新生儿ABO溶血病合并G-6-PD缺乏症52例临床分析

目的:分析新生儿ABO溶血病合并G-6-PD缺乏症的临床特点,以提高诊治水平。方法:对1316例新生儿高胆红素血症病人进行G-6-PD活性检测,对可疑病例进行ABO溶血病检查,对新生儿ABO溶血病合并G-6-PD缺乏症引起的新生儿高胆红素血症52例病人临床资料进行分析。结果:研究组占同期新生儿高胆红素血症病人的3.95%,大多数病例发生贫血及代谢性酸中毒,严重的可出现胆红素脑病。男女发生比例为4.78∶1,男性与女性患儿间血红蛋白的差异有统计学意义(P<0.05),男性与女性患儿间血清总胆红素的差异无统计学意义(P>0.05)。结论:新生儿ABO溶血病合并G-6-PD缺乏症引起的黄疸程度重,并发症多,易发生胆红素脑病,早期综合干预可预防胆红素脑病发生。     

新生儿6-磷酸葡萄糖脱氢酶缺乏症患儿生后早期血清总胆红素水平变化

目的探讨新生儿6-磷酸葡萄糖脱氢酶(G-6-PD)缺乏症患儿生后早期血清总胆红素(TSB)水平变化特点。 方法选择2014年1月1日～12月31日,于柳州市妇幼保健院产科出生的96例足月、广西籍新生儿为研究对象。根据脐带血G-6-PD酶活性定量测定结果,将96例新生儿分为G-6-PD缺乏组(n＝31)和G-6-PD正常组(n＝65)。统计学比较两组新生儿生后3 h内,生后第1、2、3天TSB含量,TSB上升速率及新生儿高胆红素血症发生率差异;分析两组新生儿生后3 h内TSB含量与生后第1、2、3天TSB含量及TSB上升速率间相关性。两组新生儿出生体重、胎龄、母亲年龄、自然分娩率、催产素使用率、开始排胎便时间及胎便排完时间比较,差异均无统计学意义(P>0.05)。本研究遵循的程序符合柳州市妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象监护人知情同意,并与监护人签署临床研究知情同意书。 结果①G-6-PD缺乏组新生儿性别构成比(男性74.2%、女性25.8%)与G-6-PD正常组性别构成比(男性52.3%、女性47.7%)比较,差异有统计学意义(χ²＝4.168,P＝0.041)。②G-6-PD缺乏组新生儿生后3 h内及生后第1、2、3天TSB含量,TSB上升速率,以及高胆红素血症发生率[(2.7±0.6) mg/dL,(6.6±1.7) mg/dL,(10.4±2.2) mg/dL,(12.3±2.3) mg/dL,(0.14±0.04) mg/(dL·h),45.2% ]均显著高于G-6-PD正常组新生儿[(2.4±0.4) mg/dL,(5.8±1.4) mg/dL,(9.2±2.0) mg/dL,(11.0±2.6) mg/dL,(0.12±0.04) mg/(dL·h),10.8%],且差异有统计学意义(t＝3.349、2.540、2.648、2.274、2.659,P<0.05;χ²＝14.527,P＝0.000)。③G-6-PD缺乏组新生儿生后3 h内TSB含量与生后第1、2、3天TSB含量及TSB上升速率间均分别存在正相关关系(r＝0.393、0.619、0.596、0.549,P＝0.029、0.000、0.001、0.001);G-6-PD正常组新生儿生后3 h内TSB含量与生后第1、2、3天TSB含量及TSB上升速率间均分别存在正相关关系(r＝0.529、0.428、0.468、0.365,P＝0.000、0.000、0.000、0.003)。 结论新生儿G-6-PD缺乏症患儿的溶血在宫内已发生,生后3 h内的TSB含量可预测新生儿高胆红素血症的发生。新生儿G-6-PD筛查及生后早期TSB含量监测,对防治新生儿高胆红素血症具有重要临床意义。     

新生儿G-6-PD缺乏症合并高胆红素血症的临床分析

目的 探讨红细胞葡萄糖-6-磷酸脱氢酶(G-6-PD)缺乏症合并新生儿高胆红素血症的影响因素及其特点.方法 收集2014年10月至2016年2月在深圳市龙华新区中心医院新生儿科住院的1 091例新生儿高胆红素血症患儿的临床资料,患儿分为G-6-PD缺乏症组和非G-6-PD缺乏症组,对两组患儿的临床资料进行比较分析.结果 入院时平均胆红素值G-6-PD缺乏组明显高于非G-6-PD缺乏组,差异有统计学意义(t=20.31,P=0.000);入院时胆红素值＜256 μmol/L的范围内,两组的人数占比差异无统计学意义(P=0.878＞0.05),但在256 ～ 342 μmol/L及＞342μmol/L的范围内两组差异均有统计学意义(x2值分别为7.84、15 93,均P＜0.05).合并症和并发症中新生儿肺炎、宫内细菌感染、胆红素脑病两组比较差异均有统计学意义(x2值分别为10.11、3.90、22.28,均P＜0.05),两组合并细菌感染发生率比较差异有统计学意义(x2=10.55,P＜0.05).G-6-PD缺乏组发病籍贯主要以广东、广西地区为主,非G-6-PD缺乏组地域现象不明显,两组比较差异有统计学意义(x2=36.81,P＜0.05).G-6-PD缺乏纽伴有贫血较非G-6-PD缺乏组明显增多,差异有统计学意义(x2=5.81,P＜0.05).结论 G-6-PD缺乏症黄疸出现时间早、进展快,胆红素峰值高,且易并发胆红素脑病,细菌感染是诱发G-6-PD缺乏患儿合并新生儿高胆红素血症的主要原因.     

脐带血血清总胆红素检测在新生儿溶血病早期诊治中的应用价值

目的探讨脐带血血清总胆红素检测在新生儿ABO溶血病(ABO-HDN)早期诊治中的意义,为早期筛查诊治新生儿溶血病提供参考。方法选择2013年3月-2016年2月浙江省台州医院482例母婴ABO血型不合新生儿为研究对象,进行ABO溶血三项试验,全自动生化分析仪测定脐带血血清总胆红素水平,分析脐带血血清总胆红素与HDN溶血三项不同试验结果、母亲血型、黄疸出现时间的相关性。结果 482例新生儿中ABO-HDN发生率为31.95%,其中母婴O-O型、O-A型、O-B型各占22.08%、46.75%、31.17%;77例发生高胆红素血症,HDN发生率、脐带血胆红素水平、抗体释放试验与游离抗体试验阳性率母婴O-A/B血型明显高于母婴O-O血型组(P0.05),HDN发生率、脐带血胆红素水平在母婴O-A血型及母婴O-B血型间比较差异无统计学意义(P0.05),抗体释放试验与游离抗体试验阳性率母婴O-A血型明显高于母婴O-B血型组(分别χ~2=5.265,P=0.021;χ~2=9.075,P=0.000),脐带血总胆红素在日龄≤3 d组明显高于日龄3 d组,脐带血总胆红素水平DAT阳性患者明显高于DAT阴性患者(P0.05),脐带血总胆红素水平在DAT阳性患者之间、DAT阴性患者之间比较差异无统计学意义(P0.05),游离试验阳性与阴性之间比较差异无统计学意义;脐带血总胆红素水平越高,高胆红素血症发生率越高(r=0.741,P0.05)。结论对于ABO血型不合新生儿脐带血血清总胆红素检测及溶血三项试验在早期诊治ABO-HDN方面有重要意义。     

CD144+内皮微粒标志物与母婴血型不合新生儿溶血病患儿血管内皮损伤及功能障碍的相关性研究

目的:研究CD144+内皮微粒标志物与母婴血型不合新生儿溶血病患儿血管内皮损伤及功能障碍的相关性.方法:选取45例ABO新生儿溶血病患儿(ABO新生儿溶血病组)、20例Rh血型不合溶血病患儿(Rh血型不合溶血病组)和20例健康新生儿(对照组),收集所有患儿的外周血样本进行血液分析,检查红细胞(RBC)形态、网织红细胞计数和溶血标志物(乳酸脱氢酶LDH和间接胆红素),进行高灵敏度C-反应蛋白(CRP)检测、直接抗球蛋白试验(新生儿)和间接抗球蛋白试验(母亲),定量检测血管性血友病因子抗原(vWF:Ag),并进行抗CD144检测分析和内皮微粒分析,对检查结果进行统计学分析.结果:3组新生儿出生体重及胎龄比较差异无统计学意义(P＞0.05).两溶血组患儿血红蛋白、LDH和间接胆红素水平与对照组比较差异有统计学意义(P＜0.05),两溶血组组间比较差异无统计学意义(P＞0.05),Rh血型不合溶血病组患儿直接抗球蛋白试验阳性率为100％,且网织红细胞计数较ABO新生儿溶血病组患儿高.两溶血组患儿vWF:Ag和治疗前内皮细胞来源的细胞微粒(EMP)水平均较正常组高,且ABO新生儿溶血病组最高(P＜0.05);进行换血治疗和/或光线治疗后EMP水平较治疗前显著减低(P＜0.05),且患有严重高胆红素血症的ABO新生儿溶血病组患几经过换血治疗后EMP水平较换血治疗前EMP水平降低得更显著(P＜0.05).两溶血组患儿治疗前EMP水平与LDH、间接胆红素和vWF:Ag水平呈正相关,而治疗前EMP与血红蛋白水平呈负相关(P＜0.05).治疗前EMP和血红蛋白水平仅在ABO新生儿溶血病组呈正相关(P＜0.05).多重回归分析发现:血红蛋白、LDH和间接胆红素水平与ABO新生儿溶血病组患儿治疗前EMP水平独立相关(r2=0.834,P＜0.05),Rh血型不合溶血病组患儿仅血红蛋白和LDH水平与治疗前EMP水平呈现独立相关性(r2=0.877,P＜0.05).结论:EMP在ABO新生儿溶血病患儿中的水平升高可用于反映IgG抗体介导的内皮损伤,测量HDN新生儿的EMP水平有助于评估可能发生的严重血管功能障碍风险.     

脐带血早期诊断新生儿ABO溶血病对预防严重高胆红素血症的价值

目的探讨出生时采用脐带血直接抗人球蛋白试验(DAT)及抗体释放试验早期诊断新生儿ABO溶血病,对预防严重高胆红素血症的价值。 方法选择2013年6月至2016年6月,于四川大学华西第二医院新生儿科确诊为ABO溶血病的655例晚期早产儿及足月新生儿为研究对象。其中,出生时经脐带血DAT及抗体释放试验确诊为ABO溶血病的188例患儿纳入研究组,入院后经静脉血DAT及抗体释放试验确诊为ABO溶血病的467例患儿纳入对照组。回顾性分析2组患儿的临床病例资料,并采用t检验或χ²检验,对2组患儿的一般临床资料、主要实验室检查结果、治疗及近期预后等,进行统计学比较。本研究与所有患儿监护人均签署知情同意书。 结果①研究组患儿入院年龄及发现黄疸时年龄,均小于对照组[(34.3±21.8) h vs (58.8±34.3) h,(22.0±12.8) h vs (32.3±19.0) h],入院时血清总胆红素(TSB)浓度及血红蛋白(Hb)水平,均低于对照组[(185.5±49.2) μmol/L vs (243.3±85.1) μmol/L,(147.3±21.6) g/L vs (153.8±24.9) g/L],剖宫产比例高于对照组(70.2% vs 56.5%),并且上述临床指标比较,差异均有统计学意义(t＝9.071,P<0.001;t＝6.831,P<0.001;t＝8.743,P<0.001;t＝3.132,P＝0.002;χ²＝10.492,P＝0.001)。②研究组患儿换血率及白蛋白使用率均低于对照组(0 vs 9.0%,9.6% vs 22.5%),并且差异均有统计学意义(χ²＝18.532,P<0.001;χ²＝15.151,P<0.001)。③7例发生胆红素脑病患儿,均为对照组患儿。 结论出生时采用脐带血DAT及抗体释放试验筛查ABO溶血病,可使医师和监护人对ABO溶血病患儿的黄疸加强监测,有助于早期发现需要住院光疗的患儿,避免发生需要采取换血治疗的严重高胆红素血症和胆红素脑病。     

O型血孕妇血型抗体与新生儿ABO溶血病的关系

目的探讨O型血孕妇血型抗体效价与新生儿ABO溶血病的关系.方法检测O型血孕妇孕后期IgG抗A(B)血型抗体效价,母婴血型不合新生儿血型血清学检查及血清胆红素水平,观察新生儿的临床表现.结果O型血产妇分娩的新生儿中,有68.3%发生ABO溶血病,母亲的IgG抗A(B)抗体效价与新生儿ABO溶血病的发生有统计学意义(P＜0.05),与新生儿血清胆红素水平无统计学意义(P＞0.05).结论母亲血型抗体效价是发生新生儿ABO溶血病的重要指标,但不是绝对指标.重要的是监测O-A、O-B母子血型不合的新生儿的血清胆红素水平及特异性血型抗体的情况,及早发现,及早治疗.     

O型血孕妇血型抗体与新生儿ABO溶血病的关系

目的 :探讨 O型血孕妇血型抗体效价与新生儿 ABO溶血病的关系。方法 :检测 O型血孕妇孕后期 Ig G抗 A(B)血型抗体效价 ,母婴血型不合新生儿血型血清学检查及血清胆红素水平 ,观察新生儿的临床表现。结果 :O型血产妇分娩的新生儿中 ,有 6 8.3%发生 ABO溶血病 ,母亲的 Ig G抗 A(B)抗体效价与新生儿 ABO溶血病的发生有统计学意义 (P<0 .0 5 ) ,与新生儿血清胆红素水平无统计学意义 (P>0 .0 5 )。结论 :母亲血型抗体效价是发生新生儿 ABO溶血病的重要指标 ,但不是绝对指标。重要的是监测 O- A、O- B母子血型不合的新生儿的血清胆红素水平及特异性血型抗体的情况 ,及早发现 ,及早治疗。     

蓝光治疗对新生儿红细胞葡萄糖-6-磷酸脱氢酶缺乏症所致高胆红素血症患儿溶血反应的影响

目的研究蓝光治疗对新生儿红细胞葡萄糖-6-磷酸脱氢酶(G-6-PD)缺乏症所致高胆红素血症患儿溶血反应的影响。方法选择2013年2~12月,广东省肇庆市妇幼保健院收治的59例G-6-PD缺乏症患儿为研究对象。根据入院顺序号随机将其分为G-6-PD缺乏接受蓝光治疗+综合治疗组(研究组,n=34)和G-6-PD缺乏仅接受综合治疗,未接受蓝光治疗组(对照组,n=25)。研究组与对照组患儿的性别构成比、日龄、喂养方式及分娩方式等比较,差异均无统计学意义(P>0.05)。本研究遵循的程序符合广东省肇庆市妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署临床研究知情同意书。分别比较两组患儿治疗前、后及两组患儿治疗48h后红细胞计数、血红蛋白(Hb)水平及其变化情况。结果研究组和对照组患儿治疗前出生体质量、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、红细胞计数、Hb水平比较,差异均无统计学意义(P>0.05)。研究组及对照组患儿接受治疗后,TBIL、DBIL、IBIL、红细胞计数、Hb水平均较治疗前降低,并且差异均有统计学意义(P<0.05)。此外,研究组患儿接受蓝光治疗48h后红细胞计数及Hb水平明显低于对照组,并且差异均有统计学意义(P<0.05)。结论蓝光治疗虽是治疗G-6-PD缺乏所致新生儿高胆红素血症的有效方法,但同时亦可加重G-6-PD缺乏所致新生儿高胆红素血症患儿溶血反应。     

母婴血型不合围生期管理——附40例母婴血型不合溶血病临床资料分析

[目的]探讨母婴血型不合孕妇孕期管理、妊娠结局及其影响因素。[方法]对住院分娩的40例母婴血型不合溶血病的孕产妇及新生儿临床资料进行回顾性分析。[结果]母婴ABO血型不合溶血病37例(92.5%),母体ABO血型抗体抗-A或B(IgG)不同效价之间,新生儿脐血改良直接抗人球蛋白试验(改良Coombs试验)阳性反应及新生儿黄疸发生时间有差异(P﹤0.05),母血抗-A或B(IgG)效价1︰128共14例(37.84%),其新生儿脐血改良Coombs试验阳性反应及24h新生儿黄疸发生明显增加;孕妇ABO血型抗体滴度与新生儿外周血间接胆红素水平呈正相关(P﹤0.05)。母婴Rh血型不合溶血病3例(7.5%),母体Rh血型抗体效价均≥1︰512,最高达1︰1024,新生儿均接受了换血治疗。[结论]夫妇ABO血型不同的O型孕妇,母体ABO血型抗体效价≥1︰128时发生新生儿溶血病的风险明显增加;夫妇Rh血型不同的Rh(D)阴性孕妇,应加强孕期Rh血型抗体等监护及产前产后胎婴儿观察和处理。建议在对孕妇进行血型鉴定时,同时筛查ABO血型抗体及ABO外抗体。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.