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??Abstract??Objective??To investigate alterations of circulating levels of the inflammatory markers— reflecting brain and adipose tissue inflammation—in the fetal growth restriction??FGR??fetuses and newborns??and explore its possible relation ship with adverse intrauterine development. Methods??Sixty parturients??hospitalized in Shengjing hospital of China Medical University??giving consecutively birth either to 30 appropriate for gestational-age??AGA?? singleton infants ??AGA group ?? or 30 FGR full-term singleton infants ??FGR group????were recruited.Plasm hs-CRP??PAI-1??S100B and leptin levels were determined by enzyme link immune assay??ELISA??in the umbilical cords blood ??UC ?? and venous blood from neonates on postnatal day 1 ??D1?? and day 4??D4??. Results??The birth weight??body length and the body mass index ??BMI?? of the FGR neonates were significantly lower compared with those of AGA group ??P < 0.05??.The leptin levels of UC in the FGR neonates were lower than that in the AGA groups??P < 0.05????and correlated positively with the birth weights and the BMI??P < 0.05??.Plasma hs-CRP levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05??.hs-CRP levels in Umbilical cords blood were significantly decreased when compared with D1 hs-CRP in both AGA and FGR groups ??P < 0.05????and D1 hs-CRP was significantly increasedwhen compared with respective D4 hs-CRP??P < 0.05??.Plasma PAI-1 and S100B levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05????and did not correlated with the birth weights and the BMI. Conclusion??Despite the lower birth weight??BMI and leptin levels in FGRs?? there was no difference for the levels of inflammatory markers hs-CRP and PAI-1 between IUGR and AGA fetuses/neonates.The CRP level in both studied groups fluctuated from fetus to neonate stage might attribute to parturition stress and adaptation recovery.     

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目的探讨高胆红素血症新生儿血中内皮微粒与胆红素的关系及在疾病中的意义。方法 2009年10月至2011年2月中山大学附属一院新生儿科及产科住院的新生儿78例,根据有无黄疸分为试验组(44例)和对照组(34例),试验组中33例光疗治疗后采血分析。试验组光疗前、后采血行胆红素及内皮微粒测定,对照组采血行内皮微粒测定。结果试验组血内皮微粒光疗前为1792.0(574.5,2456.0)个/μL、光疗后为789.0(540.0,999.0)个/μL,与对照组414.0(321.8,866.0)个/μL比较,差异有统计学意义(P均<0.05)。试验组光疗前、后血内皮微粒比较,差异有统计学意义(P<0.05)。试验组光疗前、后血内皮微粒与血胆红素均成正相关(r分别=0.592、0.575,P<0.05)。结论高胆红素血症新生儿和非高胆红素血症新生儿相比,血内皮微粒显著升高,提示高胆红素可能对血管内皮造成损伤。     

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??Objective??To investigate the changes and clinical significance of serum ferritin??SF??levels in children with systemic lupus erythematosus??SLE??. Methods??The serum ferritin levels of 58 children with SLE were measured by Chemiluminescence before and after treatment??and serum ferritin levels were measured in 30 normal children. Results??The serum ferritin levels were significantly higher in children with SLE than those in healthy controls as well as in active children than in inactive children with SLE.And the serum ferritin leveis were significantly decreased after treatment??Moreover?? the serum levels of ferritin were positively correlated with anti-ds-DNA antibody levels and SLEDAI??SLE Disease Activity Index??in children with SLE. Conclusion??The serum ferritin levels in children with SLE are significantly higher than those in normal children. Serum ferritin levels aree positively correlated with disease activity in children with SLE.Therefore serum ferritin levers can be a useful laboratory marker to diagnose SLE in children.     

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??Objective To explore features of the change of vitamin D level and bone mineral density in children with inflammatory bowel disease??IBD??. Methods From January 2014 to September 2014??thirty-two children with IBD??study group?? and thirty age and gender-matched healthy children??control group?? were enrolled in the study. The children of study group and control group were tested for bone alkaline phosphate??BALP????bone gla protein??BGP?? and 25??OH??D3 in blood serum by enzyme-linked immunosorbent assay??ELISA????and the clinical data such as calcium??phosphorus and albumin??ALB?? in blood serum were collected. Results There were 15 patients??9 males and 6 females?? with ulcerative colitis??UC?? and 17 patients??10 males and 7 females?? with Crohn’s disease??CD?? in the study group. There were 30 children??19 males and 11 females?? in control group. The level of BGP??U??332.5??P??0.444?? and BALP??U??350??P??0.637?? in blood serum showed no significant difference between the study group and the control group. 25??OH??D3 concentration??t??-2.876??P??0.006????BMD??U??39.5??P??0.05?? ??calcium??t??-6.654??P??0.05????phosphorus??U??216.5??P??0.007????and ALB ??U??25??P??0.05?? showed significant difference between the study group and the control group. In study group??25??OH??D3 concentration and BMD showed positive correlation??rs??0.504??P??0.005????while 25??OH??D3 and blood albumin levels showed negative correlation??rs??-0.315??P??0.019??. There was significant difference betweenUC/CD group and control group in Z score of BMD??U??29.5??P??0.05??U??10??P??0.05????but no statistical difference between UC and CD patients in Z score of BMD ??P??0.10??. Conclusion Most child patients with IBD have insufficient or lack of vitamin D and are more likely to have reduced bone mineral density.     

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??Abstract??Objective??To explore the changes and implications of serum orexin-A levels in childrens with obstructive sleep apnea-hypopnea syndrome ??OSAHS??. Methods??Polysomnography was performed in 30 OSAHS children ??OSAHS group???? 20 normal healthy children ??control group??and 30 obese subjects ??obese group??. Serum orexin-A concentration was measured with EIA kit. Results??Serum orexin-A level in the OSAHS group ???0.49±0.10?? μg/mL?? was significantly higher than that in the obese group ???0.29±0.07?? μg/mL??P < 0.01??and the control group???0.30±0.12?? μg/mL??P < 0.01??respectively?? serum orexin-A level in children with OSAHS correlated positively with the AHI??r = 0.427?? P < 0.05??and MAI ??r = 0.468?? P < 0.05???? but correlated negatively with the lowest oxygen saturation ??LSaO2?? ??r = -0.527?? P < 0.01?? and the mean oxygen saturation ??MSaO2?? ??r = -0.541?? P < 0.01????but not correlated significantly with the BMI ??r = -0.212?? P > 0.05??. Conclusion??Serum orexin-A level in OSAHS children is increased?? which may be caused by frequent awaking and hypoxia. The serum level of orexin-A should be used as a predictor in screening OSAHS children.     

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目的探讨过敏性紫癜(HSP)患儿胃肠黏膜屏障变化。方法选取2007年9月至2008年8月昆明医学院第一附属医院儿科收治的过敏性紫癜患儿60例及正常儿童30名的血浆进行二胺氧化酶(DAO)、D-乳酸和内毒素检测。结果HSP组治疗前血浆DAO、D-乳酸及内毒素测定结果均升高,与正常对照组比较,差异有统计学意义(P<0.01)。有消化道症状HSP组治疗前血浆DAO、D-乳酸及内毒素测定结果,较无消化道症状HSP组及正常对照组高,两两比较差异有统计学意义(P<0.01)。HSP组治疗前后血浆DAO、D-乳酸及内毒素测定结果比较,除无消化道症状组差异无统计学意义外(t≤1.753,P>0.05),其他组均有统计学意义(t≥2.556,P<0.01)。结论HSP患儿存在肠黏膜屏障功能损伤,有消化道症状组较为明显,经治疗后其肠黏膜屏障存在修复过程。     

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??Objective To discuss the changes of ambulatory blood pressure monitoring??ABPM?? in children with vasovagal syncope ??VVS??.Methods A total of 72 children ??VVS group??32 males??40 females??mean age ??10.98±1.86??years?? were enrolled in this study??who came from Children Syncope Outpatient Department or Inpatient Department of the Second Xiangya Hospital of Central South University from Sep 2008 to Feb 2010.After confirmed diagnosis of VVS by positive head-up tilt test ??HUTT????each patient was given ABPM.Forty healthy children ??19 males??21 females??mean age 10.24 ± 2.01 years?? were as controls ??control group??.Parameters of ABPM in children were analyzed.SPSS 17.0 software was used for the statistical analysis of these data.Results ??1??Mean pressure??24-hour mean systolic pressure ??24hSBP????24-hour mean diastolic pressure ??24hDBP????daytime mean systolic pressure ??DSBP?? and nighttime mean systolic pressure ??NSBP?? in VVS group were higher than those of the control group ??P??0.05??.??2??Blood pressure pattern??the ratio of non-spoon pressure pattern was higher than that of spoon pressure pattern with VVS ??67%vs.18%??P ??0.05??.NDBP ??P??0.05?? and NSBP ??P ??0.05?? were decreased and the systolic pressure differences and diastolic pressure differences in the daytime and at nighttime were higher in spoon pressure pattern than those of non-spoon pressure pattern with VVS ??P??0.05??.??3??Diagnostic experimental evaluation??the specificity??sensitivity??diagnostic coincidence??positive predict value and negative predict value of non-spoon pattern of ambulatory blood pressure pattern to VVS was 82.5%??66.67%??72.32%??87.27% and 57.89%??respectively.The Youden index was 45.28%.Conclusion There is autonomic nerve adjustment imbalance in children with VVS during asymptomatic time periods??especially the sympathetic nerve.The non-spoon pattern rate of fluctuation curve of ambulatory blood pressure in VVS children is higher??which is of diagnosis value to VVS children.     

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目的探讨胰岛素(Ins)、生长激素(GH)、皮质醇(Cor)与早产儿宫内发育迟缓(IUGR)的关系。方法采用放射免疫分析法检测40例IUGR早产儿和45例适于胎龄早产儿(对照组)母血、脐血和生后7日龄血清中的Ins、GH、Cor含量,并进行分析比较。结果Ins在IUGR组脐血、生后7日龄血清中的含量明显低于对照组(P<0.05)。GH、Cor在母血中含量明显低于对照组(P<0.05)。而脐血、生后7日龄血清中Cor含量在IU-GR高于对照组,但二组比较差异无显著性(P>0.05)。结论早产儿IUGR与Ins、GH、Cor等内分泌激素有关,它们通过调节代谢而影响胎儿宫内的生长发育,发挥着较重要的作用。     

新生儿低血糖性脑损伤磁共振成像动态变化研究

目的探讨弥散加权成像（DWI）、常规磁共振成像（MRI）在新生儿低血糖性脑损伤不同阶段的动态变化。方法回顾分析了2005年9月至2008年9月,中国医科大学附属盛京医院新生儿科收治的经MRI确诊的20例低血糖性脑损伤患儿（病例组）的临床资料,并随机选取同期住院MRI正常的20例单纯性低血糖患儿为对照组。 结果病例组平均最低血糖值低于对照组（P < 0.01）,低血糖持续时间长于对照组（P < 0.01）。病例组于低血糖发生后3.8（1～11）d完成首次MRI检查,受累部位主要为枕叶11例、枕顶叶8例,顶叶1例,受累部位在DWI均表现为高信号,常规MRI相应部位12例表现为T1加权成像（T1WI）、T2加权成像（T2WI）正常信号,仅6例表现为T1WI低信号、T2WI高信号;11例于首次检查后11.4（8～15）d完成第2次MRI检查,首次检查受累部位DWI 7例转为正常信号,4例低信号,常规MRI均表现为T1WI低信号、T2WI高信号。3例于6个月随访,提示枕叶DWI正常信号,T1WI低信号、T2WI高信号。结论新生儿低血糖性脑损伤早期DWI表现为异常高信号的部位,与晚期常规MRI表现为T1WI低信号、T2WI高信号的部位一致,这种一致性提示DWI异常高信号对于低血糖性脑损伤早期病情判断具有一定价值。     

磁共振弥散加权成像在新生儿脑梗死早期诊断中的意义及其变化规律

目的探讨弥散加权成像（DWI）对新生儿脑梗死（NCI）早期的诊断价值。方法收集2004年6月至2005年10月,在我院新生儿科住院的6例NCI患儿的临床资料。全部病例完成了血常规、血糖、血清总钙及离子钙、C-反应蛋白、凝血酶原时间及部分凝血活酶时间、心脏彩色多普勒及头部MRI检查。并对其中4例进行MRI动态观察。结果（1）全部病例为足月儿,1例有重度窒息史,其余5例无明显宫内窘迫及出生窒息史。（2）5例以全身惊厥为首发症状。（3）全部病例无红细胞增多症,无出血及凝血机制障碍,心内结构正常。（4）MRI检查时间：发病后18h至4d。常规MRI4例异常（T1WI低信号,T2WI高信号）,2例正常;DWI6例异常（全部高信号）,随访（2周至15个月）：常规MRI6例异常（T1WI低信号,T2WI高信号）;DWI6例异常（低信号）。梗死部位：4例左侧颞叶、顶叶和枕叶,1例左侧额叶和顶叶,1例左侧基底节。结论NCI早期,常规MRI尚未出现明显异常,DWI即显示明显高信号,从而证实DWI对NCI早期诊断的价值。     

高危晚期早产儿脑损伤病因学及其磁共振发现

目的 探讨以弥散加权成像(DWI)结合常规磁共振成像(T1WI-T2WI)诊断的高危晚期早产儿脑损伤的相关危险因素及临床特点,并分析不同时间MRI序列的信号特点及DWI的早期诊断价值。方法 首先对符合纳入标准的649例晚期早产儿的MRI片重新阅片,按照脑损伤评估标准得出诊断,其次收集相关的临床资料,分析不同类型脑损伤的危险因素和临床特点,并对其中271例确诊脑白质损伤（CWMD）的MRI序列进行分析,探讨不同类型CWMD的信号特点、损伤部位及结局。结果 ①晚期早产儿发生脑损伤332例（51.2%）,其中CWMD 271例（41.8%）,以局灶性CWMD为主（62.7％,170例）;颅内出血112例（17.3%）,主要为蛛网膜下腔出血55.4%（62/112）。②非出血性脑损伤的危险因素是男性（OR=1.510,95％CI：1.067～2.136,P=0.020）、阴道分娩（OR=2.367,95％CI：0.251～22.294 ,P=0.000）、早发型败血症（OR=2.194,95％CI：1.159～4.155,P=0.016）及抢救复苏史（OR=3.784,95％CI：1.908～7.506,P=0.000）。出血性脑损伤的危险因素是阴道分娩（OR=7.195,95％CI：4.249～12.184 ,P=0.000）和早发型败血症（OR=2.692,95％CI：1.185～6.117,P=0.018）。低钙血症（OR=2.593,95％CI：1.343～5.005,P=0.005）、晚发型败血症（OR=1.533,95％CI：1.012～2.323,P=0.044）和抽搐（OR=4.006,95％CI：1.790～8.970,P=0.001）是非出血性脑损伤组的主要临床特点。出血性脑损伤组主要表现为高血糖和抽搐。③局灶性CWMD 65.3％仅累及一处损伤,主要集中在侧脑室后脚（53.5%）,有97.1%病灶消失或病灶范围减少;广泛性CWMD 79.2%累及胼胝体和内囊;弥漫性CWMD 50％合并灰质损伤,全部发生软化。④生后2周内,DWI具有较高的敏感性,98.0%表现为高信号,T1WI信号无变化或稍高信号,伴或不伴T2WI低信号。局灶性CWMD DWI高信号持续时间长达3周以上,弥漫性CWMD DWI高信号持续时间2周以内。结论 晚期早产儿仍然容易受产前产时因素影响而发生不同类型的脑损伤。对有高危因素,或早期出现临床表现或电解质紊乱的患儿应选择生后2周内（1周内最佳）进行DWI和常规MRI检查,以早期发现病变。局灶性CWMD预后较好,合并有灰质损伤或弥漫性CWMD预后极差,需要动态随访,并进行早期康复训练。     

新生儿低血糖脑损伤的临床研究

目的探讨低血糖脑损伤的临床表现与早期影像学特征,为诊断与预后判定提供依据。方法6例人院时血糖为0.48～1.70mmol/L。胎龄35周^＋5至40周,出生体重1545～3900g。均无窒息史、败血症、颅内感染、遗传代谢及内分泌性疾病。在入院24～48h完成T1WI、T2WI和DWI磁共振扫描。结果6例均有明显的临床表现,以惊厥、萎靡最为常见,其次为呼吸暂停,4例血糖正常时仍有惊厥发生。5例低血糖发生在生后6～53h,1例在生后12d。低血糖持续时间[（47.7±38.8）（4～96）]h,最低值[（1.05±0.44）（0.48～1.70）]mmol／L。首次MRI检查1例在生后15d,余在生后2～5d,受累部位为枕叶（6例）和顶叶（3例）皮层及皮层下白质：DWI上表现为高信号6例,TlwI为低信号4例,T2WI高信号1例。3例在生后第2周接受第2次检查,1例DWI转为低信号,余信号正常;3例此时TlwI和T2W1分别表现为低信号和高信号,局部水肿明显减轻。1例3个月随访发育正常,未见顶枕部萎缩,但内囊后枝和视放射髓鞘化不良。结论枕顶叶是新生儿低血糖脑损伤的主要受累部位,DWI可以早期反映脑损伤的改变。     

枕区脑损伤影像学与临床转归特点分析

目的 探讨影像学提示脑枕区结构损伤患儿的智能发育轨迹特点.方法 收集头颅影像学提示枕区结构损伤患儿17例,按枕区损伤部位分类,采用临床随访,对癫(疒间)表现、脑电图表现、药效及生长发育等方面进行监测评价.结果 围生期低血糖为枕区脑损伤常见病因(58.8% ～ 70.6%);单纯枕区脑白质损伤3例,皮层及皮层下白质为主性损伤14例.17例患儿中,合并眼部异常表现16例,表现形式多样,表现随时间而变化;合并癫(疒间)发作14例,占82.4%,其中婴儿痉挛11例,均为枕区皮层及皮层下白质损伤为主者,脑电图提示不对称性部分起源的高度失律,促肾上腺皮质激素治疗有效者8例;出现全身异常抖动者14例,占82.4%,单纯枕区脑白质损伤患儿均出现抖动发作;丹佛发育筛查试验测评,运动发育落后15例,癫(疒间)控制后,运动能力明显进步8例,其中2例因合并先天性胼胝体发育不良,肌张力高,运动严重落后.结论 围生期低血糖常导致枕区脑损伤;枕区脑损伤常伴随眼部异常表现及导致婴儿期全身异常抖动发作,后者多为癫(疒间)发作前表现;婴儿痉挛为枕区皮层损伤常见并发症,癫(疒间)控制为智能发育进步的先决条件.     

Evaluation of protein S-100 serum concentrations in healthy newborns and seven newborns with perinatal acidosis

We measured Protein S-100 serum levels in 66 healthy newborns during the first week of life and in 7 newborns with perinatal acidosis. Normal values (n = 66) constantly ranged between 0.66 and 3.33 μg/l (2.5 and 97.5 percentiles) during the evaluation period. Conclusions: Newborns with signs of hypoxic-ischaemic encephalopathy (HIE) after perinatal acidosis showed elevated Protein S-100 serum levels, whereas newborns without these signs had normal concentrations. S-100 might thus be a marker of central nervous system damage in newborns.     

疾病状态下新生儿脑组织氧饱和度的测定

目的测定有围产期脑损伤的足月新生儿、不同胎龄早产儿的脑组织氧饱和度。方法应用TSNIR蛳3无创组织氧监测仪,测定44例围产期脑损伤的足月新生儿、198例不同胎龄早产儿的脑组织氧饱和度,并与90例对照组进行比较。结果脑损伤的足月新生儿脑组织氧饱和度为(54.9±5.2)%,对照组为(61.3±3.9)%,两者相比差异有统计学意义。不同胎龄早产儿脑组织氧饱和度不同,随着胎龄的增长,脑组织氧饱和度呈上升趋势,32周以上的早产儿脑组织氧饱和度接近足月儿。结论脑损伤患儿的脑组织氧饱和度低于对照组;早产儿随着脑血管发育的不断成熟,32周以上的早产儿脑组织氧饱和度已接近足月儿的水平。     

MRI brain imaging in neonates

MRI is now commonly used in the assessment of neonates for diagnosis and prognosis. The advantages over ultrasound are increased contrast resolution, complete coverage and multiplanar imaging. MRI is most commonly used for the assessment of neonatal encephalopathy to determine an underlying cause such as hypoglycaemia, neonatal infarction, or viral encephalitis, and may also be useful in determining complications of meningitis and planning surgical treatment. In hypoxic-ischaemic injury, where the diagnosis is typically made clinically, MRI has conventionally confirmed the diagnosis and provided prognostic information. However advanced techniques such as magnetic resonance spectroscopy and arterial spin labelling allow for earlier diagnosis and may guide treatment options. MRI may also detect less common patterns of brain injury in term infants such as punctuate white matter lesion. Imaging of preterm infants at term equivalent age can demonstrate complications such as periventricular leucomalacia or periventricular haemorrhagic infarction and provide information on neurological outcome.     

新生儿低血糖脑损伤早期MRI表现及其演变

目的 通过对低血糖患儿进行低血糖后早期、动态的MRI检查,结合临床特征探讨不同程度低血糖脑损伤患儿的MRI改变。方法 选取我院2005年5月至2013年7月以低血糖收入院,在低血糖后1周内完善首次常规MRI及弥散加权成像（diffusion-weighted imaging,DWI）检查确诊为新生儿低血糖脑损伤的患儿49例。其中34例在低血糖发生后2～3周完善第2次MRI检查,7例完善第3次MRI检查。结果 49例患儿首次MRI均有顶、枕部受累;顶、枕部受累为主33例,顶、枕部合并额叶、颞叶受累6例,弥漫性皮层及皮层下白质受累10例。均表现为受累部位DWI高信号,T1和T2加权像信号改变不明显。部分患儿合并深部脑白质及灰质受累表现。34例患儿第2次MRI检查,有20例表现为损伤部位DWI低信号,T1加权像低信号,T2加权像高信号,3例较前略吸收,11例未见异常信号。7例患儿完善第3次复查,分别出现脑软化,髓鞘发育落后,白质容积减小,胼胝体发育不良。对比不同程度脑损伤患儿的临床症状,发现临床症状较重者脑损伤也较重。结论 低血糖脑损伤具有顶、枕部易损性。低血糖后1周内完善DWI检查对急性期低血糖脑损伤有提示作用。MRI动态观察发现轻症损伤可恢复。损伤较重的患儿可出现坏死及脑软化。部分合并深部白质、灰质损伤的病例,不能除外缺氧缺血所致。     

Neonatal neurobehavioral abnormalities and MRI brain injury in encephalopathic newborns treated with hypothermia

Background

Neonatal Encephalopathy (NE) is a prominent cause of infant mortality and neurodevelopmental disability. Hypothermia is an effective neuroprotective therapy for newborns with encephalopathy. Post-hypothermia functional–anatomical correlation between neonatal neurobehavioral abnormalities and brain injury findings on MRI in encephalopathic newborns has not been previously described.

Aim

To evaluate the relationship between neonatal neurobehavioral abnormalities and brain injury on magnetic resonance imaging (MRI) in encephalopathic newborns treated with therapeutic hypothermia.

Study design

Neonates with hypoxic ischemic encephalopathy (HIE) referred for therapeutic hypothermia were prospectively enrolled in this observational study. Neurobehavioral functioning was assessed with the NICU network neurobehavioral scale (NNNS) performed at target age 14 days. Brain injury was assessed by MRI at target age 7–10 days. NNNS scores were compared between infants with and without severe MRI injury.

Subjects & outcome measures

Sixty-eight term newborns (62% males) with moderate to severe encephalopathy underwent MRI at median 8 days (range 5–16) and NNNS at median 12 days of life (range 5–20). Fifteen (22%) had severe injury on MRI.

Results

Overall Total Motor Abnormality Score and individual summary scores for Non-optimal Reflexes and Asymmetry were higher, while Total NNNS Z-score across cognitive/behavioral domains was lower (reflecting poorer performance) in infants with severe MRI injury compared to those without (p < 0.05).

Conclusions

Neonatal neurobehavioral abnormalities identified by the NNNS are associated with MRI brain injury in encephalopathic newborns post-hypothermia. The NNNS can provide an early functional assessment of structural brain injury in newborns, which may guide rehabilitative therapies in infants after perinatal brain injury.