. Incomplete resection prevents complete microscopic examination and raises the possibility that focal NB was not sampled. In an attempt to determine what features other than histology distinguish these two entities, we reviewed the charts of 25 patients with GN with regard to patient age and sex, tumor location and size, and urine catecholamine metabolite levels. One patient with GN (5%) and gross total resection had elevated quantitative vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels (2.4 × upper limit of normal for age), and two others had positive spot analyses for VMA. An additional patient with a large mass, multiple biopsies of which documented GN, also had greatly elevated (approximately 5 × normal) VMA and HVA levels. However, a subsequent attempt at resection disclosed several gross foci of NB. Even excluding this patient, there was a trend for elevated values in GN patients to correlate with tumor size (P = .07 and .14 for VMA and HVA, respectively). The incidence of elevated values appears to increase as a function of tumor size, and small tumors are not likely to result in positive urinary measurements. We conclude that while elevations of VMA and HVA are consistent with a well-documented diagnosis of GN, extreme elevations (>3 × nl) should prompt careful serial evaluation for occult NB.© 1994 Wiley-Liss, Inc.     

Comparative study of 24-hour calciuria and urinary calcium/creatinine ratio in children over 4 years of age]

The relationship between 24 hour urinary calcium excretion (U Ca/24 h) and urinary calcium/creatinine ratio (U Ca/creat) measured for morning and evening urine samples was studied in 56 children aged 4-15 years and hospitalized for benign conditions. Depending on the length of hospitalisation, 1 to 3 determinations of U Ca/24 h and U Ca/creat ratio were carried out for each child. Mean +/- SD U Ca/24 h was 0.05 +/- 0.058 mmol/kg. Mean U Ca/Cr, expressed in mmol/mmol, was 0.368 for total 24 h urine, 0.358 for the morning sample and 0.358 for the evening sample respectively. A good correlation was found between U Ca/24 h and 24 h U Ca/Cr ratio (r = 0.89), morning U Ca/creat (r = 0.83) and evening U Ca/creat ratio (r = 0.81) respectively. It is concluded that determination of the U Ca/Cr ratio for morning or evening urine samples is an efficient means of detecting hypercalciuria.     

Three years of experience with random urinary homovanillic and vanillylmandelic acid levels in the diagnosis of neuroblastoma

During the last 3 years, random urine samples from 408 patients were tested for elevated homovanillic acid (HVA) and vanillylmandelic acid (VMA) levels to rule out the diagnosis of neuroblastoma. Thirty-seven of these patients had elevated HVA and/or VMA levels, and neuroblastoma was subsequently diagnosed. In three additional patients with negative test results (normal HVA and VMA levels), tumors were subsequently diagnosed (false-negative rate of 7.5%). Ten percent of the patients with neuroblastoma had normal HVA and 27.5% had normal VMA levels at the time of diagnosis. Only one patient (2.5%) with neuroblastoma had elevated VMA levels in the presence of normal HVA levels. More than 60% of the patients with neuroblastoma had urinary HVA and/or VMA levels higher than twice the upper limit of normal. No false-positive results were encountered. Age and stage distributions of the patients are shown, and the significance of the results is discussed.     

Creatinine related reference ranges for urinary homovanillic acid and vanillylmandelic acid at 6 months of age

The relationship between homovanillic acid (HVA), vanillylmandelic acid (VMA), and creatinine in the urine of 6 month old babies has been studied and reference ranges in the form of centiles constructed for HVA and VMA against creatinine. Over 10,000 urine samples were collected from babies in four health districts in the north of England. HVA and VMA concentration, either independently or when divided by creatinine concentration, were dependent upon the absolute concentration of creatinine in the sample. After adjustment for creatinine significant differences in the mean concentration of HVA were found between sexes. No such differences were found for VMA. HVA and VMA were also found to be age dependent. Centiles were constructed using a procedure which makes no distributional assumptions about the data. The net effect of utilising these centiles was to increase the predictive value of a positive screening test from 20% to 40% without any increase in the false negative rate.     

Creatinine related reference ranges for urinary homovanillic acid and vanillylmandelic acid at 6 months of age.

The relationship between homovanillic acid (HVA), vanillylmandelic acid (VMA), and creatinine in the urine of 6 month old babies has been studied and reference ranges in the form of centiles constructed for HVA and VMA against creatinine. Over 10,000 urine samples were collected from babies in four health districts in the north of England. HVA and VMA concentration, either independently or when divided by creatinine concentration, were dependent upon the absolute concentration of creatinine in the sample. After adjustment for creatinine significant differences in the mean concentration of HVA were found between sexes. No such differences were found for VMA. HVA and VMA were also found to be age dependent. Centiles were constructed using a procedure which makes no distributional assumptions about the data. The net effect of utilising these centiles was to increase the predictive value of a positive screening test from 20% to 40% without any increase in the false negative rate.     

Reduced sympathetic metabolites in urine of obese patients with craniopharyngioma

Severe obesity is a major problem in patients suffering from craniopharyngioma (CP), a benign tumor located in pituitary and hypothalamic regions. In this study, the hypothesis that hypothalamic damage leads to a reduction in overall sympathetic tone was tested. Catecholamines, as well as their metabolites homovanillic acid (HVA) and vanillylmandelic acid (VMA), markers of catecholamine turnover, were measured in morning voided urine of 109 patients participating in a German pediatric CP study, and their physical activity was analyzed using a questionnaire. HVA and VMA results were compared with age-matched HVA and VMA in urine of patients proven to not have a catecholamine-secreting tumor. Patients with the most severe obesity displayed the lowest urine HVA and VMA values. Patients with hypothalamic CP had 3.2-fold higher BMI values (p<0.0001), lower HVA (0.72-fold, p<0.001), and VMA (0.84-fold, p<0.01) values, and significantly lower activity scores than those without hypothalamic involvement, but their epinephrine- and norepinephrine/creatinine ratios were not significantly different, possibly due to low levels. The low HVA and VMA values suggest decreased sympathetic outflow contributing to reduced physical activity and severe obesity, especially in patients with a hypothalamic tumor. In further studies investigating treatment options for hypothalamic obesity, disturbed sympathetic tone should be considered.