中国儿童青少年性发育现状研究

目的:了解中国儿童青少年性发育现状,比较不同地区性早熟情况。方法:于2009年10月至2010年10月,选择有地域代表的北京、天津、杭州、上海、重庆和南宁六地区6~18岁中小学生共18 707名(男9 812名和女8 895名),按标准化方法测定各年龄组儿童身高、体重、臀围和腰围等数据。采用女性乳房和男性睾丸容积Tanner分期指标衡量青春期发育。采用概率分析法测算男女第二性征出现的年龄中位数及95%可信区间。用精确概率法分析不同地区性早熟发生率,用t检验比较组间不同BMI、腰围计量资料。结果:女孩8岁组以前出现乳房发育的比例为2.91%,男孩9岁以前出现睾丸发育的比例为1.74%。女孩呈现乳房发育B2的中位年龄是9.69(95%CI:9.63~9.75)岁,男孩睾丸达G2期的中位年龄为11.25(95%CI:11.19~11.30)岁。共有80例儿童诊断为性早熟,女孩43例,男孩37例,其患病率为0.43%。北部地区较西南地区发病率高(0.736%vs 0.282%,P<0.05)。三个地区女孩性早熟的发病年龄没有差异,男孩性早熟华东地区发病年龄较早(7.4±0.28)岁。性早熟儿童其BMI的SD值及腰臀比(W/H)较正常同龄儿童高,不同地区性早熟儿童BMI、腰围、腰臀比比较差异均无统计学意义。结论:目前的性早熟诊断标准适合于评估调查地区的儿童性早熟状况。性早熟发病率及发病年龄在不同地区存在一定差异。肥胖与性早熟之间存在正相关。     

1231名立陶宛在校女生青春期前乳房和阴毛发育的开始时间

背景:由于内分泌系统中不同的腺体影响着乳房、阴毛和腋毛的发育,因此,为区别不同的病理状态,有必要对青春期进行正确分期。目的:确定立陶宛在校女生青春期前肾上腺皮质功能初现及乳房发育的常见时间。方法:对1231名年龄7.0～11.6岁间的在校女生进行横断面研究。根据Tanner方法,将青春期分期。根据概率分析计算进入青春期各个时期的平均年龄。结果:255例7岁女生中,2例(0.8%)表现为肾上腺皮质功能初现过早,1例(0.4%)表现为乳房发育过早。出现阴毛/腋毛的平均年龄为11.0岁。2期、3期和4期乳房发育的平均年龄则分别为10.2岁、11.3岁和13.9岁。…     

B超检测在女性性早熟诊断中的应用

女性性早熟近年来发病呈上升趋势。本文对我院儿科诊治的女性性早熟病例 34例进行回顾性分析 ,探讨B超检测在女性性早熟诊断、鉴别诊断及疗效观察中的价值。1　资料与方法1.1　临床资料　 2 0 0 2年 7月～ 2 0 0 3年 7月在我院儿科经临床检查诊断为“女性性早熟”的患者共 34例 ,其中以乳房早发育就诊的 19例 ,初诊年龄 6 212 ～ 8512 岁 ,初诊时乳房发育达TannerⅡ期～Ⅲ期[1] ,尚无月经来潮 ;以月经初潮就诊的 15例 ,初诊年龄 8112 ～ 10岁 ,初诊时乳房发育达TannerⅢ期～Ⅳ期。1.2　B超检查方法　应用ALOKASSC - 390超声诊断仪。凸…     

青春期女生发育分期与骨量关系的研究

目的探讨青春期女生发育分期与骨量的关系。方法调查柳州市区初一、初二女生共186名,年龄为12～17岁,采用Tanner分期法把青春期女生发育分为Ⅱ、Ⅲ、Ⅳ期并记录月经初潮的出现,运用双能量X线骨密度测量仪(DEXA)测量不同发育分期的全身骨密度(BMD)和全身骨矿物质含量(BMC),并对比分析。结果青春期女生的BMD和BMCⅣ期大于Ⅲ期(P<0.01),Ⅲ期大于Ⅱ期(P<0.01),两两之间差异有高度显著性。结论青春期女生发育分期与骨量有关。     

青春期学生骨量影响因素的研究

目的 了解青春期学生骨量的影响因素,从而为生命早期预防骨质疏松提供科学依据.方法 调查柳州市区初中学生353名,年龄为12～17岁,男生164人,女生189人.采用24 h回顾法了解膳食摄入、体力活动问卷了解体力活动情况.采用双能量X线骨密度测量仪(DEXA)测量全身骨量及体脂百分比.用Tanner五分期法评价第二性征发育.采用身高标准体重评价研究对象的营养状况.结果 与男生全身BMD关系最大的是体重,其次是体力活动强度、Tanner期、膳食钙摄入量、年龄和碳水化合物,与BMC关系最大的是体重,其次是身高、Tanner期和体力活动强度;与女生全身BMD关系最大的是体重.其次是乳房发育分期、年龄、月经初潮、体力活动强度、膳食钙摄入量、身高和脂肪摄入量,与BMC关系最大的体重,其次是身高、乳房发育分期、营养状况、月经初潮、蛋白质摄入量、膳食钙摄入量和磷摄入量.结论 影响青春期学生骨量主要决定因素为体重、青春发育状况、身高和体力活动强度,并且体力活动强度和膳食钙对男生全身骨量的影响大于对女生的影响.     

成都市儿童青少年肉类、奶类及锌的摄入状况与青春期发育的关系

目的 了解成都市9~15岁儿童青少年肉类、奶类、锌的摄入状况及青春期发育现状,并分析食物营养素摄入与青春期发育的关系。方法 采用分层整群抽样法选取成都市1 328例9~15岁儿童青少年作为研究对象,采用食物频率法和24 h膳食回顾法分别收集调查对象肉类、奶类以及锌的摄入状况,利用现场观测和问卷调查方法分别收集青春期发育状况及相关的基础信息。根据Tanner青春期发育标准将男女生分别进行分组,比较不同组间肉类、奶类、锌的摄入状况。结果 被调查男生初遗中位年龄为13.00岁,已初遗组总肉类、红肉平均每日摄入量均高于未初遗组（ P<0.05）,奶类平均每日摄入量低于未初遗组（ P<0.05）;男生总肉类平均每日摄入量为青春期发育晚期组最高,发育早期组次之,未发育组最低（ P<0.05）。女生初潮中位年龄为12.11岁,已初潮组总肉类平均每日摄入量高于未初潮组（ P<0.05）,奶类平均每日摄入量低于未初潮组（ P<0.05）;女生奶类平均每日摄入量青春期为未发育组最高、发育早期组次之、发育晚期组最低（ P<0.05）。结论 成都市儿童青少年肉类、奶类的摄入状况可能与青春期发育相关,性别差异有待进一步研究。     

乳腺超声检查在性早熟诊断中的应用价值

目的:探讨乳腺超声检查在女性性早熟诊断中的应用价值?方法:选取乳房发育的女童200例,其中单纯性乳房早发育组54例,中枢性性早熟组112例,对照组为34例青春发育早期儿童,分别进行乳腺超声检查和雌激素(E2)?孕激素?催乳素?黄体生成素(LH)峰值?促卵泡激素(FSH)峰值?骨龄等指标的检测,分析乳房超声检查结果与激素之间的相关性?结果:方差分析结果显示,中枢性性早熟组乳房体积较单纯性乳房早发育组及青春发育早期组明显增大(P < 0.001),卡方检验Tanner2~4期构成比各组间差异无统计学意义?相关性分析显示乳房体积与雌激素?LH峰值?LH峰值/FSH峰值?体重指数(BMI)?骨龄呈正相关,与孕酮?催乳素?年龄?FSH峰值之间没有相关性?以乳房体积为因变量,雌激素?LH峰值?LH峰值/FSH峰值?BMI为自变量,应用多元线性回归分析乳房体积的影响因素,LH峰值/FSH峰值是影响乳房体积的相关因素(乳房体积=2.523 + 2.268×LH峰值/FSH峰值;P < 0.001)?结论:乳腺超声检查对乳房发育情况的评估优于Tanner分期,对单纯性乳房发育及中枢性性早熟的鉴别诊断有一定帮助,且在预测快速进展型中枢性性早熟中有一定价值?     

性激素结合球蛋白在低龄女童乳房早发育中的临床价值

目的 探讨性激素结合球蛋白（sex hormone-binding globulin，SHBG）在低龄女童乳房早发育（premature thelarche，PT）中的临床价值。方法 选取2020年6月至2021年12月于江西省儿童医院就诊的1～3岁PT女童308例，根据乳房Tanner分期将其分为A1组（Tanner分期为Ⅱ期，226例）和A2组（Tanner分期大于Ⅱ期，82例），另选取同期于本院行健康体检的1～3岁女童45例纳入A3组。所有受试女童采用化学免疫发光法检测SHBG，分析其在低龄女童中不同乳房发育阶段的差异。结果 A2组女童的SHBG水平显著低于A1组[（160.12±28.55）nmol/L vs. （167.44±23.12）nmol/L，t=–2.30，P<0.05]和A3组[（160.12±28.55）nmol/L vs. （169.84±15.26）nmol/L，t=–2.12，P<0.05]，但A1组和A3组女童的SHBG水平比较差异无统计学意义（t=–0.67，P=0.50）。结论 SHBG与儿童乳房发育进程有关，可作为辅助判断性发育进程的指标。当低龄女童SHBG降低，应密切随访监测性发育情况，警惕中枢性性早熟的发生。     

学龄期儿童肥胖与性早熟的关联性分析

摘要 目的：分析肥胖儿童代谢指标与儿童性早熟发生的相关性。方法：择取本院儿科2019年9至2020年9月小学学生健康体检发现的53 例性肥胖儿童作为观察研究对象,作为研究组。选取同期在接受健康体检的53名健康儿童作为对照组。将两组儿童的代谢指标与性早熟的关系进行分析。结果：观察组儿童的FGB 、2hPG 及GHb 均高于对照组儿童( P＜0. 05) ;观察组儿童的BUA、HDL 低于对照组儿童,而TG、TC、LDL 高于对照组( P＜0. 05) ;观察组儿童中男性儿童的睾丸Tanner 评分、阴毛Tanner 评分、女儿童的乳房Tanner 评分以及阴毛Tanner 评分均高于对照组儿童( P＜0. 05) 。Spearman 相关性分析显示,观察组儿童的FPG、2hPG、GHb、TG、TC、LDL 与性早熟呈正相关,而BUA、HDL 与性早熟呈负相关( P＜0. 05) 。对照组儿童的上述指标与性早熟无相关性( P＞0. 05) 。结论：肥胖儿童中血糖、血脂代谢指标与性早熟关系密切。应重视对肥胖儿童中血糖、血脂指标异常儿童进行性早熟相关筛查。     

肥胖儿童血糖、血脂代谢特征与性早熟的相关性分析

目的：分析肥胖儿童的血糖与血脂代谢特征与性早熟的相关性。方法：选取2019年9月-2021年6月在北京京煤集团总医院儿科就诊的肥胖儿童60例为观察组,其中42例儿童肥胖,18例儿童合并性早熟,另选取同期60例健康儿童作为对照组,检测两组儿童血糖和血脂代谢指标,分析肥胖患儿血糖和血脂代谢特征及其与儿童性早熟之间的相关性。结果：对照组空腹血糖、糖化血红蛋白和餐后2 h血糖高于观察组,差异具有统计学意义(P<0.05);观察组的甘油三酯、低密度脂蛋白胆固醇和血清总胆固醇均高于对照组,观察组高密度脂蛋白胆固醇、尿素氮低于对照组,差异具有统计学意义(P<0.05);合并性早熟儿童的男童阴毛Tanner评分、睾丸Tanner评分和女童阴毛Tanner评分、女童乳房Tanner评分均明显高于单纯肥胖儿童,差异具有统计学意义(P<0.05);性早熟与肥胖儿童的空腹血糖、糖化血红蛋白、餐后2 h血糖、甘油三酯、低密度脂蛋白胆固醇和血清总胆固醇呈现出正相关,与高密度脂蛋白胆固醇和尿素氮呈现出负相关,差异具有统计学意义(P<0.05)。结论：肥胖儿童的血脂与血糖指标和性早熟发生之间具...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.