吸入二丙酸倍氯米松气雾剂治疗小儿哮喘对骨密度影响的研究

目的探讨长期吸入二丙酸倍氯米松治疗儿童哮喘对骨密度的影响。方法对3～15岁68例哮喘儿童给予吸入二丙酸倍氯米松，吸入剂量≤400μg／d，分级阶梯治疗，定期复查。分别于吸入前、后测骨密度(BMD)。根据吸入时间将68例患儿分3组(随患儿年龄增长，将患儿调入相应的年龄组)，A组68例，吸入时间≥6个月；B组65例，吸入时间≥1年；C组56例，吸入时间≥2年。每组又根据BMD正常参考值分3～6岁组，7～13岁组，采用SAS软件对每例哮喘儿童治疗前和治疗中测的BMD均数值分组进行配对资料t检验。结果经随访观察吸入二丙酸倍氯米松治疗≥6个月、≥1年、≥2年哮喘儿童BMD均数值与治疗前比较均无明显区别。显示吸入二丙酸倍氯米松≤400μg／d治疗哮喘，3年内是安全的。结论吸入二丙酸倍氯米松每天剂量≤400μg／d，3年内应用是安全的，对哮喘儿童骨密度无明显影响。     

丙酸倍氯米松气雾剂吸入治疗对哮喘儿童骨密度的影响

目的 探讨长期吸入丙酸倍氯米松治疗儿童哮喘对骨密度的影响。方法 对3～15岁68例哮喘患儿给予吸入丙酸倍氯米松，吸入剂量≤400μg／d，分级阶梯治疗，每0.5年复查，分别于吸入前、后测骨密度(BMD)。根据吸入时间分3组，A组68例，吸入时间≥6个月；B组65例，吸入时间≥1年；C组56例，吸入时间≥2年。每组根据BMD正常参考值又分3～6岁、～13岁组，采用SAS软件对每例哮喘儿童治疗前和治疗中测BMD均数分组进行配对资料t检验。结果 经随访观察吸入丙酸倍氯米松治疗≥6个月、≥1年、≥2年哮喘儿童BMD与治疗前比较均无明显差别。结论吸入丙酸倍氯米松≤400μg／d，3年内应用是安全的，对哮喘儿童骨密度无明显影响。     

哮喘患儿持续吸入激素治疗对骨代谢指标和骨密度影响

目的　观察持续小剂量吸入糖皮质激素对哮喘患儿骨代谢指标和骨密度的影响。方法　随机将 4 5例 5～ 8岁哮喘缓解期患儿分 3个开放治疗组 ,吸入糖皮质激素 (布地奈德 )分别为 10 0、2 0 0、30 0 μg/d ,持续 12个月。于治疗开始 ,6、12个月行临床评估和肺功能FEV1测定 ;检测血骨钙素 (OST)、胰岛素样生长因子 1(IGF 1)、骨碱性磷酸酶 (BALP)和尿脱氧吡啶 (DPD) /尿肌酐 (Cr)水平。用双能X线骨密度仪监测骨密度 (BMD)。结果　哮喘患儿治疗后临床评分和肺功能FEV1明显改善 ;血OST稍高于正常儿童对照组 ,但无显著差异 ;血BALP显著高于正常对照组 ;血IGF 1水平与同龄正常儿童比较显著增高 ;尿DPD/Cr水平显著低于正常对照组 ;治疗前后患儿股骨近端 (股骨颈 ,大转子 ,Ward′s三角 )、脊柱区域 (2～ 4 )和前臂 (前臂远端和近侧端 )的BMD无显著降低。结论　持续小剂量吸入糖皮质激素对哮喘患儿的骨代谢指标和BMD无明显抑制影响。     

大环内酯类抗生素治疗哮喘疗效观察

目的　研究大环内酯类抗生素治疗哮喘的有效性和安全性。方法　选择哮喘患儿 48例 ,随机分为治疗组和对照组 ,两组除基础治疗外 ,每日吸入丙酸倍氯米松和沙丁胺醇 ,待症状缓解后减量 ,完全缓解则停药或用丙酸倍氯米松 2 0 0 μg/d维持。治疗组加阿齐霉素 5～ 10mg/ (kg·d) ,疗程 8周。疗程结束后与对照组进行比较。结果　治疗组完全缓解 16例 ,缓解率 69.56% ;对照组缓解 10例 ,缓解率 40 .0 0 % ,两组比较有显著性差异 (P <0 0 5)。 8周后治疗组平均每日丙酸倍氯米松吸入量明显减少 ,与治疗前比较有非常显著性差异 (P <0 0 1) ;两组丙酸倍氯米松吸入量减少绝对值比较 ,有显著性差异 (P <0 .0 5)。结论　阿齐霉素有类激素样抗感染作用 ,治疗儿童哮喘安全有效     

哮喘患儿吸入糖皮质激素对骨代谢影响

目的　探讨哮喘患儿吸入糖皮质激素 (IGs)对骨代谢影响。方法　对 5 0例 5～ 12岁连续吸入IGs 2年哮喘患儿 ,于吸入前 ,0 .5、1、1.5、2年分次进行血清钙、磷、骨源性碱性磷酸酶 (BALP)、骨钙素 (OC)水平监测 ,并进行身高生长速度测定。其中观察I组 2 7例 ,平均吸入丙酸倍氯米松 2 5 0 μg/d ;观察Ⅱ组 2 3例 ,平均吸入丙酸氟替卡松 15 0 μg/d ;正常对照组 2 2例。 结果　观察Ⅰ、Ⅱ组、对照组间分次检测的血钙、磷、BALP、OC水平均无显著差异 (P均 >0 .0 5 ) ;且各组间q检验无显著差异 (P均 >0 .0 5 )。观察Ⅰ、Ⅱ组身高生长速度分别于对照组比较 ,均无显著差异 (P均 >0 .0 5 )。结论　每日小剂量较长时间IGs对儿童骨生长发育无明显影响。     

Influence of Long Term Inhalation of Beclomethasone Dipropionate on Pituitary Adrenal Axis Function in Asthmatic Children

目的　通过检测相关激素水平 ,探讨哮喘患儿吸入二丙酸倍氯米松后对垂体 肾上腺轴功能的影响。方法　将研究对象分成 4组 :正常对照组、哮喘组、短期吸入二丙酸倍氯米松组和长期吸入二丙酸倍氯米松组。应用放射免疫法 ,测定上述 4组儿童的促肾上腺皮质激素 (ACTH)和皮质醇 (cortisol)水平 ,以评估垂体 肾上腺轴功能状态及吸入二丙酸倍氯米松后对其的影响。结果　 4组儿童的血清ACTH和cortisol水平之间无明显差别 ;ACTH兴奋实验短期吸入治疗组和长期吸入治疗组与正常对照组和哮喘组比较皮质醇基础值无明显降低 ,与哮喘组比较反应值 (刺激值 -基础值 )则明显降低 (P <0 .0 5 )。结论　吸入治疗一定时间后可使肾上腺皮质功能达到轻度抑制状态 ,但并不随吸入时间延长而产生累积抑制效应。     

吸入二丙酸倍氯米松对哮喘儿童的垂体-肾上腺轴功能的影响

目的：通过检测相关激素水平,探讨哮喘患儿吸入二丙酸倍氯米松后对垂体-肾上腺轴功能的影响。方法：将研究对象分成4组：正常对照组、哮喘组、短期吸入二丙酸倍氯米松组和长期吸入二丙酸倍氯米松组。应用放射免疫法,测定上述4组儿童的促肾上腺皮质激素(ACTH)和皮质醇(cortisol)水平,以评估垂体肾上腺轴功能状态及吸入二丙酸倍氯米松后对其的影响。结果：4组儿童的血清ACTH和cortisol水平之间无明显差别;ACTH兴奋实验短期吸入治疗组和长期吸入治疗组与正常对照组和哮喘组比较皮质醇基础值无明显降低,与哮喘组比较反应值(刺激值-基础值)则明显降低(P<0.05)。结论：吸入治疗一定时间后可使肾上腺皮质功能达到轻度抑制状态,但并不随吸入时间延长而产生累积抑制效应。     

阿奇霉素治疗哮喘的有效性和安全性探讨

目的观察阿奇霉素治疗哮喘的有效性和安全性。方法对56例哮喘患儿随机分治疗组和对照组,常规吸入丙酸倍氯米松和沙丁胺醇气雾剂,症状缓解后减量完全缓解则200μg/d维持共12周。治疗组加阿奇霉素10mg/(kg.d)疗程6周。结果治疗组完全缓解17例,缓解率65%,对照组缓解11例,缓解率38%,2组比较有显著差异且6周后治疗组平均每日丙酸倍氯米松吸入量明显减少。结论阿奇霉素有类激素作用,治疗哮喘安全有效。     

吸入糖皮质激素对哮喘儿童骨龄及生长发育的影响

目的：长期吸入糖皮质激素是哮喘的首选治疗方法,但国内外对于年幼儿童长期吸入糖皮质激素治疗的安全性仍有争议,本研究旨在探讨支气管哮喘患儿吸入糖皮质激素对骨龄及生长发育的影响。方法：73例支气管哮喘患儿给予丙酸氟替卡松吸入治疗,剂量250 μg/d,3个月后减量1/3续用3个月,再减为125 μg/d续用6个月,治疗后观察疗效,治疗前后分别测量骨龄、身高、体重。结果：入选患儿治疗后身高、体重及RUS骨龄增长与正常儿童差异无统计学意义（P>0.05）;体重指数(BMI)治疗前后差异无统计学意义（P>0.05）;治疗前后C骨龄与年龄差值分别为-0.2（-0.6,0.8）岁、-0.5（-1.0、0.6)岁,治疗后明显比治疗前延迟（P<0.05）。结论：哮喘患儿吸入糖皮质激素治疗 1年对C骨龄发育有一定抑制作用,对RUS骨龄、身高、体重及BMI无明显影响;长期糖皮质激素治疗的患儿应监测生长发育状况。     

普米克 美喘清治疗儿童咳嗽变异型哮喘36例临床分析

目的 观察普米克、美喘清对儿童咳嗽变异型哮喘的治疗效果。方法 36例患儿均应用普米克和美喘清治疗。普米克气雾剂吸入：50 ～100 μg,每日3次,咳嗽控制后减量至50 μg,每日1次,疗程2月;美喘清在普米克吸入前半小时口服：<7岁12.5 μg,≥7岁25 μg,每日2次,疗程15 d,治疗结束后随访半年。对其中≥7岁者于治疗前,治疗后15 d,1月,3月进行最高呼气流速率(PEFR)检测。结果36例中的29例在治疗15 d内临床症状消失,5例在治疗30 d内咳嗽消失,1例咳嗽减轻,1例无效,随访1例复发,总有效率97.22%(35/36),复发率2.78%(1/36)。与治疗前相比,PEFR在治疗后15 d,1月,3月有明显改善,P分别<0.02,0.02及0.01。结论普米克、美喘清联用对儿童咳嗽变异型哮喘疗效满意,对肺功能有明显改善。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.