小呼吸道病变对慢性咳嗽儿童非典型哮喘的预测价值

目的 探讨小呼吸道病变(SAD)对慢性咳嗽儿童非典型哮喘的预测价值.方法 收集广东省中医院2007年6月-2010年6月慢性咳嗽儿童176例.男95例,女81例;年龄5～12岁.对其进行肺功能检测及支气管激发试验(BPT),分别分析SAD、呼吸道高反应性(AHR)与哮喘的关系.应用SPSS 17.0软件进行统计学分析.结果 170例慢性咳嗽儿童完成全部检测项目.其中122例肺功能正常,48例有SAD.BPT检测发现78例有AHR,阳性率为45.88%(78/170例).其中SAD组BPT阳性率为87.50%(42/48例),远远高于肺功能正常组[29.51%(36/122例)](χ2=46.655,P<0.01).随访发现,78例AHR患儿中72例确诊为哮喘,其中SAD组41例(85.42%),肺功能正常组31例(25.41%),二组哮喘患病率比较,差异有统计学意义(χ2=50.803,P<0.01).结论 慢性咳嗽儿童SAD与AHR发生密切相关,SAD对慢性咳嗽儿童非典型哮喘的预测价值较高,无BPT检测条件的基层医院可将其作为哮喘的初筛检查.     

Recognition of asthmatic symptoms in the pediatric age group

Asthma produces substantial morbidity in childhood. Under‐diagnosis may lead to inappropriate treatment and prolonged periods of illness and absence from school. The results of a recent International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire study in Malta showed a higher prevalence of wheezy symptoms in the Central North Region. The present study was carried out to test the null hypothesis that there is no correlation between potential exposure to pediatricians (measured as pediatric private clinics/1000 childhood population/week) and percentage of children aged 13–15 years
of age responding positively in the questionnaire to having had wheezy symptoms. A significant, positive correlation was found between potential exposure to pediatricians and percentage of children aged
13–15 years responding positively to having had wheeze in the previous year (p=0.009). A negative correlation was also found for severity of asthma (> 12 attacks in the previous 12 months) and potential exposure to pediatricians (p=0.01). This is the first report of potential exposure to pediatricians influencing the regional incidence of asthma on a national basis. This skew may be caused by the greater exposure of pediatricians to patients with severe forms of asthma in a hospital setting, and hence a higher index of suspicion for the milder forms of the disease. Asthma may be less severe in regions where there are a greater number of pediatricians because of recognition of the condition with appropriate treatment and/or prophylaxis.     

儿童呼吸道病毒感染的流行病学特点

呼吸系统感染是儿童门诊就诊最为常见的病因,也是造成＜5岁儿童死亡的首要原因。病毒是儿童时期呼吸道感染最为常见的病原,需要引起儿科医师关注。该文讨论了常见呼吸道病毒的流行病学特征,着重介绍了呼吸道合胞病毒、流感病毒、鼻病毒和腺病毒等较为常见的呼吸道病毒的好发年龄、好发季节、流行区域等流行病学特点。同时,也简要介绍了副流感病毒、偏肺病毒和冠状病毒等近期新发现的病毒的流行病学特征,并回顾了病毒共感染的相关信息。     

Exhaled carbon monoxide levels in preschool‐age children with episodic asthma

Background: The concentration of exhaled carbon monoxide (eCO) in young children with stable asthma and during acute asthma attack is not known. Methods: A sampling bag was developed to collect the exhaled air of preschool children. A total of 257 preschool‐age children (≥3 years and ≤6 years old) were studied; 111 had a diagnosis of asthma (43 suffering a mild asthma attack and 68 without active asthmatic symptom), 99 had upper respiratory infection (URI) and 47 were healthy. Results: In preschool‐age children, eCO levels of those with asthma attacks (mean ± SE, 2.7 ± 0.3 p.p.m., n= 43) were significantly higher than those of subjects with asymptomatic asthma (0.5 ± 0.1 p.p.m., P < 0.05), URI (0.8 ± 0.1 p.p.m., P < 0.05) and healthy children (0.4 ± 0.1 p.p.m., P < 0.05). A multivariate linear regression model showed that eCO was higher in children with asthma attacks independent of age and gender. In 33 asthmatic children followed before and after treatment, eCO levels during asthma attacks significantly decreased after inhalation therapy with a combination of salbutamol and sodium cromoglycate (before therapy, 2.9 ± 0.4 p.p.m.; after therapy, 0.6 ± 0.1 p.p.m., P < 0.0001). Conclusions: The measurement of eCO using a novel collecting system is useful in the recognition of asthma in preschool children.     

Factors influencing child mental health: A state‐wide survey of Victorian children

Aims: This study aims to estimate the prevalence of mental health problems among Victorian children and to investigate factors associated with poorer mental health. Method: Computer‐assisted telephone interviews were undertaken with the parents of 3370 randomly selected Victorian children aged 4 to 12 years. They reported on their child's mental health and special health‐care needs as well as their own mental health, family functioning and a range of community and socio‐demographic variables. Population estimates and odds ratios (OR) were calculated with 95% confidence intervals (95% CI). Results: Overall, 11.6% (95% CI = 10.3–12.9%) of Victorian children were estimated to be at risk of having mental health problems. Factors independently placing children at increased risk of mental health problems that were ‘of concern’ include a child having special health‐care needs (OR = 7.89, 95% CI 5.16 to 12.08), unhealthy family functioning (OR = 3.84, 95% CI 2.19 to 6.74), parental mental health problems (OR = 7.89, 95% CI 5.16 to 12.08), neighbourhood safety (OR = 2.47, 95% CI 1.20 to 5.07) and area of residence (OR = 2.01, 95% CI 1.33 to 3.02). Conclusions: A significant proportion of Victorian children are at some risk of mental health problems. These limited but important predictors of children's mental health reinforce the need for policy solutions that will extend beyond those offered by traditional mental health service systems.     

儿童哮喘控制测试在哮喘病情评估中的应用

多年来的国内外研究证明,经过合理诊断、评估及治疗,哮喘可以得到有效的管理和控制,其中,对哮喘患儿病情的准确评估成为哮喘控制管理中的重要环节。1儿童哮喘病情评估方法的发展1.1哮喘严重度自1991年美国哮喘教育和预防项目     

哮喘儿童支气管舒张试验中大小气道功能指标变化对比研究

目的 探讨儿童哮喘发作时支气管舒张试验中大小气道功能指标变化的临床意义.方法 选择2012年10月至2014年4月哮喘初次发作患儿51例,采用Master Screen肺功能仪,在雾化吸入硫酸沙丁胺醇前、后进行肺功能检测;比较用力肺活量(FVC)、呼气峰流速(PEF)、1秒用力肺活量(FEV1)、1秒率(FEV1/FVC)、最大呼气中段流量(MMEF)、用力呼气流速(FEF)25、FEF50、FEF75的变化.结果 51例患儿的平均年龄(7.30±2.33)岁.患儿哮喘发作时支气管舒张试验总阳性率58.8%,并有随病情加重而升高的趋势;与舒张试验前比较,舒张试验后大小气道各指标的绝对值、占预计值百分比均明显增加,差异有统计学意义(P均<0.01);以代表大气道指标的FEV1改善率≥12%判定为舒张试验阳性,阳性率58.8%;以代表小气道指标的MMEF改善率≥25%判定为舒张试验阳性,阳性率70.6%,两者比较差异无统计学意义(P=0.214).结论 哮喘发作患儿FEV1基础值>70%亦可行支气管舒张实验,同时结合大、小气道指标以判断气道可逆性可以更全面反映哮喘的病情严重程度.     

Regional variation in the diagnosis of asthma among preschool‐age children

To study potential regional variation in asthma diagnostics, we retrospectively analyzed the management of 800 acutely wheezing preschool‐age children in two university clinics in Finland. Multivariate modelling indicated that the place of treatment was a strong independent predictor of asthma diagnosis during acute symptoms. Similar regional preferences in diagnostic activity may exist in other countries.     

上海地区儿童脉冲振荡肺功能预计值建立

目的建立上海地区5～11岁儿童脉冲震荡肺功能的预计值。方法纳入上海地区5～11岁的746名健康儿童,采用德国Jaeger公司生产的Master Screen IOS肺功能检测仪检测受试儿童平静呼吸状态下的呼吸总阻抗(Zrs)、响应频率(Fres)、不同振荡频率下的黏性阻力(Rrs)及弹性阻力(Xrs)等指标,并进行分析。经多元逐步回归建立不同性别脉冲振荡(IOS)相关参数的回归方程。结果 746例儿童中男510例、女236例,年龄5～11岁,中位年龄8岁。5岁组男性身高高于女性,5～、7～、10～岁组男孩体质量均高于女孩,差异均有统计学意义(P0.05)。无论男女,不同年龄、身高组之间IOS主要参数的差异均有统计学意义(P0.05),Zrs、Fres、R_5和R_(20)数值随年龄和身高的增长而下降,而X_5则随着年龄和身高的增加逐渐增大。多元逐步回归分析发现,IOS参数与身高、年龄、体质量均有关,多数IOS参数与身高关系最为密切(回归系数绝对值最大)。结论建立了上海地区健康儿童脉冲震荡肺功能正常预计值;在肺功能检查评估中,采用该预计值方程式更符合中国儿童特点。     

广州市儿童变应性疾病流行病学调查分析

目的 了解广州市城区儿童支气管哮喘(哮喘)、变应性鼻炎及湿疹等变应性疾病的流行状况,为今后儿童变应性疾病防治工作提供科学依据.方法 采用多阶抽样的方法抽取广州市社区0～14岁儿童4072名,通过变应性疾病国际通用的International Study of Asthma and Athergies in Childhood( ISAAC)调查书面问卷的核心问卷对儿童哮喘、变应性鼻炎及湿疹等变应性疾病患病情况进行调查,了解儿童变应性疾病的患病情况.采用SPSS 13.0软件进行统计学分析.结果 儿童哮喘患病率为2.09％,男女患病率之比为1.59:1.00,其中2～6岁儿童患病率最高,首次发作年龄＜3岁者占60.00％.变应性鼻炎患病率为7.83％,3岁后逐渐上升,以6～9岁儿童发病率较高.儿童湿疹患病率为7.22％,且随年龄增加逐渐降低.哮喘并变应性鼻炎占34.83％,并湿疹占19.10％.结论 广州市社区儿童变应性疾病患病率呈上升趋势.     

常规肺通气功能检测在儿童哮喘评估中的应用

目的探讨哮喘病情与肺功能指标变化特点,为哮喘规范化治疗提供客观依据。方法采用肺功能测定系统对25例哮喘患儿于急性期、缓解期6个月及1年分别行常规肺通气功能测定,比较各期实测值与预计值比值之间的差异。结果哮喘患儿的症状与肺功能指标呈现出一致性,急性期大气道指标用力肺活量(FVC)、1秒钟用力呼气量(FEV1)、最大呼气峰流量(PEF)及75%、50%、25%肺活量时用力呼气流速(FEF25、50、75)、中段呼气流速(MMEF75/25)等实测值与预计值比值均降低,治疗6个月后FVC、FEV1等大气道功能指标基本恢复,1年后小气道功能指标FEF50、75及MMEF75/25等指标恢复。结论肺功能指标在哮喘的病情评估方面具有重要作用,对于哮喘治疗具有重要指导作用。     

儿童呼吸道感染博卡病毒流行病学特征分析

目的　分析儿童呼吸道感染博卡病毒（human bocavirus, HBoV）流行病学特征, 为临床合理诊治提供参考依据。方法　收集2009年1月至2016年12月在苏州大学附属儿童医院呼吸科住院治疗的16 913例呼吸道感染患儿的痰标本和临床资料,采用实时荧光定量PCR法检测HBoV,分析HBoV检出情况。结果　16 913例患儿中,HBoV阳性检出率为5.16%（873/16913例）。男性患儿HBoV阳性检出率为5.42%（573/10566例）,女性患儿为4.73%（300/6347例）,男性患儿HBoV检出率高于女性患儿（χ2＝3.928,P＝0.047）。＜1岁、 ～3岁、～7岁以及≥7岁患儿的HBoV检出率分别为4.03%（325/7963例）、8.75%（401/4584例）、3.99%（134/3357例）、1.29%（13/1009例）, 各年龄组HBoV检出率差异有统计学意义（χ2＝182.075, P＜0.01）。春夏秋冬四季HBoV阳性检出率分别为3.36%（146/4341例）、 6.92%（295/4261例）、 6.88%（287/4172例）、 3.50%（145/4139例）, 夏秋季患儿HBoV阳性检出率明显高于冬春季（χ2＝93.801, P＜0.01）。结论　苏州大学附属儿童医院2009年1月至2016年12月呼吸道感染患儿HBoV检出率为5.16%, 幼儿HBoV检出率高, 男性患儿高于女性。夏秋季为HBoV感染的高发季节。     

家庭环境香烟烟雾暴露对哮喘患儿疾病控制状况的影响

目的 了解家庭环境香烟烟雾暴露(ETS)与哮喘患儿疾病控制情况的关系.方法 通过病例对照研究方法,对83名ETS和80名非ETS的哮喘儿童进行为期1年的随访,比较两组患儿的儿童哮喘控制测试(childhood asthma control test,C-ACT)评分良好(＞19分)的例次,哮喘控制用药增加天数、急救用药使用天数,以及尿cotinine含量.结果 ETS患儿C-ACT＞19分802例次,占总C-ACT评分例次的80.5%;非ETS患儿 C-ACT＞9分921例次,占95.9%,两组患儿的哮喘控制状况差异无统计学意义(P＜0.05);ETS患儿的尿cotinine含量、支气管扩张剂使用天数、吸入激素增加天数、全身激素使用天数也均明显多于非ETS患儿(P均＜0.05).ETS患儿以尿cotinine含量分为重度(＞4 ng/ml)和轻度(≤4 ng/ml),其中重度ETS患儿的C-ACT＞19分例次低于轻度ETS患儿,而支气管扩张剂使用天数、吸入激素增加天数、全身激素使用天数也均明显多于轻度ETS患儿,差异均有统计学意义(P均＜0.05).结论 ETS是儿童哮喘控制不良的重要危险因素之一.     

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??Objective??To analyze the epidemiological characteristics of human bocavirus??HBoV?? infection in children with respiratory tract diseases??and to provide scientific basis for clinical diagnosis and treatment. Methods??Sputum specimens and clinical informations of 16 913 cases of hospitalized children with respiratory tract diseases from January 2009 to December 2016 in Children’s Hospital of Soochow University were collected. HBoV DNA was detected by fluorescence quantitative polymerase chain reaction at real time to analyze the detections. Results??The HBoV detection rate was 5.16%??873/16 913 cases?? in 16 913 children. The HBoV detection rate of boys was 5.42%??573/10 566 cases????which was significantly higher than that of girls??4.73%??300/6 347 cases????χ2??3.928??P??0.047??. The HBoV detection rate of children at the age of less than 1 year old??-3 years old??-7 years old and older than 7 years old were 4.03%??8.75%??3.99% and 1.29%??respectively??the difference of which had statistical significance??χ2??182.075??P??0.01??. The HBoV detection rate in spring, summer??autumn and winter were 3.36%??146/4341 cases????6.92%??295/4261 cases????6.88%??287/4172 cases?? and 3.50%??145/4139 cases????respectively. The HBoV detection rate in summer and autumn was significantly higher than that in spring and winter??χ2??93.801??P??0.01??. Conclusions??The HBoV detection rate in children with respiratory tract diseases is 5.16% in Suzhou area from Jan. 2009 to Dec. 2016. The highest HBoV detection rate is high in infant??especially in boys. Epidemical seasons of HBoV infection in Suzhou are summer and autumn.