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Objective To explore the metabolic syndrome and its association with arterial compliance in Chinese children and adolescents. Methods 337 participants aged 6 to 18 years with males accounted for 55.8% were grouped according to their traits of metablic syndrome. Anthropometry, blood pressure, fasting plasma glucose, insulin and serum lipid profile were measured. Homeostasis model was assessed and insulin resistance (HOMA-IR) index was measured and calculated for estimating individual insulin resistance. Arterial compliance was also measured using digital pulse wave analyzing method (Micro medical, London), and stiffness index was calculated. Results The stiffness index in participants with metablic syndrome was significant higher than that in participants with no riskof metablic syndrome [(7.69±1.63) vs (6.25±0.86) m/s, P<0.01] and stiffness index and HOMA-IR were progressively increased with the increase of traits of metablic syndrom (P for linear trend <0.001). After gender, age, and pubertal development were adjusted, both traits of metablic syndrome and HOMA-IR were correlated positively with stiffness index (both P<0.05). Conclusion The clustering of metablic syndrome was closely associated with risk at increased arterial stiffness in Chinese children and adolescents. It was suggested that arterial compliance assessment of children and adolescents might be an important measure for prevention of cardiovascular diseases.
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Objective The purpose of this study was to explore an objective measure to assess actual body shape of children and adolescents in China.
Methods Based on the Chinese National Survey on Student’s Constitution and Health (CNSSCH) in 2005, 210 927 children and adolescents' (7-18 years) body height, body weight, chest circumference, sitting height, chest circumference-height ratio, chest circumference-sitting height ratio, chest circumference-low limb ratio, and sitting height-low limb ratio measurements were used to develop an objective measure by using transformation variables and explored factor analysis (EFA). Discrimination power of the objective measure was evaluated based on BMI reference and Receiver Operating Characteristic curves (ROC).
Results The objective measure included four dimensions scores:transverse dimension (TD) indicating weight and chest circumference; length dimension (LD) indicating height and sitting height;transverse-length ratio dimension (TLD) indicating chest circumference-height ratio, chest circumference-sitting height and chest circumference-low limb ratio; proportion dimension (PD) indicating sitting height-low limb ratio. The whole dimension (WD) indicating the whole body shape was showed by the average of four dimensions scores. Four dimensions and WD scores were approximately 80 in children and adolescents with normal weight, and higher than those of overweight, obesity, and underweight (all P-values<0.001). Areas under ROC of overweight and obesity compared with normal weight ranged from 0.88 to 1.00 for scores of TD, TLD, and WD.
Conclusion The objective measure which included four dimensions was explored, and TD, TLD, and WD had significant discrimination power. -
儿童和青少年1型糖尿病临床实践指南摘要
1.定义、流行病学和分类儿童和青少年1型糖尿病诊断标准为:①存在典型的症状和体征;②空腹静脉血浆葡萄糖浓度≥7.0 mmol/L,和/或,餐后2小时后的任意静脉血浆葡萄糖浓度≥11.1mmol/L.
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提高儿童及青少年代谢综合征的研究水平
我国正处于快速的社会转型期.随着社会的发展和生活水平的显著提高,儿童青少年的生存环境和生活方式发生了明显改变.但是,健康的生活观念没有得到相应的宣传和落实,因而生活方式相关疾病不断蔓延,已严重影响了儿童青少年的身体素质和健康状况.在中度以上肥胖儿童中并发高血压、高血脂、脂肪肝、高尿酸血症、糖耐量低减(impaired glucose toleranee,IGT)1种或多种并发症者达82.5%,出现2型糖尿病(type 2 diabetes mellitus,T2DM)的1.4%.代谢综合征(metabolic syndrome,MS)在重度肥胖组高达22.1%[1].
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儿童糖尿病酮症酸中毒诊疗指南(2009年版)
糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)是以高血糖、高血酮、酮尿、脱水、电解质紊乱、代谢性酸中毒为特征的一组症候群.DKA是糖尿病患儿血循环中胰岛素缺乏/胰岛素抵抗,反调节激素增加,导致代谢紊乱进展,病情不断加重的结果,是儿童糖尿病常见的死亡原因之一.新发1型糖尿病患儿DKA的发生率与地域、社会经济状况及发病年龄相关,年龄越小,DKA越多.各国报道不一,约15%~70% [1].国内尚缺乏多中心流行病学调查的结果,北京地区报道约为20% [2] ,浙江为43% [3].国外报道儿童2型糖尿病患者诊断时DKA的发生率可高达25% [4],而北京儿童医院6年来97例住院2型糖尿病儿童中,首次诊断糖尿病时DKA的发生率为7.4%.DKA的诊断和处理在各地也存在较大差异.为规范儿童DKA的诊断治疗,降低DKA的死亡风险和严重不良事件发生率,儿科学分会内分泌遗传代谢学组根据国内外儿童糖尿病DKA诊治研究进展,拟定2009版DKA诊断治疗指南.
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儿童及青少年糖尿病的胰岛素治疗指南(2010年版)
前言糖尿病儿童不同于一般儿童,他们在长期的治疗中有着特殊的需求并随着成长而不断变化.1992年国际糖尿病联盟(IDF)考虑到该群体的特殊性成立了专门委员会(Task Force).1993年9月4日,儿童及青少年国际糖尿病学会(International Society for Pediatric and Adolescent Diabetes,ISPAD)在圣温森特(St. Vincent)提出应"提高全世界儿童及青少年糖尿病患者的健康、社会福利和生活质量"的宣言.IDF专门委员会与ISPAD共同发布了"社会应对患病儿童和家庭提供一切必要的支持,包括医疗、社会、公众、政府的各种努力以及企业的资源及支持"的宗旨.
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儿童青少年血脂异常防治专家共识
儿童青少年血脂异常是指发生在儿童青少年时期的血脂代谢紊乱,通常称为高脂血症,系指血浆中总胆固醇(totalcholesterol,TC)和(或)甘油三酯(triglyceride,TG)水平高于正常参考值以及低高密度脂蛋白-胆固醇(high densitylipoprotein-cholesterol,HDL-C)血症 [1].儿直青少年血脂异常与成人动脉粥样硬化(atherosclerosis,AS)相关性心血管疾病(cardiovascular disease,CVD)发生密切相关,且直接损害儿童健康,如引起黄色瘤、酮体症、脂质肾毒性、脂肪肝、胆石症、胰腺炎等 [1] .血脂异常进展缓慢,常无明显症状与体征,特别是在儿童青少年时期,但严重的家族性高胆固醇血症(familial hypercholesterolemia,FH)儿童可出现黄色瘤,甚至有CVD的临床表现 [2].
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《儿童青少年血脂异常防治专家共识》解读
心血管疾病(CVD)是严重危害人类健康的疾病,是我国城市和乡村人群的第一位病死原因,脂质代谢紊乱是CVD的致病性危险因素,早期有效干预是防治的重要措施[1-2].
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肥胖青少年胰岛素敏感性分析
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肥胖儿童青少年腹部脂肪不同评价方法比较
Objectives To assess the clinical value of ultrasonography (US) and bioelectrical impedance analysis (BIA) in analyzing abdominal fat contents of obese children and adolescents through comparison with MRI. A correlation with other obese related metabolic parameters was conducted. Methods Ninety 7-17-y-old obese children and adolescents (60 boys and 30 girls with mean age of 9.6 ± 2.9 y and mean BMI of 24.5 ± 4.5 kg/m2) were recruited. Metabolic parameters were measured, and insulin resistance was estimated according to homeostasis model assess-ment (HOMA-IR). On the same day abdomen subcutaneous fat thickness (SFTUS) was measured by US. Body fat mass (FMBIA) and abdominal visceral fat area (VFABIA) were analyzed by bioelectrical impedance analysis (BIA). After obtaining informed consent, abdominal MRI was performed in 20 subjects. Each section of umbilicus level was analyzed by image threshold value segmentation using SigmaScan Pro 5 and abdominal subcutaneous fat area (SFAMRI) and visceral fat area (VFAMRI) were calculated. Results (1) A strong positive association was found between SFTUS and SFAMRI (P< 0.05), VFABIA and VFAMRI (P < 0.01) respectively. (2) FMBIA and SFAMRI, VFAMRI, SFTUS also showed significant correlations (P < 0.05). (3) VFAMRI showed extremely significant positive correlations with TG, Insulin,C-peptide and HOMA-IR (P < 0.01 ) ; SFAMRI was also correlated positively with them (P < 0.05). (4) SFTUS was correlated positively with UA (uric acid), Insulin, 2HIns (insulin measured at 2 hours after meal), C-peptide,2HC-peptide (C-peptide measured at 2 hours after meal) and HOMA-IR (P < 0.01). (5) VFABIA was correlated significant positively with UA, insulin, TG, 2HIns and HOMA-IR. FMBIA showed positive correlation with UA, Insulin,2HIns, C-peptide, 2HC-peptide and HOMA-IR. Conclusions abdominal subcutaneous and visceral fat of obese children and adolescents evaluated by US and BIA are correlated well with those assessed by MRI, and also correlated well with TG, insulin, C-peptide and other metabolic biochemical parameters. Our data support the value of using cost effective, simple and convenient methods such as BIA and US to evaluate the obese and related metabolic risk of children and adolescents in clinical practice.
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长处与困难问卷(父母版)在中国8个省份22,108名小学生中的调查结果
背景:我国儿童心理问题不断增多,因此能够有效评估儿童行为和情绪问题的筛选工具对于促进我国儿童身心健康和预防儿童精神疾病有重要的意义。
目的:在来源于中国不同地区城市和农村的大样本儿童中对国际公认的长处和困难问卷(SDQ)中文版的使用进行评估,包括情绪症状、品行问题、多动/注意缺陷、同伴交往问题和亲社会行为。
方法:采用分层随机抽样选取8省份22,108名小学生(年龄在5岁至13岁)的法定监护人(父母为主)进行SDQ(父母版)中文版问卷调查。本研究评估了SDQ评分与社会人口学特征之间的关联性,并比较了中国与日本和英国在“异常”,“临界”和“正常”标准的百分位划界分。
结果:SDQ(父母版)5个分量表中有4个内部一致性尚可,但是“同伴关系问题”分量表则较差(alpha=0.22)。监护人反映男孩比女孩的多动/注意力缺陷问题更多,而女孩比男孩的情感症状问题突出。男孩和女孩的多动/注意力缺陷问题都会随着年龄的增长而减少,而同伴交往问题随着年龄增长而增多。农村地区和监护人不是父母(即祖父母或其他亲属)的孩子中,情绪症状、品行问题和同伴交往问题较为普遍。中国儿童中判定为“异常”的90%百分位划界分(19-40)要高于日本和英国报道的儿童划界分。
讨论:此项研究提示,对男孩的多动/注意缺陷问题应在10岁之前开始预防,并且在青春期早期就要开始训练如何减轻与同伴交往带来的压力。进一步的研究需要注重于提高SDQ在中国文化背景下的信效度,并确定SDQ对于识别孩子是否需要心理健康服务的敏感性和特异性。 -
青少年甲状腺癌47例临床分析
青少年甲状腺癌临床并不少见,其临床表现,病理特征及预后与成人甲状腺癌均有较大的差异.青少年正处于生长发育阶段,避免误诊,选择合理的治疗方法更显重要.为此,对1988~2004年我院收治的25岁以下青少年甲状腺癌47例进行分析.
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儿童及青少年卵巢肿瘤(附108例临床病理分析)
沂蒙山区1966~1984年间收治卵巢肿瘤1,715例,其中儿童及青少年(<1~17岁)卵巢肿瘤108例,发病率为6.4%.按WHO卵巢肿瘤组织学分类,结合范郎娣提出的标准,复查了全部病理切片,并整理有关临床资料,报道如下.
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儿童及青少年卵巢肿瘤(附108例临床病理分析)
沂蒙山区1966~1984年间收治卵巢肿瘤1,715例,其中儿童及青少年(<1~17岁)卵巢肿瘤108例,发病率为6.4%.按WHO卵巢肿瘤组织学分类,结合范郎娣提出的标准,复查了全部病理切片,并整理有关临床资料,报道如下.
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青少年甲状腺癌治疗进展
甲状腺癌是头颈部常见的恶性肿瘤,也是常见的内分泌恶性肿瘤,多发于青壮年,平均年龄约40岁.但是青少年甲状腺癌并不罕见,文献报道[1]约10%的患者不到21岁,占儿童和青少年肿瘤的3%,其中男女发病率之比为1∶2.国内尚无青少年甲状腺癌发病率统计资料.对于青少年甲状腺癌治疗方法,尤其是手术方式国内外存有争议[2].现对青少年甲状腺癌的治疗进展作一扼要叙述.