中国部分地区双胎妊娠孕期贫血6063例临床分析

目的 探讨不同孕周、不同地区、不同程度的双胎妊娠贫血及缺铁性贫血(iron deficiency anemia,IDA)发生率。方法 回顾性分析2020年1月1日至2020年12月31日于中国18个省市32家医院(中国妇幼保健协会双胎妊娠专委会双胎贫血学组成员单位)产前检查并分娩的6063例双胎妊娠孕妇的临床资料,统计孕妇年龄,孕期血清铁蛋白(serum ferritin,SF)和血红蛋白(hemoglobin,Hb)数值,分娩孕周,新生儿体重等数据,计算双胎妊娠不同孕周、不同地区、不同程度的贫血及缺铁性贫血的发生率,分析其存在的差异及可能原因。结果 孕早、中、晚期贫血发生率分别为8.5%(162/1898)、21.5%(608/2821)、29.3%(1142/3904),差异有统计学意义(χ²=318.560,P<0.005)。孕早、中、晚期缺铁性贫血的发生率分别为1.8%(34/1898)、6.6%(186/2821)、8.7%(339/3904),差异有统计学意义(χ²=100.149,P<0.005)。地区发生率：东北地...     

妊娠期预防性补铁的研究进展

<正>缺铁性贫血(iron deficiency anemia,IDA)是妊娠期最常见的合并症,发达国家妊娠期IDA的发病率约为14%,发展中国家平均为56%(35%~75%),我国妊娠期妇女IDA的发病率为19.1%,铁缺乏症的发病率更高,发达国家妊娠期妇女有30%~40%处于铁缺乏状态,我国妊娠期铁缺乏症的发病率达61.7%[1-3]。妊娠期铁缺乏及缺     

双胎妊娠期缺铁性贫血诊治及保健指南（2023年版）

<正>1背景与目的缺铁性贫血(iron deficiency anemia,IDA)是双胎妊娠期常见的合并症之一，约30%～45%的双胎孕妇在孕晚期发生贫血^[1-2]。2016年一项对中国16个省进行的横断面研究发现，妊娠妇女孕早期、中期、晚期的贫血患病率分别为4.9%、16.6%、23.2%，其中多胎妊娠的贫血及IDA的患病率高达28.7%及20.6%，均高于单胎妊娠^[3]。     

短程结构式游戏对学习困难儿童生活质量心理干预的研究

目的 改善与提高学习困难儿童的生活质量。方法 2003年2~8月采用短程结构式游戏对学习困难儿童进行生活质量心理干预，并用程灶火编制的儿少主观生活质量问卷(ISLQ)对学习困难儿童干预前后的生活质量进行检查评定。采用整群随机抽取湛江市2所小学4年级儿童共750名，按标准筛选出学习困难儿童83名，分为观察组与对照组，同时从该2所小学同年级学习成绩在中等或以上水平的学生中随机抽取50名，作为正常组。结果 按随机抽样原则经过短程结构式游戏干预后观察组生活质量的总分和认知、情感两个成分的分值均高于对照组，差异具有显著性(P<0.01)。其中家庭生活、同伴交往、学校生活、自我认识和抑郁体验5个方面明显高于对照组，差异具有显著性(P<0.01)。结论 短程结构式游戏是改善学习困难儿童生活质量的一种有效心理干预方法。 Abstract Objective To evaluate the life quality of the children with learning disability.Methods The quality of life were assessed in children with learning disability pre and post psychological intervention with short time programmed game by Inventory of Subjective Life Quality for children and adolescent(ISLQ) edited by Cheng Zhaohuo.Results The levels of total score,recognition score and emotion score were higher in experimental group than that in control group(P<0.01) after psychological intervention,in which the scores of family life,school life,self cognition and depression practice are significantly higher than that in control(P<0.01).Conclusion Short time programmed group game is an effective psychological intervention method to improve the life quality of children with learning disability. Key words Children;Learning disability;Quality of life     

生血康合剂补血片治疗妊娠期缺铁性贫血临床疗效观察

目的 探讨生血康合剂补血片（红桃K）治疗妊娠期缺铁性贫血（IDA）孕妇的临床疗效与安全性。方法 选取产检时被诊断为妊娠期IDA并给予生血康合剂补血片治疗的孕妇共156例,用药至少4周,根据贫血程度分为轻度贫血组和中度贫血组。观察两组孕妇用药后的临床疗效与安全性。结果 156例孕妇中轻度贫血92例,占58.97%;中度贫血64例,占41.03%。与治疗前比较,轻度贫血组孕妇治疗后的血红蛋白（Hb）、红细胞计数（RBC）、红细胞比容（HCT）、平均红细胞血红蛋白量（MCH）、平均红细胞血红蛋白浓度（MCHC）、平均红细胞体积（MCV）、铁蛋白（SF）指标均明显升高（P<0.05）,红细胞分布宽度（RDW-cv）指标明显降低（P<0.05）;与治疗前比较,中度贫血组治疗后孕妇Hb、RBC、HCT、MCH、MCHC、MCV、SF均明显升高（P<0.05）,RDW-cv指标明显降低（P<0.05）。生血康合剂补血片治疗妊娠期IDA总治愈率为70.51%。结论 生血康合剂补血片治疗妊娠期IDA疗效明确,安全性与依从性良好,无明显不良反应,值得临床应用。     

Survivin在儿童急性白血病中的表达和P53的相关性及其临床意义

目的探讨Survivin在儿童急性白血病(AL)中的表达及其与抑癌基因P53的相关性，同时观察Survivin与急性淋巴细胞白血病(ALL)临床分型的关系。方法应用免疫组织化学链霉亲和素-生物素-过氧化物酶复合物(SABC)方法，检测华中科技大学同济医学院附属同济医院儿科2004年1~7月收治的37例儿童AL骨髓细胞Survivin和P53的表达，对照组为10例非恶性血液病且骨髓正常患儿。结果在37例AL患儿中，Survivin蛋白表达阳性率为35.14%，P53表达阳性率为32.43%，显著高于正常骨髓组织(P均<0.05)，Survivin和P53表达呈强相关性(P<0.05)，Survivin在高危(HR)ALL患儿的表达为46.15%，在标危(SR)ALL患儿的表达为0，差异有显著性意义(P<0.05)。结论(1)Survivin在儿童AL中异常表达，且与ALL的临床分型有关，提示其在判定儿童ALL预后中有意义；(2)抑癌基因Ｐ53的失活与Survivin的表达可能在AL发生中起协同作用。 Abstract Objective To investigate the expression of Survivin in pediatric acute leukemia and its relationship with expression of P53 and clinical significance.Methods The expression of Survivin and P53 proteins were detected by immunohistochemical assay in 37 acute leukemia children.The control included 10 children with normal bone marrow.Results Survivin protein expression rate was 35.14% and P53 protein expression rate was 32.43% in 37 AL children.Both of them were significantly higher than that in control group (P<0.05).The expression of Survivin and P53 being strongly related (P<0.05).The expression rate of Survivin was 46.15% in HR ALL and 0% in SR ALL,the difference was statistically significant(P<0.05).Conclusion (1)Survivin protein expression rate is abnormal and is associated with the clinical typing of ALL.It may play an important role in the prognosis of ALL.(2)Expression of Survivin and de activation of anti oncogene P53 might play synergetic roles in the process of genesis of AL. Key words Survivin;P53;Children;Acute leukemia     

反复呼吸道感染儿童血清甘露聚糖结合凝集素水平及54密码子基因突变筛查

目的 了解反复呼吸道感染(RRTI)儿童血清甘露聚糖凝集素(MBL)水平及第一外显子54密码子的突变率，探讨血清MBL水平与RRTI的关系。方法 用ELISA方法检测2000~2003年在重庆医科大学附属儿童医院就诊的65例RRTI儿童和238名正常儿童血清MBL水平，测定其中11例低MBL血症的RRTI儿童的免疫学指标(IgG、IgA、IgM、C3、C4)，并用聚合酶链反应(PCR) 限制性内切酶片段长度多态性分析(RFLP)方法与55名正常儿童MBL第一外显子54密码子基因多态性进行分析。结果RRTI儿童出现低血清MBL水平频率明显多于正常儿童(χ2=6.96,P<0.05)，其MBL 54密码子突变率亦明显增高(P<0.05)，低血清MBL血症导致RRTI主要在2岁以前，血清MBL水平越低，感染频率越高，其C3、C4水平也越高。结论 儿童MBL 54密码子突变导致低MBL血症在2岁以前有反复呼吸道感染的倾向，MBL水平越低，感染机率越高。 Abstract Objective To detect the mannose binding lectin (MBL) serum levels and the mutation on code 54 of MBL in children with recurrent respiratory tract infections(RRTI),and to find the relationship between MBL serum levels and recurrent respiratory tract infections(RRTI).Methods To detect the serum MBL level of 238 normal people and 65 children with RRTI through the methods of enzyme linked immunoadsordent assay,then compare the immune data(IgG,IgA,IgM,C3,C4) of 11 children with low serum MBL level and compare the rate of the mutation on code 54 through the methods of polymerase chain reaction(PCR) restriction fragment length polymorphism (RFLP) with 55 normal children.Results The rate of low serum MBL level in the children with RRTI was higher than that in the normal population(χ2=6.96,P<0.05),the same went for the frequency of mutation of code 54 (P<0.05).RRTI caused by low serum MBL level occurred mostly among children under 2 years of age,and the rate of respiratory tract infection in the individuals with MBL level under 100μg/L was more than that in children with levels ranged from 100μg/L to 200μg/L (P<0.05),and was associated with reverse chang of serum levels of C3,C4(P<0.05).Conclusion Under 2 years of age,the children with the low serum MBL levels caused by mutation on MBL 54 show the susceptivity to IRRTI,and the low serum MBL level is parallel to high serum levels of C3，C4，and the lower the level the more possible infection. Key words Mannose binding lectin;Repeated respiratory tract infections;Gene;Polymorphism;Child     

育龄妇女缺铁性贫血影响因素分析

目的 :了解青岛地区育龄妇女妊娠期和非妊娠期缺铁性贫血 (IDA)的影响因素 ,为制定防治措施提供依据。方法 :对青岛市城区及农村 1314例妊娠期和非妊娠期育龄妇女进行外周血红蛋白浓度 (Hb)、血清铁蛋白 (SF)等检测以及通过问卷调查其影响因素 ,分析影响妊娠期和非妊娠期缺铁性贫血的各种因素。结果 :影响妊娠期IDA发病的主要影响因素为 :年龄、孕周、流产次数、生育次数、维生素B2 缺乏、所在地等 ;影响非妊娠期IDA的主要影响因素为 :经济是否独立、家庭人口数、消费结构是否偏重、所在地等。结论 :育龄妇女妊娠期和非妊娠期影响IDA的因素不同 ,应针对各自影响因素进行干预     

1314例育龄妇女缺铁性贫血发病现状调查

目的 :研究育龄妇女缺铁性贫血 (IDA)的发病现状及营养状况与IDA的关系。方法 :检测青岛市城市及农村 1314例妊娠期和非妊娠期育龄妇女的外周血红蛋白浓度 (Hb)、平均红细胞体积 (MCV)、平均红细胞血红蛋白量 (MCH)、血清铁蛋白 (SF) ,并进行个人问卷调查 ,应用营养计算软件评价膳食营养。结果 :1314例育龄妇女IDA发病率为 2 0 .4 0 % ,其中非孕妇的发病率高于孕妇。农村育龄妇女的发病率明显高于城市。孕妇中孕≥ 2 8周组发病率最高 (4 0 % ) ,与其他孕周组相比差异有高度显著性 (P <0 .0 1)。营养评价结果显示非孕妇组热量、维生素A、E、B1、B2 、PP、C的缺乏率高于孕妇组(P <0 .0 0 1)。结论 :农村育龄妇女及孕 2 8周以上的孕妇为IDA高发人群。应加强对农村育龄妇女的膳食营养宣教及指导 ,对孕晚期的孕妇及时采取有针对性的干预措施。     

多层螺旋CT和经胸二维超声心动图检查

目的 探讨多层螺旋CT(MSCT)及联合经胸二维超声心动图(TTE)检查在先天性心脏病诊断中的意义。方法收集广东省心血管病研究所自2002年9月至2003年12月间86例儿童先天性心脏病病例，全部患儿接受了MSCT和TTE检查，12例接受心导管检查，其中69例进行了外科手术，将术前MSCT、TTE和心导管检查结果分别与手术诊断进行比较。结果 69例患儿共计有129处畸形，TTE正确诊断116处(89.9%)，MSCT正确诊断112处畸形(86.8%)，两者联合正确诊断127处畸形(98.4%)，12例心导管检查未能提供更有价值的资料。结论 MSCT对先天性心脏病诊断具有较高的价值，尤其是联合TTE可取代部分心导管检查为外科手术提供正确和充分的术前诊断。对于年龄小或重症不耐受心导管检查的患儿具有更大的意义。 Abstract Objective To evaluate the effectiveness of multislice computed tomography (MSCT) in diagnosis of congenital heart diseases in children.Methods 86 patients were involved.69 had been performed operations.The preoperative results of transthoracic two dimensional echocardiography (TTE),MSCT and angiocardiography were compared with those of surgery.Results Of the totally 129 malformations,TTE had correctly revealed 116 (90%),MSCT 112(86.8%),and both combined had correct diagnosis for 127(98.4%).Angiocardiography in 12 patients had not provided further information. Conclusion MSCT is a valuable additional diagnosis tool in congenital heart diseases,especially when combined with TTE.They might take place some of the angiocardiography before surgery. Key words Multislice computed tomography;Transthoracic two dimensional echocardiography;Congenital heart disease     

急性淋巴细胞白血病患儿化疗时脑脊液神经元特异性烯醇化酶的变化及意义

目的 探讨大剂量甲氨蝶呤静滴+鞘内注射治疗急性淋巴细胞白血病(ALL)患儿时中枢神经系统损伤的监测指标。方法 2003年1~12月在青岛大学医学院附属医院收治的42例标危ALL患儿中。在行大剂量甲氨蝶呤静滴+鞘内注射化疗前及化疗后15、30、45d腰穿留取脑脊液(CSF)各1mL,用双抗体夹心酶联免疫法测定CSF中神经元特异性烯醇化酶(NSE)的质量浓度。结果 化疗后，CSF中NSE质量浓度升高,于第15天达峰值,化疗30d NSE质量浓度下降，与化疗前比较差异有统计学意义；化疗45d后NSE质量浓度与化疗前比较差异无统计学意义。结论 CSF中NSE是ALL患儿行大剂量甲氨蝶呤静滴+鞘内注射化疗时，神经细胞急性损伤的一个有价值的预报因子。 Abstract Objective To investigate the monitoring factors for the central nervous system from intrathecal injections and high dose methotrexate therapy (HDMTX+IT) given during treatment for acute lymphoblastic leukemia in children.Methods Forty two children aged from 5 to 11 years with ALL participated in the study.children had the history of ALL less than one year,while twenty two children had ALL more than one year.CSF was sampled for analyses of NSE on four occasions.Results No difference was found between the NSE concentration of the children who had ALL more or less than one year.The NSE content in the CSF samples increased from (3.9±0.5) ng/mL before the start of treatment to (6.5±1.1) ng/mL at day 15 and then gradually decreased to (4.3±0.9) ng/mL at day 30 and to (4.0 0.7) ng/mL at day 45.Conclusion NSE is a useful marker for acute brain damage in acute lymphoblastic leukemia children. Key words Leukemia,lymphoblastic,acute;Children;Methotrexate;Neuron-specific enolase     

荧光定量聚合酶链反应检测儿童病毒性脑炎病原体的研究

目的 探讨荧光定量聚合酶链反应(FQ PCR)检测儿童病毒性脑炎脑脊液(CSF)中的病原体的价值。方法 应用定性聚合酶链反应(PCR)对2002年1月至2004年10月保定市儿童医院收治的病毒性脑炎患儿78例的CSF标本筛选,检测最常见的引起病毒性脑炎的6种病毒,对单纯疱疹病毒(HSV)，柯萨奇病毒(CV)，埃可病毒(EV)阳性者做FQ-PCR检测，其中HSV分别在3个时点(治疗前、治疗中、出院时)检测DNA拷贝数。结果 定性聚合酶链反应阳性标本FQ PC检测100%阳性,HSV-DNA拷贝数在3个时点有统计学差异，病毒核酸拷贝数与临床表现一致。结论 FQ-PCR可作为儿童病毒性脑炎早期诊断的有效方法之一，动态观察HSV-DNA含量有助于指导治疗，估计疾病的发展和预后. Abstract Objective To discuss the value of using FQ-PCR to check pathogen in children viral encephalitis.Methods From Janurary,2002 to October,2004,PCR was used to select the children of viral encephalitis and check the six kinds of common virus which cause viral encephalitis and then we used FQ-PCR to check the children with HSV(+),CV(+)EV(+) while checking the copied number of HSVE-DNA before,during and after treatment.Results It was 100% that FQ-PCR checked the sample of PCR (+).The number of HSV DNA was different at three time points. The copied number of virus DNA was consistent with clinical symptom.Conclusion FQ-PCR is one of the effective methods to diagnose the children's viral encephalitis.Observing the number of HSV DNA is beneficial for instructing,treating and estimating the development and future disease. Key words Children’viral encephalitis;Pathogen;FQ-PCR;PCR     

大剂量维生素C对川崎病急性期肱动脉血流介导扩张反应影响的临床观察

目的 观察大剂量维生素C(VitC)对川崎病(KD)急性期肱动脉血流介导的扩张反应(FMD)的影响，探讨VitC对KD急性期血管内皮功能障碍是否有改善作用。方法 采用高分辨率多普勒超声仪测定2001年1月至2002年12月在华中科技大学同济医学院附属同济医院儿科住院的36例KD急性期患儿(KD组)及15名健康儿童(正常对照组)肱动脉FMD，并比较KD组静脉滴注大剂量VitC(200mg/kg，最大量为4g)和安慰剂(10%葡萄糖)前后肱动脉FMD的变化。结果 KD组肱动脉FMD明显低于正常对照组(P<0.001)；KD组静滴大剂量VitC后肱动脉FMD明显增加(P<0.01)，静滴安慰剂后肱动脉FMD无明显增加(P>0.05)。结论 大剂量VitC能明显改善KD急性期肱动脉FMD，其对KD急性期血管内皮功能障碍可能有显著改善作用。 Abstract Objective To observe the effect of high dose vitamin C on flow mediated vasodilation(FMD) of brachial artery in acute phase of Kawasaki disease(KD) and investigate whether high dose vitamin C could improve vascular endothelial dysfunction in KD.Methods Using high resolution vascular ultrasound,we measured FMD of the brachial artery of 36 patients who were admitted to our hospital from Jan.2001 to Dec.2002. in acute phase of KD and 15 matched healthy subjects as controls.Studies were performed before and after intravenous infusion of high dose vitamin C (200mg/kg，max≤4g) or placebo in KD group.Results The FMD of the brachial artery in KD group was significantly lower than that in the control group (3.55±3.00% vs 10.34±4.29%，P<0.001).Intravenous infusion of vitamin C significantly increase the FMD of the brachial artery in 18 KD patients (6.97±2.93% vs 3.51±2.01%，P<0.01),while after administration of placebo in the other 18 patients,there was no significantly increased in the FMD(4.12±2.21% vs 3.75±3.00%，P>0.05).Conclusion Intravenous infusion of high dose vitamin C can increase the FMD of the brachial artery,and it can improve vascular endothelial dysfunction in KD. Key words Kawasaki disease;Vitamin C;Flow mediated vasodilation;Endothelial dysfunction     

儿童横纹肌肉瘤8例临床分析

目的 分析儿童横纹肌肉瘤的临床特点，提高其诊治水平。方法 对中国人民解放军总医院1998年1月至2002年10月收治的8例横纹肌肉瘤患儿临床资料进行分析。结果 8例患儿中，男5例，女3例；发病年龄7个月至11岁，<5岁者3例；依据美国横纹肌肉瘤研究组(IRS)的分期标准I期2例、Ⅱ期2例、Ⅲ期1例，Ⅳ期3例；原发于头颈部4例、四肢2例，泌尿、消化系统各1例。病理类型:胚胎型7例,腺泡型1例。临床表现随原发部位不同有很大差异，基本为肿瘤组织占位、侵蚀后引起。明确诊断依靠病理，治疗以手术、化疗和放疗相结合，放疗总量40~50Gy，化疗共有3种方案:VDCA、VAC和VadrC。对Ⅰ、Ⅱ期手术彻底切除肿瘤患儿行VAC、VadrC方案交替共2年，Ⅲ、Ⅳ期患儿前14周用VDCA方案，后VAC、VadrC方案交替共2年。全部患儿2年生存率为37.5%(3/8)。结论 儿童横纹肌肉瘤是多发于头颈部，病理多表现为胚胎型的极度恶性软组织肿瘤，早期诊断，合理应用手术、化疗与放疗结合的综合治疗，是提高该肿瘤患儿生存率的关键。 Abstract Objective To analyze the clinical characteristics of the childhood rhabdomyosarcoma.Methods Clinical data was analyzed in 8 children with rhabdomyosarcoma.Results From Jan,1998 to Oct,2002,eight children with rhabdomyosarcoma had been diagnosed in our department,5 boys and 3 girls,7 months to 11 years old.Primary site was head and neck (n=4),extremities(n=2),kidney (n=1),bile duct(n=1).2,2,1,3 patients were in stage Ⅰ,Ⅱ,Ⅲ,Ⅳ respectively.Pathological data revealed embryonal rhabdomyosarcoma(n=7) and alveolar rhabdomyosarcoma(n=1).The clinical manifestation was mass in primary site or the tumor erodes.All patients had been diagnosed pathologically.The treatment included multimodal therapy with combination of surgery,chemotherapy,and radiation,whose doses were 40 to 50 Gy.Chemotherapy was given to all patients with VDCA、VAC or VadrC.The patients with pre Stage II have received chemotherapy with protocol of VAC or VadrC for two years.The protocol of VDCA has been used to the patients with Stage Ⅲand Ⅳ for 14 weeks,then the VAC or VadrC has been used until 2 years later.Two year EFS was 37.5%.Conclusion The head and neck are the most common primary site for rhabdomyosarcoma in children,with mainly histological embryonal rhabdomyosarcoma.Early diagnosis and combination therapy including surgery,chemotherapy,and radiation are key for those with rhabdomyosarcoma to get long EFS. Key words Rhabdomyosarcoma;Children;Treatment     

经食管超声心动图在小儿先天性心脏病围术期的应用价值

目的 评价经食管超声心动图(TEE)对指导小儿先天性心脏病(先心病)外科手术和介入治疗的应用价值及其安全性。方法 2000年11月至2005年1月，在上海市复旦大学附属儿科医院心血管中心接受外科开胸手术或经导管介入治疗的先心病患儿中有317例进行了TEE检查，年龄2个月至17岁6个月(平均4.7岁)。采用HP/SONOS2500超声诊断仪，频率5.5~7.5MHz双平面经食管探头，全麻状态下进行。结果 与术前经胸超声心动图(TTE)比较，术前TEE检查对诊断作出修正或补充者51例(16.1%)，其中因此而修正了手术治疗方案25例(7.9%)。术后TEE检查发现有并发症或残余问题57例(18.0%)，其中8例(2.5%)因此立即再次手术。所有病例均未因TEE检查而引起并发症。结论 TEE可安全地应用于小儿先心病围术期检查，对术前诊断做出修正或补充，术后可及时发现并发症或残余问题。 Abstract Objective To evaluate the utility of transesophageal echocardiography (TEE) for surgical and interventional repairs in children with congenital heart disease (CHD) and its safety as well.Methods 317 patients with CHD underwent TEE examinations at the age of 2 months~17 years and 6 months(mean 4.7 years).HP/SONOS2500 ultrasonic instrument with transesophageal biplane probe of 5.5~7.5MHz was used to perform TEE under general anesthesia.Results Compared with preoperative transthoracic echocardiography(TTE),TEE had new findings or made revision of the diagnoses in 51 cases(16.1%) before operations,which led to the changes of surgical or interventional precedure in 25 cases(7.9%).TEE had found residual problems or evolving situations in 57 cases(18.0%) after operations,which led to a second immediate surgical intervention in 8 cases(2.5%).There were no detectable complications due to TEE in all cases.Conclusion TEE is valuable in providing meaningful preoperative emendations or additions and finding residual problems after operations. The technique is safe in children. Key words Transesophageal echocardiography (TEE);Congenital heart disease (CHD);Perioperative period;Children     

小儿复杂上尿路感染的因素及致病菌分析

目的 了解小儿复杂上尿路感染的因素及致病菌的耐药现状。方法 1999年1月至2004年3月在复旦大学附属儿科医院住院治疗的复杂上尿路感染患儿178例，分析其尿培养阳性的因素、致病菌分布及其对抗生素的耐药性。结果 复杂上尿路感染患儿的年龄以≤1岁为主，占46.6%。致病因素中以膀胱输尿管反流为主，占61.8%,40例肾瘢痕患儿中有92.5%存在反流。复杂上尿路感染致病菌中以大肠埃希菌为主，占33%，但与单纯上尿路感染相比所占比例明显下降(P<0.001)；克雷白杆菌与绿脓假单孢菌感染所占比例明显高于单纯上尿路感染所占比例(分别P<0.01,P<0.05)。产超广谱β-内酰胺酶(ESBLs)菌株占革兰阴性杆菌的28%，以大肠埃希菌易产生ESBLs。革兰阴性杆菌对未加β-内酰胺酶抑制剂的青霉素类及第1、2、3代头孢菌素类抗生素耐药率均高，而ESBLs菌株交叉耐药情况更为严重。结论 复杂上尿路感染以婴儿期多见，膀胱输尿管反流是复杂上尿路感染及肾瘢痕的主要因素，大肠埃希菌仍是其主要致病菌，但克雷白杆菌、绿脓假单胞菌比例明显上升，致病菌耐药性高，产ESBLs菌株多重耐药严重。 Abstract Objective To investigate the factors and resistance of the pathogens of complicated upper urinary tract infection (UTI) in children.Methods Distribution and resistance of pathogens,complicated factors in 178 urinary culture positive UTI patients hospitalized from 1999 to 2004 were analyzed.Results Infants with complicated upper UTI accounted for 46.6%.Among the complicated factors,vesicoureteric reflux (VUR) accounted for 61.8%,and 37 of 40 children with venal scar had VUR.E.coli in the complicated upper UTI accounted for 33% of all the pathogens,which was significantly lower than in simple upper UTI (P<0.001)However,Klebsiella and Pseudomonas aeruginosa accounted for 15.8% and 8.1% respectively,which were significantly higher than in simple upper UTI (5.6% and 2.4% respectively,P<0.01 and 0.05 respectively).Nearly 28% of the Gram negative bacilli were the ESBLs producing strain,most of which were E.coli.Gram negative bacilli had a high resistance rate towards not only the penicillin uncombined with the beta lactamases inhibitors but also the first,second and third generations of cephalosporins.Furthermore,the multi cross resistance of the ESBLs strains was even more serious.Conclusion The complicated upper UTI is predominant in infants and VUR induces complicated upper UTI and renal scar.E.coli is still the major pathogen,while the proportion of Klebsiella,Pseudomonas aeruginosa are significantly increasing.The pathogens have high drug resistance and the ESBLs producing strains have serious multi resistance. Key wordsUpper urinary tract infectionPathogenResistance     

改良单管多重PCR检测低平均红细胞体积儿童3种缺失型α地中海贫血基因

目的调查广西地区平均红细胞体积(MCV)<80fL儿童中3种缺失型α地中海贫血基因(即SEA、α3.7和α4.2)的携带率及基因型。 方法2004年6~12月，广西医科大学第一附属医院优化前人建立的单管多重聚合酶链反应(mPCR)技术，并用22例已知基因型的α地中海贫血DNA标本加以验证，运用此方法检测78例MCV<80fL的儿童。 结果经单管mPCR方法检测的22例α地中海贫血，所得基因型与已知基因型一致。78例MCV<80fL儿童中共检出37例缺失型α地中海贫血基因携带者，检出率为47.4%其中SEA缺失型杂合子(SEA/αα)29例，α3.7缺失型纯合子(α3.7/α3.7)6例，α3.7和α4.2缺失型双重杂合子(α3.7/α4.2)1例，HbH病(SEA/α3.7)1例。SEA缺失型等位基因检出最多，在78例受检者156条染色单体中，其携带频率为19.2%(30/156)，α3.7和α4.2缺失型分别为9.0%和0.6%。 结论单管mPCR技术能快速、准确地检测SEA、α3.7和α4.2基因，经优化后，可使该技术更为简便。缺失型α地中海贫血是广西地区儿童MCV降低的主要原因之一。     

早产儿甲状腺功能检测及分析

目的 研究早产儿甲状腺功能。方法 将青岛大学医学院附属医院2004年10月至2005年10月收治的早产儿60例按胎龄分成两组：小胎龄早产儿组(A组，胎龄<34周，n1=30)，大胎龄早产儿组(B组，胎龄≥34周，n2=30)。对照组为我院出生的正常足月儿30例，应用放免法对3组新生儿生后第1，7天血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平进行测定。结果 A、B组及对照组血清FT3、FT4生后1~7d呈下降趋势；对照组生后第1，7天血清FT3、FT4明显高于A、B组，B组明显高于A组；血清TSH在A、B及对照组生后呈下降过程；生后第1天对照组TSH>A组>B组；生后第7天，血清TSH A组高于B组和对照组，而B组与对照组差异无显著性。结论 早产儿生后甲状腺功能有暂时性低下，胎龄越小，功能越低，生后应激反应持续时间越长。 Abstract ObjectiveTo investigate the thyroid function in the premature infants.MethodsFrom Oct.2004 to Oct.2005 serum free triodothyrorine (FT3),free thyroxine (FT4) and thyrotropin (TSH) in 60 premature infants on the 1st,7th days after birth were detected by radioimmunoassay (RIA) and were compared with those in 30 normal neonate controls.The 60 premature infants were divided into two groups according to the gestational age:the very premature infants (the group A,less than 34 weeks of gestational age,n1=30) and the older gestational age infants (the group B,34~41 weeks of gestational age,n2=30).ResultsThe serum concentrations of FT3,FT4,TSH showed a declining tendency in all neonates from the 1st day to the 7th day after birth.The serum concentrations of FT3，FT4 on the 1st and 7th day after birth were significantly higher in the controls than those in group A and group B,and those in group B were also significantly higher than those in group A.The serum TSH on the 1st and 7th day after birth were significantly higher in the controls than those in both group A and B,and those in group A were also significantly higher than those in group B.On the 7th day after birth,the serum TSH in group A were higher than those in group B and controls,whereas the serum TSH were not significantly different between group B and controls.ConclusionThe thyroid function in the premature infants is transiently low.The shorter the gestational age,the lower the thyroid function and the longer the stress reaction. Key wordsPremature infants;Thyroid function     

围生期窒息新生儿二氧化碳分压和pH值改变与神经系统损害的关系

目的 探讨围生期窒息新生儿PaCO2及pH快速变化及其与神经系统损害之间的关系。 方法 2002年1月至2003年12月南华大学第一附属医院将55例足月窒息新生儿分为3组：组Ⅰ，pH>7.00，无神经系统异常，无需呼吸支持；组Ⅱ，pH≤7.00，余同组Ⅰ；组Ⅲ，pH≤7.00，神经系统异常，需辅助呼吸支持。采集脐动脉血、产后1h和2h桡动脉血进行血气分析并观察Apgar评分和临床经过。 结果 脐动脉血pH值和PaCO2各组间差异有显著性；产后1h动脉血pH组Ⅰ、Ⅲ间和组Ⅱ、Ⅲ间差异有显著性；产后1h动脉血pH、PaCO2分别和脐动脉血pH、PaCO2比较，差异有显著性；三组间有不同的神经系统表现；Apgar评分组Ⅲ较低。 结论 在严重酸中毒时，胎儿出生后pH、PaCO2会发生显著改变，需持续辅助机械通气的患儿有不良的神经系统预后。 Abstract Objective To explore the relationship between the rapid changes in CO2 and pH value and neurologic injury in asphyxia infants in presence of severe academia. Methods Umbilical arterial blood and radial arterial blood at postnatal 1,2h were checked in 55 infants.These infants were categortized in three groups:Ⅰ,pH>7.00,normal neurologic examination without respiration support;Ⅱ,identification to Ⅰexcept pH≤7.00;Ⅲ,pH≤7.00,abnormal neurologic examination with mechanical ventilation. Results Umbilical arterial blood pH was significantly different in Ⅲ vs Ⅰ and in Ⅱ vs Ⅲ.PaCO2 was significantly different in Ⅲ vs Ⅱ vs Ⅰ.At postnatal 1h pH increased and PaCO2 decreased in all groups,significant differences in three group remained.At postnatal 2h,no differences were observed for pH and PaCO2 in Ⅱand Ⅲ,there was different neurologic prognosis among groups.Apgar score was lower in Ⅲ. Conclusion After delivery pH and PaCO2 have rapid changes in presence of severe academia.Lower pH and Apgar score with mechanical ventilation are poor prognosis factors of neurologic result. Key words Asphyxia;Acidosis;Blood gas;Newborn infants