Update on paediatric inflammatory bowel disease

Inflammatory bowel disease in children is more prevalent than previously realized. Recent studies suggest an incidence in the UK of 5.3 per 100,000 in children under the age of 16 years, equivalent to around 700 new cases per annum, with Crohn's disease (CD) being at least twice as common as ulcerative colitis. The diseases appear to have a polygenic basis, with environmental factors providing the trigger of clinical disease in susceptible individuals. Endoscopy is vital for diagnosis, and new treatment modalities include the use of enteral nutrition as the sole therapy to induce and maintain remission, and the increasing early use of immunomodulatory agents such as azathioprine as steroid-sparing agents. Carefully timed, surgery is still important in both the acute and the chronic situation, particularly in the latter regard when growth faltering has not responded to medical therapy. Closer co-operation between specialist centres in the UK will hopefully provide an opportunity to conduct worthwhile multicentre research, in order to help tackle the many questions that still require a definite answer.     

小儿炎症阑尾肌间神经丛观察

目的 探讨小儿炎症阑尾壁肌间神经节及节内神经节细胞（节内细胞）数量变化，形态以及肌间乙酰胆碱酯酶染色纤维的数量变化的意义。方法 应用HE染色对1－13岁（平均6.9岁）急性单纯性阑尾炎40例，急性化脓性阑尾炎47例，急性坏疽性阑尾炎30例及42例对照组进行观察，分别取每个标本的尖端、中部、根部三处，测定肌间神经节密度（神经节总数／周长）及节内细胞数，并对其中各类型阑尾各6级及对照组7例的肌间乙酰胆碱酯酶阳性纤维进行观察。结果 炎症阑尾肌间神经节密度及节内细胞数较对照组减少，并随炎症的加重而明显减少；同一病理类型阑尾炎，从根部至尖端两参数亦呈递减趋势，而神经节细胞的成熟度无异常。胆碱酯酶阳性纤维也随炎症加重而明显减少。结论 炎症阑尾肌间神经节密度、节内细胞及胆碱酯酶染色数目减少与阑尾炎症程度关系密切。     

全身炎症反应综合征专题讨论会纪要

2006年3月25至26日,中华儿科杂志组织有关专家于广州市召开了全身炎症反应综合征（systemic inflammatory response syndrome,SIRS）专题讨论会。与会专家有新生儿、ICU专业：孙眉月、樊寻梅、曾其毅、陈贤楠、胡浩夫、封志纯;免疫专业：杨锡强、何晓琥、王宏伟、李永柏、李彩凤、胡坚、赵晓东、刘宇隆（香港）;肾脏专业：易著文、魏珉;成人ICU专家：刘大为、马朋林共18人。曾其毅、刘大为、陈贤楠和马朋林先后作了重点发言,董永绥教授发来书面发言稿,会议回顾和学习了SIRS提出和认识深化的过程。     

肠道菌群与儿科肠道炎症性疾病研究进展

新生儿坏死性小肠结肠炎(NEC)、儿童炎症性肠病(IBD)及先天性巨结肠合并小肠结肠炎(HAEC)等是儿科较常见的、严重影响患儿生活质量甚至威胁生命的肠道炎症性疾病。目前其发病机制尚不明确。研究表明,肠道炎症性疾病与肠道菌群紊乱有密切关系,但约85%的肠道细菌无法由培养得到。近年来高通量测序技术的迅速发展,使全面深入探究肠道微生物群落成为可能。文章综述近年来肠道菌群在儿科肠道炎症性疾病发病中的作用及益生菌应用的研究进展。     

Paediatric inflammatory bowel disease- brief update on current practice

Paediatric inflammatory bowel disease (PIBD), consisting of Crohn's disease, ulcerative colitis and inflammatory bowel disease unclassified, is a chronic inflammatory condition associated with significant morbidity. The incidence of PIBD is increasing and disease phenotype remains more severe than adult onset disease. Diagnosis of PIBD is often slow and requires referral to specialist services; however, the emergence of faecal calprotectin as a tool for prioritizing further investigation, alongside improved use of treatments (including anti-TNF monoclonal antibody therapy) is changing diagnosis and management. Whilst significant challenges remain in the longer-term treatment of PIBD, including growth, nutrition and management of refractory disease there remains a strong research focus on understanding underlying disease pathogenesis and a move towards personalized medicine. This review describes investigations, diagnosis and management of PIBD and presents the most up to date evidence on nutritional and medical management.     

Effect of obesity on inflammatory markers and renal functions

AIM: To examine the relationship between inflammation criteria and body mass index in otherwise-healthy obese schoolchildren and to evaluate the effect of obesity on renal functions. METHODS: Sixty-five otherwise-healthy obese children (median age 10.8 y, range 7.1-16.5 y; median body mass index 26.8 kg/m(2), range 19.9-38.7 kg/m(2)) and 20 healthy controls (median age 12.4 y, range 10.1-17.1 y; median body mass index 18.8 kg/m(2), range 17.3-23.1 kg/m(2)) were included. Blood and urine samples were taken from every child. RESULTS: Children in the obese and control groups had similar age and sex distributions (p>0.05). Inflammatory mediators were higher in obese children (p<0.05). A significant positive correlation was found between glomerular filtration rate and body mass index in the whole study group (r=0.39, p=0.001). A positive correlation was found between body mass index standard deviation and inflammatory mediators and glomerular filtration rate. No significant difference existed regarding protein and microalbumin excretion in the urine. CONCLUSION: Inflammatory mediators increased significantly in obese children, and the glomerular filtration rate increased as the body mass index increased. To prevent obesity-related complications in adulthood, it is important to take measures to prevent development of obesity during childhood.     

Pediatric inflammatory bowel disease

Background

The incidence of inflammatory bowel disease is increasing in the pediatric population worldwide.

Need and purpose of review

There is paucity of high quality scientific data regarding pediatric inflammatory bowel disease. Most of the guidelines are offshoots of work done in adults, which have been adapted over time to diagnose and treat pediatric patients. This is in part related to the small numbers in pediatric inflammatory bowel disease and less extensive collaboration for multicentric trials both nationally and internationally.

Methods

A literature search was performed using electronic databases i.e. Pubmed and OVID, using keywords: pediatric, inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, epidemiology and guidelines. This article amalgamates the broad principles of diagnosing and managing a child with suspected inflammatory bowel disease.

Main conclusions

25% of the patients with inflammatory bowel disease are children and and young adolescents. The primary concern is its impact on growth velocity, puberty and quality of life, including psychosocial issues. Treatment guidelines are being re-defined as the drug armamentarium is increasing. The emphasis will be to achieve mucosal healing and normal growth velocity with minimal drug toxicity.

     

炎症型心肌病研究进展

病毒性心肌炎可以引起严重的心肌损伤和急性心力衰竭,进而演变成扩张型心肌病,称为炎症型心肌病.免疫系统在病毒性心肌炎向扩张型心肌病的转化中起重要作用,包括病毒RNA持续复制、免疫介导损伤和细胞凋亡等细胞免疫反应,及抗心肌抗体等体液免疫应答.临床治疗方面,除抗心力衰竭、营养心肌之外,应进一步强调利巴韦林、免疫球蛋白、α1受...     

胎儿炎症反应综合征

胎儿炎症反应综合征是胎儿体内先天免疫系统被激活的一种状态,为生后72 h的新生儿炎症,其定义为以下几项中＞2项:(1)呼吸过快(＞60次/min),伴有呼吸困难或氧饱和度下降；(2)体温不稳(＞37.9℃或＜36℃)；(3)毛细血管充盈时间＞3 s；(4)白细胞计数＞34×109/L或＜4×109/L;(5) CRP＞10mg/L;(6) IL-6或IL-8 ＞70 g/ml;(7) 16S rRNA基因PCR检测阳性.胎儿炎症反应综合征可由感染和非感染因素诱发,显著的特点就是针对外来的侵害胎儿免疫系统过度激活,导致炎症介质、细胞因子的失控性释放,多种炎症介质、细胞因子直接或间接激活凝血系统及干扰机体的抗凝系统,致凝血机制失常,多个系统参与的炎症反应贯穿这一过程.胎儿炎症反应综合征能导致早产、围生儿死亡、脑白质损伤、坏死性小肠结肠炎、影响胎肺的成熟及多器官的损害,为减少胎儿的损伤,对胎儿炎症反应综合征的恰当处理和预测是必要的.     

Systemic inflammatory response syndrome

Systemic inflammatory response syndrome is a term used to describe the host's response to infection or diffuse tissue injury characterized by the release of various proinflammatory and antiinflammatory mediators. The local release of inflammatory mediators is critical in the development of a systemic inflammatory response. If the initial response is balanced and contained, homeostasis is preserved. However, if either response is excessive, systemic involvement and end organ damage occur. Understanding the relationships between the initiators and secondary mediators generated in response to inflammation improves our understanding of the clinical syndrome associated with infection and progressive multiple system organ dysfunction. It also creates a potential role for the use of cytokines in early diagnosis of infection and development of targeted therapeutic strategies to attenuate the systemic inflammatory response and improve clinical outcome. Copyright © 2001 by W.B. Saunders Company     

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炎症性肠病(Inflammatoryboweldisease,IBD)包括溃疡性结肠炎(UlcerativeColitis,UD)和克罗恩病(Crohn’sdis ease,CD)。CD又称局限性肠炎(regionalenteritis)、节段性肠炎,也有称为肉芽肿性结肠炎(granulomatouscolitis)。19世纪30年代Crohn等人在美国医学会杂志上发表文章首次描述了该病的一些临床特征,到60年代中期Lockhart Mummery等人详细观察了本病的肠道特征,并率先提出与其它疾病肠道病变的鉴别要点,至1973年WHO专门委员会定名为Crohn's病。UD是1875年Wilks和Moxoh首先观察注意到该病的一些基本特征,到1903年Wilks和Boas…     

Systemic inflammatory response syndrome

Despite advances in perinatal care in the past decade, sepsis and its complications continue to present problems for the neonate, remaining a major cause of neonatal morbidity and mortality. Sepsis research is focusing on how the neonate (host) responds to bacteria. The newborn may develop a systemic reaction to bacteria that induces the release of substances known as inflammatory mediators. Termed the systemic inflammatory response syndrome (SIRS), this reaction is believed to be responsible for the signs and symptoms of sepsis. This article introduces the neonatal nurse to SIRS, providing an overview of various inflammatory mediators and cytokines, their clinical consequences, and potential new therapies in the management of SIRS.     

小儿全身炎症反应综合征早期敏感炎症因子的研究

目的研究筛选小儿全身炎症反应综合征(SIRS)早期敏感炎症因子指标,为今后的合理早期干预提供理论依据。方法用化学发光酶免疫分析法(CLEIA)测定SIRS患儿血白介素1β(IL-1β),白介素-6(IL-6),白介素-8(IL-8),肿瘤坏死因子-α(TNFα-),采用酶联免疫吸附比色法(ELISA)测定血白介素-10(IL-10),白介素-13(IL-13)。结果SIRS患儿与对照组比较血TNFα-明显升高,血IL-6阳性率明显升高,有显著性差异(P<0.05),其他指标则无统计学意义(P>0.05)。结论血清TNFα-和IL-6是SIRS早期检测敏感指标。     

Extrapulmonary inflammatory pseudotumor in children

Inflammatory pseudotumor (IPT), an unusual etiology of an intraabdominal mass, is typically heralded by fever, anemia, thrombocytosis, and systemic symptoms that bear a resemblance to an inflammatory diathesis. Two cases of IPT seen within a 1-year period are presented: an adrenal IPT simulating a neuroblastoma was seen in an 8-year-old girl, and IPT in the jejunal mesentery mimicked a sarcoma in a 9-year-old boy. Although IPTs are histologically benign, they can be locally aggressive and often mimic a malignancy both radiographically and grossly. This diagnosis is rarely considered in the differential diagnosis of an abdominal mass.