儿童乳糖酶缺乏的临床评价

目的　探讨健康儿童乳糖吸收不良 (LM )和乳糖不耐受 (LI)的发生率与年龄的关系 ;研究感染性腹泻LM和LI的发生与临床特征。方法　随机选择健康儿童 138名 ,男 72名 ,女 6 6名 ,年龄为 4个月至 12岁 ,和感染性腹泻患儿 95名 ,男 5 9名 ,女 36名 ,年龄为 2个月至 4岁。采用乙醇乳糖耐量试验 (LTTE)尿半乳糖 (U gal)测定法与症状反应评分 (SRS)进行判断。结果　 138名儿童中LM和LI的发生率 :<4岁、4～ 5岁、6～ 7岁、8～ 9岁、10～ 12岁分别为 10 %、5 0 %、6 9.6 %、87%和 91.7%。 <4岁组LM和LI发生率明显低于其它各组 (P <0 .0 1)。 95名感染性腹泻患儿LM和LI的发生率和恢复率与腹泻病原有关。轮状病毒肠炎 ,大约 4周可痊愈。结论　健康儿童LM和LI发生率 4岁后明显增加 ;感染性腹泻儿童LM和LI的发生率与感染原有关 ,腹泻期免乳糖食品值得推荐     

胃切除术后氢呼吸试验的研究

本文采用口服乳糖及葡萄糖后氢呼吸试验的方法对正常人及胃切除术后患者进行研究。结果正常人乳精呼吸试验阳性率81.2％,葡萄糖呼吸试验均正常。7例毕Ⅰ式及14例毕Ⅱ式术后患者乳精试验阳性率与正常人无显著差别(均为85.7％),但葡萄糖呼吸试验阳性率升高(14.2％～35.7％)。提示胃切除术后对乳糖呼吸试验无影响,葡萄糖呼吸试验异常,其中毕Ⅱ式较毕Ⅰ式明显。     

The prevalence of lactase deficiency and lactose intolerance in Chinese children of different ages

Objective To determine lactose metabolism and lactase activity in Chinese children of diff erent ages, prevalence of lactase deficiency (LD), and lactose intoleran ce (LI).
Methods All 1168 healthy subjects between 3 and 13 years were recruited from schools in four large cities in China. They were screened by a 25 g lactose tolerance tes t. Some subjects were challenged with 50 g milk powder on different days. Bot h indicators, the expiratory H₂ concentration and intolerance symptoms, were a nalyzed.
Results LD occurred in 38.5% of children in the 3-5 year age group, and 87% of the 7-8 year and 11-13 year old groups. The age of occurrence for LD may be at 7-8 years among Chinese children. The prevalence of LI among Chinese children w as 12.2% at age 3-5 years, 33.1% at age 7-8 years, and 30.5% at age 11-13 yea rs, respectively.
Conclusion The results demonstrate that LD is very common in Chinese children from these fo ur cities. LD and LI have a dose dependent response: lactose absorption and sym ptoms are based on lactase activity. The relationship between breast feeding hi story (or the history of cow milk intake) and lactase activity among Chinese chi ldren has not been established.      

Lactase deficiency in Australian school children

The prevalence of lactase deficiency is high in Mediterranean, Middle Eastern and Asian countries, which suggests that many immigrants and immigrant children from these regions may be unable to produce lactase. Therefore, the aim of this study was to determine the prevalence of lactose malabsorption in primary school-aged children, in two communities with a high proportion of immigrants in metropolitan Sydney. A total of 109 children, aged five to 12 years, were studied by means of the breath hydrogen method. Forty per cent (44/109) showed lactose malabsorption, as defined by a rise in end-expiratory hydrogen levels of 20 ppm or more, two hours after loading with lactose. The prevalence was highest in the subjects of Asian origin (93%; 14/15), followed by Greek subjects (56%; 14/25) and subjects from other Mediterranean and Middle Eastern countries (41%; 15/37). Of the 77 children who were available for follow-up, 57% (44) reported symptoms of lactose intolerance, of whom nearly two-thirds were children who showed lactose malabsorption. The high prevalence of lactase deficiency in children at both schools underlines the need to consider the multiracial identity of Australians in planning educational programmes about nutrition.     

儿童乳糖吸收不良的临床与实验研究

本文参考Arola描述的方法对41名健康儿童进行乙醇乳糖耐量试验(LTTE)血、尿半乳糖测定。血半乳糖(B-gal)<0.3mmol/L、尿半乳糖(U-gal)<2mmol/L诊断为乳糖吸收不良(LM)。另采用LTTE尿法和症状反应记分(SRS)法对138名健康儿童和95名急性腹泻小儿做了LM和乳糖不耐症(LI)的研究。结果提示LTTE半乳糖测定法诊断LM可信;健康儿童随年龄增加LM和LI发生率亦增加;轮状病毒肠炎易并发LM和LI。     

不同年龄住院患者真菌菌血症的调查与分析

目的研究不同年龄段住院患者真菌菌血症流行病学特征、菌种分布及药敏谱、临床治疗及转归的差别,为有效治疗和预防提供科学依据。方法回顾分析和比较武汉同济医院2008年1月至2010年12月住院不同年龄段真菌菌血症患者的临床资料和实验室检查结果。结果 3年间共发现1 104例住院真菌菌血症病例,其中新生儿69例,儿童72例,成人963例,发病率分别为新生儿1.93%、儿童0.45%、成人0.41%;主要的危险因素:新生儿为早产、低出生体重及静脉内营养,儿童为白血病、中性粒细胞减少症及入住ICU≥4d,成人为糖尿病、泌尿系统疾病、血液透析、恶性肿瘤、使用碳青霉烯类抗菌药物;引起真菌菌血症的菌株中48.01%为白假丝酵母菌,近平滑假丝酵母菌在新生儿和儿童更多见(新生儿占44.9%、儿童占38.9%、成人占15.1%),而光滑假丝酵母菌则在成人更多见(新生儿占8.8%、儿童占2.8%、成人占20.1%);儿童真菌菌血症分离菌株对氟康唑的敏感性显著高于成人,所有菌株对氟康唑的耐药率均较低;所有病例以氟康唑治疗为主;发生真菌菌血症后30d内病死率分别为:新生儿21.8%、儿童9.9%、成人29.3%。结论不同年龄段住院患者真菌菌血症流行病学及临床特征存在显著的差异,新生儿科及儿科医生在制订治疗和预防方案时应考虑年龄差异。     

不同年龄段婴幼儿抗生素性腹泻与乳糖不耐受的相关性研究

目的 探讨不同年龄段婴幼儿应用β-内酰胺类抗生素后出现腹泻与乳糖不耐受的相关性.方法 选择近3个月以乳糖乳制品为主食的住院应用β-内酰胺类抗生素的患儿80例,根据年龄分为4组,应用β-内酰胺类抗生素出现腹泻后,采用尿半乳糖测试盒进行测试,并记录乳糖不耐受的发生情况,同时对患儿进行便常规、便一般细菌培养、便轮状病毒检测,并记录其检测结果.结果 80例样本中便常规示:红细胞:无或0～1个/HP;白细胞:无或0～1个/HP;脂肪滴:(-).便一般细菌培养均为阴性.便轮状病毒检测阴性77例(96.25%),阳性3例(4.75%)(其中2例乳糖不耐受阳性,1例乳糖不耐受阴性).乳糖不耐受结果阳性44例(55.00%),阴性36例(45.00%).不同年龄组乳糖不耐受阳性率比较,差异有统计学意义(χ2=14.95,P＜0.001).结论 β-内酰胺类抗生素可破坏肠道乳糖酶活性致腹泻,即药物性腹泻继发乳糖不耐受.     

Relative lactose intolerance. A clinical study of tube-fed patients.

A relative intolerance of lactose was demonstrated in 14 of 16 patients receiving nasogastric tube feedings following surgery for head or neck carcinoma. Two liquid diets differing only in the presence or absence of lactose, were administered for eight to 20 days per patient in a double-blind crossover study. Increased stool frequency, decreased stool consistency, and more frequent flatulence, borborygmi, and distention were found with the lactose diet, although classic lactose intolerance (plasma glucose rise of less than 26 mg/dl) was indicated in only two patients. Differences between amounts and times of peak rise following the glucose tolerance test and lactose tolerance test for each patient indicated the advisability of locating patients on a continuum of ability to hydrolyze lactose. The results indicate that lactose should be reduced or eliminated from tube-feeding diets to improve patient tolerance and comfort and to reduce diarrhea.     

毛细支气管炎合并腹泻的临床分析

目的分析毛细支气管炎合并腹泻的年龄特点和临床表现,探讨毛细支气管炎引起的小儿腹泻的机制。方法观察196例确诊为毛细支气管炎患儿用药前后腹泻发生率,分析其年龄特征,并作腹泻的病因学检查。结果196例毛细支气管炎患儿用药前合并腹泻28例（14.3％）,用药后继发腹泻104例（53.1％）,合计132例（67.4％）,且年龄越小所占比例越大,合并继发感染,继发乳糖不耐受,菌群失调的比例越大。结论毛细支气管炎可引起患儿腹泻,于年龄明显相关,其腹泻原因通过粪便检测发现与菌群失调、合并继发感染和乳糖不耐受等有关,应引起临床医师的重视。     

牙周炎患者临床探诊深度与牙槽骨吸收程度的相关性分析

目的:探究牙周炎患者临床探诊深度（CPD）与牙槽骨吸收程度的相关性。方法:纳入2018年2月—2020年12月在天津医科大学口腔医院牙周科就诊的105例牙周炎患者,搜集患者的一般资料、第一磨牙的CPD和第一磨牙牙槽骨吸收程度的锥形束计算机断层扫描（CBCT）影像学数据。用Pearson相关分析研究CPD与牙槽骨吸收程度的相关性。结果:“轻度牙槽骨吸收组”与“重度牙槽骨吸收组”仅年龄（t=-2.147,P=0.034）和CPD（t=-2.941,P=0.004）差异具有统计学意义;二元Logistic回归纳入年龄这一混杂因素,校正后CPD每增加1 mm,牙槽骨吸收程度加重发生的概率为72.1%（P=0.002）;简单效应分析显示年龄与CPD之间交互作用显著（P=0.000）。用年龄（≤45岁为青壮年,＞45岁为中老年）和牙槽骨吸收程度进行分层,“青壮年轻度牙槽骨吸收组”CPD与牙槽骨吸收程度呈中度正相关（r=0.579 5, P=0.001 2）,“青壮年重度牙槽骨吸收组”CPD与牙槽骨吸收程度呈中度正相关（r=0.404 7,P=0.021 6）,“中老年轻度牙槽骨吸收组”CPD与牙槽骨吸收程度不相关（r=0.232 2,P=0.445 2）,“中老年重度牙槽骨吸收组”CPD与牙槽骨吸收程度不相关（r=0.082 01,P=0.655 4）。结论:CPD可以在一定程度上反映患者牙槽骨的破坏程度,尤其是45岁以下的青壮年牙周炎患者。     

广东省中山地区白癜风临床分析

目的分析中山地区白癜风患者的临床资料,总结白癜风发病特点,探讨白癜风发病机制。方法对90例至我院皮肤科门诊就诊的白癜风患者进行问卷调查,对各种可能涉及的因素进行统计分析。结果92．2％的患者在0～40岁范围内首次发病,发病高峰为6～30岁,该年龄段占发病总数的63．3％;其中局限型（35．6％）、散在型（22．2％）、神经节段型（18．9％）、泛发型（12．2％）、肢端型（11．1％）;有阳性家族史者为22．2％,有明显发病诱因者为41．1％,夏季发病者为52．5％。结论①大龄儿童、青少年是白癜风的高发人群,其次是40岁以下壮年,再次是幼儿;②40岁以上发病率明显降低,男性发病年龄早于女性;③精神神经心理因素对发病的影响不可轻视,平素精神紧张、压力过大者更易患病;④夏季为白癜风的高发季节;阳性家族史、过度日晒可能为罹患白癜风的危险因素。     

锌剂联合去乳糖饮食佐治轮状病毒肠炎并发乳糖不耐受患儿疗效观察

目的探讨锌剂配合去乳糖饮食佐治轮状病毒肠炎并发乳糖不耐受患儿的效果。方法将100例轮状病毒肠炎并发继发性乳糖不耐受患儿分为观察组和对照组,每组50例,2组患儿均给予口服或静脉补液、复方胃蛋白酶散、蒙脱石散及酪酸梭菌二联活菌散等治疗。对照组患儿给予常规喂养,观察组患儿给予口服葡萄糖酸锌及无乳糖奶粉喂养。比较2组患儿的治疗效果、腹泻缓解时间及总病程。结果观察组和对照组患儿治疗总有效率分别为98.0%和86.0%,观察组患儿治疗总有效率显著高于对照组,差异有统计学意义(P<0.05)。观察组患儿腹泻缓解时间和总病程显著短于对照组,差异均有统计学意义(P<0.05)。结论口服锌剂联合去乳糖饮食佐治轮状病毒肠炎并发继发性乳糖不耐受能够缩短病程,减轻症状。     

Systemic lactose intolerance: a new perspective on an old problem

Intolerance to certain foods can cause a range of gut and systemic symptoms. The possibility that these can be caused by lactose has been missed because of "hidden" lactose added to many foods and drinks inadequately labelled, confusing diagnosis based on dietary removal of dairy foods. Two polymorphisms, C/T13910 and G/A22018, linked to hypolactasia, correlate with breath hydrogen and symptoms after lactose. This, with a 48 hour record of gut and systemic symptoms and a six hour breath hydrogen test, provides a new approach to the clinical management of lactose intolerance. The key is the prolonged effect of dietary removal of lactose. Patients diagnosed as lactose intolerant must be advised of "risk" foods, inadequately labelled, including processed meats, bread, cake mixes, soft drinks, and lagers. This review highlights the wide range of systemic symptoms caused by lactose intolerance. This has important implications for the management of irritable bowel syndrome, and for doctors of many specialties.     

早产儿出生后4周内肠道微生物的产气差异

 目的 探究早产儿出生后4周内肠道微生物产气量及各种气体成分所占比例的差异。方法 本研究招募了2020年5月1日—6月1日期间生后即入上海市儿童医院治疗的19名早产儿。被纳入研究的早产儿均符合出生胎龄≥28周同时<37周,无畸形或代谢性疾病,被纳入前均获得父母书面知情同意。收集其出生后3天内,出生后第1周、第2周、第3周、第4周时自然排出的粪便,12h内送达实验室处理。通过体外发酵系统,将所收集的粪便接种到分别以乳糖（lactose,LAT）、低聚果糖（fructo-oligosaccharides,FOS）、2'-岩藻糖基乳糖（2'-Fucosyllactose,FL-2）和低聚半乳糖（galacto-oligosaccharides,GOS）作为主要碳源的培养基中进行体外发酵;另外检测肠道菌群的产气量、各种气体成分（二氧化碳、氢气、甲烷、硫化氢）等代谢指标。结果 培养基组早产儿的肠道微生物经体外发酵的产气量均逐渐增加。早产儿自出生起至第4周,肠道微生物体外产气中均测到甲烷。早产儿自出生2周后,其他气体普遍产生,肠道微生物的体外产气中二氧化碳占比最多,其次为氢气、甲烷和硫化氢。此外,不同日龄早产儿肠道微生物皆在以FL-2为碳源的培养基中产气量最少,以LAT为碳源的培养基中产气量最多。结论 早产儿出生后4周内,肠道微生物经体外发酵的产气量与其日龄呈正相关。早产儿出生后4周内所排粪便可能含产甲烷菌。     

Somatosensory evoked potentials to median nerve stimulation in normal children]

Short latency somatosensory evoked potentials to median nerve stimulation (MN-SSEP) were studied in 292 normal children of 1 month to 14 years old and in 34 adults. We divided these normal children into 7 groups, each group containing about 40 children. Evoked potentials were recorded at 3 levels: Erb's point, seventh cervical vertebra, and contralateral parietal scalp. N 9, N 13 and N 20 wave forms were recorded in all the children, except that in some children under 2 months of age the N 20 component was absent on one side (7.3%). The mean latency of N 9 N 13 and N 20 decreased with age until they reached 1 year and 3-5 years of age respectively, and then it increased with age. The interpeak latency of N 13-N 20 decreased steadily with age, becoming close to the value of adults at about 8 years of age. There was no significant sex difference in interpeak latencies, but the difference was significant in absolute peak latencies. In this paper are proposed the normal referential values of MN-SSEP in children.     

30例低三碘甲状腺原氨酸综合征临床观察

目的 观察低三碘甲状腺原氨酸(T3)综合征对早产儿的影响.方法 按照纳入标准及排除标准选取2019年1-12月蚌埠医学院第一附属医院新生儿病房住院的早产儿作为研究对象,在生后4～7 d及第4周采集空腹静脉血2 mL,应用电化学发光法测定血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)及三碘甲状腺原氨酸(T3)...     

金双歧加蒙脱石散治疗婴儿继发性乳糖不耐受临床分析

目的:探讨金双歧加蒙脱石散在婴儿继发性乳糖不耐受的治疗价值.方法:乳糖不耐受患儿170例,随机分为两组,治疗组93例,口服金双歧加蒙脱石散辅助治疗,将金双歧片加入腹泻配方奶中溶化后喂养,根据患儿体重每次半片至一片,每日3次;蒙脱石散每次1/3包,以15 mL温开水搅匀后服用.两组均不停母乳,辅以多美滋金装无乳糖婴儿配方奶粉喂养.结果:治疗组93例,显效58例,有效33例,显效率62.37%,总有效率97.85%;对照组显效27例,有效30例,显效率35.06%,总有效率74.02%,两组显效率(χ2=12.56,P<0.01)及总有效率(χ2=21.22,P<0.01)比较差异有显著性,治疗组疗效显著优于对照组.结论:应用金双歧加蒙脱石散联合治疗婴儿乳糖不耐受,其显效率及总有效率均优于对照组,未发现毒副反应,保证腹泻患儿母乳喂养的顺利进行,取得了较好的临床效果,值得推广.     

胆囊切除后乳糖吸收功能及小肠传递时间的观察

采用国产ＨＴＢ－Ｉ型氢气微分析仪，以２５ｇ乳糖为基质，对３２例胆囊切除后患者作氢气呼吸试验，测定其乳糖吸收功能及小肠传递时间。结果乳糖吸收不良占７８．１２％、乳糖不耐受３７．５％、小肠传递过速者３１．２５％。提示胆囊切除后患者乳糖吸收不良及不耐受的发生率与健康人群相似，说明不存在继发性乳糖酶缺乏，但小肠传递时间过速的发生率较高，可以是胆囊切除后形成ＰＣＳ的因素之一。     

药物性腹泻继发乳糖不耐受与无乳糖奶粉的干预研究

目的 探讨无乳糖奶粉对药物性腹泻继发乳糖不耐受的临床疗效.方法 选择门诊未用抗生素体格检查正常儿童151例.记录饮奶后消化道症状及尿半乳糖测定情况;住院应用抗生素患儿186例(呼吸系统及其他系统疾病静脉滴注抗生素者,用药前无腹泻,用药后7天内出现腹泻的婴幼儿),记录住院患儿用抗生素后第1、2、3、4、5、6、7天消化道症状及尿半乳糖测定情况,并用无乳糖奶粉对其进行干预.结果 治疗组乳糖不耐受的发病率明显高于对照组(P<0.01);治疗组3天总有效率为97.06%,对照组的总有效率55.89%,两组比较有显著性差异(P<0.05).结论 药物性腹泻可继发乳糖不耐受,无乳糖奶粉治疗疗效显著.     

Effect of Retinoic Acid on Lung Injury in Hyperoxia-Exposed Newborn Rats

Bronchopulmonary dysplasia(BPD) is a chroniclung condition which has been associated withpreterm delivery,infection and continuous exposureto hyperoxia.Impaired septal formation and de-creased alveolarization are characteristic features ofBPD[1] .Attempts to limit the incidence and severityof BPD by lowering oxygen concentration and by re-ducing barotrauma through early weaning from me-chanical ventilation have been helped by the use ofglucocorticoids in the postnatal period.Several stud-i…