小儿传染性单核细胞增多症临床特点分析

目的 探讨传染性单核细胞增多症(IM)临床特点.方法 将92例IM患儿分成2个月～3岁,～6岁,～15岁3个组,进行回顾性分析.结果 6岁以下IM患儿占71%,临床表现以发热、咽峡炎、淋巴结肿大、肝脾大为主.扁桃体有白色分泌物者以3岁以上儿童居多;眼睑水肿和皮疹在年幼儿多见.外周血白细胞年幼儿升高明显,异型淋巴细胞年幼儿偏低,血清ALT、AST在年长儿偏高,血清LDH在各年龄组均呈高值.年长儿血清嗜异性凝集试验结果 阳性率高.结论 应重视IM某些临床特点,以提高确诊率.     

传染性单核细胞增多症实验诊断初探

对５６例怀疑为传染性单核细胞增多症（ＩＭ）患儿进行实验性检测。确诊的１４例中外周血异形淋巴细胞〉１０％者３例，嗜异性凝集试验阳性９例，但抗ＶＣＡ－ＩｇＭ阳性为１２例；因此测定ＥＢＶ抗体才能真正提高诊断ＩＭ的水平，而嗜异性凝集试验阳性率低，在非ＩＭ疾病中假阳性率高，特异性不强，作为ＩＭ的诊断指标值得商榷。     

可溶性白细胞介素-2受体检测在儿童EB病毒感染相关疾病中的应用价值

目的探讨可溶性白细胞介素(白介素)-2受体检测在儿童EB病毒(EBV)感染相关疾病鉴别诊断中的应用价值。方法将72例患儿分为IM组、IM转化EBV相关的噬血细胞淋巴组织细胞增生症(EBV-HLH)组和EBV-HLH组;采用酶联免疫吸附试验(ELISA)分别检测患儿血清可溶性白介素-2受体和EBV抗体四项(EBV壳抗原VCA-IgM、VCA-IgG和EBV早期抗原EA-IgG、EBV核抗原-1 EBNA-1-IgG),荧光实时定量PCR检测患儿血浆EBV-DNA的表达,流式细胞术分析淋巴细胞亚群(CD3,CD4,CD8,CD19,CD56)。结果 72例患儿急性期可溶性白介素-2受体水平均超过2 400 U/ml;IM转化组在急性期可溶性白介素-2受体水平仅轻度增高(4 320 U/ml),与IM组(3 310 U/ml)无明显差异,治疗后却明显增高(8 970 U/ml),并接近EBV-HLH组水平(11 230U/ml);EBV抗体四项显示IM转化组和EBV-HLH组在治疗后VCA-IgG和EA-IgG仍然持续高滴度,同时EBV核抗原-1-IgG仍持续阴性;三组急性期都有EBV-DNA拷贝数从低拷贝至高拷贝的病例,治疗后IM转化组和EBV-HLH组仍可检测到EBV-DNA(3×103~4×105copies/ml);IM转化组和EBV-HLH组CD8+细胞在治疗后仍持续较高水平[(61.32±4.63)%,(68.36±4.32)%],并同时出现NK细胞(CD56+)比例下降[(9.23±3.28)%,(10.52.±3.34)%]。结论结合EBV抗体、EBV-DNA和淋巴细胞亚群检测,可溶性白介素-2受体检查有可能成为追踪观察EBV感染相关疾病的指标之一。     

EB病毒感染患儿CD163表达及其临床意义

目的　通过检测EB病毒(EBV)感染患儿CD163水平, 探讨CD163在EBV相关噬血细胞综合征(HLH)的诊断、病情监测及预后中的意义。方法　将因不同感染就诊的94例患儿分为EBV阳性组(n=55)和EBV阴性组(n=39, 对照组), 进一步将EBV阳性患儿分为传染性单核细胞增多症(IM)组(n=47)和HLH组(n=8)。应用酶联免疫法检测血清可溶性CD63(sCD163)水平; 流式细胞术检测外周血单核细胞表面CD163表达率。结果　HLH患儿血清sCD163水平均>10 000 ng/mL, 其中3例>30 000 ng/mL; HLH组患儿血清sCD163水平远高于对照组和IM组(P<0.05)。EBV阳性患儿血清sCD163水平与EBV-DNA拷贝数、乳酸脱氢酶和血清铁蛋白水平呈正相关, 与白细胞计数、中性粒细胞计数、血红蛋白和血小板计数呈负相关(P<0.05)。HLH患儿sCD163水平在治疗后逐步下降, 但随病情反复又升高。结论 EBV感染患儿的CD163水平与临床严重程度密切相关, sCD163>10 000 ng/mL的EBV感染患儿需警惕并发HLH。     

白细胞轻度升高的上呼吸道感染儿童的病原学分析

目的 研究外周血白细胞计数轻度升高且以中性粒细胞为主的急性上呼吸道感染患儿的病原学,并分析白细胞计数及分类对此类患儿鉴别诊断的临床意义.方法 对33例外周血白细胞计数轻度升高(10.0×109～15.0×109/L)的急性上呼吸道感染患儿,取鼻咽分泌物进行细菌培养、呼吸道常见病毒间接免疫荧光检测及PCR法肺炎支原体抗原检测.结果 33例中有28例(85%)病原检测结果阳性,其中单纯病毒感染12例(43%),单纯细菌感染8例(29%),肺炎支原体感染2例(7%),细菌与病毒混合感染6例(21%).在12例单纯病毒感染中,11例(92%)外周血白细胞总数<13.5×109/L.结论 外周血白细胞计数轻度升高的上呼吸道感染患儿的病原体仍以病毒为首位,其次为细菌;当白细胞总数>13.5×109/L时,病毒感染的可能性较小.     

小儿肺炎支原体感染后血常规分析及临床意义

目的探讨小儿肺炎支原体（MP）感染后血常规的变化规律。方法对50例MP感染患儿和50例同期健康儿童的血常规进行比较。结果与健康儿童比较，MP感染患儿白细胞总数升高（P〈0．01），中性粒细胞比例及绝对值增高（P〈0．01），淋巴细胞比例及绝对值降低（P〈0．01），单核细胞比例及绝对值增高（P〈0．01），红细胞计数、血红蛋白含量、血小板计数、嗜酸粒细胞比例及绝对值、嗜碱粒细胞比例及绝对值均无明显变化。结论通过小儿血常规变化可初步推断是否威染MP．     

儿童慢性活动性EB病毒感染临床及实验室检查特征

目的 研究慢性活动性EB 病毒感染(CAEBV)患儿的临床及外周血淋巴细胞亚群等实验室检查特征,为CAEBV 的诊治提供依据.方法 分析13 例CAEBV 患儿的临床资料,包括患儿的临床表现、病毒学检测及淋巴细胞亚群测定结果,并与15 例急性EB 病毒感染(AEBV)病例作对照研究.结果 两组患儿临床表现类似,主要为发热、肝脾肿大、淋巴结肿大等传染性单核细胞增多症(IM)样症状,区别在于CAEBV 患儿病程较长,上述症状持续或反复出现.CAEBV 组患儿外周血EBV-DNA 载量明显高于AEBV 组(P<0.05).CAEBV 组VCA-IgG 明显高于AEBV 组(P<0.05).CAEBV 组外周血白细胞计数、淋巴细胞计数、B 细胞计数、总T 细胞计数、CD4+ T 细胞计数和CD8+ T 细胞计数均低于AEBV 组(P<0.05).随访13 例CAEBV 患儿,8 例死亡,2 例好转,2 例病情仍有反复,1 例转院后失访.15 例AEBV 患儿均治愈,随访1 年无病情反复.结论 CAEBV患儿临床表现多样,早期较难与AEBV 鉴别,预后差,病死率高.外周血EBV-DNA 载量、VCA-IgG 及淋巴细胞亚群的测定对CAEBV 诊断具有一定帮助.     

新生儿败血症的诊断学

新生儿败血症的临床表现缺乏特征性,确诊依靠血培养,但培养阳性率受各种因素影响并不很高,而且培养时间长,不能达到早期诊断和治疗的目的。为此,多年来有不少新生儿败血症的诊断方法问世,一般将其分为三类:①特异性高、并能达到快速目的的测定项目,包括各种病原菌抗原的检测如对流免疫电泳、乳胶凝集等;②非特异性、但具有一定诊断价值并能达到快速要求的项目,包括外周血白细胞计数和分类、急相蛋白等;③诊断价值可疑的项目,包括血小板计数、血IgM测定等。现择其主要者尤能在一般实验室能开展的测定项目介绍如下。一、外周血白细胞计数和分类白细胞计数和分类,对新生儿败血症的诊断价值不大,因为不少患儿败血症的诊断肯定,但白细胞计数正常。此外,新生     

儿童传染性单核细胞增多症临床特点与发病年龄的关系(附142例分析)

目的　探讨儿童传染性单核细胞增多症(infectiousmononucleosis ,IM )临床特点与发病年龄的关系。方法　将1 4 2例儿童IM分成0～3岁,>3～6岁,>6～1 5岁3个组,进行回顾性分析。结果　儿童IM 6岁以下儿童占66.9% ,临床表现以发热、咽峡炎、淋巴结肿大、肝脾大为主。年长儿发热时间长,眼睑浮肿和皮疹在年幼儿多见。外周血白细胞年幼儿升高明显,异型淋巴细胞年幼儿偏低,血清ALT、AST值在年长儿偏高,血清LDH值在各年龄组均呈高值。血清嗜异性凝集试验年长儿阳性率高。结论　儿童IM某些临床特点与发病年龄有关,应予以重视,以提高确诊率。     

共刺激分子CD40/CD40L在儿童慢.性活动性EB病毒感染中的作用

目的 探讨共刺激分子CD40/CD40L在儿童慢性活动性EB病毒感染(CAEBV)发病机制中的作用.方法 选择30例EB病毒(EBV)感染患儿,其中CAEBV患儿、传染性单核细胞增多症(IM)患儿各15例;另选择15例健康儿童作为健康对照组.应用反转录-PCR检测EBV感染患儿及健康儿童外周血单个核细胞(PBMC) CD40mRNA和CD40L mRNA的表达量;应用流式细胞仪检测EBV感染患儿及健康儿童外周血淋巴细胞亚群的变化.结果 1.CAEBV组PBMC CD40 mRNA及CD40L mRNA表达量明显升高,与健康对照组及IM组比较差异均有统计学意义(Pa＜0.05);IM组PBMC CD.mRNA、CD40L mRNA表达量与健康对照组比较差异均无统计学意义(Pa＞0.05).2.CAEBV组外周血CD3+、CD8+、CD19+CD.+、CD16+56+淋巴细胞明显升高,CD4+、CD4+/CD8+淋巴细胞明显降低,与健康对照组比较差异均有统计学意义(Pa＜0.05),与IM组比较差异均无统计学意义(Pa＞0.05);IM组外周血CD3+、CD8+、CD19+CD23+、CD16+56+明显升高,CD4+、CD4 +/CD8+明显降低,与健康对照组比较差异均有统计学意义(Pa＜0.05).结论 共刺激分子CD40/CD40L异常表达及淋巴细胞功能紊乱参与CAEBV的发病,存在免疫功能障碍是CAEBV发病的主要原因之一.     

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??Objective To investigate clinical characteristics and laboratory feature of Epstein-Barr Virus??EBV?? infection and infectous mononucleosis in children. Method A retrospective study was conducted in 108 hospitalized patients who were enrolled from Jan 2010 to May 2011.Among them 77 patients were diagnosed with IM. Results In our investigation most of the IM was seen in preschool children??41.6%??and in young children??36.4%?? . Eyelid edema was common clinical manifestations of IM??the percentage of which was higher than enlarged spleen and rash in IM group.Increased ratio of atypical lymphocytes ??≥10%?? was seen in only 33.8% of the IM patients.The EBV-DNA level in plasm of IM patients was in the range of 1.04 × 103??2.88 × 105 copies/mL??with a mean value of 7.18 × 104 copies/mL. All of 3 cases of EBV-HLH in our study were negative in sera of anti-VCA-IgM?? but were positive of EBV-DNA in plasma and mean EBV-DNA loads were 2.71 × 107 copies/mL. Conclusion In our observation eyelid edema has the same diagnostic value as the other typical manifections in IM.The clinical significance of atypical lymphocyte in the diagnosis of IM??especially in infants and young children??needs to be further confirmed.EBV-DNA copy in peripheral blood seems to be closely related to the active infection of EBV and in EBV-HLH the diagnostic value of detection of EBV-DNA in serum by FQ-PCR should be emphasized.     

小儿传染性单核细胞增多症218例临床特点分析

目的通过分析传染性单核细胞增多症(IM)患儿的临床特点与实验室检查结果,以提高临床诊断水平。方法回顾性分析2010年1月～2012年3月我院儿科收治的218例IM患儿的临床特点和实验室检查结果。结果本组患儿≤7岁者占86.5%,重症病例25例,死亡2例。临床症状多种多样,以发热、咽峡炎、颈淋巴结炎最常见,肝脏肿大者占61.5%,脾脏肿大占55.5%,眼睑及眶周水肿占25.7%,皮疹占22.5%。实验室检查:95.6%的患儿血液学指标有改变,异型淋巴细胞比例>10%者占91.4%,35.1%的患儿出现血液系统并发症,肝功能损害占61.5%,心肌酶学改变占19.7%,尿常规异常者占16.5%。结论小儿IM临床表现与实验室检查表现复杂,部分病例临床表现不典型,提高对本病实验室结果与临床特点的认识,可减少临床误诊和漏诊。     

Possible Role of Streptococcus Pyogenes in Mucocutaneous Lymph Node Syndrome. XII. Variable Responses of Platelets in MCLS Seem to Be Explainable by Streptococcal Pyrogenic Exotoxin

As a model system for mucocutaneous lymph node syndrome (MCLS), we have advocated and used mice which had been rendered tolerant to Streptococcus pyogenes-associated antigens by neonatal infection with group A fteta-hemolytic streptococci, because these mice have shown a variety of peculiar bioimmunological characteristics bearing a striking resemblance to those of MCLS patients. The results of our current investigations reaffirmed the reliability of the animal model by indicating that mice subjected to neonatal infection with 5. pyogenes , or inoculation with streptococcal pyrogenic exotoxin (SPE) in Freund's adjuvant, were perfect counterparts of patients with MCLS on account of their platelet activation and hyperaggregability in response to provocative treatment, which are familiar findings in this disease.     

Infectious mononucleosis in adolescents.

Infectious mononucleosis is a clinical manifestation of primary EBV infection in adolescents, characterized by a triad of clinical, laboratory, and serologic features. The classic signs and symptoms are not seen in every patient; rather, the presentations tend to fit into one of three clinical forms (pharyngeal, glandular, or febrile). Recognizing these syndromes provides a useful framework for anticipating the clinical course, complications, and differential diagnosis. Nonclassic presentations of IM include a wide variety of neurologic abnormalities, thrombocytopenic purpura, and splenic rupture. The laboratory features of IM include absolute lymphocytosis with a large percentage of atypical lymphocytes, and abnormal liver chemistries in 90% of patients. The diagnosis of IM is confirmed serologically, usually with the demonstration of heterophile antibodies; the test can conveniently be performed in office laboratories. If the heterophile antibody test is negative, EBV-specific serologic tests can identify whether the illness is due to primary EBV infection. Once the diagnosis of IM is made, appropriate guidelines for resumption of activity should be provided to patients, especially to those with evidence of splenomegaly. Medical management includes supportive therapy with adequate analgesia. Corticosteroids are indicated for patients with upper airway obstruction; they may be helpful in patients with neurologic, hematologic, or cardiac complications. Acyclovir may prove to be useful, but further studies are needed before its use can be recommended.     

An Immunological Study on Mucocutaneous Lymph Node Syndrome: Activation of Tg Suppressor Cells

We analyzed the lymphocyte function of MCLS in pokeweed mitogen-induced immunoglobulin production. T cell suppressor activity was activated in the acute phase adn normalized in convalescence. T cells showing suppressor activity in this system were identified to be Tg cells, and they seemed to be activated as suppressor by a certain factor in the serum. the sera of patients whose T cells showed suppressor activity could induce the suppresoor activity of normal control Tg cells. The suppressor inducing factor in sera is likely to be circulating immune complexes, since T_g cells usually show suppressor activity when they interact with immune complexes. The induction of the suppressor activity of Tg cells by immune complexes may provide a kind of negative feedback suppression mechanism feedback mechanism on the antibody formation and it may be related to the self-limiting characteristics of MCLS. MCLS is different from collagen diseases such as rheumatoid arthritis in that Tg cells do not usually work as suppressor cells in the later diseases.     

Cytomegalovirus Mononucleosis in Chinese Infants

Two Chinese infants had cytomegalovirus inclusion disease presenting as persistent pneumonia and thrombocytopenic purpura, respectively. Both had lymphadenopathy, hepatosplenomegaly, pneumonia, and more than 14% atypical lymphocytes in the peripheral blood at some stage of the disease. The Paul-Bunnell reactions were serially negative. A clinical picture simulating infectious mononucleosis, including the presence of a high percentage of atypical lymphocytes in the peripheral blood, but serially negative Paul-Bunnell reactions, may be one of the many manifestations of cytomegalovirus inclusion disease in infancy and childhood.     

Possible Role of Streptococcus pyogenes in Mucocutaneous Lymph Node Syndrome. Ill Electron Microscopic Observations on Group A Hemolytic Streptococci Inoculated into Mice

Because of various circumstantial evidence, we have been asserting the streptococcal etiology of mucocutaneous lymph node syndrome (MCLS), although there has been no recovery of Streptococcus pyogenes from the patients at any site. The present study was designed to provide a satisfactory explanation for the failure to isolate these bacteria from patients with MCLS, by electron microscopic observation of group A ftera-hemolytic streptococci which had been inoculated intramuscularly into mice. “Spherical bodies” were detected in biopsy specimens obtained from the infection sites from 10 – 14 days onward after infection; these were spherical, 0.5–1.5 yua in diameter, devoid of cell walls, perhaps uncultivable on any culture medium, and undistinguishable from those discovered in the buffy coat from peripheral blood of MCLS patients and described as ruined etiological microorganisms by Ueno et al. The implications of these findings, particularly in terms of the etiology of MCLS, were discussed.     

Cord blood cells and indices: smoking–related differences between the sexes

The values of whole blood cell count, leucocyte differential, and platelet and reticulocyte counts were determined in cord blood of both male ( n = 64) and female ( n = 75) newborns of 87 non–smoking and 52 smoking mothers. Leucocytes and neutrophils in cord blood from the male newborns of smokers were significantly lower than those in their female counterparts and in male newborns of non–smokers. These results suggest that male newborns are more affected by cigarette exposure than females with regard to some haematological parameters.     

氨甲环酸在小儿先天性心脏病体外循环中对凝血功能的影响

目的 观察氨甲环酸,乌司他丁二种药物在小儿先天性心脏病体外循环术中对凝血功能的影响.方法 60例先天性心脏病手术患儿心肺转流(CPB)中,随机分为氨甲环酸用药组(A组),乌司他丁+氨甲环酸用药组(B组)和对照组(C组).于肝素化前、鱼精蛋白中和肝素后和术后24h分别测定血小板数量与聚集功能、D-二聚体,记录各组术后6h、24h纵隔心包引流量及术后输血量.结果 肝素化前测定血小板计数、血小板聚集率三组无显著差异;CPB停机鱼精蛋白中和肝素后活化凝血时间恢复正常校正值时血小板计数C组为(98.0±37.51)×109/L,明显低于B组(164.8±42.17)×109/L和A组(148.7±46.33)× 109/L,A、B组转流前后血小板计数比较无显著差异;C组停机鱼精蛋白中和肝素后血小板计数明显低于转流前.三组患儿D-二聚体值肝素化前各组无显著性差异外,其余各时间段,A、B组与C组比较均有显著性差异,A组与B组之间比较,差异无统计学意义(P>0.05).A、B组术后6h内出血量分别为(4.6±2.2)ml/kg、(3.9±1.9)ml/kg,比C组(6.5±3.1)ml/kg明显减少,差异有统计学意义(P<0.05),B组术后输血量(17±10.5)ml/kg显著少于C组(28±16.7)ml/kg.结论 在体外循环中应用氨甲环酸,抗纤溶作用和对血小板的保护作用明显,其与乌司他丁协同作用不明显;两药合用可减少术后的引流量、全血及成分血的输入量.