Objective To analyze the influence of intestinal mucosal injury and Helicobacter Pylori(H.pylori) infection on intestinal disaccharidase activity in children.Methods A total of 152 Children under the age of 14 years with chronic gastroenterological symptoms were included.Gastroendoscopy was used to obtain distal duodenal mucosa biopsies.The intestinal disaccharidase activities were determined by Dahlqvist’s method.The presence of H.pylori infection was checked by 13C-UBT.Pathological examination was performed in the tissue sample of distal duodenal mucosa.The association of degree of intestinal mucosa injury and H.pylori infection with disaccharidase activity was analyzed.Results The mean levels of intestinal disaccharidase were not different among different intestinal mucosal pathological groups(P0.05),and were not different between H.pyloriinfected and uninfected groups(P0.05).Conclusions There is no significant correlation of intestinal disaccharidase enzyme activity with intestinal mucosal inflammation and H.pylori infection.Intestinal mucosal inflammation and H.pylori infection might not be the main cause of intestinal disaccharidase deficiency.

人生长激素(human growth hormone,hGH)是出生后促进生长的主要激素,生长激素在调节生长的许多方面都起作用,生长激素缺乏会引起生长激素缺乏性矮小(growth hormone deficiency,GHD),但特发性矮小症患儿(idiopathic short stature,ISS)并不存在生长激素(GH)缺乏[1],其发病机制一直是研究的热点,有研究认为hGH同型异构体(human growth hormone isoforms,hGHI)比例的变化可能是ISS的发病机制之一[2,3],hGH有多种同型异构体,在垂体、胎盘和外周血中均存在,各种hGHI单体型的22 kDa-hGHI含量最丰富,20 kDa-hGHI含量次之,它们在结构上有轻微差别,功能上也不全相同,无论在生物活性、结合特点及代谢清除方面都存在一定差别[4,5],20 kDa与hGH受体(growth hormone receptor,GHR)及GH结合蛋白结合能力明显低于22 kDa[6].为探讨hGHI比例的变化(20 k/22 k)与ISS的发病机制的关系,本研究应用免疫沉淀结合Western印迹方法检测ISS及正常人20 kDa所占百分比[20 k/(20 k+22 k)],旨在讨论hGHI比例变化与ISS的关系,探讨ISS的发病机制.

II gene may be important in determining the outcome of Helicobacter pylori (H. pylori) infection. This study was undertaken to explore the immunogenetic mechanism of the relation between H. pylori infection and human leukocyte antigen (HLA)-DQB1 and to search for the possible existence of susceptibility or resistance genes. Methods: A total of 133 children with chronic gastritis who had been treated at the Ruijin Hospital and 80 normal children (controls) were examined for H. pylori infection and HLA-DQB1 genotyping. HLA-DQB1 genotyping was performed with the polymerase chain reaction-specific sequence oligonucleotide (PCR-SSO) method. Results: Eighty-five of the 133 children with chronic gastritis and 33 of the 80 controls were H. pylori positive. The allelic frequency (AF) of DQB1*03032 was significantly lower in H. pylori-positive controls than in H. pylori-negative controls (10.61% vs 25.53%, P<0.05). The AF of DQB1*0602 was significantly lower in patients with H. pylori-positive gastritis than in those with H. pylori- negative gastritis (4.71% vs 12.50%, P<0.05). Conclusion: DQB1*03032 may contribute to resis- tance against H. pylori infection and the absence of DQB1*0602 may be a host genetic factor for H. pylori- associated gastritis. World J Pediatr 2006;2:109-112

Objective We determined the seroprevalence of Helicobacter pylori infection among healthy children in different familial environments in Shanghai,and assessed the role of parental infection status in the transmission of H.pylori.Methods 1119 healthy individuals (568 boys and 551girls,respectively) were selected from urban and rural schools in Shanghai.A commercial enzyme immunoassay test for IgG to H.pylori was used.Demographic,sociological and environmental data were collected by face-to-face interviews using a standard questionnaire.Results The incidence of infection was calculated to increase 3.28% annally in children between ages 7 to 12 years.Children were infected in earlier age whose parents were workers and peasants.The infection rate was higher in children whose parents were infected too.Conclusion The infection is more prevalent in younger children of families in lower socioeconomic conditions.Improvement of living conditions may be effective for prevention.

Background: It has been suggested that the HLA class II gene may be important in determining the outcome of Helicobacter pylori (H. pylori) infection. This study was undertaken to explore the immunogenetic mechanism of the relation between H. pylori infection and human leukocyte antigen (HLA)-DQB1 and to search for the possible existence of susceptibility or resistance genes. Methods: A total of 133 children with chronic gastritis who had been treated at the Ruijin Hospital and 80 normal children (controls) were examined for H. pylori infection and HLA-DQB1 genotyping. HLA-DQB1 genotyping was performed with the polymerase chain reaction-specific sequence oligonucleotide (PCR-SSO) method. Results: Eighty-five of the 133 children with chronic gastritis and 33 of the 80 controls were H. pylori positive. The allelic frequency (AF) of DQB1*03032 was significantly lower in H. pylori-positive controls than in H. pylori-negative controls (10.61% vs 25.53%, P<0.05). The AF of DQB1*0602 was significantly lower in patients with H. pylori-positive gastritis than in those with H. pylorinegative gastritis (4.71% vs 12.50%, P<0.05). Conclusion: DQB1*03032 may contribute to resistance against H. pylori infection and the absence of DQB1*0602 may be a host genetic factor for H. pyloriassociated gastritis. World J Pediatr 2006;2:109-112

消化性溃疡的愈合有多种因素参与,但对表皮生长因子(EGF)在溃疡愈合中的作用甚少报道,且对参与愈合过程的EGF来源有争议.我们采用乙酸造模,对此问题进行探索.

目的探讨人类白细胞抗原(HLA)-DQB1等位基因与儿童十二指肠溃疡( DU)和幽门螺杆菌( H.pylori)感染的遗传关联性.方法采用非同位素标记的聚合酶链反应-序列特异性寡核苷酸探针( PCR-SSO)杂交的方法,对上海地区汉族健康儿童 80例、DU患儿 58例的 HLA-DQB1等位基因进行分型;并同时检测 DU患儿 H.pylori感染情况.结果在 DU患儿中, HLA-DQB1× 05031等位基因频率明显高于正常健康儿童(分别为:6.02%、0.63%,P<0.05, RR=9),而在 H.pylori阳性和 H.pylori阴性 DU组之间差异无显著性.结论 HLA-DQB1×05031与 DU呈正相关, DU患儿与正常对照组儿童之间存在着遗传学的差异;虽然 H.pylori感染是 DU的重要致病因素,但 HLA-DQB1× 05031并不是通过 H.pylori感染而影响 DU的遗传易感性.

目的研究HLA-DQB1基因位点上是否存在幽门螺杆菌(H.pylori)感染及其相关胃炎的易感基因或抵抗基因,从免疫遗传角度探讨H.pylori感染后临床结局多样性的可能发生机制.方法对1999年9月至2000年7月上海第二医科大学附属瑞金医院收治的133例慢性胃炎及80名健康儿童(对照组),进行H.pylori检测,应用PCR-SSO杂交方法确定其HLA-DQB1等位基因型别.结果80名对照组儿童中H.pylori阳性33名,H.pylori阴性47名;133例慢性胃炎患儿中,H.pylori阳性85例,H.pylori阴性48例.DQB1*03032等位基因频率在血清学H.pylori阳性者中低于血清学H.pylori阴性的健康儿童(10.61%vs 25.53%,P＜0.05).DQB1*0602等位基因频率在H.pylori阳性胃炎患儿低于H.pylori阴性胃炎患儿(4.71%vs 12.50%,P＜0.05).结论DQB1*03032对H.pylori感染可能具有抵抗保护作用,DQB1*0602缺乏可能是H.pylori相关性胃炎发生的宿主遗传因素.

[Objective] To observe the effect of RDGLC on the ratio of small intestine propulsion,the secretion of gastric fluid acidity and pepsin of the healthy rat. [Methods] Healthy SD rats were divided randomly into saline.domperidone and different doses group of RDGLC. The effect of small intestine propulsion,the secretion of gastric fluid acidity,free acid,total acid and the pepsin were observed in all groups. [Results] The doses over 0. 5 mg/(kg ?time) of RDGLC could enhance small intestine propulsion; high dose of RDGLC could increase the secretion of gastric fluid acidity, free acid, total acid ;low, middle, high dose of ROGLC could promote the activity of pepsin. [Conclusion] ROGLC could promote the motion of small intestine, increase the secretion of gastric fluid acidity and pepsin, which might be one of the pharmacological basis for treating functional dyspepsia.

目的观察獐乳对正常大鼠胃排空、小肠推进及对盐酸多巴胺致胃排空延迟模型大鼠胃排空的影响.方法采用 SD系大鼠,随机分为空白对照组、模型对照组、吗丁啉组和獐乳不同剂量组, 观察各组大鼠胃排空及小肠推进情况.结果獐乳低、中、高剂量组胃甲基橙残留率明显降低,能促进正常大鼠胃排空;獐乳中、高剂量组对正常大鼠小肠推进有促进作用;獐乳低、中、高剂量组均不能显著促进多巴胺所致大鼠胃排空延迟,胃内甲基橙残留率与模型对照组相比无显著降低.结论獐乳具有促胃肠动力作用,但其促进胃肠动力作用的机制可能不是通过阻断多巴胺受体途径.

目的 以临床诊断作为矮小症患儿(可疑GHD)诊断标准,评估生长激素激发试验、胰岛素样生长因子Ⅰ(IGF-Ⅰ)及IGF结合蛋白3(IGFBP-3)对GHD的诊断价值.方法放免方法检测84例可疑GHD患者及63例非GHD患者GH峰值、IGF-Ⅰ及IGFBP-3,运用ROC曲线方法选定各生化检测的最佳截定值,并计算各最佳截定值的敏感性(sensitivity, S)、特异性(specificity, Sp)及诊断有效率(diagnostic efficiency, DEf).结果 ROC曲线显示GH激发试验GH峰值7.65 μg/L为最佳截定值, DEf达84.4%, S为75.9%,Sp达94.9%; IGF-Ⅰ SDS最佳截定值为-1.85,S为70.2%、 Sp为83.1%、DEf为70.2%; IGFBP-3 SDS最佳截定值为-1.55,比传统-2SD高,DEf为64.3%, Sp较高(89.8%),但S仅为45.8%.联合使用上述3种测定有较佳的DEf(91.2%), S(89.3%)和Sp(93.7%).结论 GH激发试验如选取一个好的截定值(本研究为GH峰值7.65 μg/L),则该试验对GHD具有较高诊断价值;单个IGF-Ⅰ检测则逊于GH激发试验; IGFBP-3单独诊断GHD价值不大.三者联合使用诊断率及准确率皆很高,最具诊断价值。

小儿厌食是儿科临床常见的病症,是功能性消化不良的一种表现类型,主要表现为食欲低下、不思进食、早饱、餐后腹胀.小儿长期厌食会导致营养不良,甚至影响生长发育.此病多发生在 5岁以下, 1～ 3岁最多.引起小儿厌食的常见原因有喂养不当、生活环境改变、精神紧张、药物影响、疾病影响等,目前该病的发病机制尚不明确,也缺乏有效的治疗方法.

目的对一种新型血清学方法--免疫层析法诊断幽门螺杆菌(H.pylori)感染进行评价.方法对60例均具有腹痛、呕吐等消化道症状的患儿行胃镜检查,并取活检组织,分别做快速尿素酶试验和组织学检查.上述两项均呈阳性,确诊存在H.pylori感染者采用间接固相免疫层析法(ASSURE H.pylori Rapid Test)分别检测全血和血清的pIgG,并作比较.结果血清学诊断的敏感值(Sen)、特异值(Spe)、阳性预测值(PPV)、阴性预测值(NPV)、准确度(ACC)、阳性似然比(PLR)和阴性似然比(NLR)最高分别为100%、91.9%、86.4%、100%、90.0%、10.2和5.1;而全血的结果分别是91.3%、91.9%、86.4%、94.3%、90.0%、10.2、0.2,血清与全血比较,统计学分析差异有显著性.全血的准确度更高.结论ASSURE H.pylori rapid test是血清学诊断H.pylori感染的较佳方法.因其诊断H.pylori感染有较高的特异性和敏感性;且操作方便,无须仪器,尤其适合基层、边远地区使用.

目的:观察促性腺素释放素类似物(GnRH-A)治疗特发性中枢性性早熟(ICPP)的临床疗效.方法: 用GnRH-A缓释剂治疗18例(男性1例,女性17例) ICPP病人,疗程为6～12 mo,观察第二性征变化,男性睾丸,女性乳房、子宫、卵巢容积,骨龄,生长速率,促黄体素释放素(LHRH)激发试验.结果: 经治疗男性睾丸、女性卵巢、子宫容积及乳房均缩小,子宫容积和乳房分期治疗6 mo与治疗前比较分别为[(2.4±s 0.3)cm3 vs (5.9±0.9)cm3,P<0.01]和[(1.8±0.7) vs (2.80±0.10)], P<0.01].骨龄延缓,BA / CA值随疗程而缩小.治疗后身高、骨龄及实际年龄三者间的差距逐步改善, 治疗12 mo预测成人终身高(PAH)从(154.7±1.7)cm提高到(158±3)cm. 结论: GnRH-A缓释剂治疗ICPP可有效抑制性征发育,延缓骨龄成熟,并随疗程延长而改善成人终身高.

AIM:To investigate the relationship between insulin-like growth factor-I, -II (IGF-I and IGF-II), IGF-binding protein 3 (IGFBP-3) and Child-Pugh score in patients with liver cirrhosis, and to search for potential clinical markers of liver function.METHODS:Forty-four patients with advanced liver cirrhosis of viral origin were divided into 3 groups according to severity of cirrhosis (Child-Pugh score) and 38 healthy subjects served as controls. Serum levels of IGF-I, IGF-II and IGFBP-3 were measured by immunoradiometric assay.RESULTS:Serum IGF-I, IGF-II and IGFBP-3 levels were significantly lower in patients with cirrhosis than in controls, and serum concentrations of IGF-I, IGF-II and IGFBP-3 were associated with the severity of liver dysfunction, and dropped sharply during the progression of liver failure. Among these 3 parameters, serum IGF-II was the most sensitive and effective indicator for liver dysfunction. Concentrations of IGF-I <30 ng/mL, IGF-II <200 ng/mL and IGFBP-3 <6 ng/mL implied a negative prognosis for patients with liver cirrhosis.CONCLUSION:Serum IGF-I, IGF-II and IGFBP-3 may provide a new dimension in the assessment of liver dysfunction. Combined detection of serum IGF-I, IGF-II and IGFBP-3 with Child-Pugh score is more effective in predicting prognosis than Child-Pugh score alone.

Objective To investigate the significance of liver function determination using recombinant human growth hormone stimulate test and 13C-methacetin breath test in liver cirrhosis. Methods Twenty-five patients with liver cirrhosis after hepatitis B were enrolled. After a night of empty meal, rh-GH 4. 5 IU was injected subcutaneous-ly. Venous blood sampling was taken 24h later. At the same time, after oral administration of C-methacetin(75 mg) to the patients,enrichment of breath [13C]Co2was measured by isotope ratio infrared spectroscopy and 13C MVmax40, CUM40,CUM120 were obtained. Results Before rh-GH stimulate test, the difference of IGF-I, IGFBP-3 among different groups was significant( P 0.05) ,but between Child A and Child B groups, after rh-GH stimulate test, the rise of IGF-I in Child A and B groups was significantly higher than in group C, but the difference of IGFBP-3 was not obvious in the groups. The difference of them among different groups is significant(P 0.05) , except CUM120 between group Child A and B. Conclusion The results show that both recombinant human growth hormone stimulate test and13C-methacetin breath test are useful liver function tests.

目的建立一套适合儿童幽门螺杆菌感染的PCR检查方法,了解儿童幽门螺杆菌感染的可能途径.方法对37例4～14岁患儿采用聚合酶链反应检测胃粘膜、胃液和唾液中的幽门螺杆菌,并作胃粘膜快速尿素酶、病理W-S银染色及细菌培养.结果 37例患儿中尿毒酶、病理W-S银染色、细菌培养、胃粘膜PCR、胃液PCR和唾液PCR的检出率分别为35.14%、40.54%、35.14%、45.95%、35.14%和5.40%;敏感性为68.8%、81.2%、81.3%、93.8%、81.3%、12.5%;特异性为90.5%、90.5%、100%、90.5%、100%、100%;2项或2项以上检出率阳性判断为幽门螺杆菌感染,37例患儿中阳性16例.结论胃粘膜、胃液PCR方法同其他幽门螺杆菌检测手段相比幽门螺杆菌阳性检出率相似,PCR方法具有操作简便,特异性、敏感性高的优点,是诊断儿童幽门螺杆菌感染、判断药物疗效的有效检查手段.唾液PCR阳性率低可能与口腔缺乏特定的幽门螺杆菌生长环境有关,但也提示口-口传播是幽门螺杆菌感染的可能途径.

为探讨小儿厌食症的发病机理,并观察吗丁啉混悬液对厌食症的疗效.对30例经胃镜及腹部B超排除器质性疾病的厌食患儿作血HP-IgG测定;第1次B.超胃液体排空检查后服用吗丁淋混悬液3周,第3周末B超复查胃液体排空,比较治疗前后临床症状和胃动力的变化.结果发现厌食患儿胃排空较正常儿明显延迟,存在胃运动功能障碍;吗丁啉治疗后症状及胃运动功能均有显著改善;H.pylori感染患儿与H.pylori阴性患儿相比,胃运动功能无明显差异,促动力药物对两者均有效.提示胃运动功能障碍是小儿厌食症的重要发病机制之一;H.pylori感染与其无明显相关;吗丁啉能改善厌食小儿的胃运动功能、促进胃排空.

通过测定单纯肝硬化患者和合并亚临床肝性脑病(SHE)患者的血清胰岛素样生长因子-Ⅰ(IGF-Ⅰ)浓度,探讨IGF-I与肝硬化及与SHE的关系,结合数字连接试验(NCT)评估SHE诊断的准确性,从而探索SHE的诊断辅助指标.