苯巴比妥、苯妥英、卡马西平对癫痫患儿甲状腺激素的影响

观察常用抗癫痫药物对癫痫患儿血清甲状腺激素的影响。对无甲状腺功能减退临床表现的癫痫患儿(各组均20例)共80例,应用RIA法测定血清TT4、TT3、FT4、FT3、rT3、TSH浓度。结果未经治疗癫痫患儿所有激素水平与正常对照组比较无显著差异,苯巴比妥组FT4值低于正常对照组(P<0.01),卡马西平组TT4、FT4值也明显降低(P<0.01),苯妥英组TT4、FT4、FT3值均显著降低(P<0.01),所有各组rT3、TSH无改变。资料表明,抗癫痫药物对甲状腺激素影响强度依次为苯妥英钠、卡马西平、苯巴比妥。     

Serum thyroid hormones and pituitary response to thyrotropin-releasing hormone in epileptic children receiving anti-epileptic medication

Thyroid hormones and pituitary function were assessed in 49 children with epilepsy who were receiving either a single medication of carbamazepine, phenobarbital and valproate or a combination of carbamazepine with phenobarbital or valproate. All therapeutic regimens except valproate monotherapy were associated with low levels of circulating thyroxine, free tri-iodothyronine and free thyroxine. Carbamazepine with valproate was associated with the lowest serum concentration of thyroid hormones. It seems probable that accelerated hormone metabolism is responsible for these hormonal changes. However, all drug regimens also had effects on the function of the hypothalamic pituitary axis. Because of these findings, thyroid hormones should be checked frequently during anti-epileptic drug treatment, although clinical hypothyroidism was not seen in our patients.     

丙戊酸单药治疗对癫患儿中性粒细胞功能影响的自身对照研究

目的 探讨丙戊酸（VPA）单药治疗对癫患儿中性粒细胞功能的影响，进一步指导VPA的临床应用。方法 选取复旦大学附属儿科医院2006年10月至2008年7月门诊首次确诊并给予VPA单药治疗的癫患儿。以二氢若丹明荧光染色外周血中性粒细胞，通过流式细胞仪分别检测患儿服药前和服药6个月时的中性粒细胞自身活化率和刺激指数；收集健康儿童全血，分别加适量VPA配成0、50、100、150和200 μg·mL-1浓度进行培养，于培养后6、18和24 h检测中性粒细胞自身活化率和刺激指数（SI），观察中性粒细胞功能变化的时间依赖性和浓度依赖性特征。结果 研究期间纳入癫患儿29例，其中男13例，女16例；全身性发作22例，部分性发作7例；治疗前中性粒细胞自身活化率为（6.41±3.14）%，治疗后为(12.30±7.73)%;治疗前SI为440.6±32.4，治疗后为429.6±26.5；差异均有统计学意义。全身性发作和部分性发作间中性粒细胞自身活化率和SI差异均无统计学意义。中性粒细胞自身活化率随VPA浓度升高而增高，SI随培养时间的延长而显著降低，VPA 50 μg·mL-1培养6 h后中性粒细胞SI轻度升高，但培养24 h后显著降低；VPA 200 μg·mL-1培养后各时间点均见中性粒细胞SI显著降低。结论 VPA单药治疗癫患儿体内存在中性粒细胞的自身活化现象，中性粒细胞自身活化率的升高呈浓度依赖性，SI的降低呈时间依赖性和剂量依赖性，VPA单药治疗可导致中性粒细胞功能的显著下降，且该作用与癫发作类型无关。     

Serum lipids in epileptic children treated with carbamazepine and valproate

Serum total cholesterol (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C) and very low-density lipoprotein cholesterol, triglyceride, apolipoproteins A1 and B levels were studied in 57 healthy children and in 39 children with epilepsy who had been receiving carbamazepine (CBZ) (23 children) for 1.58 ± 1.10 years or valproic acid (VPA) (16 children) for 1.34 ± 1.11 years. In patients receiving CBZ, mean TC level, mean LDL-C level, mean TC/HDL-C ratio and mean LDL-C/HDL-C ratio were significantly higher than controls. None of the mean levels of serum lipids evaluated in patients receiving VPA was significantly different from the corresponding control group mean. Changes in serum lipids correlated with neither duration of therapy or plasma antiepileptic levels nor age or gender. Conclusion Our results suggested that CBZ, a hepatic-enzyme-inducing drug, affects serum lipid status. Long-term prospective studies are necessary to determine whether chronic CBZ therapy is a risk factor for atherosclerotic disorders. Received: 15 October 1996 / Accepted: 5 February 1997     

Changes in thyroid function tests induced by 2 month carbamazepine treatment in l-thyroxine-substituted hypothyroid children

In five l-thyroxine-substituted hypothyroid children with partial epilepsy serum total thyroxine (T₄) and free T₄ (FT₄) significantly (P<0.01) decreased following 2 months of carbamazepine (CBZ) administration (20 mg/kg per BW per day) from mean (±SD) values of 12.7±1.1 g/dl and 15.5±1.8 pg/ml to mean values of 7.5±2.3 and 10.1±1.7, respectively. In all but one patient important changes in both serum total and free triiodothyronine (T₃, FT₃) were not observed; consequently T₃T₄ and FT₃FT₄ ratios significantly (P<0.05) increased in the whole series. Three subjects had post-treatment serum TSH that rose to hypothyroid levels parallel to a T₄ decrease. The negligible thyroid hormone secretion and the unmodified T₃-uptake (T₃U) or T₄-binding globulin (TBG) exclude direct effects of CBZ on thyroid gland and on carrier serum proteins, respectively. The findings observed, instead, might be due to accelerated T₄ metabolic clearance together with augmented T₄ to T₃ conversion rate, as previously demonstrated for diphenylydantoin. The sharp reduction in T₄ and FT₃ concentrations is the peripheral display of this event, which is associated with a decompensation of the metabolic status, as indicated by serum TSH enhancement. In all cases a supplement of l-thyroxine by itself was able to restore euthyroid TSH serum concentrations, suggesting that hypothyroidism in patients with partial epilepsy to whom CBZ had been administered requires a higher l-T₄ substitutive regimen.Abbreviations CBZ carbamazepine - DPH phentoin - T₄ thyroxine - T₃ triiodothyronine - TSH thyrotropin - FT₄ free T₄ - FT₃ free T₃ - rT₃ reverse T₃ - TBG thyroxine binding globulin - T₃U T₃ uptake - RIA radioimmunoassay Presented in part at the 23rd Annual Meeting of the European Society for Pediatric Endocrinology (Heidelberg, September 2–5, 1984) [5]     

Effect of valproate and carbamazepine on visual evoked potentials in epileptic children

The effects of carbamazepine (CBZ) and sodium valproate (SV) monotherapy on visual evoked potentials (VEP) were studied in 18 epileptic children receiving CBZ and nine epileptic children receiving SV. Pattern reversal VEP were determined before the administration of antiepileptic drugs (AED) and 1 year later during which time the patients had received AED. The VEP amplitude showed no consistent changes after 1 year of CBZ and SV therapy, but VEP P-100 latencies were significantly prolonged after 1 year of CBZ therapy. We conclude that CBZ causes a slowing down of central impulse conduction and that VEP is useful to evaluate the effects of AED within the central nervous system.     

丙戊酸钠与卡马西平治疗小儿癫痫的随机对照研究

目的应用临床流行病学方法评价丙戊酸钠(VPA)与卡马西平(CBZ)治疗小儿全身性强直-阵挛性发作(GTC)及部分性/继发全身性发作(P±GTC)的疗效和副作用.方法前瞻性开放的临床随机对照研究,以治疗前后癫痫发作次数的减少和用药开始到用药后第1次发作的时间作为疗效的判断标准来比较两种药物的疗效和不良反应.结果在治疗3个月后,两组患儿在癫痫发作次数的减少和用药开始到用药后第1次发作的时间上无显著性差异,VPA在减少GTC方面较CBZ更有效;共有5例患儿(6.9%)因药物的不良反应而停药,其中VPA组2例(4.6%),CBZ组3例(7%),两组均有一定的副作用.结论VPA与CBZ单药治疗小儿GTC及P±GTC均具有很好的疗效,应作为治疗的首选药物.     

Thyroid gland volume as measured by ultrasonography in preterm infants

The volume of the thyroid gland was determined by ultrasonography in 30 preterm infants (27-36 weeks' gestation) born in Madrid. Thyroid gland volume significantly increased (p < 0.01) with postnatal and postmenstrual age and was very well correlated with body weight, height and surface area (p < 0.01). Serum thyroid hormones 3,5,3'-triiodothyronine (T₃) and free thyroxine (FT₄) were linearly correlated with postnatal and postmenstrual age, thus T₃ and FT₄ levels were also correlated with thyroid gland volume (p < 0.05). We report measurements of the thyroid gland volume obtained by ultrasonography in this group of preterm infants. Quantitative determination of thyroid gland volume is more accurate for the diagnosis of goitre than clinical criteria. It is also interesting to determine the thyroid gland volume in the neonatal period when the thyroid is particularly hypersensitive to the effects of iodine deficiency and excess.     

30例癫癎儿童个性及认知功能观察

癫痫病是儿童时期最常见的慢性神经系统疾患，发病率高达5％，需长期甚至终生服用抗癫痫药。临床医师往往注重临床发作是否得到控制，而对癫痫儿童的心理行为状况如何很少关注。我们对30例癫痫儿童进行评估，观察癫痫儿童的个性及认知功能的变化，并寻找干预的措施，现将结果报告如下。     

Oral health status in epileptic children

Background: The aim of the present study was to evaluate the oral hygiene status and dental treatment requirements in children with epilepsy. Methods: The treatment group consisted of 211 children with epilepsy (120 boys and 91 girls, 4–15 years old, mean age 7.85 ± 2.98 years). The control group consisted of healthy children, matched by age and gender. Clinical features of the patients were obtained from hospital records. Clinical examinations were conducted, under standard light, using a plane buccal mirror, a dental probe and air drying to evaluate caries experience and to record the periodontal health of each child. Statistical analysis was performed using χ² test, Fisher exact test and anova . Results: The number of decayed and missing teeth, the degree of abrasion and periodontal indexes were significantly worse in patients with epilepsy, compared to the control group (P < 0.001). Gingival enlargement was documented in 42% of patients on valproate monotherapy compared to only in 16% of patients on phenobarbital. Dental caries and halitosis were the most common oral disorders. Generalized tonic–clonic seizures often cause minor oral injuries and traumatized anterior teeth. Conclusions: Epileptic children are at an increased risk of developing caries and gingivitis compared with healthy subjects.     

Motor impairments in children with epilepsy treated with carbamazepine

Nineteen children with epilepsy were tested on two occasions, first during treatment with carbamazepine (CBZ) and then 6 months later without treatment. Plasma drug concentrations were within the therapeutic limits in all children. The children were examined with a standardized test of gross- and fine- motor functions, the Bruininks-Oseretsky test of motor proficiency. Significant improvements were found in response speed ( p < 0.05), in composite fine-motor tests ( p < 0.01) and in the total test battery ( p < 0.05) after the treatment had been withdrawn. A tendency to improvement was found in the fine-motor subtest of upper limb coordination ( p = 0.08). Another group of 12 children was tested twice during treatment with CBZ with an interval of 6 months. No difference was found in this group except for an impairment of the results in the subtest of visual-motor control on the second test occasion ( p = 0.05).     

Thyroid autoimmunity in children with features of both type 1 and type 2 diabetes

Aim/hypothesis:  To assess the prevalence of autoimmune thyroid disease (ATD) in insulin-treated youth with clinical features of type 2 diabetes mellitus (T2DM).
Methods:  We evaluated prevalence of thyroid peroxidase (TPO) and thyroglobulin (TGA) antibodies at onset of insulin-treated diabetes and follow-up in 183 White and Black children. Of these, 136 had a body mass index (BMI) <85th percentile with 122 (89%) positive for β-cell autoimmunity [type 1 diabetes mellitus (T1DM)/group I], 25 were overweight (BMI ≥85thpercentile) with or without acanthosis nigricans with β-cell autoimmunity ['double' diabetes (DD)/group II], and 22 were overweight with no conventional β-cell autoantibodies (group III).
Results:  The prevalence of TPO and/or TGA was 39 and 29% (p = 0.19) in White and Black children and 39, 32, and 0% (p = 0.007) in groups I, II, and III, respectively. After a median follow-up of 60 months, 3.7, 4.3, and 0% developed hypothyroidism (increased thyroid-stimulating hormone with or without decreased free T4) in groups I, II, and III, respectively (p = 0.6). In subjects with TPO and/or TGA, hypothyroidism developed in 10 and 14% of groups I and II, respectively (p = 0.7). No child without thyroid antibodies developed hypothyroidism.
Conclusions:  In patients with clinical features of T2DM who have evidence of β-cell autoimmunity (DD), the frequency of thyroid antibodies and ATD is similar to that in classical T1DM. This suggests that TIDM comorbidities may be common in clinical T2DM patients who have β-cell autoimmunity. Despite their obesity, youth with insulin-requiring diabetes should be screened for thyroid and possibly other T1DM-associated autoimmune diseases.     

儿童癫癎患者认知功能和事件相关电位P300的研究

目的　探讨儿童癫患者认知功能状况和P3 0 0 特点及二者关系。方法　对 38例儿童癫采用odd ball刺激序列检测P3 0 0 ,采用中国修订韦氏儿童智力量表 (WISC -RC)测定智商。结果　 1.癫儿童智商低于正常 6 5 .8% ,智力损害 2 8.9% ;2 .P3 0 0 潜伏期和波幅较对照组明显延长和降低 (P <0 .0 1) ,且智力正常的癫组P3 0 0 潜伏期和波幅较对照组也明显延长和降低 (P <0 .0 5 ) ;3.相关分析显示P3 0 0 潜伏期与各智商间均呈显著负相关 (r =- 0 .2 76～ - 0 .32 7　P均 <0 .0 5 ) ,波幅与语言智商、总智商呈显著正相关。结论　癫儿童存在不同程度的认知障碍 ,智商和P3 0 0 有密切关系 ,但二者又不完全等同 ,均是评价癫儿童认知功能的客观指标     

������������ڶ�ͯ�����������е�̽��Ӧ��

??Renal imaging examination is a necessary method for an early screening or final diagnosis of various types of kidney disease. Objective and accurate measurement of renal volume and virtual reconstruction of renal morphology have important implications for early clinical evaluation of renal function. This article described the progress of renal volume measurement technique and the measurement of renal volume parameters in the field of renal function evaluation in detail. Renal volume parameters are an objective and accurate indicator in renal function evaluation?? which has been gradually accepted and applied clinically??more relevant clinical research will also be carried out gradually.     

儿童癫癎患者认知功能和事件相关电位P_(300)的研究

目的　探讨儿童癫患者认知功能状况和P3 0 0 特点及二者关系。方法　对 38例儿童癫采用odd ball刺激序列检测P3 0 0 ,采用中国修订韦氏儿童智力量表 (WISC -RC)测定智商。结果　 1.癫儿童智商低于正常 6 5 .8% ,智力损害 2 8.9% ;2 .P3 0 0 潜伏期和波幅较对照组明显延长和降低 (P <0 .0 1) ,且智力正常的癫组P3 0 0 潜伏期和波幅较对照组也明显延长和降低 (P <0 .0 5 ) ;3.相关分析显示P3 0 0 潜伏期与各智商间均呈显著负相关 (r =- 0 .2 76～ - 0 .32 7　P均 <0 .0 5 ) ,波幅与语言智商、总智商呈显著正相关。结论　癫儿童存在不同程度的认知障碍 ,智商和P3 0 0 有密切关系 ,但二者又不完全等同 ,均是评价癫儿童认知功能的客观指标     

Hyperfunctioning Thyroid Nodules in Children and Adolescents

ABSTRACT. Eight children and adolescents, seven female and one male, aged 7.1 to 15.0 years, referred over a 12-year period for a solitary mass in an otherwise normal thyroid gland, exhibited a hyperfunctioning nodule on thyroid scintiscan. Tracer uptake in the surrounding thyroid tissue was reduced or completely suppressed, but could be restored after TSH stimulation. Only one patient had mild clinical hyperthyroidism with normal T4 but increased T3 serum levels and blunted TSH responsiveness to TRH. A similar hormonal pattern suggestive of subclinical hyperthyroidism was found in three other subjects who were clinically euthyroid. One patient initially euthyroid progressed to subclinical hyperthyroidism two years later. In the whole group a significant negative relationship was found between serum T3 level and TRH-stimulated TSH peak (r= -0.829, p<0.02). All the patients underwent selective surgery after a 3-month to 2-year period of follow-up. Microscopic examination was consistent with adenoma in seven patients, while in one case a well-encapsulated papillary adenocarcinoma was found. Though hyperfunctioning nodules are seldom malignant, their surgical removal must be recommended when they become thyrotoxic, exceed 3 cm or show progressive enlargement.     

甲状腺功能异常患儿血清瘦素水平与甲状腺激素的相关性研究

目的　研究甲状腺功能异常 [原发性甲状腺功能减退 (甲减 )和原发性甲状腺功能亢进 (甲亢 ) ]患儿血清瘦素 (leptin)水平变化 ,探讨血清瘦素与甲状腺功能的关系。方法　采用放射免疫法分别检测 2 0例甲减患儿、17例甲亢患儿和 2 5例健康儿童血清瘦素水平 ,同时采用微粒子化学发光免疫分析法检测血清游离三碘甲状腺原氨酸 (FT3 )、游离甲状腺素 (FT4)、促甲状腺素 (TSH)等指标。结果　甲低组治疗前血清瘦素水平显著低于正常对照组 (P <0 .0 0 1) ,经药物治疗甲状腺功能恢复至正常后 ,其血清瘦素浓度上升至正常水平 ;甲亢组治疗前后血清瘦素水平与正常对照组相比 ,差异无显著性 (P >0 .0 5 )。结论　甲状腺激素对血清瘦素的分泌具有促进作用