每周一次补铁方案对学前儿童铁营养与体格发育作用的研究

２５５名３￣５岁学龄前儿童随机会为每周或每日补铁组，补铁剂量为每周一次或每日４ｍｇ／ｋｇ。经两个月补铁试验，观察比较正常与贫血儿童对两种不同补铁方案，在改善儿童铁营养状况和促进体格发育方面的作用。结果显示，每周一次补铁方案使贫血患病率由２４．４％下降到５．７％，血红蛋白含量增加１２．８ｇ／Ｌ。每周一次补铁儿童补铁后身高、体重、上臂围净增长值分别为１．３￣１．５ｃｍ，０．５￣０．７ｋｇ、０．１５￣０     

每周一次补铁方案的基础研究及其临床应用

每周一次补铁方案的基础研究及其临床应用刘戍年新疆昌吉自治州人民医院在我国以及各发展中国家，铁缺乏症或缺铁性贫的防治主要依靠口服补充各种铁制剂。铁剂的用量，、般为每次１．５－２ｍｇ／ｋｇ，一日２～３次，总量为４．５～６ｍｇ／ｋｇ／ｄ［１］。在近年来的实...     

提高缺铁动物对铁补充效应的实验研究

用大鼠血红蛋白恢复试验及铁补充与整体铁存留直线回归分析研究了缺铁大鼠每３日或每日连续补铁的生物利用效率。首先，用无铁基础饲料复制大鼠的缺铁性贫血（ＩＤＡ）模型，然后分别进行两周每间隔３日或每日连续补铁（８ｍｇ）试验。以０．８ｍｇ／日铁喂饲建立铁正常大鼠为对照。结果：铁正常对照，ＩＤＡ每３日或每日补铁三组大鼠血红蛋白转换效率分别为９．２１％，６．９％及２．８％，后两组相对生物利用率（ＲＢＡ）为７４．９％及３１．６％。铁补充与动物整体铁存留直线回归分析显示整体动物的ＲＢＡ分别为４２．８％及１７．７％。两种铁补充效应的评价均表明，每３日间隔补铁的ＲＢＡ为每日连续补铁的２．４倍，血液、骨骼等组织器官的铁生物利用为１．８～１．９倍。     

直肠灌注安定溶液的药代动力学研究

为了解安定直肠灌注后在儿童体内的代谢过程以及确定适宜的直肠给药部位，对８例５岁半～１３岁患儿分别在肛门内５ｃｍ和１０ｃｍ处灌注安定溶液，并观察血药浓度的变化及进行药代动力学分析。结果表明，安定的代谢符合二室开放模型，半衰期平均为３８±１１ｈ，峰浓度为６．５±０．３ｎｇ／Ｌ，清除率是０．０２４±０．００６Ｌ·ｋｇ－１·ｈ－１，表观分布容积为０．７２±０．０６Ｌ／ｋｇ。在肛门内５ｃｍ给药的４例，其血药浓度在３分钟时平均为３．４±２．３ｎｇ／Ｌ，７分钟时已达６．３±０．５ｎｇ／Ｌ，达峰浓度时间平均为０．３２±０．０９ｈ；而在肛门内１０ｃｍ处给药的另４例，在７分钟时的血药浓度平均为３．２±１．８ｎｇ／Ｌ，至３０分钟左右达５．０ｎｇ／Ｌ以上，其达峰浓度时间平均为１．１３±０．１１ｈ。提示造成两组安定吸收速率快慢差异的原因与直肠肛门血液循环的解剖生理特点有关，直肠灌注安定溶液时采用５ｃｍ左右的深度较为适宜。     

提高缺铁动物对铁补充效应的实验研究

用大鼠血红蛋白恢复试验及铁补充与整体铁存留直线回归分析研究了缺铁大鼠每３日或每日连续补铁的生物利用效率。首先，用无铁基础饲料复制大鼠的缺铁性贫血（ＩＤＡ）模型，然后分别进行两周每间隔３日或每日连续补铁（８ｍｇ）试验。以０．８ｍｇ／日铁喂饲建立铁正常大鼠为对照。结果：铁正常对照，ＩＤＡ每３日或每日补铁三组大鼠血红蛋白转换效率分别为９．２１％，６．９％及２．８％，后两组相对生物利用率（ＲＢＡ）为７４．     

同胞姐妹铁粒幼细胞性贫血二例

同胞姐妹铁粒幼细胞性贫血二例范玉金杜庆寿汪桂荣例１女，３岁。因进行性贫血３个月伴发热３天入院。体检：体温３９．６℃，重度贫血貌。肝肋下１．５ｃｍ，脾肋下１．０ｃｍ。实验室检查：血红蛋白４３ｇ／Ｌ，红细胞１．５×１０１２／Ｌ；白细胞１２．４×１０９／Ｌ...     

每周1次补铁与每日补铁防治儿童铁缺乏症效果的比较

每周１次补铁与每日补铁防治儿童铁缺乏症效果的比较刘戍年李义民田庆春兰凤荣赵志成叶涛程静徐守华张利忠动物试验已证实，每３日间断补铁与每日补铁可同样有效地改善动物的铁营养状况。其机理与此方式补铁的间断时间与动物小肠粘膜细胞生存时间相一致有关。用此方式补铁...     

准备心脏移植的充血性心力衰竭患儿的β受体阻滞剂疗法

β受体阻滞剂在成人心脏病治疗中可增加左室射血分数，减轻症状和提高生存率．本文报道４名心脏病儿童因严重充血性心力衰竭（心衰）准备心脏移植应用美托洛尔（ｍｅｔｏｐｒｏｌｏｌ）治疗的疗效．对象与方法４名儿童平均年龄７．８±３．８岁，心衰Ⅳ级。患儿在接受地高辛，利尿剂和血管紧张素转换酶抑制剂的最大耐受剂量，治疗３±１．５个月无效后采用受体阻滞剂疗法，美托洛尔从０．１ｍｇ／（ｋｇ·次）每日二次，逐渐增加到最大剂量０．９±０．７ｍｇ／（ｋｇ·ｄ）。结果随访１２．６±６个月，４名患儿左室部分缩短率增加，从１３…     

大剂量丙种球蛋白静脉输注治疗儿童再生障碍性贫血的观察

应用大剂量丙种球蛋白（１ｇ／ｋｇ·次，３￣４周１次，共６次）治疗儿童再生障碍性贫血１３例，有效率７６．９％，有效病例ＣＤ４／ＣＤ３由治疗前倒置恢复到正常状态。对照组有效率５４．５％，ＣＤ４／ＣＤ８有所增高，但未能恢复到正常。说明大剂量丙种球蛋白能纠正再障的Ｔ淋巴细胞紊乱状态，是治疗儿童再障的有效方法。     

rhG-CSF对小儿化疗所致的白细胞缺乏症的临床观察

本文报告１９９４．２～１９９５．３我们用ｒｈＧ－ＣＳＦ（惠尔血．ＧＲＡＮ）对１９例儿童肿瘤进行了３０例次在化疗后出现粒细胞缺乏症时的临床观察。有自身前后疗程对照１３例（１９例次），前后疗程化疗方案完全相同。每例前１疗程单用化疗为对照疗程，后一疗程在化疗结束后，当ｗｂｃ＜２．０×１０９／Ｌ或ＡＮＣ＜０．５×１０９／Ｌ时使用惠尔血７５ｍｃｇ，每日１次，皮下注射。一般用３～５天，ｗｂｃ及ＡＮＣ即可达到临床要求标准（ｗｂｃ≥４．０×１０９／Ｌ，ＡＮＣ≥１．５×１０９／Ｌ）。试验疗程较对照疗程粒细胞恢复时间明显缩短（ｗｂｃ提前９．３天恢复），ＡＮＣ提前８天恢复。在６例患儿化疗后用惠尔血（１１例次）未设自身对照疗程，临床观察亦获得与上述相似的疗效。本组在３０例次中仅见２例次有发热和骨痛，停药后发热和骨痛消失，未见其它不良反应。观察结果显示，惠尔血对小儿肿瘤化疗所致的粒细胞缺乏症疗效肯定。我们采用在停化疗后ｗｂｃ＜２．０×１０９／Ｌ几或ＡＮＣ＜０．５×１０９／Ｌ时开始使用惠尔血７５ｍｃｇ，１／日，皮下注射。一般３天至５天即可达到预期效果。用药量小，毒副作用少，既能减轻患儿痛苦，又能减轻家庭经济负担．是一种适合国情的用药方     

Efficacy of daily and weekly iron supplementation on iron status in exclusively breast-fed infants

Iron deficiency anemia (IDA) remains the most prevalent nutritional deficiency in infants worldwide. The purpose of this study was to determine the efficacy of daily and weekly iron supplementation for 3 months to improve the iron status in 4-month-old, exclusively breast-fed healthy infants. Infants 4 months of age were eligible for the open, randomized controlled trial if their mothers intended to continue exclusive breast-feeding until the infants were 6 months of age. Infants or mothers with iron deficiency (ID) or IDA on admission were excluded. The infants (n = 79) were randomly assigned to three groups, the first group receiving daily (1 mg/kg daily), the second group weekly (7 mg/kg weekly), and the third group no iron supplementation. Anthropometric measurements were taken on admission and at 6 and 7 months of age. Iron status was analyzed on admission and monthly for 3 months. Both hematologic parameters and anthropometric measurements were found to be similar among the three groups during the study period. Seven infants (31.8%) in the control group, six (26.0%) in the daily group, and three (13.6%) in the weekly group developed ID or IDA (P > 0.05). Infants whose mothers had ID or IDA during the study period were more likely to develop ID or IDA independently from iron supplementation. Serum ferritin levels decreased between 4 and 6 months of age in the control and daily groups; the weekly group showed no such decrease. In all groups, the mean levels of serum ferritin were significantly increased from 6 months to 7 months of age during the weaning period. In this study, which had a limited number of cases, weekly or daily iron supplementation was not found to decrease the likelihood of IDA. In conclusion, exclusively breast-fed infants with maternal IDA appeared to be at increased risk of developing IDA.     

缺铁性贫血患儿血清胃泌素水平测定及间断补铁疗效观察

研究缺铁性贫血 (IDA)儿童胃泌素水平的变化 ;观察间断补铁治疗儿童IDA的疗效。方法 :49例 IDA患儿每周口服一次铁制剂 (元素铁 2 mg/kg) ,共 1 2周。在治疗前后测查 Hb、ZPP、SF及血清胃泌素。结果 :经补铁治疗 ,Hb、SF均极显著性升高 (P<0 .0 1 ) ,ZPP则明显下降 (P<0 .0 1 ) ;IDA患儿血清胃泌素水平明显升高 ,与对照组比较差异显著 ,治疗后恢复正常。结论 :1每周一次间断补铁治疗儿童 IDA效果显著。 2 IDA患儿胃泌素的异常分泌可能与缺铁所致的胃粘膜萎缩有关     

Toxicity and efficacy of daily vs. weekly dapsone for prevention of Pneumocystis carinii pneumonia in children infected with human immunodeficiency virus. ACTG 179 Study Team. AIDS Clinical Trials Group.

BACKGROUND: Dapsone is an alternative drug for Pneumocystis carinii pneumonia (PCP) prophylaxis in individuals intolerant to trimethoprim-sulfamethoxazole (T/S). There are, however, few data on the pharmacokinetics, toxicity or efficacy of dapsone in children. Design. Randomized, multicenter trial comparing daily (1 or 2 mg/kg) with weekly (4 mg/kg) dapsone regimens in 94 HIV-infected children intolerant to T/S. METHODS: Hematologic and hepatic toxicity was monitored, as well as the occurrence of skin rash, PCP or death. RESULTS: Initial pharmacokinetic data indicated that adequate serum dapsone concentrations were not achieved with the daily 1-mg/kg regimen; the daily dose was then increased to 2 mg/kg. Both short and long term hematologic toxicities were marginally greater in children receiving the daily 2 mg/kg compared with the weekly regimen. Allergic skin rashes were similar in children receiving the daily and weekly regimens (17% in both) and were not associated with prior history of rash with T/S. PCP occurred most frequently with the daily 1-mg/kg regimen (22.0 cases/100 patient years), least frequently with the daily 2-mg/kg regimen (0 case/100 patient years) and at intermediate frequency with the weekly regimen (9.5 cases/100 patient years). More deaths were observed in patients receiving the daily than the weekly regimen (8 vs. 2, respectively), although the deaths were not directly attributable to dapsone treatment. CONCLUSION: Although a weekly dapsone regimen of 4 mg/kg produced less hematologic toxicity than a daily regimen of 2 mg/kg, this advantage was offset by a trend toward higher breakthrough rates of PCP.     

Efficacy of daily vs. weekly supplementation of iron in schoolchildren with low iron status

Iron deficiency anemia (IDA) is still a major nutritional and public health problem in developing countries. The prevalence among young children and pregnant women is particularly high. Daily oral supplementation with medicinal iron is considered an effective strategy for reducing the incidence of IDA but non-compliance is a major problem with this strategy. We undertook this study to compare the results of once-weekly vs. daily oral iron supplementation in schoolchildren. Sixty children ranging between 5 and 10 years with iron deficiency anemia were selected from a school in Karachi, Pakistan and were divided into two equal groups, i.e., daily and weekly supplementation groups. Hemoglobin (Hb), hematocrit (Hct), serum iron, total iron binding capacity (TIBC), and serum ferritin were determined before the start of the study. Ferrous sulfate (200 mg) was given daily to the daily supplementation group and once-weekly to the weekly supplementation group for 2 months. When post-supplementation values of the above-mentioned parameters were determined, a significant improvement was observed in all parameters in both groups. It is concluded that once-weekly iron supplementation is as effective as daily supplementation for the treatment of iron deficiency anemia. Moreover, weekly iron supplementation is cost effective and has no or fewer side-effects.     

Effects of three different iron supplementations in term healthy infants after 5 months of life

The aim of this study was to investigate the effects of different doses of iron on haematological status of breastfed infants. One hundred and thirteen infants were randomized into four groups at 5 months of age. Iron supplementation was given at doses of 1 mg/kg/day, 2 mg/kg/day, and 2 mg/kg/every other day in the first three study groups, respectively, and the last group received placebo. The hematological values, except hemoglobin, were higher in the group supplemented with iron at a dose of 2 mg/kg/day, and ferritin values were statistically higher in the group supplemented with iron at a dose of 2 mg/kg/every other day than in the group supplemented with iron at a dose of 1 mg/kg/day. We suggest that intermittent iron supplementation is more effective than a daily regimen in equal dosages.     

Linear growth and zinc supplementation in children with short stature

Physical growth retardation is an early and prominent feature of zinc deficiency, but the effect of zinc supplementation in children is still not completely clear. This study investigated the impact of zinc supplementation on linear growth, growth velocity, IGF-I levels, and skeletal maturation of short children during and after mineral supplementation. The study was designed as a double-blind, randomized, controlled trial of zinc supplementation during a 6-month period, with a subsequent 6-month follow-up. Anthropometric data were collected at 0, 6, and 12 months. Measurements included plasma Zn, IGF-I, height, weight, triceps skinfold thickness, and body mass index. Eighteen healthy pre-pubertal short children (z-score -2.0) 7 to 10 years old with normal GH and IGF-I levels were randomized to two groups, one with zinc supplementation (5 mg/kg/d of ZnSO4) and the other with placebo. In the first 6 months, only height velocity increased significantly, 5.99+/-0.80 cm/yr vs 5.05+/-0.85 cm/yr (p=0.03). After 12 months, height velocity returned to the initial values, 3.92+/-0.59 cm/yr vs 4.19+/-1.08 cm/yr (p=0.29). This study indicates that zinc supplementation increased growth velocity, but these effects did not persist after supplementation was discontinued.     

氯高铁血红素抗贫血疗效及追踪调查报告

本文报告用氯高铁血红素每天３００ｍｇ／ｋｇ、１５０ｍｇ／ｋｇ、５０ｍｇ／ｋｇ治疗失血性小鼠。治疗后Ｈｂ明显高于阴性对照组；大、中剂量组疗效优于葡萄糖酸亚铁组。对１２０例缺铁性贫血小儿予氯高铁血红素。服液治疗（１—２ｍｇ／ｋｇ·ｄ），治疗后Ｈｂ明显升高，ＦＥＰ明显下降；治愈率达８７．５％，总有效率１００％；治疗结束后３月，６月及１年追踪随访示有８７．５％、７５％、６０％小儿Ｈｂ≥１１０ｇ／Ｌ。提示：氯高铁血红素治疗缺铁性贫血具有良好的疗效。     

Impact of daily versus weekly hematinic supplementation on anemia in pregnant women

OBJECTIVE: To compare the effectivity of weekly versus daily iron therapy in reducing maternal anemia and to evaluate the association of maternal hemoglobin and fetal growth. DESIGN: Prospective. SETTING: Tertiary care teaching hospital in an urban metropolis. METHOD: 40 pregnant women received daily and 40 pregnant women received weekly oral therapy (335 mg of ferrous sulphate and 500 g folic acid) for a period of 14 weeks. The age of each pregnant woman and their baseline anthropometric data (weight, height and body mass index) were estimated. Hemoglobin and hematocrit estimations were carried out during follow period at 4 wks, 8 wks and 14 weeks. Serum ferritin values as a marker of iron status were also calculated in both the groups initially, at 14 weeks and at the time of delivery. Fetal anthropometric indices of 137 full term neonates delivered to mothers included in either of the supplementation groups or admitted to the hospital were also studied in relation to maternal hemoglobin concentration. RESULTS: Forty subjects each were initially randomized into groups I and II. The age of pregnant women along with their baseline anthropometric data were similar in both groups. A total of 29 pregnant women in group I and 27 pregnant women in group II could be regularly followed up. The increase in hemoglobin and hematocrit values were similar in daily and weekly supplemented mothers. An intention to treat analysis also showed similar results. The ferritin values were similar at the start of supplementation and after 14 wks of weekly or daily iron therapy. Birth weight, crown heel length, head circumference of the neonate and placental weight increased significantly with rise in maternal hemoglobin levels. CONCLUSION: Weekly iron supplementation is an effective mode of treating anemia among pregnant women and maternal anemia during pregnancy is adversely associated with fetal growth.     

Daily Subcutaneous Administration of Human Growth Hormone in Growth Hormone Deficient Children

Sixteen children (10 boys, 6 girls) on treatment for some years with i.m. injections twice or thrice weekly of human growth hormone (hGH; Crescormon® KabiVitrum), participated in a prospective study. The weekly amount of hGH (8, 12, or 16 IU) was kept the same in each child, but divided into daily (7) s.c. injections at bedtime. The growth rate increased in all children during the first year on s.c. daily hGH (5.3 to 7.4 cm/year; 1.95 to 4.27 SDS). This increased growth rate did not persist during the second year on daily s.c. hGH, but an increased predicted final height was found. The plasma profile of hGH was followed: i.m. injected hGH gave mostly a high (200 mU/1) plasma level of some hours (wide intra- and inter-patient variation), and s.c. injected hGH a lower max level of longer duration (wide inter patient variation). The daily s.c. regimen of hGH was extremely well accepted by the children and their parents and no GH-antibodies or other adverse effects were found. We recommend daily s.c. injection of hGH as an alternative in the treatment of GH-deficient children.