高胆红素血症新生儿总胆红素/白蛋白比值与脑干听觉诱发电位的关系

目的 探讨总胆红素/白蛋白比值与脑干听觉诱发电位(BAEP)的相关性及其预测高胆红素血症新生儿听力损害的临床价值.方法 检测113例新生儿的总胆红素(TSB)、白蛋白水平,计算总胆红素/白蛋白比值(B/A),将B/A值≥ 3.0 × 10-3的83例新生儿作为观察组,并根据B/A值分4个亚组;另30例B/A ﹤ 3.0 × 10-3的新生儿作为对照组.检测所有新生儿的BAEP,分析TSB水平、B/A值与BAEP异常的相关性.结果 观察组各亚组间新生儿的BAEP异常率差异有统计学意义(P ＜ 0.01),随B/A值增大,BAEP异常率增高;观察组各亚组间新生儿BAEP的Ⅴ波潜伏期及Ⅰ-Ⅴ、Ⅲ-Ⅴ波间期的差异有统计学意义(P均＜ 0.05);TSB水平、B/A值的工作特征曲线(ROC)下面积(AUC)差异也有统计学意义(P ＜ 0.05);BAEP异常与B/A值密切相关(χ2 ＝ 13.489,P ＜ 0.05).结论 B/A值与BAEP异常相关性高,具有预测高胆红素血症新生儿听力损害的临床价值.     

总胆红素与白蛋白比值对预测胆红素神经毒性价值的探讨

目的　探讨总胆红素 /白蛋白比值 (B/A)与脑干听觉诱发电位 (ABR)的关系及在预测胆红素神经毒性中的价值。方法　将 43例足月非溶血性高胆红素血症患儿 ,根据ABR表现分成A、B、C三组 ,比较三组患儿血清总胆红素 (TBC)、B/A的变化 ,分析B/A与ABR的相关性。结果　与A、B两组比较 ,C组TBC及B/A比值均明显升高 (P <0 0 5 ,P <0 0 1) ,B/A比值与ABR异常密切相关 (χ2 =7 76 ,P <0 0 5 )。结论　B/A比值是预测胆红素脑病的良好指标 ,对于足月高胆患儿B/A比值 >5 0× 10 -3 者应采取积极的治疗措施。     

胆红素脑病与胆红素/血浆白蛋白比值关系探讨

目的探讨胆红素脑病与血清胆红素/血浆白蛋白比值(B/A)的关系。方法对2008年11月至2009年10月本院住院的高胆红素血症患儿进行回顾性总结,分为胆红素脑病组(病例组)与非胆红素脑病组(对照组),对住院期间的血清胆红素高峰值、血浆白蛋白以及B/A等因素之间的关系进行统计学分析。结果共收集到2253例高胆红素血症患儿,其中88例诊断胆红素脑病。病例组B/A为(1.59±0.47),对照组B/A为(0.80±0.28),差异有统计学意义(t=474.537,P=0.000)。B/A比值为0~1.0、1.1~2.0、2.1~3.0时,胆红素脑病发生率分别为0.5%、12.9%、69.2%。结论胆红素脑病的发生与B/A比值有关,B/A越高,发生胆红素脑病的危险性越大。     

重度高胆红素血症新生儿脑干听觉诱发电位的改变

目的 观察新生儿重度高胆红素血症脑干听觉传导系统的改变.方法 根据血清总胆红素水平把77例新生儿分成3组:A组31例(胆红素342.0～427.5 μmol/L),B组29例(胆红素427.5～513.0 μmol/L),C组17例(>513.0 μmol/L),3组新生儿进行脑干听觉诱发电位检测.结果 3组患儿Ⅰ波及Ⅰ-Ⅲ峰间期异常率随胆红素水平升高而升高,差异有显著性(P<0.01),Ⅲ波、Ⅴ波及Ⅲ-Ⅴ峰间期异常率3组间差异无显著性(P>0.05).3组患儿Ⅴ波反应阈均以轻中度升高为主,A、B两组主要表现为轻度升高,C组主要表现为中度升高,1例患儿重度升高.结论 重度高胆红素血症可导致新生儿听神经损害,血清胆红素水平与脑干听觉诱发电位异常程度有直接关系,主要表现为外周听神经损害,客观听域轻中度升高,应合理干预高胆红素血症以减少神经系统损害.     

高胆红素血症新生儿血清S-100蛋白及总胆红素与白蛋白比值的变化及意义

目的 研究高胆红素血症(高胆)新生儿血清S-100蛋白水平和总胆红素(TBC)与白蛋白(B/A)比值的变化,为早期预测胆红素脑损伤提供新的方法.方法 根据胎龄、体质量和是否符合黄疸干预标准将出生7 d内的84例新生儿分为足月高胆组、足月对照组、早产高胆组、早产对照组.检测4组血清S-100蛋白、TBC、白蛋白水平,计算B/A比值.结果 足月高胆组S-100蛋白含量[(0.36±0.14)μg/L]高于足月对照组[(0.25±0.07)μg/L],差异有显著性(P＜0.05),足月高胆组S-100蛋白含量与B/A比值呈正相关性(r=0.509,P＜0.05).早产高胆组S-100蛋白含量[(0.40±0.09)μg/L)高于早产对照组[(0.28±40.05)μg/L],差异有显著性(P＜0.05),S-100蛋白含量与B/A比值无相关性(r=0.356,P＞0.05).结论 血清S-100蛋白和B/A比值可作为早期预测胆红素神经毒性的敏感指标.     

光疗对高未结合胆红素血症新生儿细胞免疫功能的影响

目的 探讨光疗对新生儿高未结合胆红素血症免疫功能的影响及其机制.方法 将100例高未结合胆红素血症足月新生儿随机分成5组:枯草杆菌二联活菌颗粒(妈咪爱)组(A组)、妈咪爱联合连续光疗组(B组)、妈咪爱联合间断光疗组(C组)、连续光疗组(D组)和间断光疗组(E组),5组均在治疗前0h和治疗第24、48小时抽血分别测定血IL-2、IL-10及血清胆红素水平,分析5组治疗前后各免疫指标的变化.结果 B组、C组、D组、E组治疗第24、48小时IL-2、IL-10水平与治疗前0h比较均增多,差异均有统计学意义(Pa＜0.05);B组、C组、D组、E组治疗第48小时IL-2、IL-10水平与24h比较也均有增多,差异均有统计学意义(Pa＜0.05).治疗后第24小时血IL-2、IL-10水平比较:B组比C组偏高,D组比E组偏高,差异均有统计学意义(Pa＜0.001);治疗后第48小时IL-2比较:B组比C组偏低,D组比E组偏低,差异均有统计学意义(Pa＜0.001);治疗后第48小时IL-10的比较:B组比C组偏高,D组比E组偏高,差异均有统计学意义(Pa＜0.001).结论 光疗除可降低新生儿血清未结合胆红素水平外,还可使血IL-2、IL-10水平增加,进而影响新生儿的免疫功能,且显示在对高未结合胆红素血症新生儿细胞免疫功能的调节方面间断光疗优于连续光疗.     

重度高胆红素血症新生儿总胆红素/白蛋白比值及酸中毒与脑干听觉诱发电位异常的关系

目的：探讨重度高胆红素血症新生儿总胆红素/白蛋白比值（B/A比值）、酸中毒与脑干听觉诱发电位（BAEP）异常的关系及其临床意义。方法：纳入2008年11月至2009年10月间重度高胆红素血症患儿967例。按照BAEP的结果,分为BAEP正常组（799例）和BAEP异常组（168例）。对B/A比值、酸中毒与BAEP的关系分别进行单因素分析,再根据日龄因素分别进行分层χ2检验。结果：单因素分析结果显示,BAEP异常组较BAEP正常组具有更低的pH值和BE值以及更高的B/A比值,差异有统计学意义。分层χ2检验分析结果显示,对于重度高胆红素血症任何日龄组的患儿,当存在酸中毒或当B/A比值>1时,其BAEP异常的发生率均较对照组增高,差异均有统计学意义。结论：高B/A比值、酸中毒是重度高胆红素血症患儿发生BAEP异常的危险因素,且对于任何日龄段的患儿均是如此。故对于任何日龄组的重度高胆红素血症患儿,当存在上述危险因素时,应尽快纠正其酸中毒,降低B/A比值,以降低胆红素听力损伤的发生。     

新生儿胆红素脑病33例临床分析

目的探讨新生儿胆红素脑病的病因及临床特点。方法选择2006年1月至2010年1月我院新生儿科收治的重症新生儿高胆红素血症患儿,分为胆红素脑病组(脑病组)与非胆红素脑病组(非脑病组),比较两组患儿病因、临床特征、胆红素水平、胆红素/白蛋白比值(B/A)以及治疗转归。结果脑病组黄疸病因以溶血性因素占首位(48.5%),其次是感染因素(24.2%);非脑病组黄疸病因主要为溶血(69.7%)。脑病组总胆红素、B/A比值、入院日龄和黄疸持续时间均大于非脑病组[(555.2±113.9)μmol/L比(431.3±62.3)μmol/L,(0.87±0.17)比(0.67±0.11),(129.5±60.7)h比(53.0±22.6)h,(81.6±39.6)h比(34.2±15.8)h,P均<0.001]。胆红素脑病警告期与痉挛期患儿入院日龄、血清胆红素及B/A比值差异无统计学意义(P>0.05)。85%的胆红素脑病患儿预后不良。结论溶血与感染是新生儿胆红素脑病的主要原因,总胆红素浓度过高和干预延迟是引起胆红素脑病的高危因素。     

足月儿溶血性高胆红素血症与胆红素脑病的关系

目的　研究足月儿溶血性高胆红素血症所致胆红素脑病的高危因素及干预标准。方法　对 1996～ 1999年间患溶血性高胆红素血症足月儿 2 9例分为脑病组与无脑病组 ,比较两组的血清胆红素、间接胆红素 /白蛋白(B/A)比值、开始治疗时间等与胆红素脑病的关系及两组急性期与远期预后。结果　血清总胆红素 >36 7 99μmol/L ,尤为 >4 2 8 18μmol/L、B/A比值 >1、开始治疗时间 >4 8h ,均与胆红素脑病密切相关。脑病急性期与远期预后均差。结论　为防止发生胆红素脑病 ,对患溶血性高胆红素血症之足月儿 ,当总胆红素 2 5 7～ 32 4 μmol/L、B/A <1时 ,可仅做光疗 ;总胆红素 343～ 4 2 8μmol/L时 ,若B/A <1、开始治疗时间 <4 8h ,应光疗及输白蛋白 ,若B/A≥ 1,或开始治疗时 >4 8h ,应换血 ;当总胆红素≥ 4 2 8μmol/L时 ,无论B/A比值或开始治疗时间如何 ,均应迅速换血。     

新生儿重度高胆红素血症脑干听觉诱发电位异常的危险因素分析

目的探讨重度高胆红素血症新生儿脑干听觉诱发电位(BAEP)异常的危险因素。方法选择2008年11月至2009年10月本院新生儿科收治的重度高胆红素血症患儿。按照BAEP结果分为BAEP正常组和BAEP异常组。对BAEP异常的影响因素进行单因素分析,并对单因素分析有统计学意义的因素纳入Logistic回归模型进行多因素分析。结果 BAEP正常组799例,BAEP异常组168例。单因素分析结果显示,入院体重、血清胆红素(TSB)峰值、酸中毒、总胆红素/血浆白蛋白(B/A)比值是BAEP异常的影响因素。多因素Logistic回归分析结果显示,酸中毒(OR=2.046)、高B/A比值(OR=4.106)是重度高胆红素血症患儿BAEP异常的危险因素。结论新生儿重度高胆红素血症时听力损伤与出生后体重下降过多、酸中毒、B/A比值关系密切,故在降低血清胆红素的同时,应积极纠正酸中毒及低蛋白血症,并避免出生后体重下降过多。     

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.     

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   

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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.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

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.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.