对慢性肝病患儿体内维生素A水平的比较

Malabsorption of fat-soluble vitamins is a major complication of chronic cholestatic liver disease. The most accurate way to assess vitamin A status in children who have cholestasis is unknown. The goal of this study was to assess the accuracy of noninvasive tests to detect vitamin A deficiency. Children with chronic cholestatic liver disease (n = 23) and noncholestatic liver disease (n = 10) were studied. Ten cholestatic patients were identified as vitamin A-deficient based on the relative dose response (RDR). Compared with the RDR, the sensitivity and specificity to detect vitamin A deficiency for each test was, respectively: serum retinol, 90%and 78%; retinol-binding protein (RBP), 40%and 91%; retinol/RBP molar ratio, 60%and 74%; conjunctival impression cytology, 44%and 48%; slitlamp examination, 20%and 66%; tear film break-up time, 40%and 69%; and Schirmer’s test, 20%and 78%. We developed a modified oral RDR via oral coadministration of d-alpha tocopheryl polyethylene glycol-1000 succinate and retinyl palmitate. This test had a sensitivity of 80%and a specificity of 100%to detect vitamin A deficiency. In conclusion, vitamin A deficiency is relatively common in children who have chronic cholestatic liver disease. Our data suggest that serum retinol level as an initial screen followed by confirmation with a modified oral RDR test is the most effective means of identifying vitamin A deficiency in these subjects.

卒中介入治疗培训指南：国际多学会共识文件

1背景 缺血性卒中是全球人口死亡和残疾的首要原因。很多急性大血管闭塞（emergent large vesselocclusion，ELVO）患者都会遗留长期残疾。事实上，这些颅内大动脉闭塞经常会导致大面积脑损伤，进而造成患者死亡或严重致残。