降钙素原在诊断儿科中枢感染性疾病中的应用研究

目的 探讨儿科中枢感染性疾病中降钙素原的改变及其临床应用价值。方法 采用免疫色谱法对97例各种中枢感染的住院患儿进行了血降钙素原(PCT)检测，同时检测50例健康儿童作为正常对照。结果 化脓性脑膜炎(化脑)14例，PCT阳性14例，阳性率100％。病毒性脑炎(病胞)72例，仅19例阳性，阳性率26．4％，且这19例均为病脑并多器官功能障碍，结核性脑膜炎(结脑)11例全部阴性。结论 PCT可作为区别化脓性脑膜炎、病毒性脑炎及结核性脑膜炎一项重要指标，能指导对儿科中枢感染性疾病的诊治及预后监测。     

荧光素钠试验对小儿中枢神经系统常见感染性疾病鉴别诊断的意义

本文对191例中枢神经系铣不同疾病患儿的脑脊液进行荧光素钠试验(FST),观察列病毒性脑炎(含病毒性脑膜脑炎)及颅内非感染性疾病全部阴性,结核性脑膜炎全部阳性,化脓性脑膜炎部分阳性,且后者多为晚期病例,它们之间的阴性、阳性率有显著性差异,提示此法对病毒性脑炎(含脑膜脑炎)与结核性脑膜炎的鉴别诊断有重要价值,对结核性脑膜炎与化脓性脑膜炎的鉴别诊断亦有重要的参考价值。     

血清抗脑抗体在小儿颅内感染性疾病中诊断价值的研究

目的　观察小儿颅内感染时血清抗脑抗体 (ABAb)的变化 ,探讨其在诊断中的价值。方法　选取 2 0 0 2年 2月至 2 0 0 3年 9月济南市儿童医院收治的 98例颅内感染患儿 ,分为病毒性脑炎 (病脑 )组 5 0例 ,化脓性脑膜炎 (化脑 )组 37例 ,结核性脑膜炎 (结脑 )组 11例。并选取 2 0例对照组患儿 ,进行血清ABAb检测 ,并与血清降钙素原(PCT)、肿瘤坏死因子 α(TNF α)、白介素 6 (IL 6 )进行对比分析。结果　血清ABAb在病脑组、化脑组、结脑组阳性率分别为 78 0 0 %、5 1 35 %、4 5 4 5 % ,与对照组比较 ,差异均有显著性 (P <0 0 5 ) ;病脑组与化脑组、结脑组比较差异亦有显著性 ( P <0 0 5 )。血清ABAb与血清PCT、TNF α、IL 6呈中度正相关 ;血清PCT、TNF α、IL 6之间呈高度正相关 ,均在化脑时升高明显 ,与其他组比较差异有显著性 (P <0 0 5 )。经多元判别分析 ,诊断病脑或化脑 ,误判率 8 0 4 % ,判别符合率 91 96 %。结论　在小儿颅内感染时 ,血清ABAb可呈阳性 ,病脑阳性率最高 ,结合血清PCT、TNF α、IL 6检查 ,可协助小儿颅内感染的诊断与鉴别诊断     

不同中枢神经系统感染患儿脑脊液肝细胞生长因子水平变化的意义

目的通过观察病毒性脑炎、细菌性脑膜炎及结核性脑膜炎患儿脑脊液肝细胞生长因子(HGF)水平变化,探讨其是否可以作为一个鉴别诊断的生化指标,为临床疾病的诊断提供依据。方法选择临床确诊病毒性脑炎30例、细菌性脑膜炎21例、结核性脑膜炎19例及对照组24例,采用酶联免疫吸附试验双抗体夹心法检测各组患儿脑脊液HGF水平。同时将HGF水平分别与脑脊液中白细胞计数和蛋白定量进行直线相关分析,观察脑脊液中HGF水平与脑脊液中白细胞计数和蛋白定量的关系。结果细菌性脑膜炎组、结核性脑膜炎组脑脊液HGF水平高于病毒性脑炎组和对照组,结核性脑膜炎组高于细菌性脑膜炎组患儿,细菌性脑膜炎组、结核性脑膜炎组及病毒性脑炎组与对照组患儿比较均有显著性差异(Pa<0.05),病毒性脑炎组与对照组患儿比较差异无统计学意义(P>0.05)。结论 HGF有可能成为鉴别细菌性脑膜炎、结核性脑膜炎及病毒性脑炎的指标之一。     

首都儿科研究所1997-2006年住院患儿中枢神经系统感染性疾病的流行病学特点

目的 了解首都儿科研究所住院患儿中枢神经系统(CNS)感染性疾病的流行病学特点.方法 对1997年1月-2006年12月在片都儿科研究所附属儿童医院住院的972例临床确诊为CNS感染性疾病患儿的临床资料进行回顾性分析,入选病例急性期血清和(或)脑脊液病原学的检测包括细菌和真菌涂片、培养及快速病原学诊断;病毒抗体、肺炎支原体抗体、结核抗体检测.结果 1.CNS感染性疾病病例占同期内科位院总人数的1.76%.2.CNS感染性疾病的主要病种:病毒性脑炎747例,细菌性脑膜炎177例,支原体脑炎21例,结核性脑膜炎12例.3.CNS感染性疾病患儿972例中男:女比例为1.72∶1.0.发病年龄为(4.75±4.03)岁.4.血清和(或)脑脊液病原学检测阳性的病例共283例(29.12%),细菌学检测阳性者48/177例(27.12%),其中以肺炎链球菌(4.52%)、大肠埃希菌(3.39%)、脑膜炎舣球菌(3.39%)、流感嗜血杆菌B(Hib,3.39%)为主;病毒抗体阳性者210/747例(28.11%),主要为疱疹病毒[128/747例(17.14%)]及肠道病毒[91/747例(12.18%)].结论 CNS感染性疾病足内科住院患儿中重要病种之一.病毒及细菌是儿童CNS感染性疾病的主要感染原.肺炎链球菌、大肠埃希菌、脑膜炎双球菌、Hib是本院细菌性脑膜炎的主要致病菌;疱疹病毒及肠道病毒是本院病毒性脑炎的主要病原.     

神经系统及精神疾病

981377中枢神经系统疾病的血清甲状腺激素的改变/冯慕仁…//实用儿科临床杂志一1997,12(2)一87一89 检测76例中枢神经系统疾病患儿血清T3、几、TSH浓度,并与20例正常儿童对照观察,结果异常46例(60.5%),其中化脓性脑膜、结核性脑膜炎、病毒性脑膜炎、流行性乙型脑炎及癫痛持续状态T:明显低于格林一巴利综合征和对照组;病脑、乙脑、结脑几明显低于对照组,而格林一巴利综合征、化脑T4不降低。认中国医学文摘·儿科学1998年第17卷第3期179为几降低意味着病危及脑实质损害,T3、T;动态变化对估计疾病预后有一定价值。表3参7(原文提要) 981378 …     

前降钙素、白细胞介素6和C反应蛋白在细菌性脑膜炎中的诊断价值

目的 比较前降钙素(PCT)、白细胞介素6(IL-6)和C反应蛋白(CRP)在急性细菌性脑膜炎(菌脑)与病毒性脑炎(病脑)鉴别诊断中的作用。方法 采用双抗体夹心免疫发光法测定菌脑20例、病脑19例血浆PCT含量,采用双抗体夹心免疫吸附法(ELISA)测其脑脊液IL-6含量,血CRP含量采用ELISA法测定。结果 与病脑组比较,菌脑组血浆PCT和CRP及脑脊液IL-6含量明显升高,其诊断灵敏性为100.0％,特异性为89.5％,明显优于CRP和IL-6。结论 PCT是鉴别菌脑与病脑灵敏、有效的指标。     

血降钙素原在儿童化脓性脑膜炎与病毒性脑膜炎中的变化

目的：化脓性脑膜炎病原学检出率较低,尤其脑脊液改变不典型时给临床诊断带来困难。已证实血降钙素原(PCT)测定对鉴别细菌与病毒感染有重要价值,但在化脓性脑膜炎与病毒性脑膜炎的鉴别诊断方面与CRP、血沉比较孰优孰劣未见报道,另外诊断化脓性脑膜炎时PCT临界值的确定也未见报道。该文通过血PCT测定并与CRP、血沉比较探讨其对儿童化脓性脑膜炎与病毒性脑膜炎的鉴别诊断意义。方法：用免疫荧光法测定了41例急性脑膜炎患儿血PCT(其中化脓性脑膜炎18例,病毒性脑膜炎23例),同时测定血CRP、血沉。结果：化脓性脑膜炎组PCT,CRP及血沉分别为51.73±30.75μg/L,182.36±54.5mg/L和50.44±8.95mm/h;明显高于病毒性脑膜炎组0.84±0.99μg/L,8.90±10.66mg/L和16.75±13.23mm/h(P<0.01),受试者工作特征曲线下面积PCT为0.984(95%可信区间0.953～1.013),而CRP为0.983(95%可信区间0.954～1.012),二者比较差异无显著性(P>0.05)。有2例病毒性脑膜炎PCT值高于0.5μg/L,而化脓性脑膜炎病人均高于此值。结论：血PCT同CRP在儿童化脓性脑膜炎与病毒性脑膜炎的鉴别诊断方面有重要参考价值,优于血沉。     

腺苷脱氨酶、抗结核抗体在颅内感染鉴别诊断中的价值

结核性脑膜炎、化脓性脑膜炎、病毒性脑膜炎(结脑、化脑、病脑)为最常见的小儿颅内感染性疾病,不典型病例较多,给诊断带来较大困难.我们对43例结脑、25例化脑、31例病脑患儿进行脑脊液腺苷脱氨酶(ADA)、抗结核抗体(结抗)测定与分析,以探讨其在颅内感染中的诊断价值.     

危重病毒性脑炎并内脏损害及内环境紊乱

病毒性脑炎（病脑）是儿科常见的中枢感染性疾病之一．重症病脑致残率、病死率较高，常合并多脏器损伤。现将近年来我们收治的36例病脑临床分析如下。     

A study of acute febrile encephalopathy with special reference to viral etiology

Objective  To study the etiological profile of patients with acute febrile encephalopathy syndrome focusing chiefly on the viral etiology, and to correlate clinical and radiological features of patients with viral encephalitis. Methods  A prospective hospital based study conducted on the consecutive patients admitted in a pediatric unit during the period of 1^st February 2004 to 31st January 2005 based on the following inclusion criteria: (1) Age more than 1 month and less than 18 years and (2) A diagnoses of acute febrile encephalopathy, based on the following criteria: (i) fever (ii) acute depression of consciousness or mental deterioration for more than 12 hours with or without motor or sensory deficit and (iii) Total duration of illness at the time of admission 1 week or less. Results  The final study group comprised of 151 patients with mean age of 3.21 ± 2.9 (range of mth-13 years) and male: female ratio of 1.71: 1. A diagnosis other than viral encephalitis was reached in 94 patients (62.3 %). Pyogenic meningitis was the most frequent diagnosis 51(33.8 %) followed by tubercular meningitis 12 (7.9 %), and cerebral malaria 8 (5.2 %) in the patient group of non-viral causes. Fifty-seven cases (37.3%) were suspected as viral encephalitis and mean age of the cases suspected as viral encephalitis was 2.8 ± 2.9 (Range 1 mth-10 yrs) with male: female ratio of 1.28: 1. Etiological diagnosis was reached or considered probable in 41 (72%) cases out of the suspected patients. The most common etiological agent identified was enterovirus 71 in 20 patients (35.1 %). The other viruses identified were mumps in 6 (10.5%), Japanese encephalitis in 5 (8.7%), and measles in 4 (7%) cases. MRI brain was done in 39 patients and was abnormal in 14 patients. Out of 57 cases of suspected viral encephalitis 10 patients expired within 48 hours, 2 > 48 hours and 19 atients had significant neurological sequels at discharge. Conclusion  The etiology of acute febrile encephalopathy varies from infectious etiologies to noninfectious metabolic disorders. There are no distinguishing clinical or radiological features to differentiate the various causes of viral encephalitis. The clinical and the radiological findings in encephalitis should be interpreted in the geographical and other epidemiological background.     

Immunoglobulins in cerebrospinal fluid in central nervous system disorders

Immunoglobulins were estimated in the cerebrospinal fluid from 70 cases of nervous system diseases. Thirty childern with evidence of C.N.S. irritation without infection served as controls. The immunoglobulins were higher in cases with C.N. S infections. Within this group meningeal involvement (tubercular and pyogenic) resulted in a significant rise in IgG compared to viral encephalitis. The proportion of immunoglobulin in the CSF protein can be helpful in distinguishing TBM from PM.     

降钙素原和C-反应蛋白对儿童全身和局部细菌感染的诊断价值

目的 探讨降钙素原（PCT）和C-反应蛋白（CRP）对诊断全身和局部细菌感染的价值。方法 检索2011年1月至2012年6月在深圳市儿童医院住院病史系统中感染性疾病患儿的资料,分为全身细菌感染组（血培养阳性的严重脓毒症和败血症）,局部细菌感染组（急性化脓性扁桃体炎、泌尿系感染及化脓性骨关节炎）,病毒感染组（传染性单核细胞增多症和手足口病）。比较各组PCT、CRP水平和阳性率的差异。绘制受试者工作曲线（ROC）,计算曲线下面积（AUC）,评估PCT和CRP对全身和局部细菌感染的诊断价值。结果 148例患儿进入分析,全身细菌感染组19例,局部细菌感染组55例,病毒感染组74例。①CRP水平(mg·L-1)、PCT水平(μg·L-1)和PCT阳性率局部细菌感染组低于全身细菌感染组（CRP：21.35 vs 76.0,P＝0.001;PCT:0.10 vs 28.09, 32.7% vs 100%,P均<0.001）;CRP水平和阳性率局部细菌感染组高于病毒感染组（21.35 vs 4.0, 73.1% vs 27.0%, P均<0.001), PCT水平和阳性率局部细菌感染组与病毒感染组差异无统计学意义。3组WBC计数差异无统计学意义;WBC阳性率全身细菌感染组高于病毒感染组（84.5% vs 54.0%,P=0.017）,局部细菌感染组与全身细菌感染组、病毒感染组差异无统计学意义。②PCT水平和阳性率局部细菌感染合并全身炎症反应综合征（SIRS）患儿显著高于不合并SIRS者（0.40 vs 0.08,P＝0.002;60.0% vs 17.1%, P＝0.001）,CRP水平和阳性率无显著差异。③PCT和CRP诊断全身细菌感染的ROC AUC分别为0.99和0.84;诊断局部细菌感染的ROC AUC分别为0.54和0.78。结论 PCT是识别全身细菌感染和监测局部细菌感染进展而合并SIRS的敏感指标。鉴别局部细菌感染时,CRP较PCT敏感。     

重症病毒性脑炎患儿内环境紊乱的临床研究

目的　探讨重症病毒性脑炎 (VE)患儿应激性高血糖 (SHG)和电解质紊乱与病情发展的关系 ,并探索重症VE患儿血糖及血清钾、钠、钙的变化及其相互关系。方法　对 1999年 10月至 2 0 0 1年 5月吉林大学第一医院 5 8例重症VE患儿进行血糖及血清钾、钠、钙动态检测 ,并以 2 0例轻症VE患儿为对照组进行比较。结果　重症VE患儿易于发生SHG、低钠血症 (HN)、低钾血症 (HK )、低钙血症 (HC)。血糖的升高 ,血钠、血钙的降低与VE患儿病情轻重关系密切 ,随VE进入恢复期 ,存活者上述指标逐渐恢复正常。结论　重症VE患儿存在应激损伤 ,机体的过度应激反应亦可引起血清电解质的改变 ,由此加重内环境紊乱 ,故控制过度应激反应、稳定内环境对重症VE患儿十分有利     

血清降钙素原联合可溶性髓样细胞触发受体-1对儿童细菌性腹泻和病毒性腹泻的鉴别诊断价值

目的 探讨血清降钙素原（PCT）联合可溶性髓样细胞触发受体-1（STREM-1）对儿童细菌性腹泻与病毒性腹泻的鉴别价值。方法 回顾性分析2018年2月至2019年5月入院接受治疗的细菌感染性腹泻患儿73例（细菌组）、病毒感染性腹泻患儿68例（病毒组）的临床资料。采用受试者工作特征（ROC）曲线分析血清PCT和STREM-1对细菌感染性腹泻与病毒感染性腹泻的诊断效能。结果 细菌组患儿粪便红细胞及脓液检出率分别为79%、51%，高于病毒组的43%、19%（P < 0.05）。细菌组患儿血清PCT和STREM-1水平均显著高于病毒组（P < 0.05）。ROC分析结果显示，血清PCT、STREM-1对儿童细菌性感染与病毒性感染腹泻鉴别的截断值分别为0.97?ng/mL、15.66?ng/mL；曲线下面积（AUC）分别为0.792、0.889。二者联合诊断的AUC为0.955，其诊断效能高于两单独指标（P < 0.05）。结论 细菌性腹泻患儿血清PCT和STREM-1水平高于病毒性腹泻患儿；血清PCT和STREM-1均可作为儿童细菌性腹泻与病毒性腹泻的鉴别指标，二者联合检测可提高鉴别诊断效能。     

C-reactive protein, Il-6 and procalcitonin as infection parameters in children with oncologic diseases

BACKGROUND: Due to anti-neoplastic therapy, there is a high incidence of infections and fever in pediatric patients with malignant disease. We have searched for parameters that may be of value in the early diagnosis of infection, in discriminating between bacterial and non-bacterial causes and for monitoring the response to antimicrobiotic therapy. PATIENTS: 46 febrile episodes in 33 children with malignant diseases under anti-neoplastic therapy, aged 0.5 to 17 years, were included. Each patient was supplied with a central venous catheter (Hickman catheter). METHODS: Blood was taken for the evaluation of C-reactive-protein (CRP), Interleukin-6 (IL-6) and Procalcitonin (PCT). Laboratory data included WBC, blood cultures, as well as microbiologic and serologic tests for important infectious agents. Patients were grouped as follows: 1. Patients with febrile diseases and positive blood cultures, 2. Patients with localized bacterial or mycotic infections and negative blood cultures, 3. Patients with fever of unknown origin, 4. Patients with viral infections, 5. Control group. RESULTS: CRP and IL-6 were more sensitive than PCT in detecting bacterial and mycotic diseases in leukopenic children, because of low PCT-levels in patients with localized infections. IL-6 values were high shortly after onset of fever and decreased under sufficient antimicrobiotic therapy until day three. CONCLUSIONS: Because of the quick response, IL-6 may be helpful in monitoring antimicrobiotic therapy. Using Procalcitonin-levels, we were not able to distinguish between localized bacterial and viral infection in leukocytopenic patients.     

儿童病毒性脑炎多中心诊断治疗研究

目的　探讨儿童病毒性脑炎的诊断与治疗问题。方法　以多中心、前瞻开放、随机对比方法观察儿童病毒性脑炎的临床症状、体征及脑脊液常规生化 ;以聚合酶链反应 (PCR)技术检测儿童病毒性脑炎脑脊液病原 ;在综合治疗的前提下 ,以单一抗病毒药物治疗儿童病毒性脑炎。结果　本组 14 3例病毒性脑炎中发热 134例(93 7% ) ,头痛 86例 (6 4 7% ) ,呕吐 87例 (6 0 8% ) ,呕吐伴头痛 5 9例 ,惊厥发作 4 7例 (32 9% ) ,以全身阵挛发作为主 ;有精神症状 87例 (6 0 8% ) ,意识障碍 2 5例 (17 5 % ) ,颈抵抗 4 6例 (32 2 % ) ,运动障碍 2 0例 ,锥体束征 9例 ;脑脊液常规生化检查异常 90例 ,其中 86例白细胞增多 ,16例蛋白定量增高。 14 3例均做了脑脊液病原学检测 ,病毒阳性 84例 (5 8 7% ) ,其中肠道病毒阳性 4 0例 ,DNA病毒阳性 4 4例 ,另外还检测出了 6例支原体。在症状、体征和脑脊液常规生化检查阳性的 4 6例中 ,脑脊液病毒学阳性 2 6例 (5 6 5 % ) ,在症状和脑脊液常规生化检查阳性者 4 4例中 ,脑脊液病毒学阳性 2 3例 (5 2 3% )。在脑脊液病原学不明的情况下 ,在综合治疗的基础上 ,三种抗病毒药物单药抗病毒治疗临床疗效无差别。结论　除常规诊断条件外 ,病毒病原学检查十分重要 ,抗病毒治疗以覆盖更广     

Non‐specific host response markers in the differentiation between pneumococcal and viral pneumonia: What is the most accurate combination?

BACKGROUND: Serum C-reactive protein (CRP), blood white cell count (WBC), serum procalcitonin (PCT) and erythrocyte sedimentation rate (ESR) were measured in 132 children hospitalized for community-acquired pneumonia. Serological evidence for viral infection was found in 38 cases and for pneumococcal infection in 41 cases, and the infiltrate was alveolar in 46 cases and interstitial in 86 cases. The aim of the present paper was to determine if there is a combination of these four host response markers and chest radiograph findings suitable for differentiating pneumococcal from viral etiology of pneumonia. METHODS: The 50th, 75th and 90th percentiles of CRP, WBC, ESR and PCT in the total group of 132 patients were calculated. By using these cut-off limits, the likelihood ratios of a positive test result were calculated for the possible combinations of CRP, WBC, ESR and PCT, and the likelihood ratio was 1.50 or more for six combinations. RESULTS: The highest likelihood ratio (1.74) was achieved with the combination CRP > 90th (80 mg/L) or WBC > 75th (17.0 x 10(9)/L) or PCT > 75th (0.84 microg/L) or ESR > 90th (63 mm/h) percentile. For this combination, the sensitivity was 61% and the specificity 65%. When the 90th percentile cut-off limit was applied also for WBC (>22 x 10(9)/L) and PCT (>1.8 microg/L), the specificity increased to 76%, but the sensitivity decreased to 37%. When the presence of an alveolar infiltration was included in the combination, the likelihood ratio was 1.89; the specificity was as high as 82% and the sensitivity as low as 34%. CONCLUSIONS: CRP, PCT, WBC and ESR have only limited value in differentiating pneumococcal or other bacterial pneumonia from viral pneumonia. If there was a high value in at least one of the markers (CRP > 80 mg/L, PCT > 1.8 microg/L, WBC > 22 x 10(9)/L or ESR > 60 mm/h), viral infections were rare. There was no combination of these markers which was sufficiently sensitive and specific to be used in clinical pediatric practice.     

小儿病毒性脑炎的病原研究

目的　 探讨小儿病毒性脑炎的病原。 方法 　应用酶联免疫吸附方法 (ELISA)测定 5 1例病毒性脑炎患儿的脑脊液 (CSF)和血清中多种病毒特异性IgM抗体。 结果 　 5 1例病毒性脑炎患儿CSF中病毒IgM抗体阳性 2 1例 ( 4 1 2 %) ,血清中病毒IgM抗体阳性 18例 ( 35 3%)。 结论 　本地区病毒性脑炎多由肠道病毒和疱疹病毒引起 ,其中以CoxB和HSV为主要病原。