Adaptation of the Manchester-Minneapolis Quality of Life instrument for use in the UK population

Introduction

The availability of health‐related quality of life (HRQL) measures that are reliable, valid, brief and comprehensible and appropriate for use with UK children is limited. We report the validation of a HRQL measure suitable for UK use in healthy children, children with chronic disease conditions and socially disadvantaged children.

Patients

A total of 1238 children took part in the study, including healthy children as controls (n = 824) and five exemplar groups: children diagnosed with asthma (n = 87), diabetes (n = 103) or inflammatory bowel disease (IBD; n = 69), children in remission from cancer (n = 68) and children in public care (n = 87).

Methods

In phase I, the Manchester‐Minneapolis Quality of Life instrument (MMQL) Child Form was translated into UK English. In phases II and III, the questionnaire was shortened and validated.

Results

MMQL was anglicised and shortened to five components comprising 29 items. Good internal reliability was found with α reaching at least 0.69 for all subscales. Construct validity was established through moderate correlations with comparable PedsQL subscales (Pearson''s r ranged from 0.38 to 0.58, p<0.01). Discriminant validity was also demonstrated in children with asthma and IBD, children in remission from cancer and children in public care, all of whom reported significantly lower HRQL than healthy children. Children with diabetes showed similar HRQL to their healthy peers. Good reproducibility and moderate responsiveness were demonstrated for the new measure.

Conclusions

The anglicised and shortened MMQL was shown to be valid and reliable and could be a valuable new tool for the assessment of HRQL in children.     

Assessment of health-related quality of life of adolescent cancer patients using the Minneapolis-Manchester Quality of Life Adolescent Questionnaire

BACKGROUND: Improved survival after childhood cancer has shifted the focus to health-related quality of life (HRQL)-an understudied problem, especially among adolescents. PROCEDURE: We assessed HRQL among adolescents utilizing a validated self-report tool, the Minneapolis-Manchester Quality of Life (MMQL) Adolescent Form, consisting of 46 items comprising seven domains: physical, cognitive, psychological and social functioning, body image, intimate relations, and outlook on life, and computed an overall QoL score. The MMQL Adolescent Form was administered to 226 adolescent survivors of childhood cancer a median of 7.8 years from diagnosis (off therapy-median age: 16.2 years), 136 adolescent cancer patients undergoing therapy (on therapy-median age: 16.4 years), and 134 healthy adolescents (controls-median age: 15.5 years). Primary diagnoses included leukemia (46%), lymphoma (26%), brain tumors (5%), and other solid tumors (23%). RESULTS: Compared to healthy controls, on-therapy patients were at increased risk for reporting poor overall QoL [Odds Ratio (OR) = 3.3, P = 0.002)] and poor physical functioning (OR = 11.8, P < 0.001). Off-therapy survivors did not differ significantly from healthy controls for overall QoL (OR = 1.6, P = 0.5) or any HRQL domains. Female patients, both on- and off-therapy, were more likely to report poorer overall QoL, physical, psychological and cognitive functioning as well as poorer body image when compared with male patients. CONCLUSIONS: While adolescent cancer patients undergoing active therapy report poor physical functioning, there is no evidence of long-term QoL sequelae.     

Validity of the child health questionnaire for use in children with sickle cell disease

OBJECTIVE: To provide accurate data on health-related quality of life (HRQL), there must be a valid tool to measure this outcome. The objective of this study was to determine the validity of the Child Health Questionnaire (CHQ) as a measure of HRQL in sickle cell disease (SCD) by examining the relationship between HRQL and disease severity. METHODS: This was a cross-sectional study of children conducted at two urban, hospital-based clinics. The study participants were children with SCD ages 5 to 18 years who presented for a routine visit to the comprehensive SCD clinic. The main outcome was HRQL, as measured by the CHQ-Parent Form 28 (PF28). A t test was used to compare HRQL between those with mild and severe disease. RESULTS: Parents/caretakers of 95 children completed the CHQ-PF28. Children with mild SCD had a significantly better HRQL, as evidenced by a higher mean physical summary score (39.1), than those with severe disease (28.0) (difference=11.1, 95% confidence interval 5.03-18.11). There was no significant difference in psychosocial summary scores between groups. CONCLUSIONS: The CHQ is a valid tool to assess HRQL in children with SCD and could serve as an important adjunct to determine the effect of SCD on the lives of children.     

脑源性神经营养因子与儿童哮喘严重程度的关系

目的探讨血清脑源性神经营养因子(BDNF)水平与哮喘患儿病情严重程度的关系。方法选取60例哮喘急性发作期儿童(轻度组18例、中度组25例、重度组17例)及60例健康体检儿童作为研究对象,采用酶联免疫吸附法(ELISA)检测血清BDNF,分析BDNF水平与哮喘严重程度的关系。结果哮喘急性发作组及症状缓解组的BDNF水平均高于对照组,以急性发作组最高(P0.05);治疗后处于缓解期时,BDNF水平较发作期明显降低(P0.05)。发作期哮喘患儿病情严重程度不同,其血清BDNF水平不同:轻度组最低、重度组最高,差异有统计学意义(P0.05)。结论 BDNF可能在儿童哮喘的发病机制中发挥一定的作用,并且与病情严重程度相关。     

Health-related quality of life and ambulation in children with myelomeningocele in a Swedish population

Aim: The aim was to study health‐related quality of life (HRQL) in Swedish children with myelomeningocele (MMC) with respect to ambulatory function. Methods: A physical examination of the lower limbs was performed, and occurrence of orthopaedic deformities and shunted hydrocephalus was documented. A questionnaire on general health‐related quality of life Child Health Questionnaire‐50 Parent Form (CHQ‐PF50) was answered by the parents of 62 children, mean age 12.5 (3.1) years. Results: The non‐ambulatory children had significantly more frequent spasticity in the lower limbs, more often joint contractures as well as hip dislocation or spine deformity compared with ambulating patients. Thirty‐two per cent of the ambulators managed without wheelchair use. All non‐ambulators were wheelchair users, of which 60% used both a manual and a powered wheelchair. The children with MMC perceived significantly lower HRQL of all subscales of CHQ compared with the healthy control group. Physical function was significantly higher in ambulatory patients, PF = 57.1 compared with 22.2 for non‐ambulatory patients. Conclusion: A Swedish population of children with MMC perceived lower HRQL compared with healthy children, but similar HRQL irrespective of ambulatory function except for the physical domain was reported.     

哮喘患儿外周血T淋巴细胞上前列腺素D2受体改变研究

目的：哮喘的慢性气道炎症与TH2的极化有关,炎症介质前列腺素D2（PGD2）可通过T淋巴细胞上前列腺素D2受体（DP1/CRTH2）调控其极化和分泌功能,而且CRTH2是TH2细胞的特征性受体,研究不同哮喘病期T淋巴细胞上受体改变,对了解哮喘患儿中TH2极化状态和哮喘发病机制有重要意义。方法：正常对照组35例,哮喘急性发作期组42例和临床缓解期组30例。用酶联免疫吸附法测定外周血IL-4,IL-5 和IFN-γ,用放射配体结合分析法测定外周血T细胞上DP1/CRTH2结合容量。结果：哮喘急性发作期和临床缓解期组T淋巴细胞上总结合和CRTH2受体结合容量比正常对照组显著增加（P<0.01）;DP1差异无显著性。哮喘急性发作期和临床缓解期组TH2细胞因子IL-4、IL-5比正常对照组显著增加（P<0.01）;TH1细胞因子IFN-γ比正常对照组显著减少（P<0.01）。结论：支气管哮喘病人临床缓解期和急性发作期外周血T淋巴细胞上CRTH2受体表达增加,外周血中TH2细胞因子分泌增加, TH1细胞因子分泌减少, 提示在哮喘病人中存在TH2的极化状态,应用CRTH2拮抗剂可能是以后哮喘治疗的一个新靶点。［中国当代儿科杂志,2009,11（3）：199-202］     

Treatment burden and health-related quality of life of children with diabetes, cystic fibrosis and asthma

AIM: To identify the time required by children with cystic fibrosis (CF), diabetes or asthma to complete daily treatment tasks and the hassle they experienced when completing these tasks. To compare parent and child reports of daily treatment time and hassle. To investigate the relationship between treatment time and hassle, and (i) children's health-related quality of life (HRQL); and (ii) disease severity. METHODS: 160 children aged 10-16 years with CF, type 1 diabetes, or asthma were followed over a 2-year period. Information about children's treatment time and hassle, and their HRQL was obtained from parents and children at baseline, 1-year and 2-year follow-up assessments. RESULTS: On average, children with CF reported spending 74.6 +/- 57.0 min completing treatment tasks, children with diabetes spent 56.9 +/- 27.8 min and children with asthma spent 6.4 +/- 9.3 min. Parents reported that children spent less time that was reported by their children. Over the two years, parent and child reports describing treatment time for children with CF did not vary significantly (P = 0.3). Treatment time for children with diabetes increased (P = 0.02) whereas that for children with asthma reduced (P = 0.001). The level of hassle experienced by children when completing individual treatment tasks was low for all three conditions. There was no significant relationship between treatment time and children's HRQL. CONCLUSION: Children with CF or diabetes spent a substantial amount of time each day completing the treatment tasks. Although this was not related to HRQL, it could impact the ability to comply with complex and all home-based-therapies for some children.     

哮喘患儿血一氧化氮及血型的相关研究

目的　探讨一氧化氮 (NO)在哮喘发病中的作用及血型与哮喘的相关性 ,以提高对哮喘的诊治水平。方法　采用比色法测定 87例哮喘患儿和 3 0例健康儿童血浆亚硝酸根离子 /硝酸根离子 (NO2 - /NO3- )含量。对 113例哮喘患儿和 1872例健康儿童行血型测定。结果　哮喘患儿急性期及缓解期血浆NO2 - /NO3 - 含量明显高于健康儿童。急性期血浆NO2 - /NO3 - 含量高于缓解期。哮喘患儿和健康儿童血型构成无显著差别(P >0 .0 5)。结论　NO参与哮喘发病的病理生理过程 ,缓解期气道炎症仍存在。血浆NO2 - /NO3 - 水平可作为判定哮喘病情程度的重要指标之一。血型与哮喘无明显相关性     

Overweight status of adolescent girls with polycystic ovary syndrome: body mass index as mediator of quality of life.

PURPOSE: Adolescent girls with polycystic ovary syndrome (PCOS) have significant disruption in health-related quality of life (HRQL) compared to their healthy peers, but it is unclear which aspects of the disorder have the greatest impact on these quality-of-life changes. Studies of adult women have indicated that weight status has a significant impact on subjective symptomatology; however, a similar effect of weight status on HRQL in adolescents with PCOS has not been established. This study evaluated the effect of body mass index (BMI) on quality-of-life disturbances in adolescent girls with PCOS. METHODS: Data were derived from the Adolescent PCOS Quality of Life Study, a cross-sectional study of healthy (n = 186) and PCOS-affected adolescent girls (n = 97). The study was conducted at an urban, hospital-based adolescent medicine clinical practice. Medical staff obtained anthropomorphic measurements. Participants in both groups completed the Child Health Questionnaire-Version CF-87 as a measure of HRQL. BMI was tested as a mediator of HRQL using bivariate analyses and multivariate linear regression models. RESULTS: The average BMI was 31.7 kg/m(2) (standard deviation [SD] = 8.4) for adolescents with PCOS and 23.5 kg/m(2) (SD = 4.2) for healthy adolescents. BMI was associated with PCOS status and HRQL. Girls with PCOS scored lower on the general health perceptions scale, physical functioning scale, family activities scale, and the general behavior scale and higher on the change in health in the last year subscale. When BMI was added to the multivariate linear regression models, coefficients were reduced on average by 3 points and became nonsignificant, indicating that the HRQL differences are mediated by the higher BMI. CONCLUSION: This study demonstrates that BMI is a primary mediator in the relationship between PCOS and the HRQL reductions experienced by girls with the disorder. Clinical interventions that effectively address weight issues in adolescents with PCOS may improve overall HRQL and other obesity-related clinical outcomes.     

Measuring quality of life in Japanese children: Development of the Japanese version of PedsQL

Background:  Health-related quality of life (HRQL) is perceived as an important health-care outcome. There are several systems for measuring the HRQL in adults but there are few such systems for children in Japan. Pediatric Quality of Life Inventory (PedsQL) is valid and demonstrates excellent reliability in the USA, Europe, and Asian countries. The aim of the present study was therefore to develop the Japanese version of PedsQL.
Methods:  A two-step procedure was performed: translation of PedsQL, followed by examination of the psychometric properties in a cross-sectional study. The feasibility, reproducibility, internal consistency reliability, factor structure, and concurrent and clinical validity were examined.
Results:  The internal consistency reliability of the Child Self-Reports of young children was slightly low, but that of the Child Self-Reports of school children and adolescents was good. Further, all the Parent Proxy-Reports had excellent alphas. The Japanese version had satisfactory feasibility for all age ranges. The intercorrelation of subscales supported the multidimensional factor structure. Clinical validity was examined by analysis of variance performed for four groups with different health conditions (healthy, chronic needs only, mental condition only, and chronic needs and mental condition). The scores of each functioning scale differed among the four groups, with the healthy group having the highest scores for all functioning scales.
Conclusions:  The Japanese version of PedsQL can be applied in community and school health settings in Japan. Because children with chronic health needs and mental conditions were included, the Japanese version of PedsQL is expected to be useful in clinical settings.     

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目的探讨支气管哮喘患儿外周血中辅助T细胞(Th)17细胞和CD4+CD25+调节性T细胞(Treg)的变化与儿童哮喘病情的相关性。方法收集2009年月5月至2010年4月于郑州大学第一附属医院就诊的患儿,均为首次确诊哮喘或规范吸入激素停用>3个月后复发及近1个月内无明显感染者。采用流式细胞仪测定患儿外周血中Th17细胞及CD4+CD25+Treg比例的变化。结果 Th17细胞在哮喘急性期组(2.24%±1.02%)较哮喘缓解期组(1.65%±0.38%)及健康儿童组(1.02%±0.28%)均显著增高(P<0.05),哮喘缓解期组(1.65%±0.38%)和健康儿童组(1.02%±0.28%)无明显差别,CD4+CD25+Treg细胞比例在3组儿童间差异均有统计学意义(F=45.604,P<0.05),与健康儿童组(7.11%±0.89%)相比,哮喘缓解期组(6.05%±0.87%)和哮喘急性期组(5.37%±0.80%)的比例明显下降,而哮喘急性期组较健康儿童组下降。哮喘急性期组轻、中、重度3组之间差异同样有统计学意义。Th17细胞与哮喘患儿病情呈正相关(r=0.649,P<0.05),而CD4+CD25+...     

哮喘和咳嗽变异性哮喘儿童肺常规通气功能的比较

目的：比较哮喘与咳嗽变异性哮喘（CVA）患儿肺常规通气功能的变化。方法：选择2010年 5月至2011年5月确诊为哮喘或CVA的患儿140例,分为哮喘急性发作组（发作组,50例）、哮喘缓解组（缓解组,50例）和CVA组（40例）;同期正常健康体检儿童30例作为对照组。测定4组儿童用力肺活量(FVC)、一秒钟用力呼气容积(FEV1)、最大呼气峰流速(PEF)、用力呼气25%流速(FEF25)、用力呼气50%流速(FEF50)、用力呼气75%流速(FEF75)、最大呼气中期流速(MMEF75/25)等7项肺功能指标。结果：发作组患儿各项肺功能指标如大气道指标FVC、FEV1、PEF、FEF25及小气道指标FEF50、FEF75、MMEF75/25的实际值/预计值平均水平均<80%,且以FEF50、FEF75、MMEF75/25等小气道指标下降为著。CVA组患儿小气道指标FEF75、MMEF75/25实际值/预计值的平均水平<80%。发作组各项肺常规通气功能指标均低于对照组;缓解组、CVA组FVC、FEV1、FEF25及 MMEF75/25实际值/预计值的平均水平低于对照组;发作组各项肺功能指标均明显低于缓解组和CVA组;CVA组与缓解组各项肺功能指标差异均无统计学意义。结论：哮喘急性发作期患儿存在大小气道功能障碍,以小气道功能障碍为主;CVA患儿以小气道功能轻微障碍为主,与哮喘缓解期相似。     

A Danish adaptation of the Pain Coping Questionnaire for children: preliminary data concerning reliability and validity

The aim of this study was to determine the reliability and validity of a Danish translation of the Pain Coping Questionnaire (PCQ) for children in Danish children. The PCQ was translated using a translation-back-translation method. The subjects were 352 healthy children and 40 children with juvenile arthritis (JA), aged 8-17 y. Sixteen of the JA children were divided into a high-pain group (n = 7) and a low-pain group (n = 9). The results were factor analysed using principal component analysis with varimax rotation. Clinical pain intensity was measured using visual analogue scales (VAS) from the Varni/Thompson Pediatric Pain Questionnaire. Experimental pain was induced using a cold pressor pain paradigm and outcome measures were pain intensity, pain discomfort and tolerance to cold pressor pain. A seven-factor solution emerged as the most consistent factor structure. Four subscales, Seeking Social Support (SSS), Cognitive Distraction (CD), Externalizing (EXT) and Internalizing/Catastrophizing (INT), corresponded with the parallel subscales proposed by Reid et al. (Pain 1998; 76: 83-96). Two subscales, Positive Self-Statements (PSS) and Behavioral Distraction (BD), were composed of four of the five items from the previously proposed subscales. One subscale, Information Seeking/Problem Solving (IP), consisted of items from two subscales proposed by Reid et al., i.e. Information Seeking and Problem Solving. Internal consistencies of the subscales were acceptable, with reliability coefficients ranging from 0.60 (BD) to 0.83 (IP) and with test-retest reliabilities between 0.59 and 0.78. Low-pain JA patients showed significantly higher levels of BD than High-pain JA patients (p<0.05). Greater utilization of PSS and BD was associated with less patient-reported present pain and less average everyday pain (p<0.05-0.01), and greater utilization of INT was significantly associated with higher experimental pain intensity (p<0.01). These preliminary findings provide support for the reliability and validity of the Danish modification of the PCQ in a Danish population and for the hypothesis that paediatric pain-coping strategies are associated with the intensity of clinical and experimental pain.     

神经激肽A在哮喘患儿血浆含量变化的动态研究

目的　动态研究哮喘患儿血浆神经激肽A(NKA)含量变化规律 ,探讨NKA与小儿哮喘的关系。方法　用酶联免疫方法 ,动态测定 35例不同严重程度哮喘小儿血浆NKA在哮喘发作期及其临床症状缓解期的含量变化。结果　 (1 )小儿哮喘发作期血浆NKA含量 [(2 56± 1 53)ng/L]高于自身症状缓解期 [(70± 66)ng/L]及正常对照组 [(38± 6)ng/L] ,差异有非常显著意义 (q分别为9 497、8 599,P均 <0 0 1 ) ;哮喘症状缓解期血浆NKA含量较正常对照组差异无显著意义 (q =1 2 4 5 ,P >0 0 5)。 (2 )哮喘小儿病情加重 ,血浆NKA含量亦随之增高 ,重度哮喘发作时血浆NKA含量 [(2 96± 1 70 )ng/L]明显高于轻、中度哮喘发作时含量 [(1 90± 99)ng/L] ,差异有显著意义 (q =3 77,P <0 0 5)。结论　小儿哮喘发作期血中NKA含量明显增高 ,病情愈重增高越明显 ,随哮喘症状缓解血中NKA含量下降至正常水平 ;血中NKA含量的变化与小儿哮喘的发作及缓解关系密切     

支气管哮喘患儿外周血辅助性T淋巴细胞17、白细胞介素-17、白细胞介素-21水平变化

目的 检测辅助性T淋巴细胞17(Th17)及细胞因子IL-17、IL-21在支气管哮喘(哮喘)患儿外周血中的表达,探讨其在儿童哮喘发病机制中的作用.方法 以哮喘患儿60例(哮喘组)为研究对象,根据病情分为哮喘发作期(发作期组,n=30)、哮喘缓解期(缓解期组,n=30);以健康儿童30例作为健康对照组.分离外周血单个核细胞,采用流式细胞术检测其Th17细胞百分率.采用ELISA法检测各组IL-17、IL-21表达水平.采用SPSS 13.0软件进行统计学分析.结果 哮喘发作期组患儿外周血中Th17及 IL-17 水平明显高于缓解期组和健康对照组(Pa<0.05);哮喘发作期组患儿血清IL-21表达水平明显低于缓解期组和健康对照组(Pa<0.05);哮喘缓解期组与健康对照组外周血Th17、IL-17、IL-21水平比较,差异均无统计学意义(Pa>0.05).结论 Th17、IL-17通过全身系统性炎症反应参与儿童哮喘的发病,IL-21可作为儿童哮喘的控制指标,亦有望为哮喘的治疗提供新的靶点.     

脉冲振荡肺功能与黏附分子在儿童哮喘中的临床意义

目的：脉冲振荡肺功能是近年来开展的一项肺功能测定新技术, 特别适用于学龄前儿童,但目前有关报道不多,且尚无统一正常值。可溶性细胞间黏附分子-1（sICAM-1）、内皮细胞黏附分子-1（sVCAM-1）是已明确的反映哮喘严重程度的指标,该文旨在探讨上述指标在儿童哮喘中的临床意义。方法：应用Master Screen系列肺功能测定系统,对25例健康儿童、40例哮喘发作期儿童用脉冲振荡法（IOS)进行肺功能检测,其中23 例患儿激素治疗达缓解期后再次检测;同时对部分上述儿童（发作期23例,缓解期20例, 对照组16例）进行sICAM-1、sVCAM-1水平检测。 结果：IOS肺功能测试发作期R5,R20,R5-R20,X5,Fres,Zrs均高于对照组和缓解组,差异均有显著性(q= 2.91 ~15.61,P<0.01或P<0.05),缓解期与对照组比较,R5,R5-R20,Fres,Zrs差异有显著性(q=3.08~9.19,P<0.01或 P<0.05)。发作期血清sICAM-1,sVCAM-1明显高于缓解期及对照组(q= 6.23~26.15,P＜0.01）,而缓解期仍高于对照组(q=16.86,12.46, P<0.01)。发作期sICAM-1,sVCAM-1与R5-R20呈正相关（r=0.45,0.57 P<0.05） 结论：IOS肺功能和sICAM-1、sVCAM-1都可以作为儿童哮喘病情严重程度和治疗效果的评价指标,两者之间有一定的相关性,IOS肺功能测定简便、无创,适合于学龄前儿童。［中国当代儿科杂志,2007,9（5）：415-418］     

γ-氨基丁酸治疗对哮喘患儿血浆P物质和降钙素基因相关肽含量的影响

目的：探讨γ-氨基丁酸（GABA）治疗前后哮喘患儿血浆P物质（SP）和降钙素基因相关肽(CGRP)含量的变化。方法：75例哮喘患儿随机分为GABA治疗组（36例）和对照组（39例）,两组患儿均给予哮喘常规治疗。治疗组在常规治疗的基础上给予GABA口服 (每日25~30 mg/kg）。采用酶联免疫吸附法（ELISA）测定患儿治疗前、缓解后血浆SP、CGRP的含量。结果：两组患儿治疗前血浆SP、CGRP含量差异无统计学意义（P＞0.05）;哮喘缓解后治疗组血浆SP、CGRP含量分别为57±15 pg/mL、23±10 pg/mL,显著低于对照组（分别为127±12 pg/mL、 42±8 pg/mL）,差异有统计学意义（P<0.01）。两组哮喘缓解后血浆SP、CGRP含量均较治疗前明显下降,差异有统计学意义（P<0.01）。哮喘患儿血浆SP与CGRP含量呈显著正相关（r=0.792,P<0.01）。结论：GABA可抑制小儿哮喘急性发作期血浆SP、CGRP的释放。     

CD4+CD25(high) Treg cells in peripheral blood during remission and exacerbation of allergic asthma in children

Aim: To determine the percentage of CD4⁺CD25^high Treg cells in peripheral blood CD4⁺ T cells of allergic asthmatic children during disease remission and exacerbation. Methods: Peripheral blood mononuclear cells (PBMC) and serum samples were collected from 6‐ to 11‐year‐old children with mild‐to‐moderate allergic asthma (n = 34) and from healthy controls (n = 15). CD4⁺CD25^high T cells in PBMC were detected by flow cytometry. Total and specific IgE in serum were analysed by enzyme‐amplified chemiluminescence, and IL‐2 was measured by ELISA. Results: There was no significant difference in CD4⁺CD25^high T‐cell proportions between asthmatic children in exacerbation and remission as compared with controls. CD4⁺CD25^high T‐cell percentages were not correlated with total and specific IgE. IL‐2 was elevated in both disease remission and exacerbation but did not correlate significantly with CD4⁺CD25^high T‐cell percentages. Conclusion: CD4⁺CD25^high T‐cell proportion in the peripheral blood of total CD4⁺ T cells is not reduced in children with allergic IgE‐mediated asthma and does not differ between disease remission and exacerbation.     

青春期前后支气管哮喘患者病情缓解状况调查

目的 了解支气管哮喘(哮喘)患儿青春期前后病情缓解基本状况.方法 对501例8 ～ 26岁的哮喘患者进行有关青春期前后病情缓解基本状况的问卷调查.结果 501例哮喘患者青春期后病情缓解率为67.5％(338/501例).男性患者(66.0％)与女性患者(69.9％)缓解率比较差异无统计学意义.在青春期病情未缓解的哮喘患者哮喘首次发作年龄及末次发作年龄与缓解组比较有统计学差异(=5.82、9.90,Pa=0.00).8岁后哮喘发作仍频繁者(年最多发作6次以上)的病情在青春期后缓解的概率更小,与年发作＜6次的患者比较差异有统计学意义(x2=20.69,P=0.00).变应性鼻炎症状越严重(中-重度)的哮喘患者,青春期前后的缓解率越低,与轻度或无明显鼻炎患者比较,差异有统计学意义(x2=8.25,P=0.02).个人高发季节在春夏秋季者在青春期前后哮喘病情缓解率更低,与高发季节在冬季的患者比较差异有统计学意义(x2 =7.71,P=0.04).血总IgE水平越高的哮喘患者,青春期后哮喘病情缓解率越低(t=2.16,P=0.03).规范化吸入激素联合特异性免疫治疗的哮喘患者在青春期前后缓解率较高,与吸入激素组及未规范治疗组比较,差异有统计学意义(x2=10.25,P=0.01).经常运动健身的哮喘患者在青春期前后缓解率更高,达75.3％,与不常运动健身的哮喘患者比较,差异有统计学意义(x2=8.76,P=0.00).结论 青春期前后哮喘患者病情缓解率较高,哮喘首次发作年龄越大、8岁后哮喘急性发作仍频繁、并变应性鼻炎越严重以及血总IgE越高,其在青春期前后的哮喘病情越不易缓解.给予积极的干预治疗措施如特异性免疫治疗及运动健身等,能使青春期前后哮喘的缓解率提高.     

Infliximab-induced psoriasis in children with inflammatory bowel disease

Infliximab is frequently used to treat both inflammatory bowel disease (IBD) and psoriasis. We reviewed the medical records of 73 children with IBD receiving infliximab therapy and identified 6 (8%) cases of infliximab-induced psoriasis. Five (83%) had Crohn disease and 4 (67%) were girls. The psoriatic lesions appeared on the face (n = 5; 83%) and perineum (n = 1; 17%). A median of 13 doses were administered during a median duration of 21 months. All of the patients were continued on infliximab to maintain clinical remission of IBD. Educating children with IBD and their caregivers about this paradoxical phenomenon and periodic dermatology evaluation may promote patient care.