Jornal de Pediatria (Vers?o em Português)最新文献

Prevalence of constipation in cystic fibrosis patients: a systematic review of observational studies 囊性纤维化患者便秘的患病率:观察性研究的系统回顾

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-11-01 DOI: 10.1016/j.jpedp.2020.03.002

Marina A. Stefano , Rosana E. Poderoso , Jochen G. Mainz , Jose D. Ribeiro , Antonio F. Ribeiro , Elizete Aparecida Lomazi

Objective

To systematically revise the literature in search of data about the prevalence of constipation in patients with cystic fibrosis according to the publications in this field, which partly refer to guidelines defined in 2010 by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

Sources

Systematic review selecting articles based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, including Cystic Fibrosis patients of all ages. Sources of information were selected to identify the articles without period limitation: CADTH – Canadian Agency for Drugs and Technologies in Health, CINAHL Complete, Clinical Trials US NIH, Cochrane Library, Embase, MEDLINE via Ovid, Scopus, Web Of Science, PubMed, SciELO, MEDLINE and LILACS, Health Systems Evidence, PDQ Evidence, CRD Canadian Agency for Drugs and Technologies in Health, INAHTA – International Network of Agencies for Health Technology Assessment, and PEDro.

Findings

The prevalence of constipation was reported in eight observational studies. Only two studies assessed the frequency of constipation as a primary objective; in the others, constipation was quoted along with the prevalence of the spectrum of gastrointestinal manifestations. Altogether, the publications included 2,018 patients, the reported prevalence varied from 10% to 57%. Only two of the six articles published after 2010 followed the definition recommended by the European Society.

Conclusions

Constipation is a frequent but still insufficiently assessed complaint of Cystic Fibrosis patients. The use of diverse diagnostic criteria restricts comparison and epidemiological conclusions, future studies should compulsorily apply the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition definition.

目的根据该领域的出版物，系统地修订文献，以寻找有关囊性纤维化患者便秘患病率的数据，其中部分参考了2010年由欧洲儿科胃肠病学，肝病学和营养学会定义的指南。来源:系统评价:根据系统评价和荟萃分析的首选报告项目选择文章，包括所有年龄的囊性纤维化患者。选择信息来源来确定没有时间限制的文章:CADTH -加拿大卫生药物和技术机构、CINAHL Complete、美国国立卫生研究院临床试验、Cochrane图书馆、Embase、MEDLINE via Ovid、Scopus、Web of Science、PubMed、SciELO、MEDLINE和LILACS、卫生系统证据、PDQ证据、CRD加拿大卫生药物和技术机构、INAHTA -国际卫生技术评估机构网络和PEDro。8项观察性研究报告了便秘的患病率。只有两项研究评估便秘的频率作为主要目标;在其他研究中，便秘与胃肠道表现的普遍性一起被引用。总共，这些出版物包括2018名患者，报告的患病率从10%到57%不等。2010年之后发表的六篇文章中，只有两篇遵循了欧洲学会推荐的定义。结论便秘是囊性纤维化患者常见的主诉，但尚未得到充分的评估。不同诊断标准的使用限制了比较和流行病学结论，未来的研究应强制应用欧洲儿科胃肠病学、肝病学和营养学学会的定义。

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引用次数: 0

Impact of the tetra viral vaccine introduction on varicella morbidity and mortality in the Brazilian macro regions 在巴西宏观区域引入四病毒疫苗对水痘发病率和死亡率的影响

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-11-01 DOI: 10.1016/j.jpedp.2019.12.001

Marcella Z. Ribeiro , Emil Kupek , Paulo V.Z. Ribeiro , Carlos Eduardo Andrade Pinheiro

Objective

To describe the impact of the introduction of the viral tetra vaccine in the National Immunization Program in 2013 for 15‐month‐old children in mortality rates and hospitalization associated with varicella in Brazil.

Methods

Mortality rates and hospitalizations rates associated with varicella were evaluated between 2010 and 2016 and described according to Brazilian macro regions and age. The population was stratified into age groups: < 1 year, 1‐4 years, and 5‐14 years. Data were collected from the Informatics Department of the Unified Health System. A percentage difference was calculated between rates of hospitalizations and mortality in the pre (2010‐2012) and post‐vaccination periods (2014‐2016) to estimate the approximate effectiveness of the vaccine.

Data synthesis

At the national level, vaccination significantly reduced the mortality rates and hospitalizations rates in all age groups analyzed. Among those under 5 years of age, mortality rates and hospitalizations rates decreased 57‐49% and 40‐47%, respectively. There was a national decrease of up to 57% in the mortality rates due to the disease, with smaller decreases seen in the North and Northeast regions and the largest in the South and Southeast regions. The hospitalizations rates for varicella reached a maximum national decline of 47%. In children aged 1–4 years, with higher vaccination coverage, the highest reduction was observed in both mortality rates and hospitalizations rates, which decreased from 2.6 to 0.4/100,000/year.

Conclusions

The tetra vaccine proved to be effective in reducing both mortality and hospitalizations of children and adolescents up to 15 years of age in the 2014‐2016 triennium.

目的描述2013年在巴西国家免疫规划中引入病毒性四联疫苗对15个月大儿童水痘相关死亡率和住院率的影响。方法评估2010 - 2016年水痘相关死亡率和住院率，并根据巴西宏观地区和年龄进行描述。人口被分为不同的年龄组:<1年、1 - 4年和5 - 14年。数据收集自统一卫生系统信息部。计算了疫苗接种前(2010 - 2012年)和疫苗接种后(2014 - 2016年)住院率和死亡率之间的百分比差异，以估计疫苗的大致有效性。在国家一级，疫苗接种显著降低了所分析的所有年龄组的死亡率和住院率。在5岁以下儿童中，死亡率和住院率分别下降了57 - 49%和40 - 47%。全国因该疾病导致的死亡率下降了57%，北部和东北部地区下降幅度较小，南部和东南部地区下降幅度最大。水痘住院率在全国最大降幅为47%。在疫苗接种覆盖率较高的1-4岁儿童中，死亡率和住院率下降幅度最大，从每年2.6 /100 000降至0.4/100 000。结论在2014 - 2016三年期间，四联疫苗被证明在降低15岁以下儿童和青少年的死亡率和住院率方面是有效的。

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引用次数: 0

Distal intestinal obstruction syndrome: a diagnostic and therapeutic challenge in cystic fibrosis 远端肠梗阻综合征:囊性纤维化的诊断和治疗挑战

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-11-01 DOI: 10.1016/j.jpedp.2019.08.007

Natascha S. Sandy , Lilian H.P. Massabki , Aline C. Gonçalves , Antonio F. Ribeiro , Jose D. Ribeiro , Maria de Fátima C.P. Servidoni , Elizete A. Lomazi

Objective

To evaluate the demographics, genotype, and clinical presentation of pediatric patients presenting with distal intestinal obstruction syndrome (DIOS), and factors associated with DIOS recurrence.

Methods

Case series of ten patients (median age 13.2 years), followed‐up in a reference center, retrospectively assessed. Data analyzed included age, gender, cystic fibrosis genotype, meconium ileus at birth, hydration status, pulmonary exacerbation, Pseudomonas aeruginosa colonization, pancreatic insufficiency (PI), body mass index (BMI) at the episodes, clinical manifestations of DIOS, imaging studies performed, acute management of DIOS, maintenance therapy, and recurrence on follow‐up.

Results

All patients had two positive sweat chloride tests, and nine of ten also had genotype study. The most common genotype identified was homozygosis for the delta F508 mutation. In seven cases, a previous history of meconium ileus was reported. All patients had pancreatic insufficiency. Diagnosis of DIOS was based on clinical and imaging findings. Of the total number of episodes, 85% were successfully managed with oral osmotic laxatives and/or rectal therapy (glycerin enema or saline irrigation). Recurrence was observed in five of ten patients.

Conclusion

In this first report of pediatric DIOS in South America, the presence of two risk factors for DIOS occurrence was universal: pancreatic insufficiency and severe genotype. Medical history of meconium ileus at birth was present in most patients, as well as in the subgroup with DIOS recurrence. The diagnosis relied mainly on the clinical presentation and on abdominal imaging. The practices in the management of episodes varied, likely reflecting changes in the management of this syndrome throughout time.

目的探讨小儿远端肠梗阻综合征(DIOS)患者的人口统计学、基因型和临床表现，以及与DIOS复发相关的因素。方法10例患者(中位年龄13.2岁)，在参考中心随访，回顾性评估。分析的数据包括年龄、性别、囊性纤维化基因型、出生时肠梗阻、水合状态、肺恶化、铜绿假单胞菌定植、胰腺功能不全(PI)、发作时体重指数(BMI)、DIOS的临床表现、影像学检查、DIOS的急性处理、维持治疗和随访时的复发。结果所有患者均有2项汗液氯化物检测阳性，其中9例同时进行基因型研究。发现的最常见的基因型是δ F508突变的纯合子。其中7例有胎粪肠梗阻病史。所有患者均有胰腺功能不全。诊断DIOS是基于临床和影像学表现。在总发作次数中，85%通过口服渗透性泻药和/或直肠治疗(甘油灌肠或盐水冲洗)成功控制。10例患者中有5例出现复发。结论在南美洲首次报道的儿童DIOS中，DIOS发生的两个危险因素是普遍存在的:胰腺功能不全和严重的基因型。大多数患者和DIOS复发亚组均有出生时便性肠梗阻病史。诊断主要依靠临床表现和腹部影像学。在管理发作的做法各不相同，可能反映了该综合征的管理在整个时间的变化。

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引用次数: 0

Baked egg tolerance: is it possible to predict? 烤蛋耐受性:有可能预测吗?

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-11-01 DOI: 10.1016/j.jpedp.2019.08.003

Lisis Karine Vilar, Pedro Rocha Rolins Neto, Mariana Amorim Abdo, Marina Fernandes Almeida Cheik, Christiane Pereira e Silva Afonso, Gesmar Rodrigues Silva Segundo

Objective

To assess the frequency of baked egg tolerance in IgE‐mediated egg allergy patients through the oral food challenge and to assess the tolerance predictability of different skin prick tests, as well as specific serum IgE measurement to egg proteins.

Methods

In this cross‐sectional study, 42 patients with a diagnosis of egg allergy were submitted to different skin prick tests with egg (in natura, boiled, muffin, ovalbumin, and ovomucoid), and specific IgE to egg white, ovalbumin, and ovomucoid; as well as to the oral food challenge with food containing egg, extensively baked in a wheat matrix.

Results

Of the total, 66.6% of patients tolerated the ingestion of egg‐containing foods in the oral food challenge. A comparative analysis with positive and negative oral food challenge found no significant differences regarding age, gender, other food allergies, or even specific skin prick tests and IgE values between the groups.

Conclusions

The study demonstrated an elevated frequency of baked egg food‐tolerant individuals among egg allergy patients. None of the tested markers, skin prick tests, or specific IgE, were shown to be good predictors for identifying baked egg‐tolerant patients. The oral food challenge with egg baked in a matrix is central to demonstrate tolerance and the early introduction of baked foods, improving patients’ and families’ quality of life and nutrient intake.

目的通过口服食物刺激评估IgE介导的鸡蛋过敏患者烘焙鸡蛋耐受的频率，并评估不同皮肤点刺试验的耐受性可预测性，以及特异性血清IgE对鸡蛋蛋白的测定。方法在本横断面研究中，42例被诊断为鸡蛋过敏的患者接受了不同的皮肤点刺试验，包括鸡蛋(天然鸡蛋、煮鸡蛋、松饼鸡蛋、卵白蛋白和卵黏液样蛋白)，以及蛋清、卵白蛋白和卵黏液样蛋白的特异性IgE;以及对含有鸡蛋的口腔食物的挑战，在小麦基质中广泛烘烤。结果66.6%的患者在口服食物挑战中耐受含蛋食物。口腔食物刺激阳性和阴性的对比分析发现，两组之间在年龄、性别、其他食物过敏、甚至特定皮肤点刺试验和IgE值方面没有显著差异。结论:该研究表明，鸡蛋过敏患者中烘焙鸡蛋食物耐受个体的频率升高。测试的标记物、皮肤点刺试验或特异性IgE均不能很好地预测烘焙蛋耐受患者。在基质中烘烤鸡蛋的口腔食物挑战是展示耐受性和早期引入烘焙食品，改善患者和家属的生活质量和营养摄入的核心。

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引用次数: 0

The importance of risk factors for bullying perpetration and victimization 欺凌行为和受害风险因素的重要性

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-11-01 DOI: 10.1016/j.jpedp.2020.05.001

David P. Farrington

引用次数: 0

Red reflex test at the maternity hospital: results from a tertiary hospital and variables associated with inconclusive test results 妇产医院的红色反射试验:来自三级医院的结果和与不确定试验结果相关的变量

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-11-01 DOI: 10.1016/j.jpedp.2019.08.009

Vinicius Mac Cord Lanes Baldino , Gabriela Unchalo Eckert , Juliana Rossatto , Mário Bernardes Wagner

Objectives

Describe the results of the red reflex test in full‐term newborns, as well as identify factors associated with red reflex test outcome and compare hospital length of stay between patients with inconclusive and normal red reflex test results.

Methods

Descriptive cross‐sectional study of the results of the red reflex test performed in a tertiary hospital maternity unit between 2014 and 2018. A nested case‐control study was also performed to search for anthropometric, gestational, and neonatal variables associated with the outcome of the red reflex test.

Results

There were121 identified cases of inconclusive red reflex test in 11,833 newborns. Sixteen alterations were confirmed, four considered severe: two cases of congenital glaucoma, one of cataract, and one of coloboma. Mean birth weight (p = 0.04), length (p = 0.03), and head circumference (p = 0.02) were lower in patients with inconclusive red reflex test; however without a relevant effect size (d = ‐0.21, ‐0.22, and ‐0.25, respectively).The proportion of white, mixed‐race, and black patients was significantly different between the groups (p < 0.001), with a higher chance of inconclusive results in mixed‐race (OR = 2.22) and black (OR = 3.37) patients when compared to whites. An inconclusive red reflex test led to an increase in hospital length of stay from 62 to 82 hours (p < 0.001).

Conclusions

The red reflex test was able to identify four severe alterations in 11,833 newborns (0.03%). In the 121 newborns in which the red reflex test was classified as inconclusive, there was a 20‐hour increase in the hospital length of stay, but a severe alteration was confirmed in only 3.3% of them. Differences in red reflex between white, mixed‐race, and black patients should be considered.

目的描述足月新生儿红色反射试验的结果，确定与红色反射试验结果相关的因素，并比较红色反射试验结果不确定和正常的患者的住院时间。方法描述性横断面研究2014年至2018年在三级医院产科进行的红色反射试验结果。还进行了一项巢式病例对照研究，以寻找与红色反射测试结果相关的人体测量学、妊娠期和新生儿变量。结果11833例新生儿中有121例红色反射检查不确定。16例改变被证实，4例被认为是严重的:2例先天性青光眼，1例白内障，1例结肠瘤。红色反射试验不确定的患者平均出生体重(p = 0.04)、体长(p = 0.03)和头围(p = 0.02)较低;然而，没有相关的效应量(d分别=‐0.21，‐0.22和‐0.25)。两组间白人、混血和黑人患者的比例有显著差异(p <0.001)，与白人相比，混血(OR = 2.22)和黑人(OR = 3.37)患者出现不确定结果的几率更高。不确定的红色反射试验导致住院时间从62小时增加到82小时(p <0.001)。结论11833例新生儿(0.03%)的红色反射试验能够识别出4种严重的改变。在121名新生儿中，红色反射测试被归类为不确定，住院时间增加了20小时，但只有3.3%的新生儿出现了严重的改变。应考虑白人、混血儿和黑人患者红色反射的差异。

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引用次数: 0

Influence of gestational and perinatal factors on body composition of full‐term newborns 妊娠期和围产期因素对足月新生儿身体组成的影响

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-11-01 DOI: 10.1016/j.jpedp.2019.09.006

Sylvia Reis Gonçalves Nehab, Letícia D. Villela, Andrea D. Abranches, Daniele M. Rocha, Leila M.L. da Silva, Yasmin N.V. Amaral, Saint Clair G. Junior, Fernanda V.M. Soares, Maria Dalva Barborsa Beker Méio, Maria Elisabeth L. Moreira

Objective

To evaluate the influence of gestational and perinatal factors on body composition and birth weight of full‐term newborns.

Method

This was a cross‐sectional study, within a prospective cohort, consisting of 124 postpartum women and their newborns. Data included the following: maternal age; ethnicity; pre‐gestational body mass index; gestational weight gain; parity; gestational morbidities (hypertension and gestational diabetes mellitus); gestational age at birth; birth weight; and newborn's gender. Anthropometric and body composition data of the newborns were collected using air‐displacement plethysmography (PeaPod® Infant Body Composition System–LMI; Concord, CA, USA). The stepwise technique was applied to a multiple linear regression model.

Results

The significant variables in the model that explained 84% of the variation in neonatal fat‐free mass were: birth weight; maternal age; newborn's gender and gestational age. For body fat mass: birth weight; newborn's gender; gestational arterial hypertension; gestational diabetes; and gestational weight gain. These variables explained 60% and 46% of fat mass, in grams and as a percentage, respectively. Regarding birth weight, the significant factors were gestational age, pre‐gestational BMI, and gestational weight gain. Female newborns showed higher body fat mass and male newborns had higher fat‐free mass.

Conclusion

Gestational and perinatal factors influence neonatal body composition. Early identification of these gestational factors, which may be modifiable, is necessary to prevent obesity and chronic noncommunicable diseases in the future.

目的探讨妊娠期及围生期因素对足月新生儿体成分和出生体重的影响。方法这是一项横断面研究，在前瞻性队列中，包括124名产后妇女及其新生儿。数据包括:产妇年龄;种族的;孕前体重指数;妊娠期体重增加;奇偶性;妊娠发病率(高血压和妊娠糖尿病);出生时胎龄;出生体重;以及新生儿的性别。采用空气置换体积脉搏仪(PeaPod®Infant body composition System-LMI)收集新生儿的人体测量和身体成分数据;康科德，加州，美国)。将逐步回归技术应用于多元线性回归模型。结果该模型中能够解释84%新生儿无脂质量变化的显著变量为:出生体重;母亲的年龄;新生儿性别和胎龄。体脂量:出生体重;新生儿的性别;妊娠期高血压;妊娠期糖尿病;妊娠期体重增加。这些变量分别解释了60%和46%的脂肪量(以克数和百分比计算)。关于出生体重，重要因素是胎龄、孕前BMI和妊娠期体重增加。女性新生儿体脂质量较高，男性新生儿无脂质量较高。结论妊娠期和围产期因素影响新生儿体成分。早期识别这些可能是可改变的妊娠因素对于将来预防肥胖和慢性非传染性疾病是必要的。

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引用次数: 0

Short‐time effect of the kangaroo position on electromyographic activity of premature infants: a randomized clinical trial 袋鼠体位对早产儿肌电活动的短期影响:一项随机临床试验

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-11-01 DOI: 10.1016/j.jpedp.2019.08.010

Kaísa Trovão Diniz , José Eulálio Cabral Filho , Rafael Moura Miranda , Geisy Maria Souza Lima , Natália Priscila dos Santos Figueredo , Kalline Fernanda Nunes de Araújo

Objective

To verify the short‐term influence of the kangaroo position (KP) on the electromyography activity of preterm newborns.

Method

A clinical study was conducted in a kangaroo unit sector (secondary and tertiary care) in the city of Recife, Brazil, with 44 preterm infants randomized to intervention (n = 21) and control (n = 23) groups. The KP was performed through a band that supports the newborn against the adult's thorax, in a prone and vertical position, and infants were dressed with few pieces of clothes, thus keeping skin‐to‐skin contact with the mother. Surface electromyography was used to investigate the muscle activity of the biceps brachii and hamstrings. The randomization of the groups was performed by the program R® (v. 3.3.1). The electromyography registrations were made at three different times: before the KP and after one and two hours of KP. In the control group, the registrations were performed at the times corresponding to those of the intervention group. The mean values of the electromyography activity among the times were analyzed by ANOVA for repeated measures and the Kruskal‐Wallis test. The clinical trial was recorded in ClinicalTrials.gov (NCT02849665 ‐ 07/28/2016).

Results

In the intervention group (n = 21), there was a variation of the electromyography activity values between the three recording moments for both the biceps brachii and hamstrings. In the control group (n = 23), there was no statistical difference between the recording moments for both.

Conclusions

The KP increases the short‐term electromyographic activity of the biceps brachii and hamstrings.

目的探讨袋鼠体位对早产儿肌电活动的短期影响。方法在巴西累西腓市的一个袋鼠单位(二级和三级保健)进行临床研究，将44名早产儿随机分为干预组(n = 21)和对照组(n = 23)。KP是通过一根带子将新生儿支撑在成人的胸部上，保持俯卧和垂直的姿势，婴儿穿着很少的衣服，从而与母亲保持皮肤对皮肤的接触。采用表面肌电图观察肱二头肌和腘绳肌的肌肉活动。各组的随机化由程序R®(v. 3.3.1)执行。在三个不同的时间进行肌电图登记:KP前和KP后一小时和两小时。对照组与干预组的登记时间一致。采用重复测量的方差分析和Kruskal - Wallis检验分析各时段肌电活动的平均值。该临床试验记录在ClinicalTrials.gov (NCT02849665‐07/28/2016)中。结果干预组(21例)肱二头肌和腘绳肌的肌电活动值在三个记录时刻之间均有变化。在对照组(n = 23)，两组的记录力矩无统计学差异。结论KP增加了肱二头肌和腘绳肌的短期肌电活动。

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引用次数: 0

Multichannel intraluminal impedance‐pH and psychometric properties in gastroesophageal reflux: systematic review 胃食管反流的多通道腔内阻抗- pH值和心理测量特性:系统综述

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-11-01 DOI: 10.1016/j.jpedp.2020.03.001

Emília Silva Gonçalves, Maíra Seabra de Assumpção, Maria Fátima Correa Pimenta Servidoni, Elizete Aparecida Lomazi, José Dirceu Ribeiro

Objective

Systematically assess studies that have analyzed the psychometric properties of multichannel intraluminal impedance‐pH for the diagnosis of gastroesophageal reflux. Systematically verify studies that have analyzed the psychometric properties of multichannel intraluminal impedance‐pH regarding the diagnosis of gastroesophageal reflux disease in pediatric patients.

Methods

Systematic review considering specific descriptors (children and adolescents, gastroesophageal reflux disease and multichannel intraluminal impedance‐pH) and their synonyms. The systematic search was carried out in the MEDLINE/Ovid, Scopus, and Embase databases, considering the period from October 2017 to December 2018. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA), which was used for study selection. The psychometric properties described in the studies were: sensitivity, specificity, accuracy, and reproducibility.

Results

Sensitivity was discussed in most studies, with a result of more than 70% in four of them. Specificity was assessed only in conjunction with sensitivity, with values from 23% to 25% in two studies, and it reached 80% in a single study. Accuracy was assessed higher than 76% in one of the selected articles. The methodological quality of the studies demonstrated low risk of bias, and there was no significant concern related to applicability of the studies.

Conclusions

According to the selected studies, multichannel intraluminal impedance‐pH was considered a safe and effective tool, presenting higher sensitivity values than pHmetry regarding the diagnosis of gastroesophageal reflux disease.

目的系统评价多通道腔内阻抗- pH在胃食管反流诊断中的心理测量特性。系统验证分析多通道腔内阻抗- pH在儿科患者胃食管反流病诊断中的心理测量特性的研究。方法系统回顾考虑特定描述符(儿童和青少年、胃食管反流疾病和多通道腔内阻抗- pH)及其同义词。系统检索MEDLINE/Ovid、Scopus和Embase数据库，检索时间为2017年10月至2018年12月。本综述是根据系统评价和Meta分析的首选报告项目(PRISMA)进行的，该项目用于研究选择。研究中描述的心理测量特性是:敏感性、特异性、准确性和可重复性。结果大多数研究都讨论了敏感性，其中4项研究的结果超过70%。特异性仅与敏感性一起评估，两项研究的值从23%到25%不等，一项研究的值达到80%。在选定的一篇文章中，准确率评估高于76%。研究的方法学质量表明偏倚风险较低，研究的适用性没有显著问题。结论根据所选的研究，多通道腔内阻抗- pH被认为是一种安全有效的工具，在诊断胃食管反流病方面比pH法具有更高的灵敏度值。

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引用次数: 0

Sleep and restless legs syndrome in female adolescents with idiopathic musculoskeletal pain 女性青少年特发性肌肉骨骼疼痛的睡眠和不宁腿综合征

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-11-01 DOI: 10.1016/j.jpedp.2019.08.012

Rita Aparecida Ribeiro Amorim , Gustavo A. Moreira , Flavia Heloisa Santos , Maria Teresa Terreri , Juliana Molina , Lívia de Freitas Keppeke , Simone Guerra Lopes da Silva , Melissa Mariti Fraga , Vanessa Bugni Miotto e Silva , Sergio Tufik , Claudio Arnaldo Len

Objectives

To assess the presence of restless legs syndrome, periodic leg movement, and sleep disorders in female adolescents with idiopathic musculoskeletal pain through a sleep scale and polysomnography, and to compare these data in adolescents without pain history.

Method

Twenty‐six adolescents diagnosed with idiopathic musculoskeletal pain followed in a pain outpatient clinic and 25 healthy controls matched by age and education were recruited. The restless legs syndrome criteria were evaluated according to the International Restless Legs Syndrome Study Group, the Sleep Disturbance Scale for Children was completed, nocturnal polysomnography was performed, and anxiety symptoms were recorded.

Results

The mean age of idiopathic musculoskeletal pain adolescents was 13.9 ± 1.6 years; in controls, it was 14.4 ± 1.4 years. One adolescent in the control group (4%) and nine patients with idiopathic musculoskeletal pain (34.6%) fulfilled the restless legs syndrome criteria (p = 0.011). The authors did not observe significant differences in Sleep Disturbance Scale for Children scores between the groups in all components: disorders of initiating and maintaining sleep (p = 0.290), sleep breathing disorders (p = 0.576), disorders of arousal (p = 0.162), sleep‐wake transition disorders (p = 0.258), disorder of excessive daytime somnolence (p = 0.594), and sleep hyperhidrosis (p = 0.797). The neurophysiological, respiratory, and periodic leg movement parameters were similar in both groups. Having anxiety was not associated with restless legs syndrome (p = 0.11). Three patients with idiopathic musculoskeletal pain (11.5%) presented restless legs syndrome and periodic leg movement simultaneously, which was absent in the control group.

Conclusion

Female adolescents with idiopathic musculoskeletal pain present criteria for RLS more frequently than healthy adolescents. However, this study did not observe relevant changes in objective and subject sleep variables.

目的通过睡眠量表和多导睡眠图评估患有特发性肌肉骨骼疼痛的女性青少年中不宁腿综合征、周期性腿部运动和睡眠障碍的存在，并将这些数据与无疼痛史的青少年进行比较。方法招募26名在疼痛门诊诊断为特发性肌肉骨骼疼痛的青少年和25名年龄和教育程度相匹配的健康对照。根据国际不宁腿综合征研究组对不宁腿综合征标准进行评估，完成儿童睡眠障碍量表，进行夜间多导睡眠描记，记录焦虑症状。结果青少年特发性肌肉骨骼疼痛的平均年龄为13.9±1.6岁;对照组为14.4±1.4岁。对照组1例(4%)和特发性肌肉骨骼疼痛患者9例(34.6%)符合不宁腿综合征标准(p = 0.011)。作者没有观察到两组儿童睡眠障碍量表在所有组成部分的得分有显著差异:启动和维持睡眠障碍(p = 0.290)、睡眠呼吸障碍(p = 0.576)、唤醒障碍(p = 0.162)、睡眠-觉醒过渡障碍(p = 0.258)、白天嗜睡障碍(p = 0.594)和睡眠多汗症(p = 0.797)。两组患者的神经生理、呼吸和周期性腿部运动参数相似。焦虑与不宁腿综合征无关(p = 0.11)。3例特发性肌肉骨骼疼痛患者(11.5%)同时出现不宁腿综合征和周期性腿部运动，对照组无此症状。结论特发性肌肉骨骼疼痛的女性青少年比健康青少年更容易出现RLS。然而，本研究未观察到客观和被试睡眠变量的相关变化。

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