亚低温治疗窒息新生儿二胺氧化酶及肠脂肪酸结合蛋白的变化及意义

目的：观察选择性头部亚低温治疗窒息新生儿中二胺氧化酶(diamine oxidase,DAO)及肠脂肪酸结合蛋白(intestinal fatty acid binding protein,I-FABP)水平的变化。方法选取2013年6月至2014年12月在河北省保定市妇幼保健院NICU住院的重度窒息患儿60例,随机分为常规治疗组和亚低温治疗组,同时选取同期住院的除外缺血缺氧及胃肠功能障碍相关疾病的新生儿30例作为对照组。分别在入院时、治疗7d后采集静脉血,收集血清应用ELISA法检测DAO、I-FABP水平,同时对患儿进行胃肠功能障碍评分。结果入院时亚低温治疗组及常规治疗组患儿DAO、I-FABP水平比较差异无统计学意义[DAO：(15.77±2.04)U/ml,(15.81±1.85)U/ml,P ﹥0.05;I-FABP：(310.01±46.43)ng/L,(301.12±38.61)ng/L,P ﹥0.05],但较对照组均升高[(7.65±0.74)U/ml,(51.65±6.91)ng/L];治疗7d后,两组患儿DAO、I-FABP 水平较入院时均减低[DAO：(7.88±1.87)U/ml,(12.51±1.53)U/ml;I-FABP：(59.16±6.17)ng/L,(121.31±21.54)ng/L],亚低温治疗组下降明显,差异有统计学意义(P﹤0.05),且DAO及I-FABP水平与胃肠功能障碍评分呈正相关(r1=0.831, r2=0.827,P﹤0.01)。结论选择性头部亚低温治疗可使DAO、I-FABP水平下降,提示其在一定程度上利于受损胃肠功能的恢复。     

Circulating adipocyte fatty acid binding protein levels in healthy preterm infants: Positive correlation with weight gain and total-cholesterol levels

Background

Adipocyte fatty acid binding protein (a-FABP) has been suggested to play an important role in the pathogenesis of metabolic syndrome. Preterm infants are at risk for the later development of insulin resistance, and, possibly, other components of metabolic syndrome.

Aim

To determine circulating levels of a-FABP in preterm infants and examine possible associations of a-FABP with metabolic indices (serum lipids, glucose, and insulin levels, and homeostasis model assessment index of insulin resistance [HOMA-IR]), levels of leptin and adiponectin, anthropometric parameters and weight gain.

Study design

Prospective cohort study.

Subjects

55 healthy preterm (mean [SD] gestational age 32.8 [1.8] weeks) and 23 fullterm infants (reference group).

Outcome measures

Serum a-FABP, lipids, glucose, insulin, leptin and adiponectin levels at 31.9 [10.4] days of life.

Results

Serum a-FABP levels did not differ significantly between preterm and fullterm infants. A-FABP levels correlated positively with total-cholesterol [total-C] in both preterm and fullterm infants (β = 0.33; p = 0.01 and β = 0.33; p = 0.04, respectively). In addition to total-C, weight gain correlated independently with a-FABP levels in preterm infants (β = 0.36, p = 0.01).

Conclusions

An association between a-FABP levels and indices of insulin resistance was not present in infants studied. As the development of insulin resistance in children born prematurely is possibly associated with weight gain in early postnatal life, follow-up of our study population is necessary to demonstrate whether a-FABP levels, shown to correlate with weight gain in preterm infants, are a predictive marker for the later development of insulin resistance in these infants.     

新生儿坏死性小肠结肠炎血浆肠脂肪酸结合蛋白水平变化的意义

目的 探讨血浆肠脂肪酸结合蛋白（I-FABP）水平变化在指导新生儿坏死性小肠结肠炎（NEC）诊断及治疗中的意义.方法 选择2011年5月至2012年12月我院新生儿科收治的患儿,按入院先后顺序,以明确诊断NEC的50例新生儿为NEC组,其中NECⅡ期30例,NECⅢ期20例,以非NEC新生儿50例为对照组.NEC组在确诊后24 h内、对照组在相应日龄取血,采用酶联免疫吸附法（ELISA）检测血浆I-FABP水平,根据NEC患儿病情转归分为存活组及病死组,按治疗方法分为保守治疗组和手术治疗组,比较不同组间血浆I-FABP水平、新生儿危重病例评分（NCIS）分值、脓毒症的发生率及病死率.结果 NECⅡ期组、NECⅢ期组和对照组血浆I-FABP水平分别为（95.6±18.5） μmol/L、（151.2±10.8）μmol/L和（1.2±2.3）μmol/L,组间比较差异有统计学意义（P＜0.05）;NECⅡ期组和NECⅢ期组NCIS评分明显低于对照组,脓毒症发生率和病死率均高于对照组,差异有统计学意义（P＜0.05）,NECⅡ期组和NECⅢ期组差异无统计学意义（P＞0.05）.病死组血浆I-FABP水平、脓毒症发生率高于存活组,NCIS评分低于存活组;保守治疗组I-FABP水平低于手术治疗组,NCIS评分高于手术治疗组,差异均有统计学意义（P＜0.05）.结论 血浆I-FABP水平可较敏感地反映NEC患儿的病情变化,可作为预测NEC病情严重程度及指导采取内外科治疗的指标之一.     

脂肪型脂肪酸结合蛋白在早产大鼠高氧肺损伤时的表达

目的 观察脂肪型脂肪酸结合蛋白4(FABP4)在早产大鼠高氧肺损伤时肺组织及支气管肺泡灌洗液(BALF)中的表达,探讨其与新型支气管肺发育不良(BPD)发病机制之间的关系.方法 早产大鼠生后6 h 内随机分为高氧组和对照组,对照组置于常压空气中,高氧组置于浓度为60% 的高氧舱中,两组均于出生后第3 天(P3)、第7 天(P7)和第14 天(P14)各随机取8 只大鼠,采用免疫组织化学方法和逆转录-聚合酶链反应技术检测不同时间两组肺组织FABP4 蛋白及mRNA 表达水平,应用ELISA 方法检测BALF中FABP4 的含量.结果 FABP4 主要在肺泡巨噬细胞、支气管上皮细胞和血管内皮细胞表达.两组FABP4 蛋白和mRNA 在肺组织中的表达以及两组BALF 中FABP4 的含量均随鼠龄递增呈逐渐增加的趋势,至P14 时最高.高氧组肺组织中FABP4 mRNA 的表达在P7、P14,FABP4 蛋白的表达在P3、P7 及P14 时均高于对照组(均P<0.05);高氧组BALF 中FABP4 的含量在P7、P14 时均高于对照组(均P<0.05).结论 高氧肺损伤时FABP4 表达升高,可能是引起肺微血管发育障碍及肺泡化进程受阻,进而导致新型BPD 发生的重要因素.     

Evaluation of a urine antibody test for Helicobacter pylori in Japanese children

OBJECTIVE: To evaluate the accuracy of a urine-based enzyme-linked immunosorbent assay (ELISA) kit for anti-Helicobacter pylori immunoglobulin G antibody (urine-HpELISA) in children, we compared its sensitivity and specificity in reference to (13)C-urea-breath test (UBT) and H pylori stool antigen test (HpSA). STUDY DESIGN: Japanese children without significant upper abdominal symptoms were included (n=100; mean age, 7.0 years; range, 2 to 15). UBT, HpSA, and urine-HpELISA were performed. RESULTS: Of 100 children, 36 and 64 were judged H pylori-positive and H pylori-negative, respectively, by UBT and HpSA. Thirty-four of 36 positive children were positive by urine-HpELISA, and 62 out of 64 negative children were negative by urine-HpELISA. Thus, the urine-HpELISA had 94.4% sensitivity and 96.9% specificity, with accuracy of 96.0%. CONCLUSIONS: The urine-HpELISA is a rapid, inexpensive, reliable, and easy-to-perform method for the diagnosis of H pylori infection in children. It may be useful not only for diagnosis but also for mass screening for epidemiological studies in pediatric population.     

瓜氨酸、肠型脂肪酸结合蛋白、肠三叶因子在儿童危重症急性胃肠损伤诊断中的作用

目的比较血清瓜氨酸、肠型脂肪酸结合蛋白(IFABP)和肠三叶因子(ITF)在儿童危重症急性胃肠损伤诊断中的价值。方法入选84例危重症患儿,应用高效液相色谱法检测血清瓜氨酸,酶联免疫吸附法检测血清IFABP、ITF,结合临床资料进行比较分析。结果胃肠损伤组血清瓜氨酸水平低于非胃肠损伤组,血清IFABP、ITF水平高于非胃肠损伤组,差异有统计学意义(P均0.05);危重症患儿血清瓜氨酸与反应蛋白(CRP)、降钙素原(PCT)、住院时间呈显著负相关(r=-0.36~-0.31,P均0.01)。结论血清瓜氨酸、IFABP、ITF对危重症患儿急性胃肠损伤均有一定的诊断价值,瓜氨酸水平可能反映危重病患儿胃肠损伤程度。     

Rett syndrome in Australia: a review of the epidemiology

OBJECTIVE: To examine the prevalence, cumulative incidence, and survival in an Australian cohort with Rett syndrome (RTT). STUDY DESIGN: The Australian Rett Syndrome Database is a longitudinal data collection that included 276 verified female cases at the end of 2004. Survival was calculated using the Kaplan-Meier product limit method, and cumulative incidence was determined using the complement of the Kaplan-Meier method. RESULTS: Most cases (88.4%) have had MECP2 mutation testing, with positive results in 73%. The prevalence of RTT was .88 per 10,000 females in 5- to 18-year-olds, and the cumulative incidence was 1.09 per 10,000 females by 12 years of age. The cumulative incidence by the age of 5 years increased from .39 per 10,000 in the 1980 to 1984 cohort to .76 per 10,000 in birth cohorts beyond 1984. Survival was 77.8% at 25 years, compared with 99.96% survival in the Australian female population. Pneumonia (10/25) was the most common cause of death. CONCLUSIONS: The availability of genetic testing has contributed to the changing pattern and timing of RTT diagnosis in Australia. Girls with RTT have worse survival compared with the general female population. When more data are available, it will be possible to evaluate the relationship between survival and specific MECP2 mutations.