106例正常儿童心肌酶正常值调查分析

目的：　检测正常儿童心肌酶指标,探讨儿童正常参考值及临床应用中有关问题。方法：　对106例健康儿童取周围静脉血采用速率法测定AST ,LDH ,HBDH ,CK ,CK-MB血清水平。结果：　心肌酶正常参考值随着年龄的增长而下降,婴幼儿组明显高于学龄前及学龄期儿童,各组测定值均明显高于沿用的成人正常参考值。结论：　诊断儿童心肌炎、缺血性心肌病应采用小儿心肌酶正常参考值,并开展应用新的生化指标,特别是心肌特异性肌钙蛋白I     

106例正常儿童心肌酶正常值调查分析

目的　检测正常儿童心肌酶指标 ,探讨儿童正常参考值及临床应用中有关问题。方法　对 1 0 6例健康儿童取周围静脉血采用速率法测定AST ,LDH ,HBDH ,CK ,CK MB血清水平。结果　心肌酶正常参考值随着年龄的增长而下降 ,婴幼儿组明显高于学龄前及学龄期儿童 ,各组测定值均明显高于沿用的成人正常参考值。结论　诊断儿童心肌炎、缺血性心肌病应采用小儿心肌酶正常参考值 ,并开展应用新的生化指标 ,特别是心肌特异性肌钙蛋白I     

缺氧缺血性脑病新生儿心肌酶谱变化的意义

目的探讨HIE新生儿心肌酶谱变化及其意义。方法选HIE新生儿（HIE组）76例。其中轻度35例，中度26例，重度15例。分别于急性期和恢复期各抽取股静脉血2mL，用全自动生化分析仪测定心肌酶谱[AST、CK、CK-MB、LDH、羟丁酸脱氢酶（HBDH）]活性。健康足月新生儿24例为健康对照组，以同样方法测定心肌酶谱。对二组所测值进行对比分析。结果1．HIE急性期患儿血AST、CK、CK-MB、LDH、HBDH随病情加重均逐渐升高（Pa〈0．05），轻、中、重度HIE组与健康对照组比较均有显著性差异（Pa〈0．05），中、重度HIE组与轻度HIE组比较均有显著性差异（Pa〈0．05）。2．HIE恢复期患儿血AST、CK、CK-MB、LDH、HBDH随病情好转心肌酶水平逐渐下降，轻度HIE组与健康对照组比较无显著性差异（Pa〉0．05），中、重度HIE组仍显著高于健康对照组（Pa〈0．05）。结论心肌酶谱测定可作为早期诊断HIE心肌损伤的指标，动态测定HIE患儿心肌酶谱可了解病情程度，指导治疗。     

疱疹性咽峡炎患儿血清心肌酶谱与超敏C-反应蛋白检测的临床意义

目的：探讨疱疹性咽峡炎患儿血清心肌酶谱与超敏C-反应蛋白( high sensitive C- reactive protein,hs-CRP)检测的临床意义。方法选择疱疹性咽峡炎患儿共80例,作为观察组,同时选择正常体检的健康儿童50例,作为对照组,检测两组患儿心肌酶谱( AST、LDH、CK、CK-MB)和hs-CRP水平。结果观察组患儿CRP升高45例(56．25%),对照组则为2例(4%),观察组明显高于健康对照组(χ2=31．55, P<0．01)。观察组患儿心肌酶谱异常59例(73．75%),其中 AST 异常51．6%、CK 40．1%、CK-MB 21．4%、LDH 72．2%;对照组患儿心肌酶谱异常6例(12%),其中AST异常16%、CK 10%、CK-MB 4%和LDH 12%,差异均有统计学意义(P<0．01)。结论疱疹性咽峡炎患儿可能存在不同程度的心肌损害,心肌酶谱和hs-CRP可作为心肌损害的有效指标,为临床诊治提供参考。     

肺炎支原体肺炎患儿心肌酶谱动态分析

目的 对婴幼儿与儿童肺炎支原体(MP)肺炎的心肌酶谱的动态变化进行检测,了解二者在发病早期与恢复期的不同。方法 婴幼儿组和儿童组MP肺炎均在发病后1周和3周早晨取空腹血测定血清心肌酶谱及其同工酶。结果 心肌酶谱在发病第1周时儿童组血清门冬氨酸氨基转氨酶(AST)、肌酸激酶(CK)、肌酸磷酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBD)均高于婴幼儿组,两组比较有显著性差异(P<0.01)。发病后3周经治疗血清心肌酶和同工酶婴幼儿组均高于儿童组,差异有显著性(P<0.01)。婴幼儿组中2次测定乳酸脱氢酶(LDH),均高于儿童组,且差异有显著性(P<0.01)。结论 MP肺炎感染早期儿童组心肌损害较婴幼儿组明显。发病后3周经治疗婴幼儿心肌损害较儿童组明显且迁延。婴幼儿组病程中LDH均高于儿童组,可能与LDH敏感性高、恢复慢、特异性差及婴幼儿肺部表现较儿童严重、且缺氧也更明显有关。     

基于干式化学法建立深圳地区3月龄至18岁健康儿童青少年心肌酶谱参考区间值

目的建立深圳地区3月龄至18岁健康人群干式化学法血清乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)和天冬氨酸氨基转移酶(AST)的参考区间值。方法根据儿童青少年生长发育规律分为3月龄至3岁、~6岁、~12岁和~18岁组。标本来源为健康体检常规检测后的剩余血标本。采用美国强生公司VITROS 350干式化学分析仪检测血清LDH、CK、CK-MB和AST水平,比较不同年龄组和不同性别间的差异,并建立4项指标在3月龄至18岁不同年龄组中的参考区间值。结果 2 345名儿童青少年合格标本进入本文分析,男1 346名,女999名。3月龄至3岁组187名,~6岁组918名,~12岁组916名,~18岁组324名。1~6岁组CK,~12岁组CK、AST,~18岁组CK、AST、CK-MB男、女童间检测结果差异均有统计学意义(P均﹤0.05),均为男童高于女童,其他指标男、女童间检测结果差异均无统计学意义(P均﹥0.05)。4项指标在不同年龄组间检测结果差异均有统计学意义(P均﹤0.05),两两比较3月龄至3岁组与~18岁组CK、3月龄至3岁组与~6岁组CK-MB、3月龄至3岁组与~6岁组AST检测结果差异无统计学意义(P均﹥0.05),其他各组间两两比较均有统计学意义(P均﹤0.05)。24项指标检测结果均与年龄呈负相关。3LDH参考区间值(U·L-1):3月龄至3岁504~896,3~12岁491~790,12~18岁342~716。CK参考区间值(U·L-1):3月龄至12岁50~226,12~18岁男童47~256,12~18岁女童34~235。CK-MB参考区间值(U·L-1):3月龄至6岁18~44,6~12岁7~35,12~18岁7~28。AST参考区间值(U·L-1):3月龄至3岁23~60,3~12岁24~47,12~18岁17~47。结论干式化学法建立的深圳地区3月龄至18岁健康儿童青少年心肌酶谱的参考区间值有其独特性,均与年龄呈负相关,与国内外报道和厂家说明书有差异。     

有无疫苗接种史麻疹患儿心肌酶谱变化的意义

目的了解有无麻疹疫苗接种史麻疹患儿急性期心肌酶谱变化及临床意义,探讨疫苗接种对麻疹患儿心肌的保护作用。方法对71例住院麻疹患儿按有无麻疹疫苗接种史分为有疫苗接种史组23例（有接种组）和无疫苗接种史组48例（无接种组）,并设健康对照组30例。分别检测各组血清肌酸激酶（CK）及其同工酶（CK-MB）,乳酸脱氢酶（LDH）及其同工酶1（LDH1）,α-羟丁酸脱氢酶（α-HBD）水平,同时行心电图检查。结果无接种组与有接种组比较,CK-MB、LDH1及α-HBD明显升高（Pa〈0.05）,并肺炎增多（P〈0.05）,平均住院天数增加（P〈0.01）。二组分别与健康对照组比较,CK-MB、LDH、LDH1及α-HBD均明显升高（Pa〈0.01）。结论麻疹患儿急性期存在心肌酶谱升高,接种麻疹疫苗对急性期麻疹患儿心肌有一定保护作用,可减少合并症。     

Duchenne��Ӫ����������Ѫ���ļ�ø�ױ仯����̽��

目的观察Duchenne肌营养不良(Duchenne Muscular Dystrophy,DMD)患儿血清心肌酶谱是否随病程进展变化及其规律。方法回顾性分析1984—2011年299例来中国医科大学附属盛京医院发育儿科就诊的DMD患儿血清心肌酶谱水平,包括天冬氨酸转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)和α-羟丁酸脱氢酶(α-HBDH)。依据发病特点将DMD患儿不同年龄段分为3组:<5岁组、5～<10岁组、≥10岁组。所有数据资料经方差齐性及正态分布检验,计量资料取对数后符合正态分布规律进行分析。结果 DMD患儿各年龄组心肌酶谱均显著升高,且<5岁组、5～<10岁组心肌酶谱升高最明显,≥10岁组心肌酶谱显著低于<5岁组、5～<10岁组。结论 DMD患儿血清心肌酶谱10岁升高最明显,之后随年龄增加呈下降趋势,这种变化规律可以反映肌纤维坏死速率和病程进展速度。     

先天性心脏病心肌损害临床分析

目的 探讨先天性心脏病(先心病)患儿心肌损害程度与缺氧及心功能的关系,为心肌保护提供理论依据。方法 测定115例先心病患儿心肌酶谱和58例先心病心肌肌钙蛋白I(CTnI)。结果 115例中A、D、E组心肌酶谱改变以乳酸脱氢酶(LDH)、乳酸脱氢酶同工酶1(LDH1)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)增高明显,在各组心肌酶谱结果比较及与正常值比较中,两组有显著差异或非常显著差异(P<0.05或P<0.01);CK-MB／CK>0.05。先心病患儿58例中A、D、E组cTnI检出阳性率明显升高(P<0.05),且A、D、E组中cTnI与LDH、LDH1、CK、α-HBDH阳性率比较,各组间有显著差异(P<0.05),与CK-MB比较,无显著差异(P>0.05)。结论 LDH、LDH1、CK-MB、CK-MB／CK、α-HBDH、cTnI是判断先心病患儿心肌损害重要指标;CK-MB与cTnI是诊断心肌损害的血清金标准。     

室间隔缺损患儿介入治疗前后心肌酶谱及心功能变化的意义

目的 探讨经导管室间隔缺损(VSD)封堵术治疗前后心肌酶谱及心功能的变化.方法 检测VSD患儿介入治疗前后血清肌钙蛋白(cTnI)、磷酸肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、AST水平,并通过超声心动图(UCG)测定其左室射血分数(LVEF),对治疗前后资料进行对比分析.应用SPSS 10.0软件进行统计学分析.结果 介入治疗后VSD患儿较治疗前血清cTnI明显升高[(0.29±0.17) μg/L vs (0.02±0.01) μg/L,t=9.0 P＜0.01],LVEF有所降低[(75.4±5.1)% vs (78.3±6.2)%,t=2.14 P＜0.05],血清CK、CK-MB、LDH、AST水平无明显变化(t=0.15,0.46,0.89,0.45 Pa＞0.05).结论 经导管VSD封堵术对患儿心肌酶及心功能有一定影响.予以相应的干预治疗仍是必要的.     

磷酸肌酸对儿童柯萨奇病毒性心肌炎的保护作用

目的观察磷酸肌酸(CP)对儿童柯萨奇病毒心肌炎(CVM)的保护作用,并初步探讨其可能机制。方法选取40例柯萨奇B组病毒感染心肌炎患儿为CVM组,并随机分为CP治疗组(CP组)和1,6-二磷酸果糖治疗组(果糖组),每组20例。同时,选择体检正常的健康儿童20例作为健康对照组。观察指标主要包括:血清柯萨奇病毒RNA和抗体IgM、心肌酶、高敏C反应蛋白(hs-CRP)、丙二醛(MDA)/超氧化物歧化酶(SOD)和细胞凋亡因子sFas/sFasL。MDA测定采用硫代巴比妥法,SOD测定采用化学比色法,sFas和sFasL测定采用双抗体夹心ABC-ELISA法;AST、LDH、α-羟丁酸脱氢酶(HBDH)、CK和CK-MB等心肌酶均由本院检验科采用全自动生化分析仪测定。应用SPSS13.0软件进行统计学分析。结果与健康对照组比较,CVM组血清柯萨奇病毒RNA和抗体IgM均显著增高,心肌酶、hs-CRP、MDA、sFas/sFasL显著升高(Pa<0.05,0.01),SOD明显降低(P<0.01);与治疗前比较,CP组及果糖组治疗后心肌酶(除果糖组CK外)、hs-CRP、MDA、sFas和sFasL各指标均显著下降(P...     

Behavior and self-perception in children with a surgically corrected congenital heart disease

OBJECTIVE: We sought to combine parental and child reports in order to describe the behavior, self-perception, and emotional profile of children with a surgically corrected congenital heart disease (CHD). METHODS: Forty-three children with a surgically corrected CHD were selected and compared to an age- and sex-matched healthy group. The parents of the CHD children completed a behavior rating scale, the Child Behavior Checklist. Children 8 years and older (n = 23) completed a self-report questionnaire concerning perceived competence, their anxiety level, and feelings of depression. RESULTS: Compared to parents of healthy children, those of CHD children report significantly lower school results (p < .01), more school problems in general (p < .01), and a higher percentage of their children repeated a school year (p < .01). They also reported more social (p < .01) and attention problems (p < .01) and more aggressive behavior (p < .05). On self-perception and state anxiety questionnaires, no significant differences were found between the patient group and the healthy group. On a depression scale, however, children with a surgically corrected CHD reported more depressive feelings than healthy controls (p < .01). CONCLUSION: Parents of children with CHD rate their child's school competence to be weaker than healthy peers, they report more attention and social problems and more aggressive behavior. Children themselves did not report differences on perceived competence or anxiety but they do indicate more depressive symptoms than healthy peers.     

Health‐related and diabetes‐related quality of life in Japanese children and adolescents with type 1 and type 2 diabetes

Background: The aim of this study was to assess (i) the health‐related quality of life (HR‐QOL) of primary, junior and high school children with type 1 and type 2 diabetes and to compare it with that of healthy school children; and (ii) to compare the diabetes‐related QOL (DR‐QOL) and the QOL of parents of children with diabetes, between type 1 and type 2 diabetes in Japan. Methods: Overall, 471 patients aged 9–18 years (368 with type 1 and 103 with type 2 diabetes) and their parents were involved. QOL was assessed using a self‐administered questionnaire. Results: The total score for HR‐QOL of primary and junior school children with type 1 diabetes was significantly higher than that of those with type 2 diabetes and healthy controls. However, there were no significant differences in high school children. Some subscales regarding HR‐QOL were significantly lower for children with type 2 diabetes than for children with type 1 diabetes or healthy controls. The DR‐QOL of children with type 1 and type 2 diabetes did not significantly differ. The Family Burden and Family Involvement were significantly greater in parents of children with type 1 diabetes. There were significantly positive correlations between HR‐QOL and DR‐QOL in both groups. In type 1 diabetes only, there were significant negative correlations between glycated hemoglobin and some subscales of the HR‐QOL and QOL of parents of children with diabetes, and weak positive correlation between glycated hemoglobin and Family Burden. Conclusions: The HR‐QOL of school children with type 1 diabetes was higher than that of those with type 2 diabetes and healthy school children. The QOL of school children with type 1 diabetes was not impaired.     

艾司洛尔在危重型手足口病中的应用价值

目的 探讨艾司洛尔治疗危重型手足口病(HFMD)的临床疗效其作用机制。方法 102例危重型HFMD患儿随机分为常规治疗组和艾司洛尔组,每组51例患儿。常规治疗组按照HFMD诊疗指南予以常规治疗,艾司洛尔组在常规治疗组基础上加用艾司洛尔。两组患儿均持续监测心率(HR)、收缩压(SBP)、呼吸频率(RR)。两组患儿分别于治疗前及治疗后1 d、3 d、5 d采血检测外周血去甲肾上腺素(NE)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及单核细胞NF-κB p65含量。在治疗前和治疗5 d后采血检测血清心肌酶及氨基末端脑钠肽前体(NT-pro BNP)的水平。结果 治疗前两组患儿HR、SBP、RR、NE、TNF-α、IL-6、NF-κB p65、心肌酶、NT-pro BNP水平差异均无统计学意义。与治疗前相比,治疗后2组患儿各时间点检测的以上各指标均明显降低(P0.05)。与常规治疗组相比,艾司洛尔组治疗1 d、3 d后上述各项指标改善更明显(P0.05)。治疗5 d后艾司洛尔组患儿血清心肌酶和NT-pro BNP水平较常规治疗组改善更显著(P0.05)。结论 早期应用艾司洛尔能有效地稳定危重型HFMD患儿生命体征,其可能的作用机制为降低血清儿茶酚胺浓度,减轻心肌损伤,改善心功能,减轻炎性反应。     

Slight cognitive impairment and magnetic resonance imaging abnormalities but normal school levels in children treated for acute lymphoblastic leukemia with chemotherapy only

OBJECTIVES: To investigate persistent neuropsychologic late effects in children treated for acute lymphoblastic leukemia at a young age with chemotherapy only by means of serial neuropsychologic assessments (NPAs), magnetic resonance imaging (MRI) of the brain, and evaluation of school levels. STUDY DESIGN: Consecutive patients (n = 17) had 2 extensive NPAs (12 psychometric measures) after cessation of therapy. Test results were compared with those of both healthy control subjects and 28 previously treated children who received cranial irradiation. MRI findings were related to test scores. School levels were evaluated in the patients and their healthy siblings. RESULTS: Initial participation (n = 17) and availability of the study group after 8 years of follow-up were 100%. Significant group differences between patients who received chemotherapy and healthy control subjects were found for memory and fine-motor functioning. The 17 patients combined showed 16 deficits on various test measures. MRI abnormalities were seen in 6 children, but these did not correlate with cognitive performance. No differences in school levels were seen when the patients who received chemotherapy were compared with their siblings. The current nonirradiated patients demonstrated significantly better test results and significantly fewer learning disabilities and MRI abnormalities than did the previously irradiated group. CONCLUSION: Treatment with chemotherapy only may be associated with some cognitive impairment. However, these children attained normal school levels.     

轻度窒息新生儿动态心电图及心肌酶变化的临床研究

目的 探讨轻度窒息新生儿动态心电图（AECG）、心肌酶变化特点及其临床意义.方法 选取2011年6月至2013年8月我院新生儿科收治的轻度窒息新生儿为窒息组,同期选择本院分娩的30例健康新生儿为对照组,均于生后24h内行AECG检查,于出生18 ～24 h内抽取静脉血测定血清肌酸磷酸激酶（CK）、血清肌酸磷酸激酶同工酶（CK-MB）、血清乳酸脱氢酶（LDH）、血清谷草转氨酶（AST）、心肌肌钙蛋白（cTnI）.结果 窒息组（46例）与对照组（30例）新生儿AECG窦性心律指标（最慢心率、最快心率、平均心率）差异均无统计学意义（P＞0.05）;窒息组ST段改变及心律失常等其他几项综合指标（包括房早、房速、室早、Q-T间期延长、交界性逸搏）异常发生率高于对照组（65.2％比16.7％,89.1％比13.3％,P均＜0.01）.窒息组心肌酶指标及cTnI值均高于对照组[CK（604.7±275.4）比（162.0±95.1）,CK-MB（87.9±61.0）比（28.3±27.1）,LDH（686.0±383.5）比（310.7±133.5）,AST （95.0±63.1）比（35.2±13.9）,cTnI（0.12±0.11）比（0.02±0.01）,P均＜0.01].窒息组CK、CK-MB、LDH、AST异常发生率高于对照组（63.0％比16.7％,82.6％比6.7％,95.7％比20.0％,32.6％比6.7％,P均＜0.01）.结论 轻度窒息新生儿AECG监测可发现各种心律失常、ST段改变,其心肌酶亦明显高于正常新生儿,ST段改变及CK-MB的升高是诊断轻度窒息新生儿心肌损伤的可靠依据.     

School achievement following hemolytic disease in the newborn

Repeated psychological investigations were performed in a group of 123 children who as newborns received exchange transfusions due to a haemolytic disease. Their school-career was compared with a control group of healthy newborns at an age of 16 years. In the Mhn-group a lower level of school performance could be observed. There was a higher percentage of backward children according to additional perinatal risks and a lower socioeconomic status of the parents. Even at the same class the two groups differed in their median school marks for the different subjects and behaviour proving the Mhn-children in spite of early exchange transfusion at risk for later failure in school.     

危重症患儿胰岛素抵抗与心肌损害的临床相关性研究

目的：危重症患儿多伴明显的胰岛素抵抗和心肌损害。本研究探讨危重症患儿胰岛素抵抗与心肌损害的关系。方法：选取2010年3月至2011年6月住院治疗的危重症患儿63例为病例组,测定空腹血糖、血清胰岛素及心肌酶、肌钙蛋白I（CTnI）水平,同时计算胰岛素抵抗指数（HOMA-IR）。HOMA-IR>1.0 者归入胰岛素抵抗组（30例）,HOMA-IR≤1.0者归入非胰岛素抵抗组（33例）。同时选取健康儿童30例作为对照组。结果：胰岛素抵抗组患儿的HOMA-IR、乳酸脱氢酶（LDH）、天门冬氨酸氨基转移酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、α-羟丁酸脱氢酶（α-HBDH）、CTnI水平均明显高于非胰岛素抵抗组及对照组,差异有统计学意义（均P<0.05）;非胰岛素抵抗组患儿的LDH、AST、CK、CK-MB、α-HBDH、CTnI水平明显高于对照组,差异有统计学意义（均P<0.05）。胰岛素抵抗组患儿的HOMA-IR与LDH、CK、CK-MB、AST、α-HBDH、CTnI水平呈正相关（分别r=0.697,0.739,0.781,0.642,0.381,0.792,均P<0.05）。结论：胰岛素抵抗可以加重心肌损害,HOMA-IR可以作为心肌损害程度的预测指标。     

Prevalence of intolerance to food additives among Danish school children

The prevalence of intolerance to food additives was assessed in a group of unselected school children aged 5–16 years. A study group of 271 children was selected on the basis of the results of a questionnaire on atopic disease answered by 4, 274 (86%) school children in the municipality of Vihorg. Denmark. The children in the study group followed an elimination diet for two weeks before they were challenged with a mixture of food preservatives, colourings and flavours. The challenge was open and the additives were prepared as a fizzy lemonade. If the open challenge was positive, a double-blind placebo controlled challenge with gelatine capsules was perfomed. The study included 281 children. 10 were excluded, and the remaining 271 children were given the open challenge (98 healthy controls and 173 with atopic symptoms). The open challenge was negative in all 98 healthy control children who had not reported any atopic symptoms. of the 173 children reporting present or previous atopic disease 17 had a positive open challenge. Of these 17 children 1 experienced gastrointestinal symptoms, 13 reacted with aggravation of atopic eczema, and 3 with urticaria. Twelve of these 17 children went through the double-blind challenge which was positive in 6 cases. Five of these 6 children had positive reactions to synthetic colourings and l to citric acid. No serious reactions were seen. Based upon calculations of the results from this study and an earlier multi-center study in children referred to hospital clinics, the prevalence of intolerance to food additives in school children is estimated to be 1-2%.