儿童嗜酸性淋巴肉芽肿的临床特点与治疗

目的 探讨儿童嗜酸性淋巴肉芽肿（ELG）的临床特点和诊治方法，以提高对本病的认识。方法 回顾性分析5例ELG患儿的临床特征、实验室检查、病理、治疗及疗效，并进行相关文献复习。结果 ELG5例均为男童，主要表现为多发性皮肤软组织肿块和淋巴结大，其中1例并肾病综合征，2例有反复湿疹样皮疹，1例2次发生喘息性支气管炎，患儿均无肝脾大，生长发育良好。最初单纯化疗4例均复发，经配合局部放疗或加用环孢素（CsA）等治疗后未复发。结论 儿童ELG临床及病理特点与成人相似，但儿童发病较少。单纯化疗易复发，配合放疗、手术、应用CsA等综合治疗可提高疗效。     

颌骨嗜酸性肉芽肿的临床特点

颌骨嗜酸性肉芽肿的临床表现及X线改变缺乏特征性,临床上较少见,实际工作中存在着较高的误诊率,常延误疾病治疗。本文就近年来关于颌骨嗜酸性肉芽肿的临床表现、影像学改变、诊断、治疗以及预后等方面的相关研究作一综述。     

颌骨嗜酸性肉芽肿的临床特点——文献复习及1例报告

目的分析颌骨嗜酸性肉芽肿的临床特点。方法报告1例多发性颌骨嗜酸性肉芽肿,并复习相关文献。结果检索收集中文文献15篇,英文文献61篇。颌骨嗜酸性肉芽肿主要发生在下颌骨,男女比大约2∶1,临床表现和X线片改变与病变的发生部位有关。治疗以外科刮除为主,必要时可行放疗或化疗。有一定的复发率。结论颌骨嗜酸性肉芽肿,临床积极治疗和密切随访十分必要。     

误诊为嗜酸粒细胞增多症1例分析

回顾性分析我院收治的1例误诊为嗜酸粒细胞增多症的腹水型嗜酸粒细胞性胃肠炎(EG)患者的临床资料,并复习相关文献,探讨EG的临床特征、误诊原因及防范措施。患者以“腹胀半个月”入院,入院前腹部CT提示腹腔及盆腔积液,入院后查血常规示嗜酸性粒细胞计数及比例异常增多,腹水有核细胞涂片镜检可见大量嗜酸粒细胞。骨髓穿刺提示嗜酸粒细胞增多症;直肠黏膜组织活检镜下见黏膜内散在淋巴细胞、嗜酸粒细胞及中性粒细胞浸润。临床诊断嗜酸粒细胞增多症。患者转上级医院继续诊疗,上级医院修正诊断为腹水型EG。EG发病率低,外周血及骨髓检查类似嗜酸粒细胞增多症,临床医师应注意鉴别;临床对不明原因的腹水患者,应警惕浆膜型EG存在的可能性,以免误诊。     

深部真菌在儿童消化道的定植与感染

目的 了解儿童消化道深部真菌感染的临床特点,避免临床误诊及漏诊.方法 回顾性分析总结自2005年1月至2016年5月在广州市妇女儿童医疗中心消化科住院治疗,确诊为儿童消化道深部真菌感染患儿的临床特征及治疗效果.结果 总计确诊为消化道深部真菌感染6例,所有患儿均出现真菌性食管炎,其中合并真菌性胃肠病2例.主要临床表现为呕吐、喂养或进食困难.其中2例患儿伴有间歇性胸痛、腹痛.病程4~12周.起病前应用广谱抗生素1例;诊断先天性免疫缺陷1例;因先天性食管闭锁经历手术治疗3例.食管造影均提示食管狭窄.胃镜检查均出现食管黏膜损伤,散在成簇的灰白色斑点或豆腐渣样附着物3例,食管全周被灰白色豆腐渣样物覆盖,范围1/3~1/2食管全长,伴有食管腔堵塞3例.多发巨大的浅表溃疡2例.病变累及胃、十二指肠2例,其中1例累及范围自口腔至肛门整个消化道.6例患儿经黏膜病理检查或分泌物涂片检查确定为白色念珠菌感染.3例轻症患儿选择制霉素片口服,疗程2~3周.3例重症患儿予伊曲康唑口服,疗程3~4周.胃镜复查见食管、胃、十二指肠黏膜光滑,食管溃疡表面未见附着物.1例患儿结肠及末端回肠黏膜豆腐渣样附着物及溃疡明显减少.4例临床痊愈,1例确诊免疫缺陷病,因肺部感染死亡;1例全消化道感染者,3月后复发,目前仍在随诊中.结论 儿童消化道深部真菌感染主要表现为反复呕吐,进食困难及腹痛,病变范围可累及食管以至全消化道.食管黏膜损伤可能是诱因之一,同时应注意排除先天性免疫缺陷.确诊依赖于消化内镜检查、黏膜活检.抗真菌治疗有效.     

Gut Microbiome Changes Occurring with Norovirus Infection and Recovery in Infants Enrolled in a Longitudinal Birth Cohort in Leon,Nicaragua

Noroviruses are associated with one fifth of diarrheal illnesses globally and are not yet preventable with vaccines. Little is known about the effects of norovirus infection on infant gut microbiome health, which has a demonstrated role in protecting hosts from pathogens and a possible role in oral vaccine performance. In this study, we characterized infant gut microbiome changes occurring with norovirus-associated acute gastroenteritis (AGE) and the extent of recovery. Metagenomic sequencing was performed on the stools of five infants participating in a longitudinal birth cohort study conducted in León, Nicaragua. Taxonomic and functional diversities of gut microbiomes were profiled at time points before, during, and after norovirus infection. Initially, the gut microbiomes resembled those of breastfeeding infants, rich in probiotic species. When disturbed by AGE, Gammaproteobacteria dominated, particularly Pseudomonas species. Alpha diversity increased but the genes involved in carbohydrate metabolism and glycan biosynthesis decreased. After the symptoms subsided, the gut microbiomes rebounded with their taxonomic and functional communities resembling those of the pre-infection microbiomes. In this study, during disruptive norovirus-associated AGE, the gut microbiome was temporarily altered, returning to a pre-infection composition a median of 58 days later. Our study provides new insights for developing probiotic treatments and furthering our understanding of the role that episodes of AGE have in shaping the infant gut microbiome, their long-term outcomes, and implications for oral vaccine effectiveness.     

慢性嗜酸性粒细胞型鼻窦炎的研究进展

慢性嗜酸性粒细胞型鼻窦炎(ECRS)是以嗜酸性粒细胞浸润为特征的呼吸道黏膜炎性疾病。嗜酸性粒细胞是一种特殊的炎症细胞,与Th2型免疫反应密切相关。促进和维持ECRS患者嗜酸性炎症的机制主要有以下4个方面：白介素-5(IL-5)调控嗜酸性粒细胞的生物学效应、嗜酸性粒细胞胞外陷阱的免疫调节作用、细胞自噬调节和纤维蛋白异常沉积。ECRS表现出病因复杂、难治愈和易复发等特点,嗜酸性粒细胞在ECRS的发生发展中扮演着重要的角色。本文就国内外最新报道进行综述,以期为ECRS的治疗提供理论依据。     

Clinical characteristics of patients with chronic eosinophilic pneumonia in a Chinese tertiary‐care hospital: A 6‐year retrospective study

IntroductionChronic eosinophilic pneumonia (CEP) is a rare disease with unknown etiology. Due to lack of specificity of CEP symptoms, clinicians are not experienced in establishing its diagnosis.ObjectivesTo summarize the clinical data of CEP patients to improve the understanding of CEP and reduce misdiagnosis.MethodsData of patients pathologically diagnosed with CEP in the PLA General Hospital between May 2013 and May 2019 were collected, and clinical manifestations, imaging characteristics, pathological features, and treatment were retrospectively analyzed.ResultsTwenty patients, including 6 males and 14 females, were diagnosed with CEP. The average age was 47.0 ± 10.2 years. The main clinical manifestations were cough and dyspnea. The average duration of CEP was 15.5 ± 11.5 months. The average proportion of eosinophils in the peripheral blood was 18.9 ± 17.8%, and the average proportion of eosinophils in the bronchoalveolar lavage fluid was 41.5 ± 19.4%. The main imaging features were patchy shadows and consolidation shadows. The most common manifestations on bronchoscopic examination were congestion and edema of the bronchial mucosa. Two patients had granular protrusions of the endotracheal membrane. Histological examination indicated infiltration of numerous eosinophils. All patients improved after prednisone therapy.ConclusionCEP onset is insidious, and clinical manifestations lack specificity. Typical imaging features are peripheral and subpleural distribution of lung infiltrates. Some patients have a normal proportion of eosinophils in the peripheral blood, but most have an increased number of eosinophils in the BALF, which contributes to CEP diagnosis. A biopsy is necessary when differential diagnosis is difficult. A systemic glucocorticoid is effective.