黄芪对哮喘患儿IFN-γ、IL-4及IgG亚类体外产生的影响

为探讨中药黄芪对哮喘患儿免疫功能的影响，检测了在体外培养系统中加入黄芪水提剂后，１３例哮喘患儿及１０例健康儿童外周血单个核细胞（ＰＢＭＣ）产生ＩＦＮ－γ、ＩＬ－４及ＩｇＧ亚类水平的变化。结果显示黄芪明显促进ＰＨＡ诱导的ＰＢＭＣ产生ＩＦＮ－γ及ＰＷＭ诱导的ＰＢＭＣ产生ＩｇＧ１、ＩｇＧ２和ＩｇＧ３；但对ＰＢＭＣ产生ＩＬ－４及ＩｇＧ４无明显影响。结果提示黄芪可调节ＴＨ１及ＴＨ２细胞的部分功能，具有预防哮喘的感染诱因及调节患儿免疫功能的潜在意义。     

一氧化氮与Ⅰ型辅助细胞因子在过敏性紫癜中的作用

目的观察过敏性紫癜（ＨＳＰ）患儿急性期的一氧化氮（ＮＯ）及Ⅰ型辅助细胞（ＴＨ１）因子水平,以探讨其在该病全身血管炎发病机制中的作用。方法用镉还原法测定血浆ＮＯ水平,用ＥＬＩＳＡ法检测血浆及外周血单个核细胞（ＰＢＭＣ）培养上清中白细胞介素－２（ＩＬ－２）及干扰素－γ（ＩＦＮ－γ）水平。结果ＨＳＰ急性期血浆ＮＯ水平较对照组明显增高（Ｐ＜００５）,血浆ＩＬ－２及ＩＦＮ－γ与正常对照组比较无显著性差异（Ｐ＞００５）,但患儿的ＰＢＭＣ培养上清的ＩＬ－２及ＩＦＮ－γ明显低于正常对照组（Ｐ＜００５）。结论ＮＯ及ＴＨ１细胞因子在ＨＳＰ全身血管炎的发生、发展中起作用     

毛细支气管炎后反复喘息的免疫机理研究

为了解毛细支气管炎（毛支）后反复喘息患儿的细胞因子分泌水平,采用ＥＬＩＳ列毛支随访外因单个核细胞（ＰＢＭＣ）培养上清液中细胞因子及血清ＩｇＥ含量。结果表明：（１０反复喘息组中特应症阳性率（７３．３％）明显高于非喘息组（２５．０％,Ｐ〈０．０５）;（２）与非喘息组比较,喘息组ＩＮＦ－γ水平降低,而ＩＬ０４、ＩＬ－１０,ＩｇＥ水平增高（Ｐ均〈０．０５）;（３）喘息组ＩＬ－４／ＩＦＮ－γ比值及ＩＬ０１     

哮喘患儿外周血白细胞介素10水平及其对白细胞介素2等的调节作用

目的 探讨白细胞介素２、１０（ＩＬ－２、１０），一氧化氮（ＮＯ）和肿瘤坏死因子α（ＴＮＦ－α）在小儿哮喘发病机制中的作用。方法 采用双抗夹心酶联免疫吸附试验（ＥＬＩＳＡ）技术检测了２８例哮喘患儿血浆及外周血单个核细胞（ＰＢＭＣ）在植物血凝素（ＰＨＡ）刺激下产生ＩＬ－１０的水平，同时检测了ＮＯ、ＩＬ－２和ＴＮＦ－α的水平，并研究了重组人ＩＬ－１０（ｒｈＩＬ－１０）对ＰＢＭＣ体外诱生ＮＯ、ＩＬ－２和Ｔ     

新生儿肿瘤坏死因子α基因表达及其调控

为了探讨γ干扰素（ＩＦＮ－γ）、白细胞介素１２（ＩＬ－１２）、活化Ｔ细胞核因子（ＮＦ－ＡＴ）活性与新生儿肿瘤坏死因子α（ＴＮＦ－α）基因表达调控的关系，用酶联免疫吸附试验（ＥＬＩＳＡ）和逆转录聚合酶链反应（ＲＴ－ＰＣＲ）技术测定１２例新生儿脐血单个核细胞（ＣＢＭＣ）ＴＮＦ－α、信使核糖核酸（ｍＲＮＡ）、ＩＦＮ－γ及其ｍＲＮＡ和ＩＬ－１２ｐ４０ｍＲＮＡ表达水平，并用电泳迁移率转换试验（ＥＭＳＡ）检测８例新生儿ＣＢＭＣ的ＮＦ－ＡＴ活性。结果：新生儿ＣＢＭＣ中ＴＮＦ－α、ｍＲＮＡ、ＩＦＮ－γ及其ｍＲＮＡ、ＩＬ－１２ｐ４０ｍＲ－ＮＡ表达水平均较成人低下，ＮＦ－ＡＴ活性也较成人明显低下。提示：缺乏ＩＦＮ－γ、ＩＬ－１２调节作用可能是新生儿ＣＢＭＣ产生ＴＮＦ－α不足的重要原因；ＮＦ－ＡＴ活性低下可能与新生儿Ｔ细胞转录ＴＮＦ－α及ｍＲＮＡ不足有关。     

哮喘患儿血浆和淋巴细胞诱生γ－干扰素水平的检测及其意义

应用生物素－亲合素双抗体夹心酶联免疫吸附分析技术（ＡＢＣ－ＥＬＩＳＡ）检测了２４例哮喘患儿血浆和外周血单个核细胞（ＰＢＭＣ）诱生γ－干扰素（ＩＦＮ－γ）水平。结果显示：患儿血浆ＩＦＮ－γ水平极低（１．３３±０．０８μｇ／Ｌ），经植物血凝素（ＰＨＡ）刺激后，ＰＢＭＣ诱生ＩＦＮ－γ水平仍明显低于正常对照组（Ｐ＜０．００１）。哮喘患儿血清总ＩｇＥ水平明显升高。用麻疹疫苗治疗后ＩＦＮ－γ诱生水平无明显变化。提示患儿体内细胞因子产生失衡，ＩＦＮ－γ产生减少与哮喘的发病、病程和易诱发病毒反复感染有一定关系。     

白细胞介素1和垂体—肾上腺皮质轴在原发性肾病综合征中的变化

采用逆转录聚合酶链反应等技术观察１８例肾病患儿外周血单个核细胞（ＰＢＭＣ）及３例肾穿组织中白细胞介素１β（ＩＬ－１β）ｍＲＮＡ表达，ＰＢＭＣ上清液中ＩＬ－１β，血浆ＡＣＴＨ及皮质醇水平的变化。结果：（１）患儿血浆皮质醇明显低于正常对照，ＡＣＴＨ与正常对照组比差异无显著意义；（２）ＰＢＭＣ中ＩＬ－１βｍＲＮＡ表达及其上清液中ＩＬ－１β都明显低于正常，（３）病肾组织中ＩＬ－１βｍＲＮＡ表达明显高于正常     

前炎症细胞因子及IgG亚类在支气管哮喘发病中的作用

目的：探讨前炎症细胞因子（ＰＩＣ）及ＩｇＧ亚类在儿童支气管哮喘发病中的作用。方法：采用ＥＬＩＳＡ方法检测哮喘不同病期（发作期３５例,稳定期１８例）和２８例正常对照组血清及外周血单个核细胞（ＰＢＭＣ）诱生ＩＬ－６、ＩＬ－８、ＴＮＦ－α水平和血清ＩｇＧ亚类浓度。结果：哮喘发作期血清ＩＬ－６、ＩＬ－８、ＴＮＦ－α显著升高,随病情缓解渐降低。发作期哮喘ＩｇＧ亚类缺陷检出率为２８．５７％（１０／３５）,以Ｉ     

泌尿系统疾病诊治进展

１临床方面１９９８年度肾病综合征（ＮＳ）仍为关注重点。有关其免疫功能紊乱，有作者观察患儿外周血单个核细胞（ＰＢＭＣ）淋巴因子基因表达和蛋白产生，发现ＩＬ－１０、ＩＬ－４明显增高，ＩＬ－２下降，干扰素－γ和ＩＬ－５无明显变化。多数报告有ＩＬ－６及其ｍＲ...     

白细胞介素1和垂体－肾上腺皮质轴在原发性肾病综合征中的变化

采用逆转录聚合酶链反应等技术观察１８例肾病患儿外周血单个核细胞（ＰＢＭＣ）及３例肾芽组织中白细胞介素１β（ＩＬ－１β）ｍＲＮＡ表达、ＰＢＭＣ上清液中ＩＬ－１β、血浆ＡＣＴＨ及皮质醇水平的变化。结果：（１）患儿血浆皮质醇明显低于正常对照，ＡＣＴＨ与正常对照相比差异无显著意义；（２）ＰＢＭＣ中ＩＬ－１βｍＲＮＡ表达及其上清液中ＩＬ－１β都明显低于正常；（３）病肾组织中ＩＬ－１βｍＲＮＡ表达明显高于正常，且与ＰＢＭＣ上清液ＩＬ－１β水平呈负相关趋势。结果提示：原发肾病综合征患儿有ＩＬ－１β、垂体－肾上腺皮质轴、及其间调节网络的紊乱。     

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.