超敏C-反应蛋白和胰岛素敏感指数在儿童阻塞性睡眠呼吸暂停综合征中的变化

目的：探讨阻塞性睡眠呼吸暂停综合征（OSAHS）患儿超敏C-反应蛋白（hsCRP）和胰岛素敏感指数（ISI）的变化。方法：51例患儿分为 OSAHS组（29例）和原发性鼾症（PS）组（22例）。均实施多导睡眠监测仪（PSG）检测,分别测体重指数（BMI）、hsCRP、血脂、空腹血糖(FPG)、空腹胰岛素(INS),计算ISI。结果：与 PS 组比较,OSAHS组的呼吸暂停通气指数（AHI）增高（13.2±9.2 vs 1.2±1.1, P<0.05）;OSAHS组的最低血氧饱和度（LSaO2）低于PS患儿［(78.5±5.4)% vs (87.4±3.7)%, P<0.05］;OSAHS组的hsCRP高于PS组（2.8±2.7 mg/L vs 0.6±0.9 mg/L,P<0.05）;OSAHS组的ISI、血脂与 PS 组的差异无统计学意义。OSAHS 组的hsCRP与LSaO2呈负相关（r=-0.531, P<0.05）。结论：OSAHS患儿hsCRP水平增高,可能与日后心血管疾病的发生相关,应早期给予干预。     

肺表面活性物质联合布地奈德干预治疗对伴呼吸窘迫综合征的低出生体质量儿心功能的保护作用

目的探讨肺表面活性物质(PS)联合布地奈德对伴呼吸窘迫综合征(RDS)的极低出生体质量儿(VLBWI)心功能的保护作用,并评估联合用药的效果。方法选取2010年8月-2011年3月南京市妇幼保健院收治的胎龄<34周、出生体质量<1 500 g、出生4 h内发生RDS的早产儿30例,将其随机分为PS+布地奈德组和PS组。PS+布地奈德组使用PS和布地奈德混合剂(每70 mg PS中加入0.25 mg布地奈德),PS剂量70 mg.kg-1,布地奈德0.25 mg.kg-1。PS组单使用PS,剂量70 mg.kg-1。在出生30～60 min由气管内滴入。于1、7、14 d进行血清CK-MB和肌钙蛋白测定,同时进行超声心动图检查,对左心室射血分数(LVEF)、右心室射血分数(RVEF)、二尖瓣舒张早期和舒张晚期血流峰比值(MVE/A)、三尖瓣舒张早期和舒张晚期血流峰比值(TVE/A)、左心室(LV)-Tei指数进行测定。结果 PS+布地奈德组血清CK-MB和肌钙蛋白14 d低于PS组(Pa<0.05);与PS组比较,PS+布地奈德组心脏收缩功能LVEF 14 d明显增加(P<0.05),RVEF 7、14 d均明显增加(Pa<0.05)。2组MVE/A和TVE/A均逐渐增加,PS+布地奈德组增加明显,MVE/A 14 d,TVE/A 7、14 d与PS组比较差异有统计学意义(Pa<0.05)。PS+布地奈德组LV-Tei指数14 d低于PS组(P<0.05)。结论使用PS联合布地奈德对伴RDS的VLBWI进行干预对其心脏具有保护作用,可促进心脏功能恢复。     

鼾症对儿童睡眠结构及生长发育的影响

目的探讨原发性鼾症(PS)及阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对儿童睡眠效率(SE)、睡眠结构、呼吸事件及生长发育的影响。方法选择2007年12月-2009年7月因打鼾、张口呼吸、呼吸困难等来本院呼吸科及耳鼻喉科就诊的患儿122例,经多导睡眠监测分为PS组(58例)和OSAHS组(64例),对2组患儿的SE、睡眠结构、睡眠事件及生长发育情况进行统计学分析。结果OSAHS组患儿SE低于PS组(P<0.01);OSAHS组Ⅰ期、Ⅱ期睡眠百分比高于PS组,Ⅲ+Ⅳ期及快速动眼睡眠(REM)期睡眠百分比低于PS组(Pa<0.01);OSAHS组呼吸暂停总次数高于PS组(P<0.01);最长呼吸暂停时间OSAHS组明显延长(P<0.01)。二组低通气总次数比较差异有统计学意义(P<0.01),OSAHS组较多;二组最长低通气时间比较差异亦有统计学意义(P<0.01),OSAHS组较长;呼吸紊乱指数、氧减指数二组比较差异均有统计学意义(Pa<0.01),OSAHS组较高。二组患儿身高、体质量、体质量指数、颈围比较差异均无统计学意义(Pa>0.05),OSAHS组腺样体面容发生率较PS组显著增高(P<0.05)。结...     

先天性心脏病肺动脉高压患儿左室舒张功能与血浆脑利钠水平的相关性研究

目的：探讨先天性心脏病 (CHD)合并肺动脉高压 (PAH) 患儿脑利钠肽（BNP）水平及与左室舒张功能的关系。方法：对95例CHD继发有PAH的患儿和42例无PHA的CHD患儿（对照组）的多普勒超声心动图资料与其血浆BNP水平进行对比分析。结果：与对照组相比, PAH组的左室舒张末内径（LVDd ）、右室舒张末内径（RVDd） 和肺动脉内径（PAd）明显增大(P<0.05),三尖瓣返流（VTR）速度增快及肺动脉收缩压（PASP）升高(P<0.05)。与对照组比较,PASP组患儿二尖瓣口多普勒血流频谱A峰流速（AV）、A峰流速积分（AVI）和E峰流速积分（EVI）及AV/EV和AVI/EVI比均逐渐明显增大(P<0.01);左室等容舒张时间明显延长(LIVRT)(P<0.05)。血浆BNP水平随着PASP增高而升高,与对照组相比差异有显著性（P<0.01）。PAH组先心病患儿其肺动脉压与二尖瓣口血流频谱AV/EV比值呈正相关（P<0.01）,二尖瓣口血流参数与血浆BNP水平亦呈正相关（P<0.01）。结论：CHD合并PAH患儿左室舒张功能与血浆BNP水平呈正相关;BNP在PAH引起左室舒张功能障碍的发生发展过程中发挥了重要作用。［中国当代儿科杂志,2010,12（1）：13-16］     

不同体质指数的阻塞性睡眠呼吸暂停低通气综合征患儿多导睡眠图监测分析

目的通过对不同体质指数(BMI)的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿的多导睡眠图(PSG)监测结果分析,探讨BMI与OSAHS患儿病情的关系。方法9例高BMI、10例低BMI和25例正常BMI经全夜PSG监测明确诊断OSAHS的患儿,对其PSG监测的夜间血氧和睡眠结构各项指标进行分析比较。结果高BMI组睡眠呼吸暂停低通气指数(AHI)为(21.61±742)次/h,SaO2低于90%的持续时间占睡眠时间的百分比(SLT)90%为(74.11±4.84)%、最长睡眠呼吸暂停时间(TL)为(14020±52.86)s,显著高于正常BMI组(P<0.01);SaO2的低谷值(SaO2L)为(70.67±831)%明显低于正常BMI组(P<0.05);低BMI组AHI为(17.18±7.43)/h,TL为(113.50±14.77)s,显著高于正常BMI组(P<0.05)。结论肥胖与消瘦的OSAHS患儿其疾病程度重于正常BMI的OSAHS患儿.尤其是肥胖的OSAHS儿童。     

儿童少年期高血压左室结构及心功能的超声评价

目的 观察儿童少年期原发性高血压左室结构及心功能的变化,对高血压患儿靶器官异常进行评估.方法 应用超声心动图对47例儿童少年期原发性高血压患儿和62名健康体查者进行检查,测量其心脏结构和功能改变.结果 高血压组舒张末期室间隔厚度(IVST.D)、舒张末期左室后壁厚度(LVPWT.D)、舒张末期左室内径(LVED.D)、收缩末期左室内径(LVES.D)、左室质量(LVM)、左室质量指数(LVMI)较正常组显著增高(P均<0.01),射血分数(EF)、左室短轴缩短率(FS)较正常组降低(P<0.05).舒张早期充盈峰速度(E峰)较正常组下降,但差异无统计学意义(P>0.05),舒张晚期充盈峰速度(A峰)上升(P<0.05),E/A显著下降(P<0.01).11 例患儿存在左室肥厚(LVH),出现心脏构型改变.结论 在儿童少年期原发性高血压病中,作为病变累及的靶器官心脏存在结构和功能的异常改变.     

儿童阻塞性睡眠呼吸障碍低通气综合征临床特点分析

目的分析儿童阻塞性睡眠呼吸障碍低通气综合征(OSAHS)的临床及多导睡眠监测(PSG)特点。方法选取2016年12月-2019年4月以打鼾或/伴张口呼吸症状就诊的患儿为研究对象,收集临床及PSG监测资料。根据PSG结果分为OSAHS组、单纯打鼾(PS)组及鼾症伴氧减组,分析各组患儿的临床资料及PSG结果。结果共入组408例患儿,中位年龄5岁(4～7岁),男260例、女148例。OSAHS患儿99例,PS患儿201例,鼾症伴氧减患儿42例。OSAHS组扁桃体肿大、腺样体肥大比例高于PS组,鼻炎/鼻窦炎比例低于PS组,OSAHS组的夜间打鼾、呼吸费力、呼吸暂停、夜尿比例均高于PS组,OSAHS组的日间思睡比例高于PS组和鼾症伴氧减组,差异均有统计学意义(P0.05)。OSAHS组的PSG监测NREM1期睡眠时间、鼾声指数均高于PS组,NREM3期比例低于PS组。OSAHS组及鼾症伴氧减组的最低血氧饱和度(LSaO_2)均低于PS组,差异有统计学意义(P0.05)。OSAHS组的呼吸暂停低通气指数(AHI)最高,呼吸暂停最长时间最长,其次为鼾症伴氧减组,差异均有统计学意义(P0.05)。多元logistic回归模型分析显示,腺样体肥大、肥胖、存在过敏性鼻炎/鼻窦炎是儿童OSAHS发生的独立危险因素(P0.05)。结论 OSAHS患儿存在睡眠结构紊乱,主要为NREM1期睡眠时间延长,NREM3期时间缩短。肥胖、腺样体肥大、鼻炎或鼻窦炎是OSAHS发生的危险因素。     

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目的评估缺氧新生儿肺动脉高压(PAH)的发生及其对左室形态及功能的影响,探讨缺氧性PAH新生儿血浆脑利钠肽(BNP)水平与左室舒张功能的关系。方法选择2003年11月至2008年11月解放军总医院和北京军区总医院附属八一儿童医院新生儿重症监护室(NICU)收治的缺氧新生儿52例,根据彩色多普勒超声检查是否存在PAH分为PAH组(34例)与对照组(18例),比较2组患儿彩色多普勒超声心动图资料及其与左室舒张功能、血浆BNP水平的关系。结果(1)与对照组相比,PAH组左室舒张末内径(LVDd)、右室内径(RV)、肺动脉内径(PA)明显增大(P<0.05);三尖瓣反流峰值(VTR)流速增快及肺动脉收缩压(PASP)升高(P<0.05),室间隔增厚不明显(P>0.05)。(2)PAH组二尖瓣口血流多普勒频谱A峰流速(AV)、舒张早期充盈时间速度积分(AVTI)及A峰流速与E峰流速比值(AV/EV)、左房充盈分数(AVTI/EVTI)均较对照组显著增加(P<0.01);PAH组的左室等容舒张时间(LIVRT)延长,但与对照组相比差异无统计学意义(P>0.05),EV、舒张末期充盈时间速度积分(EVTI)及E峰减速时间(...     

Tei指数评价缺氧新生儿左心室功能障碍的作用研究

目的：探讨Tei指数在评价缺氧新生儿左心室功能障碍中的作用。方法：52例低氧血症新生儿（轻度20例,中重度各16例）和40例正常新生儿作为研究对象,于生后1、3、7 d用多普勒超声心动图测定反映心脏收缩及舒张功能的指标：左心室射血分数（LVEF）、二尖瓣口E/A值;左心室Tei指数（LV-Tei）。结果：（1）中度低氧血症组生后1、3 d LVEF、左室E/A值明显低于对照组（P<0.01）;重度低氧血症组生后1、3、7 d LVEF、左室 E/A 值均明显低于对照组（P<0.01或0.05）。（2）轻度低氧血症组生后1 d、中度及重度低氧血症组生后1 d、3 d LV-Tei 值明显高于对照组（P<0.01）。（3）低氧血症组生后1 d、3 d PaO2与LV-Tei呈负相关(r=-0.50, P<0.05; r=-0.71, P<0.01)。结论：LV-Tei可敏感地发现低氧血症患儿左心室功能下降,对临床的诊治有重要的指导作用。     

18例尿毒症患儿心脏彩色多普勒超声表现

目的　探讨尿毒症患儿彩色多普勒超声心动图表现。方法　采用彩色多普勒超声心动图仪观察 18例8岁～ 14岁尿毒症患儿心脏各腔室内径、室壁厚度及瓣膜返流。结果　尿毒症患儿心脏受到不同程度的损害 ,其中左心室扩大 8例 (44 .4% ) ,左心房扩大 9例 (5 0 .0 % ) ,左心室肥厚 3例 (16 .7% ) ,心包积液 10例 (5 5 .6 % ) ,二尖瓣返流 11例(6 1.1% ) ,三尖瓣返流 4例 (2 2 .2 % ) ,主动脉瓣返流 3例 (16 .7% ) ,左室舒张功能减退 8例 (44 .4% ) ,未见左室收缩功能减退。结论　彩色多普勒超声心动图能客观地反映尿毒症患儿心脏病变 ,对指导临床治疗具有重要意义。     

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.     

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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.     

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   

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.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.