孕期及婴幼儿期补充益生菌预防儿童特应性皮炎效果的Meta分析

目的 系统评价孕期及婴幼儿期补充益生菌预防儿童特应性皮炎的效果。方法 运用RevMan5.3软件,对2008年1月至2018年5月国内外发表的有关孕期及婴幼儿期使用益生菌预防儿童特应性皮炎的随机对照试验研究进行Meta分析,并按干预菌株、随访时间、补充益生菌时间、研究地区进行亚组分析。结果 最终纳入22篇文献,干预组和对照组病例分别为3280例和3 281例。合并效应量结果显示,孕期和/或婴幼儿期使用益生菌可减少儿童特应性皮炎的发生（RR=0.81,95% CI：0.70~0.93,P < 0.05）。亚组分析结果显示,使用乳酸杆菌和双歧杆菌混合菌株干预效果显著（RR=0.68,95% CI：0.52~0.90,P < 0.05）;孕期及婴幼儿期均补充益生菌效果显著（RR=0.77,95% CI：0.66~0.90,P < 0.05）;孕期和/或婴幼儿期补充益生菌预防特应性皮炎对≤ 2岁儿童效果较显著（RR=0.74,95% CI：0.61~0.90）,而对2岁以上儿童效果不显著;研究地区为澳洲或欧洲/美国的效果显著（P < 0.05）,合并RR及95% CI分别为0.83（95% CI：0.73~0.96）、0.74（95% CI：0.61~0.91）。异质性主要源于不同随访时间（I²=62.7%）和补充益生菌时间（I²=53.5%）。结论 孕期及婴幼儿期补充益生菌有利于预防儿童特应性皮炎的发生,其中使用乳酸杆菌和双歧杆菌混合菌株干预效果显著。     

孟鲁司特治疗婴幼儿喘息疗效和安全性系统评价

目的 评价孟鲁司特对<2岁喘息患儿的疗效及安全性。方法 计算机检索EMBASE、PubMed、在研对照试验数据库、Cochrane图书馆、中文科技期刊全文数据库、中国期刊全文数据库和万方数字化期刊群,检索时间均从建库至2010年3月。并手工检索相关会议论文集、药厂资料及所有纳入文献的参考文献,获得孟鲁司特治疗<2岁喘息患儿安慰剂对照的RCT文献。采用Cochrane评价手册5.0.2推荐的方法评估纳入文献的方法学质量。以喘息相关病死率、临床症状评分和β2受体激动剂、糖皮质激素需求量为主要结局指标,以不良反应发生率和生活质量为次要结局指标。对无法进行定量合并的文献进行描述性分析。结果 共检索到相关文献906篇,其中符合纳入标准的6篇RCT文献进入系统评价。5篇文献为在研对照数据库登记的研究。纳入对象为喘息患儿。文献质量评价结果显示：4篇文献详细描述了随机化分组的方法,3篇文献描述了分配隐藏,6篇文献均采用双盲法,5篇文献存在选择性报告研究结果,2篇文献描述了其他偏倚来源。2篇RCT文献的失访率较高（分别为21.7%和32.1%）。因各纳入文献间存在明显的临床异质性,无法进行Meta分析,故而描述性分析。①纳入文献均无喘息相关死亡的报道;②孟鲁司特4 mg·d-1或8 mg·d-1组临床症状评分、使用β2受体激动剂和糖皮质激素等,与安慰剂组差异均无统计学意义（均P>0.05）;③纳入文献均报道了研究过程中药物不良反应的发生率,患儿对孟鲁司特有较好的耐受性。孟鲁司特组和安慰剂组不良反应发生率差异无统计学意义（P>0.05）。6篇文献均没有生活质量的评价指标。结论 现有研究尚不能证实孟鲁司特治疗<2岁婴幼儿喘息有效,治疗20周也未见明显的不良反应。     

口服益生菌预防早产儿严重坏死性小肠结肠炎疗效和安全性的Meta分析

目的评价口服益生菌预防早产儿严重坏死性小肠结肠炎（NEC）的疗效和安全性。方法制定原始文献的纳入标准、排除标准及检索策略,检索PubMed、EMBASE、 Ovid、Springer、中国期刊全文数据库、万方数据库、维普中文科技期刊数据库 及中国生物医学文献光盘数据库等。应用Cochrane协作网推荐的方法评价文献质 量。采用RevMan 4.22软件对满足纳入标准的有关口服益生菌预防早产儿严重NEC （Ⅱ期及以上）的RCT研究进行Meta分析。主要观察指标为严重NEC的发生率、总 病死率、NEC相关病死率和院内感染导致脓毒症的发生率。结果共检索到107篇文献,符合纳入标准的10项RCT研究（共2 117 例早产儿）进 入Meta分析,文献质量评价8篇为A级,1篇为B级,1篇为C级。各研究间的基线水 平差异较大,出生体重,胎龄,益生菌应用的种类、剂量、开始应用时间和治疗 持续时间等均有差异。Meta分析结果表明,益生菌组可显著降低严重NEC的发生率 和总病死率,OR分别为0.34(95%CI：0.22~0.55,P<0.000 1)和0.36(95%CI： 0.22~0.58,P<0.000 1)。无证据表明预防性口服益生菌可减少院内感染导致脓毒 症的发生率和NEC相关的病死率,OR分别为0.94(95%CI：0.62~1.42)和0.48(95%CI ：0.16~1.47)。所有研究均未见口服益生菌导致相应菌株全身感染的发生。结论预防性口服益生菌可显著降低早产儿严重NEC的发生率和总病死率。对低出生 体重儿可给予口服益生菌预防NEC的发生。现有的研究尚不能证实预防性口服益生 菌对超低出生体重儿的疗效和安全性。有关超低出生体重儿预防性口服益生菌的 安全性和疗效仍有待大规模的临床多中心RCT研究予以明确。     

中文儿科临床试验疼痛评价量表使用情况调查

目的 调查中文儿科RCT疼痛评价量表的使用情况。方法 检索中国生物医学文献数据库、中文科技期刊全文数据库、中国知网和万方数据库,并手工检索9本与儿科或麻醉疼痛相关的中文杂志,检索时间均从建库或创刊至2012年7月。2名评价员独立对检索文献进行筛选,提取纳入RCT使用的疼痛量表及所评价儿童的年龄、疼痛类型等信息。采用频数和百分比进行统计描述。结果共纳入612篇RCT,其中116篇（19.0%）未采用明确的疼痛评价量表。余496篇采用的疼痛评价量表有31个（21个观察性量表和10个自我报告性量表）,其中使用最多的3个量表为视觉模拟评分（VAS,26.6%）、FLACC疼痛评价量表（FLACC,9.3%）和新生儿疼痛评价量表（NIPS,6.9%）。19个观察性疼痛评价量表引自国外,仅FLACC被规范化翻译为中文,并对其在儿科人群中的效度和信度进行评价。39篇RCT（6.6%）仅采用自我报告性量表对<3岁儿童的疼痛程度进行评价。结论 约1/4中文RCT未规范使用疼痛评价量表,可能误导儿童疼痛的治疗。鉴于中国使用的疼痛评价量表多来自国外,建议今后应对国外疼痛评价量表按照相关指南进行改编,并行效度和信度评价,对量表适用年龄及疼痛类型做出推荐。     

沐舒坦预防早产儿呼吸窘迫综合征的Meta分析

目的：系统评价沐舒坦预防早产儿呼吸窘迫综合征（respiratory distress syndrome,RDS）的有效性及安全性。方法：电子检索Cochrane图书馆、PubMED、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、万方和维普数据库等,手工检索Pediatrics及Pediatric Research中刊载的会议论文。检索沐舒坦预防早产儿RDS的随机对照试验（randomized controlled trial,RCT）文献。应用Cochrane协作网推荐的方法评价文献质量,对同质研究采用RevMan 5.0.17软件进行Meta分析。结果：共纳入6个RCT,其中1篇质量评价为A级,1篇为B级,4篇为C级,包括823例早产儿。Meta分析结果显示,沐舒坦预防组与对照组比较,在RDS发病率(OR=0.24,95%CI［0.15,0.64］,P＜0.01)、支气管肺发育不良（BPD）发病率(OR=0.41,95%CI［0.23,0.75］,P<0.01)、脑室内出血（IVH）发病率(OR=0.39,95%CI［0.24,0.64］,P<0.01)、动脉导管未闭（PDA）发病率(OR=0.33,95%CI ［0.17,0.67］,P<0.01) 及肺部感染发病率(OR=0.24,95%CI［0.14,0.38］,P＜0.01)差异均有统计学意义。所有研究均未报道不良反应的发生。结论：现有证据表明,早产儿早期使用沐舒坦预防性治疗能有效减少RDS、BPD、IVH、PDA及肺部感染的发病率。［中国当代儿科杂志,2010,12（11）：858-863］     

氟康唑预防极低出生体重儿侵袭性真菌感染疗效和安全性的Meta分析

目的 系统评价使用氟康唑预防极低出生体重儿（VLBWI）侵袭性真菌感染的疗效和安全性,为临床更好地预防性使用氟康唑提供依据。方法 计算机检索PubMed、Embase、Cochrane图书馆、万方数据库、中国科技期刊数据库（维普）和中国知网,纳入VLBWI预防性使用氟康唑的随机对照试验（RCT）研究。采用Review Manager 5.3统计软件对符合纳入标准的临床研究进行Meta分析。结果 共纳入12篇RCT研究,合计1 679例VLBWI。Meta分析结果显示：试验组（使用氟康唑）侵袭性真菌感染的发生率显著低于安慰剂对照组（RR=0.44,95% CI：0.27~0.71,P < 0.001）;真菌定植率低于对照组（RR=0.31,95% CI：0.24~0.40,P < 0.001）;住院期间病死率低于对照组（RR=0.74,95% CI：0.58~0.94,P=0.01）。使用不同预防剂量氟康唑的两组侵袭性真菌感染发生率和真菌定植率比较差异均无统计学意义（P > 0.05）;耐药情况及并发症发生率在试验组和对照组组间比较差异均无统计学意义（P > 0.05）。结论 氟康唑预防VLBWI侵袭性真菌感染有效且相对安全。小剂量给药可取得类似预防效果。     

meta分析:益生菌在防治儿童特应性皮炎中的作用

目的 系统评价益生菌在预防和治疗儿童特应性皮炎中的效果.方法 通过检索相关数据库中关于防治特应性皮炎患儿对添加益生菌与安慰剂的随机双盲安慰剂对照试验研究,并应用国际Cochrane协作网的系统评价方法Revman 4.3.1对其进行系统评价和敏感性分析.结果 在检索到的5项临床试验研究中,691例添加益生菌的受试婴儿中有128例发生了特应性皮炎,患病率为18.5%(95% CI:0.16～0.21),在给予安慰剂的702例婴儿中186例发生了特应性皮炎,患病率为26.5%(95% CI:0.23～0.30),OR:0.55(95% CI:0.33～0.90).仅一项治疗特应性皮炎的试验研究适合meta分析,SCORAD降低的WMD值为6.30(95% CI:0.28～12.32).结论 添加益生菌对预防儿童特应性皮炎有积极的效果,对于患有特应件皮炎的儿童可能也是有益的.更重要的是益生菌对于儿童肠道和全身免疫系统的发育有积极的影响.     

补锌对婴幼儿智力及运动发育影响的Meta分析

目的 评价补锌对婴幼儿运动和智力发育改善的作用。目的 评价补锌对婴幼儿运动和智力发育改善的作用。方法 检索 PubMed、EMBASE、Cochrane 图书馆、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库等, 获得补锌对婴幼儿运动和智力发育影响的 RCT文献。 根据随机分配方法,分配隐藏,对研究对象、治疗方案和研究结果测量者采用盲法,结果数据的完整性,选择性报告研究结果,其他偏倚来源进行文献偏倚评估。以生后6~36个月智力发育指数（MDI）、运动发育指数（PDI）和发育商（DQ）为疗效判定指标。采用RevMan 5.0软件进行Meta分析,检验异质性,根据异质性结果进行原因分析,并选择相应的效应模型分析。计量资料以SMD或WMD及其95％CI表示。结果 ①共检索到文献84篇,共10篇RCT满足纳入条件进入Meta分析。7篇文献采用了正确的随机方法,8篇文献采用了分配隐藏,9篇文献对受试者采用了盲法,8篇文献对研究者和结局测量者采用了盲法,9篇文献提及报道数据的完整性,9篇文献未选择性报告研究结果, 仅1篇文献报道了其他偏倚来源。漏斗图检验未见显著发表偏倚。②Meta分析结果显示,补锌组与对照组MDI的差异无统计学意义,WMD=-0.08(95％CI：-1.55～1.40);补锌组与对照组PDI的差异无统计学意义,SMD＝0.15(95％CI：-0.12～0.42)。但研究间均具显著统计学异质性,根据补锌的剂量、是否与其他营养物质合用、纳入对象的营养状况行亚组分析,进一步探讨异质性产生的原因。亚组分析显示不能完全消除文献间的异质性,异质性可能还与其他因素有关。③补锌组与对照组DQ评分的差异无统计学意义,WMD＝-0.72（95％CI：-7.97 ～6.53 ）。补锌组与对照组干预前后Alberta运动指数的差异无统计学意义, WMD＝0.30（ 95％CI：-2.09 ～2.69 ）。结论 早期补锌并未提高MDI、PDI及DQ评分,对婴幼儿运动和智力发育未显示有改善作用。鉴于研究间存在显著的统计学异质性,结论仍需谨慎看待。     

产前应用糖皮质激素预防足月择期剖宫产儿呼吸窘迫综合征系统评价和Meta分析

目的：系统评价产前应用糖皮质激素（GC）预防足月择期剖宫产新生儿呼吸窘迫综合征（RDS）的有效性和安全性。 方法：计算机检索PubMed、Embase、Cochrane图书馆、ClinicalTrials.gov、中国生物医学文献服务系统（CBM）、万方数据库、中国知网（CNKI）和维普期刊数据库（VIP）,纳入足月妊娠择期剖宫产的孕妇产前给予GC预防新生儿RDS的RCT,试验组产前给予GC治疗（药物种类、剂量、给药途径、疗程不作限制）,对照组给予安慰剂或为空白对照。采用主题词与自由词相结合的方式进行检索,检索时间均为建库至2018年4月19日。主要结局指标为新生儿RDS发生率和新生儿病死率,次要指标为新生儿暂时性呼吸增快（TTN）发生率、新生儿呼吸困难发生率、因呼吸困难入住NICU率、新生儿败血症发生率、产妇感染率及不良反应发生率。按照Cochrane手册推荐的RCT的偏倚风险评估工具评价纳入文献的偏倚风险。采用RevMan5.3软件进行Meta分析。 结果：共纳入4篇RCT文献3 893例单胎新生儿。4篇文献质量中等。Meta分析显示,试验组和对照组新生儿RDS发生率差异有统计学意义（OR=0.45,95%CI：0.24～0.83）,新生儿病死率差异无统计学意义;试验组和对照组TTN发生率（OR=0.41,95%CI：0.29～0.59）、新生儿因呼吸困难入住NICU率（OR=0.42,95%CI：0.29～0.63）和新生儿呼吸困难发生率（OR=0.34,95%CI：0.22～0.53）差异均有统计学意义。1篇文献报告了新生儿败血症发生率和产妇感染率,两组差异均无统计学意义。产前应用GC,并未引起母亲严重的不良反应率。 结论：基于现有临床证据,产前使用1疗程的GC可以降低足月单胎择期剖宫产儿RDS风险。     

C反应蛋白对不明原因发热儿童严重细菌感染诊断价值的系统评价

目的 系统评价CRP对不明原因发热儿童严重细菌感染的诊断价值。方法 检索Medline、EMBASE、Cochrane图书馆、维普中文科技期刊数据库、中国知网、万方数据库和中国生物医学文献数据库，纳入CRP对不明原因发热儿童严重细菌感染诊断价值的文献，检索时间均为建库至2012年10月。采用QUADAS量表对纳入文献进行质量评估，使用MetaDisc 1.4软件对纳入文献进行异质性检验及Meta分析。结果 初检到314篇文献，7篇文献符合纳入标准进入系统评价（n=2 179）。6篇为前瞻性研究，1篇为回顾性研究。CRP的最适界值为30~91 mg·L-1。严重细菌感染的患病率为1.7%~29.3%。4篇文献采用多变量Logistic回归分析显示，CRP是严重细菌感染独立的预测因素。报道敏感度和特异度文献间具有高度的异质性，采用描述性分析，CRP不同最适界值诊断严重细菌感染的敏感度为33%~89%，特异度为75%~97%。报道阳性似然比和阴性似然比的文献间具中度异质性，采用随机效应模式合并，合并阳性似然比为4.43 （95%CI：3.49~5.63），阴性似然比为0.39（95%CI：0.29~0.54）。SROC曲线下面积为0.85，Q指数为0.78。结论 在以不明原因发热就诊的婴幼儿中，CRP对严重细菌感染具有中等的诊断价值，应用时尚需结合临床表现及其他实验室检查指标。     

益生菌预防极低出生体重儿迟发型败血症的Meta分析

目的 评估益生菌预防极低出生体重儿迟发型败血症(late-onset sepsis,LOS)的有效性.方法 检索PubMed、Web of Science、Cochrane Library、万方数据库、中国知网、中国生物医学文献数据库等数据库中关于益生菌预防极低出生体重儿LOS的临床随机对照试验.LOS类型包括临床败血...     

Probiotics in the prevention of antibiotic-associated diarrhea in children: a meta-analysis of randomized controlled trials

OBJECTIVE: To systematically evaluate the effectiveness of probiotics in preventing antibiotic-associated diarrhea (AAD) in children. STUDY DESIGN: The following electronic databases up to December 2005, in any language, were searched for studies relevant to AAD and probiotics: MEDLINE, EMBASE, and The Cochrane Library. Only randomized controlled trials (RCT) were considered for study inclusion. RESULTS: Six placebo-controlled, RCTs (766 children) were included. Treatment with probiotics compared with placebo reduced the risk of AAD from 28.5% to 11.9% (relative risk, RR, 0.44, 95% CI 0.25 to 0.77, random effect model). Preplanned subgroup analysis showed that reduction of the risk of AAD was associated with the use of Lactobacillus GG (2 RCTs, 307 participants, RR 0.3, 95% CI 0.15 to 0.6), S. boulardii (1 RCT, 246 participants, RR 0.2, 95% CI 0.07-0.6), or B. lactis & Str. thermophilus (1 RCT, 157 participants, RR 0.5, 95% CI 0.3 to 0.95). CONCLUSIONS: Probiotics reduce the risk of AAD in children. For every 7 patients that would develop diarrhea while being treated with antibiotics, one fewer will develop AAD if also receiving probiotics.     

Probiotics for preventing healthcare-associated diarrhea in children: A meta-analysis of randomized controlled trials

Aim

To systematically update evidence on the efficacy of using probiotics for the prevention of healthcare-associated diarrhea in children.

Methods

MEDLINE, EMBASE, The Cochrane Library, Health Source: Nursing/Academic Edition, two clinical trials and reference lists were searched in June 2013, for randomized controlled trials (RCTs) performed in children aged 1 month to 18 years that compared the effects of the administration of probiotics with placebo or no intervention. The primary outcome measure was the incidence of healthcare-associated diarrhea.

Results

Six RCTs involving 1343 children met the inclusion criteria. Administration of Lactobacillus rhamnosus GG (LGG) compared with placebo reduced the risk of healthcare-associated diarrhea (2 RCTs, n = 823, RR 0.37; 95% CI 0.23–0.59), reduced the risk of rotavirus gastroenteritis (3 RCTs, n = 1043, RR 0.49, 95% CI 0.28–0.86), but did not reduce the risk of asymptomatic rotavirus infection (2 RCTs, n = 301, RR 1.39, 95% CI 0.74–2.62). Administration of Bifidobacterium bifidum & Streptococcus thermophilus compared with placebo reduced the risk of healthcare-associated diarrhea (1 RCT, n = 55, RR 0.22, 95% CI 0.05–0.96), rotavirus gastroenteritis (1 RCT, n = 55, RR 0.27, 95% CI 0.08–0.87), and rotavirus asymptomatic infection (1 RCT, n = 55, RR 0.27, 95% CI 0.08–0.87). Administration of two other probiotics (i.e., Lactobacillus reuteri DSM 17938 and Lactobacillus delbrueckii H2B20) was ineffective.

Conclusion

In hospitalized children, the administration of LGG, compared with placebo, reduced the incidence of healthcare-associated diarrhea, including rotavirus diarrhea. Evidence on the effects of other probiotics, whether positive or negative, is limited.     

Probiotics and prebiotics in pediatrics

This clinical report reviews the currently known health benefits of probiotic and prebiotic products, including those added to commercially available infant formula and other food products for use in children. Probiotics are supplements or foods that contain viable microorganisms that cause alterations of the microflora of the host. Use of probiotics has been shown to be modestly effective in randomized clinical trials (RCTs) in (1) treating acute viral gastroenteritis in healthy children; and (2) preventing antibiotic-associated diarrhea in healthy children. There is some evidence that probiotics prevent necrotizing enterocolitis in very low birth weight infants (birth weight between 1000 and 1500 g), but more studies are needed. The results of RCTs in which probiotics were used to treat childhood Helicobacter pylori gastritis, irritable bowel syndrome, chronic ulcerative colitis, and infantile colic, as well as in preventing childhood atopy, although encouraging, are preliminary and require further confirmation. Probiotics have not been proven to be beneficial in treating or preventing human cancers or in treating children with Crohn disease. There are also safety concerns with the use of probiotics in infants and children who are immunocompromised, chronically debilitated, or seriously ill with indwelling medical devices. Prebiotics are supplements or foods that contain a nondigestible food ingredient that selectively stimulates the favorable growth and/or activity of indigenous probiotic bacteria. Human milk contains substantial quantities of prebiotics. There is a paucity of RCTs examining prebiotics in children, although there may be some long-term benefit of prebiotics for the prevention of atopic eczema and common infections in healthy infants. Confirmatory well-designed clinical research studies are necessary.     

Hygiene levels in a contemporary population cohort are associated with wheezing and atopic eczema in preschool infants.

BACKGROUND: The hygiene hypothesis states that insufficient exposure to certain infectious agents during childhood increases the risk of developing asthma and atopic diseases. Improvements in hygiene levels may be partly responsible for this decline in exposure. AIMS: To assess whether hygiene levels in infancy are associated with wheeze and/or atopic eczema, independent of a number of possible confounding factors. METHODS: Data were gathered from the Avon Longitudinal Study of Parents and Children (ALSPAC). Parental self completion questionnaires provided symptom data on infant wheeze and atopic eczema at 0-6 months and 30-42 months, respectively. A simple hygiene score was derived using questionnaire responses at 15 months, which ranged from least hygienic to most hygienic. Multivariable logistic regression models analysed the effect of hygiene scores on health outcomes, while adjusting for a number of important confounding variables. RESULTS: Increasing hygiene scores were independently associated with wheezing (OR = 1.04; 95% CI: 1.00 to 1.08) and atopic eczema (OR = 1.04; 95% CI: 1.01 to 1.07) between 30 and 42 months, but not in the first six months. The odds ratio was higher for atopic eczema if the rash was reported to have become sore and oozy (OR = 1.09; 95% CI: 1.02 to 1.16). CONCLUSIONS: High levels of hygiene at 15 months of age were independently associated with wheeze and atopic eczema reported between 30 and 42 months, and there was an increased risk for children with more severe eczema during this period. The importance of hygiene in public health should not be dismissed; however, the creation of a sterile environment through excessive cleanliness may potentially be harmful to the immune system.     

去氨加压素单独使用和联合抗胆碱药物治疗儿童单症状夜遗尿疗效的Meta分析

目的 采用系统评价的方法比较去氨加压素单独使用和联合抗胆碱药物治疗儿童夜遗尿的疗效.方法 计算机检索PubMed(1966年1月至2016年8月)、Cochrane library(1996年1月至2016年8月)、Embase(1974年1月至2016年8月)、CNKI(1994年1月至2016年8月)、万方数据库(1989年1月至2016年8月)、CBM(1978年1月至2016年8月)数据库,按照纳入和排除标准选择随机对照试验(RCT),评价纳入文献质量并提取资料,采用RevMan5.0软件进行Meta分析.结果 收录7个随机对照试验,含660例患儿,其中联合用药治疗组患儿332例,去氨加压素单药治疗组患儿328例.Meta分析结果:去氨加压素单独使用和联合抗胆碱药物治疗儿童夜遗尿,二者在治疗1个月后部分有效率[RR:1.28;95％CI(1.14,1.44),P＜0.000 1]、1个月后治愈率[RR:2.29;95％CI(1.61,3.25),P＜0.000 1]、3个月后治愈率[RR:1.69;95％CI (1.28,2.22),P=0.0002]差异均有统计学意义.结论 去氨加压素联合抗胆碱药物治疗小儿遗尿疗效优于去氨加压素单药治疗.     

Margarine and butter consumption, eczema and allergic sensitization in children. The LISA birth cohort study

It has been hypothesized that margarine intake is associated with allergic diseases. However, the epidemiological evidence in children is limited. The aim of the present study was to assess the relationship between dietary intake of margarine and butter with eczema and allergic sensitization in 2-yr-old children. Data of 2582 children at the age of 2 yr with complete information on exposure to diet and allergic outcome were analyzed in a German prospective birth cohort study (LISA). Margarine and butter intake were estimated from a semiquantitative food frequency questionnaire about general fat use at home combined with questions on the child's spread intake. Multiple logistic regression analysis was applied comparing predominant margarine and predominant butter intake with consumption of both butter and margarine. Predominant margarine intake was positively associated with lifetime prevalence of symptomatic eczema (aOR: 1.71; 95% CI: 1.12-2.61) and doctor-diagnosed eczema (aOR: 2.10; 95% CI: 1.36-3.25) and allergic sensitization against inhalant allergens (aOR: 2.10; 95% CI: 1.01-4.41) at the age of 2 yr. No statistically significant associations were found for butter intake. Stratification for parental history of atopic diseases indicated that children at high risk of atopic diseases have higher effect estimates for margarine intake compared to children without parental history of atopic diseases. Stratification for sex also showed higher effect estimates in boys. Children with predominant margarine consumption had an increased risk for eczema and allergic sensitization, while butter intake was no predictor for allergic diseases. However, we could not determine whether margarine is a causal risk factor or whether other lifestyle factors have influenced this association.     

Probiotics in allergy management

The gut contains a diverse bacterial flora that is acquired at birth and has a number of physiological functions. Administration of prebiotics or probiotics may favourably alter this gut microflora. Prebiotics are poorly digested oligosaccharides that promote the growth of desirable bacteria and may have other beneficial gastrointestinal and systemic effects. Probiotics are "helpful" human bacteria that provide a variety of health benefits when administered exogenously. Probiotics produce beneficial effects in the prevention and treatment of traveller's diarrhoea, viral diarrhoea, and diarrhoea in day care centres. Moreover, probiotics have been shown to reduce relapses associated with Clostridium difficile, and Lactobacilli are effective in the prevention of antibiotic-associated diarrhoea. Probiotics may also be efficacious in the treatment of gastroenteritis. Clinical studies of probiotics in inflammatory bowel disease have proved disappointing, but beneficial effects in adults with irritable bowel syndrome have been reported with Bifidobacterium infantis 35624. Lactobacilli GG reduces the incidence of gastrointestinal symptoms and gut permeability in patients with atopic dermatitis, and administration of probiotics reduces the frequency and severity of atopic eczema when administered to pregnant women and then to newborn infants. In conclusion, probiotics are effective in the treatment and/or prevention of a number of conditions, including diarrhoea, irritable bowel syndrome and atopic dermatitis, and the product used should be selected based on the particular indication.