小儿反复发作性腹痛病因分析

目的探讨反复发作性腹痛(RAP)小儿胃镜表现,并分析RAP胃肠病因。方法对313例RAP患儿,男145例,女168例行胃镜检查,并取胃窦黏膜活组织行病理检查及快速尿素酶检测。根据镜检结果判断上消化道疾病,胃黏膜炎症程度与Hp关系。结果胃镜下病变检出率99.68%,其中单纯慢性浅表性胃炎(CGS)118例,CGS伴胆汁返流56例,CGS伴十二指肠球炎44例,CGS伴十二指肠溃疡33例,Hp感染率分别为31.36%、25%、38.64%、60.61%。活动性胃炎与非活动性胃炎Hp感染率分别为92%、23.19%,两组比较有较显著性差异(P<0.0001);中度胃炎与轻度胃炎Hp感染率分别为76.47%、25.96%,两组比较非常显著性差异(P<0.0001)。结论上消化道疾病是小儿RAP的主要病因,Hp感染是引起RAP的重要原因。Hp感染者胃黏膜病理变化较非Hp感染者严重,Hp感染阴性而组织学改变为中度炎症活动性者,需随访排除Hp检查的假阴性。     

120例小儿纤维胃镜检查及病理分析

1992年2月～1997年2月我院应用日本产Olympus—GIF XQ30型纤维胃镜检出消化性溃疡、胃炎120例。其中男78例,女42例;年龄2.5～14岁。门诊50例,住院70例。胃镜表现:十二指肠球部溃疡(DU)31例,胃溃疡(GU)8例,复合性溃疡(CU)2例,溃疡呈类圆形、霜斑样、椭圆形、星形、点状或米粒状,溃疡面最大2×1.5cm,最小0.1×0.1cm,单发溃疡28例,多发溃疡14例,3例为霜斑样溃疡。检查中还发现7例消化性溃疡未经治疗已接近愈合。DU伴浅表性胃炎10例,伴胃窦炎3例,伴十二指肠球部炎症2例,DU伴随炎     

上海和昆明地区儿童上消化道疾病胃镜检查及临床资料比较

目的对比上海和昆明儿童上消化道疾病种类、发生率及幽门螺杆菌(Hp)感染状况,探讨儿童Hp感染与上消化道疾病的关系。方法对上海儿童医学中心和昆明市儿童医院近5年来的上消化道疾病胃镜检查与病理资料进行回顾性总结和归类对比。结果上海儿童上消化道疾病的胃镜总检出率为98.6%,其中十二指肠球部溃疡占12.3%,Hp阳性共165例;昆明儿童的胃镜总检出率为99.0%,十二指肠球部溃疡占5.9%,Hp阳性共209例。结论小儿慢性胃炎是上海和昆明地区腹痛常见病因,而上消化道出血病因以十二指肠溃疡最多见;上海地区十二指肠溃疡发病率远较昆明高。     

儿童消化道出血病因的临床与病理研究

目的　分析儿童消化道出血 (GIB)的病因 ,了解其临床与病理检查结果的关系。方法　对 15 3例GIB患儿进行胃镜或结肠镜及其相应病理学等检查 ,包括幽门螺杆菌 (Hp)检测。 结果　明确病因 14 0例 ,确诊率 91.5 % ,上、下消化道出血 (UGIB、LGIB)分别为 74例和 6 6例。胃病理检查 5 6例 ,均显示慢性浅表性胃炎(CSFG) ,Hp( ) 33例。炎症组与溃疡组Hp( )检出率有显著差异 (P <0 .0 5 )。对轻、中、重度炎症Hp( )检出率进行比较 ,3组均有显著差异 (P均 <0 .0 5 )。LGIB前 3位病因依次为结、直肠息肉、梅克尔憩室和肠重复畸形。LGIB 6 6例中 ,病理证实 6 4例 (97% )。结论　儿童UGIB以十二指肠溃疡 (DU)并CSFG多见 ,溃疡组Hp感染率高于炎症组 ,且胃部炎症越严重 ,Hp感染率越高。LGIB以结、直肠息肉多见。小肠部位的肠系膜及肠壁血管瘤少见 ,且经常规检查不易确诊。     

幽门螺杆菌阳性十二指肠溃疡患儿幽门螺杆菌根除前后肠道菌群变化特征及临床意义北大核心CSCD

目的:探讨幽门螺杆菌(Hp)阳性十二指肠溃疡患儿Hp根除治疗前后肠道菌群变化特征及临床意义。方法:回顾性分析2018年1月至2020年12月济南市第二妇幼保健院收治的98例十二指肠溃疡患儿的临床资料,根据是否感染Hp分为Hp感染组与Hp未感染组,留取Hp感染组治疗前及治疗7 d、治疗14 d、治疗结束后30 d的粪便行16S rDNA测序,应用独立样本 t检验比较Hp感染组与Hp未感染组肠道菌群检出情况,配对 t检验比较Hp感染组治疗前后的肠道菌群检出情况,以非参数检验比较Hp感染组与Hp未感染组的菌群多样性[多样性(Shannon、Simpson)指数和丰富度(Chao 1)指数]和Hp感染组治疗前后的菌群多样性。 结果:治疗前Hp感染组与Hp未感染组的双歧杆菌[(5.92±1.85) lg copies/g粪便比(6.58±2.01)lg copies/g粪便]、乳杆菌[(4.89±1.35) lg copies/g粪便比(4.47±1.59)lg copies/g粪便]、类杆菌[(8.42±2.12) lg copies/g粪便比(8.01±2.20) lg copies/g粪便]、产气荚膜梭菌[(5.90±1.90) lg copies/g粪便比(5.88±2.01) lg copies/g粪便]、肠球菌[(5.41±1.27) lg copies/g粪便比(5.02±1.48) lg copies/g粪便]、肠杆菌[(5.01±1.80) lg copies/g粪便比(5.37±1.47) lg copies/g粪便]、酵母菌[(5.90±1.85) lg copies/g粪便比(5.88±2.01) lg copies/g粪便]检出数量比较,差异均无统计学意义(均 P>0.05)。Hp感染组与Hp未感染组的肠道菌落多样性Shannon指数(3.84±0.52比3.90±0.45)、Simpson指数(0.16±0.04比0.15±0.05)、Chao 1指数(178.52±40.22比185.32±42.47)比较,差异均无统计学意义(均 P>0.05)。与治疗前比较,Hp感染组治疗后不同时间双歧杆菌、乳杆菌、类杆菌检出数量均下降(均 P<0.05);与治疗7 d及治疗14 d比较,治疗结束后30 d双歧杆菌[(4.54±1.78) lg copies/g粪便比(4.20±1.22) lg copies/g粪便比(5.21±1.55) lg copies/g粪便]、乳杆菌[(4.01±1.20) lg copies/g粪便比(3.89±1.32) lg copies/g粪便比(4.43±1.10) lg copies/g粪便]、类杆菌检出数量[(6.78±1.88) lg copies/g粪便比(6.55±1.90) lg copies/g粪便比(7.68±2.00) lg copies/g粪便]均有所升高(均 P<0.05);Hp感染组治疗前后不同时间的产气荚膜梭菌、肠球菌、肠杆菌、酵母菌检出数量比较,差异均无统计学意义(均 P>0.05)。与治疗前比较,Hp感染组治疗后不同时间的Shannon指数与Chao 1指数均降低,Simpson指数均增加(均 P<0.05);与治疗7 d及治疗14 d比较,治疗结束后30 d的Shannon指数(2.85±0.45比2.57±0.48比3.20±0.50)与Chao 1指数(148.45±32.33比140.32±30.47比160.42±38.42)均增加,Simpson指数(0.25±0.06比0.27±0.08比0.19±0.05)降低(均 P<0.05)。 结论:Hp感染对十二指肠溃疡患儿肠道菌群无明显影响,抗Hp治疗可导致肠道菌群失衡及肠道菌群多样性下降,在抗Hp治疗时应考虑大量抗生素对肠道菌群的影响。     

慢性结节状胃炎与幽门螺杆菌的关系

目的观察儿童慢性结节状胃炎幽门螺杆菌(Hp)感染状况及病理组织学改变。方法对经胃镜检查有结节状改变的慢性胃炎患儿41例,男17例,女24例,进行快速尿素酶试验和病理组织学检查,并进行血清Hp抗体检测。所有患儿用奥美拉唑、阿莫西林、克拉霉素三联除菌治疗,3个月后行胃镜随访。结果结节状胃炎41例患儿中Hp感染39例,感染率95%;胃黏膜活检病理显示所有病例均有慢性炎性细胞浸润,且黏膜固有层内淋巴细胞增多,淋巴滤泡形成。所有患儿经成功除菌治疗3个月后36例胃镜随访胃窦部结节状隆起消失,病理证实淋巴滤泡消失,炎性细胞明显减少。结论儿童慢性结节状胃炎是一种特殊类型的胃炎,为儿童Hp感染后的典型表现,Hp根除治疗是儿童结节性胃炎有效的治疗方法。     

心力衰竭患儿血浆血管活性肠肽和胰高血糖素的变化

目的 探讨心力衰竭(CHF)患儿血浆血管活性肠肽(VIP)及胰高血糖素(Glu)变化及其临床意义。方法 CHF患儿40例,男23例,女17例;年龄0.5~7.8岁。其中心功能Ⅰ级15例,心功能Ⅱ~Ⅳ级25例。应用放射免疫法测定患儿血浆VIP和Glu水平,以年龄性别相匹配且无CHF健康体检者23例为正常对照。结果 CHF患儿血浆VIP明显高于正常组[(43.22±5.48)ng／L vs(32.24±4.46)ng／L P<0.05];CHF患儿血浆Glu亦明显高于正常组[(298.23±123.43)ng／L vs(224.67±89.44)ng／L P<0.05]。应用洋地黄治疗,心功能控制后血浆VIP水平较治疗前明显下降[(34.78±5.43)ng／L vs(43.22±5.48)ng／L P<0.05],Glu水平亦较治疗前明显下降[(236.22±98.57)ng／L vs(298.23±123.43)ng／L P<0.05]。结论 CHF患儿血浆VIP、Glu水平明显升高,VIP、Glu参与CHF的病理生理过程。     

儿童幽门螺杆菌感染的菌株类型及治疗

目的评估幽门螺杆菌(H.pylori)不同菌株对儿童胃粘膜炎症程度和治疗效果。方法对94例经胃镜和活检确诊H.pylori相关性胃炎的5～14岁儿童,用免疫印迹试验测血清细胞毒相关蛋白(CagA)、细胞空胞毒素(VacA)、尿素酶(urase)亚型抗体;抗H.pylori三联疗法10d,67例分A组(LAC组,用奥美拉唑 克拉霉素 阿莫仙治疗)和B组(BCF组,用果胶铋 克拉霉素 呋喃唑酮治疗),停药4周后用13C-UBT测定H.pylori根除率。结果①94例中检出CagA和/或VacA阳性86.2%,CagA和/或VacA阴性13.8%;慢性胃炎(CSG)27%,CSG 十二指肠球炎(DG)48%,CSG DG 十二指肠溃疡(DU)21%,胃溃疡(CU) DU4%,滤泡样改变56%,各种疾病检出菌株差异无显著性(χ2=2.551,P>0.05)。②94例H.pylori根除率76%,其中A组90.32%(28/31例),消化性溃疡(PU)根除率100%(12/12例)、CSG根除率84.21%(16/19例);B组H.pylori根除率为88.89%(32/36例),PU76.00%(6/8例),CSG92.86%(26/28例),两组差异无显著性(P>0.05)。各菌株根除率差异无显著性(P>0.05)。症状消退慢、难治及未能根除者大多为阳性菌。结论H.pylori蛋白印迹法简单、可靠,是流行病学筛选H.pylori细胞毒素的指标;阳性患儿必须予以根治。以下各组患儿推荐根治:①慢性活动性胃炎H.pylori阳性者;②胃十二指肠溃疡病患者;③产细胞毒素CagA阳性者。LAC三联根治H.pylori相关性胃炎疗程短、副作用小和根除率高,值得推广。     

抗幽门螺杆菌治疗再发性腹痛与慢性浅表性胃炎的疗效

目的探讨抗幽门螺杆菌(Hp)治疗再发性腹痛(RAP)和慢性浅表性胃炎(CSG)的疗效及其必要性。方法选择本院符合RAP诊断的患儿118例,其中Hp感染52例;胃镜检查后确诊CSG120例,其中Hp感染58例。分别将其分为3组(Hp阴性组、抗Hp治疗组、未抗Hp治疗组),所有患儿治疗3个月,分别行胃镜检查、Hp检测和临床疗效判断,应用SPSS11.0软件进行统计学分析。结果CSG和RAP的发病与Hp感染与否均无关(Pa>0.05)。RAP抗Hp治疗组治疗前后疗效比较差异有统计学意义(χ2=6.74,P<0.05);CSG抗Hp治疗组治疗前后疗效比较差异有统计学意义(χ2=6.16,P<0.05)。结论CSG和RAP的发病与Hp感染无明确相关性,但CSG和RAP的患儿一旦明确有Hp感染,仍应予Hp根除治疗。     

幽门螺杆菌感染对十二指肠溃疡患儿十二指肠球部黏膜菌群的影响

目的探讨幽门螺杆菌(Hp)感染对十二指肠溃疡患儿十二指肠球部黏膜菌群的影响。方法前瞻性队列研究。以2018年1至8月在浙江大学医学院附属儿童医院因腹痛、腹胀、呕吐等症状就诊并经胃镜检查确诊为十二指肠溃疡的23例患儿为研究对象, 根据有无Hp感染分为Hp阳性溃疡组和Hp阴性溃疡组。提取十二指肠球部黏膜DNA, 行高通量测序分析。比较分析两组样品α多样性差异、β多样性差异及其在各分类水平丰度变化情况, 利用PICRUSt软件预测微生物功能。组间比较采用t检验、秩和检验或χ2检验。结果 23例十二指肠溃疡患儿中Hp阳性溃疡组15例[年龄(11.2±3.3)岁, 男11例、女4例]、Hp阴性溃疡组8例[年龄(10.1±4.4)岁, 男6例、女2例]。Hp阳性溃疡组螺杆菌属丰度明显高于Hp阴性溃疡组[0.551%(0.258%, 5.368%)比0.143%(0.039%, 0.762%), Z=2.00, P=0.045], 而梭状杆菌属、链球菌属及丛毛单胞菌科的一个未分类菌属丰度均明显低于Hp阴性溃疡组[0.010%(0.001%, 0.031%)比0.049%(0.011%, 0.310%...     

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??The physiological characteristics of children determine their own particularity of their needs for the quality and quantity of proteins. Proteins not only play an important role in the development of children’s growth and development??cognitive function and immune function??but also have important effects on the long-term health of children.In this paper??the dietary protein reference intakes??amino acid patterns??dietary amino acid reference intakes??sources of high quality protein??and harm of deficiency and excess of protein in children were discussed in detail.     

Age-dependency of alpha- and beta-adrenoceptors on thrombocytes and lymphocytes of asthmatic and nonasthmatic children

Among the possible mechanisms which may cause wheezing or asthmatic episodes a genetically determined -adrenoceptor blockade and a hyperresponsiveness of -andrenoceptors has been postulated. Evidence to support this hypothesis stems from an increased bronchial sensitivity to -blockers, a reduced formation of cyclic AMP in response to -adrenergic stimulation and enhanced -adrenergic responses in asthmatic subjects. The recent development of techniques for measuring the specific, high-affinity binding of radiolabeled -and -adrenergic antagonists made it possible to study - and -adrenoceptors in vitro. Based upon the assumption that a change in the number and/or affinity of adrenergic receptors might be a general phenomenon, we have performed - and -receptor binding studies on lymphocytes and platelets from wheezing infants and asthmatic children as well as of infants, children, and adults not suffering from these diseases.Using ¹²⁵[I]-cyanopindolol (ICYP) and ³[H]-yohimbine (HYOH) as highly specific ligands for - and -adrenoceptors, the following results were obtained: (1) Lymphocytes and platelets from control subjects and asthamatics bound similar amounts of ICYP and HYOH and thus showed no differences either in the number or the affinity of - and -adrenoceptors. Lymphocytes and platelets of wheezing and nonwheezing infants also bound the same amounts of the radioligands. (2) In asthmatic children receiving 4×2 puffs salbutamol -adrenoceptor were down-regulated and this may mimic -adrenoceptor blockade. (3) When subjects were divided into four categories according to age (0–5, 5–10, 10–20 years, adults) the number of -adrenoceptor binding sites showed an age-dependent increase. The number and affinity of -adreneceptor binding sites on platelets was neither influenced by age nor disease.It is concluded that the - and -adrenoceptors of wheezing infants and asthmatic children at least on blood cells are normal. However the -adrenoceptors show an age-dependent maturation process, which may account for an unresponsiveness to -adrenoceptor agonists in wheezing infants.Supported by a grant from the Ministerium für Wissenschaft und Forschung, NRWPresented at the 19th Workshop for Pediatric Research, University of Göttingen, March 10–11, 1983     

Parent Preferences and Perceptions of Milliliters and Teaspoons: Role of Health Literacy and Experience

Background and Objectives

A recent American Academy of Pediatrics policy statement recommends milliliter-exclusive dosing for pediatric liquid medications. Little is known about parent preferences regarding units, perceptions about moving to milliliters only, and the role of health literacy and prior milliliter-dosing experience.

Perinatal and neonatal use of sedation and analgesia

Optimal obstetric and neonatal care requires the provision of adequate analgesia for painful procedures. However, anesthetic and analgesic agents have the potential to adversely impact the developing fetal/neonatal brain. In this setting, clinicians must assess the risks and benefits of pharmacologic anesthesia and analgesia for specific indications in this population. General anesthesia is required for non-obstetric surgery and cesarean section in the absence of neuraxial anesthesia for the health of the mother and fetus. Although experimental data raise concerns, human data are reassuring and future research may focus on neuroprotective adjuncts in the setting of repeated or prolonged anesthetic exposures. Opioid analgesia is standard of care for preterm infants undergoing major procedures including invasive surgery and endotracheal intubation. The use of opioids for agitation resulting from mechanical ventilation is controversial, but prevalent. Randomized and retrospective studies detect short-term toxicity with inconclusive long-term impact, suggesting the need to explore alternative therapies.     

Recrudescence and relapse of meningococcal meningitis and septicaemia

Three cases of recrudescence and relapse of Neisseria meningitidis group B meningitis and septicaemia are reported. The recrudescence and relapses could not be explained by infectious foci, increased bacterial penicillin resistance or immunological defects. As a supplement to antibiotic treatment, all three patients received corticosteroids for the initial 2 days of treatment, and this may have contributed to the unusual course of the disease in our patient.     

发作性睡病的延迟诊断及与癫痫的鉴别诊治

发作性睡病是临床少见的睡眠-觉醒节律障碍性疾病,表现为白天反复发作的不可遏制的睡眠,常伴猝倒发作、睡眠瘫痪及入睡前幻觉。临床医师对发作性睡病的认识不足是导致误诊和延迟诊断的主要原因之一。癫痫发作类型复杂多样,与发作性睡病易混淆,二者需相互鉴别,且当二者共患病时,诊断和治疗会更加困难。现通过对发作性睡病的临床特征与延迟诊断原因进行分析,总结发作性睡病与癫痫的鉴别要点及共患病的诊治经验,以提高临床医师对发作性睡病及其与癫痫共患病的认识,改善患者的预后及生活质量。     

Mechanism of onset and exacerbation of chronic glomerulonephritis and its treatment

Immunoglobulin A nephropathy (IgAN) is one of the most common causes of chronic glomerulonephritis (CGN) in the world. The proliferative and crescentic forms of IgA are found in up to 30% of cases and are associated with nephritic‐range proteinuria, accelerated hypertension, and accelerated decline toward end‐stage renal disease. On the other hand, Henoch–Schönlein purpura (HSP) is a systemic disorder characterized by leukocytoclastic vasculitis involving the capillaries and the deposition of IgA immune complexes. Renal involvement is the principal cause of morbidity and mortality in children with HSP. Two entity diseases are important as renal diseases in childhood. We herein review the mechanism of the onset and exacerbation of IgAN and HSP nephritis (HSPN) and its treatment. As to the pathogenesis, we found that CB4 provoked exacerbation of renal pathologic findings in hyper IgA mice via endothelial injury, γ‐interferon production, and dysfunction of the mesangial pathway and could possibly become one of the factors involved in the mechanism of the onset or evolution of human IgAN. As to the treatment of IgAN and HSPN, we evaluated the efficacy of multidrug combination therapy (prednisolone, warfarin, and dipyridamole, including mizoribine) for diffuse IgAN and the efficacy of methylprednisolone and urokinase pulse therapy plus immunosuppressive drugs for severe HSPN in children. These therapies were effective in ameliorating the proteinuria and histologic severity of patients with IgAN or HSPN. In future, detailed investigations into the pathogenesis of CGN and double‐blind randomized control studies on children with IgAN or HSPN will be necessary.