窒息新生儿脐血乳酸值的临床意义(英文)

目的：Apgar评分和血气分析作为判断新生儿窒息程度和预后的指标有一定的局限性,为寻找更具敏感性和特异性的指标,该研究探讨脐血乳酸值在新生儿窒息中的临床意义。方法：对31例足月窒息新生儿(分为轻度窒息组22例和重度窒息组9例)和30例正常新生儿(对照组)的脐动脉血进行乳酸测定及微量血液气体分析,并在第14天进行新生儿20项行为神经测定(NBNA)。结果：轻、重度窒息组脐动脉血乳酸值［(6.42±0.14) mmol/L,(10.77±0.12) mmol/L］较对照组［(4.20±0.15) mmol/L］显著升高(P<0.01),pH值［(7.16±0.07),(7.04±0.09)］较对照组(7.18±0.11)明显降低(P<0.01);其中重度窒息组的乳酸值高于轻度窒息组,pH值低于轻度窒息组,差异均有显著性(P<0.01)。脐血乳酸值与pH值及第14天NBNA评分呈显著负相关(r=-0.76,-0.85,P<0.01)。结论：脐血乳酸值可作为判断新生儿窒息程度和近期预后的指标。     

窒息新生儿血清胱抑素C变化及其与血尿酸的关系

目的探讨新生儿窒息时血清胱抑素C(CysC)变化及其与血尿酸(UA)的关系。方法选择本科2010年12月至2011年9月住院的40例窒息新生儿(轻度窒息25例,重度窒息15例)和20例来自本院产科观察室、无窒息史的湿肺及咽下综合征新生儿,均在生后24～48h检测血清CysC和血UA水平,比较各组差异,并对CysC和UA水平进行相关性分析。结果轻度窒息组和重度窒息组血清CysC(mg/L)与UA(μmol/L)水平均明显高于对照组[CysC:(1.9±0.2)、(2.6±0.2)比(1.3±0.2),UA:(296.6±72.4)、(445.9±78.6)比(210.6±115.5),P<0.05],重度窒息组高于轻度窒息组(P<0.01)。各组血清CysC与UA水平均呈正相关(重度窒息组r=0.75,轻度窒息组r=0.24,对照组r=0.20,P均<0.001)。结论窒息新生儿CysC明显升高,血清CysC水平可作为判断新生儿窒息后肾脏损伤的早期指标,指导临床诊断和治疗。     

窒息新生儿选择头部亚低温治疗前后血清神经元特异性烯醇化酶的变化

目的 探讨窒息脑损伤新生儿选择头部亚低温治疗前后血清神经元特异性烯醇化酶(NSE)的变化及早期亚低温治疗效果.方法 窒息新生儿82例.其中轻度窒息39例,重度窒息43例.无窒息足月新生儿29例作为健康对照组.重度窒息新生儿随机分成亚低温治疗组和常规治疗组,亚低温治疗组采用选择性头部亚低温治疗方法 ,维持鼻咽温度(34.0±0.5)℃,持续72 h;常规治疗组仅采用常规对症治疗.分别于治疗前、治疗72 h采集各组新生儿静脉血2 mL,采用放射免疫分析方法 检测血清NSE.采用SPSS 12.0软件进行统计学分析.结果 轻度窒息组血清NSE水平[(34.83±6.17)μg/L]及重度窒息组[(59.58±8.87)μg/L]均明显高于健康对照组[(30.57±4.88)μg/L](t=3.07 P<0.01;t=16.02 P<0.001);且重度窒息组明显高于轻度窒息组(t=14.52 P<0.001).亚低温治疗组和常规治疗组患儿治疗前血清NSE水平分别为(60.65±8.85)μg/L、(58.46±8.98)μg/L,二组比较无显著差异(t=0.81 P>0.05);治疗72 h亚低温治疗组[(40.97±6.55)μg/L]明显低于常规治疗组[(48.15±5.57)μg/L](t=3.86 P<0.001).结论 NSE可作为新生儿窒息脑损伤的早期监测指标之一,早期亚低温治疗重度窒息新生儿有脑神经保护作用.     

宫内窘迫新生儿脐动脉血乳酸检测与新生儿行为神经测定的临床意义

目的探讨新生儿脐动脉血乳酸水平与宫内窘迫的关系及其对新生儿行为神经表现的影响。方法对160例发生宫内窘迫的足月新生儿(出生时无窒息为窘迫I组,出生时有窒息为窘迫II组)和310例正常足月新生儿(对照组)的脐动脉血进行乳酸测定及血气分析,并在生后4～6d、26～28d进行新生儿20项行为神经测定(neonatal behavioral neurological assessment,NBNA)。结果窘迫I组和窘迫II组脐动脉血乳酸值均较对照组显著升高(P<0.01),两组pH值较对照组明显降低(P<0.01);窘迫II组的乳酸值明显高于窘迫I组,pH值低于窘迫I组,差异均有非常显著性(P<0.01)。脐血乳酸值与pH值呈直线负相关关系(r=-0.53,P<0.01),窘迫II组的脐血乳酸值与NBNA评分也呈直线负相关关系(r=-0.78,P<0.01)。三组NBNA评分随日龄增长均升高,差异有非常显著性(P<0.01)。结论脐动脉血乳酸检测可协助宫内窘迫的诊断,并可望作为评估、预测新生儿窒息损伤的指标之一。     

血浆N端脑钠肽原和血清电解质联合检测在新生儿缺氧缺血性脑病中的诊断价值

目的 探讨HIE新生儿血浆N端脑钠肽原(NT-proBNP)和血清电解质的变化,评价血浆NT-pmBNP对新生儿窒息并心功能障碍的诊断价值.方法 将确诊为HIE的64例患儿分为轻度组、中度组和重度组,对各组HIE患儿及41例健康新生儿(健康对照组)采用竞争性酶免疫法(EIA)检测血浆NT-proBNP,采用电解质分析仪检测其血清钾、钠、氯、钙水平.结果 轻度HIE组血浆NT-proBNP[(3 540±992)pmol/L]明显高于健康对照组[(3 192±1 486)pmol/L](t=1.908 P<0.05);中度HIE组血浆NT-pmBNP[(4 012±1 002)pmol/L]明显高于轻度组(t=1.979 P<0.05);重度HIE组血浆NT-proBNP[(4 228±1 087)pmol/L]明显高于中度HIE组(t=2.71 P<0.05).血钠、氯、钙随HIE程度的加重而渐降低.轻度HIE组血清钠、氯、钙水平明显低于健康对照组(t=2.45,2.56,3.01 Pa<0.05),二组血清钾水平无明显差异(t=1.18 P>0.05);中度HIE组血清钠、氯、钙水平明显低于轻度组(t=2.78,2.91,3.21 Pa<0.05),二组血清钾水平无明显差异(t=1.09 P>0.05);重度HIE组血清钠、氯、钙水平明显低于中度组(t=2.92,2.98.3.32 Pa<0.05),二组血清钾水平比较无明显差异(t=1.21 P>0.05).重度HIE组血浆NT-pmBNP水平与血清钠、氯、钙水平均呈显著负相关(r=-0.762,-0.781,-0.802 Pa<0.01).结论 HIE患儿血浆NT-pwBNP水平能反映其心功能损害及心肌损害的程度及疗效.联合检测HIE息儿血浆NT-proBNP和血清电解质水平对于判断病情、评价疗效和预测预后均有一定价值.     

窒息新生儿血浆神经肽Y测定及临床意义

目的：研究窒息新生儿血浆神经肽Y(NPY)及β内啡肽(βEP)的含量,探讨它们与新生儿窒息及窒息后脑损伤的关系。方法：采用放射免疫分析法测定37例窒息新生儿及12例健康新生儿(对照组)血浆NPY及β－EP的含量,同时行头颅CT检查,并测定脑实质CT值。结果：重度窒息组血浆NPY及β EP明显高于对照组［(1.85±1.10) μg/L vs (0.04±0.03) μg/L,(2.0 3±1.45)μg/L vs (0.06±0.04) μg/L］,差异有显著性(P<0.01);轻度窒息组NPY及β EP［(0.47±0.38) μg/L,(0.34±0.33)μg /L］低于重度窒息组(P<0.01),但高于对照组(P<0.01)。轻、重度窒息组脑CT值水平分别为(15.60±2.20) Hu和(13.08±2.18) Hu,均低于正常对照组［(20.16±2.66) Hu］(P<0.01);其中重度窒息组脑CT值低于轻度窒息组(P<0.01)。重度窒息组NPY和β EP呈正相关(r=0.4220,P<0.05)。结论：血浆NPY,β-EP含量及脑CT值与窒息程度密切相关。窒息越重,血浆NPY和β-EP含量越高,CT值越低。NPY,β-EP可作为观察新生儿窒息程度和窒息后脑损伤的指标。     

窒息新生儿血清总胆汁酸、前白蛋白变化及其临床意义探讨

目的探讨窒息时新生儿血清总胆汁酸(TBA)、前白蛋白(PAB)变化及其临床意义.方法检测各30例轻度、重度窒息新生儿及20例缺氧缺血性脑病(HIE)新生儿的(TBA)、(PAB)、丙氨酸转氨酶(ALT)、白蛋白(ALB)水平,并设30例正常新生儿为对照.结果轻度、重度窒息儿和HIE新生儿血清TBA、PAB水平与正常儿比较差异均有非常显著性(P＜0.001)窒息时血清TBA、PAB水平与Apgar评分均呈线性相关(r=0.571,-0.689,P＜0.001),随病情好转血清TBA和PAB水平逐渐恢复正常.结论血清TBA和PAB是反映窒息儿肝功能损害灵敏的生化指标,动态测定血清TBA和PAB水平变化能很好地、灵敏地反映窒息儿肝脏损害情况及病情转归.     

血清胆红素对新生儿听力的影响

目的 探讨不同血清胆红素水平对新生儿听力的影响. 方法本院156例高胆红素血症新生儿,根据血清胆红素水平分为轻、中、重度3组.采用瞬态耳声发射技术(TEOAE)对其进行听力筛查,未通过者4周后复查,仍未通过者3～6月龄进行听觉脑干诱发电位(ABR)检查.结果 初筛时轻度组及中度组TEOAE通过率差异无显著性(χ2=0.21 P>0.05);重度组与轻、中度组比较差异有显著性(χ2=10.697,8.548 Pa<0.01).复筛时轻度与中度组通过率差异无显著性(χ2=0.479 P>0.05);重度与轻、中度比较有统计学意义(χ2=11.115 P<0.01;χ2=6.451 P<0.05).TEOAE通过率与血清胆红素水平呈负相关(r=-0.292 P<0.01).ABR检测表明重度组听力障碍发生率明显高于轻、中度组(χ2= 5.867,5.60 Pa<0.05). 结论轻、中度血清胆红素升高对新生儿听力影响较小,而重度高胆红素血症是造成新生儿听力障碍的高危因素,应予积极干预.     

窒息新生儿血清总胆汁酸、前白蛋白变化及其临床意义探讨

目的探讨窒息时新生儿血清总胆汁酸(TBA)、前白蛋白(PAB)变化及其临床意义。方法检测各30例轻度、重度窒息新生儿及20例缺氧缺血性脑病(HIE)新生儿的(TBA)、(PAB)、丙氨酸转氨酶(ALT)、白蛋白(ALB)水平,并设30例正常新生儿为对照。结果轻度、重度窒息儿和HIE新生儿血清TBA、PAB水平与正常儿比较差异均有非常显著性(P<0.001)窒息时血清TBA、PAB水平与Apgar评分均呈线性相关(r=0.571,-0.689,P<0.001),随病情好转血清TBA和PAB水平逐渐恢复正常。结论血清TBA和PAB是反映窒息儿肝功能损害灵敏的生化指标,动态测定血清TBA和PAB水平变化能很好地、灵敏地反映窒息儿肝脏损害情况及病情转归。     

窒息新生儿甲状腺激素水平的变化及其临床意义

目的探讨足月新生儿窒息后血清甲状腺激素水平的变化及其临床意义。方法采用化学发光法测定52例足月窒息新生儿(重度窒息20例、轻度窒息32例)和35例健康足月儿出生1天及10天的血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及促甲状腺激素(TSH)含量,并观察其动态变化。结果生后第1天窒息组FT3、FT4明显低于对照组(P<0.01),重度窒息组低于轻度窒息组(P<0.05);重度窒息组TSH明显高于对照组(P<0.01),轻度窒息组与对照组间TSH差异无统计学意义(P>0.05)。10天后各组FT3、FT4、TSH差异无统计学意义(P>0.05)。生后1天时窒息组FT3、FT4低于正常值的比例和TSH高于正常值的比例均高于对照组(P<0.05),轻度窒息组FT3、FT4低于正常值的比例高于对照组(P<0.05),TSH高于正常值的比例与对照组比较差异无统计学意义(P>0.05),生后10天时各组各指标异常率差异无统计学意义(P>0.05)。结论新生儿窒息可导致甲状腺功能受损,且随窒息程度加重而加重,血清甲状腺激素水平对判断窒息新生儿病情及观察疗效有一定意义。     

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.     

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.     

How well are we doing? – Metabolic control in patients with diabetes

OBJECTIVE: To compare the present level of metabolic control in children and adolescents with insulin-dependent diabetes mellitus (IDDM) attending Brisbane paediatric diabetes clinics with published overseas data. METHODOLOGY: Blood HbA1c concentrations, population characteristics, current treatment practices and short-term complications were recorded in all patients, aged 19 years and under, attending the diabetes clinics of the two Brisbane Children's Hospitals or the private practice of one of the authors (MJT) in the first quarter of 1998. RESULTS: Two hundred and sixty-eight patients were assessed (M/F 142/126). Ages ranged from 1 to 19 years (mean 11. 2 years); duration of IDDM was 0-16 years (mean 4.4 years); and 141 (53%) were pubertal. Of those aged less than 13 years, only 4% had more than two injections daily. Insulin doses (U/kg/day) rose with increasing age. Larger doses were required in regimens involving more than two injections per day than those involving one to two injections per day. Ketoacidosis or severe hypoglycaemia in the last 3 months were reported in eight (2.7%) and 17 (6.3%) of patients, respectively. Mean HbA1c (+/- SD) was 8.6 +/- 1.4% (range 5.2-14.0%), with 33% of children having a HbA1c concentration < 8%. HbA1c concentrations were significantly related (P < 0.05) to insulin dose and to duration of diabetes, but not to severe hypoglycaemia, ketoacidosis, age, frequency of injections, or number of clinic visits per year. Mean HbA1c concentration was significantly higher (P < 0.05) in those children in puberty (8.7 +/- 1.5%) than in those not in puberty (8.5 +/- 1.2%). CONCLUSION: Only 33% of patients had a HbA1C concentration less than 8% and 6.3% had a severe hypoglycaemic episode in the 3 months. These results are similar to published overseas data.     

MAINTENANCE OF DIFFERENTIATED FUNCTION OF THE SURFACTANT SYSTEM IN HUMAN FETAL LUNG TYPE II EPITHELIAL CELLS CULTURED ON PLASTIC

We report a simplified culture system for human fetal lung type II cells that maintains surfactant expression. Type II cells isolated from explant cultures of hormone-treated lungs (18-22 wk gestation) by collagenase + trypsin digestion were cultured on plastic for 4 days in serum-free medium containing dexamethasone (Dex, 10 nM) + 8-bromo-cAMP (0.1 mM) + isobutylmethylxanthine (0.1 mM) or were untreated (control). Surfactant protein (SP) mRNAs decreased markedly in control cells between days 1 and 4 of culture, but mRNA levels were high in treated cells on day 4 (SP-A, SP-B, SP-C, SP-D; 600%, 100%, 85%, 130% of day 0 content, respectively) . Dex or cAMP alone increased SP-B, SP-C, and SP-D mRNAs and together had additive effects. The greatest increase in SP-A mRNA occurred with cAMP alone. Treated cells processed pro-SP-B and pro-SP-C proteins to mature forms and had a higher rate of phosphatidylcholine (PC) synthesis (2-fold) and higher saturation of PC (~34% versus 27%) than controls. Only treated cells maintained secretagogue-responsive phospholipid synthesis. By electron microscopy, the treated cells retained lamellar bodies and extensive microvilli. We conclude that Dex and cAMP additively stimulate expression of surfactant components in isolated fetal type II cells, providing a simplified culture system for investigation of surfactant-related, and perhaps other, type II cell functions.