反复呼吸道感染儿血清β-胡萝卜素、维生素A、E含量与免疫功能的关系

探讨反复呼吸道感染（RRYI）患儿血清β-胡萝卜素（β-CT）、维生素A（VA）、维生素E（VE）与免疫功能关系。方法采用高效液相色谱Miller改良法测定RRTI患儿血清β-CT、VA、VE含量，散射比浊法测定IgA、IgG、IgM，用McAb－ApAAp法测定外周血T淋巴细胞亚群，并与健康儿童对比。结果RRTI血清β-CT、VA含量明显低于对照组（P＜0．001）；RRTI血清IgA水平与β-CT、VA含量是显著正相关（r=0．347～0．441P<0．05）；RRTI组外周血CD 3；降低，CD 8增多，CD 4／CD 8比值降低，与对照组相比有显著差异性（P<0．001）。结论β-CT、VA缺乏时体液免疫和细胞免疫功能均降低，β-CT、VA缺乏可能是导致RRTI的重要原因。     

反复呼吸道感染患儿血清免疫球蛋白、IgG亚类及细胞免疫水平

目的探讨反复呼吸道感染(RRTI)与免疫球蛋白、IgG亚类及细胞免疫的关系,为临床治疗反复呼吸道感染提供一定的理论依据。方法RRTI患儿28例,男18例,女10例,平均年龄(3.70±1.44)岁;对照组30例,男15例,女15例,平均年龄(3.98±1.18)岁。采用免疫散射比浊法检测血清IgG﹑IgA、IgM及IgG亚类水平;采用流式细胞术检测CD3、CD4、CD8、CD19及CD16+56的表达。结果RRTI患儿血清IgG﹑IgA水平与对照组相比差异均无统计学意义(P均>0.05);IgM水平低于对照组(Z=3.149,P<0.01);RRTI患儿血清IgG2和IgG4水平较对照组明显降低(t=2.107,Z=2.916;P均<0.05);RRTI患儿淋巴细胞CD3﹑CD4较对照组明显降低(t=2.319,2.44,P均<0.05),余CD分子与对照组相比差异无统计学意义(P均>0.05)。结论RRTI患儿存在一定程度的体液免疫和(或)细胞免疫功能紊乱;对RRTI患儿同时检测总IgG、IgG亚类及细胞免疫功能具有重要的临床意义。     

儿童反复呼吸道感染与血清免疫球蛋白G亚类及IgA亚类缺陷

目的 探讨儿童反复呼吸道感染（RRTI）的病因。方法 采用径向免疫扩散法检测血清免疫球蛋白（Ig）G亚类、IgA亚类和T细胞亚群的变化。选择RRTI患儿42例与同年龄的健康儿童以配对方式进行对照观察。结果 RRTI组检出IgG亚类缺陷20例，占47．62％，以IgG2，以IgG2和IgG4缺陷为主；IgA亚类缺陷17例，占40．47％，以IgA1缺陷为主；CD3^ 、CD4^ 细胞及CD4^ /CD8^ 显著低于对照组，P均＜0．001。结论 IgG、IgA亚类缺陷是儿童RRTI的主要原因之一。     

反覆呼吸道感染与IgG亚类缺乏30例临床报告

以免疫缺乏过筛试验无异常发现的30例反复呼吸道感染患儿为研究对象，分反覆肺炎组（14例）和反复气道炎组（16例）。采用相应的单克隆抗体用改良的单向免疫扩散法检测血清IgG亚类水平，发现其中5例IgG亚类含量低于同龄正常值XG－1SD（均为反复肺炎组），占该组总例数的35．7％。本文结合5例的临床与实验资料，对IgG亚类缺陷病的诊断与治疗进行探讨。     

支气管哮喘血清微量元素,IgG亚类变化及其关系

检测21例儿童哮喘缓解期血清12种微量元素、血清IgG亚类浓度、外周皿T细胞亚群等变化，结果表明哮喘组血清锌、铁、钙、铜、锂明显低于对照组；血清IgG1、IgG3、IgG4和IgA显著高于对照组；血清IgG亚类缺陷检出率为28.57％（6／21），以IgG2缺陷居多，各IgG亚类均有增高，以IgG4增高为显著（占95.24％）；外周血CD3、CD8细胞百分率及T细胞增殖反应明显降低、CD4／CD8细胞比值增高。提示儿童哮喘存在以IgG亚类失衡、T抑制细胞数量和（或）功能不足为主的免疫功能失调，同时伴有多种微量元素缺乏或不足．     

儿童哮喘及反复呼吸道感染与维生素A缺乏的关系

为探讨亚临床状态维生素Ａ（ＶＡ）缺乏对儿童哮喘，反复呼吸道感染（ＲＡＩ）的影响，采用微量荧光测定法对２２例哮喘患儿２７例ＲＡＩ患儿及３５例健康儿童血清ＶＡ水平进行了检测，结果为各年龄组哮喘患儿，ＲＡＩ患儿血清ＶＡ水平明显低于正常同龄儿对照组，Ｐ〈０．０５）。儿童哮喘及反复呼吸道感染与亚临床状态ＶＡ缺乏有密切关系，这可能与ＶＡ缺乏所致的呼吸道上皮细胞分化及其完整性受损，免疫功能低下有关。     

82例反复呼吸道感染患儿细胞免疫功能探讨

反复呼吸道感染(RRTI)是小儿时期常见病,其病因及发病机理尚不清楚。据报告RRTI与IgG亚类缺陷有关。大量文献表明机体免疫功能异常是RRTI的重要原因之一。本文观察了82例RRTI患儿的总T淋巴细胞(CD3)、辅助性T淋巴细胞(CD4)、抑制性T淋巴细胞(CD8)及淋巴母细胞转化率(LTT)的变化,同时检测了B淋巴细胞,以探讨细胞免疫功能与RRTI的关系。     

儿童哮喘及反复呼吸道感染与维生素A缺乏的关系

为探讨亚临床状态维生素Ａ（ＶＡ）缺乏对儿童哮喘、反复呼吸道感染（ＲＡＩ）的影响，采用微量荧光测定法对２２例哮喘患儿，２７例ＲＡＩ患儿及３５例健康儿童血清ＶＡ水平进行了检测。结果为各年龄组哮喘患儿、ＲＡＩ患儿血清ＶＡ水平明显低于正常同龄儿对照组，Ｐ＜００５。儿童哮喘及反复呼吸道感染与亚临床状态ＶＡ缺乏有密切关系。这可能与ＶＡ缺乏所致的呼吸道上皮细胞分化及其完整性受损、免疫功能低下有关。     

格林—巴利综合征急性期免疫学改变

目的探讨格林-巴利综合征（GBS）急性期IL-2、IL-6、TNF-α和免疫球蛋白等免疫学改变及其与临床的关系。方法采用ELISA法测定GBS组21例，正常对照组16例血清及外用血单个核细胞（PBMC）上清液IL-2、IL-6、TNF-α及IgG水平，同时检测血清IgA、IgM、IgG亚类。结果GBS患者血清IL-2、TNF-α，PBMC上清液IL-2、IL-6、TNF-α及IgG均高于对照组（P＜0．05或0．01）。14例有一种以上血清免疫球蛋白或IgG亚类升高。重型组TNF-α高于轻型组（P＜0．05）。结论GBS患者存在T细胞功能紊乱和B细胞多克隆活化，IL-2、免疫球蛋白、尤其TNF-α升高在GBS发病中起重要作用。     

儿童哮喘与亚临床状态维生素A缺乏关系的研究

采用微量荧光测定法对２０例哮喘患儿及３５例健康儿童进行血清维生素Ａ（ＶｉｔＡ）检测。结果表明：各年龄段哮喘患儿血清Ｖｉｔ Ａ水平明显低于正常对照组,尤其是≤３岁组及〉６岁组（Ｐ〈０．００１）。哮喘组亚临床ＶｉｔＡ缺乏发生率为８０％（１６／２０例）,正常对照组为２０．８％（１／３５例）,有显著性差异（Ｐ〈０．００５）。其中≤３岁组最高,占５０．０％（１０／２０例）。结论：儿童哮喘存在着亚临床状态ＶｉｔＡ缺乏,两者可能互为因果关系。     

IgG and IgG subclasses deficiency in children undergoing continuous ambulatory peritoneal dialysis and its provocative factors

BACKGROUND: Low levels of serum IgG or IgG subclasses may be responsible for the defective peritoneal defense and for peritonitis attacks in continuous ambulatory peritoneal dialysis (CAPD) children. Malnutrition, peritoneal loss or frequent peritonitis may lead to IgG or IgG subclasses deficiency. METHODS: Levels of IgG subclasses were determined in 12 children undergoing CAPD treatment. Radial immunodiffusion technique was used for determination. Patients were aged from 6 to 16 years (mean age 12.3 years) and had been on CAPD for 11-26 months (mean duration 19.4 months). We evaluated whether IgG and IgG subclasses deficiency are related to malnutrition, the peritonitis rate and the duration of CAPD using the SPSS program. RESULTS: Serum total IgG levels were found to be low in eight out of 12 patients. Eight patients showed low levels of IgG1, four patients IgG2, one patient IgG3 and three patients IgG4. Total IgG values were found to be positively correlated to malnutrition status, peritonitis rate and duration of CAPD. The IgG2 values were found to be related to the duration of CAPD. The IgG4 values were found to be correlated to the peritonitis rates. CONCLUSIONS: The IgG and IgG subclasses deficiency may develop in children while on CAPD treatment. Periodical determinations of either serum IgG or the subclasses may be useful in the follow-up of these patients.     

肾病综合征患儿血清铁与转铁蛋白的变化

目的：肾病综合征(NS)患儿尿中丢失白蛋白的同时也伴有转铁蛋白的丢失,测定血清铁及转铁蛋白等铁代谢相关指标以及尿转铁蛋白,了解其变化及其相互关系。方法：NS患儿37例,测定其治疗前和恢复期铁代谢相关指标(血清铁、铁蛋白、转铁蛋白、转铁蛋白饱和度、总铁结合力以及外周血红细胞参数)及尿转铁蛋白,并与正常对照组比较。结果：①在NS治疗前血清铁为18.8±3.8μmol/L,分别与恢复期的21.0±3.5μmol/L,及对照组的22.2±3.8μmol/L比较,差异有显著性(P<0.01);转铁蛋白为1.9±0.3g/L,分别与恢复期的2.9±0.6g/L和对照组的3.1±0.5g/L比较,差异有显著性(P<0.01);总铁结合力为56.4±9.2μmol/L,分别与恢复期的51.9±7.7μmol/L和对照组的50.7±6.8μmol/L比较,差异亦有显著性(均P<0.01);转铁蛋白饱和度为(55.7±9.2)%,与NS恢复期及对照组的(47.4±13.3)%,(46.4±8.2)%比较,差异有显著性(P<0.01)。②血清白蛋白与转铁蛋白呈正相关(r=0.609,P<0.01)。③血清转铁蛋白浓度与尿转铁蛋白呈负相关(r=-0.550,P<0.01)。结论：NS患儿血清铁及转铁蛋白明显降低,可能与转铁蛋白从尿中丢失有关。     

Bone turnover in children with vitamin D deficiency rickets before and during treatment

Biochemical markers of bone formation [alkaline phosphatase, osteocalcin, and carboxyterminal propeptide of type I procollagen (PICP)] and bone resorption [cross-linked carboxyterminal telopeptide of type I collagen (ICTP) and cross-linked N-telopeptides of type I collagen (NTX)] were measured in 14 children aged 8.5-10.5 mo with vitamin D deficiency rickets before and longitudinally during vitamin D treatment (3000-4000 IU/daily). Forty-four healthy children aged 8-10.5 mo were enrolled as sex- and age-matched controls. Before treatment, serum levels of alkaline phosphatase, PICP, and ICTP, and urinary excretion values of NTX were significantly higher, and serum osteocalcin levels significantly lower than controls (31.4 +/- 3.5 microkat/L and 9.8 +/- 2.9 microkat/L, p < 0.001; 1025 +/- 89 microg/L and 952 +/- 97.4 microg/L, p < 0.02; 15.6 +/- 2.6 microg/L and 14.2 +/- 1.3 microg/L, p < 0.01; 370.7 +/- 109.4 nmol BCE and 201.8 +/- 69.2 nmol BCE, p < 0.001: 17.6 +/- 9.1 microg/L and 22.5 +/- 7.6 microg/L, p < 0.05, respectively). During treatment, serum alkaline phosphatase levels progressively declined in association with the radiographic healing of the skeletal lesions. Serum levels of osteocalcin, PICP, and ICTP, and urinary excretion values of NTX showed a transient but significant (p < 0.05 to p < 0.001) increase in comparison with baseline values during the first 2-4 wk of treatment, and decreased slowly thereafter. They were within the mean +/- 2 SD of controls before the recovery of the skeletal lesions. CONCLUSIONS: These findings suggest that children with vitamin D deficiency rickets have increased bone turnover before and during the first weeks of treatment. Alkaline phosphatase is a more reliable marker than osteocalcin, PICP, ICTP and NTX for diagnosing and monitoring these patients.     

Diagnostic significance of urinary growth hormone measurements in children with growth failure: correlation between serum and urine growth hormone

Twelve-h overnight urine and serum samples obtained simultaneously at 20-min intervals were assayed for growth hormone (GH). Ninety-one children, 5 to 16 y (Tanner stage 1 to 3) participated; group 1 were healthy children, group 2 were children with organic GH deficiency, and group 3 had idiopathic growth failure and normal GH stimulation tests. Serum pool GH concentrations in group 1 were similar to those in group 3 (3.3 +/- 0.3 versus 3.4 +/- 0.2 micrograms/L); group 2 had significantly lower GH concentrations (1.6 +/- 0.2 micrograms/L). Plasma IGF-I levels were significantly greater in groups 1 (14.2 +/- 2.6 nmol/L, p less than 0.001) than in groups 2 and 3 (2.6 +/- 0.5 and 5.5 +/- 0.7 nmol/L, respectively). Urinary GH (mean +/- SEM) standardized for body weight (micrograms/kg) in group 1 (0.31 +/- 0.02) was significantly greater than in group 2 (0.14 +/- 0.01) and group 3 (0.20 +/- 0.01). However, when expressed as microgram/mol creatinine, the output of GH was similar in group 1 (4.0 +/- 0.3) and group 3 (3.4 +/- 0.3); both groups had significantly greater output compared to group 2 (1.3 +/- 0.2). Urinary IGF-I (nmol/kg) in group 1 (0.22 +/- 0.02) was significantly greater than in group 2 (0.12 +/- 0.01) or group 3 (0.07 +/- 0.01). Urinary GH correlated with serum pool GH concentration (r = 0.64, p less than 0.001). Although urinary GH output reflects endogenous GH secretion, the overlap between groups 1 and 3 precludes using urinary GH measurements as a diagnostic test for GH deficiency in children with idiopathic growth failure.     

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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MBL54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MBL54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。     

Serum citrulline levels correlate with enteral tolerance and bowel length in infants with short bowel syndrome

OBJECTIVE: To determine if serum levels of CIT (a nonprotein amino acid synthesized by the intestine) correlate with total parenteral nutrition (PN)-independence in children with short bowel syndrome (SBS). STUDY DESIGN: We prospectively obtained serum amino acid profiles over a 24-month interval from all infants with SBS 3 weeks to 4 years of age. Remaining small intestine length was recorded at surgery, and percent enteral calories tolerated (enteral calories divided by enteral plus parenteral calories x 100) was determined in 24 infants with SBS and 21 age-matched controls (blood drawn for non-gastrointestinal symptoms). RESULTS: Mean CIT for controls was 31 +/- 2 micromol/L. In patients with SBS (n = 24), serum CIT correlated linearly with percent enteral calories (R = 0.85; P <.001) and with bowel length (R = 0.47; P < or =.03). CIT level in patients with SBS weaned off PN was 30 +/- 2 micromol/L; in those subsequently weaned off PN, 20 +/- 2 micromol/L; and in those who would remain PN-dependent, 11 +/- 2 micromol/L ( P < or =.01). Serum CIT > or =19 micromol/L had 94% sensitivity and 67% specificity for being off or coming off total PN. CONCLUSIONS: Serum CIT level >19 micromol/L in children with SBS is associated with development of enteral tolerance and may be a useful predictive test.     

Vitamin E treatment of nonalcoholic steatohepatitis in children: a pilot study

AIM: To determine whether supplemental oral vitamin E is effective in lowering serum aminotransferase and alkaline phosphatase levels in children with nonalcoholic steatohepatitis (NASH) associated with obesity. STUDY DESIGN: Open-label pilot study enrolling all children <16 years old with chronically elevated serum aminotransferase (alanine aminotransferase and aspartate aminotransferase) levels for greater than 3 months, who demonstrated a diffusely echogenic liver on ultrasonography, had no demonstrable reason for abnormal serum chemistry values other than obesity, and therefore were diagnosed to have NASH. Patients were prescribed oral vitamin E between 400 and 1200 IU per day. Serum chemistry values were monitored monthly during treatment. RESULTS: Eleven subjects with a mean age of 12.4 years were enrolled; treated patients were followed up for 4 to 10 months. The body mass index did not change significantly before and after treatment (32.8 +/- 3.8 kg/m(2) vs 32.5 +/- 4.4 kg/m(2), respectively). Serum alanine aminotransferase decreased from 175 +/- 106 IU/L to 40 +/- 26 IU/L (P <.001, paired Student t test), serum aspartate aminotransferase decreased from 104 +/- 61 IU/L to 33 +/- 11 IU/L (P <.002), and alkaline phosphatase decreased from 279 +/- 42 IU/L to 202 +/- 66 IU/L (P <.003) during treatment. Serum aminotransferase levels remained normal during treatment but returned to abnormal in those electing to stop treatment. Serum alpha-tocopherol levels were within the normal range before the commencement of therapy and increased significantly with supplementation. The liver remained diffusely echogenic during therapy, at the time serum aminotransferase levels were reduced. CONCLUSIONS: Daily oral vitamin E administration normalized serum aminotransferase and alkaline phosphatase levels in children with NASH. Obese children with NASH should be encouraged to lose weight as part of a comprehensive weight reduction program and to consider taking supplemental alpha-tocopherol.     

Growth and nutrition of Chinese vegetarian children in Hong Kong

OBJECTIVE: The study investigated the nutritional status of Chinese lacto-ovo-vegetarian children aged 4-14 years. METHODOLOGY: Dietary intake over 7 days was assessed using a computer program, previously used for a local population-based dietary survey. Anthropometric measurements were made and fasting venous blood was examined for serum lipids, haematological data, iron, vitamin B12 and folate status. Bone mineral density (BMD) of the spine (L2 - L4) was measured as a reflection of calcium status. RESULTS: Fifty-one lacto-ovo-vegetarians aged 4-14 years were investigated. The mean +/- standard deviation (SD) daily energy intake was 1600 +/- 425 kcal. The mean (+/- SD) daily protein intake was 1.6 +/- 0.6 g/kg bodyweight which met the United States recommended dietary allowance. Compared to that of the local omnivore diet, the vegetarian diet was closer to the recommended healthy diet with lower fat (20-23%), more fibre (5.8-8.7 g/day) and better polyunsaturated to saturated fatty acid ratio (1.0-1.1). Growth and BMD of the vegetarian children were comparable to the general omnivore population. Two children had iron deficiency and two children had anaemia. The calcium status, as reflected by the BMD, was not impaired. Serum folate and vitamin B12 were within the normal range. Six (25%) boys and four (15%) girls were obese. Three boys had hyperlipidaemia. CONCLUSIONS: A Hong Kong Chinese vegetarian diet appears healthy, providing adequate iron and vitamin B12 nutrition, but the prevalence of obesity was high.     

Serum zinc levels in children with acute gastroenteritis

BACKGROUND: The aim of the present study was to determine the serum zinc levels on admission and 7-10 days after clinical recovery from acute gastroenteritis of <8 days' duration. METHODS: This prospective study included 82 infants aged 2-24 months who had no associated bacterial infection, chronic disease, prior antibiotic use, moderate or severe malnutrition or dysentery. Forty-one healthy children formed the control group. RESULTS: The mean serum zinc level on admission (Zn1) was 11.85 +/- 2.83 micromol/L and at 7-10 days after recovery (Zn2) was 10.92 +/- 2.17 micromol/L; mean serum zinc level of the control group was 11.81 +/- 3.45 micromol/L. Zn2 was significantly lower than Zn1, but there was no statistical difference between the mean of the control group and Zn1 and Zn2. When dehydrated patients were excluded from the patient group, Zn1 and Zn2 did not differ. Although asymptomatic, 39% of the control group had low zinc. Serum zinc levels were not affected by sex, age, clinical characteristics of the patients or severity of gastroenteritis. CONCLUSION: Serum zinc levels of the patients admitted with acute gastroenteritis without any other disease and without moderate or severe malnutrition were not affected by disease state. Gastroenteritis did not further decrease serum zinc levels in patients with asymptomatic or subclinical zinc deficiency.     

Analysis of IgG subclasses in chronic active Epstein–Barr virus infection

BACKGROUND: Although elevated serum levels of immunoglobulins are frequently observed in patients with chronic active Epstein-Barr virus (EBV) infection, there have been no reports concerning levels of IgG subclasses. METHODS: Serum levels of IgG subclasses were measured by the enzyme-linked immunosorbent assay (ELISA) in 30 children with severe chronic active EBV infection. RESULTS: Serum levels of IgG1 were elevated in most patients, except for one who showed an abnormally low level of IgG1 and progressive hypogammaglobulinemia. Serum levels of IgG2, IgG3 and IgG4 in the patients were comparable to those in control children, while abnormally low levels of IgG2, IgG3 and IgG4 were observed in six, three and four cases, respectively. CONCLUSION: Although not always susceptible to bacterial infections, low levels of IgG2 were frequently observed in patients with chronic active EBV infection and elevated IgG1 is responsible for the increase of serum IgG in these patients.