婴幼儿手术损伤与外周血淋巴细胞凋亡的关系

目的　手术应激可引起细胞介导的免疫受到抑制 ,包括淋巴细胞数量减少 ,导致感染并发症增加 ,确切的原因尚不清楚 ,本研究探讨婴幼儿大手术损伤和淋巴细胞凋亡的关系。方法　 1 2例择期大手术婴幼儿和 6例严重感染的婴幼儿 ,择期手术患儿包括先天性胆总管囊肿 7例和先天性巨结肠 5例 ,其中男 8例 ,女 4例 ,年龄 6个月～ 3岁 ;6例正常婴幼儿作为对照 ,抽取外周血 ,用Boyum描述的方法借助梯度离心分离淋巴细胞 ,用AnnexinV/PI双染色法来分析淋巴细胞早期凋亡情况 ,流式细胞仪测定淋巴细胞Fas的表达。结果　术后患儿外周血淋巴细胞明显下降 ,术后 1d为最低 ,术后 3d仍处于低值。大手术组患儿淋巴细胞凋亡率为 (1 4 .1± 1 .1 ) % ,严重感染组为 (1 2 .3±2 .0 ) % ,与正常对照组 (5 .1± 0 .3) %相比有统计学意义 (P <0 .0 5) ;Fas阳性淋巴细胞百分数术毕为(50 .3± 6 .3) % ,术后 1d为 (49.3± 4 .3) % ,与术前 (36 .3± 1 .1 % )相比有统计学意义 (P <0 .0 5)。结论　经历大手术的患儿循环淋巴细胞呈现凋亡的早期征象 ,可能是全身炎症反应中免疫细胞低反应的原因     

Th1/Th2细胞的功能变化在婴幼儿重症肺炎中的意义

采用急性肺损伤评分标准、儿童危重评分标准对 2 3例重症肺炎和 2 7例普通肺炎的严重程度进行评估。采用ＥＬＩＳＡ方法测定上述肺炎患儿外周血干扰素γ(ＩＦＮ γ)、白介素 4 (ＩＬ 4 )的浓度。结果 :1.重症肺炎患儿的急性肺损伤评分高于普遍肺炎 (1.5 7± 0 .5 3/ 0 .5 4± 0 .36 ) (Ｐ <0 .0 1) ,而危重评分低于普通肺炎 (79.2 4± 5 .38/ 94 .0 0± 3.34) (Ｐ <0 .0 1)。 2 .重症肺炎患儿ＩＦＮ γ低于普通肺炎 (Ｍ :3.4 9ｐｇ/ｍｌ,Ｐ95 :7.2 0ｐｇ/ｍｌ) / (Ｍ :5 .2 0 ｐｇ/ｍｌＰ95 :3.4 9ｐｇ/ｍｌ) (Ｐ<0 .0 5 ) ,而ＩＬ 4在重症…     

支原体肺炎患儿辅助性T淋巴细胞亚群TH1、TH2细胞状况

目的　探讨肺炎支原体肺炎急性期患儿外周血淋巴细胞亚群以及辅助性T淋巴细胞亚群TH1、TH2细胞的改变 ,为免疫治疗的可能性提供依据。方法　采用流式细胞仪技术 (FACS)检测了3 5例支原体肺炎急性期患儿外周血T淋巴细胞亚群以及NK细胞和B细胞 ,同时通过检测分泌细胞因子γ干扰素 (IFN γ)、白细胞介素 4(IL 4)的CD+ 4细胞方法 ,测出相应TH1、TH2细胞的百分比 ,并与2 8例正常儿童进行比较。同时对 3 5例支原体肺炎患儿中的 3 0例进行了血清免疫球蛋白及精制结核菌素 (PPD)皮肤试验。全部患儿均系在我院住院的患儿 ,男 15例 ,女 2 0例 ,年龄 3～ 13岁 ,平均 9岁。对照组男 14例 ,女 14例 ,年龄 3～ 12岁 ,平均 7岁。结果　支原体肺炎患儿急性期外周血CD+ 3 、CD+ 4T细胞百分率为 68 0 0± 6 66及 3 7 86± 5 84,较对照组 63 71± 7 92及 3 4 54± 6 2 3高 ,(P <0 0 5) ;患儿外周血TH1细胞百分率为 14 13± 8 46,对照组为 2 0 77± 6 89,两者差异有非常显著意义 (P =0 0 0 1)。NK细胞及TH1/TH2比值在患儿组降低 (P分别为 <0 0 1和 <0 0 5)。两组间CD8、TH2、B细胞百分率及CD4/CD8比值差异无显著意义。 3 0例患儿之血清免疫球蛋白与同龄正常儿童比较 ,IgG全部正常 ;IgA升高 7例 ;IgM升高 4例。皮肤P     

Th1/Th2细胞功能变化在婴幼儿重症肺炎中的意义

通过观察婴幼儿重症肺炎中T辅助细胞Th1/Th2细胞的功能变化及结合相关的临床评分,以探讨其在重症肺炎发生、发展中的作用。采用急性肺损伤评分标准、儿童危重评分标准对23例重症肺炎和26例普通肺炎的严重程度进行评估;采用ELISA方法测定上述肺炎患儿外周血中IFN-γ、IL-4的浓度。结果显示:①重症肺炎患儿急性肺损伤评分高于普通肺炎(1.57±0.53/0.54±0.37,P<0.01),而危重评分低于普通肺炎(79.24±5.38/94.00±3.41,P<0.01)。②重症肺炎患儿IFN-γ平均水平低于普通肺炎(M=3.49pg/ml,P95=7.20pg/ml)/(M=5.28pg/ml,P95=21.71pg/ml),P<0.05;而IL-4在重症肺炎中的水平略高于普通肺炎,但无统计学意义(M=1.12pg/ml,P95=1.46pg/ml)/(M=0.69pg/ml,P95=1.69pg/ml),P>0.05;重症肺炎患儿IFN-γ/IL-4的比值低于普通肺炎,(M=2.88,P95=9.63)/(M=7.02,P95=24.32),P<0.05。③IFN-γ/IL-4的比值与急性肺损伤评分成负相关,r=-0.31,P<0.05,与危重评分成正相关,r=0.32,P<0.05。提示婴幼儿重症肺炎的发生可能与Th2优势反应、抗炎反应过强有关。     

肺炎支原体感染患儿T淋巴细胞亚群检测及分析

目的　观察肺炎支原体肺炎患儿急性期外周血T淋巴细胞亚群、T淋巴细胞活化状态的改变,探讨其发病机制。方法　采用流式细胞仪技术检测了2 0 0 2年1 0月至2 0 0 3年6月就诊于上海市金山区中心医院的1 7例肺炎支原体肺炎患儿急性期外周血T淋巴细胞亚群及T细胞亚群上CD2 5+的表达和CD4+细胞上CD4+CD45RA+、CD4+CD45RO+的表达;对照组为1 0例健康体检儿童。两组年龄、性别差异无显著意义。结果　肺炎支原体肺炎患儿急性期外周血CD3 +百分率( % )为( 62 . 2 3±6 .2 7) ,较对照组( 68 .60±4. 74)低,差异有显著性意义(P <0 . 0 5) ;CD4+、CD8+百分率较对照组差异无显著性意义(P >0. 0 5) ;CD8+CD2 5+百分率( % )为( 0 . 61±0 . 58) ,较对照组( 2 .1 6±0 . 40 )降低,差异有极显著性意义(P <0 .0 1 ) ;CD4+CD45RA+/CD4+CD45RO+比值与对照组相比降低(P <0 . 0 5)。结论　肺炎支原体肺炎时存在细胞免疫失调,主要表现为总T细胞降低,T细胞活化障碍和CD4+CD45RA+/CD4+CD45RO+平衡失调。     

缺铁性贫血患儿T辅助细胞的免疫与调控

为研究缺铁性贫血患儿T辅助细胞 (TH)的细胞调控及免疫功能。对 2 0 0 2年 1月至 2 0 0 2年 1 2月住院患儿进行TH 细胞检测 ,同时设正常健康儿童 2 8人为对照组。对两组儿童应用ELISA法检测白细胞介素 2 (IL 2 )及γ干扰素 (INF γ)水平 ,用单细胞内染色法检测TH1、TH2 百分率。结果 :缺铁贫血患儿IL 2 ( 1 6 55± 2 87ug L)水平明显降低 ,与对照组IL 2 ( 2 4 73± 4 37ug L)比较差异有显著意义 (t =8 6 2 ,P <0 0 1 ) ;INF γ( 4 75 6± 2 7 1pg mL)水平也明显降低 ,与对照组IFNγ( 6 54 0 7± 1 4 6 4pg mL)比较 ,差异有极其显著性意义 (t =7 4 2 ,P <0 0 1 ) ;缺铁性贫血患儿TH1百分率( 1 2 2 4± 2 51 % )亦明显低于对照组TH1百分率 ( 1 6 6 7± 2 73% ) ,经t检验差异亦有极显著意义 (t=6 89,P <0 0 1 ) ;缺铁性贫血患儿TH2 百分率明显升高 (t=5 37,P <0 0 5)。结果表明 :缺铁贫血患儿机体TH1细胞数量及功能低下 ,TH1 TH2 值下降 ,TH1、TH2 极化异常 ,导致细胞毒性T细胞 (CTL)介导的细胞免疫功能受到抑制     

FasL基因转移诱导同种异体反应性T细胞凋亡的实验研究

目的　研究FasL基因转染鼠骨髓单个核细胞 (BMMNC)后 ,诱导同种异体反应性T淋巴细胞凋亡的效率。方法　采用脂质体法将mFasL cDNA转入Balb/C小鼠造血细胞 ,Western Blot检测其是否表达 ,然后将转染mFasL cDNA的BMMNC与BAC鼠 (Balb/C×C5 7BL/6 ,H 2d×b ,F1)脾单核细胞 (SMNC)混合培养 ,通过混合淋巴细胞反应 (MLR)及流式细胞仪 (FCM)检测SMNC的凋亡效率。结果　基因转移后Western Blot分析Balb/C鼠BMNC显示明显抗FasL抗体识别的条带 (约 4 0 0 0 0 ) ,未转基因的BMMNC无阳性条带发现 ;转基因组进行MLR其每分钟脉冲数 (CPM)值为 5 6 2 8± 186 ,明显低于对照组 (96 74± 78) (t=4 4 86 ,P <0 0 0 1) ;FCM检测转基因组诱导SMNC凋亡率为 (14 8± 0 4 ) % ,明显高于对照组 [(1 8± 0 4 ) % ](t=3 0 1,P <0 0 1)。结论　采用脂质体法能将mFasL cDNA转入鼠BMMNC ,并能有效表达 ,转基因后的BMMNC有诱导同种异基因反应性T淋巴细胞凋亡的作用     

肿瘤坏死因子α诱导K_(562)凋亡

为探讨肿瘤坏死因子 - α(TNF- α)诱导 K562 凋亡的作用 ,应用细胞形态学观察、DNA琼脂糖凝胶电泳 ,原位末端标记法检测 K562 、TNF-α诱导的 K562 。结果　表明 ,细胞形态学观察 K562 自然凋亡率 (2 .9± 0 .7) % ,TNF- α5 0 ng/ml、1 0 0 ng/ml诱导的 K562 凋亡率分别为 (1 6 .5± 4.1 ) % ,(2 3.9± 4.8) %。 (F=89.9,P<0 .0 1 )。 DNA琼脂糖凝胶电泳 TNF- α1 0 0 ng/ml诱导的 K562 DNA电泳呈梯状条带。原位末端标记法K562 自然凋亡率 (3.5± 1 .0 ) % ,TNF- α5 0 ng/ml、1 0 0 ng/ml诱导的 K562 凋亡率分别是(2 1 .4± 4.5 ) %、(2 7.4± 4.9) %。 (F=1 0 4.9,P<0 .0 1 )。结论　 TNF-α 5 0 ng/ml、1 0 0 ng/ml能诱导 K562 凋亡     

小儿病毒性心肌炎与Fas/Fasl介导的外周血淋巴细胞凋亡的关系

目的 探讨Fas/Fasl介导的外周血淋巴细胞凋亡在病毒性心肌炎发病中的作用.方法 选择临床诊断病毒性心肌炎患儿和正常小儿各25例,采用Annexin V/PI双参数法经流式细胞仪定量检测两组小儿外周血淋巴细胞凋亡百分率,并用双色流式细胞仪检测外周血淋巴细胞Fas、Fasl蛋白表达结果心肌炎患儿外周血淋巴细胞凋亡率[(0.697 6±0.110 9)%]较正常对照组[(0.128 8±0.106 9)%]明显升高(t=18.459,P＜0.001),且与肌酸激酶同工酶、乳酸脱氢酶、肌酸激酶、羟丁酸脱氢酶升高程度均呈正相关(r=0.817,P＜0.01;r=0.785,P＜0.01;r=0.726,P＜0.01;r=0.712,P＜0.01);心肌炎患儿外周血淋巴细胞Fas、Fasl蛋白表达[(2.8804±0.3020)、(4.4496±0.4836)]较对照组[(2.1300±0.6200)、(0.123 8±0.0384)]明显增加(t=17.321,P＜0.001;t'=44.577,P＜0.001);心肌炎患儿外周血淋巴细胞凋亡百分率与 Fas、Fasl蛋白表达均呈正相关(r=0.972,P＜0.01;r=0.958,P＜0.01)结论病毒性心肌炎患儿外周血淋巴细胞凋亡增加,可能为细胞免疫功能下降的原因之一,且与心肌损害程度相关 Fas、Fasl基因在病毒性心肌炎患儿外周血淋巴细胞凋亡中起着重要作用.     

脐血CD3AK细胞诱导K562细胞凋亡的实验研究

目的　探讨脐血CD3AK细胞诱导K5 6 2 细胞凋亡的作用。方法　用细胞形态学观察 ,DNA琼脂糖凝胶电泳 ,原位末端标记法检测 2 0例K5 6 2 细胞、2 3例CD3AK细胞诱导的K5 6 2细胞凋亡率。结果　K5 6 2 细胞自然凋亡率 (3.5 0± 0 .97) % ;经CD3AK细胞诱导的K5 6 2 细胞凋亡率 (2 7.38± 4.91) % ,二者之间具有显著性差异 (t=15 .1　P <0 .0 1)。结论　脐血CD3AK细胞能诱导K5 6 2 细胞凋亡。     

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.     

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   

�¶�֢��ϵ�ϰ���ע��ȱ�ݶද�ϰ������ڵ�ת��

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.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

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.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

---

---

Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.