6岁以下儿童哮喘诊断标准验证的多中心研究

目的　建立客观、稳定的6岁以下儿童哮喘诊断标准。 方法　2020年9月至12月,共22个医疗中心纳入2263例6岁以下有喘息史的患儿相关信息,设计标准化病历系统,建立数据库。将喘息患儿根据现有诊断标准分为哮喘组1151例和非哮喘组1112例,并以“33111评分法”重新诊断,检测其对哮喘组和非哮喘组诊断的特异度、敏感度。结果　哮喘组患儿依据“33111评分法”仍诊断为哮喘者1068例,未诊断哮喘者83例;非哮喘组患儿依据“33111评分法”仍未诊断哮喘者950例,诊断为哮喘者162例。以现有诊断方法为依据,“33111评分法”诊断的ROC曲线下面积为0.934,95%可信区间（0.924,0.934）,灵敏度为0.928,特异度为0.854。阳性预测值86.80%,阴性预测值92.00%,阳性似然比6.36,阴性似然比0.084,Youden指数0.752。 结论　经多中心大样本验证,“33111评分法”稳定性较强,指标客观,可操作性强,具有较高临床应用价值。     

儿童哮喘诊断及治疗指南——2007年版美国儿童哮喘诊断与管理指南解读

支气管哮喘(哮喘)是一种慢性呼吸道炎症性疾病,目前已成为全球严重的公共卫生问题。2007年版美国儿童哮喘诊断与管理指南是由美国哮喘教育和预防计划(NAEPP)协作组的专家制订,由美国健康协会的心、肺和血液学组共同完成。该指南以1997年第2版美国儿童哮喘诊断和治疗指南及2002年以来的最新资料作为框架,综合文献综述及最新建议制订了哮喘长期治疗方案。现着重介绍儿童哮喘诊断、防治的相关内容。     

6岁以下儿童哮喘的早期诊断研究进展

6岁以下儿童由于其特殊的生理解剖结构和免疫特点,并且病因复杂,哮喘较难诊断.然而肺功能损害往往起源于婴幼儿期,早期诊断十分重要,但目前关于6岁以下哮喘的诊断在全球范围尚无统一标准.该文总结了国内外关于6岁以下儿童哮喘的早期诊断研究进展,提出了6岁以下儿童哮喘早期诊断策略.     

建立社区儿童哮喘防治家庭医学模式探索

儿童哮喘患病率高 ,危害严重 ,今已成为儿科临床的热点之一 ,９０年代以来ＧＩＮＡ规划在我国已引起广泛重视。为探索适合我国国情的儿童哮喘防治方案 ,我们于１９９８年１０月～２０００年４月在社区组织网络、开展流行病学调查、建立电脑档案、制订规范化治疗方案等 ,使哮喘防治工作逐步走上科学管理轨道 ,今将有关情况报道如下。资料方法 :①建立与健全管理网络和技术指导网络。组织管理系统 ,建立领导小组 ,由街道副主任任组长 ,医院儿科主任配合任副组长 ,居委保健站参加为组员 ,并建立定期会议制度。建立技术指导网络 ,由医院儿科主任…     

过敏原皮肤点刺试验和串联法在儿童哮喘诊断中的作用

过敏原皮肤点刺试验是一种体内特异性免疫学检测方法,可用于测定哮喘患儿的特应性（对一种或多种过敏原敏感）。鉴于特应性与哮喘的发生、发展及严重程度有一定的关联,我们自１９９８年以来采用国际间儿童哮喘和过敏性疾病的对比研究（ＩＳＡＡＣ）第二阶段的方案,对过敏原皮肤点刺试验和问卷与之结合的方法（简称串联法）在儿童哮喘诊断中的作用进行了探讨,报告如下。对象：（１）１９９８年４月～１９９８年５月在北京朝阳区小学用整群抽样的方法选择９７０名１０～１２岁近１年内无哮鸣症状者（简称非哮喘儿童）,男５２０名,女５２…     

儿童偏头痛的诊断标准

目的研究儿童偏头痛的临床特点,探讨儿童偏头痛的诊断标准。方法符合慢性头痛诊断且排除其他疾病的患儿346例,均具有完整的病史资料。分析偏头痛的临床特点,采用评价诊断试验方法,以ICHD-Ⅱ儿童偏头痛诊断标准为金标准,以偏头痛的临床特征为变量,探讨儿童偏头痛的诊断标准。结果1.慢性头痛346例患者中,157例(45.4%)符合ICHD-Ⅱ儿童偏头痛诊断标准。男75例,女82例。2.偏头痛类型中以可能的偏头痛最多见,占68.8%(108/157例)。主要的不符合指标是缺乏消化道伴随症状;其次为无先兆型偏头痛19.7%(31/157例)。3.偏头痛诊断标准最敏感的单个指标为头痛伴随症状,灵敏度为70.7%、特异度为83.6%,阳性预测值为78.2%,阳性似然比4.31,ROC曲线下面积(AUC)达0.771。最佳组合指标为持续时间1～72h、中重度头痛、头痛伴随症状,灵敏度为52.2%,特异度96.2%,阳性预测值为90.1%,阳性似然比13.7,AUC达0.657。结论儿童偏头痛的诊断标准最敏感的单个诊断指标为头痛伴随症状,最佳组合诊断指标为头痛持续时间1～72h、中重度头痛、头痛伴随症状。     

呼气峰值流量在儿童哮喘诊断及管理中的应用进展

呼气峰值流量（peak expiratory flow,PEF）是一种简单、可靠、低成本的肺功能检查方法。PEF可反映呼气气流受限情况,其变异率可判断气流受限有无可逆性,为儿童哮喘的诊断提供客观依据。短期监测PEF可协助管理哮喘急性发作、查找诱发因素、评估治疗效果等。长期监测PEF有助于哮喘控制的评估及预警急性发作,适用于重度哮喘患儿。该文就儿童PEF的检查方法、影响因素、结果判读,以及在儿童哮喘诊断和管理中的应用进展进行综述,为儿童PEF的临床应用提供参考。     

小儿感染性心内膜炎的诊断标准(试行)

一、临床指标(一 )主要指标1.血培养阳性 :分别 2次血培养有相同的感染性心内膜炎常见的微生物 (如草绿色链球菌 ,金黄色葡萄球菌 ,肠球菌等 )。2 .心内膜受累证据 :应用超声心动图检查心内膜受累证据 ,有以下超声心动图征象之一 :(1)附着于瓣膜或瓣膜装置 ,或心脏、大血管内膜、或置植人工材料上的赘生物 ;(2 )心内脓肿 ;(3)瓣膜穿孔、人工瓣膜或缺损补片有新的部分裂开。3.血管征象 :重要动脉栓塞 ,脓毒性肺梗死 ,或感染性动脉瘤。(二 )次要指标1.易感染条件 :基础心脏疾病 ,心脏手术 ,心导管术 ,或中心静脉内插管。2 .较长时间的发热 (≥…     

小儿急性肾衰竭诊断标准及治疗进展

急性肾衰竭是儿科临床常见的危重症肾脏疾病。早期诊断、早期治疗是改善儿童急性肾衰竭预后、提高患儿生存率的关键。现重点介绍小儿急性肾衰竭诊断标准及治疗方案研究进展，从急性。肾损伤的定义、诊断标准和分期到急性肾衰竭的治疗措施进行阐述。     

胡桃夹现象的诊断标准及随访分析

通过对２２例胡桃夹现象的总结和随访，为便于早期诊断，将本病的诊断标准进行了归纳和分类。为探讨本病预后，对全部患儿分别随访３￣５年，结果：２２例本病患者中１９例血尿、蛋白尿持续数年后自然消失；３例症状持续至今，感冒、劳累后加重，肾功能和肾活检检查无明显异常变化。     

Diagnostic criteria for Tuberculous Meningitis

Objective : Tuberculous Meningitis is associated with a high morbidity and mortality if there is a delay in diagnosis. The diagnosis is based on clinical evaluation since the bacteriological diagnosis takes time and has a low yield. This study attempts to validate these criteria in children with TBM.Methods : Forty-two children clinically suspected to have TBM were enrolled in the study. History, examination, CT scan and CSF findings were utilized to categorize patients into “definite”, “highly probable”, “probable” and “possible” TBM based on the criteria laid down by Ahuja et al. The validity of these criteria was tested against bacterial isolation and response to treatment.Results : Thirty one children, with complete data, were included for analysis. Using “improvement on therapy” as a criterion for definite TBM, we analyzed the sensitivity and specificity of the Ahuja criteria in diagnosing TBM. Using the criteria of “highly probable” TBM, the sensitivity was 65% with a specificity of 75%. When the criteria of “probable” TBM were used, the sensitivity increased to 96% while the specificity dropped to 38%. In an attempt to make these criteria more appropriate for children, we modified the criteria by including mantoux reaction, and family history of exposure in the criteria. The modified criteria gave a sensitivity of 83% and a specificity of 63%.Discussion : A sensitivity of 65% (highly probable group) implies that 35% of TBM patients will be missed, while the probable criteria gave a 63% false positive rate suggesting that the trade-off for a higher sensitivity makes the criteria very unreliable. Our modification of the criteria gave us a reasonable sensitivity of 83% with a higher specificity of 63%. The false positive rate was also reduced to 38%. Thus the modified Ahuja criteria worked better for children with TBM.Conclusion : The modified Ahuja criteria are better applicable for use in pediatric patients with TBM. Since the number of patients was small in this study, the study needs to be validated with a larger sample size     

Urogenital schistosomiasis and urological assessment of hematuria in preschool-aged children in rural communities of Nigeria

ObjectiveThe study evaluates the prevalence of urogenital schistosomiasis and diagnostic performance of chemical reagent strips used for disease diagnosis in preschool-aged children (≤5 years) in Nigeria rural communities.Patients and methodsUrine samples from 419 children were observed microscopically for Schistosoma haematobium and screened for hematuria using standard urine chemical reagent strips.ResultsPrevalence and intensity of infection were 9.8% and 14.4 eggs/10 ml of urine, respectively. Prevalence of infection was similar in girls (10%) and boys (9.6%) (p > 0.05). The intensity of infection was higher in boys (17.1 eggs/10 ml of urine) than in girls (12.8 eggs/10 ml of urine); however, this was not gender dependent (p > 0.05). The occurrence of hematuria was not associated with gender (p > 0.05), but was associated with prevalence of infection (p < 0.05).ConclusionInfection with S. haematobium occurs early in life in the communities and although intensity of infection is low, it could have serious implications in disease transmission. Hematuria, although moderately sensitive to infection, is an important morbidity indicator of urogenital schistosomiasis in the study population.     

儿童哮喘与环境空气污染物关系的调查研究

目的探讨环境空气污染物与儿童哮喘的关系。方法对哮喘专科56例哮喘儿童的肺功能和发作情况进行跟踪调查一年,同时由本市环境监测站对区域内的空气污染指标和空气污染物进行监测,并分析它们的关系。结果空气污染物不同程度影响儿童肺功能,其中以可吸入颗粒物影响最大,并导致β2受体激动剂控制发作的治疗时间延长。结论环境空气污染导致哮喘儿童的肺功能下降,并加重临床症状,影响治疗效果。     

两种标准筛查儿童超重和肥胖的比较

目的 探讨更适合中国儿童的超重、肥胖初筛标准.方法 对广西南宁地区13万余儿童(年龄7～18周岁)进行流行病学调查,参照国内、国际两种儿童超重及肥胖标准进行分析比较.结果 大多数年龄组超重及肥胖儿童国内标准的检出率均高于国际标准,肥胖的发生率在7～10岁组升高,男童超重及肥胖的检出率高于女童.结论 使用国内的儿童超重及肥胖标准可能更有利于我国儿童青少年超重、肥胖的早期干预.     

按哮喘预测指数分组治疗在5岁以下喘息儿童中的应用

目的 观察按哮喘预测指数（asthma predictive index, API）分组治疗在5 岁以下喘息儿童中的应用价值。方法 239 例5 岁以下喘息患儿,API 阳性组126 例,API 阴性组113 例,分别随机分为糖皮质激素吸入治疗组（ICS 治疗组）及孟鲁司特钠治疗组（LTRA 治疗组）。治疗开始4 周内2 组所用药物种类和剂量相同,在疾病稳定期（第4 周后）ICS 治疗组仅使用布地奈德混悬液雾化吸入治疗,LTRA 治疗组仅使用孟鲁司特钠口服治疗,评估记录各组患儿不同时间点哮喘症状评分。结果 API 阳性组及阴性组在治疗后的前4 周,ICS和LTRA 2 种方法均有效,哮喘症状评分与治疗前比较差异有统计学意义,但2 个治疗组间比较差异无统计学意义;在治疗24 周时,2 种治疗方法仍有效,但API 阳性组中LTRA 治疗组较ICS 治疗组更有效;在API 阴性组中,LTRA 治疗组与ICS 治疗组疗效比较差异无统计学意义。结论 5 岁以下的儿童喘息,在疾病稳定期,可根据不同的API 分组,选择不同治疗方案,以达到更有效地控制喘息的目的。     

长三角4935名在校学生中高血压诊断标准探讨

目的了解长三角地区儿童青少年血压水平及高血压检出率,探讨适用于该地区儿童青少年的高血压诊断标准。方法测量长三角地区6～18岁在校学生的身高和血压,采用3种高血压诊断标准统计检出率。结果共计4 935名儿童纳入本研究。男2 542名,女2 393名。血压随着儿童青少年年龄的增长而逐渐升高;男女生收缩压(SBP)分别为(109±14)mmHg、(105±12)mmHg,差异有统计学意义;男女生舒张压(DBP)分别为(65±9)mmHg、(64±9)mmHg,差异有统计学意义。高血压分别以3种标准统计,检出率分别为17.9%、12.6%、11.3%,差异有统计学意义,且标准一与标准二、标准一与标准三、标准二与标准三之间,诊断效度一致性Kappa值分别为0.73、0.78、0.90。结论男生SBP和DBP均显著高于女生。美国高血压教育项目(NHBPEP)第4次报告中儿童身高P50水平同年龄性别组血压P95水平较适合长三角地区儿童。     

Medication compliance in children with asthma

A questionnaire to assess compliance with prescribed therapy was completed by 200 children with asthma. The validity of the questionnaire was assessed objectively by measuring plasma theophylline concentrations in 37 subjects and by weighing metered dose aerosol canisters before and after use in 19 subjects. The average compliance was 67.9%. The close agreement between answers to the questionnaire and the objective measurements of compliance indicated that most participants recalled the drug regimens accurately. Good compliance was related to whether Australia was the parents' country of origin, to knowledge of the disorder and to comprehension of medication but was not related to perception of the severity of the illness. This study demonstrates that compliance is relatively poor even in a clinic population which attends regularly and appears well-motivated.     

Correlates of the CBCL-dysregulation profile in preschool-aged children

Background: A growing literature indicates that the Child Behavior Checklist‐Dysregulation Profile (CBCL‐DP) identifies youths with heightened risk for severe psychopathology, comorbidity, and impairment. However, this work has focused on school‐age children and adolescents; no studies have examined whether preschool‐aged children with the CBCL‐DP exhibit a similar constellation of problems. Method: Using a community sample of preschoolers, we compared children with (N = 61) and without (N = 488) the CBCL‐DP on a broad range of variables assessed using multiple methods. Results: Univariate analyses revealed numerous differences between children with the CBCL‐DP and their peers on psychiatric symptomatology, temperament, parenting behavior, and parental personality, psychopathology, and marital functioning. In multivariate analyses, children with the CBCL‐DP exhibited greater temperamental negative affectivity and lower effortful control. They also had more depressive and oppositional defiant symptoms, as well as greater functional impairment. Parents of CBCL‐DP children reported engaging in more punitive, controlling parenting behavior than parents of non‐profile children. Conclusions: In a non‐clinical sample of preschoolers, the CBCL‐DP is associated with extensive emotional and behavioral dysregulation and maladaptive parenting.