不同营养方式对呼吸科老年重症患者呼吸肌力及临床预后的影响

目的 比较不同营养方式对呼吸科老年重症患者呼吸肌力和临床结局的影响.方法 采用随机数字表法,将147例呼吸科老年重症患者按入院先后顺序随机分为肠内(EN)肠外(PN)混合营养组,EN组和PN组,每组49例,观察营养支持前后患者能量代谢指标和呼吸肌力的变化情况及短期结局.结果 营养支持后第7天,各组患者的血浆白蛋白(ALB)、血红蛋白(Hb)、肌酐(Cr)水平和氮平衡均较营养支持前明显升高(P均＜0.01),血尿素氮(BUN)水平较营养支持前明显下降(P＜0.01);混合营养组ALB、Hb、Cr和氮平衡升高幅度均明显高于EN组和PN组(P＜0.05或P＜0.01),BUN下降幅度明显高于EN组(P＜0.05).混合营养组(P=0.021)和EN组(P=0.011)的最大吸气压水平明显高于营养支持前,混合营养组的气道阻断压水平明显低于营养支持前(P=0.025).PN组患者感染性并发症及非感染性并发症发生率明显高于EN组 (P=0.002,P=0.017)和混合营养组(P=0.005,P=0.004),EN组患者的胃潴留发生率明显高于PN组(P=0.035).混合营养组患者的脱机时间、呼吸重症监护病房停留时间、住院时间与20 d死亡率均明显小于EN组和PN组(P均＜0.05).结论 EN与PN联用改善呼吸科老年重症患者营养状况和呼吸肌力的效果明显优于单用EN和PN,其短期临床结局也好于单用EN和PN.

Abstract：

Objective To compare the influences of different routes of nutrition on the outcome and respiratory muscle strength of elderly patients in respiratory intensive care unit (RICU). Methods Totally 147 elderly patients in RICU were equally randomized into combined nutrition group ( combinination of parenteral nutrition and enteral nutrition), total enteral nutrition (EN) group, and total parenteral nutrition (PN) group. The changes of energy metabolism, respiratory muscle strength, and short-term outcome were observed or determined.Results Plasma albumin (ALB), hemoglobin (Hb), creatinine (Cr) levels, and nitrogen balance significantly increased in all group 7 days later ( all P ＜ 0. 01 ), while blood urea nitrogen (BUN) significantly decreased ( P ＜0.01 ). The increase of ALB, Hb, Cr levels, and nitrogen balance were significantly more remarkable than that in EN group and PN group (P＜0.05 or P＜0.01). The decrease of BUN level in the combined nutrition group was significantly more remarkable than that in EN group ( P ＜ 0. 05 ). After nutritional support, the maximum inspiratory pressure in the combined nutrition group (P =0. 021 ) and EN group (P = 0. 011 ) became significantly higher, and occlusion pressure at 0.1 second inspiration level in the combined nutrition group became significantly lower ( P =0. 025). The incidences of infectious and non-infectious complications in PN group were significantly higher than those in EN group (P = 0. 002 and 0. 017, respectively) and combined nutrition group ( P = 0. 005 and 0. 004, respectively). Gastric retention was more common in EN group than that in PN group ( P = 0. 035). The weaning time,length of RICU stay, length of hospital stay and 20-day-mortality were significantly decreased in the combined nutrition group than those in the other two groups ( all P ＜ 0. 05 ). Conclusion The effectiveness of the combined application of PN and EN is superior to PN or EN alone in improving nutritional status and respiratory muscle strength as well as in improving the short-term outcome in elderly patients in RICU..     

急性白血病患儿治疗期人体组成成分的变化

Objective To investigate the changes of body composition in the children with acute leukemia during different treatment stages.Methods From January 2009 to April 2010,56 children with acute leukemia hospitalized in Shanghai Children's Medical Center for chemotherapy were enrolled.Meanwhile,56 healthy children with matched age and sex were enrolled as the control group.The body compositions of children in the control group and the children with acute leukemia at the end of the first course of each treatment stages ware detected by segmental multiple-frequency bioelectrical impedance analysis.The distribution of body compositions was recorded asthe percentage of each body composition to the body weighL Results Among 56 children with acute leukemia,41were with acute lymphoblastic leukemia and 15 with acute nonlymphoblasdc leukemia.Twenty-three cases were in remission-induction chemotherapy stage,15 in consolidation chemotherapy stage,and 18 in maintenance chemotherapy stage.Compared with children in the control group,children with acute leukemia showed a reduction in the percentage of intracellular fluid (P = 0.000), extracellular fluid (P - 0.005), protein (P = 0.000), mineral (P = 0.001), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000), while an increase in body fat mass [(26.2 ± 8.3)% vs.(20.3±3.8)%, P=0.000].The body weight (P = 0.001), the percentage of intracellular fluid (P = 0.005), protein (P = 0.004), body cell mass (P = 0.001), and active cell mass ( P = 0.020 ) in the children during remission-induction chemotherapy stage were significantly lower than those of the healthy children.However, the parameters of the consolidation chemotherapy stage were significantly lower than those of the control group, including the percentage of intracellular fluid (P = 0.000), extracellular fluid (P =0.000), protein (P = 0.000), mineral (P =0.001), body fat mass (P =0.000), non-fat mass (P = 0.000), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000).Most body compositions in the maintenance chemotherapy stage were lower than those of the healthy children ( P < 0.05) except for body mass index (P = 0.127) and the percentage of extracellular fluid (P = 0.097).Conclusions Body compositions remarkably change in children with acute leukemia after chemotherapy.Therefore, the nutritional status of children with acute leukemia should be closely monitored, and proper nutritional support should be provided when necessary to improve the prognosis.     

慢性阻塞性肺疾病的炎症反应与营养不良密切相关

Objective To study the relationship between inflammation and malnutrition in patients with stable chronic obstructive pulmonary disease (COPD).Methods A total of 85 patients with stable COPD and 30 healthy subjects were recruited .All patients were divided into the lower body mass index (BMI,BMI<18.5 kg/m~2) group and normal BMI (BMI=18.5-23.9 kg/m~2) group.Lung function,arterial blood gall,cell differenti-als in induced sputum,and the levels of serum C-reactive protein (CRP),interleukin-8(IL-8),interleukin-6 (IL-6),interleukin-10 (IL-10),and tumor necrosis factor-α(TNF-α) were determined.Results The levels of total cell count and neutrophils in induced sputum were significantly higher in lower BMI group than in normal BMI group and healthy subjects (P<0.05).The forced expiratory volume in 1 second percentage,forced expiratory volume in 1 second/forced vital capacity,and arterial oxygen tension were significantly lower in lower BMI group than in normal BMI group,and the arterial carbon dioxide tension was significantly higher in lower BMI group than in normal BMI group (P<0.05).The levels of serum CRP,IL-8,IL-6,and TNF-α were significantly higher in lower BMI group than those in normal BMI group and healthy subjects (P<0.05).In lower BMI group,BMI was negatively correlated with total cell count (r=-0.492,P=0.0038) and neutrophils (r=-0.501,P=0.0032) in induced sputum and the levels of serum CRP (r=-0.473,P=0.0083),IL-8(r=-0.382,P=0.0421),IL-6(r=-0.422,P=0.0147),and TNF-α(r=-0.416,P=0.0156),respectively.Conclu-sion Local and systemic inflammatory reaction is responsible for malnutrition associated with COPD.     

大剂量N-乙酰半胱氨酸对染尘大鼠肺组织的影响

目的 观察大剂量N-乙酰半胱氨酸(NAC)对矽肺形成过程中炎症和纤维化反应的影响.方法 将Wisar大鼠随机分为模型组、干预组、对照组,每组32只.模型组和干预组以二氧化硅结晶体诱发染尘大鼠模型,干预组以大剂量NAC进行干预.分别在染尘后的第3、7、14、28天处死8只大鼠.对大鼠肺组织进行HE染色及Masson染色,观察肺组织病理变化.用酶联免疫法(EusA)测定肺泡灌洗液中肿瘤坏死因子-α(TNF-α)和白细胞介素-8(IL-8)的含量.结果 NAC干预组病理观察显示,肺泡炎症和纤维化程度均较模型组明显减轻.与模型组(13.84±1.61、9.23±0.87、11.23±1.25、9.56±0.76)比较,第3、7、14、28天十预组肺脏系数(9.30±0.78、6.29±0.74、7.63±0.88、6.06±1.16)均明显降低.差异有统计学意义(P＜0.01.与对照组相比,各时间点模型组肺泡灌洗液中TNF-α和IL-8含量均明显升高,差异有统计学意义(P＜0.01);与模型组相比,各时间点干预组的TNF-α和IL-8含量均明显降低,差异有统计学意义(P＜0.01).结论 早期大剂量NAC干预能够明显减轻染尘大鼠的肺组织炎症,降低肺泡灌洗液中TNF-α和IL-8含量,抑制和延缓肺纤维化的发生.

Abstract：

Objective To explore the effects of high-dose N-acetylcysteine on the lung tissues of rats exposed to silica. Methods Ninety-six Wistar rats were randomly divided into model group, intervention group and control group (32 rats for each group). The rats of model group and intervention group were exposed to silica by intratracheal infusion of silica dust suspension. The rats in the intervention group were orally given high dose N-acetylcysteine. In 3,7,14,28 days after exposure, eight rats in each group were sacrificed, respectively and the lung samples were collected. The pathological changes of lung were evaluated by HE and Masson staining methods. The levels of TNF-α and IL-8 in the BALF were detected by ELISA. Results Compared with the control group, the alveolitis and pulmonary fibrosis in the intervention group were significantly reduced. In 3,7,14,28 days after exposure, the lung/body coefficients in the intervention group were 9.30±0.78, 6.29±0.74,7.63±0.88,6.06+1.16 respectively, which were significantly lower than those (13.84±1.61,9.23±0.87, 11.23±1.25,9.56±0.76, P＜0.01 )in the model group (P＜0.01). At the different time points, the levels of TNF-α and IL-8 in the BALF in the intervention group were significantly higher than those in the control group (P＜0.01), but were significantly lower than those in the model group (P＜0.01). Conclusion The intervention with high dose N-acetylcysteine can significantly reduce the alveolitis and the TNF-α and IL-8 levels in the BALF, therefore, inhibit and delay the development of pulmonary fibrosis of rats exposed to silicon dioxide.     

三种不同经外周置入中心静脉导管固定方法临床效果的比较

目的 比较3种不同的经外周静脉置人中心静脉导管(PICC)固定方法对导管固定的临床效果.方法 将120例留置PICC导管患者采用便利抽样的方法分为3组,每组各40例,分别采用缝合固定(A组)、免缝胶带交叉固定(B组)和思乐扣免缝导管固定装置固定(C组).观察并比较3组患者置管后留置期间导管固定的牢固性、并发症发生率、固定部位皮肤损伤情况及患者的满意度.结果 B组导管移位的发生率(57.5%)明显高于A组(12.5%,P=0.000)和C组(7.5%,P=0.000),导管脱出的发生率(15.0%)亦明显高于A组(0,P=0.034)和C组(0,P=0.034).导管留置期间静脉炎的发生率在B组(25.0%)明显高于A组(7.5%,P=0.034)和C组(5.0%,P=0.012);在A组中并发穿刺部位蜂窝织炎的发生率明显高于C组(20.0%比2.5%,P=0.034).A组患者出现固定翼下的皮肤压痕的发生率(37.5%)明显高于B组(5.0%,P=0.000)和C组(5.O%,P=0.000),且A组患者皮肤破损的发生率(22.5%)也高于B组(5.0%,P=0.023)和C组(0,P=0.005);各种原因所致的皮肤刺激痛在A组(52.5%)中明显增加,高于B组(0,P=0.000)和C组(2.5%,P=0.000).患者对3组不同导管固定法的满意度在A组(12.0%)显著低于B组(62.5%,P=0.000)和C组(90.0%,P=0.000),且C组满意度最高,明显高于B组(P=0.004).结论 思乐扣免缝导管固定装置固定法可以作为胶带和缝合固定的替代,具有等同于缝合法对导管的固定作用,预防了导管移位、脱出等导管相关并发症,同时也避免了缝合固定造成的皮肤损伤.

Abstract：

Objecfive To compare the clinical effectiveness of three different fixation methods for peripherally inserted central catheter(PICC).Methods Totally 120 patients requiting PICCs were randomized into suture securement group(group A),tape securement group(group B),and sutureless adhesive-hacked device (StatIock)securement group(group C),with 40 patients in each group.Patients were followed up throughout their entire catheter course,and the securement effectiveness,catheter-related complications,risk of skin injury,and patients'satisfaction were observed.Results The rate of catheter migration without function loss in group B (57.5%)was significantly higherthan in group A(12.5%,P=0.000)and in group C(7.5%,P=0.000).Catheter dislodgment rate in group B(15.0%)was also significantly higher than group A(0,P=0.034)and group C(0,JP=0.034).Phlebitis documented during their catheter course in group B(25.0%)were more than in group A(7.5%,P=0.034)and in group C(5.0%,P=0.012).In addition,the rate of cellulitis in group A was significantly higher than group C(20.0%vs.2.5%,P=0.034).The rate of skin injury in group A 0.005).Nearly half of patients in group A (52.5%)complained irritation and/or pain at the sucure site,which was significantly higher than in other two groups ( both P = 0.000 ).The patients' satisfaction rate was significantly lower in group A (12.0% ) than in the other two groups ( both P = 0.000), documented highest in group C (90.0%) (group C vs.group B, P = 0.004).Conclusions The availability of sutureless adhesive-backed de vice StatLock provides an alternative for securement of PICCs.It performs as well as suture securement in catheterfixing.Meanwhile, it can prevent catheter-related complications such as migration and dislodgment Furthermore, it avoids skin injuries during catheter fixation or securement.     

急性白血病患儿治疗期人体组成成分的变化

目的 探讨不同治疗阶段的急性白血病患儿人体组成成分变化的特点,为其营养支持提供依据.方法 前瞻性观察2009年1月至2010年4月在上海儿童医学中心住院接受化疗的急性白血病患儿56例,同时选择同年龄同性别健康儿童56名作为正常对照组.使用节段多频生物电阻抗分析法对正常对照组儿童及在各个治疗期的第1个疗程结束时的白血病患儿进行人体组成成分测定.人体各组成成分的分布情况使用各成分占体重的百分比表示.结果 56例急性白血病患儿中,急性淋巴细胞性白血病41例,急性非淋巴细胞性白血病15例;处于诱导缓解期23例,巩固强化期15例,维持治疗期18例.56例白血病患儿与正常对照组儿童人体组成成分比较后发现,白血病患儿细胞内液(P=0.000)、细胞外液(P=0.005)、蛋白质(P=0.000)、无机盐(P=0.001)、骨骼肌(P=0.000)、体细胞群(P=0.000)和活动细胞群(P=0.000)占体重的百分比均明显低于正常对照组儿童,而体脂肪含量高于对照组[(26.2±8.3)%比(20.3 ±3.8)%,P=0.000].诱导缓解期患儿的人体组成与正常对照组儿童相比,表现为体重下降(P=0.001),细胞内液(P=0.005)、蛋白质(P=0.004)、体细胞群(P=0.001)和活动细胞群(P=0.020)明显减少.进入巩固强化期的患儿,细胞内液(P=0.000)、细胞外液(P=0.000)、蛋白质(P=0.000)、无机盐(P=0.001)、体脂肪(P=0.000)、去脂体重(P=0.000)、骨骼肌(P=0.000)、体细胞群(P=0.000)和活动细胞群(P=0.000)占体重的百分比均明显低于正常对照组儿童.而维持治疗期的患儿与正常对照组儿童相比,除体重指数(P=0.127)和细胞外液占体重的百分比(P=0.097)差异无统计学意义外,其余各项指标差异仍具有统计学意义(P均<0.05).结论 急性白血病患儿经化疗后人体组成成分发生明显改变.应尽早监测白血病患儿营养状况变化,及时予以营养支持,以改善患儿预后.

Abstract：

Objective To investigate the changes of body composition in the children with acute leukemia during different treatment stages.Methods From January 2009 to April 2010,56 children with acute leukemia hospitalized in Shanghai Children's Medical Center for chemotherapy were enrolled.Meanwhile,56 healthy children with matched age and sex were enrolled as the control group.The body compositions of children in the control group and the children with acute leukemia at the end of the first course of each treatment stages ware detected by segmental multiple-frequency bioelectrical impedance analysis.The distribution of body compositions was recorded asthe percentage of each body composition to the body weighL Results Among 56 children with acute leukemia,41were with acute lymphoblastic leukemia and 15 with acute nonlymphoblasdc leukemia.Twenty-three cases were in remission-induction chemotherapy stage,15 in consolidation chemotherapy stage,and 18 in maintenance chemotherapy stage.Compared with children in the control group,children with acute leukemia showed a reduction in the percentage of intracellular fluid (P = 0.000), extracellular fluid (P - 0.005), protein (P = 0.000), mineral (P = 0.001), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000), while an increase in body fat mass [(26.2 ± 8.3)% vs.(20.3±3.8)%, P=0.000].The body weight (P = 0.001), the percentage of intracellular fluid (P = 0.005), protein (P = 0.004), body cell mass (P = 0.001), and active cell mass ( P = 0.020 ) in the children during remission-induction chemotherapy stage were significantly lower than those of the healthy children.However, the parameters of the consolidation chemotherapy stage were significantly lower than those of the control group, including the percentage of intracellular fluid (P = 0.000), extracellular fluid (P =0.000), protein (P = 0.000), mineral (P =0.001), body fat mass (P =0.000), non-fat mass (P = 0.000), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000).Most body compositions in the maintenance chemotherapy stage were lower than those of the healthy children ( P < 0.05) except for body mass index (P = 0.127) and the percentage of extracellular fluid (P = 0.097).Conclusions Body compositions remarkably change in children with acute leukemia after chemotherapy.Therefore, the nutritional status of children with acute leukemia should be closely monitored, and proper nutritional support should be provided when necessary to improve the prognosis.     

低蛋白饮食对3/4期慢性肾脏病患者肾功能及营养状况的影响

Objective To assess the influences of low-protein diet on the renal function and nutritional status in patients with stage 3/4 chronic kidney diseases (CKD).Methods Totally 34 patients with stage 3/4 CKD were randomly divided into group A (protein intake:0.6 g·kg~(-1)·d~(-1);n=14) and B (protein intake:0.8 g·kg~(-1)·d~(-1);n=20).Anthropometric measurement and blood biochemical tests were performed,nutri-tional status was assessed,and 24-hour dietary recall survey was conducted before and after the treatment.Patients were followed up for 6 months.Results In group A,the creatinine level significantly decreased (P=0.010),while albumin level (P=0.042) and the intake of energy (P=0.018) and carbohydrate (P<0.001) signifi-cantly increased after the treatment In all the 34 patients,in group A and group B,the malnutrition rates were de-creased by 14.7%,7.2%,and 21.1% after nutritional intervention.Conclusion The low-protein diet (protein intake 0.6 g·kg~(-1)·d~(-1)),in which part of the staple food was replaced by wheat starch,can increase the in-takes of carbohydrate and energy and improve renal function and nutritional status in patients with stage 3/4 CKD.     

全胃切除术后3种不同空肠构建贮存袋与保持十二指肠连续性消化道重建患者生活质量的比较

Objective To compare the short-term quality of life after total gastrectomy in patients with gastric cancer with three recontructive methods of stamoch storage function. Methods Totally 62 cases underwent jejunal interposition afar total gastrectomy from March 2000 to December 2007. Patients were divided into three groups according to the procedures: functional jejunal interposition (FJI-type) group ( n = 23 ), modified jejunal interposition ( Ⅲ -type) group ( n = 20), and P-type jejunal interposition (P-type) group (n = 19). In each group,the patients' general conditions, the nutritional status at month 3 and 12, and gastrointestinal symptoms were evaluated. Results The durations of procedures were significantly different among three groups (P ＜0. 01 ). The intraoperative bleeding volume, postoperative complications, and food intake of each meal at month 3 were not significantly different ( P ＞ 0. 05 ). Compared with the data at month 3, the levels of hemoglobin and serum calcium at month 12 were significantly higher in all three groups (P ＜ 0. 01 ). Compared to the level at month 3, the level of serum albumin at month 12 significantly increased in FJI-type group (P ＜ 0. 05 ) but showed not significant difference in Ⅲ-type group and P-type group ( P ＞ 0. 05 ). The incidence of reflux esophagitis in three groups and the comparative parameters among the three groups at month 12 were not significantly different ( P ＞ 0. 05 ). Conclusions The jejunal interpositions after total gastrectomy will not increase the complexity and risk of the surgical procedure. In fact, they can reduce the reflux esophagitis and improve quality of life by keeping the storage function and restoring food passage through the duodenum. FJI-type is simpler than the other two types, and P-type is preferred for operations that need to open the pectoral cavity.     

饮食、C反应蛋白与2型糖尿病颈动脉内膜厚度的关系

Objective To compare the characteristics of food and nutrition intake in type 2 diabetes mellitus (T2DM) patients with or without carotid atherosclerosis and analyze the relationship between diets/C-reactive protein (CRP) and carotid intima-media thickness (C-IMT). Methods Sixty patients with T2DM were enrolled and divided into two groups based on C-IMT: group A (C-IMT ＜ 1 mm, n=30) and group B (C-IMT≥1 mm, n=30). All subjects were investigated with questionnaires including 3-day food recall They all took somatometric measurement. Blood and urine samples were collected in all subjects to examine the levels of high sensitive-CRP,C-peptide, blood glucose, glycosylated hemoglobin, blood lipid, renal function, urine microalbumin, and other indicators. Results The intakes of vegetables, fruits, and aquatic products were significantly higher in group A than in group B ( P ＜ 0. 05 ). The intake of vitamin C in group A was significantly higher than that in group B ( P ＜0. 05 ). The levels of CRP in group B was significant higher than that in group A (P = 0. 000). Positive correlation was found between CRP level and C-IMT in T2DM patients ( r = 0. 36, P = 0. 004). Furthermore, CRP was negatively correlated with the intakes of vegetables and fruits ( r = - 0. 334, P = 0. 01 ), aquatic products ( r = -0. 315, P = 0. 016), and vitamin C ( r = - 0. 2786, P = 0. 038 ), respectively. The intake of fruits was negatively correlated with C-IMT (r, = -0. 33, P = 0. 01 ). Conclusions T2DM patients without carotid atherosclerosis intake more vegetables, fruits, aquatic products and vitamin C than those with atherosclerosis. Vegetables, fruits,sea foods and vitamin C may be the protective factors against atherosclerosis in T2DM patients. CRP is associated with the development of atherosclerosis in T2DM patients.     

儿童急性白血病缓解期微量元素和营养相关蛋白的变化

目的 探讨儿童急性淋巴细胞白血病和急性粒细胞白血病缓解期某些微量元素及营养相关蛋白的变化.方法 应用原子吸收光谱法、散射比浊法、干化学法和化学发光法等,对上海儿童医学中心43例急性淋巴细胞白血病和19例急性粒细胞白血病缓解期患儿(缓解组)和30名体检正常儿童(正常对照组)红细胞计数、血红蛋白含量、血清总蛋白、白蛋白、铁、铁蛋白、转铁蛋白、乳酸脱氢酶、铜蓝蛋白、铜、锌及铜/锌比值等指标进行检测,并对缓解组和正常对照组之间的差异进行比较.结果 缓解组与正常对照组相比,血清总蛋白(P=0.454)、铁(P=0.769)、转铁蛋白(P=0.903)和锌(P=0.343)差异均无统计学意义.缓解组血清铁蛋白(P=0.000)、乳酸脱氢酶(P=0.000)、铜蓝蛋白(P=0.000)、铜(P=0.002)和铜/锌比值(P=0.003)均显著高于正常对照组,而红细胞计数(P=0.000)、血红蛋白含量(P=0.000)和白蛋白(P=0.046)均显著低于正常对照组.缓解组中急性淋巴细胞白血病和急性粒细胞白血病相比,除乳酸脱氢酶(P=0.025)外,其他指标差异均无统计学意义(P均>0.05).结论 在儿童急性淋巴细胞白血病和急性粒细胞白血病的疾病缓解期,血清中微量元素与营养相关蛋白含量正逐步恢复正常,重建原有的平衡状态.

Abstract：

Objective To investigate the changes of serum trace elements and nutritional proteins in children with acute lymphoblastic leukemia and acute myeloid leukemia at the stage of remission.Methods Erythrocyte count,hemoglobin,serum levels of total protein,albumin,iron,ferritin,transferrin,lactate dehydrogenase,ceruloplasmin,cuprum,zinc and their ratio were measured in 43 patients with acute lymphoblastic leukemia,19patients with acute myeloid leukemia at stages of remission(remission groups),and 30 healthy controls(control group)enrolled from Shanghai Children's Medical Center using atomic absorption spectrometry,nophelometry assay,dry chemical method,and chemiluminescence method.The differences of these indicators between remission groups and control group were analyzed.Results Serum levels of total protein(P=0.454),iron(P=0.769),transferrin(P=0.903),and zinc(P=0.343)were not significantly different between the remission groups and the control group.Serum levels of ferritin(P=0.000),lactate dehydrogenase(P=0.000),ceruloplasmin(P=0.000),cuprum(P=0.002),and Cu/Zn ratio(P=0.003)in the remission groups were significantly higher than those in control group.On the contrary,erythrocyte count(P=0.000),hemoglobin(P=0.000)and albumin(P=0.046)were significantly lowerin remission groups than those of control group.Serum levels of all detected indicators were not significantly different between the acute lymphoblastic leukemia remission group and acute myeloid leukemia remission group(P>0.05)except for lactate dehydrogenase(P=0.025).Conclusion At the remission stage of acute lymphoblastic leukemia and acute myeloid leukemia,serum levels of some trace elements and nutritional proteins gradually returned to normal,and the original balance is established again.     

生活方式干预改善超重及肥胖青少年氧化应激状态

目的超重和肥胖已成为影响青少年健康的关键问题。本研究探讨饮食及运动干预对青少年体内氧化应激状态的影响。方法124名受试者中的93名超重及肥胖青少年年龄（13．6±0．7）岁,体重指数（BMI22．4～34．1kg／m。）随机分为四组：饮食干预组（D）、运动干预组（E）、饮食运动干预组（DE）、超重及肥胖对照组（O）。饮食方案根据研究对象的年龄及理想体重制定;运动干预为放学后1h中等强度运动,每周4次。干预周期为10周,干预前后分别进行人体测量、身体成分、代谢及氧化应激等指标检测。31名正常体重者为对照组。结果超重及肥胖组的空腹血糖、TC、LDL—C和MDA水平明显高于正常体重组（P〈0．05）,SOD水平低于正常体重组（P〈0．05）;MDA水平与体重、BMI、TC、LDL-C呈正相关（R=0．209,0．228,0．274,0．263,P〈0．05）,SOD与体重及BMI呈负相关（R=一0．334,一0．362,P〈0．05）;干预后D、E、DE组BMI、腰围、全身脂肪显著下降（P〈0．05）,D和E组的MDA水平下降（P〈0．05）;两个运动干预组的TC和LDL—C下降亦达统计学差异（P〈0．05）。结论超重青少年在糖脂代谢正常阶段体内即存在氧化应激失衡状态。为期10周的饮食和（或）运动的生活方式干预在改善青少年超重状态、调节血脂水平的同时,还可显著降低其体内的氧化应激水平。     

Cognitive behavioral therapy improves diet and body composition in overweight and obese adolescents

BACKGROUND: Cognitive behavioral therapy (CBT) teaches behavioral and cognitive strategies that focus on achieving and maintaining lifestyle changes. OBJECTIVE: We examined the effectiveness of a CBT program (CHOOSE HEALTH) for improving body composition, diet, and physical activity in overweight and obese adolescents. DESIGN: Adolescents [16 male, 31 female; aged 14.5 +/- 1.6 y; body mass index (BMI; in kg/m(2)) 30.9 +/- 4.2] were block-matched into 2 groups by age, sex, Tanner stage, BMI, and hip and waist circumferences and were randomly assigned to CBT or no treatment (control). CBT consisted of 10 weekly sessions, followed by 5 fortnightly telephone sessions. RESULTS: Compared with the control, over 20 wk, CBT improved (significant group x time interactions) BMI (CBT, -1.3 +/- 0.4; control, 0.3 +/- 0.3; P = 0.007), weight (CBT, -1.9 +/- 1.0 kg; control, 3.8 +/- 0.9 kg; P = 0.001), body fat (CBT, -1.5 +/- 0.9 kg; control, 2.3 +/- 1.0 kg; P = 0.001), and abdominal fat (CBT, -124.0 +/- 46.9 g; control, 50.1 +/- 53.5 g; P = 0.008). CBT showed a greater reduction in intake of sugared soft drinks as a percentage of total energy (CBT, -4.0 +/- 0.9%; control, -0.3 +/- 0.9%; P = 0.005 for group x time interaction), which was related to reductions in weight (r = 0.48, P = 0.04), BMI (r = 0.53, P = 0.02), and waist circumference (r = 0.54, P = 0.02). Physical activity did not change significantly. CONCLUSIONS: A 10-wk CBT program followed by 10 wk of fortnightly phone contact improved body composition in overweight and obese adolescents. Changes in soft drink consumption may have contributed to this benefit.     

运动干预对超重肥胖儿童青少年身体成分影响的网状Meta分析

目的 采用网状Meta分析方法比较有氧、抗阻、有氧结合抗阻3种运动方式对超重/肥胖儿童、青少年身体成分的影响,为儿童青少年超重/肥胖干预研究和实践提供更全面有效的证据.方法 检索中国知网、维普网、万方、PubMed、Web of Science数据库公开发表的与"运动干预对超重/肥胖儿童青少年体成分"相关的随机对照试验...     

肥胖、超重青少年通气功能与体成分关系

目的了解肥胖、超重和体重正常青少年的通气功能差异,探讨体成分对通气功能的影响.方法对研究对象测量身高、体重、腰围、臀围,采用中国肥胖问题工作组肥胖、超重筛查标准,对筛选出的肥胖(64人)、超重(56人)和对照(75人)3组青少年进行体成分和通气功能测定.结果3组青少年用力肺活量(FVC)测量值肥胖组＞超重组＞对照组,差异无统计学意义(F=25.213,P=0.000).单位体重深吸气量(IC)、单位体表面积最大通气量(MVV)均表现为对照组＞超重组＞肥胖组,差异有统计学意义(F=10.316,P=0.000;F=9.660,P=0.000).3组青少年小气道功能差异无统计学意义.肥胖、超重男生体重及瘦体重含量与通气功能呈显著正相关,肥胖男生腰围、体脂百分比与通气功能呈负相关;肥胖、超重女生体质指数(BMI)与通气功能呈负相关.结论与对照相比,肥胖、超重青少年通气功能有一定影响,小气道功能差异无统计学意义.肥胖、超重男生瘦体重对通气功能有正性作用,体脂百分比对肥胖男、女青少年通气功能有负性作用.中心性体脂分布模式对男生通气功能有负性影响.     

左旋肉碱类膳食补充对超重肥胖成年人体格指标的影响

目的 评价左旋肉碱类膳食补充对超重肥胖成年人减重干预的有效性。方法 招募北京居住一年以上20～50岁符合标准的志愿者120名,采用随机对照研究设计,将受试者随机分组,干预组60名,对照组60名。给予干预组左旋肉碱类膳食补充,同时两组均给予健康生活宣传材料,干预期为6个月。对受试者进行基线和终期2次常规体检,包括身高、体重、腰围、臀围和体脂率。结果 干预6个月后,干预组60名研究对象的体重、腰围、臀围、体质指数(Body mass index,BMI)、腰臀比和体脂率相较于对照组有明显改善,干预组体重下降2.76(SD:1.81)kg,腰围下降4.46(SD:4.34)cm,臀围下降3.48(SD:2.65)cm,BMI下降0.99(SD:0.68)kg/m²,腰臀比下降0.01(SD:0.04),体脂率下降0.97(SD:2.00)%,干预组和对照组上述指标差异具有统计学意义(体重差值t=6.277, P<0.001; 腰围差值t=5.010, P<0.001; 臀围差值t=4.452, P<0.001; 体质指数差值t=6.264, P<0.001; 腰臀比差值t=2.347, P<0.05; 体脂率差值t=2.873, P<0.05); 不同性别之间腰臀比和体脂率变化具有差异。结论 左旋肉碱类膳食补充配合运动与健康宣教能够有效降低超重肥胖人群BMI、腰臀比和体脂率水平,为超重肥胖人群减重方法的选择提供参考。     

有氧及复合运动对单纯性肥胖青少年身体形态和生化指标影响

评价有氧运动及复合运动方式对改善单纯性肥胖青少年体脂和血液生化指标的影响,为指导肥胖学生科学有效地控制体重提供参考.方法 将43名参加2015年暑期江苏某减肥夏令营的肥胖或超重青少年随机分为有氧运动组(22名)和有氧运动结合核心力量训练的复合运动组(21名),进行为期6周的运动干预.分别在入营后和出营前进行体重、体脂率、体质量指数(BMI)、腰围、臀围、大腿围等形态指标和空腹血糖(GLU)、血清胰岛素(INS)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)和低密度脂蛋白(LDL)等血液生化指标测量.结果 经过6周2种运动干预,肥胖青少年的体成分和人体围度指标均下降,与运动前差异均有统计学意义(P值均<0.05).复合运动组BMI、体脂率、腰围、臀围、大腿围、皮褶厚度的改善幅度均比有氧运动组高.6周的运动干预后,血脂、血糖和血清胰岛素的指标均有变化,且两组TC,LDL变化差异均有统计学意义(有氧运动t值分别为2.736,2.091;复合运动t值分别为2.574,2.991,P值均<0.05);复合运动组的血清胰岛素改善幅度比有氧运动组更大,差异有统计学意义(P<0.05).结论 有氧运动、复合运动干预均能有效改善肥胖青少年体脂和代谢指标.     

Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women

OBJECTIVE: To compare the effects of isocaloric, energy-restricted very low-carbohydrate ketogenic (VLCK) and low-fat (LF) diets on weight loss, body composition, trunk fat mass, and resting energy expenditure (REE) in overweight/obese men and women. DESIGN: Randomized, balanced, two diet period clinical intervention study. Subjects were prescribed two energy-restricted (-500 kcal/day) diets: a VLCK diet with a goal to decrease carbohydrate levels below 10% of energy and induce ketosis and a LF diet with a goal similar to national recommendations (%carbohydrate:fat:protein = ~60:25:15%). SUBJECTS: 15 healthy, overweight/obese men (mean +/- s.e.m.: age 33.2 +/- 2.9 y, body mass 109.1 +/- 4.6 kg, body mass index 34.1 +/- 1.1 kg/m2) and 13 premenopausal women (age 34.0 +/- 2.4 y, body mass 76.3 +/- 3.6 kg, body mass index 29.6 +/- 1.1 kg/m2). MEASUREMENTS: Weight loss, body composition, trunk fat (by dual-energy X-ray absorptiometry), and resting energy expenditure (REE) were determined at baseline and after each diet intervention. Data were analyzed for between group differences considering the first diet phase only and within group differences considering the response to both diets within each person. RESULTS: Actual nutrient intakes from food records during the VLCK (%carbohydrate:fat:protein = ~9:63:28%) and the LF (~58:22:20%) were significantly different. Dietary energy was restricted, but was slightly higher during the VLCK (1855 kcal/day) compared to the LF (1562 kcal/day) diet for men. Both between and within group comparisons revealed a distinct advantage of a VLCK over a LF diet for weight loss, total fat loss, and trunk fat loss for men (despite significantly greater energy intake). The majority of women also responded more favorably to the VLCK diet, especially in terms of trunk fat loss. The greater reduction in trunk fat was not merely due to the greater total fat loss, because the ratio of trunk fat/total fat was also significantly reduced during the VLCK diet in men and women. Absolute REE (kcal/day) was decreased with both diets as expected, but REE expressed relative to body mass (kcal/kg), was better maintained on the VLCK diet for men only. Individual responses clearly show the majority of men and women experience greater weight and fat loss on a VLCK than a LF diet. CONCLUSION: This study shows a clear benefit of a VLCK over LF diet for short-term body weight and fat loss, especially in men. A preferential loss of fat in the trunk region with a VLCK diet is novel and potentially clinically significant but requires further validation. These data provide additional support for the concept of metabolic advantage with diets representing extremes in macronutrient distribution.     

Anthropometric and psychosocial changes in obese adolescents enrolled in a Weight Management Program

OBJECTIVE: To determine short- and long-term effects of the Bright Bodies Weight Management Program on obese adolescents and to further observe if a diet or nondiet approach is more successful. DESIGN: Twenty-five obese adolescents completed a 1-year, comprehensive weight-management program and returned for a 2-year follow-up. Adolescents were 11 to 16 years old (17 female, eight male) with mixed ethnic backgrounds. Although the program emphasizes a nondiet approach, eight children requested a structured meal plan (diet approach), while 17 were taught to make better food choices (nondiet approach). Body mass index (BMI) z score, body fat percent, and self-concept were measured at 0, 1, and 2 years. Outcomes were analyzed for the entire group and by diet method groups. STATISTICAL ANALYSIS: Changes in outcome variables were evaluated using covariance pattern models for repeated measures. RESULTS: At 1 year, the entire group (N=25) demonstrated a decrease in BMI z score (P <.001) and body fat percent (P <.001), while self-concept scores increased (P <.001). At 2 years, the decrease in BMI z score was still significant (P =.004) and body fat percent and self-concept scores remained improved, although not significant compared to baseline (P =.15 and P =.10, respectively). When comparing dietary approaches, the dieting group (n=8) tended to show favorable results short-term for BMI z score at year 1 (P =.11), but by year 2, the nondieting group (n=17) further improved BMI z score (P =.006), while the dieting group reverted toward baseline. CONCLUSIONS: The Bright Bodies Weight Management Program was successful at decreasing BMI z scores both short and long term. In a separate analysis, dieting showed more superior short-term results, but a nondiet approach demonstrated improved long-term results.     

Effects of a reduced-glycemic-load diet on body weight, body composition, and cardiovascular disease risk markers in overweight and obese adults

BACKGROUND: Lowering the dietary glycemic load and increasing protein intake may be advantageous for weight management. OBJECTIVE: This randomized controlled trial was designed to evaluate the effects of an ad libitum reduced-glycemic-load (RGL) diet on body weight, body composition, and cardiovascular disease (CVD) risk markers in overweight and obese adults during an initial weight-loss phase (12 wk) and a weight-loss maintenance phase (weeks 24-36). DESIGN: Subjects were assigned to RGL (n = 43) or low-fat, portion-controlled (control; n = 43) diet groups. The RGL group was instructed to eat until satisfied, maintaining a low carbohydrate intake during weeks 0-2 and adding low-glycemic-index carbohydrate thereafter. Control subjects were instructed to reduce fat intake and decrease portion sizes, with a targeted energy deficit of 500 to 800 kcal/d. RESULTS: The RGL group had lost significantly more weight than did the control group at week 12 (-4.9 and -2.5 kg, respectively; P = 0.002), but the 2 groups did not differ significantly at week 36 (-4.5 and -2.6 kg, respectively; P = 0.085). Changes in fat mass differed between the groups at week 12 (-1.9 and -0.9 kg, respectively; P = 0.016) but not at week 36 (-2.0 and -1.3 kg, respectively; P = 0.333). At the end of the study, no differences were found in responses for CVD risk markers except a larger mean change in HDL cholesterol in the RGL group than in the control group (3.8 and 1.9 mg/dL, respectively; P = 0.037). CONCLUSION: These findings provide evidence that an ad libitum RGL diet is a reasonable alternative to a low-fat, portion-controlled eating plan for weight management.     

综合干预对肥胖男性青少年血管生成素样蛋白2和血管内皮功能的影响

  目的  观察运动结合饮食控制的综合干预方案对肥胖男性青少年血管生成素样蛋白2(angiopoietin-likeprotem 2, ANGPTL2)和血管内皮功能的影响，为运动降低肥胖男性青少年心血管疾病风险提供理论依据。  方法  选取42名肥胖男性青少年和10名健康男性青少年分别为实验组和对照组，对实验组青少年开展6周运动结合饮食控制的综合干预，测定干预前后身体形态和血压、糖脂代谢、炎症水平和血管内皮功能的变化。  结果  6周综合干预后，实验组青少年的体重、体质量指数(BMI)、腰围、腰臀比、收缩压、舒张压指标均降低(P值均 < 0.05)；总胆固醇、三酰甘油、低密度脂蛋白胆固醇血脂水平均降低(P值均 < 0.05)；肿瘤坏死因子α、ANGPTL2炎症水平均降低(P值均 < 0.05)；反应性充血指数(RHI)、一氧化氮/内皮素-1(NO/ET-1)、一氧化氮、动脉粥样硬化指数(AI)血管内皮功能显著改善(P值均 < 0.05)。综合干预前后，肥胖男性青少年的ANGPTL2变化值与体重(r=0.37)、BMI(r=0.45)、RHI(r=-0.46)、NO/ET-1(r=-0.41)、NO(r=-0.45)、AI(r=0.33)的变化值显著相关(P值均 < 0.05)。  结论  综合干预能有效改善肥胖男性青少年的身体形态、血脂水平和血管内皮功能，降低ANGPTL2水平。ANGPTL2可能参与了综合干预对肥胖男性青少年血管内皮功能的改善过程。