基于限制性立方样条模型分析青少年三酰甘油-葡萄糖指数及其衍生指数与血压异常的关系

目的 探讨青少年三酰甘油-葡萄糖指数(triglyceride-glucose index,简称TyG)、三酰甘油-葡萄糖-体重指数(triglyceride-glucose-body mass index,简称TyG-BMI)以及三酰甘油-葡萄糖-腰围指数(triglycerideglucose-waist circumference index,简称TyG-WC)与血压异常的关系,为青少年高血压的防控提供理论依据。方法 通过分层整群抽样的方法抽取银川市1 572例12～18岁青少年进行问卷调查、体格测量和实验室检测,通过logistic回归分析模型结合限制性立方样条分析青少年TyG、TyG-BMI、TyG-WC与血压异常的关系。结果 多因素logistic回归分析显示,校正混杂因素后,TyG、TyG-BMI、TyG-WC最高四分位数组发生血压异常的风险分别为最低四分位数组的1.48倍(95%CI:1.07～2.04)、3.71倍(95%CI:2.67～5.15)和4.07倍(95%CI:2.89～5.73);且随着TyG、TyG-BMI和TyG-WC水平升高,血压异常风险逐渐增加(...     

黄芪对肾病综合征患儿血清免疫球蛋白G及血清蛋白的影响

采用黄芪 (ＡＭ)协同治疗肾病综合征 (ＮＳ)患儿 ,国内报道甚少。我们对进入第二阶段的ＮＳ患儿使用黄芪辅佐治疗 ,现报道如下。对象和方法一、对象　按 1981年全国儿科肾脏病协作组制定的诊断标准 ,对确诊并正规治疗的出院儿 80例 ,随机分为黄芪液口服组 (1组 )及对照组 (2组 ) ,其原发病缓解情况基本相同 ,各项指标比较均无差异 (Ｐ >0 .0 5 ) ,见表 1。表 1　两组患儿激素治疗后缓解情况 ( ｘ±ｓ)组别ｎ平均年龄浮肿消退尿蛋白转阴血清总蛋白 (ｇ/Ｌ) 白蛋白 (ｇ/Ｌ) 胆固醇 (ｍｍｏｌ/Ｌ)ＩｇＧ(ｇ/Ｌ)1 4 0 5ａ 7个月 40 4 0 67± 1 .…     

不同类型抗精神病药物对精神分裂症患儿血清同型半胱氨酸水平及认知功能的影响

目的 探讨抗精神病药物对精神分裂症患儿血清同型半胱氨酸(Hcy)水平及认知功能的影响.方法 将96例首发精神分裂症患儿分为非经典抗精神病药物治疗组(研究组)和经典抗精神病药物治疗组(病例对照组),分别测定治疗前后2组患儿血清Hcy水平和事件相关电位(ERP),并将检测结果与50例健康儿童(健康对照组)进行比较.结果 与健康对照组比较,治疗前研究组和病例对照组患儿血清Hcy水平明显增高,ERP测定中N2波潜伏期(PL)、P3PL明显延长,P3波幅(amp)明显降低,差异均有统计学意义(Pa＜0.01);研究组和病例对照组治疗前血清Hcy水平及ERP各指标比较差异无统计学意义.与治疗前比较,治疗后研究组N2PL、P3PL缩短,P3 amp增高,血清Hcy水平降低,差异均有统计学意义(Pa＜0.01);而病例对照组各指标比较差异均无统计学意义.治疗后与病例对照组比较,研究组N2PL、P3PL缩短,P3 amp增高,血清Hcy水平降低,差异均有统计学意义(Pa＜0.01).结论 儿童精神分裂症患者存在一定程度的高Hcy血症和认知功能损害,非经典抗精神病药物治疗可明显改善精神分裂症患儿的Hcy水平和认知功能.     

肾病综合征患儿血清骨保护素改变及糖皮质激素对其的影响

目的：观察肾病综合征（nephrotic syndrome, NS）患儿骨保护素改变及糖皮质激素治疗对骨保护素的影响,探讨骨保护素在NS骨代谢改变中的应用价值。方法：随机选取NS患儿44例,其中NS初发患儿24例,糖皮质激素治疗减量过程中复发患儿20例,其糖皮质激素累积剂量为28327±5879 mg/m2;23例年龄性别匹配的正常儿童设为对照组。采用酶联免疫吸附法测定血清骨保护素浓度,采用电化学发光免疫法测定血清骨钙素N端中分子片段（骨钙素N-MID）含量。结果：初发NS组血清骨保护素、骨钙素N-MID含量分别为 211±55 ng/L、46±14 ng/mL,均明显低于对照组（分别为470±57 ng/L、73±9 ng/mL）（P<0.05）。NS复发组血清骨保护素、骨钙素N-MID含量均较NS初发组及对照组低,分别为176±42 ng/L、29±10 ng/mL（P<0.05）。结论：NS患儿本身即存在骨代谢异常,大剂量应用糖皮质激素后可进一步加重骨代谢改变,提示NS患儿骨保护素改变受疾病本身及糖皮质激素治疗的双重影响,骨保护素有望成为预测NS患儿骨代谢改变的新型生化指标。     

口服孟鲁司特钠对哮喘患儿血清细胞因子水平的影响及疗效观察

目的观察口服孟鲁司特钠对哮喘患儿血清白细胞介素（interleukin,IL）-5、IL-10及肿瘤坏死因子（tumornecrosisfactor,TNF）水平的影响及疗效观察。方法我院儿科门诊就诊急性发作期的180例哮喘患儿随机分为治疗组和对照组。对照组仅常规吸入激素治疗。治疗组在常规吸人激素治疗的琏础上加用盂鲁司特钠片,2～5岁患儿服用孟鲁司特钠咀嚼片4mg,6～14岁患儿服用孟鲁司特钠咀嚼片5mg,1次／d,连用12周。两组患儿均在治疗前和治疗12周后抽取静脉血检测IL-5、IL-10及TNF水平,同时进行日、夜间症状评分。结果两组患儿治疗后日、夜间症状评分均较治疗前显著下降（P〈0．05）,但是治疗组较对照组下降更明显（P〈0．05）;两组患儿治疗后IL-5[（33．4±7．9）pg／mlVS．（21．9±9．4）pg／ml,P〈0．05]和TNF[（7．7±1．1）ng／mlVS．（5．8±0．8）ng／ml,P〈0．05]较治疗前明艟下降,而IL—10[（11．7±2．7）pg／mlVS．（14．7±4．3）pg／ml,P〈0．05]则明显升高（P〈0．05）;而治疗组IL-5和TNF的下降及IL-10的升高水平较对照组更明显（P〈0．05）。结论哮喘患儿口服盂鲁司特钠能明显减轻炎症反应,减少细胞因子IL-5和TNF的合成,显著改善哮喘患儿口、夜症状评分。,     

免疫及锌剂治疗对反复呼吸道感染患儿血清免疫球蛋白水平的影响

目的 研究反复呼吸道感染(RRI)患儿血清Ig水平,并探讨免疫及锌剂辅助治疗对其的影响,为RRI进行免疫干预提供依据.方法 选择1999年12月-2004年12月洛阳轴承集团公司总医院RRI患儿108例,随机分为治疗组和对照组,每组各54例,均予抗感染对症支持治疗,其中治疗组予WIG静脉滴注和锌硒宝片口服治疗.采用单向琼脂扩散法对2组治疗前后血清Ig及补体水平进行测定,并进行比较.结果 治疗前二组血清IgG、IgA、IgM水平均低于正常值,2组间比较差异均无统计学意义(Pa> 0.05).治疗后治疗组血清IgG、IgA、IgM水平均高于对照组,其差异均有统计学意义(Pa<0.05).结论 RRI患儿存在免疫功能异常,免疫及锌剂补充辅助治疗可改善RRI患儿免疫功能.实用儿科临床杂志,2009,24(10):796-797     

脑电生物反馈对支气管哮喘患儿的血清皮质醇和神经生长因子的影响及意义

目的探讨支气管哮喘的神经心理发病机制,为支气管哮喘的防治提供有利的干预措施。方法将诊断为支气管哮喘的患儿220例随机分为常规GINA方案吸入治疗1组(116例)和常规GINA方案吸入治疗加脑电生物反馈治疗2组(104例),同时选择保健门诊同性别,同年龄,家族中无精神病、癫疒间及智力低下儿童80例为对照组。三组儿童(哮喘患儿一经诊断明确后在未治疗前)均检测血清皮质醇(8 am和4 pm)、神经生长因子(NGF)、脑电波θ/β比值;哮喘患儿经过6个月的治疗后再次复查对上述指标。结果哮喘患儿与对照组儿童的脑电波θ/β比值在治疗前比较差异有统计学意义,经过6个月的治疗后治疗2组θ/β比值接近正常对照组儿童。哮喘患儿在治疗前,8 am和4 pm皮质醇数值均较对照组儿童低,差别有统计学意义,治疗1组治疗前后变化差异无统计学意义,治疗2组6个月后皮质醇8 am测定值较未治疗前明显上升,下午则无明显变化;哮喘组患儿治疗前的NGF数值明显较对照组儿童高,差异有统计学意义,治疗1组治疗后NGF有所下降但差异无统计学意义,治疗2组NGF数值较对照组明显降低,差异有统计学意义。结论适度的神经心理调节可协调下丘脑-垂体-肾上腺轴反应,...     

血液灌流治疗对过敏性紫癜患儿血清IL-23及IL-17水平的影响及意义

目的 探讨血液灌流治疗对过敏性紫癜(HSP)患儿血清白介素(IL)17和IL-23水平的影响及临床意义。方法 选取2011年1月至2012年12月诊断为HSP的患儿87例为病例组,所有患儿均行血液灌流治疗;另选取27例健康儿童为对照组。采用ELISA法检测HSP患儿治疗前后及对照组血清IL-17和IL-23的水平。结果 HSP患儿治疗前血清IL-23及IL-17水平均明显高于对照组(P< 0.05);HSP患儿治疗后血清IL-23及IL-17水平较治疗前均显著降低(P< 0.05),与对照组比较差异无统计学意义(P> 0.05)。HSP患儿血清IL-23与IL-17表达水平呈正相关(P< 0.05)。结论 IL-23和IL-17可能同时参与了HSP的发病过程。血液灌流治疗可以有效降低HSP患儿血清IL-23、IL-17水平,是有效的治疗HSP的方法之一。     

连续性肾替代治疗对脓毒症患儿血清细胞因子及内毒素的影响

目的 探讨连续性肾替代治疗(CRRT)对脓毒症患儿细胞因子及内毒素的影响.方法 2003年6月-2007年3月在本院PICU住院治疗脓毒症患儿12例.男8例,女4例;年龄3～12岁.在常规综合治疗的基础上(原发病的治疗,抗生素,血管活性药物,营养对症支持治疗,维持水电酸碱平衡,机械通气)均采用颈静脉或股静脉插管,CRRT采用连续静-静血滤透析(CVVHD),分别在CRRT治疗(0 h),治疗开始12、24和48 h抽取桡动脉血5 mL,分离其血清,检测其血清肿瘤坏死因子(TNF-α)、IL-8、IL-10及内毒素水平.内毒素检测采用基质偶氮显色鲎试剂法,IL-10、IL-8、TNF-α.测定采用生物素-免疫亲和素酶联免疫吸附法.SPSS 11.5软件进行LSD-t检验.结果 CRRT后48 h进行临床转归评价,12例中临床好转6例,恶化4例,死亡2例.IL-10在CRRT期间无显著变化(F:1.98 P＞0.05);IL-8、TNF-α、内毒素均有显著性变化(Pa＜0.01).IL-8、内毒素在CRRT后12 h即明显下降,降幅分别达50.65%和54.10%;TNF-α在CRRT后24 h才出现明显下降,降幅达42.19%.结论 CRRT是脓毒症有效的治疗方法,有效清除体内细胞因子和内毒素是CRRT治疗脓毒症的可能机制.     

东莞市学龄前儿童维生素A缺乏现状及维生素A对血清铁蛋白及红细胞参数的影响

目的 了解东莞市学龄前儿童维生素A缺乏现状,探讨维生素A对血清铁蛋白、红细胞及网织红细胞参数的影响。方法 于2015年4月至2016年12月通过整群抽样方法,选取东莞市无现患疾病的学龄前儿童（3~6岁）2 085例,对所选儿童进行血常规、网织红细胞计数、血清铁蛋白、血红蛋白电泳及维生素A浓度检测。分析年龄、性别与维生素A浓度及血清铁蛋白浓度的关系,维生素A浓度对血清铁蛋白、红细胞及网织红细胞参数的影响以及维生素A缺乏加重储存铁减少对红细胞参数的影响。结果 储存铁减少的儿童占比为6.71%（140/2 085）;维生素A缺乏儿童占比为32.52%（678/2 085）,其中亚临床缺乏占维生素A缺乏总人数的95.4%（647/678）,临床缺乏占维生素A缺乏总人数的4.6%（31/678）。不同性别组儿童维生素A浓度比较差异无统计学意义（P > 0.05）,但女性儿童血清铁蛋白浓度高于男性（P < 0.05）。维生素A临床缺乏组儿童血清铁蛋白浓度高于亚临床缺乏组和正常组（P < 0.05）。维生素A缺乏时,储存铁减少组平均红细胞体积和平均红细胞血红蛋白含量较储存铁正常组降低（P < 0.05）。维生素A缺乏组血红蛋白浓度、平均红细胞血红蛋白浓度、红细胞计数、红细胞压积、网织红细胞绝对值、网织红细胞百分比、网织红细胞血红蛋白含量均低于维生素A正常组,而平均红细胞体积高于维生素A正常组（P < 0.05）。结论 东莞市学龄前儿童维生素A缺乏状况仍较严重;维生素A缺乏可对血清铁蛋白、红细胞以及网织红细胞参数产生影响。     

Clinical Analysis of the Cleft Patterns of Lip and Palate

The patterns in the cleft lip and palate were classified in great detail, and the point of center of the clefts in this disease was speculated. The purpose of the present study was to establish the basic data for classifications of epidemiological surveys in the future. The subjects were 377 patients with cleft lips and palates who visited the Second Department of Oro-Maxillo-Facial Surgery, Aichi-Gakuin University Hospital. The models of cleft lip and palate divided into 17 segments prepared for an analysis of cleft patterns. And as consequence, the following results were obtained.     

A Review of Unilateral Cleft Lip and Palate Surgery*

ABSTRACT Operative techniques for unilateral cleft lip and palate have undergone continuous development, with improvement and modification, during the last three decades. The author's operation began with Tennison's method and gradually changed into a narrower and long triangular flap method. The edge of the orbicularis oris muscle on the cleft side is tucked under the center of the philtral dimple to obtain muscles linkage and a philtral ridge on the affected side. The longitudinal line is sutured with meticulous subcuticular stitches using 6–0 Nylon, resulting in a neat scar. Relationship between vertical height of lip and width of triangular flap was examined in follow-up studies. Flap width increased rapidly for one year after surgery and then slowed down to a pace proportionate with lip height. Although ratio of flap width to height increased from 27% to 40%, the balance of both sides of the lip did not, as had been thought might be possible, change. Correction of the cleft lip nose by the triangular flap method is rather difficult. It is considered natural for many surgeons to prefer a combination of the rotation-advancement flap and small triangular flap. Much remains to be discussed regarding cleft palate treatment. Author prefers closure of the hard palate using a vomer flap in the primary cleft lip operation because the most effective push-back of the palate, without fistulae, is achieved. Underdevelopment of lip and maxilla should be evaluated from many aspects, and with a long-term view.     

Clinical Aspects of Cleft Lip and Cleft Palate Patients Treated at Kanazawa Medical University Hospital from 1974 to 1993*

ABSTRACT Currently, clefts of the lip, alveolus, and palate are thought to be the most common congenital malformations. In this study, we examined 1,565 cases of clefts we treated over the last 18 years, in order to summarize the clinical features and to evaluate the treatment outcomes. This study involved 589 cleft lip (CL) cases, 576 cleft lip and palate (CLP) cases, 286 cases of cleft palate (CP), 81 cases of submucous CP and 33 cases of CL and submucous CP. The familial incidence was 11.1% (174 cases). Overall, the average incidence of associated congenital abnormalities was 27.9%. Approximately half of the patients with CP alone or with submucous CP were found to have additional congenital malformations. Standeard surgical techniques for unilateral and bilateral CL cases were the Skoog's and Millard's methods, respecively, which resulted in satisfactory outcomes. As a primary operation for CP, pushback procedure was performed using a partial mucosal flap from the palate. Using this procedure 96.5% of 455 cases achieved satisfactory nasopharyngeal closure. The main objective in the treatment of CL patients is not only the repair of growing tissues but also appropriate morphological, functional and psychological reconstruction for the purpose of correcting growth inhibitory problems caused by anatomical malposition. Surgical procedures for CP patients are designed to meet several needs: correction of anatomical abnormalities of the palate and pharynx, achievement of proper nasopharyngeal closure necessary for normal phonation, prevention of growth disturbances of the maxilla, improvements in hearing and auditory tube function, and normalization of occlusion.     

Effects of Short-term High-carbohydrate Feeding on Serum Triglyceride of Children with Familial Hypercholesterolaemia

In 5 children with familial hypercholesterolaemia, serum triglyceride levels, which were initially normal, rose after three days on a high-carbohydrate diet; a similar response occurred in one child with normal serum lipoproteins. These observations suggest that a rise in serum triglyceride on high-carbohydrate feeding is a normal finding in children and therefore should not be used as a test for the diagnosis of the pathological state of `carbohydrate-induced hypertriglyceridaemia''. The findings in familial hypercholesterolaemia indicate that diets used in the treatment of this condition should not contain an unduly high proportion of carbohydrate.Detailed investigations showed that most of the increase in triglyceride occurred in the very low density lipoproteins, but small increases were also found in the other lipoproteins. The lipid composition of all the lipoproteins changed, the proportion of triglyceride being increased. In all children the fatty acid composition of serum triglyceride (g./100 g. total fatty acids) showed an increase in palmitoleic acid and a decrease in linoleic acid. A raised percentage of palmitoleic acid appears to be the most consistent indicator of accelerated lipogenesis during high-carbohydrate feeding. Changes in triglyceride fatty acid composition were similar in all the lipoproteins. On high-carbohydrate feeding the absolute concentration of all triglyceride fatty acids, including linoleic acid, increase.     

Effect of Maternal Treatment with Methylmercury on the Manifestation of Cleft Lip in CL/Fr Mice

Abstract The interaction between methylmercury teratogenesis and manifestation of cleft lip and palate (CL(P)) of genetic origin was experimentally investigated in CL/Fr mice. Pregnant mice were given methylmercuric chloride orally on day 10 of pregnancy at doses of 5, 10, 15 and 20 mg/kg. Animals were put to death on day 18 of pregnancy and the fetuses were examined for malformations, especially facial anomalies. About 23% of fetuses manifested CL(P) in the control group. After maternal treatment with methylmercuric chloride, the incidence of fetuses with CL(P) did not remarkably change in groups of 5 mg/kg (about 30%) and 10 mg/kg (about 24%), but decreased significantly (p<0.01) in groups of 15 mg/kg (about 12%) and 20 mg/kg (about 12%). The average numbers of both early and late fetal deaths in the mercury-treated groups were not significantly different from those in the control group (p > 0.05): This suggested that the decreased incidence of fetuses with CL(P) was not attributable to the preferential mortality of embryos with CL(P). The incidence of isolated cleft palate (CP) was about 1, 5,40 and 80% after maternal treatments of 5,10,15 and 20 mg/kg methylmercuric chloride, respectively, showing the distinct threshold. No significant difference in mercury concentration was observed among normal fetuses, fetuses with CL(P) and with CP within any dose group.     

A Study on the Growth and Development of the Cranial Base in the Japanese Unilateral Cleft Lip and Palate: Comparison with the Japanese Skeletal Class I Occlusion

Abstract The purpose of this study is to investigate the growth and the developmental dimension and the feature of cranial base transition in unilateral cleft lip and palate (UCLP). With regared to this proposition, we have already submitted a paper in which we compared our study with skeletal reversed occlusion on a scholary journal. The authors will present this proposition in comparison with skeletal class I. The subject group consisted of 15 males and 12 females with UCLP. The control group consisted of 11 males and 14 females with skeletal class I. Standared lateral cephalometric radiographs taken at first medical examination and three years later were used. The three linear dimensions (S-N, S-Ba, N-Ba) and craniobasal angle (N-S-Ba) were measured. The results were as follows: 1) Females showed no significant difference in S-N, S-Ba and N-Ba but males had smaller S-Ba and N-Ba in the UCLP as compared with the control at the first examination and 3 years later. 2) There were no significant difference in the three distance items, S-N, S-Ba, N-Ba, for females but significantly larger changes in N-Ba appeared in the UCLP as compared with the controls for males. 3) The cranial base angle (N-S-Ba) showed no significant difference between the UCLP and controls for both male and female subjects at any observation time. From the above evidences, it is estimated that the cranial base size and angle in the UCLP as compared with those of controls show no consistent trend owing to possible involvement of differential growth pattern between the anterior cranial base and posterior cranial base. The growth of cranial base itself per se seems to be influenced mutually at minimal level by the maxillofacial growth. This suggests growth patterns of cranial base and maxillofacial region are independent from each other.     

Epidemiological Approaches to Identify Risk Factors for Human Congenital Malformations: Descriptive and Analytical Epidemiology of Cleft Lip and/or Palate in Japan*

Abstract This paper described three major epidemiological approaches to explore etiological clues to and risk factors for human congenital malformations, taking cleft lip and/or palate as an example. (1) An analysis of mortality statistics demonstrated an apparently downward trend of infant mortality from cleft lip and/or palate over the recent three decades in Japan. This particular finding was found to be plausibly ascribable to changing clinical assignment of causes of death from “cleft lip and/or palate” to “congenital heart diseases” or “multiple anomalies, syndromes or chromosome abnormalities”, when previous reports on incidence rate and autopsy series were examined. (2) A case-control study of 194 infants with cleft lip and/or palate (cases) and 194 normal infants (controls), who were matched to cases for sex, maternal age to within one year, birth order and residential area, yielded the following major findings, (a) A significantly increased risk was associated with parental highest educational attainment of less than 19 years, parental occupation of unskilled/service workers, positive family history of cleft lip and/or palate, positive past history of artificial abortion, maternal smoking habits at first trimester, and maternal episodes at first trimester of suffering from any diseases and of ingesting any drugs, (b) A significantly decreased risk was linked with frequent maternal intake at first trimester of such animal proteins as meats, fishes and shells, eggs and milk, (c) Maternal drinking habits and radiation exposures, and frequent maternal ingestion of Japanese/black tea were not associated. (d) Maternal coffee drinking at first trimester significantly elevated the risk, but turned to be unrelated when maternal smoking habits were statistically corrected. (3) A cohort study of approximately 10,000 pregnants, which is ongoing from April 1989 in Nagoya and aims to disclose the associations of parental life-style habits with general pregnancy outcomes including major congenital malformations, was briefly discussed.     

丙戊酸钠对癫癎患儿瘦素及血脂的影响

目的研究丙戊酸钠(VPA)对癫患儿体质量指数(BMI)、瘦素及血脂的影响。方法选择准备单独服用VPA治疗的癫患儿24例,分别于治疗前、治疗后3、6个月观察BMI、瘦素、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)的变化。结果VPA治疗3个月在BMI、瘦素、TC、TG、LDL-C均较治疗前明显升高(P均<0.05),HDL-C变化不明显。治疗6个月,其各项指标的变化基本同治疗3个月时,仅LDL-C又回降至治疗前水平。结论VPA有导致癫患儿肥胖的作用,且多在服用VPA3个月内发生,并对血脂有一定影响。