南宁市新生儿细菌性脑膜炎监测研究

目的掌握本地区新生儿细菌性脑膜炎的流行病学和临床特征,提高该病的防治水平.方法对南宁市2000年12月～2002年11月67,342名新生儿进行主动监测.疑似病例作脑脊液(CSF)常规检查和血、CSF细菌分离培养.脑膜炎患婴进行动态评估与定期随访.结果临床细菌性脑膜炎47例,发病率69.8/10万,农村病例占76.6%;明显高于城区;≤7天新生儿占61.7%,其中2天内占34.0%;医源性感染占6.4%.临床表现不典型,CSF中WBC中位数(M)=46×106/L,蛋白中位数(M)=1.83g/L,WBC数与蛋白定量之间具有高度相关性(r=0.5308t=4.2015 P＜0.001).CSF培养出病原菌4例(8.5%),阳性率低可能与检测前使用抗生素病例较多有关.血培养阳性率29.8%,以大肠埃希菌和葡萄球菌为主.病死率25.5%,后遗症发生率48.6%.结诊降低该病发生率的关键,在于加强农村围产儿感染的防治和控制医源性感染.致病原流行病学监测,有利于临床诊治水平的提高.     

新生儿细菌性脑膜炎预后不良的危险因素分析

目的 探讨新生儿细菌性脑膜炎预后不良的危险因素。方法 回顾性分析152例细菌性脑膜炎新生儿的临床资料,根据转归分为预后良好组（n=122）与预后不良组（n=30）,比较两组患儿的一般情况、首发症状及实验室检查结果,分析预后不良的危险因素。结果 预后不良组极低出生体重、外周血WBC < 5×10⁹/L或 > 20×10⁹/L、C-反应蛋白 > 50 mg/L、脑脊液WBC > 500×10⁶/L、脑脊液糖 < 1 mmol/L、脑脊液蛋白 > 2 g/L比例高于预后良好组（P < 0.05）,血培养和/或脑脊液培养阳性率、革兰阳性菌及无乳链球菌培养阳性率高于预后良好组（P < 0.05）。多因素logistic回归分析显示,脑脊液糖 < 1 mmol/L、脑脊液蛋白 > 2 g/L是新生儿细菌性脑膜炎预后不良的独立危险因素。结论 脑脊液糖 < 1 mmol/L、脑脊液蛋白 > 2 g/L是新生儿细菌性脑膜炎预后不良的危险因素。     

53例小儿细菌性脑膜炎有关病原研究

研究目的 小儿细菌性脑膜炎(菌脑)的病原构成及病原检测方法的阳性率比较。 研究方法 共53例,应用肺炎链球菌多价型(PNC)、流感嗜血杆菌B型(Hib)、脑膜炎双球菌A及B群(MCA,MCB)三种细菌抗血清,采用对流免疫电泳(CIE)检测脑脊液(CSF)、血、尿抗原共47例,CSF涂片革兰氏染色找细菌25例,CSF培养20例,血培养20例。 结果和结论 1.明确病原菌者86.7％,其中Hib占45.28％为主要病原菌,而MC28.3％占第二位,PNC占9.43％。2.检测方法中证明CIE检测抗原阳性率(89.4％)明显优于常规检查细菌的方法(15～35％),(P<0.01)。3.入院时第一次CSF,用CIE法检测病原阳性率最高。     

足月儿与早产儿细菌性脑膜炎的临床分析

目的 探讨足月儿和早产儿细菌性脑膜炎的临床特征及转归特点。方法 回顾性分析102例新生儿细菌性脑膜炎患儿的临床资料,根据胎龄分为早产儿组（n=46）及足月儿组（n=56）,比较两组患儿临床表现、实验室结果、影像学结果及临床转归。结果 早产儿组临床表现主要为反应差和呼吸暂停/急促（P < 0.05）,足月儿组则以发热及抽搐多见（P < 0.05）。足月儿组脑脊液糖高于早产儿组（P < 0.05）,早产儿组C-反应蛋白、血培养阳性率及不良预后发生率高于足月儿组（P < 0.05）。两组外周血白细胞计数、脑脊液白细胞、脑脊液蛋白及脑脊液培养阳性率差异无统计学意义（P > 0.05）。结论 早产儿及足月儿细菌性脑膜炎临床表现有所不同,早产儿组不良预后发生率更高。     

新生儿化脓性脑膜炎的临床特点与早期诊断

目的探讨新生儿化脓性脑膜炎的临床特点与早期诊断方法。方法选择2010年3月-2011年12月就诊于本院新生儿科疑似化脓性脑膜炎患儿100例,均于本院应用抗生素前行腰椎穿刺术,留取脑脊液(CSF)标本行常规、生化检测及培养,同时留取CSF 1 mL行PCR检测16 S rRNA。结果临床诊断为化脓性脑膜炎者40例,其中发热36例(90%),惊厥29例(72.5%),呼吸暂停5例(12.5%),前囟饱满23例(57.5%)。临床诊断为化脓性脑膜炎40例患儿,其CSF PCR检测均为阳性。CSF培养阳性5例,该5例CSF参数异常,PCR检测均呈阳性。PCR检测16 S rRNA阳性58例,PCR阳性率明显高于CSF培养、CSF参数(χ2=65.09,P=0.00;χ2=6.48,P=0.01)。结论新生儿化脓性脑膜炎临床特点不典型,CSF检查存在一定局限性,CSF培养阳性率低,结合PCR检测能提高阳性率。     

儿童脑膜炎球菌性脑膜炎在诊断中的困难

本文复习了1973～1977年间111例细菌性脑膜炎患儿及其诊断拖延的原因。脑脊液培养阳性者95例,最常见的感染细菌为奈瑟氏脑膜炎球菌占52%;流感嗜血杆菌占39%;肺炎球菌占6%。其中有6例,尽管早期进行腰穿,仍未及时明确诊断,而每例都是奈瑟氏脑膜炎球菌,其中两例脑脊液(CSF)细胞学检查正常,但其后的培养为阴性。强调了不论CSF细胞学结果如何,标本都应作细菌培养的重要性。另外4例的首次CSF细胞检查正常,涂片阴性,培养亦无细菌生长。但再次腰穿(间隔分别为24小时、48小时、36小时和11天)则确证为脑膜炎球菌性脑膜炎。鉴于细菌性脑膜炎常为败血症所致,故对首次CSF正常的败血症患儿,如果临床情况允许,须行进一步腰穿。但是在败血症患儿,腰穿本身可以在实际上引起     

荧光定量PCR测定在小儿非细菌性脑膜炎病原学诊断中作用及其临床意义

目的 研究疱疹类病毒与肺炎支原体(MP)在潍坊地区小儿中枢神经系统(CNS)感染发病中的作用 及荧光定量PCR测定(FQ-PCR)与临床的关系。方法 利用FQ-PCR法检测小儿非细菌性脑膜炎(非菌脑)脑脊液 (CSF)中EBV、HSV、CMV和MP的核酸,并与CSF中其特异性抗体结果进行比较。结果 192例非菌脑患儿中84 例病原DNA阳性(阳性率43.8％),且年龄越小,阳性率越高,以0-3岁组最高,占50.0％;阳性者中,EBV-DNA阳 性率最高(46.4％),其次是HSV-DNA和MP-DNA(28.6％和14.3％),CMV-DNA阳性率最低(10.7％);重型患儿 CSF 4种病原DNA的拷贝量明显高于轻型患儿(P<0.05,0.01);CSF病原DNA阳性率与特异性IgM阳性率分 别为43.8％(47／192例)和24.5％(84／192例)(P<0.01)。结论 小儿CNS感染发病中上述4种病原不可忽视; CSF病原DNA拷贝量检测对判断非菌脑病情具有重要指导意义;MP的直接损伤是MP脑膜炎的发病机制之一; FQ-PCR特异性强、敏感性高,需标本量少,是早期快速诊断小儿非菌脑的可靠方法,值得推广使用。     

中枢神经系统感染患儿脑脊液和血清胰岛素样生长因子结合蛋白-3的测定

本研究检测了 5 3例中枢神经系统 (CNS)感染患儿脑脊液 (CSF)和血清中胰岛素样生长因子结合蛋白 3(IGF BP 3)的质量浓度 ,以探讨其在CNS感染性疾病中的变化及临床意义。临床资料 :2 0 0 1年 2～ 12月本院儿科和结核科住院的CNS感染患儿 5 3例。 (1)初治细菌性脑膜炎 (iBM )组 14例 ,男 10例 ,女 4例 ,年龄 (1 2± 0 3)岁 ;诊断符合以下条件之一 :①CSF细菌培养或涂片查菌阳性 ,CSF特点符合细菌性脑膜炎改变且未经过抗菌药物治疗者 ;②CSF细菌培养阴性 ,而临床表现、治疗经过、CSF常规检查均符合典型的细菌性脑膜炎特点 ,同时…     

用C反应蛋白对新生儿感染进行快速床边监测

有关新生儿细菌性感染问题,最确切的诊断主要靠细菌培养,尤其对新生儿败血症,血培养需取血1～3 ml/次,培养时间至少需要16～24小时甚至一周,为了能在短时间内检查出结果,我们用耳血或足跟微量全血法测C反应蛋白(CRP),在细菌性感染疾病中升高,为临床医生提供一种快速诊     

脑脊液CK-BB测定在诊断细菌性脑膜炎中的意义

目的：了解脑脊液中CK-BB浓度测定对鉴别细菌性脑膜炎和病毒性脑膜炎的意义。方法：测定怀疑中枢神经系统感染的85例患儿脑脊液中CK-BB浓度,其中,经确诊无中枢神经系统感染患儿17例,病毒性脑膜炎患儿36例,细菌性脑膜炎患儿32例。结果：以无中枢神经系统感染的17例作为对照组,其CSF中CK-BB浓度为(0.90±0.63) U/L,病毒性脑膜脑炎中CK-BB为(1.20±0.52) U/L;细菌性脑膜炎的CSF中CK-BB浓度为(32.40±13.60) U/L,显著高于病毒性脑膜炎患儿(t=2.95,P<0.01)和对照组(t=3.12,P<0.01)。结论：脑脊液中CK-BB可作为鉴别细菌性脑膜炎和病毒性脑膜炎的一项可靠指标。     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Psychopathologie du syndrome d’Asperger et « aspérigisation » de la société contemporaine

The author has attempted here to point out, just for a start, the characteristics of Asperger syndrome from the point of view of psychopathology through a rereading of Hans Asperger's original paper (1944). This thesis merits reevaluation, if for no other reason than to fill the gaps in operational diagnostics based on the DSM. It is found by rereading that Asperger's view of the principal disturbances of autistic psychopathy include a “disturbance of natural evidence” or a “crisis of common sense”. This question of natural evidence that he evokes with regard to autistic psychopathy corresponds to W. Blankenburg's natural evidence, which constitutes a key concept for comprehending schizophrenia in the form poor-symptom (“symptomarme Schizophrenie”) that he observes in the speech of his patient Anne Rau. One can deduce from this that in terms of fundamental disturbances, Asperger syndrome and this “symptom-poor” schizophrenia overlap at the level of loss of natural evidence. It is moreover possible to classify Asperger syndrome among the disturbances of spacing in the sense meant by the evolutionary psychiatry of A. Stevens and J. Price. The author then develops our comprehension of Asperger syndrome from the point of view of the perspective proposed by the notion of resilience in people with Asperger syndrome and of the possibility for them, through these mechanisms of adaptation, to find in the organization of the personality of the “as if” type a position of relative equilibrium. They concur or overlap in the creation of crutches, of borrowed personalities secondarily legitimated by the reaction of the socius. This will end up in the production of inventions and œuvres (works). Clearly, one rarely encounters several cases that one could consider pertinently to be “successful” Asperger syndrome. Finally, the author notes that one can find a sort of isomorphism between Asperger syndrome and contemporary society when he proposes the term “asperigisation” to characterize our society, given that the equilibrium between emotion and logic is strongly disturbed in these patients, in whom logic undergoes hypertrophy while emotion is impoverished. From this perspective, the author hopes to suggest reasons for the increase in the number of cases of Asperger syndrome in the clinical setting and in society in general in our contemporary era.     

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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.