��ﻼ������Y����Ũ�ȱ仯���ٴ�����

目的探讨癫癎患儿血浆和脑脊液中神经肽Y(NPY)质量浓度的变化及临床意义.方法 2003年7月至2004年5月,采用放射免疫分析方法测定沈阳医学院奉天医院53例癫癎患儿血浆和脑脊液中NPY质量浓度,其中原发性癫癎43例,继发性癫癎10例;原发性癫癎未经治疗者34例,治疗后仍有抽搐发作者9例,并与对照组比较.结果 (1)癫癎患儿血浆NPY(210.57±71.28)pg/mL明显高于对照组(159.99±65.10)pg/mL,差异有显著意义(P<0.01).(2)原发性癫癎与继发性癫癎血浆NPY[(210.57±71.28)pg/mL与(219.25±97.14)pg/mL]相比,差异无显著意义(P>0.05).(3)原发性癫癎未经治疗者与治疗后仍有抽搐发作者血浆NPY[(205.57±63.89)pg/mL与(229.44±96.61)pg/mL]相比,差异无显著意义(P>0.05).(4)癫癎患儿脑脊液中神经肽Y(45.81±7.39)pg/mL明显高于对照组(19.73±5.12)pg/mL,差异有显著意义(P<0.01).结论癫癎患儿血浆和脑脊液中NPY质量浓度显著增高,可作为诊断癫癎的一项生化参考指标.     

6�����ڽ�����Ӥغͪ �����������������������Ѫ��Ũ�ȱ仯����

目的探讨6月龄内健康男婴睾酮、黄体生成素(LH)与促卵泡生成素(FSH)的血清浓度变化及意义。方法收集2010年4月至2011年10月重庆医科大学附属儿童医院6月龄内健康足月分娩男婴336名的血清标本,采用免疫化学发光法测定其睾酮、LH及FSH的浓度。结果睾酮于生后<1d达第一个高峰[(28.45±11.92)nmol/L];于10～<50d达第二个高峰[(8.41±3.83)nmol/L],峰值较第一个低,随后下降,4～6个月降至(0.48±0.45)nmol/L。LH、FSH于生后数月内均有短暂升高,以LH升高为主。LH、FSH在生后数天内保持在一个低浓度,随后开始升高,于10～<50d达高峰,之后下降,于4～6个月LH浓度降至(0.43±0.47)U/L,FSH浓度降至(0.48±0.51)U/L。结论男婴生后6个月内血清睾酮及促性腺激素浓度均有短暂升高,对男婴性腺发育有重要作用。     

��Ⱦ�Լ������������ļ�ø�ı仯���ٴ�����

感染性疾病常常合并心肌损伤,本文对2003年7月至2004年3月住院的感染性疾病31例同时检测α羟丁酸脱氢酶(αHBDH)、肌酸磷酸激酶同工酶MB(CK MB)、心肌肌钙蛋白I(cTnI),以观察其对心肌损伤的诊断价值。对象:31例中男13例,女18例,平均年龄3.9岁,其中上呼吸道感染5例,支气管炎7例(6例为支原体感染),支原体肺炎1例,鼻窦炎2例,咽炎、增殖体肥大1例,泌尿系感染2例,肠系膜淋巴结炎1例,毛细支气管炎2例,支气管肺炎3例,肠炎1例,肺炎并心衰1例,喘息性支气管炎2例,幼儿急疹1例,肺炎并心肌炎1例,心肌炎1例(巨细胞包涵体病毒感染)。所有患儿均进行…     

�����������Է���������þ����Ũ�ȱ仯���ٴ�����

目的探讨哮喘儿童急性发作期血镁、尿镁、红细胞内镁离子的浓度变化,了解尿镁在判断低镁缺乏症中的意义。方法观察组为自2001年9月至2004年12月浙江省东方医院以及鄂州市中心医院就诊的哮喘急性发作期患儿100例,年龄3~14岁;对照组为同时期、相同年龄段的托幼机构、学校健康儿童80例。2组研究对象均取静脉血3mL、同时收集24h尿,记录尿量。全自动生化分析仪检测血镁、血钙,尿镁、尿肌酐和红细胞内镁浓度。结果观察组尿镁、红细胞内镁浓度明显低于对照组(P<0·001);两组儿童血镁、血钙差异无显著性(P>0·05)。结论儿童哮喘在急性发作期会合并镁缺乏症,尿镁浓度测定是判断是否有镁离子缺乏的简单、有效方法,血浆镁浓度不能作为衡量体内镁离子平衡的一个可靠指标。     

��������Էμ���֧���ܷ��ݹ�ϴҺ��ϸ������ʵı仯

目的探讨细胞外基质在早产儿慢性肺疾病(CLD)支气管肺泡灌洗液(BALF)中动态改变及其在CLD形成中的作用。方法对1999-12—2004-11在华中科技大学同济医院NICU住院需机械通气的62例患儿每日行支气管肺泡灌洗,并检测灌洗液中细胞总数及分类、透明质酸(HA)、Ⅲ型胶原(PCⅢ)及羟脯氨酸(Hyp)水平。病例分为4组:肺炎组20例;肺透明膜病(HMD)组13例;CLD组15例;对照组14例(无肺部疾病者)。结果(1)CLD组BALF中HA和PCⅢ水平分别较肺炎组及HMD组明显升高,并且也分别高于对照组BALF中的水平;(2)CLD组BALF中的HA和Hyp均分别与细胞总数和中性粒细胞数(%)呈正相关,而PCⅢ与肺泡巨噬细胞总数呈正相关。另外,HA、PCⅢ及Hyp之间均呈明显的正相关。结论CLD患儿肺内HA、PCⅢ及Hyp产生增多;BALF中HA、PCⅢ及Hyp的水平从不同侧面反映了疾病活动性并具有估计预后的作用。     

����H1N1����Σ�ػ���5���ٴ��ص����

??Abstract??Objective??To discuss the clinical features and realizations of severe influenza A??H1N1?? virus infection in children. Methods??Analyzed the clinical features?? laboratory examinations and imaging data of 5 children with severe influenza A??H1N1?? virus infection. Results??5 children with severe influenza A??H1N1?? virus infection do not have special symptoms and signs?? just have flu-like symptoms such as fever?? cough?? headache?? some children are also accompanied with digestive symptoms such as abdominal pain?? vomit and diahorrea. When the patients’ conditions worsen?? they have bad coughs?? breathing difficulties?? wet rales in the lungs?? high heart rates?? poor peripheral circulation?? drowsiness or dysphoric and so on. The patients often experience MODS?? among them the lungs are prominent. In laboratory examinations?? white blood cells counts normal?? low or high?? most patients experience abnormal function of the liver?? kidney and coagulation. The main x-ray manifest that many parts of the lungs are damaged. Conclusion??Severe influenza A??H1N1?? virus infection in children develop at an alarming rate?? the risk of death is high. Early recognization?? early diagnosis and early treatment is the key to decrease the death rate of severe influenza A??H1N1?? virus infection.     

C������-ƥ�˲�4���ٴ�����

目的分析C型尼曼-匹克病(NPC)临床特征、诊断及治疗方法。方法总结中南大学湘雅医院2006年1月至2010年4月收治的4例NPC患儿的临床表现、实验室资料及治疗情况。结果 4例起病年龄6个月至10岁。首发症状为步态不稳2例,吐字不清1例,脾大1例。就诊时主要症状为内脏受累和锥体外系症状。骨髓细胞学检查发现典型尼曼-匹克细胞和海蓝细胞各2例。4例均予低脂饮食、多种维生素等支持治疗,2例给予抗癫痫治疗。随访1个月至4年,1例死亡,3例智力运动发育仍在倒退。结论 NPC是一种致死性常染色体隐性遗传病,临床表现为肝脾大、共济失调、神经退行性改变和脑干功能损害。本病目前尚无特效治疗,美格鲁特(Miglustat)早期治疗可延缓神经系统症状的出现时间、延长寿命。     

С�����ظβ������̺�ϸ��֢7���ٴ�����

目的探讨严重肝病并棘刺红细胞症的临床特点。方法对2001年1月至2005年5月间桂林医学院附属医院儿科收治的7例严重肝病并棘刺红细胞症患儿的症状、体征,血细胞光镜检查,肝功能,血脂检查,预后,并结合文献资料进行总结分析。结果7例中男4例,女3例,年龄5个月至9岁,主要临床表现有黄疸(6例)、出血(3例)、贫血(7例)、肝肿大(6例)或肝硬化(1例)、脾肿大(3例),外周血中棘刺红细胞占所有红细胞的8·5%~94·4%,肝功能损害明显,血脂均有不同程度的改变。结论严重肝病并棘刺红细胞症临床罕见,这7例患儿的共同特点是:(1)原发病各异;(2)病程长;(3)有程度不等的贫血,红细胞平均容积(MCV)以增大为主;(4)外周血中均有多少不等的棘刺红细胞;(5)肝功能损害明显;(6)血脂均有多项改变;(7)预后不良。     

��ͯ������˯�ߺ�����ͣ��ͨ���ۺ���Ѫ�����Ͷȱ仯����

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)儿童血氧饱和度(SpO2)的变化。方法选择于2009年7月至2010年3月因存在打鼾、睡眠张口呼吸、睡眠憋气或呼吸暂停等睡眠呼吸相关问题,在首都儿科研究所附属儿童医院进行整夜睡眠监测的141例患儿,以呼吸暂停低通气指数(AHI)>5作为OSAHS诊断标准,将入组儿童分为OSAHS组(78例)和非OSAHS组(63例),比较两组血氧指标、OSAHS儿童快速眼动期(REM期)和非快速眼动期(NREM期)的血氧指标。结果 OSAHS组和非OSAHS组相比,最低SpO2和氧减指数(ODI)差异具有统计学意义(Z=-3.64,-5.67,P<0.01),平均SpO2两者相比差异无统计学意义(Z=-0.90,P>0.05)。OSAHS组REM期和NREM期相比,ODI和每小时氧减事件时间差异存在统计学意义(Z=-5.568,-5.937,P<0.05),平均SpO2、最大氧减百分比和最长氧减时间差异无统计学意义(t=0.364,1.868,t=-0.33,P>0.05)。结论 OSAHS儿童存在SpO2的下降,而且REM期同NREM期相比,SpO2下降频率高,持续时间长...     

��­�����ճ������Ѫ�����������ʻ�����Ѫ������ѧ�仯����

??Objective To analyze the cerebral blood flow dynamics of vasovagal syncope??VVS?? by transcranial cerebral Doppler??TCD?? and explore the clinical value of TCD to VVS. Methods A total of 38 children with vasovagal syncope and 20 healthy children received head-up tilt test??HUTT??. In the process of test??they were monitored by TCD. Results Under basic condition??there were no obvious differences between patients and healthy children on the result of TCD. In the process of HUTT for healthy children??there were no obvious differences on the result of TCD. In the process of HUTT for vasovagal syncope children??compared with data of TCD under basic condition??the cerebral blood flow velocity??Vs??Vd??Vm?? and pulse index??PI?? had great improvement when syncope was induced by HUTT. Conclusion Patients with vasovagal syncope have obstacles in terms of cerebral blood flow regulation. TCD can become a routine examination method in those children with vasovagal syncope.     

Myelin basic protein in cerebrospinal fluid from children

Forty-one cerebrospinal fluid (CSF) specimens from children were investigated with a radioimmunoassay for their content of myelin basic protein (BP). Eight specimens were regarded as BP-positive (BP1.0 ng/ml). Twenty-nine were BP-negative and 4 could not be analyzed because of an excessive protein content. The BP-positive samples were from 6 children with evidence of severe acute brain damage leading to death in 5 cases: i.e., 2 term newborns with perinatal asphyxia, a 4 week-old child with severe convulsions, a 3 year-old boy with hypoxia due to laryngitis, and a 12 year-old girl with encephalitis. One preterm baby survived severe hypoxia and developed hydrocephalus shortly afterwards. We conclude that BP becomes detectable in CSF of newborns and older children under certain pathological conditions, and that the presence of BP in CSF may be associated with severe brain tissue destruction.Supported by Deutsche Forschungsgemeinschaft, SFB 33     

新生儿细菌性脑膜炎脑脊液一氧化氮检测的临床意义

目的旨在探讨一氧化氮(NO)在新生儿细菌性脑膜炎中的作用及临床意义。方法18例细菌性脑膜炎患儿,随机分为抗生素组10例,抗生素+地塞米松组8例,均于入院时(治疗前),入院后5、10d3个时间段,行腰穿抽取脑脊液,用硝酸根还原法测定其亚硝酸盐浓度。结果(1)治疗前细菌性脑膜炎组脑脊液亚硝酸盐浓度为(4.98±0.28)μmol L,显著高于对照组(1.64±0.30)μmol L(t=6.68,P<0.01),经治疗后亚硝酸盐浓度渐下降,脑脊液恢复正常后亚硝酸盐浓度(1.08±0.59)μmol L与对照组(1.64±0.28)μmol L比较无差异(t=0.12,P>0.05);(2)两治疗组(抗生素,抗生素+地塞米松组)治疗前、中、后脑脊液亚硝酸浓度比较无显著差异;(3)细菌性脑膜炎组脑脊液亚硝酸盐浓度与脑脊液糖含量负相关,与蛋白质含量、白细胞计数中度相关。4例近期有神经系统并发症患儿(3例脑室扩大,1例硬膜下积液),脑脊液亚硝酸盐浓度(6.98±2.31)μmol L与无上述并发症14例患儿脑脊液亚硝酸盐浓度(4.41±1.39)μmol L有显著差异。结论NO也参与新生儿细菌性脑膜炎病理生理过程,且与预后有一定相关性,地塞米松使用未见降低脑脊液中NO水平。     

�Լ�Һϸ��ѧ���170������

目的总结170例脑脊液(CSF)细胞学的检查结果,分析其在小儿神经系统疾病或具有中枢神经系统表现疾病诊断中的临床意义。方法2000-06—2004-04河北省儿童医院对170例患儿进行CSF细胞学检查,CSF标本经玻片离心法制片,常规采用迈-格-姬染色后观察。结果CSF细胞学检查结果发现包括特异性病原体与恶性肿瘤,共4例,占全部CSF检查的2.3%,其中新型隐球菌2例,脑膜白血病2例。跟踪观察治疗前后CSF细胞学变化89例,其中结核性脑膜炎20例,化脓性脑膜炎29例,病毒性脑炎40例,治疗前后CSF细胞学检查主要表现为细胞成分及数量的变化。结论CSF细胞学检查对小儿神经系统疾病的临床诊断和治疗有重要意义,其特异性发现恶性肿瘤主要为脑膜白血病,病原体以新型隐球菌多见。脑脊液细胞学检查能直接、客观地评价临床疗效。     

窒息新生儿血浆神经肽Y测定及临床意义

目的：研究窒息新生儿血浆神经肽Y(NPY)及β内啡肽(βEP)的含量,探讨它们与新生儿窒息及窒息后脑损伤的关系。方法：采用放射免疫分析法测定37例窒息新生儿及12例健康新生儿(对照组)血浆NPY及β－EP的含量,同时行头颅CT检查,并测定脑实质CT值。结果：重度窒息组血浆NPY及β EP明显高于对照组［(1.85±1.10) μg/L vs (0.04±0.03) μg/L,(2.0 3±1.45)μg/L vs (0.06±0.04) μg/L］,差异有显著性(P<0.01);轻度窒息组NPY及β EP［(0.47±0.38) μg/L,(0.34±0.33)μg /L］低于重度窒息组(P<0.01),但高于对照组(P<0.01)。轻、重度窒息组脑CT值水平分别为(15.60±2.20) Hu和(13.08±2.18) Hu,均低于正常对照组［(20.16±2.66) Hu］(P<0.01);其中重度窒息组脑CT值低于轻度窒息组(P<0.01)。重度窒息组NPY和β EP呈正相关(r=0.4220,P<0.05)。结论：血浆NPY,β-EP含量及脑CT值与窒息程度密切相关。窒息越重,血浆NPY和β-EP含量越高,CT值越低。NPY,β-EP可作为观察新生儿窒息程度和窒息后脑损伤的指标。     

脑脊液细胞因子检测在小儿中枢神经系统感染鉴别诊断中的意义

目的　探讨脑脊液 (CSF)γ 干扰素 (IFN γ)、粒细胞集落刺激因子 (G CSF)、α肿瘤坏死因子 (TNF α)、白细胞介素 6 (IL 6 )及白细胞介素 8(IL 8)的变化在小儿中枢神经系统感染 (CNSI)中的诊断价值。方法　采用双抗体夹心ELISA法检测 14例化脓性脑膜炎 (PM)、30例病毒性脑膜炎 (VM)及2 2例非中枢神经系统感染患儿CSF中IFN γ、G CSF、TNF α、IL 6及IL 8水平。结果　PM组G CSF及IL 8[(132± 4 1)、(2 5 3± 0 5 6 ) μg/L]水平明显高于VM组 [(5 3± 2 2 )、(0 5 3± 0 4 6 ) μg/L](P <0 0 0 1) ;IFN γ在VM组 [(2 0± 0 4 ) μg/L]水平明显高于PM组 [(0 8± 0 5 ) μg/L](P <0 0 1) ;各脑膜炎组中TNF α及IL 6水平均高于对照组 (P <0 0 0 1) ,但各组间比较差异无显著性。G CSF及IL 8水平增高程度与CSF中性粒细胞计数呈正相关 ;IFN γ增高程度与CSF白细胞数及葡萄糖定量间无相关性。结论G CSF、INF γ及IL 8在CSF中显著增高有助于PM与非PM的鉴别诊断 ;TNF α、IL 6在感染性脑膜炎发病过程中的作用是非特异性的 ,其在CSF中的变化对感染性脑膜炎患儿鉴别诊断无临床意义     

Excitatory amino acid levels in cerebrospinal fluid of patients with infantile spasms

Infantile spasm is an age-specific epileptic encephalopathy. Long-term intellectual outcome of affected infants remains poor. The pathogenesis of infantile spasms, as well as the development of mental retardation, remains unclear. Increased excitatory amino acid neurotransmission may play a role in neuronal dysfunction and epilepsy. To study the significance of cerebrospinal fluid excitatory amino acids in infantile spasms, we determined glutamate and aspartate concentrations in cerebrospinal fluid of 13 patients with infantile spasms and 13 controls. The aspartate level in cerebrospinal fluid of the patients with infantile spasms (968 ± 416 nmol/1) was higher than the control group (426 ± 272nmol/l). No difference in the mean glutamate levels was found between the patients (966 ± 395 nmol/1) and the controls (1135 ± 594 nmol/1). The elevated aspartate levels in cerebrospinal fluid of the patients with infantile spasms might be secondary to change in metabolism of aspartate. Aspartate is an excitatory and neurotoxic neurotransmitter, which might have a role in triggering the spasms and the development of neuronal dysfunctions in the patients with infantile spasms.     

神经肽Y神经在大鼠膀胱中的分布和膀胱去神经后的变化

测定神经肽Ｙ神经在正常大鼠和经手术神经后的大鼠膀胱中的分布情况。方法用ＰＡＰ免疫组织化学方法测定１０对大鼠膀胱中ＮＰＹ阳性神经的分布。结论大鼠膀胱底,体部均有ＮＰＹ肽能神经分布。大部分ＮＰＹ神经均是外源性神经。ＮＰＹ神经可能与膀胱排密切相关。     

Measurement of cerebrospinal fluid protein is unnecessary in children with leukemia

To determine the incidence and importance of abnormal cerebrospinal fluid (CSF) protein in children with acute leukemia, we performed a retrospective chart review. On 160 pediatric patients a total of 2,172 LPs were performed (median per patient = 15; range 1-38). Overall, 314 (14%) of CSF protein measurements were abnormal: 141 (7%) were abnormally low (<15 mg/dL) and 158 (7%) were abnormally high (>45 mg/dL). In no case did an abnormal CSF protein impact patient management. We conclude that routine measurement of CSF protein is not indicated in children with acute leukemia.     

细菌性脑膜炎患儿脑脊液一氧化氮变化的研究

目的观察细菌性脑膜炎患儿脑脊液一氧化氮(NO)的变化及地塞米松对其的影响.方法应用Griess法和氨基酸自动分析仪检测23例细菌性脑膜炎患儿脑脊液中NO代谢终产物--亚硝酸盐和NO前体--L-精氨酸的浓度,并将31例无神经系统疾病患儿的脑脊液作为对照组.结果(1)治疗前,细菌性脑膜炎患儿脑脊液亚硝酸盐浓度[(10.76±4.09)μnol/L]明显高于对照组[(2.69±1.20)μnol/L],差异有显著性(t1=10.41,P＜0.01);经治疗后,脑脊液亚硝酸盐浓度渐下降.脑脊液指标恢复正常后,亚硝酸盐浓度[(3.00±1.16)μmol/L]与对照组差异无显著性(t=1.24,P＞0.05).(2)23例细菌性脑膜炎患儿中,14例单用抗生素治疗,其余9例在抗生素治疗的基础上,加用地塞米松治疗.抗生素+地塞米松治疗组脑脊液亚硝酸盐浓度[(5.92±1.90)μnol/L]显著低于单用抗生素组[(8.86±3.50)μnol/L],差异有显著性(t=2.30,P＜0.05).(3)细菌性脑膜炎患儿治疗前脑脊液L-精氨酸浓度[(12±6)μmol/L]显著低于对照组[(17±8)μnol/L],差异有显著性(t＝2.29,P＜0.05).结论NO参与了细菌性脑膜炎的病理过程,而地塞米松能部分抑制NO的过度产生.     

Osmolality and electrolytes in cerebrospinal fluid and serum of febrile children with and without seizures

Abstract During acute febrile diseases mild disturbances of water and electrolyte balance occur frequently. It has been suggested that changes in electrolyte balance, in particular hyponatraemia, might predispose a child to convulsions during febrile illness; however, the changes of electrolytes in the CSF are not known.We have studied the effects of fever and convulsions on water and electrolyte balance in CSF and serum by measuring osmolality and electrolyte concentrations in children. The febrile population consisted of 60 children, 36 of whom had seizures during fever. Twenty-one children without convulsions and nine children with epileptic symptoms were nonfebrile controls. We noticed that CSF is subject to changes in osmolality and electrolyte concentration during fever, while convulsions do not exhibit such changes. CSF osmolality and sodium concentrations were lower in febrile children than in nonfebrile controls. The osmolality in febrile children with convulsions was 3.8% (P<0.01) and without seizures 3.5% (P<0.01) lower than in nonfebrile nonconvulsive children. The changes in CSF sodium concentration, and to a lesser extent potasium and chloride concentrations, paralleled those of CSF osmolality. A positive correlation was observed between the CSF and serum osmolatities (r=0.73,P<0.0001), and sodium concentrations (r=0.63,P<0.0001). A negative correlation between the body temperature and both CSF osmolality (r=–0.66,P<0.0001) and sodium concentration (r=–0.59,P<0.0001) exhibits also the important regulative role of increased body tmeperature.Conclusion Fever is an important factor for disturbances in fluid and electrolyte balance. The alterations in CSF osmolality and sodium concentration do not, however, give an unambiguous explanation for the susceptibility to simple febrile seizures.