健康新生儿血二胺氧化酶、D-乳酸测定及意义

目的探讨健康新生儿血二胺氧化酶(DAO)、D-乳酸的正常含量,为新生儿胃肠功能衰竭的早期诊断寻找可靠的检验依据.方法对79例健康新生儿(足月儿59例,早产儿20例)进行血清DAO、D-乳酸含量测定.结果血清DAO为(8.851±3.424)u/ml,血D-乳酸为(0.918±0.715)ug/ml,血清DAO含量在足月儿与早产儿、在性别之间比较无差异,在日龄之间比较＜3天组与～7天及晚期新生儿各组比较差异无显著性,P值均＞0.05,～7天组与晚期新生儿各组比较有显著性差异,P值均＜0.05.D-乳酸含量在性别之间差异无显著性(P＞0.05),但在早产儿与足月儿、＜3 d的早期新生儿与＞14 d的晚期新生儿之间的比较差异有显著性(P＜0.05).结论血DAO不受性别、孕周的影响,血D-乳酸在胎龄、日龄有差别.     

胃肠功能衰竭新生儿血清二胺氧化酶和D-乳酸的测定及意义

目的探讨胃肠功能衰竭新生儿血清二胺氧化酶(DAO)和D-乳酸含量变化特点及其临床意义。方法19例胃肠功能衰竭新生儿为病例组,79例健康新生儿为对照组,测量两组新生儿血清DAO、D-乳酸含量。结果对照组血清DAO含量为(8.851±3.424)U/ml,血D-乳酸含量为(0.918±0.715)μg/ml。病例组血清DAO含量为(11.610±3.909)U/ml,D-乳酸含量为(1.859±0.972)μg/ml;病例组血清DAO、D-乳酸水平显著高于对照组(P<0.05,P<0.01)。不同疾病严重程度、不同胎龄、不同日龄患儿血清DAO、D-乳酸含量比较无显著性差异(P>0.05)。结论血清DAO和D-乳酸含量测定可作为新生儿胃肠功能衰竭早期诊断的敏感指标。     

危重症新生儿血清二胺氧化酶和D-乳酸测定的意义

目的 探讨危重症新生儿血清二胺氧化酶(DAO)和D-乳酸的变化及其临床意义.方法 选取危重症新生儿52例为研究组,同期住院的非危重无胃肠功能障碍新生儿15例为对照组.研究组按有无胃肠功能障碍(胃障)分为胃障组(n=18)和无胃障组(n=34),胃障组轻度障碍5例,重度障碍13例.病例均于入院时采静脉血1～2 mL,分离血清,用分光光度计测定其血清DAO、D-孚L酸水平.比较各组新生儿血清DAO、D-乳酸水平的变化.采用SPSS 10.0软件进行统计学分析.结果 血清DAO:研究组明显高于对照组(t=-4.706 P＜0.01),胃障组高于无胃障和对照组(F=16.694 P＜0.01);不同严重程度胃肠障碍患儿血清DAO比较差异无统计学意义(t=0.633 P＞0.05).血清D-乳酸:研究组明显高于对照组(t=-2.332 P＜0.05),胃障组高于对照组(t=0.814 P＜0.05),无胃障组与对照组间比较无明显差异(t=0.679 P＞0.05),不同严重程度胃肠障碍患儿血清D-乳酸比较差别无统计学意义(t=0.561 P＞0.05).结论 血清DAO可作为危重症新生儿胃肠障碍早期诊断的敏感指标之一,血清D-乳酸升高能特异性反映新生儿胃肠屏障受损,其变化可能与新生儿肠道细菌定植、微生态的平衡特点有关.     

不同日龄新生儿凝血指标的临床研究

目的 探讨不同日龄新生儿凝血指标的变化及其临床意义.方法 以我院2005年1至12月129例生后无合并症新生儿为研究对象,按胎龄分为足月儿组和早产儿组,分别于生后1、3、10 d采血测定凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、凝血酶时间(TT)及D-二聚体含量.结果 在出生后1、3、10 d三个不同日龄,早产儿和足月儿两组间的PT、D-二聚体差异均无显著性(P>0.05),但早产儿组的APTT、TT在三个不同的日龄均高于足月儿,Fg低于足月儿,差别均有显著性(P<0.05).同时随着新生儿目龄的增加,PT、APTT,TT、、D-二聚体减少,而Fg增加,三个时间点凝血指标的差别均有显著性(P<0.05).结论 胎龄、日龄对新生儿凝血指标均有影响,为临床诊断和治疗提供了一定的参考依据.     

早产儿D-二聚体和纤溶酶原的动态变化研究

目的观察不同日龄正常早产儿纤溶活性指标栓溶二聚体(D-二聚体,DD)和纤维蛋白溶酶原(纤溶酶原,PLG)生理水平及其变化规律.方法选取日龄1、5、10、20 d的早产儿各40例及1、5、10,20 d正常足月儿各20例作对照,观察其纤溶指标DD、PLG值的日龄变化规律.结果早产儿和足月儿DD阳性在新生儿期较多见,尤其是在生后1周内,DD阳性率随日龄增长而减低,早产儿减低较慢.早产儿PLG在第1、5 d与足月儿比较差异无显著性(P＞0.05),在第10、20d与足月儿比较差异有显著性(32.00±11.82)%比(41.30±9.74)%,(27.58±9.04)%比(43.65±17.38)%,(P＜0.05).早产儿PLG随着日龄增长有下降趋势,而足月儿无明显变化.结论新生儿出生后DD阳性率高和较低活性PLG水平提示纤溶活性的增强,尤其是早产儿更明显.对新生儿特别是早产儿临床出现DD阳性或PLG降低时,对DIC诊断要慎重.     

不同胎龄新生儿细胞和体液免疫功能检测

目的 了解不同胎龄新生儿的免疫功能特点.方法 2012 年6 月1 日至2013 年6 月1 日收治的115 例无感染早产儿,根据出生时胎龄分为早期早产儿组(28~33+6 周,n=57)和晚期早产儿组(34~36+6 周,n=58);同期选取88 例健康足月儿(37~41+6 周)为对照.于出生后24 h 内采集各组静脉血,采用流式细胞仪检测各组淋巴细胞亚群CD3+、CD4+、CD8+、CD19+ 和NK 细胞,并根据血常规结果计算各淋巴细胞亚群含量;采用免疫比浊法检测各组血清IgG、IgA 和IgM 含量.结果 早期和晚期早产儿组CD3+、CD4+ 百分比及CD4+/CD8+ 比值均高于足月儿组(P<0.05),而CD8+、CD19+ 和NK 细胞百分比均低于足月儿组(均P<0.05);早期和晚期早产儿组总淋巴细胞、CD3+、CD4+、CD8+、CD19+ 和NK 细胞含量均低于足月儿组(P<0.05),且上述指标在晚期早产儿组的水平均高于早期早产儿组(P<0.05);早期和晚期早产儿组血清IgG 水平低于足月儿组(P<0.05),而IgA、IgM 含量在3 组间差异无统计学意义(P>0.05).结论 新生儿胎龄影响其细胞免疫及体液免疫功能;随胎龄增长,新生儿免疫功能将逐渐完善.     

不同胎龄新生儿肾功能发育状况

分析不同胎龄新生儿肾功能发育状况,测定了40例足月儿,39例早产儿,18例足月小样儿生后3天内血、尿α1M、β2M含量.所选对象均排除了影响肾功能的外在因素,结果足月儿血、尿α1M分别为20.87±4.17mg/L、8.12±5.20mg/g.cr;早产儿血、尿α1M为32.76±11.46mg/L及37.30±26.10mg/g.cr;足月小样儿血、尿α1M各为22.53±4.32mg/L及10.12±4.73mg/g.cr;足月儿与早产儿相比血、尿α1M均有显著性差异;足月儿与足月小样儿相比血尿α1M没有显著性差异.结果提示早产儿肾功能比足月儿差,足月小样儿与足月儿肾功能则没有差异.αM是检测新生儿肾功能的一项更稳定、更敏感的指标.     

晚期早产儿潮气呼吸肺功能研究

目的 探讨晚期早产儿潮气呼吸肺功能的特点,并比较晚期早产儿与足月儿肺功能之间的差异.方法2009年8月至2010年8月本院新生儿病房收治的81例晚期早产儿(晚期早产儿组)和同期本院产科出生的足月适于胎龄儿75例(足月对照组),于生后1、2、3d行潮气呼吸肺功能测定,观察2组新生儿肺功能的动态变化.结果生后第1天,晚期早产儿组潮气量、分钟通气量均低于足月对照组(P＜0.05);反映气道阻塞的指标达峰时间比、达峰容积比,晚期早产儿组均高于足月对照组,差异有统计学意义(P＜0.05).第2天,晚期早产儿组的潮气量低于足月对照组(P＜0.05),达峰时间比、达峰容积比仍比足月对照组高(P＜0.05).至生后第3天,2组新生儿各指标比较差异无统计学意义(P＞0.05).晚期早产儿组间,分钟通气量第1天较第2天低,呼吸频率比第2天快(P均＜0.05);达峰时间比、达峰容积比均比第2天高(P＜0.05);其他指标比较差异无统计学意义(P＞0.05).结论胎 龄＞ 34周的早产儿存活率与足月儿几乎一样,但晚期早产儿潮气呼吸肺功能,早期存在一定程度的限制性通气功能障碍,气道阻塞也较明显.加强晚期早产儿呼吸道管理,潮气呼吸肺功能检测是晚期早产儿呼吸监护的重要手段.     

新生儿出生后24小时内凝血功能检测的临床意义分析

目的探讨不同胎龄以及不同体重新生儿凝血功能指标的差异,为判断凝血功能指标的临床意义提供参考。方法2015年1月至2018年12月期间,在解放军总医院第五医学中心新生儿科住院治疗的新生儿中,纳入170例胎龄28~42周、出生8 h内入院的新生儿,其中男性87例,女性83例。按胎龄分为早期早产儿组、晚期早产儿组和足月儿组。按新生儿出生体重分为正常出生体重组、低出生体重组和极低出生体重组。按是否小于胎龄分为早产适于胎龄儿组、早产小于胎龄儿组、足月适于胎龄儿组、足月小于胎龄儿组。于生后24 h内抽取静脉血,检测活化部分凝血活酶时间(activatedpartial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)、凝血酶时间(thrombin,TT)及D-二聚体(D-dimer)。结果早期早产儿组的APTT、PT、D-二聚体水平均高于晚期早产儿组及足月儿组(P值均<0.05),FIB水平低于晚期早产儿组及足月儿组(P值均<0.05);晚期早产儿组的APTT、PT水平均高于足月儿组(P值均<0.05),但两组间D-二聚体、FIB水平比较,差异无统计学意义(P值均>0.05)。极低出生体重组的APTT、PT、D-二聚体水平均高于低出生体重组及正常出生体重组(P值均<0.05),FIB水平低于低出生体重组及正常出生体重组(P值均<0.05);低出生体重组的APTT、PT水平均高于正常出生体重组(P值均<0.05),但两组间D-二聚体、FIB水平比较,差异无统计学意义(P值均>0.05)。早产小于胎龄儿组D-二聚体水平高于早产适于胎龄儿组(P<0.05),其余指标比较差异无统计学意义(P值均>0.05);足月适于胎龄儿与足月小于胎龄儿组的凝血指标比较,差异均无统计学意义(P值均>0.05)。早产儿出血发生率高于足月儿[26.6%(29/109)与8.2%(5/61),χ^2=9.019,P=0.003]。结论新生儿凝血指标有胎龄和体重差异,胎龄越小、体重越低的新生儿凝血功能越不完善。     

新生儿血清EPO水平与孕周、日龄的关系

研究不同孕周出生的新生儿脐血及不同日龄静脉血的EPO水平 ,并分析其与贫血的关系 ,分别取 4 9例早产儿与 4 6例足月儿脐静脉血清 1ml;并对其中 1 8例早产儿于生后第 7天、1 4天、2 8天取静脉血清 1ml,对其中 1 7例足月儿于生后第 7天取静脉血 1ml,用ELISA方法检测EPO值 ,结果显示 :( 1 )早产儿与足月儿脐血EPO水平无显著差异 (P >0 0 5)。 ( 2 )足月儿生后第 7天血清EPO与脐血比较有显著差异 (P <0 0 0 1 )。早产儿生后第 7天、1 4天、2 8天EPO值与脐血比较明显降低 ,有极显著差异 (P <0 0 0 1 )。因此 ,初步结论 ,新生儿脐血EPO水平与孕周无关。新生儿生后 7天血中EPO水平迅速下降 ,早产儿下降幅度比足月儿更显著 ,持续下降到生后2 8天无上升趋势 ,早产儿贫血多发生在新生儿早期 ,与此时期血中EPO水平大幅度下降有关 ,故用rhEPO治疗早产儿贫血应早期应用。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.