青海不同海拔MCEP/MCH比值分析

在整理、总结铁缺乏症与高原乏氧相关研究资料的基础上,除得出与国内外所共识的三项红细胞系的血红蛋白定量（Hb）、红细胞计数（RBC）和压积红细胞容积（H。t）均是随着海拔的升高而增加外,同时亦初步得出如压积红细胞重量（HCtW）、平均红细胞容积（MCV）亦是随着海拔的升高而增加,但各个增加的幅度各异。然而,在其他有关红细胞测定值如红细胞游离原叶琳（FEP）、有关红细胞演算值如平均红细胞血红蛋白（MCH）、平均红细胞血红蛋白浓度（MCHC）、平均红细胞重量（MCW）和平均红细胞原卟啉（MCEP）,则是在随着海拔的升高…     

铁缺乏症与高原乏氧相关研究的前瞻

本文引出铁微量原素在人体内对带氧的生理作用，同时指出在青藏高原乏氧情况下，缺铁则更视为重要，乃对铁缺乏症与高原乏氧的相关，进行探讨。初步结果表明，除在体格方面年幼儿童发育较差、进入青春期呈现“后追”现象、肺活量示出与海拔高度成正比而进入青春期藏族大于汉族外，在血液方面重点突出改变为红细胞系。除与国际共识的随海拔升高而增高的有压积红细胞容积、红细胞计数和血红蛋白定量外，还显示出五项红细胞演算值即平均     

新生儿红细胞增多症与围产期缺氧因素分析

本文总结了１９９３年３月￣１９９６年２月三年的新生儿红细胞增多症与其胎生有无宫内窘迫的关系其出生。结果表明：在８４例红细胞增多症瘤儿中，分为足月儿和早产儿两组，宫内窘迫急性缺氧若导致红细胞增多以足月儿为多；慢性缺氧则以早产儿为多（Ｐ〈０．００５）。但是，血红蛋白、红细胞压积及红细胞计数与宫内急慢性缺氧和胎龄无密切相关，有待进一步深入了解导致宫内乏氧因素与红细胞增多关系。     

铁缺乏症与高原乏氧相关研究初探(铁缺乏症五项演算值与海拔不同高度的相关)

研究背景 自70年代初期国外建立血清铁蛋白实验检测方法以来,把铁缺乏症分为非贫血型和贫血型。为进一步深入研究,应首先确定两型血红蛋白分界指标,即明确血红蛋白正常值低限。 研究方法 实验组共152例,年龄6～7岁,青海省西宁市29例,贵德县24例,共和县26例,贵南县40例,玛多县33例;对照组由北京市36名6～7岁健康儿童组成。用高铁氰化法检测血红蛋白,目镜目测计数红细胞,并测定压积红细胞、压积红细胞重量、游离原叶啉。 研究结果 有关血红蛋白三项指标(血红蛋白、平均红细胞血红蛋白、平均红细胞血红蛋白浓度);有关红细胞三项指标(红细胞、压积红细胞、平均红细胞容积);红细胞重量两项指标(压积红细胞重量、平均红细胞重量);红细胞游离原叶啉两项指标(游离原卟啉、平均红细胞原卟啉)实验组与对照组相比较均有极显著差异。 结论 不同地区儿童,以上10项指标的检测值各不相同,且随海拔高度的增加各项指标均有不同程度增加。建立这10项指标的正常值对我国铁缺乏症和高原乏氧的研究具有十分重要的意义。     

高原乏氧及铁缺乏对儿童体格及智能发育的影响

为了解高原乏氧及铁缺乏对儿童身心发育的影响，对195例亚高原和233例高原城区儿童进行体格发育、智能发育筛查（DDST）、红细胞内游离原卟啉（FEP）及血红蛋白（Hb）等调查和对照研究。结果显示：（1）两组儿童体重和身高Z分较平原参照人群（1985年中国九市城区儿童）呈不同程度降低，其中以身高Z分的降低更为显著，随年龄段升高亚高原组两Z分逐渐向参照人群靠近，而高原组无此趋势。（2）FEP与儿童身高Z分呈负相关，DDST结果异常或可疑者FEP水平高于正常者。（3）本文高原组FEP水平及贫血患病率明显高于亚高原组，其随年龄的变化在两组间亦有差异。提示：高原乏氧和铁缺乏对儿童发育的不利影响，本文资料示随海拔升高而趋于明显。因此，对不同海拔地区儿童采取相应的保健措施，重视对铁缺乏的防治，是促进高原儿童身心发育的重要手段。     

新生儿红细胞增多症与围产期缺氧因素分析

本文总结T1993年3月～1996年2月三年的新生儿红细胞增多症与其胎生有无宫内窘迫的关系其出生。结果表明：在84例红细胞增多症瘤儿中，分为足月儿和早产儿两组，宫内窘迫急性缺氧若导致红细胞增多以足月儿为多；慢性缺氧则以早产儿为多（P＜0．005）。但是，血红蛋白、红细胞压积及红细胞计数与宫内急慢性缺氧和胎龄无密切相关，有待进一步深入了解导致宫内乏氧因素与红细胞增多关系。     

小儿贫血的实验室基础检查（一）

贫血是小儿时期的一种常见综合征，是指外周血单位容积内血红蛋白（Hb）浓度、红细胞数（RBC）及红细胞压积（HCT）低于同龄、同性别、同地区的正常标准。根据WHO资料，Hb低限值为：6个月～6岁110g／L，6～14岁120g／L，海拔每升高1000米，Hb上升4％，低于以上的值称为贫血。6个月以内的婴儿，由于生理性贫血等因素的影响，Hb值变化较大，目前尚无统一标准。     

亚高原地区新生儿铁缺乏症研究(附70例)

营养性缺铁性贫血是６个月－３岁小儿常见病、多发病,严重威胁着小儿生长、发育和健康,但对新生儿铁营养问题,鲜见报道。本文就西宁地区７０例出生３天之内新生儿进行了血红蛋白（Ｈｂ）、红细胞内游离原卟啉（ＦＥＰ）和ＦＥＰ／Ｈｂ值进行了检测,探索亚高原西宁地区及其郊区（海拔２２６１—２５６０米）,大气压７７．４５－７４．３８ＫＰａ）［１］新生儿缺铁状况及有关因素,结果平均Ｈｂ值２００．５２±２７．４ｇ／Ｌ;ＦＥＰ５４４．４±２６９．６μｇ／Ｌ;ＦＥＰ／Ｈｂ２．７μｇ／ｇ。其中男性平均ＦＥＰ值为５３６．２±２０９．９３μｇ／Ｌ,女性为５５３．５８±３１１．６２μｇ／Ｌ,和全国铁缺乏症标准比较［２］,男女性均有差异性。     

亚高原地区新生儿铁缺乏症研究（附70例）

营养性缺铁性贫血是６个月－３个小儿常见病、多发病,严重威胁着小儿生长、发育和健康,但对新生儿铁营养问题,鲜见报道。本文主西宁地区７０例出生３天之内部生儿进行了血红蛋白（Ｈｂ）、红细胞内游离原卟啉（ＦＥＰ）和ＦＥＰ／Ｈｂ值进行了检测,探索亚高原西宁地区及其郊区（海拔２２６１－２５６０米）,大气压７７．４５－７４．３８ｋＰａ）＾１新生儿缺铁状况及有关因素,结果平均Ｈｂ值２００．５２±２７．４ｇ／Ｌ;Ｆ     

高原乏氧及铁缺乏对儿童体格及智能发育的影响

为了解高原乏氧及铁缺乏对儿童身心发育的影响，对１９５年亚高原和２３３例高原城区儿童进行体格发育、智能发育筛查（ＤＤＳＴ）、红细胞内游离原卟啉（ＦＥＰ）及血红蛋白（Ｈｂ）等调查和对照研究。结果显示：（１）两组儿童体重和身高Ｚ分较－平原参照人群（１９８５年中国九市城区儿童）呈不同程度降低，其中以身高Ｚ分的降低更为显著，随年龄段升高亚高原组两Ｚ分逐渐向参照人群靠近，而高原组无此趋势。（２）ＦＥＰ与儿童身     

西宁地区正常儿童四唑氮兰(NBT)实验值微量法的测定及分析

微量法测定白细胞氢化硝基四唑氮兰实验（NBT）具有快速、简便、准确等优．点，是协助临床区分病毒与细菌感染较特异的一种实验方法。为了使此法在我省开展，我们于1994年7月至1995年6月对海拔2260米的西宁市247名正常儿童及167名健康孕妇进行了微量法NBT实验值的测定，结果在正常）L童是4．96士3．63（％）健康孕妇是4．53士2．49（％），与国内报导3—10％平均8．5％及国外报导＜10％是一致的。表明全血法NBT实验正常值也适用于海拔2260米西宁地区微量法NBT的测定。经统计学处理，说明微量法NBT阳性率在不满4周岁至不满7周岁儿童各年龄组及性别间不存在显著差异性。在健康孕妇NBT阳性率亦不存在不同妊娠月份之间的差异。故本实验不仅适用于儿童，同样适用于孕妇感染的判断。     

Normal values of pulse oximetry in newborns at high altitude

The aim of the study was to establish normal values of pulse oximetry saturation, respiratory rate, heart rate, and blood pressure in healthy newborns at high altitude. Vital signs and oximetry saturation readings were collected from healthy term newborns at birth, at 1 h, and at 24 h of life. These were analyzed and compared with reference ranges at sea level. This study was carried out at altitudes of 1640 m above sea level in Taif city, Saudi Arabia. A total of 6011 term newborns were examined at birth and 1 h and 4274 were examined at 24 h of life. At birth, the mean SpO(2) was 68.6 per cent and 60.3 per cent from the right upper and lower limbs, respectively. Mean SpO(2) was 94.3 per cent and 95.4 per cent at the age of 1 and 24 h, respectively. These values were significantly lower than those reported at sea level. The mean respiratory rate, heart rate, and mean blood pressure at 24 h were 45.7/min, 149.7/min, and 46.9 mmHg, respectively. It is concluded that pulse oximetry saturation for newborn babies is lower at higher altitudes than at sea level. This effect is observable at altitudes of 1600 m above sea level. Cut-off levels lower than those used at sea level should be adopted when dealing with newborns living at high altitudes.     

Lipoproteins and apoproteins of fetal and newborn piglets

Serum lipids, very low in the fetus and at birth, increased rapidly after the first feeding. Cholesterol was mainly in the free form. Esterified cholesterol rose rapidly, but free cholesterol remained in high proportions (30%) until after weaning. Very high phospholipid concentrations show that triglycerides are not the only major product of esterification and suggest a possible use for energetic purposes. Fetal lipoproteins had a general pattern similar to that of adults, but high-density lipoproteins (HDL) were denser (1.128 g/ml) and correspondingly richer in proteins. The presence of apoprotein AI and of the light intestinal form of apoprotein B in the triglyceride-rich fractions as well as that of apoprotein AIV in HDL was indicative of an early contribution of enterocytes to the lipoprotein pool. Low-density lipoprotein apoproteins were heterogeneous until 14 days, as they are in the human fetus, and contained, besides apoprotein B, all the main apoproteins, HDL reached concentrations of 400 mg/100 ml at 3 and 4 weeks of age, above 3-fold higher than those of chow-fed adults, but also 1.5-fold higher than those of growing pigs fed a 20% fat diet, thereby showing a high capacity of the very young animal to synthesize HDL and apoprotein AI in particular. The many similarities with the evolution of lipoprotein in the newborn human validate the young pig as a model in the study of perinatal nutrition.     

超声对不同海拔地区健康儿童肺动脉压相关参数的对比性研究

目的探讨高原地区健康儿童肺动脉压变化的特点。方法采用随机抽样调查的方法,应用美国HP-8500和CAL-163多普勒超声诊断仪测定海拔16 m、2260 m及3700 m地区1061例健康儿童的右室收缩时间间期(right ventricular systolic time interval,RSTI)和进行平均肺动脉压(mean of pulmonary arterial pressure,mPAP)的估测,并作对比性研究。结果 2260 m及3700 m组的右室射血加速时间(ascending time,AT)和右室射血加速时间/射血时间(AT/ejection time,AT/ET)比16 m组缩短(P值为0.03—0.000)。3700 m组右室射血前期(previous ejection period,PEP)、PEP/AT及mPAP明显高于16 m、2260 m组(P值为0.007～0.000)。3700 m组3岁及3岁之前各年龄段比3岁之后各年龄段的mPAP有明显升高(P值为0.006—0.000)。3700 m组移居汉族与世居藏族小儿血氧饱和度(SO2)、RSTI及mPAP差异无显著性(P>0.05)。结论 高原地区健康儿童肺动脉压不同于平原。海拔3700 m地区健康儿童的肺动脉压明显升高,新生儿及婴幼儿的肺动脉压升高更明显。儿童期在高原低氧环境下,种族对肺动脉压变化影响不明显。高原低氧环境是影响儿童肺动脉压变化的重要因素。     

Cyclophosphamide therapy in frequently relapsing nephrotic syndrome with and without steroid dependence

An 8-week therapy with cyclophosphamide (CP) and alternate-day prednisone was given to 65 patients having steroid-sensitive, frequently relapsing nephrotic syndrome, including 17 with steroid dependence. It induced remissions of less than 6 months in 18 patients, 6 to 36 months in 21 and over 3 years in 26. Considering a remission of 6 months as significant, certain clinical variables were compared in patients without such a response with those getting longer remissions. In the group with frequent relapses a higher proportion of patients aged above 8 years had remissions of over 6 months as well as over 3 years, than those who were younger at CP therapy. Among patients with frequent relapses as well as those with steroid dependence, a post-CP remission of more than 6 months was associated with a better long-term course. The response to CP in both groups was similar regarding the duration of remissions, but a greater proportion of steroid-dependent patients subsequently again showed steroid dependence or frequent relapses. Our findings suggest that a higher age at CP therapy and an ensuing remission of over 6 months are predictors of a better response, and steroid dependence of a less favorable outcome.     

高原乏氧对不同胎龄胎儿发育的影响

本文通过不同胎龄胎儿142例进行直接测量体重、身长、顶臂长、头围、胸围的值来研究高原乏氧对不同胎龄胎儿发育的影响。结果：①13～16孕周胎儿开始体重低于海平面、两组比较有明显差异（P＜0.01），到出生较海平面体重低369～440克；②胎儿于13～16孕周体重衡量指数（PI）明显高于海平面；③顶臂长于9～12孕周开始低于海平面，两组对比有明显差异（P＜0.01）；④身长于17～20孕周开始低于海平面、两组对比有显著性差异（P＜0．01）。     

Why do children rarely have gallstones? Examinations of the lithoindices and the bile acid pattern in infants and children in health and disease (author's transl)

Cholesterol gallstones occur 600-1000 times more frequent in adults than in children. Seeking a possibility to explain this discrepancy, the molar concentrations of cholesterol, lecithin and bile acids as well as the bile acid pattern have been determined in duodenal juice, after an injection of 2 U/kg pancreocymin, of 33 children aged between 4 months and 14 years who were gastroenterologically healthy. The absolute values as well as the percentage composition were calculated. The lithoindices have been determined to be Li1=0.54 +/- 0.25 and Li2=1.06 +/- 0.50 according to the formulas of Thomas and Hofmann. Dependence on age in infancy and during childhood could be excluded. The main reason for the fact that hardly any gallstones occur among children, compared to the occurrence in adults seems to be the small concentration of cholesterol in the bile. Whereas there had been no deviations either of lithoindices or in the bile acid pattern in 10 patients with coeliac disease, 2 out of 6 children with mucoviscidosis and 3 out of 4 children with small bowel syndrome showed apparently increased lithoindices. Only in the last group a bile acid pattern was found which could reduce the higher risk of getting cholelithiasis.     

Influence of immediate newborn care on infant adaptation to the environment

The indicators of newborns' adaptation during 75 min after birth were compared in three randomised groups of full-term newborns: skin-to-skin contact (group I), swaddled newborns beside the mother (group II), swaddled and separated from the mother (group III). The changes in skin temperature, blood glucose, pH, heart rate, respiration rate and crying time were studied. All the above characteristics but pH were significantly the most favourable for infants in the skin-to-skin group. The analysis of individual trends of changes in skin temperature indicated that for all but two newborns not separated from the mother (skin-to-skin or lying besides) the temperature was growing during the observation period, whereas in the separated group, six newborns (27%) had unstable not growing temperature. The mean level of blood glucose was the highest in skin-to-skin group (60.1 mg/dl), lower in group of swaddled and lying beside mother (52.5 mg/dl) and the lowest (49.6 mg/dl) in the separated group. The mean duration of crying time in the skin-to-skin contact was a little shorter than in the group of newborns lying besides the mother and more than three times shorter than in the separated group. The observed number of episodes of crying were 7, 17 and 38 in the three groups respectively. All results indicated that skin-to-skin contact is optimal for newborns', adaptation after birth especially as a protection against hypothermia and hypoglycaemia.