酪酸梭菌活菌散治疗母乳性黄疸疗效观察

目的观察酪酸梭菌活菌散（商品名：宝乐安）治疗母乳性黄疸的临床疗效。方法将60例母乳性黄疸的足月儿随机分为观察组30例和对照组30例。观察组在常规治疗的同时给予酪酸梭菌活菌散口服,0．5g／次,2次／d,加水2-5ml溶解口服;对照组仅常规治疗。2组均不停止母乳喂养。结果观察组胆红素日均下降值为（42．1±16．2）μmol／L,显著高于对照组的（22．6±11．2）μmol／L（P〈0．05）;观察组胆红素下降至119．5μmol／L以下的天数为（4．6±1．6）d,显著短于对照组的（9．6±2．5）d（P〈0．05）。结论酪酸梭菌活菌散治疗母乳性黄疸,可迅速降低胆红素水平,缩短治疗时间。     

S-腺苷蛋氨酸对梗阻性黄疸患者术后肝功能及营养状况影响的临床研究

目的：探讨S-腺苷蛋氨酸对梗阻性黄疸患者术后肝功能及营养状况的影响。方法：选择2010年8月至2012年7月我院肝胆病区收治的90例梗阻性黄疸患者为研究对象,随机分为S-腺苷蛋氨酸治疗组（48例）和对照组（42例）,比较和分析静脉滴注S-腺苷蛋氨酸对梗阻性黄疸患者术后第5d、10d肝功能及营养指标的影响。结果：术后5d、10d,两组患者血总胆红素、直接胆红素、谷丙转氨酶、1．谷氨酰转肽酶、碱性磷酸酶水平较术前1d显著降低,且组内比较差异有统计学意义（P〈0．05）,治疗组以上指标的下降程度较对照组更明显,差异有统计学意义（P〈0．05）。术后第10d,两组患者的血白蛋白、前白蛋白、转铁蛋白水平较术后第5d显著改善（P〈0．05）;术后第5、10d,两组组间血白蛋白、前白蛋白、转铁蛋白水平比较差异有统计学意义（P〈0．05）。结论：梗阻性黄疸患者术后应用腺苷蛋氨酸能促进黄疸消退,加快胆红素的排泄和肝功能的恢复,有利于患者营养状况的改善。     

酪酸梭菌活菌散在治疗母乳性黄疸中的应用

目的观察在常规治疗的基础上加用酪酸梭菌活菌散（商品名：宝乐安）治疗新生儿母乳性黄疸的疗效。方法176例母乳性黄疸患儿随机分为治疗组和对照组,治疗组90例,对照组86例,对照组采用常规治疗,治疗组在常规治疗基础上加服酪酸梭菌活菌散,2组均不停止母乳喂养,并观察2组患儿日均总胆红素水平及黄疸消退时间的变化。结果治疗组日均胆红素下降值为（58．61±26．52）μmol／L,显著高于对照组（39．12±25．41）μmol／L（P〈0．01）;黄疸消退时间,治疗组为（4．25±2．68）d,显著短于对照组（6．42±2．74）d（P〈0．01）。结论在常规治疗的基础上加用酪酸梭菌活菌散治疗母乳性黄疸,可迅速降低胆红素水平,缩短治疗时间。     

肝硬化患者幽门螺杆菌感染与血氨的关系

目的 :探讨幽门螺杆菌 (Hp)感染对肝硬化患者血氨浓度的影响。 方法 :35例肝硬化患者及 2 5例消化性溃疡患者分别测定Hp感染情况及空腹血氨浓度 ,对于Hp阳性病人口服质子泵抑制剂三联方案1周后测定空腹血氨。结果 :Hp阳性的肝硬化患者空腹血氨较Hp阴性的肝硬化患者空腹血氨显著升高(P <0 0 1)。根除Hp后 ,肝硬化患者空腹血氨浓度显著下降 (P <0 0 5 )。 结论 :Hp感染可引起肝硬化患者血氨浓度升高 ,对此类患者采用Hp根除治疗 ,可显著降低血氨浓度。抗Hp治疗可能有助于预防及治疗肝硬化患者的高氨血症及由此诱发的肝性脑病及亚临床肝性脑病。     

酪酸梭菌活菌散联合光疗治疗新生儿母乳性黄疸临床观察

目的探讨酪酸梭菌活菌散（商品名：宝乐安）联合光疗治疗母乳性黄疸的临床疗效。方法将母乳性黄疸患儿116例随机分为观察组和对照组,观察组59例在光疗、补液等常规治疗的同时给予口服酪酸梭菌活菌散;对照组57例应用光疗、补液等常规治疗。治疗中观察患儿黄疸消退时间并定期检测血清胆红素含量,比较胆红素日均下降速度及治愈时间。结果观察组治愈时间短于对照组（P〈0．05）,观察组日均胆红素下降值高于对照组（P〈0．01）,差异具有非常显著性。结论酪酸梭菌活菌散联合光疗治疗母乳性黄疸能够缩短光疗时间和快速降低血清胆红素,值得临床推广应用。     

更昔洛韦联合大剂量丙种球蛋白治疗婴儿巨细胞病毒性肝炎的疗效观察

目的:研究更昔洛韦联合大剂量丙种球蛋白治疗婴儿巨细胞病毒性(CMV)肝炎的临床疗效,为婴儿CMV肝炎的抗菌治疗提供理论依据。方法:选取我院自2009年7月至2016年1月收治的103例CMV肝炎婴儿,根据随机数字表法分为治疗组58例,对照组45例。两组患儿均常规给予退黄、保肝药物治疗,对照组在此基础上给予更昔洛韦治疗,治疗组给予大剂量丙种球蛋白联合更昔洛韦治疗。对比观察两组患儿治疗后黄疸消退情况、肝功能变化、血CMV-IgM和尿CMV-DNA转阴情况、肝和脾B超变化、治疗效果及不良反应情况。结果:治疗组患儿黄疸消退时间、血CMV-IgM和尿CMV-DNA转阴时间均短于对照组(P0.05);治疗组肝功能指标包括总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)水平均较对照组和治疗前降低(P0.05);治疗后两组肝、脾明显减小,且治疗组减小更显著,差异有统计学意义(P0.05);治疗组中血CMV-IgM转阴率、尿CMV-DNA转阴率、治疗总有效率均高于对照组(P0.05);治疗组不良反应发生率低于对照组(P0.05)。结论:更昔洛韦联合大剂量丙种球蛋白治疗婴儿CMV肝炎临床效果良好,可以有效缓解黄疸症状,恢复肝脏功能,肝、脾回缩明显,不良反应少,值得推广。     

水面舰艇和核潜艇艇员幽门螺杆菌感染调查及相关因素分析

目的 :了解和比较水面舰艇和核潜艇长时间航行对艇员幽门螺杆菌 (H P)感染率的影响并初步探讨其相关因素。方法 :1)对象分组 :水面舰艇长航组 67例 ,核潜艇长航组 73例 ,岸勤组 5 2例 (对照组 )。2 ) H P感染的测定 :用1 4 C—呼气试验检测 ,以 DPM值 >2 0 0为界值 ,判定两长航组艇员 H P感染发生率。3 )相关性分析 :用 Wilcoxon等级相关分析判断长航艇员 H P感染与环境社会因素、肠道正常菌群及心理应激各变量之间的相关关系。结果 :1) H P感染情况 :水面舰艇组长航后 ,DPM值为 2 67.13± 48.92 ,H P感染发生率为 47.76% ,与航前 (DPM值 86.95± 2 0 .3 2 ,H P感染率 8.96% )和岸勤组 (DPM值 81.3 5±19.86,H P感染率为 13 .46% )比 ,差异有非常显著性 (P<0 .0 1)。核潜艇组航后 DPM值为 198.3 3±73 .5 1,H P感染率 3 9.73 % ,与航前 (DPM值 73 .2 8± 41.0 3 ,H P感染率 10 .96% )和岸勤组 (DPM值 81.3 5± 2 9.86,H P感染率 13 .46% )比 ,差异有显著性 (P<0 .0 5 )。 2 )相关性分析 :环境社会因素中 ,水面舰艇组和核潜艇组 H P感染均与营养条件、文化程度呈非常显著负相关 (P<0 .0 1) ,与活动空间及兵龄呈显著负相关 (P<0 .0 5 ) ,与工作强度呈正相关 (P<0 .0 5 ) ;核潜艇组 H P感染还与专业分工呈     

凝结芽孢杆菌活菌片治疗母乳性黄疸的临床观察

目的探讨凝结芽孢杆菌活菌片（商品名：爽舒宝）治疗母乳性黄疸的临床疗效。方法将母乳性黄疸患儿69例随机分为观察组和对照组,观察组34例在常规治疗的同时给予口服凝结芽孢杆菌活菌片;对照组35例应用蓝光、菌栀黄颗粒等常规治疗。治疗中观察患儿黄疸消退时间并定期检测血清胆红素含量,血常规情况。结果治疗后观察组总有效率、日均胆红素下降值均明显高于对照组,治疗第5天血清胆红素值低于对照组,黄疸消退时间亦明显短于对照组,差异具有统计学意义（P〈0．05）。观察组和对照组的白细胞计数和红细胞计数均降为正常值,血红蛋白也有所降低,但仍高于正常值,差异无统计学意义（P〉0．05）。结论凝结芽孢杆菌活菌片治疗母乳性黄疸,可提高总有效率,迅速降低胆红素水平,缩短黄疸消退时间,且无不良反应发生。     

原发性高血压患者α-Adducin基因单核苷酸多态性(Gly460Trp)与血清胆红素含量相关性

探讨了自 2 0 0 0年 9月到 2 0 0 1年 1月来自安徽省霍邱县地区原发性高血压人群中α Adducin基因单核苷酸多态性与血清中总胆红素、直接胆红素和间接胆红素含量的相关性。在原发性高血压女性患者中 ,在校正了许多可能影响胆红素含量的重要因素后 ,与携带有Gly4 6 0Gly基因型的高血压女性患者相比较 ,携带有Trp4 6 0Trp基因型的高血压女性患者血清平均总胆红素 (β =- 1 2 μmol/L ;P =0 0 1)、直接胆红素 (β =- 0 4 μmol/L ;P =0 0 2 )和间接胆红素 (β=- 0 8μmol/L ;P =0 0 3)的含量比较低。在女性中抽取总胆红素、直接胆红素和间接胆红素含量最高和最低的各 2 5 % ,在校正了重要的变量后发现携带Trp/Trp基因型的女性比Gly4 6 0Gly基因型的女性有更大的可能性血清总胆红素含量 (OR值 =4 0 ;95 %可信区间 :1 6～ 10 2 ;P <0 0 1)、直接胆红素含量 (OR值 =4 0 ;95 %可信区间 :1 6～ 9 7;P <0 0 1)和间接胆红素含量 (OR值 =2 7;95 %可信区间 :1 1～ 6 7;P =0 0 3)更低。然而 ,在男性高血压患者中没有发现任何明显的相关性。以上的结果认为在中国原发性高血压女性患者中 ,Trp/Trp基因型与低的血清胆红素含量有直接关系 ,因为Trp/Trp基因型的女性的低血清胆红素 ,进而认为也许增加了患心血     

微生态制剂早期干预新生儿黄疸的临床研究

目的观察微生态制剂干预新生儿黄疸的疗效。方法正常新生儿102例,随机分为试验组52例与对照组50例,试验组服用“妈咪爱”,对照组不服用。观察第1次胎便排出及第1次胎便转黄时间,观察黄疸高峰期峰值及高胆红素血症的发生率。结果2组胎便早排差异有非常显著性（P〈0．01）,胎便早变黄差异有非常显著性（P〈0．01）,黄疸高峰期峰值差异有非常显著性（P〈0．01）,高胆红素血症发生率差异有非常显著性（P〈0．01）。结论微生态制剂“妈咪爱”能促胎便早排,减少胆红素肝肠循环,辅助退黄,降低高胆红素血症发生。     

Comparison of Venous and Capillary Differential Leukocyte Counts Using a Standard Hematology Analyzer and a Novel Microfluidic Impedance Cytometer

Capillary blood sampling has been identified as a potentially suitable technique for use in diagnostic testing of the full blood count (FBC) at the point-of-care (POC), for which a recent need has been highlighted. In this study we assess the accuracy of capillary blood counts and evaluate the potential of a miniaturized cytometer developed for POC testing. Differential leukocyte counts in the normal clinical range from fingerprick (capillary) and venous blood samples were measured and compared using a standard hematology analyzer. The accuracy of our novel microfluidic impedance cytometer (MIC) was then tested by comparing same-site measurements to those obtained with the standard analyzer. The concordance between measurements of fingerprick and venous blood samples using the standard hematology analyzer was high, with no clinically relevant differences observed between the mean differential leukocyte counts. Concordance data between the MIC and the standard analyzer on same-site measurements presented significantly lower leukocyte counts determined by the MIC. This systematic undercount was consistent across the measured (normal) concentration range, suggesting that an internal correction factor could be applied. Differential leukocyte counts obtained from fingerprick samples accurately reflect those from venous blood, which confirms the potential of capillary blood sampling for POC testing of the FBC. Furthermore, the MIC device demonstrated here presents a realistic technology for the future development of FBC and related tests for use at the site of patient care.     

Influence of perinatal factors and sampling methods on TSH and thyroid hormone levels in cord blood.

To evaluate the effect of perinatal factors and sampling methods on thyroid stimulating hormone (TSH) and thyroid hormone levels in cord blood, serum TSH, free thyroxine (FT4) and free triiodothyronine (FT3) concentrations were measured in 124 healthy term neonates. Eighty-eight infants were born in normal vaginal deliveries, 25 were delivered by vacuum extractor and 11 by Cesarean section. There was no significant difference among the three infant groups in the mean TSH levels. Birth weight, the infant's sex, duration of labor and uterotonic agents had no effect on cord serum TSH and free thyroid hormone levels in the neonates born by normal vaginal delivery. To assess the adequacy of specimen collection, mixed cord blood samples, obtained by a direct application of cord on a filter paper, and venous blood withdrawn with a plastic syringe were collected in another 200 infants. There was a significant linear correlation in the TSH concentration in mixed cord blood and cord venous serum from the same individuals, while a poor correlation was found in T4 values from two specimens. Our results suggest that the TSH value in cord blood is less influenced by perinatal factors, including the sampling method, and the mixed cord blood collected by this technique might be a feasible alternative specimen for a TSH screening program with cord blood which is useful in countries where neonatal blood is not available.     

影响脐带血采集质量的相关性因素分析

目的回顾性分析影响脐带血采集质量的母婴因素和采集处理因素。 方法记录389份脐带血的采集量、母亲年龄、孕龄、新生儿体重、分娩方式、新生儿性别、胎次及脐带血采集至计数间隔以及采集方式。用KX-21型全自动血液分析仪进行细胞计数并计算有核细胞总数（TNC）。采用Pearson相关和Spearman秩相关进行相关性分析,采用t检验、Mann-Whitney U检验、方差分析及Kruskal-Wallis H检验进行分组比较,分析影响脐带血采集量和TNC的相关因素。? 结果脐带血采集量与TNC显著相关（r = 0.723,P < 0.001）,脐带血采集量大于80 ml时的TNC显著高于低体积者。在母婴因素中,母亲年龄与采集量及TNC差异均无统计学意义;孕龄与采集量负相关（r = -0.119,P = 0.019）,而与TNC正相关（r = 0.138,P = 0.007）,足月儿脐带血的TNC显著高于早产儿（P = 0.038）;婴儿出生体重与采集量及TNC均正相关（r = 0.236,P < 0.001;r = 0.275,P < 0.001）,体重较大婴儿脐带血的采集量和TNC均显著高于体重较小者（P?< 0.001）;剖宫产的脐带血采集量虽高于阴道分娩（P < 0.001）,但其TNC不及阴道分娩;男婴与女婴在脐带血采集量和TNC之间无显著差异。在采集处理因素中,脐带血采集至计数的时间间隔与采集量及TNC均无显著相关。 结论为提高脐带血的保存质量,应侧重选择胎儿体重较大、经阴道分娩的产妇作为脐带血供者,实验室应首先处理采集量较大的脐带血。     

Adaptive responses during anemia and its correction in lambs.

There is limited information available on which to base decisions regarding red blood cell (RBC) transfusion treatment in anemic newborn infants. Using a conscious newborn lamb model of progressive anemia, we sought to identify accessible metabolic and cardiovascular measures of hypoxia that might provide guidance in the management of anemic infants. We hypothesized that severe phlebotomy-induced isovolemic anemia and its reversal after RBC transfusion result in a defined pattern of adaptive responses. Anemia was produced over 2 days by serial phlebotomy (with plasma replacement) to Hb levels of 30-40 g/l. During the ensuing 2 days, Hb was restored to pretransfusion baseline levels by repeated RBC transfusion. Area-under-the-curve methodology was utilized for defining the Hb level at which individual study variables demonstrated significant change. Significant reciprocal changes (P < 0.05) of equivalent magnitude were observed during the phlebotomy and transfusion phases for cardiac output, plasma erythropoietin (Epo) concentration, oxygen extraction ratio, oxygen delivery, venous oxygen saturation, and blood lactate concentration. No significant change was observed in resting oxygen consumption. Cardiac output and plasma Epo concentration increased at Hb levels <75 g/l, oxygen delivery and oxygen extraction ratio decreased at Hb levels <60 g/l, and venous oxygen saturation decreased and blood lactate concentration increased at Hb levels <55 g/l. We speculate that plasma Epo and blood lactate concentrations may be useful measures of clinically significant anemia in infants and may indicate when an infant might benefit from a RBC transfusion.     

早期光疗对早产儿黄疸的影响

目的：探讨在经皮胆红素监测下早期蓝光干预对早产儿高胆红素血症的防治作用。方法：选择2009年10月-2011年10月我院新生儿科收治的86例出生体重≤2000g,无出生窒息史的早产儿,按住院号单双号分为观察组46例和对照组40例。对照组按照我国2000年制定的新生儿黄疸干预推荐方案的干预标准进行光疗。观察组于出现黄疸和／或经皮胆红素〉85．50μmol／L,但尚未达方案的干预标准就进行光疗,监测经皮胆红素至黄痘消失。经皮胆红素值达187．5μmol／L以上时同时查静脉血监测血清总胆红素。比较2组早产儿经皮胆红素峰值及恢复正常时间。结果：观察组与对照组比较经皮胆红素峰值较低,黄疸持续时间较短,两组比较P均〈0．05,有统计学差异。结论：早产儿在经皮胆红素监测下进行早期蓝光干预有利于降低早产儿胆红素峰值,缩短黄疸持续时间。有效预防早产儿胆红素脑病。     

Serum bilirubin levels in breast- and formula-fed infants in the first 5 days of life.

A prospective study was conducted in a level II maternity unit to investigate the incidence of hyperbilirubinemia in healthy, term, breast-fed and formula-fed infants. Serum bilirubin levels were determined for 176 breast-red and 164 formula-fed infants in cord blood and on days 1, 2, 3 and 5 after birth. The mean total bilirubin levels were significantly higher on each postnatal day in the breast-fed infants, as was the proportion of infants with peak levels above 12 mg/dl (205 mumol/l; 28% v. 6%). The breast-fed infants also had significantly higher proportional weight losses on each postnatal day than the formula-fed infants. However, there was no correlation between the cumulative weight loss on day 3 and bilirubin levels on the same day with either feeding regimen. None of the infants required an exchange transfusion or prolonged care in hospital for hyperbilirubinemia.     

Comparative study of sodium, potassium, ionized calcium, urea and creatinine circadian rhythm documented in samples of capillary and venous blood from healthy subjects

Circadian rhythms of sodium, potassium, ionized calcium, creatinine and urea concentrations were determined in venous and capillary blood of practically healthy volunteers (10 women and 8 men). Electrolytes were determined on the ionoselective analyzer Microlyte (KONE, Finland). Circadian rhythmicity of parameters was revealed in venous and capillary blood by means of group-mean cosinor analysis. Acrophases of the rhythms occurred in the late evening (Na) or in the first (K, venous ionized Ca) and in the second half (creatinine, urea) of sleep. Circadian rhythms of electrolytes (except ionized Ca rhythm) and final products of nitrous metabolism in capillary blood turned out to be the markers of the corresponding indices rhythms of venous blood.     

孕妇体内维生素D含量与新生儿湿疹的相关性

目的:研究孕妇维生素D(25(OH)D)含量与新生儿湿疹的关系,为改善孕期维生素D缺乏,预防婴儿湿疹提供临床依据。方法:选取2013年9月-2013年11月在我院生产的孕妇及所生的新生儿,调查研究对象的基本情况。采集孕妇的静脉血进行25(OH)D含量测定,并诊断新生儿湿疹的发生情况。结果:孕妇25(OH)D含量的中位数是15.17 ng/m L,新生儿湿疹的发病率是26.1%。孕妇不同含量25(OH)D水平与孕中晚期补充复合维生素、服用奶制品、摄入鱼蛋类次数、每天晒太阳时间等有关(P0.05);孕妇25(OH)D含量20 ng/m L会增加子女6个月内患湿疹的风险(OR=3.19,95%;CI:1.54,4.21)。结论:孕妇25(OH)D含量缺乏会增加新生儿湿疹的发病率。     

Capillary blood sampling as an alternative to venipuncture in the assessment of serum 25 hydroxyvitamin D levels

This study compared 25-hydroxyvitamin D [25(OH)D] measurements in capillary and venous blood samples collected, respectively by fingerprick and venipuncture. Capillary blood for measuring 25(OH)D has potential advantages by reducing blood volume required (2mL versus 0.3mL for venipuncture and capillary sampling, respectively), facilitating blood collection for those populations in whom venipuncture is difficult (e.g. infants and children), improving patient convenience and reducing costs associated with phlebotomy. The results demonstrated a highly significant relationship between 25(OH)D levels in serum derived from venous and capillary blood samples (r(2)=0.901). Despite statistically higher 25(OH)D levels in fingerprick samples (108+/-9nmol/L) compared with venipuncture samples (90+/-7nmol/L), the correlation between venous and capillary samples provides support for this approach as a practical alternative to venipuncture for vitamin D determination. However, clinical application may require the incorporation of a correction factor for the assessment of insufficiency, and research studies should avoid using the two methods interchangeably. Studying vitamin D's role in health and disease requires collection techniques and measurement methods that are reliable, reproducible, easily accessible, inexpensive and minimally burdensome to the patient. The option to collect patient samples by fingerprick may facilitate the collection process.     

Prediction of Severe Neonatal Hyperbilirubinemia Using Cord Blood Hydrogen Peroxide: A Prospective Study

Background

We hypothesized that cord blood hydrogen peroxide (H₂O₂) could be utilized to predict the severity of neonatal hyperbilirubinemia.

Methods

We prospectively enrolled term or near-term healthy neonates. Cord blood and capillary blood at three days of age were measured for hydrogen peroxide and bilirubin concentrations. For newborns with hyperbilirubinemia, further blood samples were obtained at five and seven days of age. Newborns were divided into severe or less severe hyperbilirubinemic groups (peak bilirubin ≥17 mg/dL or not). The sensitivity, specificity, and negative predictive values were determined.

Results

There were 158 neonates enrolled. The incidence of neonatal hyperbilirubinemia was 30.5% for a concentration ≥15 mg/dl. The rising patterns were similar among bilirubin concentrations and hydrogen peroxide levels during the first few days of life. There was a strong positive correlation between bilirubin concentrations and hydrogen peroxide levels after correlation analysis. The rate of severe hyperbilirubinemia was 13.3%. It revealed that a cord blood hydrogen peroxide signal level of 2500 counts/10 seconds was an appropriate cut-off for predicting severe hyperbilirubinemia. Sensitivity and the negative predictive value were 76.2% and 93.3%, respectively.

Conclusions

Our findings confirm that hydrogen peroxide levels and bilirubin concentrations in cord and neonatal blood are closely related. A cord blood hydrogen peroxide level above 2500 counts/10 seconds associated with a high predictive value for severe hyperbilirubinemia. This method provides information about which neonate should be closely followed after discharge from the nursery.