葡萄球菌性烫伤样皮肤综合征65例临床分析

葡萄球菌性烫伤样皮肤综合征（staphylococcal scalded skin syndrome,SSSS）主要发生于婴幼儿，是一种少见而严重的急性感染性皮肤病，成人极为罕见。由凝固酶阳性噬菌体Ⅱ组（尤其是71型）金黄色葡萄球菌产生的表皮剥脱毒素（exfoliative toxin，ET）引起。临床特点为皮肤急性泛发性红斑、松弛性水疱和表皮剥脱。现将我院2004—2005年收治的65例SSSS回顾性分析如下。     

口服氟康唑在预防早产儿深静脉置管时真菌感染中的临床意义

Objective With the widespread application of peripherally inserted central catheters (PICC) in neonatal intensive care unit (NICU), the incidence of invasive fungal infections increased significantly than ever. The present study aimed to explore the clinical significance of oral fluconazole in premature infants with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 grams who had catheter insertions. Method This study enrolled 118 infants admitted between January 2006 and December 2007 who did not receive fluconazole prophylaxis (control group) and 106 infants admitted between January 2008 and June 2009 who received oral fluconazole prophylaxis (prophylaxis group). Statistical analyses were performed by using SPSS 11.5 software. The clinical characteristics and the risk factors for invasive fungal infection between the two groups were compared. Liver functions ( alanine transaminase, ALT and direct bilirubin) were monitored to evaluate the safety of fluconazole prophylaxis. Result Except for the proportion of infants bom via vaginal delivery in the control group (56/118, 47. 5% ) was significantly lower than that in prophylaxis group (69/106, 65.1%, P = 0.007), there were no significant significant differences in the demographics and other baseline clinical characteristics between the two groups. There were no significant differences in the risk factors for invasive fungal infection between the two groups either.Nine infants developed invasive fungal infection in control group (7. 6% ), while no invasive fungal infection was found in prophylaxis group (0%, P=0.01 ). Compared to infants in control group, those in prophylaxis group showed no significant changes in alanine transaminase ALT and direct bilirubin levels at 2 weeks and 4 weeks after fluconazole prophylaxis: the incidences of abnormal ALT and direct bilirubin levels were 8. 5%(10/118) and6.8% (8/118) in control group compared to 11.3% (12/106) and 8.5% (9/106) in prophylaxis group after 2 weeks ( P = 0. 47 and 0. 63 ); the incidences of abnormal ALT and direct bilirubin levels were 3.4% (4/118) and 3.4% (4/118) in control group compared to 5.7% (6/106) and 8.5%(9/106) in prophylaxis group after 4 weeks (P = 0. 62 and 0. 15). Conclusion For infants with PICC insertions and gestational ages at birth ≤32 weeks and/or low birth weight ≤ 1500 grams, oral fluconazole is effective to prevent invasive fungal infection. Oral fluconazole in premature infants neither affected the liver function, nor increased the incidence of cholestasis.     

以皮疹为主要表现的婴儿粪肠球菌败血症一例

患儿男,6个月,因发热、皮疹2 d就诊。2 d前患儿无明显诱因出现发热,体温波动于39-40℃,不伴畏寒、寒战,无抽搐发生,四肢出现红色环形皮疹,伴四肢远端轻度水肿,皮疹无明显瘙痒感。于当地医院抗炎治疗,无明显好转,仍发热,皮疹渐增多,累及躯干。患儿精神食     

生长激素缺乏症儿童重组人生长激素替代治疗前后IGF-1的动态变化

目的为了解重组生长激素（rhGH）治疗矮小症儿童前后类胰岛素生长因子-1（IGF-1）水平的变化，并对其有关因素进行研究分析。方法对57例应用rhGH治疗的矮小症患儿进行随访，包括23例完全性生长激素缺乏症（CGHD）和34例部分性生长激素缺乏症（PCHD）。以年龄、性别匹配20例儿童作为对照。在诊断时和治疗中每间隔3个月检查IGF-1、空腹血糖和胰岛素水平。结果与对照组比较，CGHD组和PGHD组GF-1水平偏低，其中对照组与CGHD组间差异具有显著性意义，IGF-1在治疗3个月时即明显上升，此后呈逐渐上升趋势。相关分析发现IGF-1与患儿年龄、胰岛素抵抗指数（HOMA-IR）、体重指数和治疗持续时间呈显著正相关，而与性别和激发GH峰值无显著相关。结论本研究证实矮小症儿童IGF—1偏低，经过rhGH治疗可使IGF-1升高，治疗中IGF-1水平与治疗时间、胰捣素抵抗有关。     

儿童亚急性坏死性淋巴结炎临床病理分析

目的:探讨儿童亚急性坏死性淋巴结炎(subacute necrotizing iymphadenitis)的临床病理特点。方法:回顾性分析19例儿童亚急性坏死性淋巴结炎病例的临床资料,全部病例切片进行组织学观察,并行免疫组化染色,随访全部病例。结果:19例中男性14例,女性5例,平均年龄7.3岁,临床主要表现为发热、颈淋巴结肿大和白细胞减少,抗生素治疗无效。组织学显示淋巴结内出现程度不同的碎片状坏死,伴有多种形态的组织细胞增生,坏死灶边缘可见浆样单核细胞、多形核细胞及免疫母细胞,无或很少有中性粒细胞浸润。随访5月~3年,全部存活。结论:儿童亚急性坏死性淋巴结炎是一种良性自限性疾病,具有特殊的临床表现和独特病理特点;掌握其临床和病理形态学特点,有助于与其他病变相鉴别。     

Infanib对新生儿重症监护病房出院早产儿早期运动发育及预后评估

目的：探讨 Infant Neurological International Battery (Infanib)对新生儿重症监护病房出院的高危早产儿后期运动发育异常的预测效度。方法：纳入对象为 2008年6月至2010年3月入住新生儿重症监护病房治疗出院的早产儿,在纠正年龄3~4月、6~7月龄时采用 Infanib 进行运动发育评估;在纠正年龄12月龄或12月龄以上采用 Peabody 运动发育量表或临床神经学体检评估运动结局。通过计算 Infanib 对后期运动发育结局评估的敏感性、特异性、阳性预测值以及阴性预测值等进行预测效度评价。结果：共147例早产儿参与临床随访,在纠正年龄3~4月、6~7月龄时进行 Infanib 评估的患儿分别为147例、117例;纠正年龄12月龄或12月龄以上 129例。最终运动发育正常90例(69.8％),运动发育落后 28例(21.7％),脑瘫 11例(8.5％)。纠正年龄3~4月龄和6~7月龄 Infanib评估对运动发育异常的敏感性分别为84.6％、100％;特异性75.6％、91.7％;阳性预测值60.0％、82.5％;阴性预测值91.9%、100％。结论：Infanib 可以用于早产儿运动发育的早期评估,并具有较好的预测效度。     

口服氟康唑在预防早产儿深静脉置管时真菌感染中的临床意义

Objective With the widespread application of peripherally inserted central catheters (PICC) in neonatal intensive care unit (NICU), the incidence of invasive fungal infections increased significantly than ever. The present study aimed to explore the clinical significance of oral fluconazole in premature infants with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 grams who had catheter insertions. Method This study enrolled 118 infants admitted between January 2006 and December 2007 who did not receive fluconazole prophylaxis (control group) and 106 infants admitted between January 2008 and June 2009 who received oral fluconazole prophylaxis (prophylaxis group). Statistical analyses were performed by using SPSS 11.5 software. The clinical characteristics and the risk factors for invasive fungal infection between the two groups were compared. Liver functions ( alanine transaminase, ALT and direct bilirubin) were monitored to evaluate the safety of fluconazole prophylaxis. Result Except for the proportion of infants bom via vaginal delivery in the control group (56/118, 47. 5% ) was significantly lower than that in prophylaxis group (69/106, 65.1%, P = 0.007), there were no significant significant differences in the demographics and other baseline clinical characteristics between the two groups. There were no significant differences in the risk factors for invasive fungal infection between the two groups either.Nine infants developed invasive fungal infection in control group (7. 6% ), while no invasive fungal infection was found in prophylaxis group (0%, P=0.01 ). Compared to infants in control group, those in prophylaxis group showed no significant changes in alanine transaminase ALT and direct bilirubin levels at 2 weeks and 4 weeks after fluconazole prophylaxis: the incidences of abnormal ALT and direct bilirubin levels were 8. 5%(10/118) and6.8% (8/118) in control group compared to 11.3% (12/106) and 8.5% (9/106) in prophylaxis group after 2 weeks ( P = 0. 47 and 0. 63 ); the incidences of abnormal ALT and direct bilirubin levels were 3.4% (4/118) and 3.4% (4/118) in control group compared to 5.7% (6/106) and 8.5%(9/106) in prophylaxis group after 4 weeks (P = 0. 62 and 0. 15). Conclusion For infants with PICC insertions and gestational ages at birth ≤32 weeks and/or low birth weight ≤ 1500 grams, oral fluconazole is effective to prevent invasive fungal infection. Oral fluconazole in premature infants neither affected the liver function, nor increased the incidence of cholestasis.     

腹部X线量表在新生儿坏死性小肠结肠炎中的应用价值

目的：评价腹部X线量表在新生儿坏死性小肠结肠炎中的诊断价值及在手术选择中的意义。方法：将2005年1月至2011年3月收住入院的61例新生儿坏死性小肠结肠炎患者根据Bell分期标准分为NECⅠ组（25例）,NECⅡ组（11例）,NECⅢ组（25例）。统计患儿的出生胎龄、性别、体重、临床表现、治疗方法及预后,并对患儿的腹部X线进行量表评分。结果：NECⅠ组、Ⅱ组、Ⅲ组的X线量表评分分别为3.2±1.4、5.3±1.7、8.9±1.7（χ2 =39.006,P<0.05）,NECⅢ组的分数最高,NECⅠ组的分数最低。NECⅢ组手术患儿和非手术患儿的X线评分分别为8.7±1.8和9.4±1.2,差异无统计学意义。肠穿孔组的X线评分（9.6±1.1）高于肠坏死组（6.8±1.8）（P<0.05）。手术组患儿X线量表分数为7分以上者占80%。NECⅠ组治疗好转率为96%,NECⅡ组好转率为64%。NECⅢ组患儿中,手术组痊愈出院患儿占71%,非手术组只有9%的患儿好转。结论：腹部X线量表可以评估新生儿坏死性小肠结肠炎的病情严重程度,X线评分在7分及以上是手术干预的指征。NECⅢ期患儿行外科手术治疗短期疗效好。