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功能性构音障碍(functional articulation disorder,FAD)是最常见的语言障碍[1],患儿常因语音不清造成人际交往困难和一系列情绪及行为问题。目前国内有关FAD的研究较少,对FAD儿童感觉统合能力的研究尚未见报道。为探讨FAD儿童的感觉统合能力发展水平及其在FAD发生中的作用,我们对FAD患儿和正常儿童进行了感觉统合能力的对照研究,现将结果报告如下。1对象和方法1.1对象病例组:以2005-01—2006-06来我院发育儿科就诊的以吐字不清为主诉的6~12岁儿童为研究对象,符合FAD诊断标准者共38例,其中男35例,女3例。FAD的诊断依据日本听力言…     

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??Abstract??Objective??To investigate alterations of circulating levels of the inflammatory markers— reflecting brain and adipose tissue inflammation—in the fetal growth restriction??FGR??fetuses and newborns??and explore its possible relation ship with adverse intrauterine development. Methods??Sixty parturients??hospitalized in Shengjing hospital of China Medical University??giving consecutively birth either to 30 appropriate for gestational-age??AGA?? singleton infants ??AGA group ?? or 30 FGR full-term singleton infants ??FGR group????were recruited.Plasm hs-CRP??PAI-1??S100B and leptin levels were determined by enzyme link immune assay??ELISA??in the umbilical cords blood ??UC ?? and venous blood from neonates on postnatal day 1 ??D1?? and day 4??D4??. Results??The birth weight??body length and the body mass index ??BMI?? of the FGR neonates were significantly lower compared with those of AGA group ??P < 0.05??.The leptin levels of UC in the FGR neonates were lower than that in the AGA groups??P < 0.05????and correlated positively with the birth weights and the BMI??P < 0.05??.Plasma hs-CRP levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05??.hs-CRP levels in Umbilical cords blood were significantly decreased when compared with D1 hs-CRP in both AGA and FGR groups ??P < 0.05????and D1 hs-CRP was significantly increasedwhen compared with respective D4 hs-CRP??P < 0.05??.Plasma PAI-1 and S100B levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05????and did not correlated with the birth weights and the BMI. Conclusion??Despite the lower birth weight??BMI and leptin levels in FGRs?? there was no difference for the levels of inflammatory markers hs-CRP and PAI-1 between IUGR and AGA fetuses/neonates.The CRP level in both studied groups fluctuated from fetus to neonate stage might attribute to parturition stress and adaptation recovery.     

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目的探讨弥散加权成像(DWI)、常规磁共振成像(MRI)在新生儿低血糖性脑损伤不同阶段的动态变化。方法回顾分析了2005年9月至2008年9月,中国医科大学附属盛京医院新生儿科收治的经MRI确诊的20例低血糖性脑损伤患儿(病例组)的临床资料,并随机选取同期住院MRI正常的20例单纯性低血糖患儿为对照组。结果病例组平均最低血糖值低于对照组(P<0.01),低血糖持续时间长于对照组(P<0.01)。病例组于低血糖发生后3.8(1～11)d完成首次MRI检查,受累部位主要为枕叶11例、枕顶叶8例,顶叶1例,受累部位在DWI均表现为高信号,常规MRI相应部位12例表现为T1加权成像(T1WI)、T2加权成像(T2WI)正常信号,仅6例表现为T1WI低信号、T2WI高信号;11例于首次检查后11.4(8～15)d完成第2次MRI检查,首次检查受累部位DWI7例转为正常信号,4例低信号,常规MRI均表现为T1WI低信号、T2WI高信号。3例于6个月随访,提示枕叶DWI正常信号,T1WI低信号、T2WI高信号。结论新生儿低血糖性脑损伤早期DWI表现为异常高信号的部位,与晚期常规MRI表现为T1WI低信号、T2WI高信号的部...     

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目的探讨氨溴特罗口服液改善毛细支气管炎患儿气道功能的疗效影响。方法将2009年11月至2010年9月广州市妇女儿童医疗中心93例毛细支气管炎患儿随机分为治疗组(氨溴特罗口服液组)和对照组。观察两组患儿治疗前后潮气呼吸流速-容量环(TBFV)的形态改变以及肺功能各项指标的变化。结果两组患儿治疗前TBFV环均变窄,呼气曲线升枝陡峭,高峰提前,降枝呈波谷样凹陷;治疗后明显好转。两组患儿治疗前各项主要参数比较,差异无统计学意义(P>0.05)。两组患儿治疗前后比较:呼吸频率(RR)、呼气峰流速(PEF)、呼吸系统阻力(Rrs)、每千克体重功能残气量(FRC/kg)均降低(P<0.05或P<0.01);每千克体重潮气量(VT/kg)、吸呼比(TI/TE)、呼气达峰时间(TPTEF)、达峰时间比(TPTEF/TE)、呼气达峰容积(VPTEF)、达峰容积比(PFV)、呼出75%潮气量时的呼气流速/呼气峰流速(25/PF)、潮气呼气中期流速/潮气吸气中期流速(ME/MI)、每千克体重顺应性(Crs/kg)均增加(P<0.05或P<0.01)。其中治疗组与对照组比较,反映大小气道阻塞主要指标PFV、25/PF、ME/MI及肺顺...     

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??Abstract?? Objective To study the application of ambulatory electrocardiography to screen obstructive sleep apnea/hypopnea syndrome ??OSAHS?? in children was evaluated by time-domain and frequency-domain analysis of heart rate variability ??HRV??. Methods Totally 100 individuals underwent polysomnography and 24-h ambulatory electrocardiography simultaneously. Identify appropriate boundary of HRV parameters to diagnose OSAHS by using ROC curve. Evaluate the feasibility of screening for OSAHS by time-domain and frequency-domain analysis of HRV. Results SDNNall day?? SDANNall day?? PNN50night?? PNN50day-night and LF/HFnight were significantly different in OSAHS group as compared with non-OSAHS group. Thresholds were set at SDNNall day≤95.5 ms?? SDANNall day≤80.5 ms?? PNN50night≤24.6?? LF/HFnight≥0.845 and absolute PNN50day-night≤24.55 by using the ROC curve. The area under ROC curve ??AUC?? could reach 0.695 by uniting 5 parameters. Conclusion Time-domain and frequency-domain analysis of HRV is a useful method for OSAHS screening.     

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??Objective??To study the mixed infections in hospitalized children with community-acquired pneumonia ??CAP??. Methods??We retrospectively reviewed the medical records of CAP patients admitted to Children’s Hospital of Soochow University from January 2015 to December 2015. Samples were tested for multiple pathogens.Results??One or more pathogens was detected in 647??76.5%?? of 846 cases??34.63?? cases were considered mixed infection. The rates of mixed infection in ??6-month????1-year????3-year????5-year?? ≥5-year group were 24.2%??43.5%??43.8%??36.8% and 27.3% respectively. The most frequent combinations of pathogens were those of virus plus bacteria in ??6-month and ??1-year group??virus plus MP in ??3-year and ≥ 5-year group?? and MP plus bacteria in??5-year group??Rhinovirus-H.influenzae was the most commonly found combination of virus and bacteria. The most frequent etiological agent in virus coinfected with MP was rhinovirus. S.pneumoniae was the most important pathogen for bacteria coinfected with MP. No significant difference in clinical characteristics??complications??PICU admission or hospital stay was observed between the patients with mixed infections and those with monomicrobial CAP. Conclusion??Mixed infections account for certain proportion in the cause of CAP. The positivive rate in patients in??1-year and ??3-year groups is significantly higher than that in other age groups. Patients of different ages present with different combinations of pathogens. Mixed infections have no relationship with CAP patients’ mortality.     

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??Objective To investigate the predictive value of lipopolysaccharide binding protein ??LBP?? in early diagnosis of preterm infection with premature rupture of membrane??PROM??. Methods Totally 93 preterm infants with PROM were enrolled in this study?? and were divided into infection group ??45 cases?? and non-infection group ??48 cases?? according to the discharge diagnosis. Their serum LBP levels were detected within 24 hours after birth. High-sensitivity C-reactive protein ??hs-CRP???? procalcitonin ??PCT?? and interleukin-6 ??IL-6?? levels were compared with LBP. Receiver operator characteristic curve ??ROC?? was drawn and the area under the curve ??AUC?? was calculated. Each parameter was evaluated for the diagnosis of early-onset infection in preterm infants with PROM. In addition?? according to the severity of the disease infection group was further divided into severe infection group??21 cases?? and general infection group??24 cases??. LBP levels were detected in two groups of premature infants to assess the value of LBP in the diagnosis of premature infants with premature rupture of membranes. Results The serum levels of IL-6?? PCT and LBP in the infection group were significantly higher than those in the non-infection group. There was no significant difference on serum levels of hs-CRP between the two groups. The level of LBP in the severe infection group was higher than that in the general infection group?? and the difference between the two groups was statistically significant. The AUC of ROC for LBP ??0.974?? in early-onset bacterial infection of preterm infants with PROM was the highest?? PCT ??0.694?? second?? IL- 6 ??0.588?? third?? and hs-CRP ??0.478?? was the lowest. Conclusion Serum level of LBP is superior to hs-CRP and PCT in the diagnosis of early-onset bacterial infection in preterm infants with PROM. LBP can be used as a useful index for the early diagnosis of bacterial infection in preterm infants with PROM. LBP levels can evaluate the severity of premature premature infection in preterm premature rupture of membranes.     

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目的了解儿童乙型肝炎病毒(HBV)基因型与临床分度的关系。方法选择甘肃省人民医院儿科和兰州大学第一医院感染科2008年4月至2010年4月门诊和住院患儿中HBV-DNA阳性的124例乙型肝炎患儿,其中男84例,女40例。HBV携带者65例,慢性乙型肝炎59例(轻度31例、中度18例、重度10例),对以上患儿进行基因分型、同时检测肝功、术前出凝血、HBV-DNA载量。结果 124例肝病患儿中,C基因型62例(50.0%),B基因型48例(38.7%),B/C混合型9例(7.3%),非B/C型5例(4.0%);HBV携带者和轻度组中,以B基因型为主,分别为47.7%和45.2%;中度和重度组中,以C基因型为主,分别为72.2%和80%;在C、B基因型分布方面,HBV携带者和轻度组与中度和重度组比较差异有统计学意义;C基因型患者的HBV-DNA载量、丙氨酸转氨酶(ALT)、天冬氨酸转移酶(AST)、总胆红素(TBIL)均高于B基因型;C基因型患者与B基因型比较,凝血酶原时间(PT)延长、凝血酶原活动度(PTA)下降、纤维蛋白原(FIB)减少。B、C型通过母婴传播的比例差异无统计学意义。结论甘肃省儿童乙型肝炎病毒基因...     

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??A case-control study on family environment factors in attention-deficit hyperactivity disorder with learning disabilities.????ZHANG Yue-bing*??LUO Xue-rong??LIU Xia??DING Jun??GUAN Bing-qing??YUAN Xiu-hong??YE Hai-sen??YANG Wei??NING Zhi-jun??WEI Zhen. *Mental Health Institute??Second Xiangya Hospital??Central South University??Changsha 410011??China
Abstract??Objective??To further explore the characteristics of family rearing pattern in ADHD with learning disabilities??LD??. Methods??From Sep. to Dec. 2005??a total of 9495 children and their parents were sampled at random in Hunan province using two-stage investigation. Those who were diagnosed with ADHD with LD and the normal control filled out Egna Minnen av Barndoms Uppfostran ??EMBU?? and family adaptability and cohesion scale ??FACESII—CV?? by themselves. Results??The parents’ punishments??rejection??excessive intervention??excessive protection and preference of ADHD with LD were lower than the normal children??P < 0.05??. The actual family cohesion??ideal family cohesion?? actual family adaptation??ideal family adaptation and affectionate warmth of ADHD with LD were lower than the normal children??P < 0.05 or P < 0.01??. Conclusion??There are some problems in the parental rearing pattern of ADHD with learning disabilities. It is important to avoid bad rearing pattern and find effective interventions.     

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目的 了解儿童急性下呼吸道感染(ALRTI)病毒病原学特点.方法 2007年3月至2008年2月,在北京儿童医院内科就诊及住院治疗的临床诊断为ALRTI的患儿共572例.对每例患儿在就诊当日或次日采集鼻咽吸取物1份,采用逆转录(RT)-PCR方法进行常见呼吸道病毒核酸检测,包括呼吸道合胞病毒(RSV)、鼻病毒(RV)、副流感病毒(PIV)1～4型、甲型及乙型流感病毒(IFA、IFB)、腺病毒(AdV)、肠道病毒(EV)、冠状病毒(HCoV)、偏肺病毒(hMPV)及博卡病毒(HBoV).结果 572例患儿标本中,444例检出至少1种病毒,总检出率77.6%.各种病毒中,RSV检出率最高,占48.3%,其次是RV(27.1%)和PIV(13.3%).不同年龄组病毒的总检出率差异有统计学意义,<3岁组检出率较高,≥5岁组病毒检出率明显降低.不同年龄组JLRTI病原谱有所不同,<5岁各组主要是RSV、RV、PIV,而≥5岁组则主要为RV、IFV、RSV.572例中,158例(27.6%)检出2种或2种以上病毒,<1岁惠儿混合感染率最高,为40.2%,随年龄增长混合感染率逐渐下降,≥5岁患儿混合感染率仅为14.0%.结论 就诊于北京儿童医院的ALRTI患儿中,5岁以下者ALRTI的主要病毒病原是RSV、RV、PIV;≥5岁则主要为RV、IFV、RSV.     

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本文对30例单纯性肥胖儿童进行了血糖、血胰岛素、血脂及尿微量白蛋白和肾小球滤过率(GFR)的测定,旨在探讨单纯性肥胖儿童早期肾脏功能的改变及其发生机制,报道如下。单纯性肥胖组:从2003年济南市区部分小学生查体中,筛选出30例肥胖儿童,男18例,女12例,年龄7～12(9.92±1.62)岁,身高(150.51±12.07)cm,体重指数(BMI)范围为20.35～35.38(29.92±4.13)。肥胖诊断标准为:按身高别体重超过同身高标准体重的20%以上,20%～30%为轻度,～50%为中度,>50%为重度。经查体排除其他疾病或药物所致的继发性肥胖[1]。本组轻度2例,中度13例,重度15例。正…     

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目的探讨荧光定量聚合酶链反应(FQ PCR)检测儿童病毒性脑炎脑脊液(CSF)中的病原体的价值。方法应用定性聚合酶链反应(PCR)对2002年1月至2004年10月保定市儿童医院收治的病毒性脑炎患儿78例的CSF标本筛选,检测最常见的引起病毒性脑炎的6种病毒,对单纯疱疹病毒(HSV),柯萨奇病毒(CV),埃可病毒(EV)阳性者做FQ PCR检测,其中HSV分别在3个时点(治疗前、治疗中、出院时)检测DNA拷贝数。结果定性聚合酶链反应阳性标本FQ PC检测100%阳性,HSV DNA拷贝数在3个时点有统计学差异,病毒核酸拷贝数与临床表现一致。结论FQ PCR可作为儿童病毒性脑炎早期诊断的有效方法之一,动态观察HSV DNA含量有助于指导治疗,估计疾病的发展和预后     

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目的探讨三维超声心动图(3DE)在圆锥动脉干畸形(CTD)室间隔缺损(VSD)定量研究中的准确性及其临床意义。方法2000年5月至2003年11月在上海儿童医学中心住院且二维超声心动图(2DE)、经胸3DE、心血管造影及手术等定量测量结果完整的CTD患儿共63例,将3DE测量结果与2DE、造影及手术测值对比。结果方差分析、SNK均数间两两比较及相关分析显示,3DEVSD长径测值为1.69cm(从右室面)和1.63cm(从左室面),虽较手术测值(1.84cm)低估,但低估程度小于2DE测值(1.27cm)及造影测值(1.12cm);3DE与手术测值的相关性(r=0.74)明显高于2DE(r=0.39)及造影测值(r=0.25)。3DEVSD短径测值与造影测值相接近,两者比较无统计学差异(P>0.05)。3DEVSD短径测值与2DE及造影测值的相关性(r=0.45,r=0.54)高于3DEVSD长径测值与2DE及造影测值的相关性(r=0.37,r=0.44)。3DEVSD面积测值与手术测值呈良好相关(r=0.57)。结论3DE可作为CTDVSD定量分析的又一无创手段,能提供较2DE更准确的定量诊断。     

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??Objective??To understand the characteristics of eye tracking in children with autism spectrum disorder??ASD???? to provide objective indicators for early diagnosis of ASD??and to establish a diagnostic predictive model which is suitable for clinical diagnosis. Methods??The subjects of the study were 38 children with ASD??22.03±4.97 months old?? and 35 children ??21.38±4.36 months old?? with developmental normal children??TD group??. Visual stimulation is a dynamic video of geometries and social figures??for 2 minutes with Eyelink1000 plus eye tack instrument. The ASD group and the TD group indexes were analyzed by ndependent-samples T-test and Chi-square Test??showed that the factors affecting the difference was statistically significant the regression analysis of the two Logistic classification??based on the children with ASD eye tacking prediction model and dynamic scene video scoring system. The receiver operating haracteristic curve??ROC curve?? and the area under the curve??AUC?? model is used to predict the accuracy of self display of children with ASD. Results??73 children were analyzed with single factor and Logistic regression analysis??we selected 4 significant predictive indexes of children with ASD????DGI??fixation time??and??DGI?? numbers of fixations??the percentage of fixation time on DGI times??and the numbers of fixations on DSI. Regression equation In??P/1-P????β0+β1X1+β3X3+β5X5+β6X6??13.03+1.01X1+0.25X3-98.72X5-0.55X6?? which β0??13.03 is a constant term??βi is regression coefficient. The self built model predicts AUC for children with ASD was 0.713. Conclusion??Self built model is of great value in predicting children with ASD.     

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??Objective To investigate the effect of mild obstructive sleep apnea syndrome??OSAS?? on the neurocognitive function of the children and evaluate the potential value of sleep pressure score??SPS?? in the diagnosis of the neurocognitive deficits in these children. Methods Consecutive OSAS children??aged 5??7 years?? were recruited from Shanghai Children’s Medical Center as the case group?? and non-snoring healthy children as the control group. Both of the 2 groups underwent the overnight polysomnography??PSG?? and a comprehensive neuropsychological battery including attention and memory test. The case group was divided into 2 subgroups according to the apnea hypopnea index??AHI????mild OSAS??AHI 1??5 times per hour?? and moderate to severe OSAS ??AHI≥5 times per hour??. The sleep architectures and sleep arousal parameters were analyzed and the neurocognitive tests were performed in the three groups. Analyze the SPS as a diagnosis tool of neurocognitive impairment in mild OSAS in children by ROC curve. Results There were 30 cases recruited into the control group. Mild OSAS group included 33 cases and moderate to severe group 28 cases. In the 3 groups?? there was no difference with regard to the age?? gender?? BMI z score or parents’ education level ??P??0.05??. There was significant difference in AHI?? obstructive apnea index ??OAI???? nadir SpO2 and respiratory arousal index ??RAI???? spontaneous arousal index ??SAI???? sleep pressure score ??SPS?? in the 3 groups. The AHI?? OAI?? nadir SpO2?? RAI and SPS of mild and moderate to severe OSAS group were significantly higher than those in control group. There was no significant difference in retention and the percentage of recall of the immediate memory ??P??0.05??. There was significant difference in cognition-attention index in the 3 groups even in the mild OSAS group?? and the moderate to severe OSAS group was the worst. In the ROC analysis?? the area under the curve was 0.88 ??95% confidence interval ??CI?? = 0.82 to 0.94?? for SPS. The cutoff point of 0.11 for SPS was optimal for diagnosing cognitive-attention deficit in mild OSAS group ??sensitivity 71.4%?? specificity 74%??. Conclusion Mild OSAS may be associated with the deficit of attention and SPS could be an effective index to evaluate it in mild OSAS children.     

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目的了解肥胖儿童中阻塞性睡眠呼吸暂停/低通气综合征(OSAHS)和睡眠低通气的发病情况,并探讨肥胖与儿童OSAHS的相关性。方法对2006年4月至2007年12月在北京儿童医院就诊,年龄大于7岁的肥胖儿童行问卷调查、体格检查、血常规及动脉血气分析,拍摄鼻咽侧位X线平片并进行整夜多导睡眠监测(PSG)。以体重正常的儿童作为对照组。结果 203例肥胖患儿及171例体重正常的对照儿童纳入研究。肥胖但腺样体、扁桃体不大的患儿中,OSAHS占50.8%(31/61),肥胖同时伴有腺样体、扁桃体大(ATH)的患儿中,OSAHS占81.5%(116/142)。肥胖和对照组间睡眠效率、呼吸暂停/低通气指数(AHI)、最低血氧饱和度差异有统计学意义(P值分别为0.018、<0.01、<0.01)。肥胖、扁桃体大、腺样体大是OSAHS发病的危险因素(肥胖:OR=20.4,P<0.01;扁桃体大:OR=2.1,P=0.03;腺样体大:OR=4.7,P<0.01)。肥胖的程度和AHI呈正相关(r=0.383,P<0.01),而与最低血氧饱和度呈负相关(r=-0.312,P<0.01)。结论肥胖是导致儿童OSAHS发病的危险因素,肥胖...     

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目的通过对哮喘儿童呼出气一氧化氮(FENO)水平的监测,为哮喘的临床诊断治疗及病情评估提供帮助。方法选择2007年10月至2009年8月于首都儿科研究所附属儿童医院门诊确诊的哮喘患儿共358例,根据其哮喘发作与治疗情况分为哮喘发作组与非发作组、治疗组与未治疗组。设计临床观察表记录各组患儿治疗、发作、肺部喘鸣音情况,并进行FENO及1秒用力呼气容积(FEV1)、用力肺活量(FVC)及最大用力呼气中段流量(MMEF)等肺功能指标的测定。结果 358例哮喘患儿的FENO值为28.5(15.5～55.0)×10-9,其中男性为29.0(15.0～49.8.0)×10-9,女性为28.0(16.0～58.6)×10-9,男女相比差别无统计学意义(Z=-1.006,P>0.05)。111例11岁以上哮喘儿童FENO为36.0(20.0～65.0)×10-9,其中男性为30.0(26.0～63.0)×10-9,女性为40.5(17.7～73.8)×10-9,与395例正常儿童相比FENO明显增高,差异具有统计学意义(Z=-11.352,P<0.001)。358例哮喘患儿FENO与年龄呈正相关(r=0.206,P<0.01)...