生长发育迟缓与胰岛素样生长因子的关系

目的提高由于生长激素－胰岛素样生长因子（ＧＨ－ＩＧＦ）轴异常引起的生长发育迟缓诊断的准确性。方法分别收集门诊６８例生长发育迟缓儿童运动激发试验前后２次血清和１４例住院患儿药物激发试验１０次血标本,用免疫放射计量（ＩＲＭＡ）方法测定ＩＧＦ－１,ＩＧＦ－２和ＩＧＦＢＰ－３,放免方法（ＲＩＡ）测定ＧＨ。结果药物激发试验ＧＨ水平与ＩＧＦ－１,ＩＧＦ－２和ＩＧＦＢＰ－３测定一致。运动激发试验根据运动后ＧＨ水平及身高百分位的情况将６８例分为３组：ＧＨ＜５０μｇ／Ｌ,５０～１００μｇ／Ｌ,＞１００μｇ／Ｌ。ＧＨ＜５０μｇ／Ｌ组１４例,其中１０例身高小于第３百分位,其ＩＧＦ－１,ＩＧＦ－２和ＩＧＦＢＰ－３水平分别是（３９±２０）,（２７４±１２２）,（４２０±２１０）ｎｍｏｌ／Ｌ,低于正常值（Ｐ＜００１）,ＧＨ水平与ＩＧＦ－１,ＩＧＦ－２和ＩＧＦＢＰ－３相符。结论用运动激发试验联合测定ＧＨ、ＩＧＦ－１和ＩＧＦＢＰ－３三项指标可以提高由于ＧＨ－ＩＧＦ轴异常所引起的生长发育迟缓诊断的准确性。     

高频振荡通气结合一氧化氮吸入对急性肺损伤兔氧合的影响

目的　判断高频振荡通气（ＨＦＯ）伴低浓度一氧化氮（ＮＯ） 吸入对急性肺损伤家兔气体交换和血液动力学参数的影响。方法　用３７ ℃温盐水反复进行支气管灌洗（按每次３０ ｍｌ／ｋｇ）制成急性肺损伤模型。应用高频振荡呼吸机和１×１０－６ＮＯ吸入对１０ 只急性肺损伤家兔进行实验性治疗,并测定肺力学、血液动力学等参数。结果　ＨＦＯ＋ ＮＯ 与急性肺损伤基础值比较：ＰａＯ２／ＦｉＯ２ 比值由１５６±３２ 上升至４０５±４８（Ｐ＜ ０－０１）、氧合指数（ＯＩ）和肺内动静脉分流量（Ｑｓ／Ｑｔ） 分别由７－８ ±１－７ 和０－４１±０－０６ 下降至３－７ ±０－８ 和０－３０±０－０５（ Ｐ均＜ ０－０１）。ＨＦＯ＋ ＮＯ 与单纯ＨＦＯ 比较：ＰａＯ２／ＦｉＯ２ 比值由３７９±８６ 上升至４０５±４８（ Ｐ＜ ０－０５） 、ＯＩ和Ｑｓ／Ｑｔ 分别由５－８ ±１－９ 和０－３５ ±０－０６ 下降至３－７ ±０－８ 和０－３０±０－０５（Ｐ均＜０－０５） 。结论　ＨＦＯ＋ ＮＯ吸入可改善急性肺损伤兔的氧合,肺内分流减少,吸入１×１０－６ ＮＯ有效。应用本系统质量流量控制器,可以在高频振荡通气时提供稳定浓度的ＮＯ气体。     

不同治疗方案对先天性卵巢发育不全症患儿身高增长的疗效比较

目的比较不同治疗方案对先天性卵巢发育不全症（Ｔｕｒｎｅｒ综合征,ＴＳ）患儿身高增长的疗效。方法回顾性分析两组ＴＳ患儿的疗效：一组（６例）接受小剂量康力龙治疗５～１６个月,另一组（１２例）接受同样剂量的康力龙与生长激素（ＧＨ）联合治疗６～１４个月。结果单用康力龙组生长速度（ＧＶ）达到（５５４±１４６）ｃｍ／ａ,身高Ｚ评分（ＨｔＳＤＳ）由－３９１±１３４提高到－３５３±１４３。联合治疗组生长速度为（８５３±２５７）ｃｍ／ａ,ＨｔＳＤＳ由－３３６±１１６提高到－２６１±１０４。联合治疗组疗效较单用康力龙组为优（Ｐ＜００５）,其治疗期间ＧＶ与患儿年龄呈负相关（ｒ＝－０８０,Ｐ＜００１）。结论联合应用ＧＨ与小剂量康力龙治疗ＴＳ疗效确切,适宜临床应用。     

抗A组轮状病毒鸡卵黄免疫球蛋白的临床评价

目的：研究抗Ａ组轮状病毒鸡卵黄免疫球蛋白在临床上治疗婴幼儿轮状病毒性肠炎的效果。方法：对１９９６年下半年临床诊断为秋季腹泻并经粪便ＥＬＩＳＡ检测为Ａ组轮状病毒抗原阳性的住院患儿２１８例分组进行研究。结果：实验组总治愈率（９１／１０４）显著高于对照组（７１／１１４）（χ２＝１８１２，Ｐ＜００１）。平均止泻天数实验组（２９８±１４１）天，对照组（４１９±１５２）天。两组差异有非常显著意义（ｕ＝６１０，Ｐ＜００１）。结论：抗Ａ组轮状病毒鸡卵黄免疫球蛋白的被动免疫保护效果显著。     

肺表面活性物质治疗新生儿胎粪吸入综合征的临床研究

目的探讨肺表面活性物质（ＰＳ）治疗新生儿胎粪吸入综合征（ＭＡＳ）的有效性及临床价值。方法采用气管内滴入ＰＳ治疗８例ＭＡＳ患儿，其中６例接受ＰＳ２剂，２例接受ＰＳ３剂。结果给予首剂ＰＳ后１０分钟患儿青紫迅速消失，皮肤转红润，经皮测定血氧饱和度（ＴｃＳａＯ２）升高。３０分钟后患儿低氧血症迅速改善，动脉血氧分压、动脉血氧分压与吸入氧浓度比值、动脉肺泡血氧分压比值、呼吸机有效指数较治疗前显著增高，分别由原来的５２８±０９８ｋＰａ、８６６±３５２ｋＰａ、０１２±００６ｋＰａ及０１４±００６ｍｌ·ｋＰａ－１·ｋｇ－１增加到８９１±１４３ｋＰａ、１６８１±４１８ｋＰａ、０２１±００５ｋＰａ及０２６±００７ｍｌ·ｋＰａ－１·ｋｇ－１；而吸入氧浓度及平均气道压逐渐降低，由原来的０６８±０１９ｋＰａ及２２０±０４２ｋＰａ降低到０５３±００８ｋＰａ及１９３±０４８ｋＰａ。重复应用ＰＳ后亦有相似效果。结论ＰＳ能有效地改善ＭＡＳ患儿肺顺应性及氧合功能。重复应用ＰＳ可巩固和加强疗效。     

青春期前尿道小儿内分泌变化的研究

对３５例尿道下裂小儿及２０例正常儿作黄本素释放激素（ＬＨ－ＲＨ）兴奋试验和人绒毛膜促性腺激素（ＨＣＧ）试验，应用放射免疫法测定了血清黄本素（ＬＨ）、卵泡刺激素（ＦＳＨ）、及睾酮（Ｔ）浓度。检查结果发现，尿道下裂患儿ＬＨ－ＲＨ刺激后的血清ＬＨ、ＦＳＨ浓度高于正常对照组，而注射ＨＣＧ３天后的血清ＴＩ浓度较正常对照组低下。并对以上内异常及其可能在尿道下裂形成过程中的作用进行了讨论。     

青春期前尿道下裂小儿内分泌变化的研究

对３５例尿道下裂小儿及２０例正常儿作黄体素释放激素（ＬＨ－ＲＨ）兴奋试验和人绒毛膜促性腺激素（ＨＣＧ）试验，应用放射免疫法测定了血清黄体素（ＬＨ）、卵泡刺激素（ＦＳＨ）、及睾酮（Ｔ）浓度。检查结果发现，尿道下裂患儿ＬＨ－ＲＨ刺激后的血清ＬＨ、ＦＳＨ浓度高于正常对照组，而注射ＨＣＧ３天后的血清Ｔ浓度较正常对照组低下。并对以上内分泌异常及其可能在尿道下裂形成过程中的作用进行了讨论     

CCHD的血液粘度与红细胞压积以及动脉血氧饱和度的关系

对２０例紫绀型先天性心脏病（ＣＣＨＤ）和１８例对照组检测血液流变学有关指标。观察组全血粘度（ＷＢＶ）和红细胞压积（ＨＣＴ）明显高于对照组，差异显著，Ｐ＜００１。观察组ＨＣＴ与ＷＢＶ有明显正相关（γ＝０７３２）。观察组动脉血氧饱和度（ＳＡＴ）０８±００６，明显低于正常值，而ＳＡＴ与ＷＢＶ有明显负相关（γ＝－０８９）。本研究提示：ＳＡＴ和ＨＣＴ可做为ＣＣＨＤ患儿可能出现高粘综合征（ＨＶＳ）、脑血管并发症的预测指标，即ＳＡＴ越低，ＨＣＴ和ＷＢＶ越高，故容易发生脑血管并发症及其他高粘综合征     

病毒性心肌炎患儿急性期血清细胞因子的检测及其意义

为了解病毒性心肌炎患儿急性期血清白细胞介素６（ＩＬ－６）、肿瘤坏死因子－α（ＴＮＦ－α）的含量改变及其与乳酸脱氢酶同工酶１（ＬＤＨ１）的关系,初步探讨两者在病毒性心肌炎发病中的作用,分别采用ＥＬＩＳＡ法和酶法检测７２例病毒性心肌炎患儿的血清ＩＬ－６、ＴＮＦ－α和ＬＤＨ１生心肌炎组血清ＩＬ－６、ＴＮＦ－α、ＬＤＨ１含量均明显高于正常对照组（Ｐ〈０．０１）。ＩＬ－６水平与ＬＤＨ１呈负相关（ｒ＝－０．３     

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     

阿奇霉素对急性上呼吸道感染患儿氢呼气试验的影响

目的探讨阿奇霉素(AZM)对急性上呼吸道感染(AURI)患儿氢呼气试验(BHT)的影响。方法采用HD-1型测氢仪对38例AURI患儿应用AZM前后进行空腹BHT及乳果糖BHT,并与健康儿童空腹BHT作对照。结果应用AZM前AURI患儿空腹BHT值明显高于健康对照儿童(P<0.01);应用AZM3d后AURI患儿空腹BHT值明显降低(P<0.01);应用AZM前后AURI患儿口服乳果糖后呼气氢值无明显变化。结论AURI等感染性疾病影响氢的产生和利用;AZM等抗生素能明显抑制肠道产氢,BHT测定并动态观察小儿感染性疾病抗生素对其影响,具有快速、简便、无创、患儿易接受等优点。     

THE VOLUME OF TRAPPED GAS: A NEW AND SENSITIVE TEST FOR THE DETECTION OF EXERCISE-INDUCED BRONCHOSPASM IN CHILDREN

ABSTRACT. The volume of trapped gas (VTG) was measured at the end of a nitrogen multiple breath wash out procedure in 16 asthmatic and 10 healthy children before and after exercise. When compared to conventional spirometric variables VTG was the most sensitive test for detection of exercise-induced asthma (EIA). The VTG was significantly higher before exercise in the asthmatic children and increased significantly after exercise, while it did not change in the healthy controls. The significance of changes caused by EIA increased if VTG/TLC% or VTG/VC% were used. Salbutamol inhalation normalized the VTG in all the asthmatic children.     

Fructose breath hydrogen tests.

Fructose absorption was studied by the breath hydrogen test in 114 healthy children aged 0.1-6 years, given either 2 g/kg or 1 g/kg of fructose. All 57 children given 2 g/kg had peak breath hydrogen excretions > or = 20 ppm. At 1 g/kg only 25/57 (44%) showed incomplete absorption and the percentage incompletely absorbing fructose and the peak breath hydrogen value were significantly higher in children aged 1-3 years. Interestingly, this age distribution correlates with that of toddler diarrhoea.     

Fructose breath hydrogen tests

Fructose absorption was studied by the breath hydrogen test in 114 healthy children aged 0.1-6 years, given either 2 g/kg or 1 g/kg of fructose. All 57 children given 2 g/kg had peak breath hydrogen excretions > or = 20 ppm. At 1 g/kg only 25/57 (44%) showed incomplete absorption and the percentage incompletely absorbing fructose and the peak breath hydrogen value were significantly higher in children aged 1-3 years. Interestingly, this age distribution correlates with that of toddler diarrhoea.     

Intestinal permeability to 51Cr-EDTA and orocecal transit time in cystic fibrosis.

Intestinal permeability was investigated in 16 children with cystic fibrosis and 14 age-matched controls, making use of 51Cr-EDTA as probe molecule. Orocecal transit time was also evaluated using the lactulose/hydrogen breath test. There was an increase in permeability to 51Cr-EDTA in patients with cystic fibrosis (mean 13.62%) compared with the control group (mean 1.08%). The orocecal transit time was prolonged in patients with cystic fibrosis compared with controls. Mean fasting breath hydrogen concentration was significantly greater in cystic fibrosis patients (13 ppm) compared with control patients (3 ppm). There was no correlation between the percentage of 51Cr-EDTA excreted and the orocecal transit time in either control or cystic fibrosis patients.     

Ineffectiveness of breath methane excretion as a diagnostic test for lactose malabsorption

BACKGROUND: In clinical and field conditions, breath gas analysis has been widely used in evaluating carbohydrate digestion. A field study was performed to determine the prevalence of lactose malabsorption in Myanmar children and to evaluate the possibility of using breath methane excretion to indicate lactose malabsorption in a field situation. METHODS: The study population consisted of 118 children aged 1 to 12 years. A hydrogen breath test after a lactose meal (2 g/kg, maximum 50 g) was used as a standard test. RESULTS: Lactose malabsorption was detected in 16.7% of children aged 1 to 2.9 years, with the prevalence increasing with age from 40.5% of those aged 3 to 5.9 years to 88.5% of those aged 6 to 8.9 years and reaching 91.7% in those aged 9 to 11.9 years. Lactose malabsorption was more prevalent when children were weaned before 4 months of age (87.2 vs. 41.1%; p < 0.01). Compared with lactose-tolerant children, those with lactose malabsorption had significantly higher concentrations of breath hydrogen excretion 60 minutes after the lactose test meal. Breath methane excretion was also significantly higher in samples at 120 minutes in children with lactose malabsorption. Breath methane excretion of greater than or equal to 2 parts per million at 180 minutes as a diagnostic test for lactose malabsorption had a sensitivity of 61.5% and a specificity of 84.6%. CONCLUSION: The breath methane test for lactose malabsorption has a lower sensitivity and specificity than the breath hydrogen test and therefore does not replace the lactose breath hydrogen test.     

Epilepsy and the ketogenic diet: assessment of ketosis in children using breath acetone

High-fat ketogenic diets increase ketones (acetoacetate, beta-hydroxybutyrate, and acetone) and are used to treat refractory seizures. Although ketosis is an integral aspect of these therapeutic regimens, the direct importance of ketosis to seizure control needs further investigation. An examination of this relationship requires a reliable, minimally invasive measure of ketosis that can be performed frequently. In the present study, we examined the use of breath acetone as a measure of ketosis in children with refractory seizures on a classic ketogenic diet. Results were compared with breath acetone levels in epilepsy and healthy controls. Children on the ketogenic diet had significantly higher fasting breath acetone compared with epilepsy or healthy controls (2530 +/- 600 nmol/L versus 19 +/- 9 nmol/L and 21 +/- 4 nmol/L, respectively; p < 0.05). One hour after consumption of a ketogenic breakfast meal, breath acetone increased significantly in epilepsy and healthy controls (p < 0.05), but not in children on a ketogenic diet. Children who were on the ketogenic diet for longer periods of time had a significantly lower fasting breath acetone (R(2) = 0.55, p = 0.014). In one child on the ketogenic diet, breath acetone was determined hourly over a 9-h period, both by gas chromatography and by a prototype hand-held breath acetone analyzer. Preliminary results using this hand-held breath acetone analyzer are encouraging. Breath acetone may be a useful tool in examining the relationship between ketosis and seizure control and enhancing our understanding of the mechanism of the ketogenic diet.     

Breath hydrogen excretion in infants with colic.

Breath hydrogen excretion as an index of incomplete lactose absorption was measured in 118 healthy infants who were either breast fed or given a formula feed containing lactose, some of whom had colic. Infants with colic (n = 65) were selected on the basis of the mother''s report of a history of inconsolable crying lasting several hours each day. Infants in the control group (n = 53) were not reported to cry excessively by their mothers. Breath samples were collected using a face mask sampling device preprandially, and 90 and 150 minutes after the start of a feed. Normalised breath hydrogen concentrations were higher in the group with colic than in the control group at each time point. The median maximum breath hydrogen concentration in the colic group was 29 ppm, and in the control group 11 ppm. The percentage of infants with incomplete lactose absorption (breath hydrogen concentration more than 20 ppm) in the colic group was 62% compared with 32% in the control group. The clinical importance of the observed association between increased breath hydrogen excretion and infantile colic remains to be determined. Increased breath hydrogen excretion indicative of incomplete lactose absorption may be either a cause or an effect of colic in infants.     

Breath hydrogen response to milk containing lactose in colicky and noncolicky infants

In 122 healthy newborn infants, we studied the relationship between breath hydrogen (H2) production after feedings containing lactose (human milk or commercial formula) in colicky and noncolicky infants at 6 weeks and 3 months. Eighty-three infants (68%) developed colic (mild, moderate, or severe) by 2.6 +/- 1.8 weeks of age (mean +/- SD). Zero time (baseline) breath H2 values were significantly higher in colicky compared with noncolicky infants at both 6 weeks (40.6 +/- 41.4 vs 14.8 +/- 32.9 ppm) and 3 months (27.7 +/- 38.1 vs 8.5 +/- 18.2 ppm). There were significantly more positive breath H2 tests in colicky compared with noncolicky infants at 6 weeks (78% vs 36%) and 3 months (89% vs 45%). Failure to produce H2 throughout the breath H2 test was significantly more frequent in noncolicky compared with colicky infants at 6 weeks (50% vs 18%) and 3 months (43% vs 4%). These findings remained significant even when infants with mild colic (at 6 weeks and 3 months) were included in the noncolicky group. We conclude that colicky infants produce more breath H2 in the fasting state and in response to feedings containing lactose than noncolicky infants produce. This may represent increased lactose malabsorption, differences in colonic bacterial fermentation conditions, or differences in the handling of colonic gas produced.     

Measurement of fat digestion in early life using a stable isotope breath test

13C breath tests are a safe, non-invasive way of assessing nutrient digestion and absorption that can be used repeatedly in infancy and childhood. The aim of this study was to assess their value for measuring fat digestion in infants and young children with cystic fibrosis, and healthy controls whose pancreatic exocrine function is immature, and to monitor pancreatic enzyme supplementation. Six infants with cystic fibrosis (aged 10-18 months) and nine healthy controls (aged 6-19 months) were studied. After an overnight fast each child ingested 7.5 mg/kg 13C trioctanoin (99 atom % excess) followed by a known volume of milk. Breath samples were collected before and at 30 minute intervals thereafter for five hours. The 13C enrichment of expired carbon dioxide was measured by gas isotope ratio mass spectrometry. The mean (SD) percentage dose recovery of 13C was 13.5 (5.3) for the cystic fibrosis group and 24.2 (6.7) for the healthy controls. When those with cystic fibrosis were studied after supplementary pancreatic enzymes, the mean percentage dose recovery rose to 17.1 (6.9). Total intraluminal lipolysis was diminished by 44% in young children with cystic fibrosis. Pancreatic enzyme supplements improved digestion by 27%. The 13C trioctanoin breath test was effective in detecting fat maldigestion and can be used to measure the benefits of enzyme supplements in early life.