肺炎支原体感染与反复呼吸道感染的关系及其对患儿免疫功能的影响

目的探讨肺炎支原体（MP）感染与反复呼吸道感染（RRI）的关系及其对患儿免疫功能的影响。方法住院疑诊为MP感染和RRI患儿,采用明胶颗粒法检测其血清抗MP-IgM,用免疫比浊法检测血清IgG、IgA、IgM。比较肺外并发症发生情况。结果MP感染发生率13.94%（687/4 930例）,在RRI中发生过MP感染者24.29%（85/350例）,其中发生反复MP感染者12.86%（45/350例）。RRI并反复MP感染组肺外并发症发生率较高（P〈0.05）。学龄前RRI组IgG、IgA水平低于健康儿童,学龄前RRI＋反复或非反复MP感染组血清IgG、IgA水平高于学龄前RRI组（P〈0.01）。IgM无差异（P〉0.05）。补体C3、C4水平均无显著性上升;学龄前RRI组及学龄前RRI＋反复MP感染组补体C3水平下降（P〈0.05）。结论MP感染是RRI的重要原因之一,RRI及MP感染的患儿均存在体液免疫功能紊乱,RRI患儿如有反复MP感染应警惕MP肺外并发症的发生。     

反复呼吸道感染儿童细胞免疫与体液免疫状况

目的探讨反复呼吸道感染（RRI）患儿细胞与体液免疫状况,为临床进行免疫治疗提供依据。方法用流式细胞仪对23例RRI患儿进行外周血淋巴细胞亚群检测;同时进行免疫球蛋白（IgA、IgG、IgM）及补体C3、C4水平检测。结果与健康人群比较,RRI患儿血清IgG及IgA各有1例降低,血清IgM降低7例;补体C3降低3例,C4降低1例。RRI患儿外周血CD8较健康对照组明显增高（P=0）,CD4/CD8较健康对照组明显降低（P=0.002）。结论RRI患儿存在体液免疫功能降低,细胞免疫功能失调亦非常显著。     

复可托治疗小儿反复呼吸道感染的疗效及免疫学影响

目的观察复可托对小儿反复呼吸道感染（RRI）者免疫功能的影响。方法100例RRI患儿随机分为两组，对照组50例予以常规治疗，观察组50例在常规治疗的基础上予以复可托治疗2—3个月，治疗前后分别测定患儿T细胞亚群、免疫球蛋白及补体等指标并观察其变化情况。结果两组总有效率分别为86％和22．9％，差异有非常显著性（P〈0．005），观察组的疗效优于对照组。观察组免疫学指标CD3、CD4、CD4／CD8、IgG、IgA及IgM均明显升高（P〈0．01或P〈0．05），CD8较治疗前明显降低（P〈0．05）。结论复可托能增强RRI患儿的免疫功能。     

乳铁蛋白治疗反复呼吸道感染患儿的疗效

目的 探讨乳铁蛋白对反复呼吸道感染(RRI)患儿免疫功能的影响.方法 RRI患儿98例随机分为2组.对照组48例予常规治疗;观察组50例在常规治疗基础上予乳铁蛋白治疗2～3个月.治疗前后分别测定患儿T细胞亚群、免疫球蛋白及补体等指标,观察其变化情况.结果 2组总有效率分别为86%和22.9%,差异有非常显著性(P＜0.005).治疗后观察组免疫学指标CD3、CD4、CD4/CD8、IgG、IgA及IgM均明显升高(Pa＜0.01,0.05),CD8较治疗前明显降低(P＜0.05).结论 乳铁蛋白能增强RRI患儿的免疫功能.     

肺炎支原体感染4种特异性抗体检测的临床研究

目的：探讨肺炎支原体(MP)特异性IgM,IgA,IgG对肺炎支原体感染诊断价值,及MP IgE与支气管哮喘发病的关系。方法：采用酶联免疫吸附试验对临床高度怀疑肺炎支原体感染患儿测定特异性MP IgA,IgG,IgE,采用颗粒凝集法测定MP IgM,并对57例肺炎支原体感染患儿随访2~5. 5月。结果：在372例肺部感染患儿中,MP IgA阳性184人,占49. 5%;MP IgM阳性241人,占64. 8%; 2种抗体同时阳性140人,占37. 6%, 2种MP特异抗体测定结果的一致性非常显著。其中149例测定了MP IgG, 105例阳性,占70. 5%;而30例正常对照组中仅2例MP IgG阳性,占6. 7%,正常对照组MP IgA,MP IgM皆为阴性。MP IgA,MP IgM,MP IgG的阳性率,在发病第2周均达到80%以上,明显高于第1周,在随访的57例MP感染患儿中, 25例有反复呼吸道感染,MP IgA在随访时阳性率明显增高,MP IgM滴度居高不下;而在32例无呼吸道感染患儿中,MP IgA的阳性率变化不明显,MP IgM滴度则明显下降。MP感染组的MP IgE的阳性率达73. 3%,与哮喘合并MP感染组接近,但与哮喘合并非MP感染组及正常对照组比较差异有显著性。结论：4种特异性肺炎支原体抗体测定对于提高MP感染诊断的特异性、敏感性具有十分重要的临床价值,尤其对于MP再感染的发现及MP感染诱发支气管哮喘的发作机制研究及进一步治疗提供了     

肺炎衣原体感染与儿童急性缺血性脑血管病的相关性

目的探讨肺炎衣原体（CP）感染与儿童急性缺血性脑血管病（ICVD）的关系。方法对确诊的65例急性ICVD和30名健康对照组儿童行血浆CP抗体IgM和IgG检测;分别按病情恢复情况和临床受累情况对ICVD患儿分组,并进行组间比较。结果ICVD与健康对照组CP特异性抗体IgM和IgG阳性率比较,差异均无显著性（Pa〉0.05）;快速恢复组（54例）与迁延组（11例）比较,迁延组IgM阳性率明显高于快速恢复组（P〈0.01）,但二组IgG阳性率比较差异无统计学意义（P〉0.05）;按临床表现分组,各组IgG阳性率差异均无显著性,但肢体伴意识障碍组IgM阳性率明显高于其他各组（Pa〈0.01）;各标准分组间年龄比较,迁延组和肢体伴意识障碍组平均年龄明显小于各自健康对照组（Pa〈0.05）。结论CP急、慢性感染与ICVD发生可能无直接关系,但在ICVD迁延性病变或重症病例中CP急性期感染可能起一定作用,尤其对于年幼儿童。     

急性肾小球肾炎与肾病综合征患儿体液免疫指标比较

目的 检测急性链球菌感染后。肾小球肾炎与肾病综合征（NS）患儿体液免疫指标，进行比较、分析，以达到早期鉴别诊断、早期合理用药目的。方法 对23例链球菌感染后肾小球肾炎、48例Ns、正常对照18例儿童检测血IgG、IgA、IgM、C3、C4水平，采用英国MININEPH仪器及配套试剂，散射比浊法检测。IgE定量检测采用美国E＆ELABSINC公司全套试剂盒，ASO采用免疫比浊法，血沉采用魏氏法检测。结果急性肾小球肾炎与正常对照组比较，IgG、IgA、IgE、C3、C4有显著性差异（Pa〈0.05），ASO、血沉具有均明显升高（Pa〈0．05）。NS与正常对照组比较，IgG、IgM、IgE具有显著性差异（Pa〈0．05）；急性。肾小球肾炎与NS比较，IgG、IgA、C3、C4具有显著性差异（Pa〈0．05），前者IgG、IgA明显升高，c3、c4明显降低，而后者IgG则明显降低。结论急性肾小球肾炎与NS患儿临床表现不典型者可通过检测血IgG、IgA、C3、C4水平加以鉴别．再辅以ASO、血沉检测，可达到早期诊断、早期治疗的目的。     

儿童抽动障碍与病原微生物感染及其免疫的相关性

目的 探讨儿童抽动障碍(TD)与EB病毒(EBV)、人巨细胞病毒(HCMV)、肺炎支原体(MP)感染的相关性.方法 选择TD患儿49例为病例组.健康对照组为本院同期体检的健康儿童47例.检测二组外周血EBV DNA水平、咽拭子MP DNA水平及尿HCMV DNA水平,并检测血T淋巴细胞亚群及IgA、IgG、IgM水平.结果 病例组EBV、MP及HCMV的DNA检出率分别为22.49％、14.29％及6.12％;健康对照组分别为2.13％、2.13％及0,病例组显著高于健康对照组(Pa＜0.015).病例组CD4+T淋巴细胞、CD4+/CD8+淋巴细胞比值分别为(34.71 ±4.62)％和0.96±0.22,较健康对照组[(40.02±2.53)％、1.31±0.07]显著降低(Pa＜0.05);CD8+[(36.28±3.95)％]较健康对照组[(30.65±6.51)％]显著升高(P＜0.01).而CD3+二组比较差异无统计学意义(P＞0.05).病例组IgG[(9.43±2.95)g·L-1]显著低于健康对照组[(16.23±3.13) g·L-1],差异有统计学意义(P＜0.01).结论 EBV、HCMV、MP等感染引起的免疫紊乱可能是导致儿童TD发生的因素之一.     

甘露聚糖肽对预防特发性血小板减少性紫癜复发的作用

目的观察甘露聚糖肽对特发性血小板减少性紫癜（ITP）患儿继发感染、复发的影响。方法初治ITP患儿120例随机分为甘露聚糖肽治疗组和单纯激素对照组。对照组采用地塞米松针静脉滴注3d,后改为口服泼尼松;治疗组在此基础上口服甘露糖肽片,疗程1个月。观察治疗阶段临床出血症状控制时间及血小板变化情况,继发感染率、感染控制时间、复发率及用药前后血清IgG、IgA、IgM变化。结果二组出血症状控制时间及血小板上升至正常值时间无显著差异（Pa〉0.05）;继发感染率和复发率、感染后控制时间均显著低于对照组。用药后治疗组血清IgG、IgA上升显著,对照组无明显变化;IgM无显著变化。结论甘露聚糖肽佐治ITP有预防和降低感染,减少和预防复发的作用,增强患儿细胞和体液免疫功能。     

儿童肺炎支原体肺炎免疫功能、降钙素原及C-反应蛋白变化及意义

目的 检测肺炎支原体肺炎（mycoplasma pneumoniae pneumonia,MPP）患儿免疫球蛋白、CD4＋T、CD8＋T、血清降钙素原（PCT）和C-反应蛋白（CRP）的水平,探讨其改变及临床意义.方法 收集2012年11月至2013年10月诊断为MPP的患儿126例,分为大叶性肺炎组（42例）及支气管肺炎组（84例）,以同时期儿科门诊体检的健康儿童28例为正常对照组,分别测定免疫球蛋白、PCT和CRP.结果 （1）MPP患儿IgG、IgM、IgE异常率高于正常对照组（P＜0.05）,IgA异常率无明显差异（P＞0.05）;大叶性肺炎组IgG异常率高于支气管肺炎组（P＜0.05）,IgM、IgE及IgA异常率无明显差异.（2） MPP患儿CD4＋T、CD4＋ T/CD8＋T比值较正常对照组明显降低（P＜0.05）.（3）MPP患儿血清PCT及CRP水平较正常对照组明显升高（P＜0.05）.结论 MPP患儿体液免疫与细胞免疫功能紊乱在MPP发病过程中起重要作用,且病情越重,免疫功能紊乱越明显,PCT、CRP对MPP病情评估有临床指导意义.     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Bibliometric data: a disaster for many non-American biomedical journals

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.     

alpha -SMOOTH MUSCLE ACTIN DISTRIBUTION IN THE PULMONARY VASCULATURE COMPARING HYPOPLASTIC AND NORMAL FETAL LUNGS

We investigated the intra-acinar pulmonary vascular muscularization in the developing human fetal lung between the 17th and 24th gestational weeks, that is, during the canalicular phase of lung development. Fifteen hypoplastic and 25 normal developed lungs were included in this study using monoclonal alpha -smooth muscle (sm) actin antibodies for smooth muscle detection. Computer-aided image analysis was performed for morphometrical measurements and statistical evaluation. Alphasm-actin-immunoreactive intra-acinar vessels down to a luminal diameter of less than 10 mu m were detected in hypoplastic as well as in normally developed lungs. Crucial differences presented as follows: significantly higher density of intra-acinar vessels, especially due to alpha -sm-actin-negative vessels less than 30 mu m in luminal diameter, in the control group; significantly higher alpha -sm-actin immunoreactivity per section unit as well as per vessel in the hypoplastic lung group. As suggested by others, alpha-sm-actin-positive cells of the intra-acinar vessel wall in the developing human lung were demonstrated to be smooth muscle cells, their immediate precursors, and pericytes. We conclude that the increased alpha -sm-actin immunoreactivity represents muscularization of the vessel wall in functional terms and may be regarded as one structural cause among others for the establishment of persistent fetal circulation in hypoplastic lungs.