1400��0��5�꽡����ͯѪ�忹�����Ϲܼ��ؼ�������B�ٴ�����о�

??Objective To detect the concentrations of serum anti-Mullerian hormone??AMH?? and inhibin B??INHB?? in healthy children aged from 0 to 5 years??in order to help provide the basis for early clinical assessment of gonadal function. Methods A total of 1400 children were included. The children included 700 healthy boys and 700 girls aged from at birth to 5 years old from 5 Hospitals. They were divided into seven groups??0-1 month??m????1-6 m????6 m-1 year??yr??????1-2 yr????2-3 yr????3-4 yr and ??4-5 yr??100 children in each group. The concentrations of serum AMH and inhibin B were detected by ELISA. Results In 0-5 years old healthy boys?? serum AMH concentrations reached the peak of 210.70??55.37-439.45?? μg/L from 1 to 6 month??and maintained the relatively stable level of 147.1??17.69-321.88?? μg/L during 1-5 years of age??while in 1 to 6 month healthy girls??it reached a small peak of 1.77??0.06-7.68?? μg/L and tended to be stable at ??1.98??0.19-7.31?? μg/L?? during 2-5 years of age. Serum inhibin B concentrations were 274.23??0.00-602.34?? ng/L??with the highest during 1-6 months of birth in boys??which appeared small peak of 36.83??0.00-226.32?? ng/L in girls. Conclusion It is the first large sample research of serum AMH and inhibinB concentration range in healthy children aged 0 to 5??and the peak concentration appears at one to six months after birth.     

������pbp2b ply��lytA��϶�ͯ�����������Ĥ��Ӧ�ü�ֵ�о�

??Objective To compare pbp2b??ply and lytA genes PCR with cerebral spinal fluid culture in diagnosis of Streptococcus pneumoniae meningitis and prediction of its susceptibility. Methods A nested PCR targeting pbp2b and another two S.pneumoniae specific PCR targeting the genes of pneumolysin??ply?? and autolysin??lytA?? were developed for detection of S.pneumoniae in cerebral spinal fluid from bacterial meningitis patients. The three PCR results and culture were compared. The consistency of penicillin susceptibility PCR ??using resistant and susceptible primers respectively????sequencing and culture-based phenotypic penicillin resistant results were compared. Results Of the 161 specimens studied??there were 25 cases of S.pneumoniae infection confirmed by different methods??16 by pbp2b PCR??16 by lytA PCR??14 by ply PCR and 9 by cerebrospinal fluid culture??. Of the 16 pbp2b positive specimens??penicillin sensitive and resistant sequence types accounted for half??respectively. Four of the 16 pbp2b positive specimens had culture-based phenotypic penicillin-resistant result. Three of 4 were consistent with penicillin susceptibility PCR result. The results of susceptibility PCR targeting pbp2b was consistent with sequencing result. New sequence types were found but there were no new point mutations in these strains when compared with GenBank ??http??//blast.ncbi.nlm.nih.gov/Blast.cgi??. Penicillin resistance in pneumococcal meningitis was 66.67%??6/9?? by culture phenotype and 50%??8/16?? by PCR and sequencing when culture was negative. Conclusion Pbp2b can serve as a good target gene to detect S.pneumoniae and predict its penicillin susceptibility??which is especially important when culture is negative.     

5��14����������������һ���������������������������о�

??Objective??To explore the correlation between FeNO levels and airway reversibility and its clinical significance in assessment of children with asthma. Methods??A total of 161 children at 5 to14 years old with asthma admitted to pediatric respiratory outpatient of Shengjing Hospital Affiliated to China Medical University from November 2014 to November 2015 were divided into allergic group and non-allergic group according to the allergic condition. FeNO and bronchial dilatation tests were made in the two groups. The correlation between FeNO levels and improvement rate after bronchodilator in two groups was analyzed. Results????1??FeNO level in allergy group was obviously higher than that in non-allergic group??P??0.002??. ??2?? FeNO level of children in allergic group was positively correlated with improvent of bronchial improvement??P??0.05????and negatively correlated with FEV1%?? FEV1/FVC%?? FEF50%?? FEF25% and FEF75/25% of basic lung function??P??0.05????but was irrelevant to FVC%?? PEF% and FEF75% of basic lung function??P??0.05??.??3??FeNO level of children in non-allergic group was irrelevant to improvement rates of bronchial dilation and basic lung function??P??0.05??. Conclusion??For asthmatic children with allergic constitution??FeNO level is positively correlated with airway reversibility. It may be a good noninvasive predictor for evaluating asthma and airway reversibility in children with asthma. While for children without allergic constitution??FeNO level cannot indicate the airway reversibility effectively.     

��άˮѡ���Լ��������ڶ�ͯѪ�Ѳ��Թǹؽڲ������ʾӦ�ü�ֵ�о�

??Objective To detect the value of 3D T1W-WATS sequence on cartilage display of hemophilic arthropathy using quantitative and qualitative assessment. Methods Totally 16 joints including 8 knees and 8 ankles ??13 joints with hemosiderin deposition?? from 16 hemophilia patients were scanned on a 3.0 T MR ??Achieva TX??Philips Health care??Best??The Netherlands?? with sagittal 3D T1W-WATS sequence and 2D T2*W sequence. Signal to noise ratio ??SNR?? of cartilage and relative contrast between cartilage and surrounding tissues were employed to measure the performance of two sequences quantitatively??SNRcartilage= SIcartilage/standard deviationnoise?? relative contrast=??SIcartilage-SIsurrounding tissues??/??SIcartilage+SIsurrounding tissues??. Cartilage of 13 joints were divided into 142 subareas according to the literature. The impact of hemosiderin deposition was evaluated by counting the number of subareas where the display of cartilage was affected qualitatively. Results SNR of 3D T1W-WATS sequence was??53.93±18.80????and SNR of 2D T2*W sequence was??52.96±24.32??. There was no statistical difference for SNR between two sequences??P??0.05????3D T1W-WATS sequence exhibited better relative contrast between cartilage and bone marrow?? cartilage and fat?? cartilage and fluid than 2D T2*W sequence??P??0.05????42 of 142 subareas of cartilage were covered with hemosiderin partially or completely in 2D T2*W sequence??while the number was only 16 in 3D T1W-WATS sequence??there being statistical difference ??P??0.05??. Conclusion 3D T1W-WATS sequence is superior in the evaluation of cartilage display for hemophiliac joints with better relative contrast and immunity to hemosiderin deposition?? compared with 2D T2*W sequence.     

С�����Ը�к���в�ѧ�벡���о�

??To explore the epidemiology and etiology of chronic diarrhea diseases??CDD??in children?? and understand the incidence?? etiology and clinical manifestation. Methods??Clinical data of 179 cases of CDD hospitalized between January 1996 and January 2006 were retrospectively reviewed. Results??Morbidity of CDD was 4. 8% during these 10 years??among which 50. 3% were less than 1-year- old infants ?? and 62.2% were less than 3-year-old children. Common complications included anemia??46. 4%?? ??malnutrition??45. 3%???? growth and development retardation??24. 0%???? hypoalbuminemia??36. 3%???? etc. Totally 154 cases had been found with clear etiology?? and final diagnosis rate was 87. 7%. The first 3 causes were inflammatory bowel diseases??IBD?? ??35. 2%???? infectious diseases?? 17.3%?? and immunodeficiency diseases ??15. 6%??. Unknown pathology ??including refractory diarrhea 7 cases?? occupied 12. 3%. Conclusion??Infant and young children?? especially the infants often suffer from CDD?? and are easily complicated with malnutrition?? etc. Etiology of CDD is various??and the most common one is non-infectious diseases. IBD is the most important reason of children CDD.     

�����ⶨ������ټ����ж�Ůͯ�Է����̶�Ӧ�ü�ֵ�о�

??Objective To investigate the value of quantitative assay of urinary gonadotropins ??UGn????including ULH and UFSH??in sexual development in girls. Methods A total of 109 girls with sexual development underwent both GnRH stimulation and UGn assay admitted from October 2013 to February 2015 in Rui Jin Hospital Shanghai Jiao Tong University School of Medicine were analyzed. Two successive morning urine was collected for detection of UGn. On the second day girls underwent conventional GnRH stimulation test while serial blood samples and the total 4-hour urinary sample after GnRH administration was collected for detection of UGn. Results ??There were no significant differences in UGn concentrations between two consecutive days but UGn was significantly correlated with basic serum Gn. ??Total 4 h UGn concentrations were significantly correlated with peak value of serum Gn. The ratio of ULH/UFSH was also correlated with ratio of serum LH/FSH. ??The value of assessment for breast development in Tanner stage ?? and ?? was similar by quantitative assays of UGn or serum Gn. ??Determination of basic morning ULH level and total 4 h ULH and the ratio of ULH/UFSH after GnRH stimulation were all helpful for clinical discrimination of PT and CPP. Conclusion UGn detection is considered as a significant criteria for assessment of activity of HPG axis in children with sexual development??and can be used as a non-invasive and sensitive diagnostic method.     

ŧ�����ݿ�Һ�帴����Ѫ��������͸Ũ�ȼ���Ӧ�ü�ֵ�о�

??Abstract Objective??To research the advantages of plasma colloid osmotic pressure ??COP??monitoring in fluid resuscitation of pediatric patients in septic shock. Methods??A total of 47 pediatric patients in septic shock were divided randomly into 2 groups?? all cases were dynamically monitored COP??and under went fluid resuscitation. In Group A ??22 cases???? fluid infused depending on clinical experience??and COP indexes were not considered. Only normal sodium was used in quick transfusion period. Crystal vs colloid fluid was 2??3 ?? 1 during continuing and sustaining transfusion period.In Group B ??25 cases???? if COP was lower than normal??more colloid fluid was used in quick transfusion period and Crystal vs colloid fluid was 1 ?? 1 during continuing and sustaining transfusion period??otherwise ??treatments were the same as in group A. Average artery pressure??MAP???? urine volume per hour?? central venous pressure ??cvp????fluid resuscitation volume?? usage amount of vasoactive drug??and pediatric critical illness scores ??PCIS scores?? of two groups were recorded and statistically analyzed. Results??At first??COP??PCIS scores??MAP and CVP were similar between group A and B?? COP was obviously lower than normal. Colloid fluid volume and COP of group B in every period were more than group A. Total fluid volume of group B during 6 and 24 hours were less than group A?? at 1 and 6 hour?? PCIS scores?? urine volume per hour?? MAP and CVP of group B were more than group A?? usage amount of vasoactive drug was less than group A. After 24 hours?? PCIS scores?? urine volume per hours?? MAP??CVP were similar between group A and B?? but in group B usage amount of vasoactive drug was less than that in group A. Conclusion??Monitoring COP during fluid resuscitation of pediatric patients in septic shock?? and adjusting ctystal colloid proportion depending on it ?? was helpful to increase curative effect.     

��е��������Ƽ����ƶ�ͯ������ҩ�������ۺ���ǰհ���о�

??Objective??To observe the efficacy and safety of multi-target immunosuppressive therapy in treatment of children with steroid-resistant nephritic syndrome??SRNS??. Methods??A total of 48 children with SRNS were enrolled in this multicenter prospective study. Based on the same comprehensive treatment??the children were randomly divided into two groups?? ??1??observation group?? they were orally given CSA??3??4 mg/??kg·d???? and MMF??20 mg/??kg·d???? multi-target immunosuppressive therapy????2??control group??they were orally given CSA??4??6 mg/??kg·d????. The side effects were closely observed. The plasma concentrations of CSA??urine protein to creatinine ratios??liver and kidney function??blood routine and urine β2-microglobulin were respectively compared between the two groups after 2 weeks??1 month??3 months and 6 months of treatment. Results??The average plasma concentrations of CSA in the observation group was ??88.86±16.94?? μg/L??and in the control group it was ??152.96±19.20?? μg/L??P??0.001??. The urine protein to creatinine ratios in the observation group after 1 month and 3 months of treatment were lower than the control group in the same time period??P??0.05??. The serum albumin in the observation group after 1 month and 3 months of treatment was higher than the control group in the same time period??P??0.05??. The urine β2-microglobulin in these two groups had no differences during the treatment??P??0.05??. The overall remission rate of the observation group was 88%??and in the control group it was 87%. The remission rate of the observation group after 2 weeks and 1 month of treatment was better than the control group??P??0.05??. The main side effect during therapy was infection??gastrointestinal reaction??crinosity??hypertension and leukocyte decrease. The side effect of the observation group was less than the control group??P??0.05??. Conclusion??The multi-target therapy in children with SRNS by CSA and MMF results in early remission and can keep long-term remission with mild side effect.     

�Ź�����ɢ������������67��2���� Ӥ�׶��԰��ʷ����о�

??Abstract??Objective The purpose of this study was to use diffusion tensor imaging to investigate the status of cerebral white matter??WM?? maturation in the first 2 years after birth. Methods A total of 67 children ranging in age from birth to 24 months underwent conventional MRI and diffusion tensor imaging with gradient encoding in fifteen directions?? all on a 1.5T MRI system. All children were divided into six groups according to month. Fractional anisotropy was measured in five deep WM structures ??posterior limb of internal capsule?? anterior limb of internal capsule?? genu and splenium of corpus callosum?? optic radiation?? and four peripheral WM regions??associational WM underlying prefrontal?? occipital cortex?? temporal lobe and centrum semiovale??. Results In the same months of age?? different parts of the white matter FA values were significantly different??the deep white matter FA values were higher than the shallow??in birth-to-28 days baby?? corpus callosum FA values was the highest in deep white matter ??followed by the corpus callosumknee?? posterior limb of internal capsule?? optic radiation and limb of internal capsule??in the shallow white matter??centrum semiovale was the highest?? followed by the temporal lobe?? frontal lobe and occipital subcortical white matter. With increasing month-old?? white matter FA values of the various parts gradually increased??showing positive correlation. In the same parts of the white matter??FA values change in different rate for different ages??which was a statistically significant ??P??0.05??. Conclusion Combination of T1WI and T2WI and diffusion tensor imaging can be used for quantitative evaluation of cerebral white matter development of children in the first 2 years after birth..     

����Teiָ������ȱ���Էζ�����ѹ���������ҹ���Ӧ�ü�ֵ�о�

目的 探讨右室Tei指数(RV-Tei)在评价缺氧性肺动脉高压(HPH)新生儿右室功能中的作用.方法 对2006年6月至2008年1月在新疆医科大学第一附属医院新生儿病房住院的75例HPH新生儿(HPH组,其中轻度29例、中度21例、重度25例)及22名对照组新生儿,于生后3 d以超声心动图测定肺动脉收缩压(PASP)、右室射血分数(RVEF)、三尖瓣口舒张早期峰值(E峰)、舒张晚期峰值(A峰),计算E/A值,并从血流频谱测得右室RV-Tei.结果 (1)轻、中度HPH组RVEF、E/A值与对照组比较,差异无统计学意义.重度HPH组RVEF、E/A值较对照组减小(P<0.01).(2)HPH轻、中、重3组RV-Tei均较对照组升高(P<0.01).3组间RV-Tei差异亦有统计学意义(P<0.05).(3)HPH组RV-Tei与PASP呈正相关(r=0.75,P<0.05),与胎龄、体重、心率无相关.结论 肺动脉高压引起新生儿右室功能减低,RV-Tei是评价HPH新生儿右室功能早期变化的简便而敏感的多普勒超声新指标.     

Ѫ�峦��֬�����ϵ�������Ѫ���������ף������֢������������С���᳦��Ӧ�ü�ֵ�о�

??Objective??To investigate the value of serum intestinal fatty acid binding protein??I-FABP?? and serum amyloid A??SAA?? in the diagnosis of necrotizing enterocolitis??NEC??in the newborn. Methods??Fifty-six preterm infants with a confirmed diagnosis of NEC from October 2014 to October 2015 were recruited as case group??stage??26 cases??stage??/??30 cases??. Thirty children diagnosed with non-digestive diseases in the same period were recruited as the control group. Serum levels of I-FABP and SAA were determined by enzyme-linked immunosorbent assay.The diagnostic value of I-FABP and SAA for severe NEC was assessed using the receiver operating characteristic??ROC??curve. Results??Stage??/?? cases in the case group had significantly higher serum I-FABP levels and SAA levels than the control group and Stage??cases??P??0.05??. The area under the ROC curve for serum I-FABP was 0.80??95%CI??0.69-0.92????with the optimal cut-off point of 21.8 μg/L. Under this cut-off point??the sensitivity and specificity were 70.0%and 81.0%??respectively. The area under the ROC curve for SAA was 0.76??95%CI??0.63-0.89????with the optimal cut-off point of 1657.8 μg/L. Under this cut-off point??the sensitivity and specificity were 67.0% and 80.0%??respectively. Conclusion??In newborn infants with NEC??serum I-FABP and SAA l can be used as biomarkers for the diagnosis of severe NEC.     

��̸ŧ�����ݿ�Һ�帴��

??Fluid resuscitation continues to be recommended as the first-line resuscitative therapy for patients with septic shock. The current acceptance of the therapy is based in part on long history and familiarity with its use in the resuscitation of other forms of shock??as well as on an incomplete and incorrect understanding of the pathophysiology of septic shock. Recently??the safety of intravenous fluids resuscitation in patients with septic shock has been called into question with both prospective and observational data suggesting improved outcomes with less fluid. The current evidence for the continued use of fluid resuscitation for septic shock remains contentious with no prospective evidence demonstrating benefit to fluid resuscitation as a therapy in isolation. The article reviews the pathophysiological rationale for the introduction of fluid resuscitation as treatment for septic shock and highlights a number of significant concerns based on current clinical evidence.     

�й���ͯ�����ݸ˾���Ⱦ���в�ѧ��״���Ǩ

??The occurrence of Helicobacter pylori??H.pylori?? infection is significantly higher in developing countries when compared to developed nations. It is one of the most common chronic bacterial infections in China and significant geographic differences among regions are likely to present. The rates of
H.pylori infection and related diseases have been declining yearly in both developed and rapidly developing countries. A prospective??multicenter study performed recently in China indicates that H.pylori infection rate among Chinese asymptomatic children increases with age and is high after the age of ten. There is no overall regional difference among different cities. H.pylori infection rate in children has declined in Beijing in recent 20 years since 1991??which indicates that improvement in socioeconomic conditions might have helped to reduce the infection rate in children.     

��轻ƿ�����ԭ���������ۺ������� ����״̬���������о�

目的观察槐杞黄颗粒辅助治疗原发性肾病综合征(PNS)患儿对淋巴细胞亚群、免疫球蛋白及感染次数的影响。方法 2008-01-01—2009-10-31中国医科大学附属盛京医院小儿肾脏风湿免疫科将住院的101例PNS患儿随机分为A组(62例)和B组(39例),选取正常体检儿童22名为正常对照组。A组采用糖皮质激素联合槐杞黄颗粒治疗,B组单独服用激素。分别于治疗前和治疗3个月、6个月检测患儿的淋巴细胞亚群、免疫球蛋白及记录感染次数、肾病复发次数和药物副反应。结果 (1)A、B组治疗前,CD8+高于正常对照组(P<0.05),CD4+、CD4+/CD8+和NK细胞均明显降低于正常对照组(P<0.05),IgA与IgG均低于正常对照组(P<0.05)。(2)治疗3个月,A组(39例)与B组(30例)之间CD8+细胞差异无统计学意义,两组均明显高于正常对照组,差异有统计学意义(P<0.01);B组CD4+及CD4+/CD8+显著低于A组和正常对照组(P<0.05);A组与B组NK细胞均高于治疗前,B组低于同期A组(P<0.05);IgG明显升高但组间差异无统计学意义。(3)治疗6个月,A组(23例)、B组(9例)间各指标均差异无统计学意义,均低于正常对照组(P<0.01)。(4)感染次数,A组发生上呼吸道感染6例次,肺炎2例次,肾病综合征复发4例次。B组发生上呼吸道感染10例次,肺炎3例次,泌尿系感染2例次,肾病综合征复发6例次。1例患儿服槐杞黄颗粒后出现较严重腹泻(排除感染性腹泻)。结论 PNS患儿治疗前细胞、体液免疫功能降低、紊乱;槐杞黄颗粒辅助治疗过程中,可能通过提高NK细胞和T辅助淋巴细胞活性,减少感染并有减少肾病综合征复发的趋势,且副反应轻微。     

���Ͻ����ݷ�������Ӥ�׶���Ϣ ��Ч����ȫ���о�

目的探讨联合降阶梯方案治疗婴幼儿喘息的疗效和安全性。方法以2010年10至12月于上海交通大学医学院附属新华医院哮喘专科门诊及普通儿科呼吸门诊就诊的婴幼儿喘息患儿97例作为研究对象,以规范采用联合降阶梯疗法患儿作为治疗组,以仅采用门诊常规治疗的患儿作为对照组(非联合降阶梯疗法组)。两组均采用相同综合性治疗,包括吸氧、退热等对症处理。治疗组口服泼尼松5mg/d,每天1次,疗程3d;口服阿奇霉素0.1g(/kg·d),疗程3d;每晚用妥洛特罗贴剂1贴(0.5mg/d),疗程7d;口服氯雷他定3mL/d,疗程14d;口服孟鲁司特钠4mg/d,疗程21d。对照组采用目前门诊常用治疗方案,包括采用静脉滴注琥珀氢考或甲强龙、平喘药物、抗生素、祛痰止咳合剂、雾化吸入激素等。结果治疗组患儿咳嗽、喘息、哮鸣音评分及症状体征消失天数显著低于对照组(P<0.05),治疗组1个月内复发次数、治疗费用、家长误工天数显著低于对照组(P<0.05),且治疗组患儿对该方案接受度较高(P<0.05)。结论联合降阶梯疗法应用于婴幼儿喘息疗效肯定,且方便、安全,值得临床应用推广。     

6��12���ͯ��Ϊ������˯���ϰ�������о�

目的 探讨儿童注意缺陷、多动冲动等行为问题与睡眠障碍(SD)的关系.方法 2006年6月至2007年4月在长沙市5个行政辖区随机抽取1736名6～12岁儿童,对受试儿童的家长进行睡眠状况和注意缺陷多动障碍症状问卷调查.结果 1736名儿童中SD发生率为31.9%.SD组注意缺陷发生率为21.7%、多动冲动13.7%、白天嗜睡35.9%,均较非SD组13.0%、7.9%、24.7%高(P<0.01).行为问题与打鼾的频度有关,经常打鼾组的注意缺陷发生率为31.3%,高于从不打鼾组及偶尔打鼾组(分别为13.9%、16.2%,P<0.01);多动冲动的发生率为18.2%,亦高于从不打鼾组及偶尔打鼾组(分别为8.8%、9.9%,P<0.05).在SD的评分中,注意缺陷发生率高分组达19.2%～26.2%,明显高于其他低分组的10.9%～12.3%(P<0.01);多动冲动最高分组为16.2%,亦比低分组的5.7%～8.3%为高(P<0.01).SD、注意缺陷及多动冲动的发生率均存在性别差异,以男性为高(P<0.01).结论 儿童注意缺陷多动障碍等行为问题与SD相关,对出现注意缺陷多动障碍症状的儿童,有必要关注其睡眠状况.     

5��7������غͷ��ֶ�ͯ����ɷ��ص㼰֬�� ���⺬������ܶ�������о�

??Objective To analyze characteristics of body composition and the relativity on percentage of body fat??PBF????fat mass??FM????lean mass??LM?? with the local and systemic bone mineral density??BMD?? of low weight and obese children aged from 5 to 7 years old. Methods A total of 311 children aged from 5 to 7 years old were divided into three groups according to gender and body mass index??BMI????the low weight group??the control group and the obesity group??who came to Department of Child Healthcare of Shengyang Children’s Hospital for roution physical examination from February 2010 to February 2012 were selected as the subjects of the study. The body composition were measured by dual energy X-ray absorptiometry??DEXA??. Data had been compared between groups and correlation had been analysised among PBF??FM??LM and BMD. Results In obesity group?? the LM??upper limbs??lower limbs and systemic BMD in boys were significantly higher than those in girls??P??0.05??. In control group??girls’s PBF??FM were significantly higher than boys’. LM?? upper limbs?? lower limbs and systemic BMD in girls were lower than those in boys??P??0.05??. In low weight group??when FM was controlled??there was positive correlation between LM and BMD??P??0.01??. When LM was controlled??there was positive correlation among PBF??LM and lower limbs BMD in obesity girls??P??0.05??. When FM was controlled??there was significantly positive correlation between LM and lower limbs BMD??P??0.01??. When FM was controlled??there was positive correlation between LM and lower limbs BMD in obesity boys??P??0.05????When LM was controlled??there was positive correlation among PBF??FM and truncal BMD??P??0.05??. Conclusion The proportion is different from controls in low weight and obese children?? and the contribution to BMD is different. It should not only pay attetion to the change of body weight??but also pay attetion to the changes of PBF??FM??LM in body composition??so as to promote the healthy development of the bone.     

Ӥ����������Ѫ��ҩ��ҩ����1��P-�ǵ��ױ���о�

目的检测婴儿痉挛(IS)外周血多药耐药基因1(MDR1)及其产物P-糖蛋白(Pgp)的表达,探讨IS与多药耐药基因的关系。方法 2007年1月至2010年6月徐州医学院附属医院、徐州市儿童医院门诊及病房收治的IS患儿23例,分为2组:治疗前组、治疗超过6个月组。同期选取其他癫痫发作类型组12例、正常对照组10名。采用逆转录聚合酶链反应(RT-PCR)半定量法检测患儿外周血中MDR1基因mRNA的表达,流式细胞术检测患儿外周血Pgp表达。结果小儿外周血MDR1 mRNA与Pgp蛋白表达呈高度正相关(r=0.86,P<0.05)。治疗前组、治疗超过6个月组、其他癫痫发作类型组外周血MDR1 mRNA和Pgp蛋白表达均较正常对照组增高,且治疗前组、治疗超过6个月组MDR1基因mRNA和Pgp蛋白表达水平明显高于其他癫痫发作类型组,差异均有统计学意义(P<0.05,P<0.01)。治疗前组、治疗超过6个月组间MDR1 mRNA和Pgp蛋白表达差异无统计学意义(P>0.05)。结论 IS患儿MDR1和Pgp表达增高可能是临床耐药的重要原因,且可能为内源性耐药。     

��Ч�߼��������ζ����ƶ�ͯע��ȱ�ݶද�ϰ��ϲ�Ʒ���ϰ��о�

??Abstract??Objective To study the methylphenidate hydrochloride controlled-release tablets??OROS-MPH??dose titration treatment for children with attention deficit hyperactivity disorder??ADHD??combining conduct disorder??CD??to achieve the best clinical efficacy. Methods According to the DSM-IV diagnostic criteria of attention deficit hyperactivity disorder??ADHD??combining conduct disorder??CD????120 cases of children were randomly divided into the original dose group and dose titration group.Two groups of children accepted the 24-week treatment of OROS-MPH??in which the original dose group were chosen to 18 mg/day?? dose titration group increased to 36 mg/day or 54 mg/day??respectively??in the fifth week and thirteenth week??and after the course of treatment??the following assessments were performed??SNAP-IV scale??Child Behavior Checklist??CBCL??and Treatment Emergent Symptom Scale??TESS??.Results ??1??The best response rate in the dose titration group was significantly higher than original dose group ??P??0.05??.??2??The SNAP-IV hyperactivity / impulsivity?? inattention and confrontation behavior items showed a significant difference between dose titration group and original dose group??P??0.05??.??3??In the CBCL behavior scales??dose titration group and the original dose group showed significant difference in the presence of adverse exchanges??forcedness??hyperactivity??aggression and discipline of the five dimensions??P??0.05??.??4??The incidence of side effects in both groups of children had no significant difference??P??0.05??.Conclusion With different doses of OROS-MPH for the treatment of children with ADHD and CD??effects differ more obviously-the higher dose??36 mg/day-54 mg/day??for the improvement of symptoms is better than lower dose??18 mg/day??.     

�½����������ͯ���� ������Ѫ�峬��C-��Ӧ���׼��ȵ��صֿ�ָ��������о�

??Abstract??Objective??To approach the correlation of overweight or obesity with hsCRP and HOMA-IR in the Hazakh children in Xinjiang. Methods??A total of 2475 Hazakh students at the age of 6??14 years old in the city of Yili?? Xinjiang were studied from May 2009 to July 2009 by the method of cluster sampling. Totally 122 children with overweight or obesity were included?? and 119 healthy children were enrolled as control at the same level and sex. BMI??hsCRP??FPG and FINS were determined respectively. By calculating HOMA-IR?? the difference between the two groups was in comparison?? and the relationship was studied. Results??Compared with the control group?? hsCRP?? FINS and HMOA-IR in the overweight or obesity group increased significantly?? FPG ??LDL??CHO and HDL had not statistical significance between the two groups. Pearson correlation analysis showed that there was a notable correlation between BMI??hsCRP??HMOA-IR and FINS??a negative correlation between BMI and FPG without statistical significance??and a positive correlation between CHO?? HDL and LDL statistical significance. Multiple linear regression analysis showed that FINS??HMOA-IR??hsCRP??FPG and LDL had correlation with BMI. Conclusion??Overweight or simple obesity children in the Hazakh children exist IR??at the same time??the inflammatory factor CRP plays an important role in the development of overweight or obesity.