1型糖尿病患儿T细胞亚群、细胞因子的变化及意义

目的　分析 1型糖尿病患儿外周血T细胞亚群 (CD3+ 、CD4 + 、CD8+ )及血清白细胞介素 2 (IL 2 )、可溶性白细胞介素 2受体 (sIL 2R)水平变化 ,以了解其在 1型糖尿病发病中的作用。方法　应用免疫荧光标记技术和流式细胞仪检测 30例 1型糖尿病患儿外周血T淋巴细胞亚群 ,同时用ELISA法定量检测患儿血清IL 2 /sIL 2R水平 ,并与正常对照组 16例作比较 ,且与胰岛功能进行相关分析。结果　 1.1型糖尿病患儿CD3+ 、CD4 + 细胞均显著升高 ,CD8+ 细胞显著降低 (P均 <0 .0 1)。 2 .1型糖尿病患儿血清IL 2明显高于正常对照组 (P<0 .0 1) ;sIL 2R较对照组明显降低 (P <0 .0 1)。IL 2与反映胰岛功能C 肽 (C P)、胰岛素呈负相关 ,而sIL 2R与C P、胰岛素呈正相关。结论　T淋巴细胞亚群失衡、IL 2及其受体参与介导胰岛 β细胞的损伤和 1型糖尿病发生     

Protocolitis in exclusively breast-fed infants

We present nine exclusively breast-fed, full-term infants with mild rectal bleeding due to proctocolitis. The mean age at the onset of symptoms was 5 weeks (range 1–8 weeks). Rectosigmoidoscopic examination was performed in all the children within 2 days after admission, showing inflammatory changes such as oedematous mucosa with petechial haemorrhages. Rectal mucosal biopsy specimens, were obtained in eight cases and revealed intra-epithelial eosinophilic granulocytes in seven and a diffuse increase of eosinophils in the lamina propria in six. Allergy to cow's milk protein transferred to the infants via the breast milk was believed to be the cause of the inflammation. The intake of cow's milk protein was then restricted in seven mothers. Following this regimen, symptoms were relieved within 4 weeks in the six infants who were seen at follow up. One child recovered spontaneously without dietary restrictions. Considering the beneficial effect of the diet regimen in addition to the histological findings, allergy to cow's milk protein is possibly the aetiology of the proctocolitis seen in these nine exclusively breast-fed babies, although no challenge tests were performed to confirm this suspicion.Conclusion This report shows that proctocolitis occurs in exclusively breast-fed infants. It is speculated that allergy to cow's milk protein may have played a role in the pathogenesis.     

Food sensitive enteropathy: Overview and update

There are two types of food sensitive enteropathy; permanent and temporary. Celiac disease belongs to the former, the temporary food sensitive enteropathies of early childhood to the latter. A food sensitive enteropathy is characterized by an abnormal small intestinal mucosa while having the offending food in the diet; the abnormality is reversed by an elimination diet, only to recur once more on challenge with the relevant food. These disorders are temporary and may follow gastroenteritis. Cow's milk sensitive enteropathy is the most frequent and best known example but soy protein, egg, fish, chicken meat, ground rice and probably gluten may also temporarily damage the small intestinal mucosa in infancy. Treatment is with an elimination diet and protein hydrolysates as a cow's milk substitute. The reason why these enteropathies are temporary has not yet been established.     

Serum total and free tryptophan levels in term infants fed cow's milk formula or human milk

We found no significant differences in mean total and free tryptophan concentrations in sera of healthy, full-term infants fed cow's milk formula and healthy, full-term infants who were breast-fed. Serum tryptophan concentrations were measured 1 h after feeding when the infants were 2 and 6 days of age. In this study cow's milk formula compared favourably with human milk as primary nutrition for full-term infants, despite a two-to-three fold higher level of free tryptophan in human colostrum.     

'Normal'disaccharidase levels in children

Abstract Results of disaccharidase assays in small bowel biopsies from 887 children over a 3 year period were analysed to establish normal values. Abnormal histology, the presence of giardia trophozoites or total absence of sucrase and isomaltase were found in 307 cases and these were excluded from further consideration. The results for maltase, sucrase and lactase from the remaining 580 children have been graphed as percentiles at various ages. They represent results which are as close to normal as it is possible ethically to obtain.     

肺炎支原体肺炎患儿血清白细胞介素-6及可溶性白细胞介素-6受体活性变化及意义

目的：为正确认识肺炎支原体肺炎(MPP)患儿免疫状态，该研究检测了MPP和非肺炎支原体肺炎患儿血清白细胞介素6(IL6)及可溶性白细胞介素6受体(sIL6R)的变化，探讨其对MPP和非MPP患儿病情的影响，并为选择合理的MPP治疗手段提供理论依据。方法：用ELISA法检测MPP患儿(n=41)及非MPP患儿(n=20)急性期和恢复期血清IL-6及sIL-6R含量。结果：①MPP 患儿血清IL-6急性期和恢复期分别为 2.01±0.41，1.12±0.67 ng/L；sIL-6R急性期和恢复期分别为 1.87±0.25，1.92±0.27 μg/L，均明显高于正常对照组 0.37±0.52 ng/L，1.71±0.15 μg/L，差异有显著性(P<0.01)；MPP患儿恢复期血清IL-6含量较急性期明显下降，差异有显著性(P<0.01)，而sIL-6R恢复期与急性期比较差异无显著性(P>0.05)；②非MPP患儿血清IL-6急性期及恢复期分别为1.56±0.26，0.84±0.63 ng/L，明显高于正常对照组，差异有显著性(P<0.01或P<0.05)，而血清sIL-6R与对照组比较差异无显著性(P>0.05)；非MPP患儿急性期血清IL-6高于恢复期，差异有显著性(P<0.05)，血清sIL-6R急性期与恢复期比较差异无显著性(P>0.05)；③MPP患儿急性期血清IL-6、sIL-6R含量较非MPP患儿急性期升高(P<0.01或P<0.05)；MPP患儿恢复期血清IL-6含量与非MPP患儿恢复期的差异无显著性(P>0.05)；MPP患儿恢复期血清sIL-6R含量明显高于非MPP患儿恢复期(P<0.01)。结论：MPP患儿血清IL-6及sIL-6R改变较非MPP患儿明显，提示MPP患儿免疫功能改变较非MPP患儿显著，IL-6及sIL-6R参与了MPP的发生和发展，有必要对MPP患儿进行免疫调节治疗。     

哮喘患儿血一氧化氮,可溶性白细胞介素2受体及IgE变化

目的探讨哮喘患儿外周血一氧化氮（NO）、可溶性白细胞介素2受体（SIL-ZR）及IgE的变化。方法支气管哮喘急性发作期患者44例，男23例，女21例，对照组为15例健康儿童，男9例，女6例。分别在哮喘急性发作期和缓解期采静脉血，测定NO、SIL-ZR和IgE，并与对照组进行比较。结果支气管哮喘息性发作期患者与缓解期患者（30例）皿中NO分别为107.99±24.96μmol／L和81.36±14.31μmol／L（P＜0.001）;SIL-ZR分别为259.55±58.82kU／L和213.23±33.72kU／L（P＜0.001）;IgE分别为932.61±637.23kU／L和760.80±53644kU／L（P＞0.05）。对照组血中NO为82.26±14.21，与急性发作期哮喘息者相比，有显著性差异（P＜0.001）。结论支气管哮喘急性发作期患儿血中NO和SIL-2R均明显高于缓解期患者和健康儿童。内源性NO在哮喘的发病中可能发挥着重要作用。     

A simple method of duodenal juice collection in association with small bowel biopsy in children

ABSTRACT. A simple method of obtaining duodenal juice in association with small bowel biopsy is described. A conventional adult feeding tube is attached to the semi-stiff biopsy capsule tubing and carried into position by the capsule. This method enables several millilitres of duodenal fluid to be obtained in a few minutes and the biopsy to be taken with one intubation.     

Serum transferrin receptor in children and adolescents with inflammatory bowel disease

Iron studies are difficult to interpret in patients with chronic inflammatory states such as inflammatory bowel disease (IBD). Serum transferrin receptor (TfR) has been reported to be a reliable tool for the diagnosis of iron deficiency in adults. Our aim was to evaluate the role of serum TfR in diagnosing iron deficiency in children and adolescents with IBD. A total of 63 consecutive patients with IBD, aged 9 to 22 years (median 15 years), were tested for serum haemoglobin level, mean corpuscular volume (MCV), and serum iron, transferrin, ferritin and serum TfR levels. Those found to be anaemic were compared with seven age-matched subjects with iron deficiency anaemia (IDA) and 24 age-matched children without signs of anaemia or inflammation. Of the 63 patients with IBD, 26 had anaemia. Based on ferritin levels and MCV indices, anaemia was classified as IDA in 11 patients and as anaemia of chronic disease (ACD) in 15 patients. Mean serum TfR level in normal controls was 3.5 mg/l (range 1.2–8.2 mg/l). Mean (±SD) serum TfR levels were significantly lower in the IBD patients with ACD (5.3 ± 2.3 mg/l) than in the IBD patients with IDA (8.2 ± 3.1 mg/l) (P < 0.05). Serum TfR levels above 5 mg/l identified 10/11 IBD patients with IDA. The calculated TfR/ferritin ratio was 84 (range 17–367) for controls and 133 (range 6.4–1840) for IBD patients. A cut-off level of 350 (91% sensitivity, 100% specificity, 100% positive predictive value, 98% negative predictive value) was established for the diagnosis of IDA in IBD. Conclusion The results suggest that serum transferrin receptor is a useful parameter for the diagnosis of iron deficiency in inflammatory bowel disease, in particular, the transferrin receptor/ferritin ratio with a cut-off level ≥350. Received: 1 June 1999 / Accepted: 16 February 2000     

Intractable diarrhoea in infancy: a continuing challenge for the paediatric gastroenterologist

Intractable diarrhoea of infancy is a syndrome of severe chronic diarrhoea, associated with malnutrition, which is not easily resolved by conventional management. Application of small bowel biopsy and colonoscopy with biopsy to children with this syndrome has identified specific entities, such as autoimmune enteropathy and microvillus atrophy. There remains a group of children with unexplained small intestinal enteropathy and idiopathic enterocolitis who pose a considerable problem for diagnosis and management.     

Dieting in children: a population-based study in children aged between 9 and 12 years

AIM: Dieting can be a burden for the child and can have side effects. Insight into dieting is therefore important. A recent study showed that 13.7% (95% CI 11.5-15.9%) of the children referred to a general paediatric outpatient clinic were or had been on a diet. However, it is unknown how many children in a random population are or have been on a diet. METHODS: Parents of children in the fifth grade of primary schools in the Dutch province of Friesland were asked to complete a structured questionnaire. RESULTS: From 2500 questionnaires 90% were returned. Two hundred and thirty-one children aged between 9 and 12 years had been on a diet (10.3%, 95% CI 9.0%-11.6%). A cow's milk free diet was used most frequently (50% of the dieting children). Other diets were: diets excluding additives (16%), peanuts (16%), sugar (15%) and lactose (11%). CONCLUSION: The use of diets by children in a general population is widespread: one in every ten children was or had been on a diet. Due to the known health risks associated with diets excluding one or more foods, such diets should only be advised by healthcare professionals.     

Surface marker patterns of T cells and expression of interleukin-2 receptor in measles infection

The surface marker patterns of T cells of Ghanaian children during measles infection were studied and an attempt was made to demonstrate T cell activation and viability in vitro after activation in vivo by measles virus. The frequencies of CD4⁺ and CD8⁺ naive T cells in measles patients were high while their memory T cells were remarkably reduced with no sign of proliferation even at the acute phase of the illness. The reduction of memory T cells was prolonged during the convalescent phase (2 months after onset). The anti-CD3 monoclonal antibody-induced expression of interleukin-2 receptor α chain (IL-2R/CD25) was significantly suppressed; however, the addition of phorbol 12-myristate 13-acetate or ionomycin caused a remarkable recovery of CD25 expression. On simple culture, an appreciable proportion of T cells from measles patients died rapidly in contrast with only a few T cells from healthy controls doing so. The suppression of CD25 expression was still demonstrated during the convalescent phase of the disease. Taken together these results suggest unresponsiveness and activation-induced cell death of T cells during severe measles infection in Ghanaian children. Furthermore the prolonged abnormalities of T cells (i.e. decreased memory T cells and inhibition of CD25 expression during the convalescent phase) might be related to post-measles infection immunosuppressive status.     

Jejunal mucosa lymphoid cell subsets and the expression of major histocompatibility complex antigens in children

Using monoclonal antibodies with the immunoperoxidase technique the distribution pattern of class I and class II antigens of the major histocompatibility complex (MHC), and of the lymphocyte subsets have been studied in intestinal biopsies from children without mucosal lesions, from children with coeliac disease (CD) and from infants with cow's milk protein intolerance (CMPI). The staining of the intestinal mucosa for class I antigens is unaltered irrespective of the histological picture or the clinical diagnosis. Class II antigens are only partially or not expressed at all by epithelial cells in untreated cocliac disease and in some cases of cow's milk protein intolerance. The number and the composition of the lamina propria lymphocytes in both CD and CMPI are different from the normal situation. An increase of all lamina propria lymphocyte subsets is observed in untreated CD. A decrease of OKT4⁺ lymphocytes is observed in the lamina propria of CMPI patients. These changes may be involved in the pathogenesis of these diseases.Abbreviations MHC major histocompatibility complex - CD coeliac disease - CMPI cow's milk protein intolerance - IEL intra-epithelial lymphocytes     

Cows milk consumption in constipation and anal fissure in infants and young children

OBJECTIVE: To examine daily cows milk consumption and duration of breastfeeding in infants and young children with anal fissure and constipation. METHODS: Two groups of 30 consecutive children aged between 4 months and 3 years were evaluated retrospectively. Group I comprised children with chronic constipation and anal fissure in whom surgical causes were excluded, and group II comprised normal children. The daily consumption of cows milk, duration of breastfeeding and other clinical features of the children were investigated RESULTS: The mean daily consumption of cows milk was significantly higher in group I (756 mL, range 200-1500 mL) than group II (253 mL, range 0-1000 mL) (P < 0.001). Group I children were breastfed for a significantly shorter period (5.8 months, range 0-18 months) than group II (10.1 months, range 2-24 months) (P < 0.006). The odds ratios for the two factors - children consuming more than 200 mL of cows milk per day (25 children in group I, 11 children in group II) and breastfeeding for less than 4 months (16 children in group I, 5 children in group II) - were calculated to be 8.6 (95% confidence interval [CI]: 0.23-0.74, P = 0.0005) and 5.7 (95% CI: 0.37-0.66, P = 0.007), respectively. CONCLUSIONS: Infants and young children with chronic constipation and anal fissure may consume larger amounts of cows milk than children with a normal bowel habit. Additionally, shorter duration of breastfeeding and early bottle feeding with cows milk may play a role in the development of constipation and anal fissure in infants and young children.     

Oral versus intravenous premedication for small bowel biopsy in children: effect on procedure and fluoroscopy times

Oral alimemazine and cisapride, or diazepam and cisapride, or iv midazolam and metoclopramide were given as premedication for small bowel biopsy to three groups of children from a total population of 185 individuals. The biopsy procedures were performed under intermittent fluoroscopy and times for both were recorded. The median biopsy procedure time was significantly shorter in children given iv midazolam and metoclopramide (6 min) compared to those given oral premedication (10 min) ( p < 0.001). The median fluoroscopy time was very short in all groups, ranging between 3 and 6 s. It is concluded that iv premedication is superior to oral premedication for small bowel biopsy in children because more effective sedation is obtained.     

Serum soluble interleukin-2 receptors and tumor necrosis factor-α in hematological malignancies of childhood

The levels of soluble interleukin-2 receptors (sIL-2R) and tumor necrosis factor (TNF) were determined in the serum of 61 children with hematological malignancy, including 20 patients with leukemia and 16 with lymphoma in active state of malignancy, and 20 patients with leukemia and 5 with lymphoma in complete remission. In addition, serum samples from 15 healthy children were used as controls. It was found that the mean serum levels of sIL-2R and TNF were significantly increased in active malignancy (207.0±17.1 pmol/L for sIL-2R; 209.7±35.0 pg/mL for TNF) compared to the remission status and normal controls (P<0.001). No such difference was observed between leukemia and lymphoma groups. It was concluded that serum sIL-2R and TNF are of potential value in the diagnosis and follow up of patients with neoplastic diseases.     

Conscious or deep sedation: a questionnaire regarding the experience of parents,children and staff during small bowel biopsy

Aim: The paediatric clinics of Linköping and Norrköping, Sweden, have different procedures regarding premedication and sedation during small bowel biopsy in children with suspected or diagnosed coeliac disease. In Linköping deep sedation using intravenous propofol is the method of sedation being used and parents are not present during the biopsy procedure. In Norrköping conscious sedation using intravenous midazolam is the routine and parents stay with their child throughout the whole biopsy procedure. The aim of this study was to find out whether the preprocedural and procedural differences between the clinics affected the way in which the parents and children experienced the time before and during the biopsy procedure. Methods: A questionnaire was used to ask the parents of 102 children who had undergone small bowel capsule biopsy for their opinion regarding the discomfort experienced by their children. The parents’and children's experience was also compared with that of the paediatric nurse caring for the family during the biopsy procedure, and the paediatric gastroenterologist performing the biopsy. Results: The differences regarding premedication and sedation between the two groups did not seem to affect the parents’or the children's total experience of the biopsy procedure, nor did the presence or absence of the parents throughout the biopsy procedure. As regards the sedation given, 95% of the parents did not think that their children suffered any discomfort at all. The total experience of the biopsy procedure on a five‐grade scale (5 being very good, 1 being very bad) was 5 for the parents and 4 for the children in both centres. Parents and children in both centres were very satisfied with the way in which they were taken care of during their visit to the hospital. In both units there was an obvious correlation between how the paediatric nurse experienced the biopsy procedure and how the paediatric gastroenterologist did, but only a weak correlation between the experience of the parents and that of the paediatric gastroenterologist and paediatric nurse. The anxiety of the parents was similarly estimated by the paediatric gastroenterologist and the paediatric nurse in both centres. There was no correlation between their assessment and the experience reported by the parents. Conclusion: The children undergoing small bowel biopsy and their parents felt well taken care of during their visit to the two hospitals. The differences between the clinics regarding method of sedation and presence or absence of the parents did not seem to affect how the parents and children experienced the biopsy procedure.     

新生儿肺炎白细胞介素-10、-13与免疫球蛋白的关系

目的　探讨新生儿肺炎白细胞介素 (IL) 10、 13与免疫球蛋白 (Ig)的关系。 方法　采用免疫酶法(ELISA)和速率散射比浊法检测新生儿肺炎患儿血IL 10、IL 13、IgG、IgA、IgM。以C反应蛋白 (CRP)≥ 2 0mg/L作为诊断细菌感染的界限值 ,结合临床资料 ,将肺炎分为 4组进行结果分析。结果　 1.肺炎组 8型常见病毒及支原体特异性IgM阳性 4 0份 (36 .0 % ) ;对照组 30份血清检测均阴性。病毒及支原体感染 (病毒感染 ) 2 3例(2 0 .7% ) ,细菌感染 4 5例 (4 0 .5 % ) ,混合感染 17例 (15 .3% ) ,不明病原感染 (其他感染 ) 2 6例 (2 3.4 % )。 2 .肺炎组IgA、IgM明显高于对照组 (P <0 .0 5 )。其中病毒感染组IgA明显高于其他感染组和对照组 (P <0 .0 5 ) ;IgM含量为细菌感染组显著高于对照组 (P <0 .0 5 )。 3.病毒感染组IgG、IgA、IgM分别与IL 10有显著相关 (P<0 .0 5 )。混合感染组、细菌感染组和对照组IgM分别与其IL 13呈显著相关 (P <0 .0 5 )。结论　新生儿肺炎时 ,IgA是完成抗病毒体液免疫应答的重要成分 ,IL 10对IgA产生具有调节作用 ;IgM能在抗菌性体液免疫机制中发挥重要作用 ,IL 13有助于调节IgM产生