��ͬ���ε���������ͯ�����ź�����һ������������ı仯

目的探讨气体信号因子一氧化氮(NO)及硫化氢(H2S)在不同海拔地区健康儿童中的含量差异。方法2005-06—2006-02,将随机选取的北京市和青海省海北州体检时的健康儿童青少年,按照不同海拔分组北京地区(平均海拔43.5m)17名,男11名,女6名,年龄(7.28±4.79)岁;青海省海北州地区(平均海拔3200m以上)25名,男12名,女13名,年龄(10.42±0.49)岁。均空腹取肘静脉血,采用Griess法测定血清NO浓度,敏感硫电极法测定血清H2S的浓度。结果北京地区健康儿童血清中NO浓度(60.58±16.85)μmol/L,低于青海省海北州地区健康儿童血清中NO浓度(73.88±18.97)μmol/L;北京地区健康儿童血清中H2S浓度(65.55±9.07)μmol/L,高于青海省海北州地区健康儿童血清中H2S浓度(46.92±6.46)μmol/L。结论高海拔地区健康儿童血清中NO浓度明显高于低海拔地区,而H2S浓度则明显低于低海拔地区。     

��ͯ�ε������븹ʹ

??Abstract??The most common etiology of abdominal pain in children caused by liver and biliary disease is chronic hepatitis?? sphincter of Oddi dysfunction?? cholangitis?? cholecystitis?? choledochal cyst and biliary movement disorder?? presented with right upper abdominal dull pain?? but clinical manifestation of biliary tract roundworm disease is colic?? always complicated with hepatomegaly. Children co-infected with microorganism often have fever??jaundice??increased white blood cells??etc. History?? physical sign and imaging examinations are useful to the diagnosis.     

Ӥ�׶������Է����������ε��ڿ����

目的探讨婴幼儿期发病的先天性肺腺瘤样畸形(CCAM)患儿的临床特点。方法回顾分析1997~2004年在天津市儿童医院就诊的7例CCAM患儿临床表现、影像学改变及诊断过程。结果7例患儿产前检查和产后随访均不完整,临床表现均以咳嗽、喘憋等急性呼吸窘迫症状为主,听诊均有喘鸣音,3例伴有胸廓畸形;影像学改变包括单侧肺野透过度增加、纵隔摆动、肺内异常肺纹理等,CT表现为多发囊性改变。经手术及术后病理证实为CCAM。入院前均被误诊。结论对以急性呼吸窘迫起病,胸部透视或摄片为单侧气肿表现的患儿,应分析临床资料并行CT检查,以便早期发现CCAM。     

��ǰ��ͯ�ʺ����ļ�����׼���εĻ�������ս

??Hypertrophic cardiomyopathy??HCM?? is the second commonest cardiac muscle disease affecting children and adolescents and is a leading cause of sudden death in young athletes. HCM is highly heterogeneous in pediatric population??and currently the precision diagnosis of the etiology of the disease faces enormous challenges. In addition??prospective and randomized controlled clinical studies in the diagnosis??treatment and prognosis of pediatric HCM are extremely rare. Evidence-based consensus or guidelines needs to be developed urgently for personalized risk assessment and treatment??as well as standardized family management and genetic counseling.     

�������ڶ�ͯ�ε�������Ӧ��

??Probiotics are live??nonpathogenic bacteria with the function of improving the micro-environment and promoting the health of the host. The "gut-liver axis" shows that there is complexed relationship between the liver/gallbaldder and gut microbiota. Alterations of the type and amount of the micro-organisms in the intestinal tract can result in liver dysfunction due to the production of ammonia and endotoxin. Some studies have confirmed the positive influence of probiotic strains on the prevention and treatment of liver and biliary diseases in children??such as nonalcoholic fatty liver disease??cholestasis??cirrhosis??and liver transplantation. Probiotic therapy??as a safe??inexpensive and noninvasive treatment strategy??can alleviate and improve the pathophysiological courses and symptoms of different types of liver and biliary diseases without obvious side effects??which has great prospect of application .     

��ͯ�����ھ����εij�������֢���䴦��ԭ��

??Gastrointestinal??GI?? endoscopy plays an indispensable role in the diagnosis and management of various pediatric GI disorders. Complications during the operation of digestive endoscopy are unavoidable. The incidence of complications of diagnostic endoscopy in children is very low??but the incidence of complications is obviously increased in recent years??because of the development of endoscopic treatment in children. Following strict operation indications and contraindications of GI endoscopy??standardized operation process??and skilled pediatric endoscopists are the key to reducing complications. Early identification and timely management of complications after endoscopy is essential to ensuring the safety of children and maintaining harmonious doctor-patient relationship.     

�ҹ���ͯǦ�ж����ε���״������

近十多年来,国内儿童铅中毒防治工作受到了广泛重视,经社会各界及各级政府部门的不懈努力,全国大部分地区的环境铅污染得到了一定程度控制,儿童血铅及儿童铅中毒的流行率明显下降。因此,总体上来讲,我国环境铅污染在逐步改善,当然还存在着一系列问题,还面临着许多困难和挑战,这就需要我们进一步明确我国儿童铅中毒防治工作所面临的现状和任务。1我国儿童铅中毒防治工作的现状1.1儿童铅中毒防治的研究逐年深入自20世纪80年代后期起,国内学者开始了儿童铅中毒防治的研究,近十余年来有关铅对儿童健康危害的研究逐年增多,逐渐受到广泛重视,仅从…     

����������Ƥ�ʼ��ض���������ճ������ϵͳ�벹�弤��Ƭ�ε�Ӱ��

目的探讨长期吸入糖皮质激素对哮喘患儿粘附因子系统与补体激活片段的影响。方法采用酶联免疫吸附法(ELISA),检测了2002-01—2004-12于青岛大学医学院附属医院儿科就诊的26例哮喘患儿吸入糖皮质激素治疗前及治疗后3个月、6个月、12个月后血清细胞间粘附因子-1(sICAM-1)、血管内皮细胞粘附因子-1(sVCAM-1)和补体激活片段(sC5b-9)的质量浓度变化,并与28名健康儿童比较。结果哮喘患儿治疗前血清sICAM-1、sVCAM-1和sC5b-9质量浓度明显高于对照组;吸入糖皮质激素后血清sICAM-1、sVCAM-1和sC5b-9质量浓度逐渐下降,吸入时间越长,sICAM-1、sVCAM-1和sC5b-9质量浓度降低越明显;吸入糖皮质激素12个月后血清sICAM-1、sVCAM-1和sC5b-9质量浓度与正常对照组比较差异无显著性。结论粘附因子和补体激活片段在哮喘的发病中可能起了一定的作用。长时间吸入糖皮质激素可降低sICAM-1、sVCAM-1和sC5b-9的水平。测定血清sICAM-1、sVCAM-1和sC5b-9水平可用于吸入糖皮质激素抗炎疗效的判断,也可作为哮喘病情和治疗临床观察的指标。     

5��14�꽡����ͯ������Ǵ�лָ����������

??Objective??To study the gender and age distribution of bone metabolic markers in healthy children and adolescents??5-14 years old??. Methods??Detailed clinical documents were collected??and morning fasting 5 mL venous blood samples were drawn from 273 cases of the healthy volunteers and healthy school children. Automatic electrochemiluminescence immunoassay analyzer was applied for the tests of bone formation markers??Procollagen type 1 nitrogenous propeptides??P1NP????Osteocalcin??OC???? and bone resorption marker??β-Cross-linked C-terminal telopeptide of type 1 collagen??β-CTx????. The bone metabolic markers were used to calculate percentile values for the 5th?? 10th?? 25th?? 50th?? 75th?? 90th?? and 95th percentiles in the 3 age groups respectively. Results??The variation trends of bone formation markers??P1NP??OC?? and bone resorption marker ??β-CTx?? in two gender groups were similar??being relatively low in preschool age and school age period??gradually increasing during preadolescence??reaching peak in adolescence and declining rapidly after adolescence. There were no significant differences in bone formation markers P1NP??P??0.404?? and OC ??P??0.766?? between male and female groups??but there was significant difference in bone resorption marker β-CTx??P??0.01??. Conclusion??There are no statistically significant differences in the serum levels of P1NP or OC between male and female groups in the bone formation markers of healthy children aged 5-14 years. There is significant difference in bone resorption marker β-CTx between the two groups??the level of the boys being higher than the girls. According to the age distribution of the reference values?? the increasing trend of bone metabolic parameters of the female group will appear 1 or 2 years earlier??the peak value being lower.     

维生素D缺乏性佝偻病患儿骨胶原标志物的检测及意义

目的　研究维生素D(VitD)缺乏性佝偻病患儿骨胶原合成与分解的状况 ,探讨其与骨特异性骨碱性磷酸酶 (BALP)之间的相关性。方法　按照佝偻病临床诊断标准确定 2 0 0 1年 11月至 2 0 0 3年 1月河北医科大学附属二院及大同市第一人民医院儿科 14 8例研究对象 (佝偻病组 80例 ,对照组 6 8例 ) ,结合血清 2 5 羟维生素D(2 5 OHD)及BALP检测结果 ,经过两次筛查 ,明确最后研究对象为佝偻病组 4 3例 ,对照组 37例 ,用酶联免疫方法检测其血清I型前胶原羧基末端前肽 (PICP) ,I型胶原羧基末端交联 (crosslaps)水平。结果　佝偻病患儿血清PICP、crosslaps水平均高于正常组 ,且差异均有显著性意义。佝偻病组及正常组除血清BALP、PICP有正相关关系且有统计学意义 ,其他指标间均无相关性。结论　VitD缺乏性佝偻病患儿骨胶原的合成增强 ,并与骨碱性磷酸酶有相关性。PICP可否作为佝偻病早期诊断的指标需进一步研究。VitD缺乏性佝偻病患儿骨胶原的分解增强。佝偻病患儿骨胶原代谢处于高转换状态。     

骨钙素、Ⅰ型前胶原羧基端前肽、胰岛素样生长因子-1及其相关激素与胎儿骨发育的关系

目的 探讨骨钙素(OC)、Ⅰ型前胶原羧基端前肽(PICP) 及胰岛素样生长因子.1(IGF.1)等激素水平与胎儿骨生长发育的关系.方法 选择本院2008年10月-2009年10月收治的新生儿80例.男41例,女39例;胎龄28～42周.根据不同出生体质量分为小于胎龄(SGA)儿组22例,适于胎龄(AGA)儿组36例及大于胎龄(LGA)儿组(22例).胎儿娩出后,胎盘娩出前抽取其脐静脉血6 mL,采用放射免疫分析法测定其血清OC、IGF.1及甲状旁腺激素水平,酶联免疫吸附法检测其脐血PICP水平;同时检测其血钙、磷、ALP水平,测量新生儿生长参数,计算体质量指数(BMI).结果 1.脐血OC水平在SGA儿组、AGA儿组、LGA儿组间比较差异有统计学意义(P=0.000),LGA儿组显著高于AGA儿及SAG儿组(P＜0.01,0.001);脐血OC水平与出生体质量、头围、BMI呈正相关(Pa＜0.05),与身长无明显相关性(P＞0.05).2.LGA儿组脐血IGF.1水平显著高于AGA儿及SAG儿组,3组间比较有统计学差异(P=0.002);脐血IGF.1水平与出生体质量、头围、BMI水平均呈正相关(Pa＜0.05),与身长无明显相关性(P＞0.05).3.AGA儿组、LGA儿组脐血PICP水平明显高于SGA儿组,但3组间无统计学差异(P=0.070).脐血PICP、PTH水平与生长参数各指标水平均无直线相关关系(Pa＞0.05),偏相关分析脐血PICP与出生体质量、头围、BMI均呈正相关(r=0.239、0.250、0.306,Pa<0.05).4.脐血OC水平与PICP、IGF.1水平均呈正相关(Pa＜0.05),OC、PICP与PTH、ALP水平之间均无明显相关(Pa＞0.05).5.3组脐血钙、血磷、ALP水平均无统计学差异(Pa＞0.05).结论 SGA儿低血清OC、PICP水平与骨形成活动下降相关,脐血OC、PICP及IGF.1可作为评价胎儿骨骼生长发育的临床指标之一.     

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.     

特发性血小板减少性紫癜激素治疗患儿Ⅰ型前胶原羧基端前肽测定

目的探讨糖皮质激素(GC)对特发性血小板减少性紫癜(ITP)患儿骨组织Ⅰ型胶原合成的影响及预防措施。方法将52例ITP患儿分为激素、维生素D及钙剂治疗组(干预组)和单纯激素治疗组(未干预组),26例同期住院的呼吸道感染患儿为对照组,治疗前、治疗后4周分别测定血清Ⅰ型前胶原羧基端前肽(PICP)。结果干预组治疗前(150.69±55.22)与治疗后(157.35±47.48)比较及治疗后与对照组(148.56±40.12)比较,PICP值差异无显著性(P>0.05);未干预组治疗前(155.73±49.68)与治疗后(113.92±48.25)比较及治疗后与对照组比较,PICP值差异均有显著性(P<0.01)。结论GC治疗4周即可抑制ITP患儿骨组织Ⅰ型胶原的合成。激素治疗同时应用维生素D及钙剂能有效拮抗激素对骨组织Ⅰ型胶原合成的抑制作用。     

妊娠期低水平铅暴露对新生儿血清钙、骨钙素及骨碱性磷酸酶的影响

目的研究妊娠期低水平铅暴露对新生儿血清钙(Ca)、骨钙素(OC)及骨碱性磷酸酶(BALP)的影响。方法于新生儿娩出断脐后采集脐静脉血5 ml分别检测血铅、血清钙、血清骨钙素及骨碱性磷酸酶,将新生儿以血铅值50μg/L、100μg/L为界分为低铅组(<50μg/L)、相对高铅组(50～99μg/L)和高铅组(≥100μg/L),研究脐血铅对新生儿骨代谢相关指标的影响。结果新生儿脐血铅水平与其血清骨钙素、血清钙水平呈负相关,与骨碱性磷酸酶水平呈正相关。高铅组与低铅组比较,血清骨钙素水平、血清钙几何均数水平显著降低;高铅组碱性磷酸酶水平显著高于相对高铅组及低铅组。结论妊娠期低水平铅暴露可能干扰了新生儿骨代谢。     

Bone turnover markers in children and adolescents with type 1 diabetes—A systematic review

Type 1 diabetes (T1D) is associated with impaired bone health and both osteocalcin (OCN) and procollagen type 1 amino terminal propetide (P1NP) (markers of bone formation) and C‐terminal cross‐linked telopeptide (CTX) (marker of bone resorption) are decreased in adult patients with T1D. We review the existing literature characterizing these bone turnover markers in children and adolescents with T1D and by meta‐analysis examine whether alterations in OCN, P1NP, and CTX are evident and if potential changes correlate to the metabolic control (hemoglobin A1c, HbA1c). Systematic searches at MEDLINE and EMBASE were conducted in January 2018 identifying all studies describing OCN, P1NP, or CTX in children and adolescents with T1D. A total of 26 studies were included, representing data from more than 1000 patients with T1D. Pooled analyses of standard mean difference and summary effects analysis were performed when sufficient data were available. Pooled analysis revealed mean OCN to be significantly lower in children and adolescents with T1D compared to healthy controls (standard mean difference: ?1.87, 95% confidence interval, CI: ?2.83; ?0.91) whereas both P1NP and CTX did not differ from the controls. Only data on OCN was sufficient to make pooled correlation analysis revealing a negative correlation between OCN and HbA1c (?0.31 95% CI: ?0.45; ?0.16). In conclusion, OCN is decreased in children and adolescents with T1D, whether CTX and P1NP are affected as well is unclear, due to very limited data available. New and large studies including OCN, P1NP, and CTX (preferably as z‐scores adjusting for age variability) is needed to further elucidate the status of bone turnover in children and adolescents with T1D.     

长期应用糖皮质激素对慢性血小板减少性紫癜患儿骨代谢的影响

目的探讨长期应用糖皮质激素对慢性血小板减少性紫癜患儿骨代谢的影响以及钙剂和维生素D的干预作用。方法将36例慢性血小板减少性紫癜患儿随机分为干预组(A)和未干预组(B),给予口服泼尼松1.5mg/(kg·d),4～6周后逐渐减量。疗程超过6月。干预组同时给维生素D330万IU1次口服,口服牡蛎碳酸钙75mg,Bid(牡蛎碳酸钙:每片150mg,东盛科技启东盖天力股份有限公司)。每周3天,共6月。治疗前及应用激素4周后采集患儿静脉血,分别测定I型前胶原羧基末端前肽(PICP),尿脱氧吡啶啉(DPD)和DPD排泄率。结果两组患儿糖皮质激素治疗前血清中PICP的浓度、尿中DPD的排泄率无显著性差异(P>0.05);干预组糖皮质激素治疗后血清中PICP的浓度、尿中DPD的排泄率与治疗前相比差异无统计学意义(P>0.05);未干预组糖皮质激素治疗后血清中PICP的浓度较治疗前明显降低、尿中DPD的排泄率较治疗前明显增高,差异均具有统计学意义(P<0.05)。结论长期应用糖皮质激素对慢性血小板减少性紫癜患儿骨骼代谢有潜在的影响,早期干预可以改善。