阿奇霉素治疗咳嗽变异性哮喘的疗效观察

目的探讨咳嗽变异性哮喘（CVA）与肺炎支原体（MP）感染关系及阿奇霉素治疗的效果。方法随机选择CVA患儿100例为观察组，100例同期就诊年龄相仿的急性上呼吸道感染患儿为对照组。应用颗粒凝集法测定两组患儿MP-IgM，同时应用阿奇霉素进行治疗。结果观察组MP-IgM阳性48例，阳性率为48％，对照组阳性14例，阳性率14％，两组比较差异有显著性。观察组MP-IgM滴度明显高于对照组，其中滴度〉1：320者占43．8％。对照组较低，仅1例最高滴度为1：320。100例CVA的患儿在常规治疗的基础上，加用阿奇霉素口服，有效率88％，随访6～24个月，无一例出现哮喘发作。结论CVA与MP感染有密切关系，阿奇霉素疗效明显。     

肺炎支原体感染4种特异性抗体检测的临床研究

目的：探讨肺炎支原体(MP)特异性IgM,IgA,IgG对肺炎支原体感染诊断价值,及MP IgE与支气管哮喘发病的关系。方法：采用酶联免疫吸附试验对临床高度怀疑肺炎支原体感染患儿测定特异性MP IgA,IgG,IgE,采用颗粒凝集法测定MP IgM,并对57例肺炎支原体感染患儿随访2~5. 5月。结果：在372例肺部感染患儿中,MP IgA阳性184人,占49. 5%;MP IgM阳性241人,占64. 8%; 2种抗体同时阳性140人,占37. 6%, 2种MP特异抗体测定结果的一致性非常显著。其中149例测定了MP IgG, 105例阳性,占70. 5%;而30例正常对照组中仅2例MP IgG阳性,占6. 7%,正常对照组MP IgA,MP IgM皆为阴性。MP IgA,MP IgM,MP IgG的阳性率,在发病第2周均达到80%以上,明显高于第1周,在随访的57例MP感染患儿中, 25例有反复呼吸道感染,MP IgA在随访时阳性率明显增高,MP IgM滴度居高不下;而在32例无呼吸道感染患儿中,MP IgA的阳性率变化不明显,MP IgM滴度则明显下降。MP感染组的MP IgE的阳性率达73. 3%,与哮喘合并MP感染组接近,但与哮喘合并非MP感染组及正常对照组比较差异有显著性。结论：4种特异性肺炎支原体抗体测定对于提高MP感染诊断的特异性、敏感性具有十分重要的临床价值,尤其对于MP再感染的发现及MP感染诱发支气管哮喘的发作机制研究及进一步治疗提供了     

儿童支气管哮喘与肺炎支原体感染的关系

目的探讨儿童支气管哮喘与肺炎支原体（MP）感染的关系。方法采用MP被动冷凝集法检测哮喘急性发作期103例及对照组非感染性疾病患儿30例血清肺炎支原体抗体（MP-Ab）。MP-Ab阳性患儿随机分为阿奇霉素治疗组和常规治疗组,比较其疗效。结果哮喘组MP-Ab阳性46例,阳性率44.66%;对照组阳性2例,阳性率6.67%,二组比较差异显著（P〈0.05）;MP-Ab阳性阿奇霉素治疗组30例,有效率86.7%;常规治疗组16例,有效率43.8%,二组比较差异显著（P〈0.05）。结论MP感染与儿童哮喘关系密切,对哮喘发作期患儿要考虑MP感染可能,应常规行MP-Ab检查。大环内酯类抗生素疗效确切。     

肺炎支原体感染与儿童哮喘关系的研究

目的探讨肺炎支原体感染与儿童哮喘发病的关系。方法支气管哮喘患儿362例，肺炎患儿288例，正常对照组30例，分别采用颗粒凝集法检测血清肺炎支原体IgM（MP—IgM）抗体；同时采用同位素放射免疫法测定哮喘患儿血清总IgE。结果（1）支气管哮喘患儿MP-IgM阳性率49．45％，显著高于肺炎患儿MP—IgM阳性率39．24％，上述两组均显著高于正常对照组6．67％；（2）在各年龄组支气管哮喘患儿MP—IgM阳性率比较中，发现学龄期儿童MP-IgM阳性率最高；（3）MP—IgM阳性的支气管哮喘患儿血清总IgE水平明显高于MP-IgM阴性哮喘患儿的血清总IgE。结论儿童肺炎支原体感染与儿童哮喘发病密切相关。     

小儿喘息性疾病与肺炎支原体感染关系的研究

目的：研究小儿喘息性疾病与肺炎支原体(MP)感染关系及该地喘息性疾病患儿MP感染状况。方法：观察喘息性疾病患儿120例及健康对照组儿童46例。采用酶联免疫法微滴板技术检测MP特异性抗体IgM。结果：喘息组MP特异性抗体IgM阳性54例,阳性率45%,而健康对照组仅3例弱阳性,占6.5%,阳性率两组之间差异非常显著(P<0.01)。结论：小儿喘息性疾病与MP感染有密切关系,对喘息患儿对症治疗同时,应合理使用抗生素。     

婴幼儿肺炎68例支原体检测及其临床分析

对象与方法 :2 0 0 3年 1月 17日至 2 0 0 3年 3月 2 0日在我院住院的婴幼儿肺炎 6 8例 ,其中男 38例 ,女 30例 ;年龄1～ 6个月 15例 ,～ 1岁 18例 ,～ 3岁 35例。对病程小于7d的患儿待其病程超过 7d后再抽血查支原体IgM抗体(MP IgM) ,其余病例均于入院第 2天或第 3天抽静脉血查MP IgM。特异性MP IgM测定采用间接血凝集法 ,以支原体抗体滴度≥ 1∶32为阳性。结果 :6 8例患儿中MP IgM阳性 (诊断为支原体肺炎 )2 7例 ,阳性率为 39 7% (2 7/ 6 8) ,其中 1～ 6个月组阳性 4例 ,阳性率为 2 6 7% (4/ 15 ) ,～ 1岁组阳性 4例 ,阳性率为2 …     

肺炎支原体感染致咳嗽变异性哮喘22例

目的探讨肺炎支原体(MP)感染致咳嗽变异性哮喘(CVA)的临床特点。方法对MP感染患儿中符合CVA诊断的22例的临床和实验室资料进行回顾性分析。结果以长期慢性咳嗽为主要临床表现22例,以干咳无痰及清晨咳嗽重多见,多与气候变化有关,部分患儿和(或)亲属有过敏史。体检体征少。MP2IgM均阳性。部分患儿最大呼气流量>80%。多种抗生素疗效差,加用支气管扩张剂疗效显著。结论MP感染诱发CVA主要表现为长期反复慢性咳嗽,肺部体征和全身中毒症状少,抗生素疗效差,加用支气管舒张剂效果好。     

人类细小病毒B19感染与小儿风湿性疾病关系的探讨

目的研究人类细小病毒B19感染与小儿常见风湿性疾病的关系.方法用巢式PCR法对95例小儿常见风湿性疾病患者进行B19-DNA检测,对部分患者进行B19-IgM检测.结果 (1)病例组B19-DNA阳性33例(34.7%),健康对照组B19-DNA阳性2例(4.0%);病例组B19-DNA阳性率与对照组相比有显著差异(P＜0.01).(2)病例组B19-IgM检测50例,阳性11例(22.0%),健康对照组B19-IgM均为阴性;B19-IgM阳性率与对照组相比有显著差异(P＜0.01).(3)过敏性紫癜、幼年类风湿性关节炎、皮肌炎、系统性红斑狼疮、川崎病患儿B19-DNA及IgM阳性率分别为25%和20%、37.2%和20%、40%和20%、42.9%和28.6%、37.5%和25.0%.五种风湿性疾病B19-DNA及IgM阳性率无显著差异(P＞0.05).(4)50例成对标本中,10例B19-DNA、IgM均阳性,1例仅B19-IgM阳性,7例仅B19-DNA阳性,B19-DNA和IgM 同时阴性32例,B19-DNA和IgM一致率为84.0%,两者结果有一致性 (P＜0.01);50例中B19-DNA阳性17例(34.0%),IgM阳性11例 (22.0%),两者差异无显著意义(P＞0.05).结论 (1)我国风湿性疾病患儿有较高的B19感染率.(2) B19与小儿风湿性疾病密切相关,可能是导致这些疾病的主要病原体之一.     

肺炎支原体肺炎患儿免疫发病机制及临床分析

目的　探讨肺炎支原体 (MP)肺炎免疫发病机制及其临床特点。方法　对 6 5 6例有呼吸道感染的患儿进行血清抗MP IgM和咽拭子MP DNA PCR检测 ,同时对 5 9例肺炎患儿进行血清IgG、IgM、总补体活性(CH50 )、补体C3 和循环免疫复合物 (CIC)测定。结果　MP肺炎组CIC阳性率为 4 8.5 % (16 / 33) ;非MP肺炎组阳性率为 11.5 % (3/ 2 6 ) ,前者明显高于后者 ,差异有显著性 (P <0 .0 1) ;MP肺炎组血清IgG、IgM浓度高于非MP组 ,两组差异显著 (P <0 .0 5 ) ;而CH50 、补体C3 则明显低于对照组 (P均 <0 .0 5 )。结论　免疫复合物介导损伤与MP肺炎的发病有关。     

哮喘儿童597例变应原血清特异性IgE测定的意义

目的 观察哮喘、咳嗽变异性哮喘(CVA)患儿多价食物(fx5)、混合真菌(mxl)及吸入变应原过筛试验(phadiatop)和尘螨(d1)血清特异性IgE(sIgE)阳性率及其年龄分布特征.方法 应用全自动体外变应原检测仪UniCAP100系统的荧光酶联免疫方法,对临床诊断为哮喘、CVA的597例(6个月～16岁)患儿同时进行fx5、mxl及phadialop和dl slgE测定,比较哮喘及CVA患儿中各种变应原sIgE阳性情况,并分析各年龄段的不同变应原sIgE阳性率的特点.结果 1.fx5、mxl、phadiatop、dl总阳性率分别为34.6%、30.0%、35.2%和23.5%.2.phadiatop、dl的阳性率在6～16岁组最高(总阳性率为67.8%和46.3%),该年龄组phadiatop显著高于fx5和mxl的阳性率(P<0.001),fx5的阳性率在6～16岁组最低(总阳性率24%),但在<3岁组显著高于phadiatop和mx1的阳性率(P<0.001);mx1的高峰阳性率发生在5岁(总阳性率53.6%).3.taxi阳性的181例中有90例患儿phadiatop阴性.4.phadiatop阳性的210例中dl阴性率为66.7%.结论 哮喘、CVA患儿中有2/3患儿血清中存在sIgE,婴幼儿期儿童以食物性变应原过敏多见,吸人性变应原过敏随年龄增长逐渐增加.在≤5岁的患儿中真菌过敏阳性率随年龄增加而增加,6岁以后阳性率下降.尘螨和真菌是哮喘儿童主要的变应原.     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.