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Need for national guidance regarding proactive care of infants born at 22-23 weeks' gestation. 需要制定有关积极护理妊娠 22-23 周出生婴儿的国家指南。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-13 DOI: 10.3345/cep.2024.01277
Ga Won Jeon

With recent rapid improvements in neonatal intensive care, the limit of viability has shifted downward to 22-23 weeks' gestation. The younger the gestational age of preterm infants, the higher the risk of survival despite severe neurodevelopmental impairments. For infants born at 22-23 weeks' gestation, the limit of viability, neurodevelopmental outcomes, and survival rates may be determined by the quality of proactive care. Owing to the high risk of severe neurodevelopmental impairment in 22-23 weeks' gestation, proactive care is sometimes withheld according to ethical or legal considerations, and there are significant differences in the provision of proactive care and survival rates across countries or institutions. Additionally, there are differing or even lacking guidelines regarding the care of these infants across countries and institutions. Japan and Sweden are countries with well-established national guidance and proactive care for infants born at 22-23 weeks' gestation, resulting in higher survival rates among them. In Korea, where there is an extreme shortage of neonatologists, maternal transfer before delivery at 22-23 weeks' gestation to high-activity regions with appropriate neonatal intensive care unit resources, such as adequate personnel and facilities similar to the centralized care model seen in Sweden, is crucial for improving the survival rates of infants born at 22-23 weeks' gestation. The survival of these infants largely depends on the quality of proactive care provided. This rate is not static and can be improved through proactive case management based on national guidance and the implementation of enhanced neonatal intensive care practices, including centralization of care.

随着近来新生儿重症监护技术的迅速发展,早产儿的存活极限已下移至妊娠 22-23 周。早产儿的胎龄越小,尽管存在严重的神经发育障碍,但存活的风险也越高。对于妊娠 22-23 周出生的婴儿,存活极限、神经发育结果和存活率可能取决于积极护理的质量。由于妊娠 22-23 周的婴儿极有可能出现严重的神经发育障碍,因此有时会出于伦理或法律方面的考虑而不采取主动护理措施,而且不同国家或机构在提供主动护理和存活率方面也存在显著差异。此外,不同国家和机构对这些婴儿的护理指南也不尽相同,甚至缺失。日本和瑞典对孕 22-23 周出生的婴儿有完善的国家指导和主动护理,因此存活率较高。在新生儿科医生极度缺乏的韩国,孕 22-23 周产妇在分娩前转院到拥有适当新生儿重症监护室资源(如充足的人员和设施,类似于瑞典的集中护理模式)的高活跃地区,对于提高孕 22-23 周出生婴儿的存活率至关重要。这些婴儿的存活率在很大程度上取决于主动护理的质量。这一存活率并不是一成不变的,可以通过基于国家指导的主动病例管理和实施强化的新生儿重症监护措施(包括集中护理)来提高。
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引用次数: 0
Knowledge, attitude, and practice regarding dengue vaccine: a baseline study of community members and health providers in Indonesia. 关于登革热疫苗的知识、态度和实践:对印度尼西亚社区成员和医疗服务提供者的基线研究。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-13 DOI: 10.3345/cep.2024.00962
Abdul Wahab, Ida Safitri Laksanawati, Retna Siwi Padmawati, Asal Wahyuni Erlin Mulyadi, Wahyu Triadmajani, Jarir At Thobari

Background: Despite recent behavioral interventions aimed at reducing the burden of dengue, persistent unfavorable related behaviors in the Indonesian community suggest that vaccination could be effective. However, before this is implemented nationally, public perception and acceptance of the vaccine should be assessed in addition to health providers' points of view.

Purpose: This study aimed to assess the knowledge, attitudes, and practices (KAP) of community members and health providers in Indonesia.

Methods: A cross-sectional survey was conducted in six districts of three Indonesian provinces. Respondents included both community members and health providers living within the territory of the selected primary health care centers. Pretested questionnaires were used to gather information on the sociodemographic characteristics and KAPs regarding dengue vaccines. An independent t-test was performed to compare the mean KAP scores between community members and health providers, while a logistic regression analysis was used to identify the predictors in each domain.

Results: Only 18.5% of health providers possessed high knowledge of the dengue vaccine versus only 12.5% of community members. Approximately one-third of the health providers versus one-fourth of community members displayed a high to moderate score for attitudes about dengue vaccines. Dengue vaccination practices demonstrated a more favorable score for both health providers and community members at 59.1% and 41.1%, respectively. No individual sociodemographic characteristics were associated with KAPs; rather, only education was correlated with better dengue vaccination practices. We also found that good knowledge of dengue was the only factor associated with all domains.

Conclusions: Our findings highlight the urgent need to deliver educational interventions to health providers and community members in Indonesia to improve their awareness of dengue vaccines.

背景:尽管最近采取了旨在减轻登革热负担的行为干预措施,但印尼社会中持续存在的不利相关行为表明,接种疫苗可能是有效的。目的:本研究旨在评估印度尼西亚社区成员和医疗服务提供者的知识、态度和实践 (KAP):在印度尼西亚三个省的六个地区进行了横断面调查。受访者包括居住在选定的初级医疗保健中心范围内的社区成员和医疗服务提供者。调查使用了预先测试的问卷,以收集有关登革热疫苗的社会人口特征和 KAPs 的信息。对社区成员和医疗服务提供者的 KAP 平均得分进行了独立的 t 检验,并使用逻辑回归分析确定了每个领域的预测因素:结果:只有 18.5%的医疗服务提供者对登革热疫苗有较高的了解,而社区成员中只有 12.5%。大约三分之一的医疗服务提供者和四分之一的社区成员对登革热疫苗的态度为中高分。在登革热疫苗接种实践中,医疗服务提供者和社区成员的得分较高,分别为 59.1% 和 41.1%。个人社会人口学特征与 KAPs 没有关联;相反,只有教育程度与更好的登革热疫苗接种实践相关。我们还发现,对登革热的充分了解是与所有领域相关的唯一因素:我们的研究结果突出表明,迫切需要对印度尼西亚的医疗服务提供者和社区成员进行教育干预,以提高他们对登革热疫苗的认识。
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引用次数: 0
Effect of metabolic syndrome on pulmonary dysfunction in children with asthma. 代谢综合征对哮喘儿童肺功能障碍的影响。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-13 DOI: 10.3345/cep.2024.00360
Hyo-Bin Kim
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引用次数: 0
Global breastfeeding efforts: a long way to go. 全球母乳喂养工作:任重道远。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-13 DOI: 10.3345/cep.2024.01361
Hye-Jung Shin
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引用次数: 0
Prevalence of childhood overweight and obesity in Malaysia: a systematic review and meta-analysis. 马来西亚儿童超重和肥胖症患病率:系统回顾和荟萃分析。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-13 DOI: 10.3345/cep.2024.00899
Ker Yang Chua, Ker Yung Chua, Karuthan Chinna, Chooi Ling Lim, Maheeka Seneviwickrama

The incidence of childhood obesity is increasing worldwide. National surveys in Malaysia have shown similar trends. This review aimed to increase our understanding of the prevalence and associated factors of childhood overweight, obesity, and excess weight in Malaysia. A systemat-ic review and meta-analysis were conducted of studies reporting the prevalence of overweight and obesity in Malaysian children aged < 18 years. Systematic searches were conducted in Oc-tober 2023 and repeated in March 2024 of the PubMed, Scopus, and Web of Science databases. The grey literature was also included. Study selection, data extraction, and quality assessments were conducted by paired independent researchers. A meta-analysis of prevalence and 95% confidence interval (CI) using a random-effects model and heterogeneity (I2) was calculated. Publication bias was investigated using Egger's test. This review included 33 studies (N=273,710) conducted between 1996 and 2022. Overall, the childhood overweight, obesity and excess weight prevalence was 13.9% (95% confidence interval [CI], 13.0-14.8%), 11.8% (95% CI, 10.9-12.8%), and 24.0% (95% CI, 22.3-25.7%), respectively. Boys had a significant-ly higher proportion of obesity (12.5% [95% CI, 11.1-14.1%] vs. 9.1% [95% CI, 8.1-10.1%]) and excess weight (25.7% [95% CI, 23.5-28.1%] vs. 20.7% [95% CI, 18.8-22.8%]) than girls. Sarawak natives had a higher prevalence of obesity (17.7% [95% CI, 16.0-19.5%]). Annually, the obesity prevalence increased by 0.3% (95% CI, 0.1-0.6%; p=0.006) and excess weight prevalence increased by 0.6% (95% CI, 0.3-1.0%; p=0.002). Heterogeneity was high (I2>90%), and publication bias was possible (p<0.001). Variability was not significantly affected by the critical appraisal score or sample size. In conclusion, the prevalence of childhood overweight, obesity, and excess weight in Malaysia doubled over 26 years. Future studies of the prevalence of childhood excess weight should follow a standardized reference for body mass index by age to ease interstudy comparisons.

全世界儿童肥胖症的发病率都在上升。马来西亚的全国调查也显示了类似的趋势。本综述旨在加深我们对马来西亚儿童超重、肥胖和体重超标的发生率及相关因素的了解。我们对报告马来西亚18岁以下儿童超重和肥胖患病率的研究进行了系统回顾和荟萃分析。我们于 2023 年 10 月在 PubMed、Scopus 和 Web of Science 数据库中进行了系统检索,并于 2024 年 3 月进行了重复检索。灰色文献也包括在内。研究选择、数据提取和质量评估由配对的独立研究人员进行。采用随机效应模型对患病率和 95% 置信区间 (CI) 进行了荟萃分析,并计算了异质性 (I2)。采用 Egger 检验法对发表偏倚进行了调查。本综述包括 1996 年至 2022 年期间进行的 33 项研究(N=273,710)。总体而言,儿童超重、肥胖和超重率分别为 13.9%(95% 置信区间 [CI],13.0-14.8%)、11.8%(95% 置信区间,10.9-12.8%)和 24.0%(95% 置信区间,22.3-25.7%)。男孩肥胖(12.5% [95% CI, 11.1-14.1%] vs. 9.1% [95% CI, 8.1-10.1%])和超重(25.7% [95% CI, 23.5-28.1%] vs. 20.7% [95% CI, 18.8-22.8%])的比例明显高于女孩。砂拉越本地人的肥胖率更高(17.7% [95% CI, 16.0-19.5%])。肥胖率每年增加 0.3% (95% CI, 0.1-0.6%; p=0.006),超重率每年增加 0.6% (95% CI, 0.3-1.0%; p=0.002)。异质性很高(I2>90%),可能存在发表偏倚(p
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引用次数: 0
Promising role of Voxelotor in managing sickle cell disease in children: a narrative review. Voxelotor在治疗儿童镰状细胞病中的前景:综述。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-13 DOI: 10.3345/cep.2024.00500
Amit Agrawal, Gaurav Jadon, Japna Singh, Dalwinder Janjua

Sickle cell disease (SCD) is characterized by chronic hemolytic anemia and intermittent vaso-occlusive crises. To date, four disease-modifying drugs have been approved for the treatment of SCD: hydroxyurea (an S-phase inhibitor), L-glutamine (an amino acid), crizanlizumab (a P-selectin inhibitor), and voxelotor (a hemoglobin S polymerization inhibitor). Preclinical studies suggested that voxelotor effectively treats SCD and sickle cell anemia (SCA). In a phase III trial, voxelotor-treated patients showed significantly elevated hemoglobin levels (>1 g/dL from baseline) compared to placebo-treated patients. The group that received voxelotor also showed a greater decrease in hemolytic markers but a comparable incidence of side effects. Six ongoing clinical trials also sought to ascertain the effectiveness and safety of high-dose voxelotor when administered to children younger than 12 years. Studies assessing their long-term efficacy and safety are needed to fully understand the role of voxelotor in treating SCD/SCA. In this review, we discuss the mechanisms, trials to date, and future treatment directions of voxelotor.

镰状细胞病(SCD)的特点是慢性溶血性贫血和间歇性血管闭塞性危象。迄今为止,已有四种改变病情的药物获准用于治疗 SCD:羟基脲(一种 S 相抑制剂)、L-谷氨酰胺(一种氨基酸)、crizanlizumab(一种 P 选择素抑制剂)和 voxelotor(一种血红蛋白 S 聚合抑制剂)。临床前研究表明,voxelotor 能有效治疗 SCD 和镰状细胞性贫血(SCA)。在一项 III 期试验中,接受 voxelotor 治疗的患者与接受安慰剂治疗的患者相比,血红蛋白水平明显升高(与基线相比>1 g/dL)。接受 voxelotor 治疗的一组患者溶血指标下降幅度更大,但副作用发生率相当。目前正在进行的六项临床试验还旨在确定大剂量 voxelotor 对 12 岁以下儿童的有效性和安全性。要全面了解伏塞洛在治疗 SCD/SCA 中的作用,还需要对其长期疗效和安全性进行评估研究。在本综述中,我们将讨论 voxelotor 的机制、迄今为止的试验以及未来的治疗方向。
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引用次数: 0
Occurrence of stroke in children and young adults in Indonesia: a multicenter private hospital study. 印度尼西亚儿童和年轻人的中风发生率:一项多中心私立医院研究。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-13 DOI: 10.3345/cep.2024.01214
Jeanne Leman, Veli Sungono, Yosua Timotius Haryono, Muhammad Adam Mudzakir, Dewi Lestari Rahmawati, Callistus Bruce Henfry Sulay, Gilbert Sterling Octavius

Background: Most studies that estimate the occurrence of childhood stroke use heterogeneous methods and rely on International Classification of Diseases codes, a strategy that may be unreliable.

Purpose: This study aimed to estimate the occurrence of childhood stroke in Indonesia using imaging and clinical data from a private hospital network.

Methods: This cross-sectional study used consecutive retrospective multi-center data samples collected in 2019-2023. The study cohort included children aged >28 days to young adults aged 24 years with confirmed ischemic or hemorrhagic stroke on computed tomography (CT) or magnetic resonance imaging (MRI). The 1-year occurrence was calculated, and the data analysis was performed using SPSS version 26.

Results: Over 5 years, the performance of 8,987 CT and 6,133 MRI scans resulted in the identification of 1,074 stroke cases. The average patient age was 14.8 ± 7 years. Stroke occurrence was highest in 2021 (9.08%) and lowest in 2022 (5.91%). Male patients accounted for 67.9% of cases, with hemorrhagic strokes accounting for 83.4% of the total, primarily resulting from accidents (73.2%) and predominantly occurring in the frontal region (37.1%). A significant majority of cases (66.7%) were reported in Java. Males had a relative risk of 1.93 (95% confidence interval, 1.48-2.52; p < 0.0001) for hemorrhagic stroke versus females.

Conclusion: The incidence of childhood stroke revealed critical epidemiological trends and disparities, emphasizing the need for targeted public health interventions and enhanced stroke prevention strategies in Indonesia.

背景:目的:本研究旨在利用一家私立医院网络的影像和临床数据,估计印度尼西亚儿童中风的发生率:这项横断面研究使用了 2019-2023 年收集的连续回顾性多中心数据样本。研究队列包括经计算机断层扫描(CT)或磁共振成像(MRI)确诊为缺血性或出血性中风的年龄大于 28 天的儿童到 24 岁的年轻人。计算1年的发生率,并使用SPSS 26版进行数据分析:结果:5 年内共进行了 8,987 次 CT 扫描和 6,133 次 MRI 扫描,共发现 1,074 例中风病例。患者平均年龄为 14.8 ± 7 岁。中风发生率在 2021 年最高(9.08%),2022 年最低(5.91%)。男性患者占 67.9%,出血性中风占总数的 83.4%,主要由意外事故引起(73.2%),且主要发生在额部(37.1%)。绝大多数病例(66.7%)发生在爪哇岛。男性与女性相比,出血性中风的相对风险为 1.93(95% 置信区间,1.48-2.52;p < 0.0001):儿童中风发病率揭示了重要的流行病学趋势和差异,强调了在印度尼西亚采取有针对性的公共卫生干预措施和加强中风预防策略的必要性。
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引用次数: 0
Impact of obesity on pulmonary function of preschool children: an impulse oscillometry study. 肥胖对学龄前儿童肺功能的影响:脉冲振荡仪研究。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-13 DOI: 10.3345/cep.2024.01053
Anuvat Klubdaeng, Kanokporn Udomittipong, Apinya Palamit, Pawinee Charoensittisup, Khunphon Mahoran

Background: The increasing global prevalence of obesity poses significant public health problems, as obesity exerts adverse effects on many systems and lung function. However, research on the lung function of preschool children with obesity is limited and inconclusive. In addition, studies specific to obesity indices that influence lung function in young children with obesity are limited.

Purpose: This study aimed to evaluate lung function of obese versus normal-weight preschool children using impulse oscillometry (IOS) and identify obesity indices predictive of altered lung function.

Methods: We enrolled obese children aged 3-7 years as well as age- and sex-matched normal-weight controls. The participants underwent IOS assessments that measured the resistance at 5 Hz (R5) and 20 Hz (R20), the difference in resistance between these frequencies (R5-R20), reactance at 5 Hz (X5), resonance frequency, and reactance area (AX). We compared these parameters between groups and analyzed the correlations between obesity indices and IOS measures within the obese group using multiple linear regression.

Results: The study included 68 participants (n=34 each group). In the obese group, significantly higher values were observed for R5 (adjusted for height, p = 0.02; % predicted, p = 0.01; z-score, p < 0.001), R5-R20 (absolute value, p = 0.002; adjusted for height, p = 0.001), and AX (z-score, p = 0.01). AX adjusted for height showed a greater trend (p = 0.07). The waist-to-height ratio was the most robust independent predictor of total and peripheral airway resistance, with increases in R5 (b = 1.65, p = 0.02) and R5-R20 (b = 1.39, p = 0.03) and a near-significant correlation with AX (b = 12.12, p = 0.06).

Conclusion: Preschool children with obesity exhibit impaired lung function, characterized by elevated total and peripheral airway resistance. Waist-to-height ratio was the strongest predictor of these changes.

背景:全球肥胖症发病率的不断上升带来了严重的公共卫生问题,因为肥胖会对许多系统和肺功能造成不良影响。然而,有关学龄前肥胖儿童肺功能的研究却十分有限,且尚无定论。此外,针对影响肥胖幼儿肺功能的肥胖指数的研究也很有限。目的:本研究旨在使用脉冲振荡仪(IOS)评估肥胖与正常体重学龄前儿童的肺功能,并确定可预测肺功能改变的肥胖指数:我们招募了 3-7 岁的肥胖儿童以及年龄和性别匹配的正常体重对照组儿童。参与者接受了 IOS 评估,测量了 5 赫兹(R5)和 20 赫兹(R20)的阻力、这两个频率之间的阻力差(R5-R20)、5 赫兹(X5)的电抗、共振频率和电抗面积(AX)。我们比较了各组之间的这些参数,并使用多元线性回归分析了肥胖组中肥胖指数和 IOS 测量值之间的相关性:研究包括 68 名参与者(每组 34 人)。在肥胖组中,R5(根据身高调整,p = 0.02;预测百分比,p = 0.01;z-score,p < 0.001)、R5-R20(绝对值,p = 0.002;根据身高调整,p = 0.001)和 AX(z-score,p = 0.01)的数值明显更高。根据身高调整后的 AX 显示出更大的趋势(p = 0.07)。腰围-身高比是总气道阻力和外周气道阻力最可靠的独立预测指标,R5(b = 1.65,p = 0.02)和R5-R20(b = 1.39,p = 0.03)均有所增加,且与AX(b = 12.12,p = 0.06)有近乎显著的相关性:结论:学龄前肥胖儿童的肺功能受损,表现为总气道阻力和外周气道阻力升高。结论:学龄前肥胖儿童的肺功能受损,表现为总气道阻力和外周气道阻力升高,而腰高比是预测这些变化的最有力指标。
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引用次数: 0
Further research on impact of microplastics on children's health is essential to protecting future generations. 进一步研究微塑料对儿童健康的影响对保护后代至关重要。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-13 DOI: 10.3345/cep.2024.01459
Jongin Lee, Dong-Wook Lee
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引用次数: 0
Prednisolone impairs trabecular bone score changes in adolescents with 21-hydroxylase deficiency. 泼尼松龙会影响 21- 羟化酶缺乏症青少年骨小梁得分的变化。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-13 DOI: 10.3345/cep.2024.01060
Pattara Wiromrat, Yutapong Raruenrom, Phanpaphorn Namphaisan, Nantaporn Wongsurawat, Ouyporn Panamonta, Chatlert Pongchaiyakul

Background: Individuals with 21-hydroxylase deficiency (21OHD) require lifelong glucocorticoid (GC) therapy, which increases their risk of fragility fractures. However, fractures in GC-treated individuals can occur at normal bone mineral density (BMD) levels, suggesting an alteration in the bone microarchitecture.

Purpose: To evaluate trabecular bone microarchitecture and its changes in adolescents with 21OHD.

Methods: We enrolled 38 adolescents with 21OHD for whom complete clinical data and baseline and follow-up lumbar spine bone mineral density (LSBMD) measurements were available. The mean duration was 1.5 ± 0.6 years. Trabecular bone score (TBS), an indirect measurement of bone microarchitecture, was analyzed using iNsight™ software version 3.0. Impaired BMD and TBS were defined at Z-scores ≤ -1.5.

Results: At baseline, participants (55% female; 68% salt-wasting type; mean age, 15.2 ± 3.8 years; bone age, 17.5 ± 2.8 years; mean GC dose, 18.5 ± 6.5 mg/m2/day) had the prevalence of impaired BMD and TBS of 5% and 18%, respectively. During follow-up, adolescents with 21OHD receiving prednisolone showed a lower annual percentage change in TBS than those who received hydrocortisone (p = 0.028). A stepwise regression analysis showed that body mass index percentile (p < 0.001) and testosterone concentration (p = 0.002) were independent positive predictors of the baseline TBS Z-score, whereas prednisolone use was the only negative predictor of the annual percentage change in TBS (p = 0.002).

Conclusion: Adolescents with 21OHD have a high prevalence of impaired bone microarchitecture. Furthermore, prednisolone therapy is associated with impaired bone microarchitecture development, suggesting that hydrocortisone may better preserve bone microarchitecture and should be considered the first-line treatment for this population.

背景:21-羟化酶缺乏症(21OHD21-羟化酶缺乏症(21OHD)患者需要终生接受糖皮质激素(GC)治疗,这增加了他们发生脆性骨折的风险。目的:评估21-羟化酶缺乏症青少年骨小梁微结构及其变化:方法:我们招募了38名患有21OHD的青少年,他们都有完整的临床数据以及基线和随访腰椎骨矿物质密度(LSBMD)测量数据。平均病程为 1.5 ± 0.6 年。骨小梁评分(TBS)是对骨微结构的间接测量,采用 iNsight™ 软件 3.0 版进行分析。Z值≤-1.5为骨密度和TBS受损的定义:基线时,参与者(55% 为女性;68% 为盐浪费型;平均年龄为 15.2 ± 3.8 岁;骨龄为 17.5 ± 2.8 岁;平均 GC 剂量为 18.5 ± 6.5 毫克/平方米/天)的 BMD 和 TBS受损率分别为 5%和 18%。在随访期间,接受泼尼松龙治疗的 21OHD 青少年的 TBS 年百分比变化低于接受氢化可的松治疗的青少年(p = 0.028)。逐步回归分析表明,体重指数百分位数(p < 0.001)和睾酮浓度(p = 0.002)是基线TBS Z分数的独立正向预测因素,而使用泼尼松龙是TBS年度百分比变化的唯一负向预测因素(p = 0.002):结论:患有 21OHD 的青少年骨微结构受损的发生率很高。此外,泼尼松龙治疗与骨微结构发育受损有关,这表明氢化可的松可更好地保护骨微结构,应被视为该人群的一线治疗方法。
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引用次数: 0
期刊
Clinical and Experimental Pediatrics
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