Pub Date : 2026-02-02DOI: 10.3760/cma.j.cn112140-20251031-00969
Y Sun, L Q Han, Y Q Ying, Z M Yang, Q T Zhang, Y L Huang, X P Luo
{"title":"[Status and prospects for neonatal screening of X-linked adrenoleukodystrophy].","authors":"Y Sun, L Q Han, Y Q Ying, Z M Yang, Q T Zhang, Y L Huang, X P Luo","doi":"10.3760/cma.j.cn112140-20251031-00969","DOIUrl":"10.3760/cma.j.cn112140-20251031-00969","url":null,"abstract":"","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 2","pages":"224-227"},"PeriodicalIF":0.0,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.3760/cma.j.cn112140-20250513-00404
S Long, Y Zhang, X D Shen, L Han, L Tao, W L Yan, F Liu, G Y Huang, X C Liang
Objective: To investigate the changes and significance of cardiopulmonary adaptations in children with Kawasaki disease sequelae of giant coronary artery aneurysm (KD-GCAA). Methods: A retrospective cohort study. Twenty-nine KD-GCAA children diagnosed at the Children's Hospital of Fudan University from January 2024 to March 2025 were enrolled as GCAA group, and 67 healthy children matched in age, gender, and body mass index during the same period were selected as control group. The GCAA group underwent cardiopulmonary exercise test (CPET) after completing a questionnaire-based assessment, while the control group underwent CPET directly. The Wilcoxon signed-rank test was used to compare differences in daily activity and actual exercise capacity of children in the GCAA group, as well as differences in CPET-related indicators and treadmill exercise test (TET) related indicators. Independent sample t-test and Mann-Whitney U test were used to compare differences in CPET indicators between the GCAA group and control group. Results: The GCAA group consisted of 20 males and 9 females, with the age of (10.9±2.2) years, while the control group included 45 males and 22 females, with the age of (11.1±2.1) years. Daily activity metabolic equivalent of task (MET) 4.5 (4.5,5.0) in KD-GCAA children was significantly lower than the maximum MET 10.8 (9.9,12.1) and MET at the anaerobic threshold 8.0 (7.1,8.9) measured by CPET (both P<0.001). All subjects completed the modified Bruce protocol up to stage 5-6 without adverse events. Decreased exercise tolerance was observed in 10% (3/29) of the GCAA group, all of which were missed by TET. Peak oxygen uptake per kilogram of body mass (peak V'O2/kg), peak V'O2/kg to predicted value, maximum MET, V'O2/kg at anaerobic threshold, V'O2/kg at anaerobic threshold to predicted value,MET at anaerobic threshold, heart rate at anaerobic threshold, maximum minute ventilation and ventilatory equivalent for carbon dioxide were significantly lower than those in the control group (all P<0.05). The maximum MET measured by TET was significantly higher than that by CPET (11.5(10.2, 13.2) vs. 10.8(9.9, 12.1), Z=2.24,P=0.025) in GCAA group. Conclusions: KD-GCAA children have lower cardiopulmonary fitness and exercise tolerance than healthy children, along with insufficient daily physical activity. Compared with TET, CPET can more accurately evaluate the changes in cardiopulmonary fitness of these children, which holds important application value for clinical exercise guidance.
{"title":"[Application and clinical value of cardiopulmonary exercise test in children with Kawasaki disease sequelae of giant coronary artery aneurysm].","authors":"S Long, Y Zhang, X D Shen, L Han, L Tao, W L Yan, F Liu, G Y Huang, X C Liang","doi":"10.3760/cma.j.cn112140-20250513-00404","DOIUrl":"https://doi.org/10.3760/cma.j.cn112140-20250513-00404","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the changes and significance of cardiopulmonary adaptations in children with Kawasaki disease sequelae of giant coronary artery aneurysm (KD-GCAA). <b>Methods:</b> A retrospective cohort study. Twenty-nine KD-GCAA children diagnosed at the Children's Hospital of Fudan University from January 2024 to March 2025 were enrolled as GCAA group, and 67 healthy children matched in age, gender, and body mass index during the same period were selected as control group. The GCAA group underwent cardiopulmonary exercise test (CPET) after completing a questionnaire-based assessment, while the control group underwent CPET directly. The Wilcoxon signed-rank test was used to compare differences in daily activity and actual exercise capacity of children in the GCAA group, as well as differences in CPET-related indicators and treadmill exercise test (TET) related indicators. Independent sample <i>t</i>-test and Mann-Whitney <i>U</i> test were used to compare differences in CPET indicators between the GCAA group and control group. <b>Results:</b> The GCAA group consisted of 20 males and 9 females, with the age of (10.9±2.2) years, while the control group included 45 males and 22 females, with the age of (11.1±2.1) years. Daily activity metabolic equivalent of task (MET) 4.5 (4.5,5.0) in KD-GCAA children was significantly lower than the maximum MET 10.8 (9.9,12.1) and MET at the anaerobic threshold 8.0 (7.1,8.9) measured by CPET (both <i>P</i><0.001). All subjects completed the modified Bruce protocol up to stage 5-6 without adverse events. Decreased exercise tolerance was observed in 10% (3/29) of the GCAA group, all of which were missed by TET. Peak oxygen uptake per kilogram of body mass (peak V'O<sub>2</sub>/kg), peak V'O<sub>2</sub>/kg to predicted value, maximum MET, V'O<sub>2</sub>/kg at anaerobic threshold, V'O<sub>2</sub>/kg at anaerobic threshold to predicted value,MET at anaerobic threshold, heart rate at anaerobic threshold, maximum minute ventilation and ventilatory equivalent for carbon dioxide were significantly lower than those in the control group (all <i>P</i><0.05). The maximum MET measured by TET was significantly higher than that by CPET (11.5(10.2, 13.2) <i>vs.</i> 10.8(9.9, 12.1), <i>Z</i>=2.24,<i>P</i>=0.025) in GCAA group. <b>Conclusions:</b> KD-GCAA children have lower cardiopulmonary fitness and exercise tolerance than healthy children, along with insufficient daily physical activity. Compared with TET, CPET can more accurately evaluate the changes in cardiopulmonary fitness of these children, which holds important application value for clinical exercise guidance.</p>","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 2","pages":"150-155"},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.3760/cma.j.cn112140-20251021-00927
J Y Lu, J Ma
{"title":"[Clinical advances in transcranial magnetic stimulation for tic disorders in children].","authors":"J Y Lu, J Ma","doi":"10.3760/cma.j.cn112140-20251021-00927","DOIUrl":"https://doi.org/10.3760/cma.j.cn112140-20251021-00927","url":null,"abstract":"","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 2","pages":"228-231"},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.3760/cma.j.cn112140-20251120-01041
W Sheng, G Y Huang
{"title":"[The significance of clinical research on rare cardiovascular diseases in children].","authors":"W Sheng, G Y Huang","doi":"10.3760/cma.j.cn112140-20251120-01041","DOIUrl":"https://doi.org/10.3760/cma.j.cn112140-20251120-01041","url":null,"abstract":"","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 2","pages":"123-125"},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.3760/cma.j.cn112140-20251218-01124
J Liu, W Li, Y Q Sun, S Y Miao
{"title":"[Minutes of work conference of editor-in-chief of <i>Chinese Journal of Pediatrics</i> in 2025].","authors":"J Liu, W Li, Y Q Sun, S Y Miao","doi":"10.3760/cma.j.cn112140-20251218-01124","DOIUrl":"https://doi.org/10.3760/cma.j.cn112140-20251218-01124","url":null,"abstract":"","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 2","pages":"236"},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.3760/cma.j.cn112140-20250625-00548
Y N Li, W Y Feng, Y H Yao, C S Zhao, Y C Li, H Liu, G Liu
Objective: This study aimed to analyze the epidemiologic trends of common nationally notifiable infectious diseases (NID) among children at a single center in Beijing from 2016 to 2024. Methods: A cross-sectional study. Demographic and clinical data were retrospectively collected from 156 006 pediatric patients diagnosed with NID and reported to the National Health Information Disease Prevention and Control Information System at the outpatient or inpatient departments of Beijing Children's Hospital, Capital Medical University, between January 2016 and December 2024. The study period was divided into 3 groups based on the implementation status of non-pharmaceutical interventions (NPI) associated with the SARS-CoV-2 pandemic: pre-NPI implementation (2016-2019), during NPI implementation (2020-2022), and post-NPI lifting (2023-2024). Between-group comparisons were conducted using the χ² test and the Kruskal-Wallis rank-sum test. Results: Among the 156 006 pediatric cases included in the analysis, 89 202 were male and 66 804 were female. The median age was 4.8 (2.7, 7.2) years. No Category A infectious diseases were reported. Category B infectious diseases accounted for 12 734 cases (8.2%), while Category C infectious diseases accounted for 135 187 cases (86.7%). Following the implementation of NPI, the average annual number of reported cases decreased by 67.6% (1 036/1 532) for Category B infectious diseases and by 48.7% (5 613/11 520) for Category C infectious diseases. At the transmission route level, diseases transmitted via the fecal-oral route decreased by 79.7% (5 225/6 556), while airborne transmission diseases decreased by 27.0% (2 096/7 753). Before the implementation of the NPI, 57 352 cases were reported, with hand-foot-mouth disease (HFMD) accounting for 22 213 cases (38.7%), influenza for 19 680 cases (34.3%), and varicella for 5 134 cases (9.0%). During the NPI implementation period, 21 036 cases were reported; the three most common diseases were influenza 13 292 cases (63.2%), HFMD 2 006 cases (9.5%), and varicella 1 815 cases (8.6%). After the lifting of NPI, 77 618 cases were reported, among which influenza 64 871 cases (83.6%), HFMD 5 004 cases (6.4%) and SARS-CoV-2 infection 2 191 cases (2.8%). After the lifting of NPI, the age at onset for HFMD, varicella, scarlet fever, other infectious diarrheal diseases, and pertussis was significantly higher than that observed before NPI implementation (all P<0.001). Conclusion: The shifting spectrum of pediatric NID and age of susceptible populations highlight the importance of the need for sustained surveillance to guide prevention strategies and adjust public health preparedness.
{"title":"[Dynamic changes in epidemiology of common national notifiable infectious diseases among children in a single center in Beijing, 2016-2024].","authors":"Y N Li, W Y Feng, Y H Yao, C S Zhao, Y C Li, H Liu, G Liu","doi":"10.3760/cma.j.cn112140-20250625-00548","DOIUrl":"https://doi.org/10.3760/cma.j.cn112140-20250625-00548","url":null,"abstract":"<p><p><b>Objective:</b> This study aimed to analyze the epidemiologic trends of common nationally notifiable infectious diseases (NID) among children at a single center in Beijing from 2016 to 2024. <b>Methods:</b> A cross-sectional study. Demographic and clinical data were retrospectively collected from 156 006 pediatric patients diagnosed with NID and reported to the National Health Information Disease Prevention and Control Information System at the outpatient or inpatient departments of Beijing Children's Hospital, Capital Medical University, between January 2016 and December 2024. The study period was divided into 3 groups based on the implementation status of non-pharmaceutical interventions (NPI) associated with the SARS-CoV-2 pandemic: pre-NPI implementation (2016-2019), during NPI implementation (2020-2022), and post-NPI lifting (2023-2024). Between-group comparisons were conducted using the <i>χ</i>² test and the Kruskal-Wallis rank-sum test. <b>Results:</b> Among the 156 006 pediatric cases included in the analysis, 89 202 were male and 66 804 were female. The median age was 4.8 (2.7, 7.2) years. No Category A infectious diseases were reported. Category B infectious diseases accounted for 12 734 cases (8.2%), while Category C infectious diseases accounted for 135 187 cases (86.7%). Following the implementation of NPI, the average annual number of reported cases decreased by 67.6% (1 036/1 532) for Category B infectious diseases and by 48.7% (5 613/11 520) for Category C infectious diseases. At the transmission route level, diseases transmitted via the fecal-oral route decreased by 79.7% (5 225/6 556), while airborne transmission diseases decreased by 27.0% (2 096/7 753). Before the implementation of the NPI, 57 352 cases were reported, with hand-foot-mouth disease (HFMD) accounting for 22 213 cases (38.7%), influenza for 19 680 cases (34.3%), and varicella for 5 134 cases (9.0%). During the NPI implementation period, 21 036 cases were reported; the three most common diseases were influenza 13 292 cases (63.2%), HFMD 2 006 cases (9.5%), and varicella 1 815 cases (8.6%). After the lifting of NPI, 77 618 cases were reported, among which influenza 64 871 cases (83.6%), HFMD 5 004 cases (6.4%) and SARS-CoV-2 infection 2 191 cases (2.8%). After the lifting of NPI, the age at onset for HFMD, varicella, scarlet fever, other infectious diarrheal diseases, and pertussis was significantly higher than that observed before NPI implementation (all <i>P</i><0.001). <b>Conclusion:</b> The shifting spectrum of pediatric NID and age of susceptible populations highlight the importance of the need for sustained surveillance to guide prevention strategies and adjust public health preparedness.</p>","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 2","pages":"177-184"},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.3760/cma.j.cn112140-20250819-00769
{"title":"[Consensus on the diagnosis and treatment of chronic nonbacterial osteomyelitis in children (2026)].","authors":"","doi":"10.3760/cma.j.cn112140-20250819-00769","DOIUrl":"https://doi.org/10.3760/cma.j.cn112140-20250819-00769","url":null,"abstract":"","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 2","pages":"126-134"},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.3760/cma.j.cn112140-20250809-00734
H Yi, X Y Hong, F Lan, G X Zhou, R Zhang
{"title":"[Research progress on the genetic mechanisms of dilated cardiomyopathy in children].","authors":"H Yi, X Y Hong, F Lan, G X Zhou, R Zhang","doi":"10.3760/cma.j.cn112140-20250809-00734","DOIUrl":"https://doi.org/10.3760/cma.j.cn112140-20250809-00734","url":null,"abstract":"","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 2","pages":"219-223"},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.3760/cma.j.cn112140-20250828-00792
X C Chen, Y Q Liu, S W Chi, D Wang, Y Q Zhou, Y R Liu, K X Le, J B Wang, X L Zhou, Y Ni, G P Dong, J F Fu
<p><p><b>Objective:</b> To establish a clinical classification of pediatric non-alcoholic fatty liver disease (NAFLD) based on the homeostatic model assessment of insulin resistance (HOMA-IR) derived from healthy children, and to evaluate its clinical utility. <b>Methods:</b> This retrospective cohort study included 201 healthy children who underuent physieal examinatn at the Children's Hospital, Zhejiang University School of Medicine between July 2020 and July 2022, and also 1 918 obese children with NAFLD who underwent metabolic evaluation at the same hospital between January 2003 and March 2023. Clinical and laboratory data including height, weight, blood pressure, transaminase serum uric acid, lipid profile, and glycected hemoglobin were collected. The 95th percentile (<i>P</i><sub>95</sub>) of HOMA-IR was calculated by Tanner stage among healthy children, and a "relative HOMA-IR multiple" was derived for each child with NAFLD by comparing their values of HOMA-IR with the stage-specific <i>P</i><sub>95</sub>. The optimal cut-off point of the relative HOMA-IR multiple for classification was determined using receiver operating characteristic (ROC) analysis. Based on this cut-off point, children with NAFLD were categorized into three subtypes: non-insulin-resistant (relative HOMA-IR multiple ≤1), mild insulin-resistant (>1 to ≤cut-off), and severe insulin-resistant (>cut-off). Comparisons between the groups were performed using Mann-Whitney <i>U</i> test, Kruskal-Wallis <i>H</i> test, and Chi-square test, and binary logistic regression was used to examine associations between NAFLD subtypes and metabolic abnormalities. <b>Results:</b> Among the 201 healthy children, 103 (51.2%) were boys and 98 (48.8%) were girls, with a median body mass index (BMI) of 16.4 (14.9, 18.3) kg/m<sup>2</sup>. Among the 1 918 obese children with NAFLD, 1 422 (74.1%) were boys and 496 (25.9%) were girls, with a median BMI of 28.8 (26.3, 31.6) kg/m<sup>2</sup>. Non-alcoholic fatty liver and non-alcoholic steatohepatitis were identified in 1 121 (58.4%) and 797 (41.6%) children, respectively. The optimal classification cut-off for the relative HOMA-IR multiple was determined to be 1.78. Based on the new classification criteria, 486 children (25.3%) were categorized as non-insulin-resistant, 631 cases (32.9%) as mild insulin-resistant, and 801 cases (41.8%) as severe insulin-resistant. Significant differences were observed among the three groups in terms of sex, BMI, systolic blood pressure, glycated hemoglobin, and insulin function (all <i>P<</i>0.05). Compared with the non-insulin resistant group, severe insulin resistance was significantly associated with hypertriglyceridemia, hyperuricemia, hypertension, and non-alcoholic steatohepatitis(<i>OR</i>=2.13, 1.69, 1.51, and 1.63, respectively, all <i>P</i><0.05). Compared with the mild insulin resistance group, severe insulin resistance was significantly associated with low HDL cholesterol (<i>OR</i>=1.43, <i>P</i><0.05).
{"title":"[Clinical classification of pediatric non-alcoholic fatty liver disease based on beta-cell function].","authors":"X C Chen, Y Q Liu, S W Chi, D Wang, Y Q Zhou, Y R Liu, K X Le, J B Wang, X L Zhou, Y Ni, G P Dong, J F Fu","doi":"10.3760/cma.j.cn112140-20250828-00792","DOIUrl":"https://doi.org/10.3760/cma.j.cn112140-20250828-00792","url":null,"abstract":"<p><p><b>Objective:</b> To establish a clinical classification of pediatric non-alcoholic fatty liver disease (NAFLD) based on the homeostatic model assessment of insulin resistance (HOMA-IR) derived from healthy children, and to evaluate its clinical utility. <b>Methods:</b> This retrospective cohort study included 201 healthy children who underuent physieal examinatn at the Children's Hospital, Zhejiang University School of Medicine between July 2020 and July 2022, and also 1 918 obese children with NAFLD who underwent metabolic evaluation at the same hospital between January 2003 and March 2023. Clinical and laboratory data including height, weight, blood pressure, transaminase serum uric acid, lipid profile, and glycected hemoglobin were collected. The 95th percentile (<i>P</i><sub>95</sub>) of HOMA-IR was calculated by Tanner stage among healthy children, and a \"relative HOMA-IR multiple\" was derived for each child with NAFLD by comparing their values of HOMA-IR with the stage-specific <i>P</i><sub>95</sub>. The optimal cut-off point of the relative HOMA-IR multiple for classification was determined using receiver operating characteristic (ROC) analysis. Based on this cut-off point, children with NAFLD were categorized into three subtypes: non-insulin-resistant (relative HOMA-IR multiple ≤1), mild insulin-resistant (>1 to ≤cut-off), and severe insulin-resistant (>cut-off). Comparisons between the groups were performed using Mann-Whitney <i>U</i> test, Kruskal-Wallis <i>H</i> test, and Chi-square test, and binary logistic regression was used to examine associations between NAFLD subtypes and metabolic abnormalities. <b>Results:</b> Among the 201 healthy children, 103 (51.2%) were boys and 98 (48.8%) were girls, with a median body mass index (BMI) of 16.4 (14.9, 18.3) kg/m<sup>2</sup>. Among the 1 918 obese children with NAFLD, 1 422 (74.1%) were boys and 496 (25.9%) were girls, with a median BMI of 28.8 (26.3, 31.6) kg/m<sup>2</sup>. Non-alcoholic fatty liver and non-alcoholic steatohepatitis were identified in 1 121 (58.4%) and 797 (41.6%) children, respectively. The optimal classification cut-off for the relative HOMA-IR multiple was determined to be 1.78. Based on the new classification criteria, 486 children (25.3%) were categorized as non-insulin-resistant, 631 cases (32.9%) as mild insulin-resistant, and 801 cases (41.8%) as severe insulin-resistant. Significant differences were observed among the three groups in terms of sex, BMI, systolic blood pressure, glycated hemoglobin, and insulin function (all <i>P<</i>0.05). Compared with the non-insulin resistant group, severe insulin resistance was significantly associated with hypertriglyceridemia, hyperuricemia, hypertension, and non-alcoholic steatohepatitis(<i>OR</i>=2.13, 1.69, 1.51, and 1.63, respectively, all <i>P</i><0.05). Compared with the mild insulin resistance group, severe insulin resistance was significantly associated with low HDL cholesterol (<i>OR</i>=1.43, <i>P</i><0.05). ","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 2","pages":"197-203"},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.3760/cma.j.cn112140-20250605-00479
Y Wang, Y Sun, G Luo, S L Pan
<p><p><b>Objective:</b> To establish a multi-parametric scoring system for predicting postnatal circulatory outcomes in fetuses with critical pulmonary stenosis (CPS) and pulmonary atresia (PA) with intact ventricular septum (IVS), in order to optimize the indications for fetal pulmonary valvuloplasty (FPV). <b>Methods:</b> This was a retrospective cohort study. A total of 96 fetuses diagnosed with CPS-IVS or PA-IVS at the Women and Children's Hospital, Qingdao University between July 2018 and June 2021 were included. Fetuses who did not undergo FPV constituted the modeling cohort, while those who underwent FPV constituted the validation cohort. Fetuses were classified into biventricular and non-biventricular circulation groups based on postnatal circulatory outcomes, and prenatal fetal echocardiographic parameters were compared. Inter-group comparisons were performed using the <i>t</i> test, Mann-Whitney <i>U</i> test, <i>χ</i><sup>2</sup> test or Fisher exact test. Based on inter-group differences, parameters associated with postnatal circulatory outcomes were screened in the modeling cohort. For continuous variables, optimal cut-off values were determined using receiver operating characteristic (ROC) curves and the Youden index and then dichotomized. Right ventricular endocardial fibroelastosis (EFE) was graded as 0, 1 or 2 according to severity. <i>OR</i> of each parameter were calculated, and a multiparametric scoring system was constructed. ROC curves were used to evaluate its predictive performance. Post-FPV outcome improvement was assessed in the validation cohort. <b>Results:</b> Among the 96 fetuses, 78 were assigned to the modeling cohort and 18 to the validation cohort. Postnatally, biventricular circulation was achieved in 56 cases (72%) in the modeling cohort and 13 cases in the validation cohort. In the modeling cohort, the right ventricular long-axis/left ventricular long-axis (RV/LV), tricuspid annulus diameter/mitral annulus diameter (TV/MV) and pulmonary valve annulus/aortic valve annulus (PV/AV) in the non-biventricular group were lower than that in the biventricular group (all <i>P</i><0.05). The optimal cut-off values for predicting postnatal circulatory outcomes were 0.65, 0.82 and 0.78, respectively. There was statistically significant difference in the distribution of circulatory outcomes between fetuses with grade 2 EFE and those with no or grade 1 EFE (<i>χ</i><sup>2</sup>=21.28, <i>P</i><0.001). Therefore, right ventricular EFE was dichotomized in the model as "none or grade 1" versus "grade 2". Each parameter was assigned a corresponding weight based on its <i>OR</i> value, and an integer score was obtained to construct the scoring system: grade 2 right ventricular EFE was assigned 5 points, RV/LV≤0.65 was assigned 2 points, TV/MV≤0.82 was assigned 2 points, and PV/AV≤0.78 was assigned 1 point, with a maximum total score of 10 points. At cut-off scores of 3, 4, and 5 points, the areas under the curve were 0.88, 0.91,
目的：建立预测室间隔完整的危重性肺狭窄（CPS）和肺闭锁（PA）胎儿出生后循环结局的多参数评分系统，以优化胎儿肺瓣成形术（FPV）的适应证。方法：回顾性队列研究。共纳入2018年7月至2021年6月期间在青岛大学妇幼医院诊断为CPS-IVS或PA-IVS的96例胎儿。未接受FPV的胎儿为建模组，接受FPV的胎儿为验证组。根据出生后的循环情况将胎儿分为双心室循环组和非双心室循环组，并比较产前胎儿超声心动图参数。组间比较采用t检验、Mann-Whitney U检验、χ2检验或Fisher精确检验。基于组间差异，在建模队列中筛选与产后循环结局相关的参数。对于连续变量，采用受试者工作特征（ROC）曲线和约登指数确定最佳截断值，然后进行二分类。右心室心内膜纤维弹性增生症（EFE）按严重程度分为0、1、2级。计算各参数的OR值，构建多参数评分系统。采用ROC曲线评价其预测效果。在验证队列中评估fpv后的结果改善。结果：96例胎儿中，78例进入建模组，18例进入验证组。出生后，在建模队列中有56例（72%）实现了双心室循环，在验证队列中有13例。在建模队列中，非双心室组右心室长轴/左心室长轴（RV/LV）、三尖瓣环直径/二尖瓣环直径（TV/MV）、肺动脉瓣环/主动脉瓣环（PV/AV）均低于双心室组(Pχ2=21.28， POR值，取整数评分构建评分体系；2级右心室EFE评分5分，RV/LV≤0.65评分2分，TV/MV≤0.82评分2分，PV/AV≤0.78评分1分，总分最高10分。截止评分为3,4,5分时，曲线下面积分别为0.88,0.91和0.88，在评分阈值为5分时，特异性最高（0.95,95% CI 0.84-0.99）。在验证队列中，15个胎儿得分≥5分，其中10个胎儿出生后实现双心室循环，而在建模队列中，18个胎儿（得分≥5分）中只有1个胎儿实现双心室循环。结论：基于产前胎儿超声心动图参数的多参数评分系统可有效预测CPS-IVS和PA-IVS胎儿的非双心室产后结局。通过识别高危患者，优化FPV的适应症。
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