支气管哮喘患儿心理学特点的对照研究

目的 了解哮喘患儿的心理学特点。方法 采用ＥＰＱ、ＣＢＣＬ、ＣＲＴ、ＳＡＢ量表,对６３例病程３～１１年、年龄７～１２岁的中、重度哮喘患儿进行个性、行为、智力及适应能力的心理测试。结果 哮喘儿童Ｎ质个生高于对照组（Ｐ〈０．０１）。行为问题发生率为３０％,男孩多有攻击行为,女孩表现为抑郁、社会退缩。患儿平均智商为１０５．６５,与对照组比较差异无显著意义（Ｐ〉０．０５）,但Ｄ、Ｅ单元得分低于对照组（Ｐ〈     

抽动障碍儿童家庭、社会适应能力及行为的研究

为探讨抽动障碍儿童与正常儿童在家庭、社会适应能力及行为心理方面的异同,采用自制定向问卷对80例抽动患儿和100例正常儿童进行调查,内容包括三方面共17项。对调查结果应用Epi info Version统计软件包进行分析。结果显示,在家庭状况方面。抽动患儿和正常儿童在其家庭类型上几乎无差异,但前者神经精神阳性家族史显著高于后者(X_(MH)~2=8.93,P<0.05),在家庭教育上,抽动组家长以打骂、训斥为主的教育方式远较正常组高;在社会适应能力方面,抽动患儿与正常儿童相比,较多的表现为结识新友难,在校成绩相对较差,容易产生孤独感(t值=4.38,P<0.01);在行为问题上,抽动患儿更多的伴随多动注意障碍、攻击行为、精神紧张等。提示家族阳性神经精神病史、父母教养不当、社会适应能力欠佳、行为心理问题较多等与抽动障碍密切相关,并在该症的发病过程中起重要作用,应引起重视。     

血液肿瘤患儿及其家长心理特点的对照研究

为了解血液肿瘤患儿及其家长的心理特点，制定综合治疗方案和提高生活质量提供依据，采用艾森克人格问卷（儿童）（EPQ）、Achenbach儿童行为评定量表（CBCL）对57例年龄6岁－11岁的血液肿瘤患儿进行个性、行为的心理测试，采用90项症状自评量表（SCL－90）对57例患儿家长进行心理卫生状况调查。结果表明，血液肿瘤患儿E质个性低于对照组（P＜0．05）；行为问题发生率为21．1％％，男性多有交往不良、躯体诉述、违纪，女孩表现为抑郁、社会退缩； 血液肿瘤组患儿家长各项因子分均高于对照组，两组比较差异有极显著意义（P＜0．01）；患儿的行为问题与家长的心理卫生状况有显著的相关性。认为血液肿瘤患儿的个性、行为问题以及家长心理状况应引起医护人员的关注，适当的心理干预是必要的。     

支气管哮喘与一氧化氮及cGMP关系的初步研究

研究目的小儿哮喘时一氧化氮的作用机制及临床意义。研究方法哮喘患儿３３例，正常健康儿童２０例为对照组。测定一氧化氮（ＮＯ）水平及ｃＧＭＰ水平，并对测定结果进行统计学分析。研究结果所有哮喘患儿血浆ＮＯ及ｃＧＭＰ水平在治疗前均明显高于正常儿童（Ｐ均＜０．００１），其中９例重度哮喘患儿血浆ＮＯ水平较２４例轻中度哮喘患儿更高（Ｐ＜０．００１）；治疗后血浆ＮＯ及ｃＧＭＰ水平均恢复正常。结论哮喘发作时一氧化氮产生过多，发挥其细胞及组织毒性作用，使肺上皮细胞等损伤，从而引起和加重哮喘发病，且血浆ＮＯ水平与哮喘病情密切相关。     

肺炎支原体感染与儿童哮喘关系的研究

目的探讨肺炎支原体感染与儿童哮喘发病的关系。方法支气管哮喘患儿362例，肺炎患儿288例，正常对照组30例，分别采用颗粒凝集法检测血清肺炎支原体IgM（MP—IgM）抗体；同时采用同位素放射免疫法测定哮喘患儿血清总IgE。结果（1）支气管哮喘患儿MP-IgM阳性率49．45％，显著高于肺炎患儿MP—IgM阳性率39．24％，上述两组均显著高于正常对照组6．67％；（2）在各年龄组支气管哮喘患儿MP—IgM阳性率比较中，发现学龄期儿童MP-IgM阳性率最高；（3）MP—IgM阳性的支气管哮喘患儿血清总IgE水平明显高于MP-IgM阴性哮喘患儿的血清总IgE。结论儿童肺炎支原体感染与儿童哮喘发病密切相关。     

血管紧张素转移酶基因插入/缺失多态性与儿童哮喘的关系

目的 探讨血管紧张素转移酶（ＡＣＥ）基因插入／缺失多态性与儿童哮易感性的关系。方法 应用聚合酶链反应方法检测５２例哮喘患儿，５４例肺炎患儿及４０例正常儿童的ＡＣＥ基因型。用呼气峰速仪测定２３例哮喘患儿的最大呼气流量作为评价肺功能的指标。结果 三组儿童ＡＣＥ基因型（Ⅱ型、ＥＤ型、ＤＤ型）频率的分布差异有显著意义（Ｐ〈０．０５），哮组ＤＤ基因和正常组比较，ＤＤ与正常组（１２．５％）和肺炎组（１４．８％     

癫痫儿童适应行为特点的对照研究

目的 探讨癫痫儿童与正常儿童在适应行为方面的差异。方法 根据病例对照研究原则,采用１：１配对法,应用儿童适应行为评定量表分别对４２例３～１２岁癫痫儿童及正常儿童进行调查。结果 ①癫痫儿童的适应行为商数明显低于对照组[（８２．９±２７．３）ｖｓ（１０３．０±１４．６）］（Ｐ＜０．０５）。②癫痫儿童适应行为缺损主要表现在感觉运动、语言发展、社会责任、时空定向方面。在独立功能因子、认知功能因子方面与对照组比较差异有显著性(Ｐ＜０．０１或０．０５）。 ③癫痫的严重程度、家庭关系、父母文化程度、年龄及居住环境对癫痫儿童的适应行为有所影响（Ｐ＜ ０．０１或０．０５）。结论 癫痫儿童易出现适应行为缺损,对癫痫儿童进行必要的心理干预有助于提高其生活质量。     

支气管哮喘儿童的心理行为评价

目的分析支气管哮喘儿童的心理行为。方法采用儿童行为量表（CBCL）分别对支气管哮喘和健康儿童各100名进行问卷调查，并计算总分和行为因子，用SPSS12．0统计软件进行对比分析。结果哮喘儿童行为问题发生率显著高于健康儿童组，两组比较有显著差异（P〈0．05）；哮喘与同性别健康儿童的行为问题因子比较有显著差异（P〈0．05）。结论支气管哮喘儿童易发生心理行为异常。     

心理干预对支气管哮喘患儿的影响

目的探讨心理干预措施对治疗儿童支气管哮喘的影响。方法对112例3～12岁的哮喘儿童进行问卷调查。采用随机对照方法，分为心理干预组和对照组，两组均给同样药物治疗，干预组同时给予心理干预，心理干预前后观察两组临床疗效、复发情况等。结果 89．8％理干预能有效降低支气管哮喘的复发率，提高临床疗效，缩短病程，提高生活质量，促进患儿身心健康发展。的哮喘患儿存在明显的心理障碍。通过心理干预治疗，干预组在临床疗效、复发情况等方面均显著优于对照组（P〈0．01）。结论心     

儿童哮喘与亚临床状态维生素A缺乏关系的研究

采用微量荧光测定法对２０例哮喘患儿及３５例健康儿童进行血清维生素Ａ（ＶｉｔＡ）检测。结果表明：各年龄段哮喘患儿血清Ｖｉｔ Ａ水平明显低于正常对照组,尤其是≤３岁组及〉６岁组（Ｐ〈０．００１）。哮喘组亚临床ＶｉｔＡ缺乏发生率为８０％（１６／２０例）,正常对照组为２０．８％（１／３５例）,有显著性差异（Ｐ〈０．００５）。其中≤３岁组最高,占５０．０％（１０／２０例）。结论：儿童哮喘存在着亚临床状态ＶｉｔＡ缺乏,两者可能互为因果关系。     

哮喘儿童及家长心理健康状况调查

目的 了解哮喘儿童及其家长的心理健康状况.方法 采用艾森克人格问卷(儿童)、Rutter's儿童行为量表(父母问卷)对36例6～14岁哮喘儿童进行个性、行为心理测试.采用90项症状自评量表(SCL-90)对其家长进行心理卫生状况调查.结果 哮喘儿童E、N值均高于正常对照组(P<0.05),行为问题发生率为33.3%,哮喘家长SCL-90各项因子分均高于对照组,以抑郁、焦虑、躯体诉述及恐怖因子得分最明显(P<0.05).结论 哮喘儿童及家长的心理问题均较健康对照人群高,应引起高度重视,积极进行心理干预.     

支气管可逆性试验对哮喘儿童治疗的指导意义

目的：观察哮喘治疗期间不同临床症状患儿肺功能的变化,探讨支气管可逆性试验对儿童哮喘治疗的指导意义。方法：417例哮喘患儿通过吸入沙美特罗/氟替卡松治疗时间3个月以上。复诊时根据患儿症状分为无症状组（n=215）、单咳组（n=89）、阵咳组（n=72）和喘咳组（n=41）。34例正常儿童作为对照组。应用沙丁胺醇泵雾化进行支气管可逆性试验,试验前后行肺功能检测。结果：各个哮喘组沙丁胺醇雾化后肺功能异常率较雾化前均明显降低,FEV1%/预测值雾化后均较雾化前显著升高（P<0.05）。雾化前单咳组、阵咳组、喘咳组肺功能异常率均较对照组显著增高,FEV1%/预测值均较对照组显著降低（P<0.05）;雾化前各个不同症状哮喘组间肺功能异常率及FEV1%/预测值差异有统计学意义（P<0.05）。雾化后阵咳组、喘咳组肺功能异常率明显高于对照组（P<0.05）,其他各组与对照组比较差异无统计学意义;雾化后喘咳组FEV1%/预测值明显低于对照组,其他各组与对照组比较差异无统计学意义。不同症状的4个哮喘组支气管可逆性试验阳性率均高于对照组（P<0.05）;各个哮喘组间可逆性试验阳性率比较,除无症状组与单咳组差异无统计学意义外,其余各组间差异均有统计学意义（P<0.05）。结论：儿童哮喘治疗期间不同症状者肺功能存在差异;支气管可逆性试验结合肺功能检查有利于哮喘控制的评估和治疗指导。     

Bronchial hyper-responsiveness predicts the development of mild clinical asthma within 2 yr in school children with hay-fever

In children with mild asthma, symptoms are not always apparent. Therefore, results of tests play an important role for the diagnosis. First, to investigate whether children with bronchial hyper-responsiveness (BHR) but no symptoms of asthma in 1992 had developed clinical asthma at follow up in 1994. The second aim was to find out the diagnostic properties of tests for asthma/allergic inflammation, using either doctor diagnosed asthma (DDA), self-assessed symptoms of asthma or iso-capnic hyperventilation of cold air (IHCA), as the standard, to diagnose asthma in a group of children with hay fever. Twenty-eight children with pollinosis, 12 of them with a history of asthma for the first time during the season 1992, were studied during the birch pollen season and in the autumn of 1994. During both periods, the bronchial hyper-reactivity was estimated by methacholine bronchial provocation tests (MBPT), bronchial variability by peak expiratory flow rate variability, subjective symptoms of asthma by visual analogue scale (VAS) and bronchial inflammation by serum and urine levels of inflammatory mediators. In 1994 IHCA was added during both seasons. Eight of 16 children with BHR but without clinical asthma in 1992 had developed asthma in 1994, 14 of 16 reacted to IHCA and 13 to MBPT. All 12 children with DDA in 1992 had still asthma in 1994 and 14 children with BHR in 1992 had persistent BHR in 1994. Of 23 children with BHR in 1992, 17 had DDA in 1994 and all maintained their BHR. Furthermore, 20 of them reacted to IHCA in 1994. In 1994, 24 of 28 hay-fever children had a positive IHCA tests and 24 had positive MBPT. In relation to VAS, the sensitivity of IHCA and MBPT to predict present asthma was high, but the specificity low, whereas the specificity of most other tests was high, but based on few individuals. In relation to DDA both the IHCA test (65-80%) and the MBPT test (79-85%) had a high sensitivity and it was three to six times more likely to find a positive test among asthmatics than in non-asthmatics. Children with hay fever without clinical asthma have a high risk of developing asthma within 2 yr. In relation to DDA, inhalation of cold air and the MBPT showed a high sensitivity.     

Social and economic impact of childhood asthma

In order to assess the social, educational and economic impact in children with asthma and their families, we studied 162 children with bronchial asthma. The patients and their parents were interviewed to assess the restriction on various activities of the child and family, the impact on schooling and expenditure on therapy. One hundred and forty one (87%) children had either mild or moderate persistent asthma. Nearly two thirds of children had some restriction placed on their play activities because of asthma. Restrictions on other physical activities and social activities were reported in half the children. Children had absented from school for a median of 4 days in preceding 6 months. All these restrictions were more common in children with more severe disease and/or poor control of symptoms. The median monthly expenditure on child's medication was Rs. 333, i.e., about one third of monthly per capita income. Childhood asthma has significant adverse impact on child's daily activities, schooling, and family life and finances.     

槐杞黄颗粒辅助治疗儿童支气管哮喘疗效的真实世界研究

目的 观察槐杞黄颗粒辅助治疗儿童支气管哮喘的疗效。 方法 采取多中心、前瞻性、登记注册的真实世界研究方法,于全国21家医院门诊依序纳入已明确诊断支气管哮喘、年龄2~5岁、采用以下两种治疗方案之一的患儿：使用哮喘长期控制药物,即吸入激素和/或白三烯受体拮抗剂,但未使用槐杞黄颗粒（控制治疗组,n=390）;使用哮喘长期控制药物,同时加用槐杞黄颗粒（联合治疗组,n=1 014）。收集所有患儿的个人及临床资料,于治疗后第4、8、12、20、28、36周进行门诊或电话随访。随访内容包括哮喘发作情况、鼻炎症状等,并对随访观察指标的变化进行统计学分析。 结果 入组前两组患儿哮喘发作次数、天数及鼻炎发作天数比较差异均无统计学意义（P>0.05）。经治疗后,联合治疗组患儿每月哮喘发作天数、重度哮喘发作次数及鼻炎发作天数均显著少于控制治疗组（P<0.05）。两组患儿不良反应发生率比较差异无统计学意义（P=0.667）。 结论 在使用哮喘长期控制药物治疗基础上加用槐杞黄颗粒能够改善支气管哮喘患儿的临床症状及伴发的鼻炎症状,提高哮喘控制水平,且在治疗过程中使用安全,无明显不良反应。 引用格式:     

Gastrointestinal symptoms in patients with asthma.

AIMS: Minor gastrointestinal abnormalities have been reported in children with asthma, but the prevalence of gastrointestinal symptoms in these children has not been studied. METHODS: 75 children with bronchial asthma and an age and sex matched control group were recruited. Parents completed a questionnaire on gastrointestinal symptoms and on asthma. Weight and height were measured; a clinical evaluation of asthma was undertaken and skin prick tests were performed. RESULTS: Children with asthma had a significantly greater frequency of gastrointestinal symptoms, particularly diarrhoea, vomiting, and abdominal pain, than did controls. Gastrointestinal symptoms were slightly more common in children with atopic symptoms other than asthma, or with positive skin prick tests to foods. There was no association between current gastrointestinal symptoms and medications or attacks of asthma. CONCLUSIONS: The occurrence of gastrointestinal symptoms appears to be common in children with asthma. These symptoms might be caused by an atopic gastroenteropathy, which might play a part in the pathogenesis of asthma in some cases.     

哮喘儿童生活质量评定结果的分析

目的：评价支气管哮喘患儿的生活质量。方法：根据儿童哮喘生活质量访谈问卷,采用交谈的方式,对近1周有哮喘发作的患儿进行评分,并计算频度、均分、总均分和因子总均分。结果：哮喘组各因子总均分在哮喘症状、活动受限、对刺激原反应、心理功能状态及对自身健康关心等方面均较对照组高,差异有显著性(P<0.01 或 0.05)。结论：支气管哮喘损害儿童生活质量。     

哮喘患儿体内嗜酸性粒细胞凋亡的研究

目的　探讨嗜酸性粒细胞 (EOS)凋亡及调控因子在儿童哮喘发病机制中的作用和临床意义。方法　采用末端脱氧核苷酸转移酶介导的缺口末端标记 (TUNEL)技术进行原位活化嗜酸性粒细胞 (EG+ 2 )细胞凋亡的检测 ,以免疫组化标记EG+ 2 细胞和凋亡相关基因BcL 2的表达 ,对 1 1例哮喘缓解期患儿吸入糖皮质激素前后及 7例非哮喘患儿的支气管粘膜、痰液、BAL、外周血液中EG+ 2 细胞及其凋亡、BcL 2的表达进行研究。结果　 (1 )治疗前哮喘患儿支气管粘膜、痰液、BAL中的EG+ 2 凋亡细胞分别为 0 (0～ 3)个 /mm2 、(4 51± 2 1 2 ) %、(4 0 1± 1 91 ) % ,均低于对照组的 3(0～ 1 0 )个 /mm2 、(1 2 1 1± 0 41 ) %、(1 3 42± 3 83) % (均P <0 0 1 ) ,而EG+ 2 细胞分别为 62 (2 3～ 1 4 2 )个 /mm2 、(8 2 4±3 1 3) %、(2 0 4± 0 92 ) % ,均高于对照组 (P <0 0 0 1 ) ;吸入糖皮质激素治疗后上述标本中EG+ 2 凋亡细胞较治疗前明显增高 (均P <0 0 1 ) ,并高于对照组 ,分别为 5(1～ 1 1 )个 /mm2 、(2 0 0 1± 8 2 3) %、(2 1 2 3± 1 0 2 4 ) % ;EG+ 2 细胞较治疗前减少 (P <0 0 1 ,<0 0 5) ,分别为 30 (1 2～ 51 )个 /mm2 、(3 83± 1 1 4 ) %、(0 64± 0 1 1 ) % ,但仍高于对照组 ;治疗前后支气管     

Multiple psychosomatic symptoms can indicate child physical abuse - results from a study of Swedish schoolchildren

Aim: To examine whether children with self‐reported experiences of either physical abuse alone or combined with intimate partner violence report more psychosomatic symptoms than other children and to explore whether these possible associations are enhanced by school‐related factors, chronic condition and demographic factors. Methods: A national cross‐sectional study of 2771 pupils in grades 4, 6 and 9 from 44 schools in Sweden was carried out in 2006 (91% response rate). Data were analysed with univariate tests (chi‐square), multiple logistic regression analyses and stratified logistic regression analyses, expressed as crude odds ratio (OR) and adjusted odds ratio (AOR) with 95% confidence intervals. Results: There was a strong association between reported physical abuse and multiple (three or more) psychosomatic symptoms among schoolchildren (AOR 2.12). Chronic condition was the only determinant that had an obvious enhancing effect on the association between physical abuse and psychosomatic symptoms in childhood. Conclusion: This study shows that multiple psychosomatic symptoms are associated with child physical abuse. Health professionals therefore need to pay special attention to schoolchildren who complain about the co‐occurrence of psychosomatic symptoms and pattern of symptoms, which could not be easily explained by other causes.     

吸入变应原sIgE在不同气道过敏性疾病儿童中的分布特征

目的了解不同气道过敏性疾病患儿吸入变应原血清特异性Ig E(slg E)的分布特征。方法应用Uni CAP250变应原定量Ig E检测系统的荧光酶联免疫法,对256例3~14岁气道过敏疾病患儿测定9种常见吸入变应原的血清slg E。256例患儿按临床诊断分为:变应性鼻炎组(简称"鼻炎组",37例)、支气管哮喘组(简称"哮喘组",82例)和变应性鼻炎合并支气管哮喘组(简称"鼻炎并哮喘组",137例)。比较3组患儿9种吸入变应原阳性检出率的分布差异,并比较3组患儿变应原致敏级别和致敏种类数的差异。结果哮喘组、鼻炎组和鼻炎并哮喘组患儿吸入变应原血清s Ig E的阳性检出率分别为57.3%(47/82)、86.5%(32/37)、82.5%(113/137),3组间比较差异有统计学意义(P0.05)。哮喘组、鼻炎组、鼻炎并哮喘组患儿常见变应原均依次为霉菌类(32.9%、54.1%、48.9%)、尘螨类(30.5%、45.9%、46.0%)、花粉类(26.8%、35.1%、32.8%)、宠物类(12.2%、27.0%、18.2%)、蟑螂(9.8%、5.4%、5.8%)。鼻炎组和鼻炎并哮喘组患儿霉菌混合的阳性检出率均高于哮喘组,差异有统计学意义(均P0.0166)。3组患儿9种变应原的致敏级别和致敏种类数比较差异无统计学意义。结论支气管哮喘、变应性鼻炎或二者合并患儿前3位吸入变应原均依次是霉菌类、尘螨类、花粉类;与支气管哮喘相比,霉菌致敏可能与变应性鼻炎关系更密切;这3种常见气道过敏性疾病吸入变应原的致敏分布具有相似性。