感觉统合功能训练可有效治疗儿童注意缺陷多动障碍

探讨感觉统合功能训练对儿童注意缺陷多动障碍(ADHD)的治疗效果。选取2016年1月至2016年5月在我院儿科住院病房接受治疗的ADHD患儿324例,随机分为实验组168例和对照组156例,对照组采用常规护理,实验组实施小组感觉综合功能训练,每周训练3~4次,单次训练时间为90~120 min,40次为一个治疗周期,分别在干预前后观察两组患儿的疾病治疗效果、注意力和感觉功能变化。实验组患儿使用感觉综合功能训练后,疾病显效率,注意力集中情况和感觉功能均优于干预前,差异有统计学意义(p0.05);对照组患儿干预前后无明显改变,差异无统计学意义(p0.05)。感觉统合功能训练可显著改善ADHD患儿的治疗效果,提升注意力集中程度,改善感觉功能,可广泛应用于临床。     

儿童噬血细胞综合征38例临床分析

摘要目的：探讨噬血细胞综合征患儿的临床特征、治疗及预后。方法：对38例噬血细胞综合征患儿的Il盏床症状、体征、试验检查结果、治疗及预后,进行回顾性总结与分析。结果：38例患儿主要表现为发热、肝脾淋巴结肿大、外周血细胞减少、铁蛋白升高、凝血功能异常;经针对性治疗后,治愈3例,好转20例,疗效不佳自动出院9例,死亡6例。结论：噬血细胞综合征病因复杂,临床表现多种多样,病情凶险,预后较差,旱期诊断及治疗对预后十分关键。     

血清微量元素与多动症患儿行为症状的相关性研究

目的:探讨多动症(ADHD)患儿血清中微量元素水平与患儿行为症状的相关性。方法:以原子吸收光谱仪检测6~14岁80名ADHD患儿及72名正常儿童血清中的铁(Fe)、锌(Zn)、铜(Cu)、钙(Ca)、镁(Mg)、镉(Cd)、铅(Pb)等微量元素的含量,应用Conner氏量表评价患儿行为症状,分析血清微量元素与行为症状评分的相关性。结果:ADHD患儿血清中Zn水平明显低于正常儿童、Pb水平明显高于正常儿童,差异均有统计学意义(P0.05);Fe、Ca略低于正常儿童,Cu、Cd略高于正常儿童,但差异均无统计学意义(P0.05)。ADHD患儿品行问题、学习问题、冲动-多动、焦虑指数较正常儿童相比有显著差异(P0.05);经Pearson相关分析,ADHD患儿血清Zn与学习问题、冲动-多动、多动指数呈负相关(P0.05),血清Pb与患儿冲动-多动、多动指数呈正相关(P0.05)。结论:ADHD患儿血清中Zn与Pb异常表达,与行为症状密切相关。在治疗ADHD患儿过程中,可以通过检测这些指标进行针对性或预防性治疗,有一定的指导价值。     

儿童轮状病毒性肠炎合并惊厥18例临床分析

目的探讨儿童轮状病毒性肠炎合并惊厥的临床特点。方法对2015年2月～2018年1月我院收治的18例轮状病毒性肠炎合并惊厥患儿的临床资料进行回顾性分析。结果临床表现:18例患儿一般症状以发热、精神差、烦躁、脱水为主,消化系统症状主要表现为呕吐、腹泻、腹痛等,神经系统症状多表现为头痛、意识障碍、惊厥等。实验室检查:全部患儿的大便轮状病毒检测阳性,脑脊液生化常规均无特殊异常,头颅MRI及脑电图均无异常。治疗与随访:所有患儿均予以对症支持治疗,随访4个月结果显示,患儿具有正常的健康状态及良好的精神运动发育,未见再发惊厥,预后良好。结论轮状病毒性肠炎为目前儿童腹泻的主要原因,临床表现为发热、呕吐、腹泻,少部分患儿合并惊厥;经过补液、止泻、降颅内压、营养神经等治疗后,预后良好,极少存在神经系统后遗症。     

儿童慢性咳嗽的病因探讨

目的:探讨儿童慢性咳嗽的病因及其分类方法,从而对临床医师在诊断小儿慢性咳嗽的病因时有所借鉴和帮助。方法:对2007年1月至2009年12月我院收治的病因诊断明确的60例慢性咳嗽患儿的临床特点进行回顾,分析引起慢性咳嗽的病因,并对诊断程序进行总结。结果:引起60例患儿慢性咳嗽的病因分别为反复呼吸道感染15例(25%)、咳嗽变异性哮喘(CVA)13例(21.7%)、鼻后滴注综合征11例(18.3%)、支原体感染10例(16.7%)、胃食管反流性咳嗽(GERC)6例(10.0%)、心因性3例(5.0%)和其他2例(3.3%)。其中反复呼吸道感染、CVA、鼻后滴注综合征为引起小儿慢性咳嗽的主要病因。针对病因治疗后,全部患儿的咳嗽症状明显减轻或消失。结论:应强调对慢性咳嗽的程序式诊断,以明确病因,对小儿慢性咳嗽性疾病的治疗具有较强的可操作性。     

噬血细胞综合征临床特征与影响预后因素分析

目的:探讨噬血细胞综合症的临床特征及影响预后因素,为临床治疗提供依据。方法:选择2006年1月~2011年12月我院收治的噬血细胞综合症患儿26例,回顾分析所有患儿的临床表现、实验室检查、病因及转归等资料。结果:死亡10例,好转或痊愈16例。原发与继发性HPS转归情况比较,X2=7.825,P<0.05,差异有统计学意义。两组年龄(t=2.807)、肝肿大(t=2.817)、脾肿大(t=2.651)、白细胞计数(t=2.580)、血小板(t=2.814)、纤维蛋白原(t=2.984)、乳酸脱氢酶(LDH)(t=2.667)和丙氨酸转氨酶(ALT)(t=2.514)比较,差异有统计学意义,P<0.05。结论:儿童噬血细胞综合征病因复杂,临床特征多样,应结合患儿个体特征进行临床治疗。     

注意缺陷多动障碍儿童睡眠障碍与铁缺乏关系 的临床研究

目的:探讨注意缺陷多动障碍(ADHD)患儿睡眠障碍与血清铁蛋白水平的关系。方法:符合美国精神疾病诊断与统计手册第4版(DSM-Ⅳ)中ADHD诊断标准的62例6-14岁ADHD患儿,由ADHD患儿的父母填写睡眠障碍量表(SDSC),检测ADHD患儿的血清铁蛋白水平。结果:与血清铁蛋白水平高于45μg/L的ADHD患儿相比较,血清铁蛋白水平低于45μg/L的ADHD患儿的SDSC"睡眠醒觉转换障碍"项评分和总分明显高于前者(P<0.05)。2组间其他项评分比较无显著性差异(P>0.05)。SDSC"睡眠醒觉转换障碍"项评分与血清铁蛋白水平成负相关(P<0.05)。结论:血清铁蛋白水平低于45μg/LADHD患儿SDSC"睡眠醒觉转换障碍"(睡眠中的异常运动)的危险性显著增加。     

调任通督针刺法联合感觉统合训练对注意缺陷多动障碍患儿注意力和脑动脉血流速度的影响

摘要 目的：观察感觉统合训练联合调任通督针刺法对注意缺陷多动障碍（ADHD）患儿注意力和脑动脉血流速度的影响。方法：纳入东莞市中医院2020年1月到2021年1月期间收治的ADHD患儿100例,入组患儿按门诊号单双数分为对照组（单数,感觉统合训练）和研究组（双数,调任通督针刺法联合感觉统合训练）,各为50例,两组患儿均干预3个月。观察并对比两组疗效、中医证候总积分、注意力、脑动脉血流速度、Conners父母评症状量表（PSQ）、联合型瑞文测验 (CRT) 评分。结果：研究组的临床总有效率明显高于对照组（P<0.05）。干预3个月后,两组注意力情况：错误数、漏报数较干预前减少,反应时间较干预前缩短,且研究组的变化程度大于对照组（P<0.05）。研究组患儿干预3个月后双侧中动脉（MCA）、前动脉（ACA）、后动脉（PCA）的血流速度均较干预前增快,且高于同时期的对照组患儿（P＜0.05）。干预3个月后,两组PSQ评分、中医证候总积分下降,CRT评分升高,且研究组的变化程度大于对照组（P<0.05）。结论：调任通督针刺法联合感觉统合训练可有效改善ADHD患儿注意力,促进临床症状改善,调节脑血流速度,临床应用价值较好。     

注意力缺陷多动障碍与肠道微生物关系的研究进展

注意缺陷多动障碍(attention deficit hyperactivity disorder, ADHD)是儿童常见的神经精神行为疾病,发病率逐年增长,其病因及发病机制目前并不明确,治疗过程中面临不良反应大、疗程长以及患者和家人依从性差等问题。随着肠道微生物相关研究的逐渐深入,大量证据表明肠道微生物借助多种通路参与调节大脑信号,在神经精神系统疾病的治疗和预防方面发挥更精准的调节作用。本文试通过分析肠道微生物对中枢系统的影响及肠道微生物与ADHD的相关性,为ADHD的病因、发病机制及预防治疗提供新的研究思路和方法。     

儿童慢性腹泻病因分析

目的探讨儿童慢性腹泻的病因,以提高临床诊治水平。方法选择2005年12月至2010年12月在重庆医科大学附属儿童医院住院的141例慢性腹泻患儿为研究对象,对患儿的临床资料进行回顾性分析。结果本组病例中常见致病因素依次为过敏因素46.2%(24/52)、肠道内感染28.4%(40/141)、乳糖不耐受28.3%(26/92)。共109例明确病因诊断,55.1%(60/109)为多因素共同致病,以肠道内感染合并继发乳糖不耐受,过敏合并继发乳糖不耐受,免疫缺陷合并肠道内感染多见。前4位主要病因诊断为感染性腹泻(24.1%)、过敏性腹泻(17.0%)、乳糖不耐受(7.1%)、炎症性肠病(6.4%)。结论除肠道内感染外,过敏因素、乳糖不耐受等也是儿童慢性腹泻常见致病因素。儿童慢性腹泻常由多因素共同致病,主要病因除感染性腹泻外,过敏性腹泻、乳糖不耐受、炎症性肠病等也是常见病因。儿童慢性腹泻重在病因诊断,针对病因治疗。     

A pilot study of combined working memory and inhibition training for children with AD/HD

Building on recent favourable outcomes using working memory (WM) training, this study examined the behavioural and physiological effect of concurrent computer-based WM and inhibition training for children with attention-deficit hyperactivity disorder (AD/HD). Using a double-blind active-control design, 29 children with AD/HD completed a 5-week at-home training programme and pre- and post-training sessions which included the assessment of overt behaviour, resting EEG, as well as task performance, skin conductance level and event-related potentials (ERPs) during a Go/Nogo task. Results indicated that after training, children from the high-intensity training condition showed reduced frequency of inattention and hyperactivity symptoms. Although there were trends for improved Go/Nogo performance, increased arousal and specific training effects for the inhibition-related N2 ERP component, they failed to reach standard levels of statistical significance. Both the low- and high-intensity conditions showed resting EEG changes (increased delta, reduced alpha and theta activity) and improved early attention alerting to Go and Nogo stimuli, as indicated by the N1 ERP component, post-training. Despite limitations, this preliminary work indicates the potential for cognitive training that concurrently targets the interrelated processes of WM and inhibition to be used as a treatment for AD/HD.     

MRI evaluation of basal ganglia ferritin iron and neurotoxicity in Alzheimer's and Huntingon's disease.

BACKGROUND: The basal ganglia contain the highest levels of iron in the brain and post-mortem studies indicate a disruption of iron metabolism in the basal ganglia of patients with neurodegenerative disorders such as Alzheimer's disease (AD) and Huntington's disease (HD). Iron can catalyze free radical reactions and may contribute to oxidative damage observed in AD and HD brain. Magnetic resonance imaging (MRI) can quantify transverse relaxation rates, which can be used to quantify tissue iron stores as well as evaluate increases in MR-visible water (an indicator of tissue damage). METHODS: A magnetic resonance imaging (MRI) method termed the field dependent relaxation rate increase (FDRI) was employed which quantifies the iron content of ferritin molecules (ferritin iron) with specificity through the combined use of high and low field-strength MRI instruments. Three basal ganglia structures (caudate, putamen and globus pallidus) and one comparison region (frontal lobe white matter) were evaluated. Thirty-one patients with AD and a group of 68 older control subjects, and 11 patients with HD and a group of 27 adult controls participated (4 subjects overlap between AD and HD controls). RESULTS: Compared to their respective normal control groups, increases in basal ganglia FDRI levels were seen in both AD and HD. FDRI levels were significantly increased in the caudate (p = 0.007) and putamen (p = 0.008) of patients with AD with a trend toward an increase in the globus pallidus (p = 0.13). In the patients with HD, all three basal ganglia regions showed highly significant FDRI increases (p<0.001) and the magnitude of the increases were 2 to 3 times larger than those observed in AD versus control group comparison. For both HD andAD subjects, the basal ganglia FDRI increase was not a generalized phenomenon, as frontal lobe white matter FDRI levels were decreased in HD (p = 0.015) and remained unchanged in AD. Significant low field relaxation rate decreases (suggestive of increased MR-visible water and indicative of tissue damage) were seen in the frontal lobe white matter of both HD and AD but only the HD basal ganglia showed such decreases. CONCLUSIONS: The data suggest that basal ganglia ferritin iron is increased in HD and AD. Furthermore, the increased iron levels do not appear to be a byproduct of the illness itself since they seem to be present at the onset of the diseases, and thus may be considered a putative risk factor. Published post-mortem studies suggest that the increase in basal ganglia ferritin iron may occur through different mechanisms in HD and AD. Consistent with the known severe basal ganglia damage, only HD basal ganglia demonstrated significant decreases in low field relaxation rates. MRI can be used to dissect differences in tissue characteristics, such as ferritin iron and MR-visible water, and thus could help clarify neuropathologic processes in vivo. Interventions aimed at decreasing brain iron levels, as well as reducing the oxidative stress associated with increased iron levels, may offer novel ways to delay the rate of progression and possibly defer the onset of AD and HD.     

儿童社区获得性支原体肺炎病原学与影像学特征分析

目的:回顾性分析我院儿童社区获得性肺炎(Community-acquired pneumonia,CAP)患儿病原学检测结果,为本地区CAP患儿的临床治疗提供参考依据。方法:选取2014年5月-2018年5月812例符合中华医学会儿科学分会制定的儿童社区获得性肺炎(2013修订)诊断标准的CAP患儿,分析患儿的临床特征及影像学检查结果,并进行分析。结果:非重症CAP患儿812例,CAP占10.2%;感染病原体例数481例,阳性检出率为59.2%;1月-1岁龄组与1-5岁龄组比较差异无统计学意义(P0.05);5-14岁龄组发热发生率明显高于前两组,差异均有统计学意义(P0.05)。咳嗽、喘息、固定湿啰音发生率集中在1月-1岁龄组与1-5岁龄组,且高于5-14岁龄组发生率(P0.0);肺部影像学改变的患儿共657例,占80.9%。三个年龄组;肺部影像学改变差异有统计学意义(P0.05)。结论:不同年龄段CAP患儿病原体检出率不同;不同年龄和不同病原学感染的儿童CAP的影像学表现各有特点,对于临床医生早发现、早诊断、早治疗具有一点的指导性意义。     

Neurocognitive training for children with and without AD/HD

There is accumulating evidence that computerised cognitive training of inhibitory control and/or working memory can lead to behavioural improvement in children with AD/HD. Using a randomised waitlist control design, the present study examined the effects of combined working memory and inhibitory control training, with and without passive attention monitoring via EEG, for children with and without AD/HD. One hundred and twenty-eight children (60 children with AD/HD, 68 without AD/HD) were randomly allocated to one of three training conditions (waitlist; working memory and inhibitory control with attention monitoring; working memory and inhibitory control without attention monitoring) and completed with pre- and post-training assessments of overt behaviour (from 2 sources), trained and untrained cognitive task performance, and resting EEG activity. The two active training conditions completed 25 sessions of training at home over a 4- 5-week period. Results showed significant improvements in overt behaviour for children with AD/HD in both training conditions compared to the waitlist condition as rated by a parent and other adult. Post-training improvements in the areas of spatial working memory, ignoring distracting stimuli, and sustained attention were reported for children with AD/HD. Children without AD/HD showed behavioural improvements after training. The improvements for both groups were maintained over the 6-week period following training. The passive attention monitoring via EEG had a minor effect on training outcomes. Overall, the results suggest that combined WM/IC training can result in improved behavioural control for children with and without AD/HD.     

Deep White Matter in Huntington's Disease

White matter (WM) abnormalities have already been shown in presymptomatic (Pre-HD) and symptomatic HD subjects using Magnetic Resonance Imaging (MRI). In the present study, we examined the microstructure of the long-range large deep WM tracts by applying two different MRI approaches: Diffusion Tensor Imaging (DTI) -based tractography, and T2*weighted (iron sensitive) imaging. We collected Pre-HD subjects (n = 25), HD patients (n = 25) and healthy control subjects (n = 50). Results revealed increased axial (AD) and radial diffusivity (RD) and iron levels in Pre-HD subjects compared to controls. Fractional anisotropy decreased between the Pre-HD and HD phase and AD/RD increased and although impairment was pervasive in HD, degeneration occurred in a pattern in Pre-HD. Furthermore, iron levels dropped for HD patients. As increased iron levels are associated with remyelination, the data suggests that Pre-HD subjects attempt to repair damaged deep WM years before symptoms occur but this process fails with disease progression.     

结节性硬化症伴癫痫患儿临床特征和基因型分析

摘要 目的：探讨结节性硬化症（TSC）伴癫痫患儿的临床特征和基因型特点,旨在了解 TSC伴癫痫患儿的临床表现,以及表型与基因型的相关性,为临床诊治提供更有效的方案。方法：回顾性分析 2019年 12月至 2021年 1月安徽省儿童医院神经内科收治的 10例 TSC伴癫痫患儿的临床表现,采用芯片捕获高通量测序以及 Sanger测序验证,对 TSC伴癫痫患儿及父母进行基因检测,分析其临床及遗传变异的特征。结果：10例中男性 4例,女性 6例,首次发作痉挛 3例,局灶性 7例,70.00%首发年龄小于 1岁。临床表现：90.00%皮肤病变,80.00%心脏横纹肌瘤,20.00%眼底异常,未见肾脏、肝脏、肺脏病变。视频脑电图显示 60.00%痫样波位于额颞区,100.00%伴神经影像学皮层 /皮层下异常,90.00%双侧室管膜 /室管膜下异常,10.00%室管膜下巨细胞星形细胞瘤。研究患儿均完善基因检测,3例为 TSC1基因突变,7例为 TSC2突变,包括错义、移码及剪接位点突变,2例检测出家族变异,7例均未检测出家族变异。结论：TSC伴癫痫患儿男女发病无明显差异性,散发病例多见,发病年龄多为 1岁内,首次发作常为局灶性。视频脑电图痫样波额颞区为主,头颅影像学多为皮层 /皮层下及双侧室管膜 /室管膜下异常。TSC2突变较 TSC1突变常见,临床表现严重,痉挛发生率高,发病年龄小,多控制不佳。早期基因检测,对于发病年龄小,疗效欠佳患儿尤为重要。     

小儿慢性胃炎的消化道外表现(附864 例报道)

目的:分析和总结小儿慢性胃炎的消化道外表现。方法:选择2008年1月~2008年10月哈尔滨医科大学附属第二医院儿科门诊诊治的经腹部胃区叩诊法确诊为慢性胃炎的患儿864例,建立随访卡片,分析和总结其消化道内及消化道外的临床表现。结果:864例患儿常见的消化道症状依次为腹痛、恶心呕吐、便秘、上腹压痛。消化道外表现依次为头痛、刀枪刺、鼻出血、胸痛、多动抽动、手足搐搦。消化道外表现的发病率并不低于消化道表现,特别是头痛的发病率高达58.54%。腹痛、恶心呕吐症状缓解得最快,其次是头痛、头晕、胸闷、胸痛,多动症状较晚缓解,腹部叩痛的消失时间最晚。结论:小儿慢性胃炎的胃肠道外表现广泛存在,且极易与脑炎、心肌炎误诊,值得关注。头痛、胸痛的产生原因可能与内脏-内脏之间的牵涉痛有关。     

Anemia of Inflammation Is Related to Cognitive Impairment among Children in Leyte,The Philippines

Background

Many studies have addressed the relationship between iron deficiency anemia (IDA) and cognitive impairment, but none have evaluated the role of non-iron deficiency anemia (NIDA). One of the main causes of NIDA in developing countries is AI, largely due to infectious diseases, whereby iron is shunted away from bio-available forms to storage forms, making it less accessible for use by host tissues. The objective of this study was to determine the effect of NIDA, due largely to AI in this context, on cognitive function after adjustment for potential confounders.

Methodology

This cross-sectional study was conducted in Leyte, The Philippines among 322 children ages 7–18 years. Blood samples were collected and analyzed at the time of cognition testing. Three stool samples were collected and evaluated by the Kato Katz method for quantitative assessment for Schistosoma japonicum and geo-helminth infection. Socio-economic status (SES) was evaluated by survey. Linear regression models were used to quantify the adjusted relationship between performance in different cognitive domains and both IDA and NIDA.

Principal Findings

After adjusting for age, sex, SES and nutritional status, children in the NIDA had lower scores on the PNIT (P = <0.05) and the WRAML memory domain (P<0.05) compared to children in the non-anemic group. Children in the IDA had lower performance on the PNIT compared to the non-anemic group after controlling for potential confounders (P<0.05).

Conclusions

NIDA, predominantly due to AI in this context, was related to lower performance on two tests of cognitive function. This is likely due to decreased delivery of iron to host tissues in this context, including the CNS.     

Comorbid Externalising Behaviour in AD/HD: Evidence for a Distinct Pathological Entity in Adolescence

While the profiling of subtypes of Attention Deficit Hyperactivity Disorder (AD/HD) have been the subject of considerable scrutiny, both psychometrically and psychophysiologically, little attention has been paid to the effect of diagnoses comorbid with AD/HD on such profiles. This is despite the greater than 80% prevalence of comorbidity under the DSM-IV-TR diagnostic definitions. Here we investigate the event related potential (ERP) and psychometric profiles of Controls, AD/HD, and comorbid AD/HD (particularly AD/HD+ODD/CD) groups on six neurocognitive tasks thought to probe the constructs of selective and sustained attention, response inhibition and executive function. Data from 29 parameters extracted from a child group (age range 6 to 12; 52 Controls and 64 AD/HD) and from an adolescent group (age range 13 to 17; 79 Controls and 88 AD/HD) were reduced via a Principal Components Analysis, the 6 significant eigenvectors then used as determinants of cluster membership via a Two-Step Cluster Analysis. Two clusters were found in the analysis of the adolescent age group - a cluster dominated by Control and AD/HD participants without comorbidity, while the second cluster was dominated by AD/HD participants with externalising comorbidity (largely oppositional defiant/conduct disorder ODD/CD). A similar segregation within the child age group was not found. Further analysis of these objectively determined clusters in terms of their clinical diagnoses indicates a significant effect of ODD/CD comorbidity on a concurrent AD/HD diagnosis. We conclude that comorbid externalising behaviour in AD/HD constitutes a distinct pathological entity in adolescence.