Troponin-T levels in perinatally asphyxiated infants during the first 15 days of life

Aim: To measure serial cardiac troponin‐T, creatine kinase, creatine kinase‐MB, aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase levels in asphyxiated newborn infants during the first 15 d of life. Methods: Troponin‐T, creatine kinase, creatine kinase‐MB, aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase (LDH) concentrations were measured prospectively in blood samples obtained from 45 asphyxiated and 15 healthy term neonates within the first 2–4 h, third, seventh and 15th days. Results: Infants with severe asphyxia had significantly higher cardiac troponin‐T levels than grade I and II asphyxiated and healthy neonates within the first 2–4 h of life (0.34 ± 0.21 ag/ml vs 0.07 ± 0.03 ag/ml, 0.12 ± 0.07 ag/ml, 0.04 ± 0.02 ag/ml, respectively). Troponin‐T levels remained high on days 3 and 7 in severely asphyxiated neonates. The creatinine kinase‐MB levels were significantly higher in grade II and III asphyxiated neonates than grade I asphyxiated and healthy neonates within the first 2–4 h. No difference was found in creatinine kinase‐MB on day 3. There was cardiac involvement in 12 (80%) newborns of group III on B mode echocardiographic images on day 1. However, no echocardigraphic pathology was found in the seventh‐ and 15th‐day echocardiographic analysis in any groups. Conclusion: Our results suggest that asphyxia‐related cardiac changes were significant but reversible in severely asphyxiated neonates, and troponin T is a good determinant of the degree of injury to the heart within the first week of life. Cardiac troponin T also has a wider diagnostic frame than other diagnostic markers of myocardial damage.     

Estimation of myocardial damage in Kawasaki disease using antimyosin antibody

In a retrospective study, 121 children with Kawasaki disease (KD) were investigated to determine (i) the incidence of myocardial damage using the antimyosin antibody (AMA) titer; (ii) the differences in the electrocardiograms between the AMA-positive and -negative patients; and (iii) the effect of treatment with intravenous gamma globulin (IVGG) on the AMA. Comparisons were made with 117 normal children (controls). Patients with KD showed a significantly higher mean AMA titer and more patients were positive for AMA than the controls. The AMA titer in the KD group was not related to the presence of coronary artery lesions. Electrocardiograms obtained during the acute and the convalescent stage of KD revealed that patients positive for AMA had a significantly lower voltage of T wave in lead V6 at week four than at week two of illness, whereas patients negative for AMA showed no T wave change after week two. The group treated with IVGG showed a significantly lower AMA titer than that not given IVGG. These observations suggest that myocardial damage occurs in some patients with KD which is unrelated to the presence of coronary artery lesions and that the treatment with IVGG reduces the AMA titer in patients with KD.     

Cardiac enzyme levels in myocardial dysfunction in newborns with perinatal asphyxia

Objective  To study the usefulness of cardiac enzymes in evaluating myocardial damage in perinatal asphyxia. Methods  Thirty term babies with perinatal asphyxia and without any congenital malformations were selected as cases. They were compared with thirty healthy term babies without asphyxia. Myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac enzymes i.e, troponin-T and CK-MB levels. Results  Among the 30 cases 23 had evidence of myocardial involvement while one baby in the control group had ECG evidence compatible with cardiac involvement. Cardiac enzymes were significantly increased in babies with perinatal asphyxia. The mean level of C-troponin-T among cases and controls were 0.22±0.28 and 0.003±0.018 while CK-MB levels were 121±77.4 IU/L and 28.8 ± 20.2 IU/L respectively. C-troponin-T had higher sensitivity and specificity compared to CK-MB levels. Moreover, C troponin-T levels correlated well with severity and outcome in babies with perinatal asphyxia. Conclusion  C-Tropopnin assay is useful in evaluating the severity of myocardial damage and outcome in perinatal asphyxia.     

儿童失神癫240例治疗及预后随访报告:应用改良的1989年儿童失神癫诊断标准

目的总结儿童失神癫(CAE)的治疗和预后,为CAE的合理用药和评价远期预后提供依据。方法对1999年10月至2005年12月北京市3家医院为研究CAE易感基因收集的CAE患儿的治疗用药、疗效及预后进行随访。CAE诊断标准参考1989年国际抗癫联盟(ILAE)提出的癫及癫综合征分类诊断标准,并制定了统一的CAE纳入标准和排除标准。根据CAE的选药原则进行治疗,评估CAE患儿的远期预后。结果3家医院共收集符合ILAECAE诊断标准的患儿339例,其中296例符合本研究制定的CAE纳入标准。296例患儿中有56例患儿因失访未得到远期预后随访结果,有随访结果者240例(81.1%),其中男94例(39.2%),女146例(60.8%)。失神发作起病年龄为3岁3个月至12岁,其中4～8岁174例(72.5%)。39例(16.2%)有热性惊厥史,18例(7.5%)有热性惊厥家族史和(或)癫家族史,5例(2.1%)有失神癫家族史。失神癫发作频率为每日5～50次,其中每日发作10～30次占80%。出现失神持续状态1例。伴全面强直-阵挛发作12例(5.0%)。所有患儿发作期EEG均表现为双侧对称同步的3Hz棘慢波爆发,头颅影像学检查均未见异常。治疗首选丙戊酸234例,其中217例(92.7%)于服药后3d至6个月发作完全控制,15例加用另一种药物(其中氯硝西泮7例、硝西泮4例及拉莫三嗪4例)后发作控制,余2例单用丙戊酸2年后仍有发作,但发作次数明显减少;首选拉莫三嗪4例,其中3例发作控制,1例服药1年发作未控制,改用丙戊酸1周后发作控制。2例首选托吡酯治疗,其中1例发作控制,1例服药5个月效果不明显,改用丙戊酸2个月后发作控制。240例患儿随访时间为2～7年,158例(65.8%)已停用抗癫药物,其中停药1年以上者96例,停药后均无复发;82例尚未停用抗癫药物患儿中,80例发作完全控制2年以上,仅有2例仍有失神发作。随访的240例患儿在校学习成绩为中等及以上者有171例(71.3%)。结论丙戊酸是治疗CAE的首选药物,对绝大多数患儿疗效好。少数用丙戊酸发作未控制者可选用拉莫三嗪或苯二氮类药物。典型CAE患儿远期预后良好。     

儿童失神癫240例治疗及预后随访报告：应用改良的1989年儿童失神癫诊断标准

目的总结儿童失神癫（CAE）的治疗和预后，为CAE的合理用药和评价远期预后提供依据。方法对1999年10月至2005年12月北京市3家医院为研究CAE易感基因收集的CAE患儿的治疗用药、疗效及预后进行随访。CAE诊断标准参考1989年国际抗癫联盟（ILAE）提出的癫及癫综合征分类诊断标准，并制定了统一的CAE纳入标准和排除标准。根据CAE的选药原则进行治疗，评估CAE患儿的远期预后。结果3家医院共收集符合ILAE CAE诊断标准的患儿339例，其中296例符合本研究制定的CAE纳入标准。296例患儿中有56例患儿因失访未得到远期预后随访结果，有随访结果者240例（81.1%），其中男94例（39.2%），女146例（60.8%）。失神发作起病年龄为3岁3个月至12岁，其中4~8岁174例（72.5%）。39例（16.2%）有热性惊厥史，18例（7.5%）有热性惊厥家族史和（或）癫家族史，5例（2.1％）有失神癫家族史。失神癫发作频率为每日5~50次，其中每日发作10~30次占80%。出现失神持续状态1例。伴全面强直12例（5.0%）。所有患儿发作期EEG均表现为双侧对称同步的3 Hz棘慢波爆发，头颅影像学检查均未见异常。治疗首选丙戊酸234例，其中217例（92.7%）于服药后3 d至6 个月发作完全控制，15例加用另一种药物（其中氯硝西泮7例、硝西泮4例及拉莫三嗪4例）后发作控制，余2例单用丙戊酸2年后仍有发作，但发作次数明显减少；首选拉莫三嗪4例，其中3例发作控制，1例服药1年发作未控制，改用丙戊酸1周后发作控制。2例首选托吡酯治疗，其中1例发作控制，1例服药5个月效果不明显，改用丙戊酸2个月后发作控制。240例患儿随访时间为2～7年，158例（65.8%）已停用抗癫药物，其中停药1年以上者96例，停药后均无复发；82例尚未停用抗癫药物患儿中，80例发作完全控制2年以上，仅有2例仍有失神发作。随访的240例患儿在校学习成绩为中等及以上者有171例（71.3％）。结论丙戊酸是治疗CAE的首选药物，对绝大多数患儿疗效好。少数用丙戊酸发作未控制者可选用拉莫三嗪或苯二氮类药物。典型CAE患儿远期预后良好。     

Biochemical assessment of thiamine nutrition in childhood

The activity of red cell transketolase and TPP-effect were determined in 1028 infants and children, aged 1 month to 14 years, using a micromethod. All the children were healthy and without evidence of malnutrition. Transketolase activity decreased in the second year of life, followed by a constant increase up to the 6th year. Activity did not change in the next four years, then a steady decrease occurred. TPP-effect was not as stable as transketolase activity, and decreased significantly from years 3 to 5 and increased significantly from years 5 to 7. Beginning with year 10, TPP-effect decreased gradually. 6.6% of all children investigated had marginally deficient TPP-effects and 1.3% were biochemically deficient without clinical signs of avitaminosis. A group of 37 adults had transketolase activities and TPP-effect comparable to those of the 13 year-olds. Effect appeared to be marginal in 5.4% and deficient in 2.7%.     

血清肌酸激酶对假肥大型肌营养不良诊断价值

肌酸激酶(cK)是一种细胞内激酶,在肌细胞能量贮存、转移中起重要作用.临床上通过CK检测,可以早期发现假肥大型肌营养不良患者.该文就CK分布、同工酶、亚型、CK检测对假肥大型肌营养不良的诊断价值及新生儿期CK筛查意义作一综述.     

Late cardiac damage of anthracycline therapy for acute lymphoblastic leukemia in childhood

Long-termleukemia survivors (46) underwent cardiac evaluation, including physical examination, ECG, exercise testing, and echocardiography. They were 2-17 years old at diagnosis and 5-23 years old aftertreatment. Thirty-four survivors received anthracyclines (AC) (mean 203 mg/m2), 12 of them had also alkylating agents (AA) and 12 had no AC. Exercise tolerance was bellow predicted valuesin 21 (48%) survivors and 21 survivors had ECG abnormalities, which were more frequent in those treated with AC. Concomitant AC with AA was correlated with prolonged isovolumic relaxation time (IVRT) and influenced significantly the volume of left atrium (p = .02). Sixteen (52%) survivors had IVRT 90 ms. There were no significant differences in other parameters of diastolic orsystolic function. Despite the lack of clinical symptoms in the survivors treated with lower doses of AC, subtile abnormalities in myocardial function were found, mainly manifest as abnormal diastolic function. Prolonged IVRT may be a sensitive indicator for early detection of AC cardiotoxicity.     

肌酸激酶同工酶与血浆内皮素检测结合脑电图检查判断热性惊厥患儿脑损伤的程度及预后

目的探讨热性惊厥(FC)患儿血清脑型肌酸激酶同工酶(CK-BB)和血浆内皮素(ET)水平的变化及其两者结合脑电图(EEG)检查与脑损伤的关系。方法将2005-08—2006-12在潍坊医学院儿科就诊的52例FC患儿作为FC组,健康儿童28例作为正常对照组,分别进行血清CK-BB和血浆ET的测定及EEG检查,CK-BB采用比色法测定,ET采用放射免疫法测定。结果FC患儿血液中CK-BB和ET水平明显高于正常对照组(P均<0.01);单纯热惊厥(SFC)组CK-BB和ET的浓度与正常对照组比较差异无显著性(P>0.05);复杂热惊厥(CFC)组与正常对照组和SFC组比较差异均具有显著性(P均<0.01)。CFC组血清CK-BB与血浆ET呈正相关(r=0.652,P<0.01)。FC患儿惊厥发作后第1天EEG异常率为80.77%,其中SFC组78.12%,CFC组85.00%,差异无显著性(P>0.05);第14天为32.69%,SFC组仅18.75%,CFC组则55.00%,差异具有显著性(P<0.01)。结论CK-BB和ET水平与脑损伤的程度密切相关,CK-BB和ET含量越高脑损伤程度越严重。热性惊厥后及时检测CK-BB和ET,并结合脑电图检查对判断脑损伤程度及预后有重要价值。     

轮状病毒感染患儿肌酸激酶同工酶动态变化及其对心肌损害的诊断价值

目的：探讨肌酸激酶心肌同工酶( creatine kinase MB isoenzymes, CK-MB)在轮状病毒感染中的动态变化规律,并分析CK-MB/CK对于心肌损害的诊断价值。方法对2010年5月至2013年12月在江苏省泗洪儿童医院儿童感染科住院轮状病毒感染伴有CK-MB升高的患儿的临床表现、实验室检查结果以及临床经过进行回顾性分析。患者分为无心肌损害组和心肌损害组,比较两组患者CK-MB动态变化规律。在无心肌损害组中,对采用营养心肌治疗和常规治疗患儿的CK-MB变化进行对比分析；采用受试者操作特征曲线分析CK-MB/CK对心肌损害的预测价值。结果符合纳入标准的患儿共603例,其中男369例,女234例,年龄2~48个月；其中心肌损害共36例。轮状病毒感染患儿中,54．6%有血清CK-MB升高,伴有心肌损害的患儿为3．3%。心肌损害组与无心肌损害组比较,无心肌损害组CK-MB约在病程7 d达高峰,约14 d降至正常；心肌损害组CK-MB在病程14 d左右达高峰,持续约8周左右。在无心肌损害的患儿中,常规治疗组和营养心肌治疗组患者在病程1~14 d的血清CK-MB比较差异无统计学意义(P均>0．05)；受试者操作特征曲线分析结果显示CK-MB/CK预测心肌损害曲线下面积为0．697(0．611,0．784,95%CI)。结论 CK-MB在小儿轮状病毒感染过程中有其固有的变化规律,对于心肌损害的诊断价值有限。     

结核分枝杆菌多抗原蛋白芯片对儿童结核病的诊断价值

目的 探讨结核分枝杆菌(MTB)多抗原蛋白芯片对儿童结核病的诊断价值。方法 选取2005年4月至2006年4月在首都医科大学附属北京儿童医院诊断为结核病的住院患儿作为结核病组。选取同期住院，患感染性疾病，同时除外结核病的患儿作为非结核病组；选取体检纯化蛋白衍生物（PPD）试验阳性，既往无结核病史，无明显结核中毒症状，胸部影像学及腹部B超检查未见结核病灶的儿童作为结核感染组；选取同期行健康体检，卡疤试验阳性，无基础疾病，无结核接触史的儿童为健康对照组。各组留取血清标本。计算结核病组PPD试验阳性率及细菌学检查阳性率。应用MTB多抗原蛋白芯片同时检测标本中脂阿拉伯甘露糖（LAM）、相对分子质量16 000和38 000蛋白IgG抗体，通过蛋白芯片阅读仪判断结果，其中任意1种或1种以上抗体检测阳性，即判为蛋白芯片检测阳性。分别计算各组抗体检测阳性率，并计算该方法检测儿童结核病的灵敏度、特异度、阳性预测值和阴性预测值等指标。应用Logistic回归及χ2检验分析蛋白芯片检测阳性率与患儿年龄、病程、抗结核治疗时间、激素使用以及结核病类型的关系。结果 研究期间共纳入结核病组79例，非结核病组33例，结核感染组15例，健康对照组30例。蛋白芯片检测结核病组的阳性率为34.2%（27/79），低于PPD试验阳性率（84.8%，67/79），高于细菌学检查阳性率（12.7%，10/79）。在非结核病组阳性率为6.1%（2/33），结核感染组和健康对照组阳性率为0。蛋白芯片检测结核病组的灵敏度为34.2%，特异度为97.4%。阳性预测值93.1%，阴性预测值58.5%。Logistic回归发现蛋白芯片检测阳性率仅与病程相关，且随病程延长而阳性率升高。病程<1个月，蛋白芯片检测阳性率为18.8%（6/32），病程在～3个月，蛋白芯片检测阳性率为21.6%（8/37），病程>3个月，蛋白芯片检测阳性率为100%（13/13）。目前的统计结果尚未发现蛋白芯片检测阳性率与患儿年龄、抗结核治疗时间、激素使用情况有显著相关关系。结核病分型不同所造成的蛋白芯片检测阳性率的差异主要是由于其病程分布不同所致。结论 多抗原蛋白芯片对儿童结核病的诊断有一定价值，可作为一种诊断补充手段。但该方法灵敏度较低，不适用于早期诊断。     

1,6-二磷酸果糖联用维生素C佐治一氧化碳中毒并发心肌损害的临床研究

目的 探讨在常规治疗的基础上加用1,6-二磷酸果糖及维生素C治疗急性一氧化碳中毒并发心肌损害的有效性.方法 将40例急性一氧化碳中毒合并心肌损害的患儿分为治疗组(25例)和对照组(15例),均予以常规治疗(高压氧及对症治疗),治疗组加用1,6-二磷酸果糖及维生素C,疗程均为14 d,比较两组治疗前后血清心肌肌钙蛋白Ⅰ(cTn-Ⅰ)和肌酸激酶心型同工酶(CKMB)水平.结果 两组治疗前血清cTn-Ⅰ和CKMB水平比较差异无统计学意义;疗程结束时,治疗组血清cTn-Ⅰ和CKMB水平与对照组及治疗前比较,均显著降低,差异有统计学意义(P均＜0.05).结论 1,6二磷酸果糖联用维生素C可改善急性一氧化碳中毒患儿的心肌损害.     

Characteristics of tinnitus in childhood

Despite its incidence, there are still few reports in literature relating to tinnitus in children. Almost all data were collected by means of questionnaires or in a limited population of children. In order to collect data in a homogeneous way and directly from the patients, the protocol of study proposed by Savastano has been applied to 1,100 children. The results showed tinnitus as present in 374 children but only 6.5% of the cases complained spontaneously about it. In all, 76.4% of the children demonstrated normal hearing, whereas 64.5% reported being bothered by their tinnitus. Tinnitus measurements were obtained and are reproducible in all patients older than 8 years of age. The loudness level was <10 dB in 48.6% of cases, which was higher than 10 dB in 51.4%. As for the frequency distribution, in most cases it appears to be between 0 and 1,000 Hz. There is a correspondence between the loudness level and masking level. A total inhibition of <60 s for most children with lower loudness was obtained. The present study demonstrates that the application in the infancy of a specific protocol of study allows the presence of tinnitus to be discovered, giving specific and detailed information about it so as to minimize its damage to be obtained. Moreover, for the first time, data regarding the measurement of tinnitus in childhood has been gathered.     

血清肌酸磷酸激酶同工酶及心肌肌钙蛋白早期诊断窒息新生儿心肌损害

目的　探讨血清肌酸磷酸激酶同工酶 (CK- MB)及心肌肌钙蛋白I(cTnI)测定对窒息新生儿心肌损害的早期诊断价值。方法　窒息组 40例 (轻度窒息、重度窒息各 2 0例 )、对照组 2 0例 ,生后 1、5、1 0d测定血清CK MB及cTnI水平。结果　窒息组生后 1d血清CK- MB及cTnI明显高于对照组 (P均 <0 .0 1 ) ,重度窒息组明显均高于轻度窒息组 (P均 <0 .0 1 ) ,治疗后呈逐渐下降趋势。血清CK- MB及cTnI对心肌损害诊断的敏感性无显著差异 (P >0 .0 5)。结论　血清CK MB及cTnI可用于窒息新生儿心肌损害的早期诊断。     

呼吸道合胞病毒感染病程中肌酸激酶同工酶的动态变化及意义

目的 探讨心肌肌酸激酶同工酶（CK-MB）在呼吸道合胞病毒（respiratory syncytial virus,RSV）感染中的动态变化规律,并分析CK-MB/CK对于心肌损害的诊断价值.方法 2010年至2013年在本院住院RSV感染伴有CK-MB/CK＞ 5％的患儿,共577例,其中男317例,女260例,年龄2～18个月,其中心肌损害共44例,比较伴有心肌损害与未伴有心肌损害RSV感染患儿的CK-MB动态变化规律,并对采用营养心肌治疗和常规治疗的患儿CK-MB进行对比分析,采用受试者操作特征曲线分析CK-MB/CK对心肌损害的预测价值.结果 RSV感染患儿约46.5％伴有CK-MB异常,少数（3.5％）伴有心肌损害,伴有心肌损害与未伴有心肌损害RSV感染患儿CK-MB达到高峰及持续异常时间不同,未伴有心肌损害患儿是否营养心肌治疗CK-MB差异无统计学意义（P＞0.05）,CK-MB/CK预测心肌损害曲线下面积为0.663（95％ CI 0.578,0.747）.结论 CK-MB在小儿RSV感染过程中有其固有的变化规律,对于心肌损害的诊断价值低.     

Fibroepithelial polyp of the ureter in childhood

We report a case of fibroepithelial polyp of the ureter, a benign mesodermal tumour, that is rare, especially in the paediatric age group. The success of conservative management with renal preservation for this benign condition is emphasised.     

磷酸肌酸钠治疗新生儿窒息后心肌损伤的meta分析

目的：评价磷酸肌酸钠治疗新生儿窒息后心肌损伤的疗效。方法：检索国内外相关数据库,搜集有关磷酸肌酸钠治疗新生儿窒息合并心肌损伤的随机及半随机对照试验,采用Review Manager 5.1软件对数据进行分析。结果：共纳入6篇文献,400例患儿（试验组202例,对照组198例）。meta分析结果显示磷酸肌酸钠治疗7 d后患儿心肌酶CK、CK-MB、LDH、HBDH、cTnI均有所下降。治疗组显效率和总有效率均高于对照组,相对危险度分别为1.78和1.29,95%CI为（1.32,2.41）和（1.12,1.48）。治疗组总住院天数较对照组少4.07 d,95%CI为（-5.25,-2.89）。结论：磷酸肌酸钠对于治疗新生儿窒息后的心肌损伤显效率及总有效率均高于对照组,能缩短住院天数,且心肌酶谱可出现下降,未发现严重不良反应。但由于所纳入试验质量原因,需要更多的随机对照试验来验证。     

Pattern of childhood epilepsies in Sagumu,Nigeria

Objective  To determine the prevalence, aetiology and clinical pattern of childhood epilepsies in a Nigerian tertiary hospital. Methods  A review of hospital records of children managed for epilepsies at the Pediatric Neurology Clinic. Data studied included the age at presentation, sex, socio-economic class, probable aetiology, clinical type of seizure, Electroencephalopgraphic (EEG) pattern and presence of other neurologic disorders co-existing with seizures. Results  Out of 183 children, 138 had epilepsies giving a prevalence of 75.4%. Sixty nine (54.7%) were aged 6 months to 3 years at the first visit and 115 (69.9%) belonged to lower socio-economic classes IV and V. Birth asphyxia 47 (37.3%) and brain infections in 28 (21.9%) were the leading aetiologies. Generalized tonic-clonic seizures, complex partial seizures and rolandic seizures occurred in 55 (76.9%), 8 (6.3%) and 2 (4.8%) children respectively. Inter-ictal EEG abnormalities were recorded among 72/77 children. Seizures co-existed with other neurologic deficits in 86 (68.3%) of all epileptic cases. 95 (75.4%) children had defaulted from the clinic as at the time of the study. 21 (19.6%) had poor response to drug treatment. Presence of other neurological disorders (p = 0.029) and multiple aetiologies (p = 0.0000) were associated with poor response to drug treatment. Conclusion  Most cases of childhood epilepsy in Sagamu, Nigeria are due to preventable perinatal and neonatal conditions. Therefore, improved obstetric and neonatal care may reduce the prevalence of this condition.     

Specific and nonspecific lymphadenitis in childhood: etiology, diagnosis, and therapy

Over a period of 4 years, 39 children with lymphadenitis were treated surgically; in 31 cases cervical lymph nodes were the main location. In 9 cases the lymphadenitis was caused by mycobacterial infection.Staphylococcus aureus was the most frequent causative organism of unspecific lymphadenitis (11 cases). The therapy of choice appears to be surgical treatment and medical care after operation. Especially in mycobacterial lymphadenitis, complete surgical excision of the lymph node is decisive for definitive healing. There was only 1 case of therapy-resistant, relapsing cervical lymphadenitis that needed a second operation. Causative organisms in this case wereMycobacterium avium andMycobacterium intracellulare. All other patients showed an uneventful postoperative clinical course. We believe that a consequent diagnostic process and cooperation between the pediatric surgeon and pediatrician are necessary for effective therapy.