Pilot study describing the use of pravastatin in pediatric renal transplant recipients

Renal transplant (Tx) recipients frequently develop hypercholesterolemia. Pravastatin (P) has been shown to be effective in adult renal Tx recipients, not only in reducing serum cholesterol, but possibly also in decreasing graft rejection. However, there are no data on the use of P in children following renal transplantation. We conducted a retrospective case-control study evaluating the safety and efficacy of P (10-20 mg/day) in reducing hypercholesterolemia, when used pre-emptively in the post-Tx period in seven children, compared with an historical control (C) group of nine children who had not received P. The two groups were comparable with respect to their demographics and in their pretransplant serum cholesterol. Compared with the C group, the mean serum cholesterol in the P group was lower at 3 months (159 mg/dL vs. 225 mg/dL), 6 months (134 mg/dL vs. 200 mg/dL), 9 months (134 mg/dL vs. 209 mg/dL), and 12 months (125 mg/dL vs. 195 mg/dL) (p < 0.005 for all, Student's two-tailed t-test). At 1 month only 43% of the P group had hypercholesterolemia compared with 67% of the controls; by 12 months this difference was even more significant (0% in the P group vs. 45% in the C group). None of the treated patients developed any adverse reactions. This study demonstrates that the pre-emptive use of P in pediatric renal Tx recipients appears to be effective in significantly reducing serum cholesterol. Whether this effect will translate into improved allograft and patient survival in the long term cannot be predicted at present and will require additional studies to evaluate.     

Serum homocysteine and lipoprotein (a) concentrations in hypercholesterolemic and normocholesterolemic children

The relationship between lipids, lipoproteins, total homocysteine, and lipoprotein (a) was studied in hypercholesterolemic and normocholesterolemic children. In hypercholesterolemic children, concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein B, and triglycerides were significantly higher compared to levels in controls, whereas concentrations of high-density lipoprotein (HDL) cholesterol and apolipoprotein A-I were lower compared to those in the control group. Total serum homocysteine concentrations in children with a positive family history for cardiovascular disease CHD(+) (7.28 micromol/L) were significantly higher than those in the control group (5.45 micromol/L), and in the group of CHD(-) children (5.25 micromol/L). The median value of lipoprotein (a) in patients was 31.5 mg/dL (range, 11-209 mg/dL) and in the control group, 19 mg/dL (range, 11-95 mg/dL). Concentrations of Lp (a), exceeding 30 mg/dL, were present in 45% of CHD(+) children, in 29% of CHD(-) children, and in only 11% of the control group.     

父母高血脂对其子女青少年期血脂、血压、体质量指数的影响

目的观察父母高血脂对其子女血脂、血压、体质量指数（BMI）和腰围（WC）影响。方法父母高血脂的青少年期子女80例（A组），父母正常血脂的青少年期子女893例（B组），两组青少年均测血浆三酰甘油（TG）、胆固醇（TCH）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-c）；测量收缩压（SP）、舒张压（DP）,WC、身高、体质量，计算BMI，进行两组均数的t检验，行各指标之间相关性分析。结果A组TG、TCH、LDL-c、SP、DP及BMI均有增高趋势；HDL．c有降低趋势，其中BMI增高有统计学意义（P〈0．05）。BMI与SP、DP及WC与SP、DP间均存在正相关（r=0．639，0．529，0．619，0．504P均〈0．01）；BMI与WC间存在正相关（r=0．890P〈0．01）；BMI与HDL—c存在负相关（r=-0．359P〈o．01）。结论父母高血脂可影响青少年期子女的血脂、血压、BMI和WC。     

血清血管内皮生长因子/内皮抑素比值与儿童急性白血病的相关性

目的：检测急性白血病（AL）患儿血清血管内皮生长因子（VEGF）、内皮抑素（ES）水平,探讨VEGF /ES (V/E) 比值与儿童AL的临床相关性。方法：采用酶联免疫双抗体夹心法检测35例AL患儿化疗前后血清VEGF、ES水平及V/E比值,并与30例健康儿童进行比较。结果：化疗前AL患儿血清中VEGF和ES水平分别为196±66 pg/mL和 31±7 ng/mL,显著高于对照组（29±10 pg/mL、19±4 ng/mL; P0.05）。35例AL患儿化疗前血清VEGF、V/E 比值与骨髓白血病细胞数呈正相关 (r=0.301和0.411,P<0.05)。结论：血清VEGF和ES与儿童AL的发生发展有关,V/E比值能更准确反映AL患儿疾病动态变化情况,有利于指导相关治疗。     

The levels of asymmetric dimethylarginine, homocysteine and carotid intima-media thickness in hypercholesterolemic children

The aim of this study was to examine the intima-media thickness (IMT) of carotid arteries and endothelial function parameters such as plasma asymmetric dimethylarginine (ADMA) and homocysteine levels in hypercholesterolemic children and to investigate the relations of these parameters with hypercholesterolemia. Fifty-seven hypercholesterolemic and 37 healthy children were included in the study. Hypercholesterolemia was defined as 155 mg/dl and above for low-density lipoprotein (LDL)-cholesterol. Plasma concentrations of ADMA and homocysteine were measured and the measurement of carotid IMT was determined. Both carotid IMT and plasma ADMA levels were significantly higher in hypercholesterolemic children than healthy children (p<0.01). No significant difference was determined in homocysteine concentration between hypercholesterolemic children and the control group (p>0.05). No significant correlation was observed between lipid profiles and the levels of ADMA and homocysteine. However, a significant positive correlation was found between carotid IMT and total and LDL-cholesterol levels and between the levels of ADMA and LDL-cholesterol. In conclusion, the progressive increase in ADMA levels and carotid IMT and the positive relationship between carotid IMT and serum cholesterol levels support that plasma ADMA levels and carotid IMT can be indicators of early atherosclerosis in hypercholesterolemic children.     

超敏C-反应蛋白和胰岛素敏感指数在儿童阻塞性睡眠呼吸暂停综合征中的变化

目的：探讨阻塞性睡眠呼吸暂停综合征（OSAHS）患儿超敏C-反应蛋白（hsCRP）和胰岛素敏感指数（ISI）的变化。方法：51例患儿分为 OSAHS组（29例）和原发性鼾症（PS）组（22例）。均实施多导睡眠监测仪（PSG）检测,分别测体重指数（BMI）、hsCRP、血脂、空腹血糖(FPG)、空腹胰岛素(INS),计算ISI。结果：与 PS 组比较,OSAHS组的呼吸暂停通气指数（AHI）增高（13.2±9.2 vs 1.2±1.1, P<0.05）;OSAHS组的最低血氧饱和度（LSaO2）低于PS患儿［(78.5±5.4)% vs (87.4±3.7)%, P<0.05］;OSAHS组的hsCRP高于PS组（2.8±2.7 mg/L vs 0.6±0.9 mg/L,P<0.05）;OSAHS组的ISI、血脂与 PS 组的差异无统计学意义。OSAHS 组的hsCRP与LSaO2呈负相关（r=-0.531, P<0.05）。结论：OSAHS患儿hsCRP水平增高,可能与日后心血管疾病的发生相关,应早期给予干预。     

加速康复外科在儿童肝囊型棘球蚴病围手术期的应用

目的:探讨儿童肝囊型棘球蚴病围手术期采用加速康复外科管理模式的安全性及有效性。方法:本研究为回顾性研究,连续纳入2017年2月至2019年1月期间在新疆医科大学第一附属医院小儿外科收治的肝囊型棘球蚴病患儿44例。根据围手术期是否采用加速康复外科管理模式,将患儿分为ERAS组与对照组。其中,围手术期采用加速康复外科管理模...     

Plasma homocysteine levels in children and adolescents with type 1 diabetes

OBJECTIVE: Hyperhomocysteinemia has been established as a risk factor for cardiovascular disease. The objective was to investigate total plasma homocysteine concentrations in children and adolescents with type 1 diabetes and a control group. METHOD: Twenty-seven children with type 1 diabetes and 27 subjects of an age- and sex-matched control group were recruited. Fasting samples were collected for plasma total homocysteine, serum vitamin B12, folate, and creatinine. RESULTS: Fasting total homocysteine concentrations showed no difference between patients and controls (5.6 +/- 2.9 micromol/L vs 5.7 +/- 2.2 micromol/L; p greater than 0.05). The diabetic patients had significantly higher serum folate than the healthy controls (11.4 +/- 3.3 ng/mL vs 9.4 +/- 4.1 ng/mL; P = 0.02 and higher serum B12 than the control group (282.8 +/- 119 pg/mL vs 228.5 +/- 50.9 pg/mL; P = 0.03). Total plasma homocysteine concentration correlated with age (r = 0.44, P = 0.02), weight (r = 0.56, P = 0.002), body mass index (r = 0.57, P = 0.002), folate (r = -0.48, P = 0.01), and creatinine (r = 0.41, P = 0.03) in diabetic patients. In stepwise multivariate regression model for diabetics, the independent correlates for total plasma homocysteine concentration was folate (P = 0.002). CONCLUSION: We concluded that fasting plasma total homocysteine concentrations were within normal limits in children and adolescents with type 1 diabetes who were without any clinical evidence of microvascular and macrovascular complications.     

不同严重程度手足口病患儿肠道屏障功能的研究

目的 观察不同严重程度手足口病(HFMD)患儿血浆二胺氧化酶(DAO)、D-乳酸和内毒素的变化,探索HFMD患儿肠道黏膜屏障功能的改变以及上述指标对重型HFMD肠黏膜屏障受损的敏感性及预警作用.方法 选取西安市儿童医院2016年3月至2017年6月470例 HFMD住院患儿为研究组,同期儿保科体检的100例健康儿童为对照组.根据病情轻重将研究组分为普通组(n=300),重症组(n=110)及危重症组(n=60例).比较上述各组患儿的血浆DAO、D-乳酸和内毒素水平.结果 研究组患儿血浆D-乳酸水平[(27.670 ± 6.273)mg/L]较对照组[(25.585 ± 5.177)mg/L]明显升高,差异有统计学意义(t=3.515,P<0.05);DAO[(3.205 ± 0.956)U/L比(3.135 ± 0.884)U/L,P>0.05]、内毒素[(1.186 ± 0.486)U/L比(1.091 ± 0.494)U/L,P>0.05],与对照组比较差异无统计学意义.不同严重程度HFMD患儿的血浆D-乳酸水平比较,差异有统计学意义(F=33.488,P<0.05), DAO、内毒素水平比较差异无统计学意义(F=0.709、2.296,P>0.05).组间两两比较,危重症组血浆D-乳酸水平[(32.502 ± 4.756)mg/L]明显高于重症组[(29.872 ± 6.468)mg/L]、普通组[(25.896 ± 5.691)mg/L]及对照组,差异有统计学意义(P<0.05);重症组血浆D-乳酸水平明显高于普通组和对照组,差异均有统计学意义(P<0.05),普通组与对照组比较差异无统计学意义(P>0.05).结论 重症、危重症HFMD患儿存在肠道通透性增加、肠黏膜屏障功能受损;血浆D-乳酸在肠黏膜屏障损伤早期明显升高,相对于DAO和内毒素,血浆D-乳酸是重症、危重症HFMD肠黏膜屏障功能受损的敏感指标,可起到早期预警作用.     

γ-氨基丁酸治疗对哮喘患儿血浆P物质和降钙素基因相关肽含量的影响

目的：探讨γ-氨基丁酸（GABA）治疗前后哮喘患儿血浆P物质（SP）和降钙素基因相关肽(CGRP)含量的变化。方法：75例哮喘患儿随机分为GABA治疗组（36例）和对照组（39例）,两组患儿均给予哮喘常规治疗。治疗组在常规治疗的基础上给予GABA口服 (每日25~30 mg/kg）。采用酶联免疫吸附法（ELISA）测定患儿治疗前、缓解后血浆SP、CGRP的含量。结果：两组患儿治疗前血浆SP、CGRP含量差异无统计学意义（P＞0.05）;哮喘缓解后治疗组血浆SP、CGRP含量分别为57±15 pg/mL、23±10 pg/mL,显著低于对照组（分别为127±12 pg/mL、 42±8 pg/mL）,差异有统计学意义（P<0.01）。两组哮喘缓解后血浆SP、CGRP含量均较治疗前明显下降,差异有统计学意义（P<0.01）。哮喘患儿血浆SP与CGRP含量呈显著正相关（r=0.792,P<0.01）。结论：GABA可抑制小儿哮喘急性发作期血浆SP、CGRP的释放。     

���������γɶ�ͯԭ����IgA���� �ٴ��벡���ص����

目的了解伴新月体形成的原发性IgA肾病(IgAN)患儿临床与病理特点。方法选择2000年1月至2011年1月在温州医学院附属育英儿童医院经肾活检确诊为原发性IgAN且病历资料完整的患儿78例,根据是否伴新月体形成分为伴新月体形成的IgAN组(C组)和不伴新月体形成的IgAN组(NC组),并比较两组结果。结果 78例原发性IgAN患儿中男性57例,女性21例;年龄平均(9.32±3.16)岁。C组33例(42.3%),NC组45例(57.7%)。与NC组相比,C组肾活检前病程更短[(2.15±4.06)个月对(9.87±19.09)个月,P<0.05],肉眼血尿发生率更高(30/33对25/45,P<0.01),24h尿蛋白定量更多[(93.08±82.75)mg/(kg·d)对(44.92±68.44)mg/(kg·d),P<0.05],且表现为大量蛋白尿者更多(19/31对10/42P<0.01),肾功能损害者较多(8/33对2/45,P<0.01)。在肾脏病理改变上,C组中-重度系膜增生、球囊粘连、毛细血管内皮增生均显著多于NC组(P均<0.01)。结论儿童伴新月体形成的原发性IgAN临床表现、病理改变较重,临床上应提高对此类型IgAN的认识,争取早期肾活检,早期诊断,积极治疗,在急性期控制疾病进展以改善预后。     

Efficacy and safety of atorvastatin in children and adolescents with familial hypercholesterolemia or severe hyperlipidemia: a multicenter,randomized, placebo-controlled trial

OBJECTIVE: To determine the safety and efficacy of atorvastatin (10 to 20 mg) in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. STUDY DESIGN: Subjects (n=187) were randomly assigned to 26 weeks of treatment with atorvastatin (10 mg) or placebo. Dosage was increased to 20 mg if LDL cholesterol (LDL-C) levels remained >3.4 mmol/L (130 mg/dL) at week 4. At week 26, subjects received 10 mg of atorvastatin for an additional 26 weeks. Efficacy variables included percent changes in LDL-C, total cholesterol, triglycerides, HDL cholesterol, and apolipoprotein B from baseline to week 26. RESULTS: Atorvastatin caused a highly significant reduction in LDL-C compared with placebo (-40% vs -0.4%, respectively; P<.001). Percent changes at week 26 also significantly favored atorvastatin for total cholesterol (-32% vs -1.5%; P<.001), triglycerides (-12% vs +1.0%; P=0.03), and apolipoprotein B (-34% vs +0.7%; P<.001), with a significantly greater increase in HDL cholesterol with atorvastatin compared with placebo (+2.8% vs -1.8%; P=.02). Atorvastatin was as well-tolerated as placebo. CONCLUSIONS: Treatment with atorvastatin for 12 months was effective and safe for pediatric subjects with known familial hypercholesterolemia or severe hypercholesterolemia.     

Toll样受体4在原发性肾病综合征患儿肾组织及外周血中表达的意义

目的探讨Toll样受体4(TLR4)在原发性肾病综合征(INS)患儿肾组织及外周血中的表达及意义。方法采集2015年10月至2018年6月在新乡医学院第一附属医院确诊为INS的78例患儿肾活检组织及21例儿童正常肾组织(对照组1),应用免疫组织化学方法检测标本中TLR4表达水平,比较INS不同肾脏病理类型、不同临床分型中TLR4表达水平的差异,分析其与24 h尿蛋白、血清清蛋白的相关性;应用酶联免疫吸附试验(ELISA)检测INS患儿治疗前(活动期)及治疗后(缓解期)和23例健康儿童(对照组2)外周血中TLR4表达水平,比较INS不同肾脏病理类型、不同临床分型患儿血清中TLR4表达水平的差异,分析其与24 h尿蛋白、血清清蛋白的相关性;对INS患儿肾小管中TLR4的表达水平与血清TLR4的表达水平进行相关性分析。结果1.与正常肾组织TLR4水平[(0.93±0.26)%]比较,TLR4在各型INS患儿肾小球及肾间质的表达[系膜增生性肾小球肾炎(MsPNG)型:(0.93±0.21)%、局灶节段性肾小球硬化(FSGS)型:(1.02±0.25)%、膜性肾病(MN)型(1.03±0.09)%、微小病变(MCD)型(1.02±0.27)%]差异无统计学意义(F=0.741,P=0.562);而肾小管TLR4的表达水平明显增高[MCD型:(82.94±4.62)%、MN型:(63.54±1.98)%、MsPGN型:(42.32±2.97)%、FSGS型:(22.60±2.07)%],差异有统计学意义(F=1929.842,P<0.01),其中MCD型INS患儿肾小管TLR4表达水平较MN型、MsPGN型、FSGS型明显增高,差异均有统计学意义(均P<0.01);肾小管TLR4在临床分型为激素敏感型肾病综合征(SSNS型)肾脏组织中表达最高,在激素耐药型肾病综合征(SRNS)型表达最低,差异有统计学意义(F=220.951,P<0.01)。2.活动期INS患儿血清TLR4表达[MsPNG型:(143.36±12.99)ng/L、FSGS型(75.94±7.29)ng/L、MN型(210.22±14.66)ng/L、MCD型(283.93±21.58)ng/L]显著高于缓解期患儿[MsPNG型:(29.51±4.93)ng/L、FSGS型(15.66±3.78)ng/L、MN型(45.40±5.73)ng/L、MCD型(62.29±7.90)ng/L]及对照组2儿童[(0.69±0.33)ng/L],差异均有统计学意义(均P<0.01);且缓解期INS患儿血清TLR4的表达水平高于对照组2儿童,差异有统计学意义(F=286.287,P<0.01)。活动期及缓解期INS患儿血清TLR4的表达水平均以MCD型最高,其次为MN型,而FSGS型最低;血清TLR4在临床分型为SSNS型表达最高,SRNS型表达最低,差异有统计学意义(F=147.438,P<0.01)。3.INS患儿肾小管中TLR4的表达水平[(62.82±20.94)%]与其活动期血清中TLR4的表达水平[(213.26±73.33)ng/L]呈正相关(r=0.852,P<0.05);INS患儿肾小管及活动期血清TLR4的表达水平均与24 h尿蛋白水平[(123.05±33.55)mg/kg]均呈正相关(r=0.401、0.427,均P<0.05),与血清清蛋白水平[(19.54±3.55)g/L]均呈负相关(r=-0.602、-0.617,均P<0.05)。结论TLR4在INS患儿肾小管及血清中表达增高,且表达水平可能与不同肾脏病理类型及临床分型有关,与疾病活动具有相关性。     

CD105在高氧肺损伤小鼠肺内表达水平及意义

目的探讨吸入中浓度氧新生小鼠血清和肺部血管内皮细胞膜抗原CD105表达水平及意义,寻求高氧肺损伤新生小鼠肺微血管发育可能的机制。方法清洁级4日龄昆明小鼠50只,随机分为观察组、对照组各25只。观察组置于氧箱中(FiO2:0.6),对照组置于空气中(FiO2:0.21),建立高氧肺损伤小鼠模型,每组分别于实验第0(实验开始时)、7、14、21、28天时随机选取5只小鼠留取血标本及肺组织,HE染色观察肺组织病理形态,酶联免疫吸附法检测血中CD105含量,免疫组化染色法检测肺组织CD105表达水平,并分析血清CD105浓度与肺组织CD105表达量的相关性。结果观察组HE染色下正常肺泡结构消失、肺泡融合、肺泡间隔增厚,肺泡炎和肺组织纤维化增加,放射状肺泡计数较对照组明显减少(P<0.01),随着吸氧时间延长,CD105的表达水平呈逐渐增高趋势,实验第7、14、21、28天观察组血清CD105浓度和肺组织CD105表达水平均高于对照组,血清(ng/L):[7天:(346.4±14.7)比(265.7±2.0),14天:(400.2±20.1)比(266.3±3.2),21天:(505.1±6.1)比(267.1±5.8),28天:(451.9±10.0)比(268.6±4.5),P<0.01];肺组织累积光密度值:[7天:(2.24±0.15)比(1.19±0.14),14天:(3.42±0.20)比(1.20±0.11),21天:(4.35±0.18)比(1.16±0.18),28天:(4.04±0.12)比(1.17±0.14),P<0.01],且观察组CD105在血清中与肺组织中的表达水平呈正相关(r=0.973,P<0.001)。结论 CD105可能代替传统的血管内皮生长因子和血管生成素-1,成为氧疗通气诱导血管重塑的重要血管生长因子。     

促酰化蛋白水平与儿童肥胖的关系

目的：儿童肥胖不仅是体内脂肪过度积蓄,它常延伸至成人,导致心血管疾病、糖尿病发病增高。促酰化蛋白(ASP)与脂肪代谢密切相关,据此该文测定儿童ASP及血脂水平,并分析与肥胖的相关性。 方法：将该院门诊就诊的单纯性肥胖儿童分为肥胖组(n=30);正常体检儿童分为对照组(n=30),分别测定ASP及血脂水平。ASP检测采用ELISA方法检测血浆ASP水平,试剂盒由加拿大麦吉尔大学医学中心皇家维多利亚医院心血管研究室提供,血脂检测采用免疫比浊法在全自动生化分析仪上检测。 结果：肥胖组血浆ASP、胆固醇、甘油三酯、载脂蛋白B依次为 73.87 ± 24.04 g/L , 5.71 ±0.61 mmol/L, 1.77±0.30 mmol/L,0.98±0.20 mmol/L;对照组为 39.47±13.68 g/L,4.29±0.49 mmol/L,1.02±0.25 mmol/L,0.85±0.11 mmol/L。两组比较其差异有显著性意义(P<0.01或P<0.05);ASP与体重指数(BMI)、血浆甘油三酯、胆固醇呈正相关(相关系数分别为r=0.43,0.48,0.68,分别P<0.05,P<0.05,P<0.01);肥胖组中有肥胖家族史患儿血浆ASP水平比无家族史患儿增高更明显 103.4±10.57 g/L vs71.15±24.9 g/L,差异有显著性(P<0.01)。 结论：血浆ASP水平可作为脂质代谢检测的一种新指标,对判断儿童肥胖发展趋势和肥胖儿童未来发生心血管疾病危险度作出初步估价。     

A rat model of childhood diet-induced obesity: Roux-en-Y gastric bypass induced changes in metabolic parameters and gastric peptide ghrelin

Childhood morbid obesity is reaching epidemic proportions. Roux-en-Y gastric bypass (RYGB) results in many metabolic alterations, including changes in glucose and lipid metabolism, and changes in levels of the gastric hormone, ghrelin. As more children are undergoing RYGB, an animal model would be beneficial to further study RYGB and its subsequent metabolic effects. DIO Sprague Dawley rats underwent RYGB, sham jejunojejunostomy (SH), or no operation (HFC) after 6 weeks of high-fat diet. Non-obese rats fed standard chow (SC) were a final control group. Animals were post-operatively fed standard chow for 7 days before sacrifice. At sacrifice, venous blood and gastric mucosa was collected for metabolic parameters and ghrelin determination. RYGB rats weighed less than SH and HFC (361 ± 8.8 vs. 437 ± 9.3 and 443 ± 6.2 g, P < 0.05). Compared to HFC, RYGB animals had decreased plasma glucose (292 ± 23 vs. 141 ± 10 mg/dL), cholesterol (80 ± 12 vs. 45 ± 5 mg/dL), triglycerides (138 ± 37 vs. 52 ± 7 mg/dL), HDL (43 ± 5 vs. 20 ± 3 mg/dL), and free fatty acids (0.72 ± 0.14 vs. 0.23 ± 0.02 mEq/L), all P < 0.05. Plasma ghrelin increased in RYGB rats compared to SC and HFC (116.22 ± 32.27 vs. 31.60 ± 2.66 and 31.75 ± 0.75 pg/mL, P < 0.05). In a rat model of RYGB, we demonstrated improved metabolic parameters and increased plasma and gastric mRNA ghrelin levels. The rat model for RYBG appears to be a reasonable model for future study of the cellular and molecular regulatory pathways of obesity and its surgical treatment.     

Serum zinc,copper, and magnesium levels in obese children

Serum zinc, copper and magnesium levels were measured using atomic absorption spectrophotometry in 41 obese and 41 healthy (control) children (between 7 and 11 years of age) who were living in Malatya (Turkey). Serum zinc levels of obese children (mean value 102.40 ± 2.78 μg/dL) were found to be significantly higher than those of the control group (mean value 80.49 ± 2.98 μg/dL; P < 0.01). Serum copper concentrations were also found to be significantly higher in obese children (mean value 132.34 ± 1.79 μg/dL) than the healthy controls (mean value 107.58 ± 1.62 μg/dL; P < 0.01). On the other hand, serum magnesium levels were found to be significantly lower in obese children (mean value 1.78 ± 0.03 mg/dL) than in the healthy children (mean value 2.14 ± 0.04 mg/dL; P < 0.01).     

重症肺炎患儿血中促胃液素、胃动素及生长抑素水平变化及意义

目的了解胃肠激素在重症肺炎发病过程中的作用及临床意义。方法对重症肺炎组、普通肺炎组、正常对照组各40例,应用放射免疫法测定其血中促胃液素(GAS)、胃动素(MTL)及生长抑素(SS)水平,同时测定其动脉血氧分压(PaO2)。重症肺炎组有28例治愈或好转出院时复查了GAS、MTL及SS。结果重症肺炎患儿血中GAS、MTL及SS水平较普通肺炎组和对照组均明显增高(P<0.01);普通肺炎组GAS较对照组高(P<0.05),而MTL和SS水平与对照组比较差异无显著性(P>0.05);重症肺炎患儿治疗后GAS、MTL和SS均明显低于治疗前的水平(P分别<0.01、<0.01、<0.05);重症肺炎患儿PaO2明显低于正常对照组(P<0.01),且与血中的GAS、MTL、SS水平均呈较好的负相关(r分别为-0.611、-0.35及-0.838,P分别<0.01、<0.05及<0.01)。结论重症肺炎患儿血中GAS的增高可能是其易并发消化道出血的原因之一;支气管肺炎患儿血中GAS、MTL、SS水平可作为病情轻重的监测指标。     

儿童肠息肉术后电凝综合征的临床特征及危险因素分析

目的:探讨儿童肠息肉经结肠镜电切除术后电凝综合征(PPECS)的临床特征及相关危险因素,为儿科内镜医师提供防治依据。方法:回顾性分析郑州大学附属儿童医院内镜中心2015年1月至2019年12月收治的23例行内镜下肠息肉电切术后发生PPECS患儿的临床资料。并采用简单随机数字法选取同期由同一位内镜医师完成的手术115例作为非PPECS组。总结PPECS的发病率、临床特征及处理方案,发生PPECS的高危因素采用Logistic回归分析。结果:23例患儿术后出现PPECS,发病率为1.1%(23/2083),患儿术后均出现腹痛、发热;年龄(3.5±1.5)岁,年龄≤3岁19例(82.6%);肠息肉直径≥25 mm的18例(78.3%)。PPECS组的内镜操作时间[(56±15)比(24±8)min,t=18.086,P<0.01]、分块切除比例[78.3%(18/23)比17.4%(20/115),χ²=17.358,P<0.01]、病变直径大小[(38.4±3.7))比(15.8±4.3)mm,t=15.127,P<0.01]、息肉分布右半结肠[47.8%(11/23)比23.5%(27/115),χ²=7.035,P<0.05]、广基息肉比例[78.3%(18/23)比25.2%(29/115),χ²=29.259,P<0.01]均明显高于非PPECS组;PPECS组白细胞计数[(17.4±4.5)×10⁹/L比(8.5±1.2)×10⁹/L,t=6.085,P<0.05]、C反应蛋白[(25.8±3.6)比(1.1±0.6)mg/L,t=5.531,P<0.05]明显高于非PPECS组。多因素Logistic回归分析显示,病变直径≥25 mm(OR=7.554,95%CI 3.135~20.158,P=0.001)、广基息肉类型(OR=5.676,95%CI 1.153~9.596,P=0.002)及病变位置位于右半结肠(OR=5.845,95%CI 1.737~9.297,P=0.008)均是影响PPECS发生的独立危险因素。结论:PPECS以息肉术后发热、腹痛及白细胞升高为特征。病变直径大小≥25 mm、广基息肉类型及病变位置位于右半结肠是PPECS发生的独立危险因素。     

儿童急性胰腺炎与全身炎症反应综合征的关系探讨

目的：了解儿童急性胰腺炎合并全身炎症反应综合征（SIRS）的临床特点，探讨SIRS发生与胰腺炎病情轻重的关系。方法：对2005年5月至2007年6月该院儿科收治的71例胰腺炎患儿进行研究，全部病例分为SIRS组30例、非SIRS组41例；SIRS组中符合小儿SIRS诊断标准2项者为S1组(19例)，符合3项者为S2组(6例)，符合4项者为S3组(5例)。通过统计学方法总结急性胰腺炎合并SIRS时的临床特点，寻找能预测病情轻重的指标。结果：①重症胰腺炎（SAP）时SIRS发生率为100% ，SIRS组患儿临床症状多以剧烈腹痛和发热为主，与对照组相比差异有显著性（P＜0.01）；② CRP升高、血钙降低两组间比较差异有显著性（P＜0.01），S3组CRP平均值(120.40±10.04) mg/L＞S2组（75.78±9.50）mg/L＞S1组（28.51±8.51）mg/L＞非SIRS组(7.98±2.82) mg/L，CRP分界点在110 mg/L时诊断SAP的敏感度和阴性预测值都是最高，分别是50%和96.8%；③SIRS组CT改变较重。结论：SIRS组患儿临床症状多以剧烈腹痛和发热为主，CRP、血钙水平、CT可作为急性胰腺炎病情严重程度的辅助参考指标，CRP值随着SIRS诊断指标符合项目的增多而升高，当SIRS诊断指标符合项目多于3条时应警惕SAP的发生，CRP≥110 mg/L时SAP存在的可能性增加。