多普勒组织成像法评价窒息新生儿左心收缩功能

目的探讨多普勒组织成像法(DTI)评价窒息新生儿左心收缩功能。方法足月窒息新生儿根据出生时Apgar评分分成重度窒息组(Apgar评分≤3分)共31例,轻度窒息组(Apgar评分4~7分)共31例,在出生后24、48、72h内分别通过超声心动图检测左室射血分数(LVEF),然后转入DTI模式测定二尖瓣前叶收缩期运动速度(s),并与正常新生儿组30例相对照,同时检测心肌肌钙蛋白(cTnⅠ)。结果重度组LVEF在24h明显低于48h和72h(P<0·001),亦明显低于轻度组和对照组(P<0·01),除此之外,3组之间及3组各时段之间LVEF差异无统计学意义(P>0·05)。DTI重度组、轻度组的s在3个时段均明显低于对照组(P<0·001),且重度组s在24h亦明显低于48h和72h(P<0·001),除此之外3组之间及3组各时段之间(s),差异无统计学意义(P>0·05)。重度组cTnⅠ在3个时段明显高于轻度组及对照组(P<0·01),而轻度组与对照组比较,差异无统计学意义(P>0·05)。结论新生儿窒息时左心收缩功能降低,DTI s较LVEF更能反映窒息新生儿左心收缩功能的变化。     

窒息新生儿血清肌钙蛋白I和磷酸肌酸激酶

目的探讨血清肌钙蛋白I（cTnI）和磷酸肌酸激酶同工酶（CK—MB）对窒息新生儿心肌损伤的早期诊断价值。方法选择轻度窒息新生儿29例（轻度组）、重度窒息新生儿18例（重度组）。采用ELISA法和酶动力法检测新生儿血清cTnI水平和CK—MB活性。结果出生d1窒息新生儿血清cTnI和CK-MB水平在轻度组[（2．25±0．54）μg／L、（223．4±23．5）U／L]和重度组[（4．25±0，83）μg／L、（256．3±21．8）U／L]均显著高于对照组（Pα〈0．01）；重度组血清cTnI和CK-MB水平均显著高于轻度组（Pα〈0．01）。治疗后d7窒息新生儿血清cTnI和CK—MB水平均明显下降，轻度组[（0．69±0．18）μg／L、（151．4±18．4）U／L]与对照组均无显著差异（Pα〉0．05），重度组[（1．54±0．72）μg／L、（188．9±21．5）U／L]显著高于轻度组和对照组（Pα〈0．01）。结论窒息新生儿伴心肌损伤时血清cTnI和CK—MB水平升高；动态观察可用于窒息新生儿微小心肌损伤的早期诊断。     

窒息新生儿血中胰岛素样生长因子-1和表皮生长因子水平的变化及其临床意义

目的观察窒息新生儿血中胰岛素样生长因子（IGF）-1、表皮生长因子（EGF）的动态变化，探讨窒息对新生儿胃肠功能影响的可能机制。方法用放射免疫分析法动态测定48例窒息新生儿和30例正常足月新生儿出生后1、3、7d血中IGF-1、EGF的水平变化。观察窒息新生儿胃肠功能障碍的发生情况。结果轻、重度窒息组从生后第1天IGF-1水平较对照组明显降低，差异有非常显著性（P〈0．01）；第7天轻度窒息组IGF-1恢复至对照组水平（B〉0．05），重度窒息组IGF-1仍较对照组低，差异有非常显著性（P〈0．01）。轻度窒息组生后第3天EGF水平较对照组明显降低；重度窒息组在生后第1天EGF水平较对照组明显降低，差异有非常显著性（P〈0．01）；第7天轻、重度窒息组EGF水平恢复至对照组水平（P〉0．05）。轻度窒息组有8例发生轻度胃肠功能障碍，重度窒息组有6例发生轻度胃肠功能障碍，3例发生中度胃肠功能障碍。3例发生重度胃肠功能障碍。结论窒息新生儿血中IGF-1、EGF水平的下降，可能是造成胃肠功能障碍的因素之一。     

窒息新生儿出生后血钙、磷、镁及甲状旁腺素变化

目的观察重度窒息足月新生儿出生后血清钙、磷、镁动态变化，及其与甲状旁腺激素（PTH）的关系。方法选择重度窒息新生儿30例，测定出生后24h、72h及7天时血清钙、磷、镁及甲状旁腺素，并与同期正常足月新生儿对照。结果（1）窒息组新生儿血清镁含量在出生后24h、72h明显低于对照组（P〈0．01）；血清钙含量在出生后1周均明显低于对照组（P〈0．01）；血清PTH含量在出生后24h、7天明显高于对照组（P〈0．01）；血清磷无明显差别。（2）窒息组中血清镁24h时，轻度HIE组明显低于无HIE组（P〈0．05）；血清PTH在24h时，中～重度HIE组明显高于无HIE组（P〈0．01），72h时轻度、中～重度HIE组均明显高于无HIE组（P分别〈0．05、〈0．01），7天时差异无显著性；血清钙、磷在不同程度HIE中差异无显著性；（3）窒息组中血镁与钙、血镁与PTH的水平均无明显相关性。结论新生儿窒息后血清镁降低，并与HIE严重程度有关。提示窒息缺氧后血镁降低在HIE的发病中可能起一定作用。     

心肌肌钙蛋白I对新生儿窒息心肌损害的早期诊断价值

目的评价心肌肌钙蛋白I（cTn I）对新生儿窒息心肌损害（MCI）的早期诊断价值。方法采用双抗夹心免疫测定方法检测51例生后窒息并MCI新生儿（MCI组）血清cTnI和CK．MB水平，并以57例窒息无MCI（NMCI组）及45例正常新生儿（NC组）作为对照组。结果NC组cTnI水平在生后7d内无变化，MCI组生后24h内和1周时cTnI水平均显著高于NMCI组和NC组（P〈0．01）。MCI组生后24h内CK—MB水平显著高于NMCI组和NC组（P〈0．01）；生后5—7d3组CK—MB水平差异无显著性（P〉0．05），且均明显低于生后24h内水平。cTnI诊断新生儿MCI的敏感度为91％，特异度为88％，准确度89％；CK—MB的敏感度为86．3％，特异度为69％，准确度为74％。结论血清cTnI及CK-MB均可用于新生儿窒息MCI的早期诊断，cTnI优于CK-MB。     

新生儿生后早期外周动脉血气分析评估缺氧损伤的意义

目的探讨生后早期外周动脉血气分析对于新生儿窒息病情评判的临床价值。方法选取2012年3月至2013年4月本院新生儿科收治的足月窒息新生儿为观察组,其中1 min Apgar评分4-7者为轻度窒息组,≤3分者为重度窒息组,同期随机选取无窒息的足月新生儿为对照组,各组新生儿均在生后1 h内取右手桡动脉血进行血气分析并比较。将窒息组按外周动脉血气pH值分为〉7.25、7.0-7.25、〈7.0三组,比较各组发生脏器功能受损的比例。结果轻度窒息组98例,重度窒息组24例,对照组86例。各组新生儿性别、胎龄、出生体重、分娩方式、取血时间等差异均无统计学意义（P〉0.05）。对照组pH值和BE值均高于轻、重度窒息组[pH：（7.38±0.06）比（7.16±0.08）、（7.10±0.09）,BE：（-4.1±0.5）mmol/L比（-11.1±4.6）mmol/L、（-14.4±2.6）mmol/L,P〈0.05],轻、重度窒息组之间差异无统计学意义（P〉0.05）。窒息组患儿中,外周动脉血气pH值〉7.25组、7.0~7.25组和〈7.0组发生脏器功能受损的比例分别为53.3%、88.9%、100%,差异有统计学意义（P〈0.05）。结论 Apgar评分的轻重程度不能完全代表窒息的程度,生后1 h内外周动脉血气分析检测是弥补其不足的一项客观指标。     

缺氧缺血性脑病新生儿血清脂联素、白细胞介素-6变化的意义

目的探讨不同时期HIE新生儿血清脂联素与IL-6水平和其相关性，及其与HIE临床分度的关系。方法采用ELISA法对58例HIE患儿（HIE组）及26例非HIE新生儿（对照组）血清脂联素与IL-6水平进行动态检测，并对检测结果采用SPSS 10．0软件进行统计学处理。结果中、重度HIE组急性期血清脂联素水平与轻度组及对照组比较均明湿下降（Pa〈0．001），重度组较中度组明显下降（P〈0．001）；恢复期，中、重度组血清脂联素水平仍明显低于轻度HIE及对照组（Pa〈0．001），重度组明显低于中度组（P〈0．01）；急性期，中、重度HIE患儿血清脂联素水平降低，与恢复期比较均有差异性显著（Pa〈0．001），轻度HIE组和对照组血清脂联素水平在急性期和恢复期比较差异均无统计学意义（Pa〉0．05）。中、重度组HIE患儿急性期血清IL-6水平与对照组及轻度组比较均明显升高（Pa〈0．001），重度组与中度组比较亦明显升高（P〈0．001）；恢复期，中、重度组血清IL-6水平仍明显高于轻度HIE及对照组（Pa〈0．001），重度组明显高于中度组（P〈0．001）；急性期，中、重度HIE患儿血清IL-6水平升高，均明显高于恢复期（Pa〈0．001），轻度HIE组和对照组患儿血清IL-6水平在急性期和恢复期比较差异均无统计学意义（Pa〉0．05）。HIE患儿血清脂联素与IL-6水平呈显著负相关（r=-0．852 P〈0．001）。结论检测血清脂联素和IL-6水平可作为临床HIE病情程度的判断指标之一，对临床诊断及预后的判断具有指导意义。     

窒息新生儿血糖变化与窒息程度的关系探讨

目的探讨新生儿窒息血糖监测的临床意义。方法收集2010年1月至2012年12月我院新生儿科收治的100例确诊为新生儿窒息的新生儿,根据Apgar评分分为轻度窒息组和重度窒息组,分别于生后3 h、24 h釆末梢血监测血糖,对比观察两组窒息患儿血糖变化。结果轻度窒息组64例,重度窒息组36例。生后3 h轻度窒息患儿血糖异常35例（54.69％）,明显低于重度窒息患儿的33例（91.67％）;生后24 h轻度窒息患儿血糖异常7例（10.94％）,也明显低于重度窒息患儿17例（47.22％）;轻度窒息组患儿3 h平均血糖（3.56±1.98）mmol/L,24 h平均血糖（3.57±1.52）mmol/L,重度窒息组患儿3 h平均血糖（6.93±1.57）mmol/L,24 h平均血糖（7.21±3.44）mmol/L,重度窒息明显高于轻度窒息组,差异均有统计学意义（ P＜0.05）。结论窒息程度越重,血糖异常发生率越高;轻度窒息新生儿血糖异常以低血糖为主,重度窒息以高血糖为主。对窒息患儿生后要定期监测血糖,特别是重度窒息患儿应把血糖的变化作为常规判断病情与对症治疗的重要辅助指标。     

窒息新生儿心肌肌钙蛋白Ⅰ测定及临床分析

目的 通过测定窒息新生儿心肌肌钙蛋白Ⅰ（cTnⅠ），探讨其与新生儿窒息及窒息后心肌损害的关系。方法 采用胶乳增强免疫比浊法测定48例轻度窒息儿，42例重度窒息儿，40例健康新生儿（对照组）血清cTnⅠ浓度，同时行心电图检查。结果 两组窒息儿血清cTnⅠ浓度均明显高于对照组（P〈0．01），重度窒息组高于轻度窒息组（0．01〈P〈0．05）。结论 cTnⅠ浓度与新生儿窒息程度密切相关：窒息越重，cTnⅠ值越高，心肌损害越严重。应常规检测窒息新生儿的cTnⅠ．以及时治疗．改善预后。     

新生儿脐血pH和BE影响因素的研究

目的通过大样本收集新生儿脐血血气,研究脐血血气统计学参考值范围与不同影响因素的相关关系。方法选择2012年5～11月广东省妇幼保健院和新会妇幼保健院产科出生的新生儿进行前瞻性研究,选取其中1rainApgar评分〉7分者的脐血血气结果进行统计分析,了解正常新生儿脐血血气的统计学参考值范围;重点分析影响新生儿脐血pH和BE的因素。结果2000例新生儿中,1min Apgar评分≤7分11例,〉7分1989例,低Apgar评分组pH〈7．2的比例为45．5％,正常Apgar评分组pH〈7．2的比例为3．5％,差异有统计学意义（P〈0．001）;1800例足月单胎、体重适于或大于胎龄新生儿中,1794例1min Apgar评分〉7分者脐血pH和BE的统计学参考值范围分别是7．34±0．14（X±1．96S）和-3．53±6．57（X±1．96s）。单因素分析显示,宫内窘迫组、妊娠期并发症组pH值均低于对照组,剖宫产组pH和BE值均高于阴道分娩组,脐带绕颈组pH值降低,双胎组BE值高于单胎组;羊水性状对pH、BE值均无影响。多因素分析显示,宫内窘迫、分娩方式均对脐血血气有影响。结论足月单胎、体重适于或大于胎龄新生儿中,1min Apgar评分〉7分者脐血pH值和BE值的统计学参考值范围分别是7．34±0．14和-3．53±6．57;Apgar评分与脐血血气分析具有一致性,但单独使用Apgar评分诊断早产儿窒息可能会增加窒息的误诊率;宫内窘迫可能会增加新生儿酸中毒的发生率,不同分娩方式对脐血血气pH、BE值均有影响。     

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   

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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.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.