学龄前儿童血清中性粒细胞明胶酶相关脂质运载蛋白与铁代谢指标相关性及其意义

【目的】 初步分析中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)水平对铁代谢指标血红蛋白(hemoglobin,HB)、铁蛋白(serum ferritin,SF)、血清转铁蛋白受体(serum transferrin receptor,sTfR)、转铁蛋白/铁蛋白指数(transferritin receptor-ferritin index,TFR-F)以及机体铁含量(body iron content,BIC)的关系。 【方法】 随机抽取473名3~6岁(不足7岁)学龄前儿童纳入本研究,利用氰化高铁血红蛋白法测定HB、ELISA法测定血清NGAL、SF及sTfR,并根据相关公式计算TRFI和BIC指数。 【结果】 血清NGAL与sTfR、TFR-F和BIC均呈显著相关关系(偏相关系数r=0.23、0.24、-0.15,P<0.01或<0.05)。贫血儿童血清NGAL水平显著低于非贫血儿童[(152.8±33.4)vs (220.7±25.4)pg/mL](P<0.05);以指标中位数为界,低sTfR组儿童血清NGAL水平明显低于高sTfR组[(181.05±41.1)vs(257.6±47.8)pg/mL](P<0.05),低BIC组儿童血清NGAL水平明显高于高BIC组[(269.1±49.4)vs(181.3±30.8)pg/mL](P<0.05)。低NGAL组儿童血清sTfR水平及TFR-F指数显著低于高NGAL组(P<0.05),而HB、SF以及BIC组间差异无统计学意义(P>0.05)。 【结论】 NGAL可能主要通过阻止红系统增殖参与调节儿童铁代谢稳态,而与机体铁储备过程无关。     

急性时相反应对学龄前儿童维生素A营养评价指标的影响

【目的】评估急性时相反应对维生素A评价指标,包括血清视黄醇,视黄醇结合蛋白(retinol binding pro-tein,RBP),甲状腺素运载蛋白(transthyretin,TTR)以及RBP:TTR摩尔比值的影响。【方法】从重庆巴南地区随机抽取四所幼儿园中的350名学龄前儿童作为研究对象,利用HPLC法测定其血清视黄醇浓度,ELISA测定血清RBP浓度,免疫比浊法测定血清中TTR和C-反应蛋白(C-reaction protein,CRP)水平并对其相关性进行分析。【结果】边缘性维生素A缺乏(marginal vitamin A deficiency,MVAD)儿童的RBP水平明显低于维生素A正常(normal vitamin A,NVA)儿童(P<0.01)。维生素A缺乏(vitamin Adeficiency,VAD)儿童和MVAD儿童TTR值均显著低于NVA儿童(P<0.01)。MVAD儿童的RBP∶TTR摩尔比值显著低于NVA儿童(P<0.05)。RBP∶TTR摩尔比值在维生素A不足且伴感染的儿童中最低(P<0.05),而在正常维生素A状态不伴感染的儿童中最高(但差异不明显)。【结论】在伴感染的学龄前儿童中评价其维生素A营养状况时,RBP∶TTR摩尔比值有可能是一个有用的指标,但是还需要进一步的研究对其使用效度进行评价。     

1型糖尿病患儿血清维生素A浓度变化及其与Th1/Th2平衡相关性

【目的】 探讨1型糖尿病(type 1 diabetes mellitus,T1DM)患儿血清维生素A浓度变化及其与辅助性T淋巴细胞Th1/Th2平衡相关性,了解维生素A在儿童TIDM中的作用。 【方法】 选取32例T1DM患儿为实验组,28例健康儿童为对照组,微量荧光法检测两组血清维生素A水平,酶联免疫吸附(ELISA)法检测培养上清液中干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)水平变化; 【结果】 1)T1DM组的血清维生素A水平明显低于对照组(P<0.01);2)T1DM组PBMC产生IFN-γ水平高于对照组(P<0.01),IFN-γ/IL-4比值明显高于对照组(P<0.01);3)二组血清维生素A浓度与PBMC产生IFN-γ水平皆呈负相关(P<0.05或<0.01),与IL-4水平均无相关性(P均>0.05),与IFN-γ/IL-4比值皆呈负相关(P<0.01或<0.01)。 【结论】 T1DM患儿存在维生素A缺乏,其与T1DM患儿Th1/Th2失衡关系密切。     

儿童血清维生素A、D、E水平与肺炎支原体肺炎相关性的临床研究

目的 研究儿童血清维生素A、D、E水平与肺炎支原体肺炎的相关性,为临床防治提供指导。方法 选取肺炎支原体肺炎住院治疗患儿415例为支原体肺炎组,儿保科非呼吸道感染儿童431例为对照组。分别检测两组儿童血清维生素A、D、E水平。结果 支原体肺炎组血清维生素A、D、E平均值均明显低于对照组(P<0.01);维生素A缺乏例数明显高于对照组(P<0.01),亚临床维生素A缺乏例数与对照组相比差异无统计学意义(P>0.05);维生素D缺乏及不足例数均明显高于对照组(P<0.01);维生素E缺乏例数明显高于对照组(P<0.01)。结论 维生素A、D、E缺乏与肺炎支原体肺炎的发病相关,特别是缺乏维生素A,补充维生素A、D、E有可能对预防肺炎支原体肺炎反复发作有益,其具体机制有待于进一步探讨。     

抚顺地区6 766例0~14岁儿童血清维生素A水平调查研究

目的 调查抚顺地区0~14岁儿童血清维生素A水平状况,为本地区儿童合理补充维生素A提供依据,为临床工作提供参考。方法 对2015年1月-2018年12月在辽健集团抚矿总医院儿科保健门诊健康体检的6 766例0~14岁儿童采用高效液相色谱法测定血清维生素A水平。结果 亚临床维生素A缺乏检出率为17.85%(1 208/6 766),可疑亚临床维生素A缺乏检出率为43.26%(2 927/6 766)。近四年儿童血清维生素A水平比较差异有统计学意义(P<0.05),2018年可疑亚临床维生素A缺乏检出率为45.3%,亚临床维生素A缺乏检出率为10.5%,已较前明显下降。不同性别儿童血清维生素A水平差异无统计学意义(P>0.05)。不同季节检测儿童血清维生素A水平差异有统计学意义(P<0.05),秋季儿童血清维生素A水平高于其他季节。不同年龄组儿童血清维生素A水平差异有统计学意义(P<0.05)。随年龄增长血清维生素A缺乏检出率逐渐下降,≤1月组及1~6月组血清维生素A水平明显低于其他年龄组,6~14岁组儿童血清维生素A平均水平在正常范围。结论 抚顺地区0~14岁儿童血清维生素A水平普遍偏低,0~6月龄婴儿的维生素A营养状况问题较为严重。应注意调整膳食结构,合理补充维生素A,预防维生素A缺乏症的发生。     

北方地区儿童超声骨密度值与儿童年龄及季节的关系

【目的】 了解北方部分地区儿童骨密度现状,探讨儿童骨密度与年龄、性别及季节的关系。 【方法】 对2008-2009年度本科5 971名正常儿童骨密度检测值与年龄、性别、季节的相关性进行分析。 【结果】 北方儿童骨密度值呈正态分布,并随年龄增长而增加(P<0.001)。不同年龄段儿童骨密度差异有统计学意义(P<0.001)。青春期前儿童骨密度值与性别无关(P>0.05);而青春期女童骨密度较男童高(P<0.000 1)。学龄组(6~12岁)儿童骨密度值Z分数差异有统计学意义(P=0.008 5),其余组四季骨密度差异不显著,婴儿组秋季偏低,与冬季差异显著;学龄前组夏季偏低,与冬季差异显著(P均＜0.05)。 【结论】 北方地区儿童骨密度值随年龄而增加并受性别影响。青春期儿童应注重钙制品及维生素D的补充。儿童在夏秋季也应根据户外接受日照情况等因素适量添加维生素D。     

新生儿缺氧性肺动脉高压血清心肌酶谱变化及其意义研究

【目的】 探讨缺氧性肺动脉高压(hypoxic pulmonary hypertension, HPH) 新生儿血清心肌酶谱的变化及其意义。 【方法】 对30例HPH患儿及30例胎龄、体重与HPH组相近的非HPH患儿(对照组)于生后第1、7天检测血清心肌酶谱,彩色多普勒超声心动图测定肺动脉收缩压(pulmonary artery systolic pressure, PASP),作血气分析记录血氧分压(PaO₂)。 【结果】 1)与对照组相比生后第1天:HPH组患儿PaO₂降低,PASP升高(均P<0.05);血清心肌酶谱增高(P<0.05),血清CK-MB与PaO₂、PASP呈负、正相关(P<0.05);2)与对照组相比生后第7 d:HPH组新生儿PaO₂、PASP及血清心肌酶谱恢复正常;血清CK-MB与PaO₂、PASP均无相关关系(P>0.05)。 【结论】 HPH可导致新生儿心肌损害,心肌损伤时血清心肌酶谱升高,且与血氧分压及PASP有一定的相关性。检测血清心肌酶谱有助于临床早期诊治缺氧性肺动脉高压新生儿心肌损害。     

广州地区儿童维生素D营养状况及其与超重肥胖关系的研究

目的 了解广州地区儿童维生素D(Vit D)营养状况,分析儿童超重肥胖与Vit D营养状况的关系,为儿童Vit D的合理补充、预防Vit D缺乏性疾病提供科学依据。方法 采用横断面研究,收集广东省妇幼保健院健康体检儿童的年龄、性别,测量身高、体重,计算体质指数(BMI),采集空腹静脉血,用化学发光法检测血清中25-羟维生素D[25-(OH)D]水平。结果 共收集7 578名儿童,血清25-(OH)D平均水平为(98.57±39.96)nmol/L,其中男童为(98.58±39.64)nmol/L,女童为(98.56±40.38)nmol/L,差异无统计学意义(P>0.05);658名儿童Vit D缺乏 (8.68%)、1 602名儿童Vit D不足 (21.14%),不同性别儿童Vit D缺乏率及不足率差异无统计学意义(P>0.05)。不同年龄儿童血清25-(OH)D水平差异有统计学意义(P<0.05),血清25-(OH)D水平随年龄增加逐渐下降;不同年龄儿童Vit D营养状况差异有统计学意义(P<0.05),Vit D缺乏率及不足率随年龄增加而升高(χ²_趋势=275.266,P<0.05)。超重、肥胖儿童血清25-(OH)D水平低于正常儿童,差异有统计学意义(P<0.05);超重、肥胖儿童Vit D缺乏率及不足率均高于正常儿童,差异有统计学意义(P<0.05)。血清25-(OH)D水平与BMI呈负相关(P<0.001)。结论 广州地区学龄儿童和超重肥胖儿童Vit D营养状况均较差,应重视儿童尤其是学龄儿童、超重、肥胖儿童Vit D的合理补充。     

二甲双胍治疗不同糖代谢状态肥胖儿童效果评价

【目的】 比较单纯生活方式和加用二甲双胍对肥胖儿童血糖血脂相关指标治疗效果 【方法】 肥胖儿童101例根据OGTT分为组1,糖代谢正常高胰岛素血症组50例,组2,糖代谢异常组51例。组1A单纯生活方式治疗,组1B和组2二甲双胍加生活方式干预治疗1年。 【结果】 组1A治疗前后的体重指数,糖代谢指数,血脂,没有明显的改善(P>0.05)。组1B及组2治疗前后的体重指数,糖代谢指数,血脂,有明显的改善(P<0.01)。 【结论】 二甲双胍加用生活方式的干预优于单纯生活方式的干预。     

不同喂养方式对早产儿的影响

【目的】 探讨不同喂养方式对出院后早产儿体格发育及生化指标的影响,为临床早产儿合理喂养指导提供依据。 【方法】 早产儿91例,出生体重均在1 500 g以上。按喂养方式分为5组:1组为早产儿配方,2组为足月儿配方;3组为早产儿配方+母乳;4组为母乳;5组为足月儿配方+母乳。在矫正月龄4~6个月时测量身长、体重,计算身长、体重的Z值,测定血清总蛋白、白蛋白、微量元素等指标。 【结果】 4组身长Z值为负值,体重Z值亦低于其他各组,但差异无统计学意义(P>0.05);其余各组体重和身长的Z值均为正值,组间差异无统计学意义(P>0.05)。4组血清尿素氮低于其余各组(P<0.05),2组血清尿素氮显著高于3、4、5组(P<0.05),和1组之间差异无统计学意义(P=0.126);1组和5组的白蛋白水平之间差异无统计学意义(P=0.947),但均明显高于3组和4组(P<0.05)。其余各血清学指标之间差异无统计学意义(P>0.05)。 【结论】 1)纯母乳喂养儿体格发育和血清白蛋白水平较其他喂养方式低,提示单纯母乳不能完全满足早产儿早期生长发育需要;2)足月儿配方奶喂养的早产儿血清尿素氮偏高,其机制和远期影响有待进一步探讨。     

Use of the retinol-binding protein: transthyretin ratio for assessment of vitamin A status during the acute-phase response

The ratio plasma retinol-binding protein (RBP):transthyretin (TTR) has been proposed as a means to improve the assessment of vitamin A status of individuals with concurrent infection or inflammation. We have measured RBP and TTR in stored sera from South African children who had accidentally ingested kerosene. Samples were collected from these children in hospital when suffering acute inflammation and respiratory distress, and from them and neighbourhood control children 3 months later. Vitamin A status was defined by modified relative dose response (MRDR) tests of liver retinol stores at 3 months and by serum retinol concentration both when children were ill and when they were well. Illness was defined as either being in hospital or, at follow-up, as having a raised plasma alpha 1-acid glycoprotein (AGP) level. The RBP:TTR value was significantly decreased by both illness and low liver retinol stores. When the effects on RBP:TTR of illness and vitamin A stores were considered together for the 3-month follow-up samples, only vitamin A status significantly decreased the value. We calculated sensitivity and specificity of the RBP:TTR ratio against established measures of vitamin A status using a cut-off value of 0.3 for RBP:TTR and standard cut-off values for MRDR (0.06) and plasma retinol (0.7 mumol/l). Compared with MRDR, RBP:TTR had sensitivities of 76% and 43% and specificities of 22% and 81% to detect vitamin A deficiency in hospitalized and well children respectively. Compared with plasma retinol, sensitivities were 88% and 44% and specificities were 55% and 64% in hospitalized and well children respectively. Only for the case of clinically well children with biochemical evidence of subclinical inflammation did sensitivity (62% and 100% against MRDR and plasma retinol respectively) and specificity (100% and 60% against MRDR and retinol) approach useful levels for an assessment tool. Overall, although a trend supporting the theory behind the use of the RBP:TTR for assessment of vitamin A status in infection was observed in the current study, the ratio did not provide adequate sensitivity and specificity to be a useful assessment tool.     

Assessment of vitamin A nutritional status in newborn preterm infants

OBJECTIVE: This study assessed the vitamin A nutritional status of preterm infants determined by the vitamin A relative dose-response test (RDR) compared with serum levels of vitamin A, retinol-binding protein (RBP), transthyretin (TTR), and retinol relations with carrier proteins. METHODS: Serum levels of retinol, RBP, and TTR and retinol/RBP, retinol/TTR, and RBP/TTR molar ratios were determined in 120 infants at 7 d and in 92 at 28 d. For the determination of the performance of the tests, the RDR was considered the reference method. The sensitivity and specificity for all possible cutoff values were determined by constructing receiver operator characteristic curves. The areas under the curves were used to estimate the overall accuracy of the tests. The best cutoff values to be used for the calculation of sensitivity and specificity were determined with 95% confidence intervals. RESULTS: RDR indicated vitamin A deficiency in 60% of the infants at 7 d and in 51.1% at 28 d. In the receiver operator characteristic curves, the best area under the curve was 0.710 obtained for serum retinol at 28 d of postnatal age and considered moderately accurate. The least inadequate cutoff level was set at 25 mg/dL, but no value was considered adequate due to low sensitivity and/or low specificity. CONCLUSION: Compared with RDR, the determination of serum levels of retinol, RBP, and TTR and their molar ratios are not adequate to assess nutritional vitamin A status in preterm infants.     

学龄前儿童血清胱抑素C正常参考范围的调查

【目的】 通过检测学龄前儿童的血清胱抑素C, 旨在建立不同时期学龄前儿童的正常参考值范围, 为临床医生提供有意义的数据参考。 【方法】 应用全自动生化分析仪检测学龄前儿童474例和正常成人172例空腹血清胱抑素C。 【结果】 婴儿组、幼儿组、学龄前组及正常成人组Cys C正常值范围分别为0.62~1.74、0.47~1.15、0.41~0.97 mg/L和0.46~1.02 mg/L;各组与正常成人组比较发现, 婴儿组、幼儿组与正常成人组参考值差异有统计学意义(P<0.05),学龄前组与正常成人组参考值差异无统计学意义(P>0.05);将各组按性别分别比较,各组内男女间Cys C参考值差异均无统计学意义(P>0.05);以正常成人组参考值范围为对照,婴儿组、幼儿组超限检出率分别为56.8%、11.1%。 【结论】 婴儿组、幼儿组儿童可与成人采用不同的Cys C参考值范围,学龄前组可与成人采用相同的Cys C参考值范围,且参考值范围与性别无关。     

The concentration of free holo-retinol binding protein is higher in vitamin A-sufficient than in deficient Nepalese women in late pregnancy

Free holo-retinol binding protein (RBP) [i.e., unbound to transthyretin (TTR)] plays a role in transporting vitamin A across the placenta during pregnancy. In a cross-sectional study of clinically healthy urban women, we assessed the association among clinical and biochemical factors on estimated concentrations of free holo-RBP during the last trimester of pregnancy. Serum samples obtained from a subsample of women (n = 259), who had participated in the Night Vision Threshold Test study in Nepal, were analyzed for determinations of retinol by HPLC, and RBP, TTR, and alpha-1 acid glycoprotein by radial immunodiffusion. Free holo-RBP concentrations were calculated using dissociation constants for free holo- and apo-RBP. Among these women, 30% were vitamin A deficient based on either the RBP:TTR index < or = 0.36 or serum retinol < 1.05 micromol/L. Using stepwise regression analyses, the RBP:TTR index explained 75% of the variance in free holo-RBP concentrations, whereas retinol explained only 14%. Women were classified as vitamin A sufficient (n = 185) or deficient (n = 74) using the RBP:TTR index and were stratified into 3 gestational groups (I: 24-28 wk, II: 29-33 wk, III: >33 wk). Concentrations of free holo-RBP were higher in vitamin A-sufficient women than in vitamin A-deficient women (mean +/- SEM, 48.1 +/- 1.2 vs. 27.6 +/- 0.8 nmol/L; P < 0.001), and in a 3 x 2 factorial analysis, the interaction between gestational group and vitamin A status was significant. These results demonstrate that the RBP:TTR index is a useful proxy for free holo-RBP concentration and that vitamin A status affects its distribution.     

Vitamin a supplementation of vitamin a deficient measles patients lowers the risk of measles-related pneumonia in zambian children

This is an a posteriori analysis of previously published data to assess whether improving vitamin A (VA) status resolves measles-related pneumonia (MP). Nonhospitalized acute measles patients (2 d of rash onset) had their VA status determined based on the molar ratio of retinol-binding protein to transthyretin (RBP/TTR). Using a cutoff value of 相似文献   

Vitamin A, vitamin E, retinol binding protein (RBP), and prealbumin in digestive cancers

The existence of a relation between vitamin A and vitamin E and human cancers is supported by epidemiologic investigations. The aim of this study is to link the level of these vitamins to those of plasmatic protein carriers like retinol binding protein (RBP) and prealbumin (TTR), in three groups of subjects: healthy patients (n = 78), polyp (n = 34) and digestive cancer patients (n = 70). A paired t-test did not reveal any significant variation in any parameter between the polyp group and controls, but did evidence a significant decrease in serum levels of retinol (p less than 2.10(-4], RBP (p less than 2.10(-4), TTR (p less than 10(-5), and alpha-tocopherol (p less than 2.10(-3), in cancer cases as against control subjects. Comparison of RBP renal clearance and retinol tissue clearance in cancer and healthy patients indicates that the decrease in circulating retinol levels cannot be attributed to an increase in peripheral consumption. The simultaneous reduction of RBP and TTR serum levels is to be considered as a sign of protein denutrition. Thus our results suggest that the decrease serum levels of vitamins A and E observed in digestive cancers are a consequence of this nutritional deficiency.     

HIV-1 infection alters the retinol-binding protein:transthyretin ratio even in the absence of the acute phase response

The ratio of retinol-binding protein (RBP) to transthyretin (TTR) has been proposed as an indirect method with which to assess vitamin A status in the context of inflammation. Few studies have been conducted among adults, and none examined the effect of HIV-1 infection. Our goal was to assess the RBP:TTR ratio among adults, including the effects of HIV-1 and the acute phase response. We used data from a cross-sectional study of 600 Kenyan women, of whom 400 had HIV-1. The effect of vitamin A supplementation among the HIV-1-infected participants was subsequently assessed in a randomized trial. Among HIV-1-uninfected women without an acute phase response, a RBP:TTR cut-off value of 0.25 had approximately 80% sensitivity and specificity to detect vitamin A deficiency (retinol <0.70 micromol/L). No RBP:TTR cut-off value demonstrated both high sensitivity and specificity among HIV-1 infected women without evidence of inflammation. HIV-1 infection and advanced HIV-1 disease were associated with higher RBP:TTR ratios. The effect of HIV-1 was independent of the acute phase response, which also increased the RBP:TTR ratio. Serum retinol increased with vitamin A supplementation among those with a low RBP:TTR ratio, although the effect was small and was not present among those with concurrent inflammation. Thus, the RBP:TTR ratio has modest ability to predict vitamin A deficiency among healthy adults, but HIV-1 infection alters the ratio, even in the absence of the acute phase response. Our results raise questions about the utility of this measurement given the high prevalence of HIV-1 infection in areas where vitamin A deficiency is common.     

不同剂量维生素A强化饼干对学龄前儿童健康影响的研究

【目的】　比较三种不同剂量强化维生素A(VA)对改善学龄前儿童维生素A和铁营养状况的效果 ,探索预防VA缺乏性疾病 (VADD)的强化饼干的理想剂量。　【方法】　将 75 3名观察对象随机分为 4组 ,前两组分别给3 0 %RNI和 10 0 %RNIVA强化饼干每天一次 ,后两组分别每周给VA2万IU强化饼干一次及补充VA2 0万IU胶丸一次 ,除 3 0 %RNI组补充 9个月外 ,其余三组补充 3个月。干预前后观察血清VA、Hb、血清前白蛋白 (PA)、血清视黄醇结合蛋白 (RBP)、身高和体重的变化。　【结果】　干预前后 ,各组儿童VADD和贫血的检出率明显降低 (P <0 .0 5 ) ;补充 3月后自身对照除 3 0 %RNI组PA和Hb外 ,四组其余指标均明显升高 (P <0 .0 5 ) ;组间比较 ,2万IU组血清VA升高幅度明显大于其余组 ,3 0 %RNI组Hb、PA和身高的增加幅度明显小于其它组 (P <0 .0 5 ) ;补充 9月后 ,3 0 %RNI组Hb和PA的升高明显大于其余组 (P <0 .0 5 )。　【结论】　补充三种不同剂量VA强化饼干和 2 0万IUVA胶丸 ,均可明显改善VA和铁营养状况 ,长期补充 ,3 0 %RNI和 10 0 %RNI强化剂量可能更佳