新生儿胃肠道生长发育及胃肠激素的研究

为探讨新生儿胃肠动力学的特点 ,应用放免分析方法对 36例重度窒息新生儿、2 2例轻度窒息新生儿和 2 4例正常新生儿的血清胃泌素、血浆胃动素进行了检测和对比研究。结果显示 :重度窒息组血清胃泌素和血浆胃动素水平明显低于正常对照组 (t值分别为 8 32 5、3 5 75 ,P <0 0 1) ;轻度窒息组胃泌素和血浆胃动素与正常对照组相比无显著差异 ,(t值分别为 1 2 6 4、0 0 4 1、P >0 0 5 )。因此 ,新生儿重度窒息 (在围产期 )可导致血清胃泌素和血浆胃动素水平明显降低 ,从而导致喂养不耐受 ,易合并肠道并发症     

血清胱抑素C水平在新生儿窒息后肾损伤中的诊断价值

目的 探讨血清胱抑素C(Cys-C)水平在新生儿窒息后肾损伤中的诊断价值.方法 窒息新生儿60例按出生时Apgar评分分为轻度窒息组(37例)、重度窒息组(23例);同期选择15例健康足月新生儿作为健康对照组.窒息组新生儿在人院后第1天,健康对照组新生儿在出生1～3 d抽取外周静脉血3mL,用免疫比浊法检测各组血清Cys-C水平,并与其血清尿素氮(BUN)、肌酐(Cr)水平比较.采用SPSS 12.0软件进行统计学t检验和x2检验.结果 1.在轻度窒息组和重度窒息组中,血清Cys-C水平分别为(1.17±0.18)mg/L和(1.51±0.21)mg/L,血清BUN水平分别为(5.17±2.25)mmol/L和(6.89±2.21)mmol/L,血清Cr的水平分别为(52.59±15.80)μmol/L和(69.19±18.30)μmol/L,健康对照组血清Cys-C、BUN和Cr水平分别为(0.91±0.12)mg/L,(4.35±1.20)mmol/L和(46.55±10.63)μmol/L.与健康对照组相比,轻度窒息组和重度窒息组血清BUN、Cr和Cys-C水平明显升高,差异具有显著性意义(P.＜0.01);与轻度窒息组相比,重度窒息组血清BUN、Cr和Cys-C水平有显著升高,差异具有显著性意义(Pa＜0.01).2.轻度窒息组血清Cys-C、BUN和Cr的异常检出率分别为73%、35%和38%;重度窒息组血清Cys-C、BUN和Cr的异常检出率分别为91%、65%和70%.在轻度窒息组和重度窒息组血清Cys-C的异常检出率显著高于血清BUN和Cr的异常检出率,差异具有显著性意义(P＜0.05,0.01).3.血清Cys-C与BUN和Cr水平之间呈显著正相关关系(r=0.81,0.84 P.＜0.01).结论 Cys-C能较早反映肾脏受损时肾小球滤过率的下降.血清Cys-C可作为新生儿窒息后肾损伤的早期诊断指标之一.     

窒息新生儿32例胃排空及胃动素、一氧化氮变化的临床观察

目的探讨窒息对新生儿胃排空功能的影响.方法采用B型实时超声显像法观察32例窒息新生儿餐后胃窦纵切面积的动态变化,并检测餐前及餐后半小时血中胃动素、一氧化氮(NO)水平,同时与10例正常新生儿比较.结果与正常组相比,轻度窒息组10%、50%、100%胃排空时间及餐前、餐后胃动素、NO水平无明显变化,差异无显著性意义(均为P＞0.05),而重度窒息组胃排空时间明显延长,餐前、餐后胃动素、N水平明显升高,差异有极显著意义(均为P＜0.01).结论重度窒息新生儿胃排空延迟,与胃动素、NO的变化有关.     

危重新生儿血浆β内啡肽变化及纳洛酮对其影响

目的　探讨危重新生儿血浆β 内啡肽 (β EP)变化及纳洛酮对其影响。 方法　对NICU收治 36例危重新生儿随机分为纳洛酮治疗组及对照组各 18例 ,于治疗前后 1h及 3d采血测血浆β EP浓度 ,比较两组治疗后 β EP水平差异 ,并与正常足月儿 18例血浆 β EP浓度对比。 结果　治疗前治疗组 [(92 .0 5± 19.39)ng/L]及对照组 [(98.33± 2 8.0 4 )ng/L]血浆 β EP浓度均明显高于正常足月儿 [(2 5 .38± 7.80 )ng/L](P均 <0 .0 1) ;经纳洛酮治疗后 3d ,治疗组 [(2 4 .0 5± 6 .84 )ng/L]接近正常足月儿 ,明显低于对照组 [(5 3.39± 4 .36 )ng/L],两组比较差异有显著性 (P <0 .0 1)。结论　危重新生儿血浆 β EP浓度明显高于正常足月儿 ;纳洛酮可有效降低危重新生儿血浆 β EP水平     

Q-T间期离散度在评价新生儿窒息心肌损害中的意义

目的　探讨新生儿窒息心电图Q T间期离散度 (Q Tcd)的变化 ,用以评价心肌损害情况。方法　对60例有不同程度窒息的足月新生儿 (观察组 )及 2 0例正常足月新生儿 (对照组 )于生后 2 4～ 3 6h进行Q Tcd测量 ,并分析结果。结果　对照组Q Tcd为 (57.48± 3 1.0 1)ms ;轻度窒息组为 (67.0 4± 2 4.0 8)ms ,重度窒息组为(84.2 1± 3 4 .2 6)ms;窒息新生儿并胎儿窘迫组为 (84.3 7± 3 5.92 )ms ;单纯窒息组 (65.3 8± 18.15)ms。重度窒息组Q Tcd明显高于对照组及轻度窒息组 ,差异有显著性 (P均 <0 .0 5) ;轻度窒息组Q Tcd高于对照组 (P >0 .0 5) ;窒息并胎儿窘迫组Q Tcd明显高于单纯窒息组 ,差异有显著性 (P <0 .0 5)。结论　新生儿窒息越重 ,窒息持续时间越长 ,Q Tcd越大。Q Tcd能较敏感地反映新生儿窒息时心肌损害情况     

新生儿胃肌电变化的研究

目的 观察新生儿胃肌电发育过程，并初步探讨其变化规律。方法 对23例健康新生儿生后1周、2周及1月进行胃肌电描记。采用皮肤表面电极，从腹壁体表用PCPOLYGRAP-HR多功能胃肠检测仪记录胃电，观察主频率(DF)、主频率不稳定系数(DFIC)、正常胃慢波百分比(PNSW)。结果 餐前、餐后正常呈随周龄增大而增加的趋势，餐后PNSW明显高于餐前。DF和DFIC各阶段无明显差异，但自身比较，餐后DF高于餐前，餐后DFIC低于餐前。结论 研究显示出新生儿胃电肌运动的发育过程。     

危重新生儿血清D-二聚体的测定及超小剂量肝素的临床应用

目的　 探讨危重新生儿血清D 二聚体 (D D)水平变化 ,为肝素合理治疗提供理论依据。 方法 　比较正常足月儿3 0例和危重新生儿 42例血清D D检测结果 ;治疗组 2 1例和对照组 2 1例治疗后血清D D变化情况。 结果 　危重组血浆D D(2 45± 0 78)mg/L ,显著高于正常组 (0 48± 0 2 3 )mg/L(P <0 0 1) ;治疗后 ,治疗组血浆D D (0 65± 0 47)mg/L ,较对照组(1 2 1± 0 5 8)mg/L下降显著 (P <0 0 1)。 结论 　危重新生儿血液多呈现高凝状态 ,血清D D水平检测有利于诊断DIC早期。早期肝素治疗 ,不仅可改变血液的高凝状态 ,而且是预测DIC ,提高治愈率的有效途径。     

血清肌酸磷酸激酶同工酶及心肌肌钙蛋白早期诊断窒息新生儿心肌损害

目的　探讨血清肌酸磷酸激酶同工酶 (CK- MB)及心肌肌钙蛋白I(cTnI)测定对窒息新生儿心肌损害的早期诊断价值。方法　窒息组 40例 (轻度窒息、重度窒息各 2 0例 )、对照组 2 0例 ,生后 1、5、1 0d测定血清CK MB及cTnI水平。结果　窒息组生后 1d血清CK- MB及cTnI明显高于对照组 (P均 <0 .0 1 ) ,重度窒息组明显均高于轻度窒息组 (P均 <0 .0 1 ) ,治疗后呈逐渐下降趋势。血清CK- MB及cTnI对心肌损害诊断的敏感性无显著差异 (P >0 .0 5)。结论　血清CK MB及cTnI可用于窒息新生儿心肌损害的早期诊断。     

新生儿高胆红素血症与胃动素胃泌素水平的相关性研究(英文)

目的：新生儿高胆红素血症患儿常出现胃肠道症状。该研究目的是探讨高胆红素血症 (高胆 )对新生儿胃肠激素水平的影响及其可能的发生机制。方法：应用放射免疫分析法 (RIA)对 5 0例高胆患儿空腹状态下血中胃动素、胃泌素浓度进行测定 ,并以 30例正常新生儿作为对照。结果：高胆组患儿血浆胃动素浓度 (6 5 9±37ng/L)明显高于对照组 (4 86± 2 8ng/L) ,差异有显著性意义 (P <0 .0 1) ,且与血清胆红素水平呈正相关 ;血清胃泌素浓度 (12 8± 9ng/L)与对照组 (132± 11ng/L)比较差异无显著性 (P >0 .0 5 )。结论：高胆红素血症新生儿的某些胃肠道症状可能与胃动素分泌异常有关。     

新生儿窒息后早期血浆VWF D-二聚体及蛋白C水平的变化

目的：探讨新生儿窒息后早期血浆血管性假血友病因子(VWF)、D二聚体(D-D)以及蛋白C(PC)的变化规律观察新生儿窒息对凝血功能的影响及临床意义。方法：检测39例新生儿窒息后血浆VWF、D D及PC水平,并与25例正常新生儿比较。结果：新生儿重度窒息后血浆VWF、D D平均值分别为：(140.18±28.38)%,(3.92±1.50) mg/L,与对照组平均值(111.80±17.19)%,(0.42±0.21) mg/L比较均增高显著,差异有显著性意义(P＜0.01＝;PC平均值(2.85±0.55) μg/ml,与对照组(4.73±1.88) μg/ml比较明显降低,P<0.01;重度窒息组与轻度窒息组VWF、D D、PC平均值(128.99±11.18)%,(1.43±0.84) mg/L,(4.17±1.32) μg/ml比较变化明显(P＜0.01 或 0.05)。轻度窒息组血浆VWF、 DD平均值与对照组比较亦增高显著(P＜0.01 或 0.05),而血浆PC平均值降低不明显,与对照组比较差异无显著性意义(P＞0.05)。3组血小板计数均在正常范围,但重度窒息组血小板值较对照组低。结论：新生儿窒息后早期存在内皮细胞损伤及凝血功能异常,反映血液呈高凝状态,且各项指标异常程度与窒息分度有关。血管内皮损伤在窒息病理生理学中具有重要意义。     

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.     

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   

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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.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

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.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.