中国实用儿科杂志

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小儿结核病误诊原因及分析

赵顺英

2005, 20(06): 321-322 .

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常见病毒感染误诊原因及分析

方峰

2005, 20(06): 322-324 .

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非典型微生物感染误诊原因及分析

刘春峰

2005, 20(06): 324-325 .

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常见肿瘤误诊原因及分析

陈纯,李文益

2005, 20(06): 325-327 .

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儿童类风湿性关节炎误诊原因及分析

杨军,李永柏

2005, 20(06): 327-329 .

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某些川崎病病例易被延误诊断的原因及分析

张乾忠

2005, 20(06): 329-331 .

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局部感染误诊原因及分析

胡皓夫,解启莲

2005, 20(06): 331-333 .

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结核性中耳炎伴结核性脑脓肿误诊1例

姜敏,焦安夏,徐保平,马云,张桂芳

2005, 20(06): 333-333 .

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经食管超声心动图在小儿先天性心脏病围术期的应用价值

马晓静,梁雪村,黄国英,吴琳,陈张根,贾兵

2005, 20(06): 334-336 .

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目的评价经食管超声心动图(TEE)对指导小儿先天性心脏病(先心病)外科手术和介入治疗的应用价值及其安全性。方法 2000年11月至2005年1月，在上海市复旦大学附属儿科医院心血管中心接受外科开胸手术或经导管介入治疗的先心病患儿中有317例进行了TEE检查，年龄2个月至17岁6个月(平均4.7岁)。采用HP/SONOS2500超声诊断仪，频率5.5~7.5MHz双平面经食管探头，全麻状态下进行。结果与术前经胸超声心动图(TTE)比较，术前TEE检查对诊断作出修正或补充者51例(16.1%)，其中因此而修正了手术治疗方案25例(7.9%)。术后TEE检查发现有并发症或残余问题57例(18.0%)，其中8例(2.5%)因此立即再次手术。所有病例均未因TEE检查而引起并发症。结论 TEE可安全地应用于小儿先心病围术期检查，对术前诊断做出修正或补充，术后可及时发现并发症或残余问题。

Abstract Objective To evaluate the utility of transesophageal echocardiography (TEE) for surgical and interventional repairs in children with congenital heart disease (CHD) and its safety as well.Methods 317 patients with CHD underwent TEE examinations at the age of 2 months~17 years and 6 months(mean 4.7 years).HP/SONOS2500 ultrasonic instrument with transesophageal biplane probe of 5.5~7.5MHz was used to perform TEE under general anesthesia.Results Compared with preoperative transthoracic echocardiography(TTE),TEE had new findings or made revision of the diagnoses in 51 cases(16.1%) before operations,which led to the changes of surgical or interventional precedure in 25 cases(7.9%).TEE had found residual problems or evolving situations in 57 cases(18.0%) after operations,which led to a second immediate surgical intervention in 8 cases(2.5%).There were no detectable complications due to TEE in all cases.Conclusion TEE is valuable in providing meaningful preoperative emendations or additions and finding residual problems after operations. The technique is safe in children.
Key words Transesophageal echocardiography (TEE);Congenital heart disease (CHD);Perioperative period;Children

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反复呼吸道感染儿童血清甘露聚糖结合凝集素水平及54密码子基因突变筛查

王墨,李秋,王晓刚,王莉佳

2005, 20(06): 337-339 .

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目的了解反复呼吸道感染(RRTI)儿童血清甘露聚糖凝集素(MBL)水平及第一外显子54密码子的突变率，探讨血清MBL水平与RRTI的关系。方法用ELISA方法检测2000~2003年在重庆医科大学附属儿童医院就诊的65例RRTI儿童和238名正常儿童血清MBL水平，测定其中11例低MBL血症的RRTI儿童的免疫学指标(IgG、IgA、IgM、C3、C4)，并用聚合酶链反应(PCR)限制性内切酶片段长度多态性分析(RFLP)方法与55名正常儿童MBL第一外显子54密码子基因多态性进行分析。结果RRTI儿童出现低血清MBL水平频率明显多于正常儿童(χ²=6.96,P<0.05)，其MBL54密码子突变率亦明显增高(P<0.05)，低血清MBL血症导致RRTI主要在2岁以前，血清MBL水平越低，感染频率越高，其C3、C4水平也越高。结论儿童MBL54密码子突变导致低MBL血症在2岁以前有反复呼吸道感染的倾向，MBL水平越低，感染机率越高。

Abstract Objective To detect the mannosebinding lectin (MBL) serum levels and the mutation on code 54 of MBL in children with recurrent respiratory tract infections(RRTI),and to find the relationship between MBL serum levels and recurrent respiratory tract infections(RRTI).Methods To detect the serum MBL level of 238 normal people and 65 children with RRTI through the methods of enzymelinked immunoadsordent assay,then compare the immune data(IgG,IgA,IgM,C3,C4) of 11 children with low serum MBL level and compare the rate of the mutation on code 54 through the methods of polymerase chain reaction(PCR)restriction fragment length polymorphism (RFLP) with 55 normal children.Results The rate of low serum MBL level in the children with RRTI was higher than that in the normal population(χ²=6.96,P<0.05),the same went for the frequency of mutation of code 54 (P<0.05).RRTI caused by low serum MBL level occurred mostly among children under 2 years of age,and the rate of respiratory tract infection in the individuals with MBL level under 100μg/L was more than that in children with levels ranged from 100μg/L to 200μg/L (P<0.05),and was associated with reverse chang of serum levels of C3,C4(P<0.05).Conclusion Under 2 years of age,the children with the low serum MBL levels caused by mutation on MBL54 show the susceptivity to IRRTI,and the low serum MBL level is parallel to high serum levels of C3，C4，and the lower the level the more possible infection.
Key words Mannosebinding lectin;Repeated respiratory tract infections;Gene;Polymorphism;Child

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原发性肾病综合征患儿肾组织核因子-κB活化水平与病理类型及尿蛋白关系

赵红洋,孙若鹏,甄军晖,董俊华

2005, 20(06): 340-341 .

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目的探讨原发性肾病综合征(PNS)患儿肾组织核因子-κB(NF-κB)活化水平及其与肾组织病理类型、24h尿蛋白定量的关系。方法 2002年2月至2004年9月，收集山东大学齐鲁医院小儿内科51例PNS患儿活检肾组织及5例肾脏手术切除的正常肾组织。采用免疫组织化学染色法及多媒体彩色病理图文分析系统MPIAS-500，观察PNS患儿各病理类型肾组织及正常肾组织NF-κB的活化水平，同期收集PNS患儿24h尿蛋白定量。结果微小病变型(MCD)、非微小病变型(NMCD)PNS患儿肾小球及肾小管中NF-κB活化水平均较对照组显著增强；NMCD患儿肾小球及肾小管中NF-κB的表达水平显著高于MCD患儿；20例系膜增殖性肾小球肾炎(MsPGN)患儿肾组织NF-κB活化水平随系膜增殖程度加重而增高；PNS患儿肾小球及肾小管NF-κB表达水平与24h尿蛋白定量呈显著正相关。结论PNS患儿肾小球及肾小管中NF-κB活化水平上调，且与组织病理类型、尿蛋白量相关，NF-κB的异常活化在PNS发病中起重要作用。

Abstract Objective To study activation of transcription factor NFKappa B(NF-κB) and its role in regulating the expression of inflammatory mediators involved in pathogenesis of primary nephrotic syndrome (PNS).Methods To explore the role of NF-κB in the pathogenesis of PNS in children,and its significance for pathological changes as well as 24hour urine protein excretion,we examined NF-κB activity in glomeruli and tubular tissues by twostep immunohistochemical staining from the kidney biopsy specimen of 51 children with PNS,and from 5 patients after renal operation.Results We found that NF-κB activity significantly increased both in MCD and NMCD children compared with the controls,and the activation of NF-κB in MCD was different from that of NMCD;there was also statistical difference of NF-κB activity between mild,moderate,severe MsPGN and the controls Additionally,positive correlation was observed between NF-κB activity of glomeruli and renal tubules and 24hour urine protein excretion.Conclusion These results suggested that the upregulated activation of NF-κB in glomerular and tubular tissues of children with PNS is related to severity,pathological changes and urine protein excretion,and involved in the pathogenesis of PNS.
Key words Nuclear factor kappa B;Primary nephrotic syndrome;Pathology;Children

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大剂量维生素C对川崎病急性期肱动脉血流介导扩张反应影响的临床观察

孙东明,王宏伟,施虹,程佩萱,常青,邓又斌

2005, 20(06): 342-344 .

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目的观察大剂量维生素C(VitC)对川崎病(KD)急性期肱动脉血流介导的扩张反应(FMD)的影响，探讨VitC对KD急性期血管内皮功能障碍是否有改善作用。方法采用高分辨率多普勒超声仪测定2001年1月至2002年12月在华中科技大学同济医学院附属同济医院儿科住院的36例KD急性期患儿(KD组)及15名健康儿童(正常对照组)肱动脉FMD，并比较KD组静脉滴注大剂量VitC(200mg/kg，最大量为4g)和安慰剂(10%葡萄糖)前后肱动脉FMD的变化。结果 KD组肱动脉FMD明显低于正常对照组(P<0.001)；KD组静滴大剂量VitC后肱动脉FMD明显增加(P<0.01)，静滴安慰剂后肱动脉FMD无明显增加(P>0.05)。结论大剂量VitC能明显改善KD急性期肱动脉FMD，其对KD急性期血管内皮功能障碍可能有显著改善作用。

Abstract Objective To observe the effect of high dose vitamin C on flow mediated vasodilation(FMD) of brachial artery in acute phase of Kawasaki disease(KD) and investigate whether high dose vitamin C could improve vascular endothelial dysfunction in KD.Methods Using high resolution vascular ultrasound,we measured FMD of the brachial artery of 36 patients who were admitted to our hospital from Jan.2001 to Dec.2002. in acute phase of KD and 15 matched healthy subjects as controls.Studies were performed before and after intravenous infusion of high dose vitamin C (200mg/kg，max≤4g) or placebo in KD group.Results The FMD of the brachial artery in KD group was significantly lower than that in the control group (3.55±3.00% vs 10.34±4.29%，P<0.001).Intravenous infusion of vitamin C significantly increase the FMD of the brachial artery in 18 KD patients (6.97±2.93% vs 3.51±2.01%，P<0.01),while after administration of placebo in the other 18 patients,there was no significantly increased in the FMD(4.12±2.21% vs 3.75±3.00%，P>0.05).Conclusion Intravenous infusion of high dose vitamin C can increase the FMD of the brachial artery,and it can improve vascular endothelial dysfunction in KD.
Key words Kawasaki disease;Vitamin C;Flow mediated vasodilation;Endothelial dysfunction

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强直性脊柱炎2例

秦雪峰,吴亮

2005, 20(06): 344-344 .

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小儿复杂上尿路感染的因素及致病菌分析

陈玲,徐虹,周利军

2005, 20(06): 345-347 .

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目的了解小儿复杂上尿路感染的因素及致病菌的耐药现状。方法 1999年1月至2004年3月在复旦大学附属儿科医院住院治疗的复杂上尿路感染患儿178例，分析其尿培养阳性的因素、致病菌分布及其对抗生素的耐药性。结果复杂上尿路感染患儿的年龄以≤1岁为主，占46.6%。致病因素中以膀胱输尿管反流为主，占61.8%,40例肾瘢痕患儿中有92.5%存在反流。复杂上尿路感染致病菌中以大肠埃希菌为主，占33%，但与单纯上尿路感染相比所占比例明显下降(P<0.001)；克雷白杆菌与绿脓假单孢菌感染所占比例明显高于单纯上尿路感染所占比例(分别P<0.01,P<0.05)。产超广谱β-内酰胺酶(ESBLs)菌株占革兰阴性杆菌的28%，以大肠埃希菌易产生ESBLs。革兰阴性杆菌对未加β-内酰胺酶抑制剂的青霉素类及第1、2、3代头孢菌素类抗生素耐药率均高，而ESBLs菌株交叉耐药情况更为严重。结论复杂上尿路感染以婴儿期多见，膀胱输尿管反流是复杂上尿路感染及肾瘢痕的主要因素，大肠埃希菌仍是其主要致病菌，但克雷白杆菌、绿脓假单胞菌比例明显上升，致病菌耐药性高，产ESBLs菌株多重耐药严重。

Abstract Objective To investigate the factors and resistance of the pathogens of complicated upper urinary tract infection (UTI) in children.Methods Distribution and resistance of pathogens,complicated factors in 178 urinary culturepositive UTI patients hospitalized from 1999 to 2004 were analyzed.Results Infants with complicated upper UTI accounted for 46.6%.Among the complicated factors,vesicoureteric reflux (VUR) accounted for 61.8%,and 37 of 40 children with venal scar had VUR.E.coli in the complicated upper UTI accounted for 33% of all the pathogens,which was significantly lower than in simple upper UTI (P<0.001)However,Klebsiella and Pseudomonas aeruginosa accounted for 15.8% and 8.1% respectively,which were significantly higher than in simple upper UTI (5.6% and 2.4% respectively,P<0.01 and 0.05 respectively).Nearly 28% of the Gram negative bacilli were the ESBLs producing strain,most of which were E.coli.Gram negative bacilli had a high resistance rate towards not only the penicillin uncombined with the betalactamases inhibitors but also the first,second and third generations of cephalosporins.Furthermore,the multicross resistance of the ESBLs strains was even more serious.Conclusion The complicated upper UTI is predominant in infants and VUR induces complicated upper UTI and renal scar.E.coli is still the major pathogen,while the proportion of Klebsiella,Pseudomonas aeruginosa are significantly increasing.The pathogens have high drugresistance and the ESBLs producing strains have serious multiresistance.
Key wordsUpper urinary tract infectionPathogenResistance

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地塞米松、γ-干扰素对毛细支气管炎患儿免疫调节作用的观察

李桂花,张慧娟

2005, 20(06): 348-350 .

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目的观察地塞米松、γ-干扰素对毛细支气管炎患儿T细胞细胞免疫和T细胞体液免疫比值(TH1/TH2)的作用。方法将60例2002年11月至2004年4月在青岛市第八人民医院儿科住院的毛细支气管炎患儿，按入院顺序分成地塞米松组和γ-干扰素组，并选择15例健康婴儿为正常对照组。检测毛细支气管炎患儿治疗前血清IgE水平及细胞因子IFN-γ、IL-4水平，然后分别用地塞米松、γ-干扰素治疗，出院时复查血清IgE、IFN-γ及IL-4水平。结果正常对照组和毛细支气管炎组血清IgE水平及细胞因子IFN-γ、IL-4、IFN-γ/IL-4水平差异有非常显著意义(P<0.001)。γ-干扰素组和地塞米松组治疗前血清IgE和细胞因子IFN-γ、IL-4、IFN-γ/IL-4差异均无显著性意义(P>0.05),但治疗后,以上指标差异均有非常显著意义(P<0.001)。出院后随访12个月，统计喘息反复发生的例数，γ-干扰素组3例，地塞米松组10例，经卡方检验差异有显著意义(P<0.05)。结论毛细支气管炎患儿血清IgE水平高，TH1/TH2失衡。地塞米松短期内可起到抗炎、平喘作用，止喘起效快，但TH1/TH2治疗前后无差异，反复感染、喘息反复出现、容易发展成婴幼儿哮喘。

Abstract Objective To observe the effect of dexamethasone and IFNγ on the function of TH1/TH2 in lower respiratory tract infections.Methods Sixty patients with lower respiratory tract infections were divided randomly into 2 groups:group I with dexamethasone treatment,group II with IFNγ treatment.Normal group of 15 cases was as control.Serum levels of IgE,IFNγ and IL4 were detected before and after treatment.Results Compared with normal control,there was significant difference in the serum level of IgE,IFNγ,IL4,IFNγ/IL4 in group Ⅰ and group Ⅰ,P<0.001.There was no difference in the serum level of IgE,IFNγ,IL4,IFNγ/IL4 between group I and group Ⅱ before treatment(P>0.05).But there was significant difference after treatment(P<0.001).After being followed up for 12 months,3 cases suffered from asthma in group Ⅰ,10 cases in group Ⅱ.There were outstanding meanings by square examination,P<0.05.Conclusion In patients with lower respiratory tract infections,the serum level of IgE rises.Humoral immunity is relatively increased and cell immunity decreased.So the TH1/TH2 is out of balance.With the treatment of dexamethasone,the body’s immune system is suppressed.In short time,the infection and asthma can be controlled,but TH1/TH2 can’t change after treatment.IFN-γ can interfere the duplication of virus,increase the level of IFN-γ in body,furthermore it can strengthen the cell immune function,lower cell immunologial answer of TH2 and recover the balance of TH1/TH2 The followup suggests IFNγ has an important meaning in preventing infant asthma.
Key wordsLow respiratory tract infections;IFN dexamethasone;Cell immunity;Humoral immunity

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静滴半边莲致过敏性休克1例

汤继亮,郑玉秀

2005, 20(06): 350-350 .

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婴幼儿铅中毒脑病临床特点及预后分析

祝平照,刘钢乾,李颂宜,欧阳桂林

2005, 20(06): 351-353 .

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目的探讨铅中毒脑病的临床特点及预后。方法回顾分析衡阳市中心医院儿科2002~2003年26例铅中毒脑病患儿的临床资料及随访结果。结果 26例铅中毒脑病患儿临床均表现为频繁的抽搐伴意识障碍，中度以上贫血。伴呕吐23例、腹泻21例、发热11例、肝大5例。26例患儿治疗前血铅平均为8.486μmol/L，尿铅平均为3.598μmol/L，Hb均低于90g/L，最低55g/L。血钙均低于1.86mmol/L，最低1.03mmol/L。脑脊液蛋白均增高，22例心肌酶谱增高，提示心肌损害明显。头颅CT/MRI仅1例脑室系统轻度扩张，全部病例经驱铅治疗后无一例死亡，1年后随访,继发性癫疒间4例，脑瘫4例。结论铅中毒脑病是铅中毒的严重类型，预后不良。对不明原因的无热惊厥者应注意及时行血铅检查，以便早期诊断，防止漏诊。

Abstract Objective Study the clinical characteristics and prognosis of lead poisoning encephalopathy.Methods We reviewed and analyzed the clinical data and the results of the 26 cases of lead poisoning encephalopathy.Results All the 26 cases had frequen convulsion,accompanied by disturbance of consciousness and above middle pitch of anemia.Among the 26 cases vomit ting was found in 23 cases,diarrhea in 21 cases,fever in 11 cases,live swelling in 5 cases.Supplemental examination:before treatment,the average of blood lead level was 8.486μmol/L，urine lead level was 3.598μmol/L,Hb was lower than 90g/ L,the lowest being 5g/L.The blood calcium was all lower than 1.86 mmol/ L,the lowest being 1.03 mmol/L.Protein of cerebrospinal fluid in all cases was over normal.Myocardial enzyme of 22 cases was over normal,suggesting myocardials injured obviously.Only 1 case was found ventricle system expanding lightly in CT/MRI.All cases had no death after treatment of driving lead.The 12month followup result suggested that second epilepsy was found in 4 cases and cerebral palsy in 4 cases.Conclusion The lead poisoning encephalopathy is the most serious type of the lead poisoning,and prognosis is not good. The patient of convulsion with unknown reason,and no fever,should be checked the bloodlead for early diagnosis in order to prevent from leaking diagnosis.
Key wordsLead poisoning;Encephalopathy;Clinical characteristics;Prognosis 

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大剂量氨甲蝶呤治疗小儿急性淋巴细胞白血病水化和碱化方法的探讨

刘安生,高英,薛惠良,王耀平

2005, 20(06): 354-356 .

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目的探讨进一步降低大剂量氨甲蝶呤(HD-MTX)治疗小儿急性淋巴细胞白血病(ALL)毒副反应的方法。方法对2000年1月至2001年12月在上海儿童医学中心血液肿瘤科住院治疗的47例ALL患儿共进行的134例次HD-MTX治疗，按照两种不同的水化、碱化方法，分为全国标准治疗组和观察组。观察患儿血清中的MTX浓度、治疗效果及毒副反应的发生率。结果 (1)按WHO相关分度标准，各种毒副反应的发生率、Ⅲ度或Ⅲ度以上的毒副作用者的发生率两组比较差异有显著性意义。(2)观察组有2例次出现尿素氮的升高，标准治疗组未出现。(3)在应用HD-MTX开始后44h、68h时血清MTX浓度异常者两组相比较差异有显著性意义。结论观察组HD-MTX的毒副反应发生率及严重程度均明显低于全国标准治疗组，且减少治疗费用,而不影响HD-MTX治疗效果。

Abstract Objective To study the ways to further reduce the toxic sideeffects of the HD-MTX in the treatment of childhood acute lymphoblastic leukemia.Methods The patients were divided into two groups:the testing and the treatment group.Two different ways of hydration and alkalization were used in the course of HD-MTX to evaluate the treatment results.Monitor the dynamic changes of the serum MTX level and occurrence of the toxic sideeffects.Results The results showed:(1)comparing the above toxic sideeffects occurred in both groups,significant difference could be found;(2)blood urea nitrogen(BUN) increased in 2 cases in the testing group but no one happened in the treatment group;(3)the occurrence of the serum MTX level abnormalities after 44 and 68 hours of HD-MTX treatment appeared in both groups with significant difference.Conclusion It shows the protocol for hydration and alkalization in the testing group has greater advantage than that in the treatment group in reducing the toxic sideeffects.This may decrease the cost of treatment,but may not influence the treatment effect of HD-MTX.
Key words Methotrexate;Leukemia;Lymphoblastic;AcuteSideeffect

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儿童肾结核5例临床分析

周楠,沈颖

2005, 20(06): 356-356 .

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法洛四联症一期根治术后早期死亡危险因素分析

张陈,刘豫阳,盛锋,陈张根

2005, 20(06): 357-359 .

摘要 ( )

目的研究与法洛四联症(TOF)一期根治手术早期死亡相关的危险因素。方法回顾1995年4月至2004年3月在复旦大学附属儿科医院心血管中心行一期根治术的TOF病例152例，术后早期死亡17例，对其术前、术中27个可能的危险因素指标与术后早期死亡的关系进行单因素和多因素分析。结果单因素分析结果显示与术后早期死亡有关的指标包括：手术时体重、发生青紫年龄、动脉血氧饱和度、升主动脉与肺动脉干直径比AO/MPA 、McGoon比值、Nakata指数、肺体循环血流量之比Qp/Qs 、右向左分流量占体循环血流量比例(Qs-eQp)/Qs 、体肺侧支循环和跨瓣补片。多因素分析结果显示AO/MPA 和McGoon比值与手术早期死亡有关。结论肺动脉的发育情况是TOF一期根治术后能否生存的关键。手术病例的选择需要综合考虑多种危险因素。

Abstract Objective To identify risk factors associated with early postoperative death in patients undergoing primary repair of tetralogy of Fallot (TOF).Methods 27 preoperative and intraoperative variables potentially predictive of early postoperative death of 152 patients,who underwent primary repair of TOF between April 1995 and March 2004 at the Cardiovascular Center of Children's Hospital of Fudan University,were analyzed in a univariate and multivariate manner.Results Univariate analysis demonstrated a significant association between early postoperative death and the following variables: weight at the time of surgery,age for cyanosis to be present,SaO2,AO/MPA,McGoon ratio,Nakata index,Qp/Qs,(Qs-eQp)/Qs,multiple aortopulmonary collateral arteries and transannular patching. In the multivariate model only AO/MPA and McGoon ratio were associated with early postoperative death.Conclusion Pulmonary artery hypoplasia is the most important risk factor for early postoperative death after primary repair of TOF.Multiple risk factors should be considered when the choice of patients for the procedure is made.
Key words Tetralogy of Fallot;Primary repair;Risk factors 

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先天性心血管畸形患儿外周血DNA短串联重复序列多态性研究

张仁舜,刘愉,孙利炜,黄艳,智于霞

2005, 20(06): 360-361 .

摘要 ( )

目的探讨先天性心血管畸形与DNA短串联重复序列多态性关系。方法 2003年2月至2004年12月长春市儿童医院心外科门诊及病房收治的先天性心血管畸形患儿53例，对其DNA短串联重复序列D5S818基因座进行PCR扩增，将扩增产物进行浓度为8%、胶联度为5%聚丙烯酰胺凝胶电泳，溴化乙锭染色，紫外可见光成像系统分析D5S818等位基因多态性，同时以50名健康儿童作为对照。结果先天性心血管畸形患儿D5S818基因座等位基因频率与正常对照组有明显差异，重复碱基数的中位值观察组为8，对照组为10。短串联重复序列序列为AGAT重复数小于等于中位数的频率和大于中位数的频率两组比较有明显差异。先天性心血管畸形组D5S818基因杂合度明显低于对照组。结论 AGAT短串联重复序列发生改变可能是发生先天性心血管畸形的潜在因素。

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肺炎心衰时脑钠素改变及其与心功能关系的临床与实验研究

黄磊,马沛然,梁浩,孙献梅

2005, 20(06): 362-364 .

摘要 ( )

目的探讨重症肺炎时血清脑钠素(BNP)的变化及其与心脏收缩功能的关系。方法对2002年8月至2004年4月在山东省立医院确诊的70例肺炎患儿及20例正常健康儿行超声心动图检查，同时将50只大鼠制成肺炎大鼠30只和正常大鼠20只，也行上述检查；采用酶联免疫吸附法检测上述各组BNP水平。结果肺炎心衰组患儿及左室射血分数(LVEF)下降大鼠组血清BNP水平显著高于健康对照组及正常大鼠对照组，且与LVEF、左室短轴缩短率(LVFS)呈负相关(P<0.05)；肺炎心衰组患儿与健康组患儿比较，LVEF下降大鼠与正常大鼠比较，主动脉血流峰值流速(PFVA)、肺动脉血流峰值流速(PFVP)、主动脉血流速度积分(Viao)、肺动脉血流速度积分(Vipa)、LVEF、LVFS显著减少(P<0.05)。结论严重肺炎可引起心衰，血清BNP测定可作为诊断心功能不全的生化指标。

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常用抗癫痫药在儿科的毒副反应观察

周文智,钟佑泉,吴惧,吴梅,谢晓丽,胡文广

2005, 20(06): 364-364 .

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儿童下丘脑-垂体区肿瘤15例临床分析

向承发,余涛,吴瑾

2005, 20(06): 365-366 .

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目的总结儿童下丘脑、垂体区肿瘤临床特点。方法对四川大学华西第二医院1998~2004年15例下丘脑、垂体区肿瘤病例进行分析。结果 15例患者中，年龄4~1 5岁，男5例，女10例，以先后或同时出现的多饮多尿、生长迟缓、软弱、缺乏食欲、性早熟等为主要表现，头部MRI检查15例下丘脑、垂体区肿瘤，其中12例颅咽管瘤，2例下丘脑错构瘤，1例松果体瘤。结论下丘脑、垂体区肿瘤以颅咽管瘤最常见，临床以多种内分泌功能紊乱为主要表现；儿童下丘脑、垂体区肿瘤就诊时可能没有颅内高压症状；头部MRI是确诊下丘脑、垂体区肿瘤最重要的检查手段。

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肾病综合征、小头畸形、精神运动发育落后1例报告及文献复习

李建国,肖慧捷,石岩,刘景城,杨霁云

2005, 20(06): 367-370 .

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致心律失常性右室心肌病1例

姜兴源,张乾忠

2005, 20(06): 370-370 .

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单纯性肥胖儿童早期肾脏功能改变的研究

孙书珍,汪翼,陈瑶,李燕,刘明花,李倩

2005, 20(06): 371-371 .

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小儿特异性心肌病3例分析

苏英兰,韩奇峰,张乾忠

2005, 20(06): 372-372 .

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葡萄糖酸锌佐治小儿反复下呼吸道感染86例临床分析

吴春雁,侯国艳,崔桓

2005, 20(06): 373-373 .

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线粒体心肌病临床诊断和基因研究进展

齐建光,杜军保

2005, 20(06): 374-376 .

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新生儿颅内出血

毛健

2005, 20(06): 377-380 .

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川崎病合并心源性休克1例

李小青,安媛

2005, 20(06): 380-380 .

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儿童先天性食管和胃肠畸形影像诊断

邵剑波,叶滨宾

2005, 20(06): 381-383 .

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蓝色橡皮大疱痣综合征1例

周晓丽,倪陈,刘子美,牛俊扬

2005, 20(06): 383-383 .

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