单纯肥胖症儿童血清瘦素、肿瘤坏死因子-α测定的意义

目的　探讨单纯肥胖症儿童血清瘦素 (Leptin)、肿瘤坏死因子 浕(TNF 浕)水平变化及临床意义。 方法　从 6～ 14岁 16 78例小学生中筛选出体块指数 (BMI)≥ 2 5kg/m2 的 89例作为肥胖组 ,选择BMI在 18～ 2 3kg/m2 正常学生 32例作为对照组 ,用ELISA法测定血清Leptin、TNF 浕 ,比较两组差异。结果　 1.肥胖组儿童血清Leptin(17.38± 3.5 4 ) μg/L较对照组 (9.89± 3.0 0 ) μg/L显著增高 ,两者比较有显著性差异 (t =11.5 2 9　P <0 .0 0 1) ;肥胖组儿童血清TNF 浕水平 (196± 4 0 )ng/L较对照组 (135± 35 )ng/L显著增高 ,两者比较有显著性差异 (t=8.133　P <0 .0 0 1)。 2 .女童血清Leptin(2 7.98± 2 .0 1) μg/L较男童 (13.4 2± 1.6 1) μg/L显著增高 ,两者比较有显著性差异 (t=37.92 5　P <0 .0 0 1) ;女童血清TNF 浕水平 2 13± 4 1ng/L较男童 16 8± 37ng/L显著增高 ,两者比较有显著性差异 (t=5 .6 4 5　P <0 .0 0 1)。 3.Leptin、TNF 浕与体重和ＢＭＩ呈正相关 (P <0 .0 1)。 结论　单纯肥胖症儿童血清Leptin、TNF 浕水平明显增高 ,高水平Leptin、TNF 浕可能是单纯肥胖症重要的生物学标志之一     

单纯性肥胖儿童血清胰岛素水平与瘦素、肿瘤坏死因子-α的关系

目的探讨单纯性肥胖儿童血清胰岛素水平与瘦素（LP）、肿瘤坏死因子-α（TNF-α）的关系。方法肥胖儿童47例依据空腹血清胰岛素和空腹血糖水平,分为高胰岛素血症组（HIG）23例。男16例,女7例;年龄（11.3±2.0）岁。正常胰岛素水平组（NIG）24例。男15例,女9例;年龄（11.8±2.7）岁。并选取同年龄段非肥胖正常儿童10例为健康对照组（NCG）。测量各组身高、体质量、腰围等,检测空腹血清胰岛素（FINS）、LP及TNF-α水平,并计算相关指标,分析它们之间的关系。结果1.HIG组BMI、腰围、臀围、腰臂比（WHR）、LP、TNF-α、胰岛素抵抗指数（HOMA-IR）明显高于NIG组及NCG组（Pa〈0.05,0.01）;胰岛素敏感指数（HOMA-IAI）低于NIG和NCG组（P〈0.05,0.01）;2.与NCG组比较,NIG组BMI、腰围、臀围、WHR、LP、HOMA-IR明显增高（Pa〈0.05,0.01）,HOMA-IAI显著降低（P〈0.05）,TNF-α、空腹血糖（FBG）比较差异不显著（Pa〉0.05）;3.HIG组FINS与LP、TNF-α、HOMA-IR分别呈显著正相关（r=0.560,0.413,0.846 P〈0.01,0.05,0.01）,与HOMA-IAI呈显著负相关（r=-0.823P〈0.01）,与血糖无相关性。LP、TNF-α与IR独立相关。结论肥胖患儿血清胰岛素水平与LP、TNF-α密切相关,LP、TNF-α致胰岛素抵抗可能是肥胖患儿高胰岛素血症的原因之一。     

肺炎患儿血清肿瘤坏死因子测定

肺炎患儿血清肿瘤坏死因子测定新疆石河子医学院一附院儿科（８３０００８）宋福玲，高峻岭，张舒遴新疆石河子医学院一附院儿研室杨年，陈志刚，杜春友本文对５６例肺炎患儿血清肿瘤坏死因子（ＴＮＦ）水平进行了测定，并对其与血像及病情的关系进行了分析，现报道如下。...     

肿瘤坏死因子与儿童中枢神经系统白血病

用酶联免疫法检测了２５例儿童急性白血病（Ａ组：８例，伴中枢神经系统白血病，Ｂ组：１７例，不伴中枢神经系统白血病）脑脊液（ＣＳＦ）中肿瘤坏死因子（ＴＮＦ）及其与ＣＳＦ各化验指标的相关性，结果示：Ａ组病人ＣＳＦ中ＴＮＦ为１０．０６±１３．５０ｎｇ／ｍｌ，较Ｂ组（１．１±０．４２ｎｇ／ｍｌ）升高，差异有显著意义（Ｐ〈０．０１），ＣＳＦ中ＴＮＦ的升高与ＣＳＦ细胞数及蛋白呈正相关（ｒ＝０．６８０７，０．６７     

单纯性肥胖儿童胰岛素抵抗与肿瘤坏死因子-α的关系

目的探讨单纯性肥胖儿童胰岛素抵抗与肿瘤坏死因子-α(TNF-α)的关系。方法单纯性肥胖患儿50例作为观察组(男23例,女27例);选取同期健康儿童30例为对照组(男14例,女16例)。采用发光免疫法、放射免疫法、快速测血糖法分别对两组儿童的血糖、血胰岛素、血脂和TNF-α进行检测。并作对比分析。结果观察组稳态模型胰岛素抵抗指数(HOMA-IR)、TNF-α及舒张血压(DBP),与对照组比较均明显升高(t=3.939,4.938,3.278 P均<0.01);收缩血压(SBP)、空腹三酰甘油(TC)与对照组比较均明显升高(t=2.536,2.573 P均<0.05);胰岛素敏感指数(HOMA-ISI)观察组明显低于对照组(t=-4.75 P<0.01)。观察组TNF-α与体质量指数(BMI)、TC、HOMA-IR均呈显著正相关(r=0.284,0.328,0.361 P均<0.05)。TNF-α与HOMA-ISI呈显著负相关(r=-0.36 P<0.01)。BMI与HOMA-IR呈显著正相关性(r=0.294 P<0.05)。结论单纯性肥胖儿童存在胰岛素抵抗,血清TNF-α与肥胖儿童的BMI、TC、BP、胰岛素抵抗密切相关,TNF-α可能参与胰岛素抵抗病理生理机制。     

肥胖儿童血浆脂联素与肿瘤坏死因子-α的变化及意义

目的儿童肥胖症与血浆脂联素（ADPN）和肿瘤坏死因子-α（TNF-α）水平的变化密切相关。该文通过分析肥胖儿童血浆ADPN和TNF-α的变化及其相互关系,探讨儿童肥胖症的发病原因,为儿童肥胖症的预防提供科学依据。方法265名儿童随机分为肥胖组（147人）和正常对照组（118人）,分别测定腰围（WC）,臀围,腰臀比（WHR）,体脂百分比（%BF）,收缩压（SBP）,舒张压（DBP）,甘油三酯（TG）,总胆固醇（TC）,高密度脂蛋白胆固醇（HDL-C）,低密度脂蛋白胆固醇（LDL-C）,空腹血糖（FBG）,空腹胰岛素（FINS）,ADPN,TNF-α,计算稳态模型胰岛素抵抗指数（HOMA-IR）,并分析ADPN,TNF-α与体质量指标、糖脂代谢指标及二者的相关关系。结果①肥胖组儿童ADPN水平低于正常组儿童（P<0.05）,且与TNF-α,BMI,WHR,HOMA-IR,%BF,FINS,SBP,TG呈显著负相关（均P<0.05）;②肥胖组儿童TNF-α水平高于正常组儿童(P<0.01),且与BMI,WHR,%BF,FINS,HOMA-IR,TG,SBP呈显著正相关（P<0.01）,与HDL（P<0.05）呈负相关;③多元逐步回归分析显示ADPN,BMI和TNF-α是影响BF%的主要因素（R2=0.926）,且ADPN和TNF-α的交互作用有统计学意义。结论 肥胖儿童ADPN水平显著下降、TNF-α水平显著升高,且均是影响儿童体脂的主要因素。ADPN与TNF-α的交互作用提示二者在机体内可相互影响,共同参与儿童肥胖的形成。［中国当代儿科杂志,2009,11（1）：47-50］     

重症肺炎血清可溶性肿瘤坏死因子受体检测的临床意义

目的 研究重症肺炎患儿血清可溶性肿瘤坏死因子受体（ＳＴＮＦＲ）浓度变化。方法 采用ＥＬＩＳＡ方法测定２７例肺炎（１５例重症肺炎）患儿极期与恢复期血清ＳＴＮＦＲ浓度,并进行危重评分,结果 肺炎时血清ＳＴＮＦＲ升高,极期重症肺炎明显高于普通肺炎,随病情改善血清浓度下降;ＴＮＦ改变不明显,随着病情好转无显著下降。ＳＴＮＦＲ水平与肺炎疾病凶重评分呈负相关。结论小儿肺炎时血清ＳＴＮＦＲ明显升高,且与疾病危重     

脑脊液肿瘤坏死因子与儿童癫痫发病的关系

目的 探讨脑脊液肿瘤坏死因子（TNF－α）在儿童癫痫发病中的作用。方法 采用双抗夹心法，检测28例癫痫患儿发作期及间歇期脊液TNF－α的含量。结果 癫痫患儿发作期及间歇期脑脊液TNF－α含量均高于对照组，且发作期高于间歇期。结论 癫痫患儿发作期及间歇期脑脊液TNF－α增高，在癫痫的发病中起重要作用。     

小儿细菌感染对血清瘦素的影响及意义

目的确定瘦素(leptin)与细菌感染性疾病的相关性,探讨leptin改变的调节机制及意义。方法用免疫放射法(IRMA)检测33例细菌感染患儿发病极期和恢复期血清leptin,正常对照组25例,用酶联免疫法测肿瘤坏死因子(TNF-α)。结果(1)在感染极期,血清leptin水平(3.791±3.565)μg/L明显降低,较感染恢复期(P<0.01)和正常对照组(P<0.05),差异均有显著性意义,且重症感染组leptin水平(1.747±2.583)μg/L明显低于普通感染组(5.143±4.370)μg/L,二者差异亦有显著性意义;在感染恢复期,血清leptin水平已近正常,与对照组比较,差异无显著性意义。(2)在感染极期,血TNF-α(32.912±6.664)ng/L水平明显升高,较感染恢复期(P<0.001)和正常对照组(P<0.001),差异均有显著性意义;在感染恢复期血TNF-α水平已近正常,较对照组差异无显著性意义。(3)在感染极期,血清leptin与TNF-α呈负相关(r=-0.537,P<0.01),在恢复期二者无相关性。结论血清leptin测定对感染严重程度和预后的判断有重要意义,对进一步探讨内分泌与免疫网络的关系有一定的参考价值。     

Relationship between plasma leptin, insulin and tumor necrosis factor alpha in obese children

OBJECTIVES: 1. To evaluate the relationship between plasma leptin and TNFalpha concentrations in obese children and to assess the differences between hyperinsulinemic and normoinsulinemic groups. 2. To evaluate the relationship between plasma leptin and insulin levels in obese children. 3. To investigate the TNFalpha G308A mutation in obese children. METHODS: Body mass index (BMI), fasting plasma glucose and insulin levels, oral glucose tolerance test results, homeostasis model assessment of insulin resistance (HOMA-IR) results, and plasma leptin and TNFalpha concentrations were evaluated in obese children (n = 45) and age- and gender-matched, lean healthy controls (n = 40). RESULTS: In obese children the fasting insulin, HOMA-IR results, plasma leptin and TNFalpha concentrations were significantly higher than in controls (p <0.05). Furthermore, obese females showed higher plasma leptin and insulin resistance compared to obese males. While plasma leptin, TNFalpha levels and HOMA-IR results were similar in the prepubertal and pubertal groups, insulin levels were significantly higher in the pubertal group. Plasma leptin and TNFalpha concentrations were similar in hyperinsulinemic and normoinsulinemic obese children. In control children, plasma leptin concentrations showed a positive correlation with BMI, age, fasting insulin and HOMA-IR results. In obese children, plasma leptin levels did not correlate with BMI, fasting insulin or TNFalpha. CONCLUSION: Plasma leptin concentrations did not show any correlation with TNFalpha levels in obese children. Furthermore, plasma leptin and TNFalpha concentrations were similar in hyperinsulinemic and normoinsulinemic obese children.     

儿童单纯性肥胖血清瘦素水平分析

目的：比较单纯性肥胖儿童与正常健康儿童血清瘦素的水平，分析血清瘦素与空腹胰岛素之间的关系。方法：选择单纯性肥胖儿童30例，健康非肥胖儿童30例作对照组，分别测定其空腹胰岛素与瘦素水平。结果：单纯性肥胖组血清瘦素明显高于对照组（P＜0．001），瘦素与空腹胰岛素呈显著性相关（r=0.854，P＜0．001）。结论：单纯性肥胖儿童体内存在高胰岛素血症，同时存在瘦素抵抗，胰岛素与瘦素的调控是双向的。     

流行性腮腺炎脑膜脑炎患儿脑脊液NO及TNF-α的测定及其意义

目的　近年来一氧化氮 (NO)作为一种特殊介质在中枢神经系统感染中的作用日益受到重视 ,该文探讨NO及肿瘤坏死因子α(TNF α)在流行性腮腺炎脑膜脑炎 (腮脑 )发病中的作用 ,为腮脑的治疗提供实验依据。方法　采用硝酸还原酶法及双抗体夹心ELISA法 ,分别测定 1 5例流行性腮腺炎脑膜脑炎患儿 (腮脑组 )及 1 5例骨科及普外科择期手术患儿 (对照组 )的脑脊液NO及TNF α水平。结果　腮脑组NO及TNF α浓度明显高于对照组分别为 2 4 .93± 5 .31 μmol/Lvs1 1 .2 7± 2 .5 2 μmol/L和 4 0 .4 7± 7.1 5pg/mlvs1 6 .0 7± 5 .95pg/ml(P <0 .0 1 )。结论　NO及TNF α参与了腮腺炎脑膜脑炎的炎症过程 ;为从NO及细胞因子角度进一步认识腮脑的发病机制提供了实验依据 ,为腮脑的治疗提供了一条新的途径。     

Serum leptin level in prepubertal children with simple obesity. Part one

The aim of the study was to determine the serum leptin level and anthropometric indices (body mass index - BMI) in a group of prepubertal children with simple obesity. These parameters were compared with the values characteristic for the group of slim children. The study showed that serum leptin levels were significantly higher in obese children compared with the group of slim children (p<0.0001). There was a positive correlation (r=0.48; p<0.05) between leptin levels and nutritional status indices expressed by BMI. Results of this study suggest that leptin level in the group of children with simple obesity does not have an effect on satiety, on reduction of appetite or on the increment of adipose tissue. The study showed also that hyperleptinemia might be an effect of leptin resistance.     

Serum leptin level in prepubertal children with simple obesity. Part II

The aim of the study was to determinate the serum leptin level, glucose concentration, lipids (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride) and thyroid hormones level (triiodothyronine, thyroid stimulating hormone and free thyroxine) in a group of prepubertal children with simple obesity. Fourfold higher leptin concentration in obese (23.3 +/- 11.8 ng/mL) in comparison to a group of slim children (6.8 +/- 2.7 ng/mL), (p<0.0001) was shown. There was no significant difference in serum glucose level (87.3 +/- 9.7 mg/dL) between both studied groups. In obese subjects we showed higher triglyceride, insignificantly lower HDL-C concentrations and invariable other lipid fractions. Mean values of triiodothyronine (T3) were 3.0 +/- 0.7 nmol/L in obese children and 2.8 +/- 0.8 nmol/L in slim children. On the contrary, mean values of thyroid stimulating hormone (TSH) were 2.5 +/- 1.7 mIU/L and 2.8 +/- 0.7 mIU/L in the group of obese and normal children respectively. Free thyroxine (FT4) concentrations in our obese children were lower (11.5 +/- 2.9 pmol/L) than in slim subjects (14.6 +/- 3.1 pmol/L) but were within the reference range. The results obtained indicate that in children with simple obesity there was no dyslipidemia connected with leptin and thyroid hormones levels. However, higher triglyceride and lower HDL-C concentrations suggest a necessity of monitoring the body mass index and lipid profile in these patients.     

慢性病贫血患儿肿瘤坏死因子α、白介素6与红细胞生成素的关系

目的　探讨小儿慢性病贫血 (ACD)血清红细胞生成素 (EPO)水平与肿瘤坏死因子α(TNF α)、白介素 6 (IL 6 )的关系以及体外重组TNF α(rhTNF α)对EPO产生的影响。方法　住院患儿6 0例 ,其中ACD组 2 0例 ,慢性病无贫血组 (NA) 19例 ,缺铁性贫血组 (IDA) 2 1例。TNF α、IL 6采用ELISA方法检测 ,EPO应用化学发光法测定 ,对人肝癌细胞株HepG2进行体外培养 ,应用逆转录 聚合酶链反应 (RT PCR)半定量方法 ,探讨rhTNF α对EPO生成的影响。结果　三组患儿血清EPO水平差异有显著性 (F =4 4 6 8,P <0 0 1) ,ACD患儿血清EPO水平高于NA患儿 ,但在相同Hb值时 ,ACD患儿EPO低于IDA患儿。三组患儿血清TNF α水平差异有显著性 (F =2 5 12 ,P <0 0 1) ,血清TNF α水平 ,ACD组高于NA组和IDA组 ;三组患儿血清IL 6水平差异有显著性 (F =13 2 6 ,P <0 0 1) ,血清IL 6水平ACD组高于NA组和IDA组。ACD患儿血清TNF α及血清IL 6与EPO无相关性 (r=- 0 35 ,P >0 0 5 ;r=- 0 0 5 ,P >0 0 5 )。体外实验中 ,rhTNF α抑制低氧状态下EPOmRNA的表达 ,且随着rhTNF α剂量的增大而对EPO抑制作用增强 (F =6 4 2 0 ,P <0 0 1)。结论　ACD患儿EPO虽存在代偿性增高但代偿生成不足 ,是小儿ACD的发病原因之一 ;血清TNF α、IL 6与EPO     

Clustering of metabolic syndrome risk factors associated with lifestyle factors and serum leptin in Korean children

The present study investigated the relationships among metabolic risk factors, major lifestyle factors, and serum cytokines in a sample of Korean children. In a cross-sectional design, we studied a total of 275 children (130 boys and 145 girls) aged 12-13 years. Measured variables included anthropometrics, blood pressures (BP), VO2max, physical activity (PA), dietary intakes, lipids, glucose, and insulin. We explored the extent to which dietary intakes, VO2max, PA, and serum cytokines explained variance in a clustered risk score, which is a sum of Z scores for waist circumference, BP, TG, HDLC, and HOMA-IR, using a stepwise linear regression by blocks. VO2max, vigorous PA (VPA), and leptin were independent predictors for the clustered risk score while adjusting for age and Tanner stage. Our findings suggest that the clustered risk score is associated not only with low levels of VO2max and VPA, but also with elevated serum leptin in Korean children.     

儿童紫癜性肾炎肿瘤坏死因子α基因多态性分析

目的：探讨肿瘤坏死因子α（TNF-α）-308G/A基因多态性与儿童紫癜性肾炎（HSPN）的关系。方法应用聚合酶链反应（PCR）扩增产物直接测序方法对110例过敏性紫癜（HSP组）汉族儿童进行TNF-α-308G/A基因型分析,包括紫癜性肾炎52例（HSPN组）,无合并肾炎58例（单纯HSP组）。酶联免疫吸附法检测血浆TNF-α水平。90例健康汉族儿童作为对照组。结果HSP组TNF-α-308基因型分布频率与对照组比较差异无统计学意义（P>0.05）。HSPN组GA基因型（29%）、A等位基因频率（18%）均明显高于单纯HSP组（分别为10%和7%,P<0.05）,其中GA+AA 基因型患儿血浆TNF-α水平（7.1±2.3 pg/mL）较GG基因型患儿（5.7±1.5 pg/mL）明显升高（P<0.05）。结论TNF-α-308G/A 基因多态性与HSP儿童肾脏损害的发生有关,A等位基因可能是儿童HSPN的易感基因。