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病毒性腹泻是一组由多种病毒引起的急性肠道传染病,临床上以呕吐、水样或蛋花样泻、发热为特点,可伴有不同程度脱水及电解质紊乱临床表现,现已证实人类轮状病毒(Human Rotavirus,HRV)、杯状病毒(Human Caliciviruses,HuCV)、星状病毒(Astrovirus,AstV)和肠道腺病毒(Adenovirus,AdV)是婴幼儿病毒性腹泻的主要病原[1]。近年来随着分子生物学检测技术的提高,由病毒感     

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??Antibiotic-associated diarrhea??AAD????which results from disturbance or destroying of balance in the gut microbiota caused by antibiotic therapy??is frequent pediatric complications. Clostridium difficile-associated diarrhea??CDAD?? is considered a severe colitis type of AAD. Antibiotics administration can result in gut microbiota alterations??i.e?? disturbance and redistribution in composition and significant drops in taxonomic diversity. Changes in the microbiota composition may lead to changes of host intestinal mucosal immune response pattern??being open to pathogen invasion binding sites??increased susceptibility to infection?? and induction of antibiotic resistant strains of colonization. Microbiota alterations cause decreased bacterial carbohydrate and disturbances of bile acid metabolism. The early intervention of probiotics can effectively reduce the incidence of AAD and CDAD. Clinical application of antibiotics and the use of probiotics at the same time are reasonable and effective.     

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??The classification of thalassemia is mainly based on the types of the defective synthesis of the globin chains of adult hemoglobin A and clinical features??the former mainly includes α??β??γ??δ??δβ??etc.??and α or β thalassemia is the most common form of thalassemia??the latter is classified as transfusion-dependent thalassemia and non-transfuion-dependent thalassemia in terms of long-term survival depending on blood transfusion. The diagnostic techniques include screening test and genetic test??the former diagnostic method is mainly based on the morphology of red blood cells and the physical and chemical properities??including routine analysis of blood??red blood cell morphology and hemoglobin electrophoresis??etc.??and the latter is mainly based on PCR technology??including gap-PCR??real-time PCR??gene chip and DNA screening??etc. This paper reviews the classification and laboratory diagnosis techniques in thalassemia??combining comprehesive screening method with technique of genetic diagnosis??which appropriately contributes to the diagnosis of thalassemia.     

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目的探讨儿童糖尿病酮症酸中毒并发脑水肿的临床特征及危险因素。方法对重庆医科大学附属儿童医院1993—2005年住院治疗的糖尿病酮症酸中毒并发脑水肿患儿的临床特征及病因进行分析,并与未并发者进行对照比较。结果在71例酮症酸中毒患儿中,有6例临床表现符合脑水肿的诊断标准,临床确定为并发脑水肿,并发率为8·4%。6例均为重型酮症酸中毒。与未发生脑水肿同等程度的重型酮症酸中毒患儿相比较,并发脑水肿患儿酸中毒更为严重,在治疗期间血钠上升缓慢及持续低钠血症,尿素氮水平升高。6例患儿中有5例应用碳酸氢盐治疗,用量大于未并发者。结论糖尿病儿童并发重型酮症酸中毒易发生脑水肿。严重酸中毒、血钠上升缓慢或持续低钠血症、血尿素氮升高及碳酸氢盐的使用有可能增加脑水肿发生的危险性。     

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??To study the status of myocardial T2* and liver T2* in β- thalassemia major??β-TM?? patients with iron overload and its relationship with clinical test data. Methods??In June 2010??on a voluntary basis??out of the 80 β-TM patients over 7 years under regular blood transfusion therapy??51 were chosen to receive myocardial MRI T2* ??myocardial T2*?? and liver MRI T2* ??liver T2*?? tests. The results were compared with age??SF??LVEF??transfusion time??chelation time and Hb. Results??Eleven out of 51 cases ??21.6%?? were myocardial iron overload??including 3 mild cases??3 moderate cases and 5 severe cases. Forty-three out of 51 cases ??84.3%?? were liver iron overload??including 14 mild cases??17 moderate cases and 12 severe cases. There was no correlation between myocardial T2* and SF??LVEF or liver T2*. SF was positively correlated with liver T2*??r = 0.558??P < 0.01??. The transfusion time of myocardial T2* > 20 ms group was less than that of myocardial T2* < 20 ms group ??P < 0.05??. There was no statistical significance between the liver iron overload incidence ratios of the two groups ??P > 0.05?? . Two out of 11 myocardial iron overload cases had lower LVEF??18.2%??. Conclusion??The group of TM patients demonstrates lower myocardial iron overload incidence and higher liver iron overload incidence. As SF increases??liver iron overload becomes more severe??myocardial iron overload can not be predicted or determined by examining SF level. There is no correlation between myocardial iron overload and liver iron overload. LVEF can not be a reliable factor to predict myocardial iron overload.     

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??Abstract?? Objective To investigate the occurrance of DKA in established T1DM children. Methods According to the registration system in the following-hospitals??Beijing Children’s Hospital of Capital Medical University?? Children’s Hospital of Shanghai?? Nanjing Children’s Hospital??Children’s Hospital of Zhengzhou?? Children’s Hospital of Jiangxi?? the First Affiliated Hospital of Xi’an Jiaotong University??First Affiliated Hospital of Kunming Medical University?? Children’s Hospital of Wuhan?? SooChow University Affiliated Children’s Hospital?? Children’s Hospital of Liaocheng?? Children’s Hospital of Fuzhou?? Chengdu Women & Children’s Central Hospital???? we investigated the frequency and cause of DKA in children with established T1DM from December 1995 to June 2014. After the diagnosis of T1DM?? the first time DKA was for group 1A?? the second DKA for group 1B. We conducted a cross-sectional survey of blood glucose control status for patients with T1DM from December 2011 to May 2012 in Beijing Children’s Hospital. Patients who did not have DKA episode in the course of T1DM were selected as control group ??group 2??. Results Totally 1676 children were newly diagnosed with T1DM by 12 hospitals?? and 89 patients occurred 100 DKA after T1DM diagnosed. The incidence and frequency of DKA was 5.3% ??89/1676?? and 5.9% ??100/1676??. The frequency was different in 12 hospitals?? fluctuating between 1.1% and 24.1%. Compared with group 2?? group 1A had high level of HbA1c ???11.31±3.03??% vs. ??8.26±1.53??%?? P??0.01?? and insulin dosage ???0.85±0.42?? IU vs. ??0.71±0.31?? IU?? P??0.01??. There were more patients with insulin bump in group 1A than group2 ??25.0% vs. 11.2%?? P??0.01???? and few patients reached the standard of blood glucose monitoring ??12.1% vs.40.1%?? P??0.01?? and follow-up ??21.2% vs. 46.6%?? P??0.01??. The main reasons of DKA in group 1A were infection ??33.7%???? interrupting insulin therapy ??21.3%?? and eating disorder ??20.2%???? one patient had DKA after islet stem cell transplantation. Infection was also the major cause of DKA in group 1B ??4/10???? and 1 patient had DKA because of insulin bump failure. For DKA which occurred within different course?? the distribution of causes was different ??P??0.01??. Within 1 year of T1DM duration?? the major reason was interrupting insulin injection ??39.3%??. For patients more than 1 year?? it only accounted for 13.1%??8/61???? the major causes were infection ??22/61?? and eating disorder ??16/61??. The major cause in mutiple hospitals with high DKA frequency was infection ??50.0%???? while in other hospitals 28.1% of patients had DKA because of infection ??P??0.01??. Conclusion The frequency of DKA is 5.3%?? which is different in 12 hospitals?? with the highest up to 24.1%. Patients with DKA have poor glycemic control?? and they can not regularly monitor blood glucose and follow-up. We should emphasize the education of diabetes. Patients with insulin pump and islet stem cell transplantation must also become a new focus of education. Hospitals with high DKA frequency should give patients information how to deal with other diseases.     

北京儿童医院住院的腹泻患儿星状病毒感染分析

目的　了解北京儿童医院 5岁以下住院的腹泻患儿 ,星状病毒感染的临床和流行病学特点。方法　 1999年 9月至 2 0 0 1年 8月 2 88例 5岁以下的住院腹泻患儿 ,每例入院后采集一份粪便标本 ,应用酶免疫法进行星状病毒和轮状病毒抗原检测 ,总结星状病毒感染腹泻患儿的病例 ,进行临床特点的分析。结果　星状病毒抗原的检出率为 9 0 % (2 6 /2 88) ,与轮状病毒的共同感染者的检出率为 1 7% (5 /2 88)。星状病毒感染患儿年龄为 7天～ 17个月 ,年龄≤ 12个月的患儿占 84 6 % ,平均年龄明显小于轮状病毒感染患儿 (5 4 5± 4 6 2个月vs 9 75± 7 83月 ,P =0 0 0 5 )。 88 5 %星状病毒感染主要集中在 10月至次年 3月 ,与轮状病毒感染季节相似。主要临床表现为腹泻、呕吐、发热、脱水 ,有4例患儿心肌酶 (乳酸脱氢酶、磷酸肌酸激酶、磷酸肌酸激酶同工酶 )升高 ,4例表现为迁延性腹泻。结论　星状病毒可能是北京地区婴幼儿病毒性腹泻的重要病原之一     

上海地区儿童腹泻病轮状病毒感染的研究

目的　了解上海地区腹泻儿童中轮状病毒感染的情况。方法　收集复旦大学儿科医院1 999年 1 1月至 2 0 0 1年 1 2月住院的腹泻病儿童粪便标本 1 2 30份 ,采用聚丙烯酰胺凝胶电泳(PAGE)法和酶联免疫吸附法 (ELISA)检测轮状病毒。结果　 1 2 30份粪便标本中 ,493份检测到A组轮状病毒RNA基因组 ,阳性检出率为 40 1 % ,未发现B组及C组轮状病毒。其中RNA长型有397份 ( 80 5 % ) ,短型有 5 5份 ( 1 1 2 % ) ,混合型有 1 8份 ( 3 7% ) ,RNA部分降解未能分型有 2 3份( 4 7% )。对 471份有明确编号的轮状病毒阳性标本来源的患儿分析显示 ,平均发病年龄 1 4 2个月 ,社区感染 32 0例 ( 67 9% ) ,院内感染 1 5 1例 ( 32 1 % ) ,5岁以下儿童占 464例 ( 98 7% ) ,3个月至2岁儿童 369例 ( 78 3% )。 3年冬季 1 1月份与 1 2月份轮状病毒阳性检出率均达到 5 0 %以上。结论　A组轮状病毒是上海地区 5岁以下住院儿童腹泻病的主要病原 ,3月龄至 2岁婴幼儿是轮状病毒的易感人群 ,以冬季 1 1月份至 1 2月份为流行高峰 ,基因组以长型为主。     

2008至2011年上海单中心住院腹泻儿童轮状病毒基因型别流行特征

目的 监测并分析上海单中心住院腹泻儿童A组轮状病毒（RV）基因型别的变化特征,为RV性腹泻的防治提供基础数据和理论依据。方法 收集2008年1月至2011年12月入住复旦大学附属儿科医院<5岁的腹泻患儿粪便标本,RV抗原阳性者345份,采用套式多重RT-PCR法进行RV的基因分型。结果 ①G基因型：2008至2010年以G3型为主,检出率分别为49.2%、44.6%和78.0%;G9型的流行呈上升趋势,成为2011年最主要的流行型别（51.1%）;G1型在4年中均有检出（8%~20%）;G2型少见,G4型未检出。G混合型中,以G3+G9型为主,其次为G3+G1型,还检出4例3种G基因型的混合。②P基因型：2008、2010和2011年均以P［8］型为主,检出率分别为55.6%、60.0%和68.1%,2009年以P混合基因型（43.2%）为主;P［4］型在4年均有流行;P［6］、P［9］型少见,仅在混合感染中检出P［10］型。P混合型中,以P［8］+P［4］型为主,其次为P［8］+P［10］型。③P［8］G3型是2008至2011年最主要的RV流行株（24.3%）,其次为P［8］G9型及PmG3型。2011年P［8］G9型跃升为最主要的流行型别（40.5%）。结论 与2001至2007年相比,2008至2011年上海地区A组RV基因型出现了新的流行特点,G1型及G9型的流行呈上升趋势,G3的流行有所下降,各种混合型别多见。对RV基因型保持系统性的连续监测对RV疫苗在上海的应用是必要的。     

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目的分析住院急性呼吸道感染(ARI)患儿病毒病原检测结果,为临床儿童急性呼吸道感染提供病毒病原学诊断依据。方法选择2003年4月至2005年3月重庆医科大学儿童医院呼吸内科住院治疗的急性呼吸道感染患儿,取其鼻咽分泌物做免疫荧光检测筛查7种常见呼吸道病毒抗原,包括呼吸道合胞病毒(RSV)、腺病毒、流感病毒A及B型、副流感病毒Ⅰ、Ⅱ、Ⅲ型,对检测标本阳性的病例进行统计分析。结果1052份标本中,阳性标本409份,占38.88%。其中RSV阳性标本360份,占总阳性标本例数的88.02%,副流感病毒Ⅲ37份占9.05%;RSV发病高峰时期在12月至次年2月和7、8月两个时期;RSV感染多见于3岁以下,发病高峰年龄为2～6个月,男女发病比例为2.24∶1。结论2003～2005年重庆地区急性呼吸道感染的病毒病原体仍以RSV为主。     

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目的探讨小儿肺炎继发腹泻的危险因素及应用微生态制剂(培菲康)预防的效果。方法调查2002年1月至2004年5月在福建医科大学附属第一医院住院治疗的小儿肺炎314例,以住院期间抗生素治疗同时应用微生态制剂(培菲康)的患儿为病例组,仅使用抗生素治疗或住院72h后因出现继发腹泻才开始应用微生态制剂(培菲康)的患儿为对照组,对肺炎患儿的临床特征、微生态制剂的应用情况与继发腹泻的关系进行单因素卡方分析和非条件Logistic回归模型多因素分析。结果病例组114例,住院治疗期间继发腹泻病21例,发生率为18.4%;对照组200例,继发腹泻79例,发生率39.5%。单因素卡方分析显示:患儿发病年龄、住院天数、住院后有无侵入性操作、微生态制剂的应用、居住地、病情严重程度、血中性粒细胞、血红蛋白数量、激素应用与小儿肺炎继发腹泻有关联。非条件Logistic多因素回归分析筛选出3个危险因素,即患儿年龄(χ2=14.120,P=0.000)、住院天数(χ2=11.532,P=0.001)、入院后接受侵入性操作(χ2=6.827,P=0.009)和1个保护因素:微生态制剂应用(χ2=12.943,P=0.000)。结论肺炎患儿年龄越小、住院时间越长或进行侵入性操作可增加继发腹泻的发生率;微生态制剂能够降低小儿肺炎继发腹泻的发生率,提示具有预防作用。     

Clinical risk factors for fatal diarrhea in hospitalized children

It is important to determine the specific factors for diarrheal deaths in infants & young children to enable the intervention and reduce the mortality rates. This study aimed to identify these factors in children under five years of age, hospitalized with diarrheal complaints. Four hundred diarrheal children were included in the study. Twenty-seven (6.75%) of them died and 373 (93.25%) survived. The nutritional status of the patients was determined using weight for height for age as percentage of Harward Standard. It was found that severe malnutrition (p=0.000 for weight for height ration <70% and p=0.036 for height for age <85%), co-existent sepsis (p=0.000), shigella infection (p=0.0014), hypoalbuminemia (p=0.0000), hypoglycemia (p=0.0002), hyponatremia (p=0.016), hypokalemia (p=0.0041) and metabolic acidosis (p=0.0069 for pH<7.35 and p=0.000 for HCO₃<20moL/l) were significant risk factors for diarrheal deaths in the univariate analysis. In the multivariate analysis, young age (under 6 months of age) {Odds ratio (OR) 10.49, 95% confidence interval (Cl) 1.75, 62.75)}, moderate or severe dehydration (OR 8.17, 95% Cl 1.53, 43.67), severe malnutrition (OR 0.04, 95% Cl 0.00, 0.22 of weight for height <70% and OR 0.03, 95% Cl 0.00, 0.36 for height for age<85%), co-existent sepsis (OR 37.26, 95% Cl 6.94, 200.06), shigella infection (OR 23.01, 95% Cl 3.08, 171.98), hypoalbuminemia (OR 0.11, 95% Cl 0.02, 0.54), metabolic acidosis (OR 0.03, 95% Cl 0.00, 0.33 of HCO3<20 mMol/L) were significant risk factors. It is concluded that, in addition to electrolyte and fluid treatments, prevention of malnutrition, continuation of feeding which lessens weight loss and may prevent fatal hypoglycemia, and early detection and treatment of probable sepsis are important in reducing diarrheal deaths.     

2002-2005年北京儿童医院住院患儿病毒性脑炎流行病学分析

目的 了解北京地区儿童病毒性脑炎的流行病学特点.方法 对2002-01-2005-12在北京儿童医院住院治疗、出院诊断为病毒性脑炎的1 016例进行回顾性总结分析,入选病例急性期血清和(或)脑脊液检测病毒IgM抗体,标本选择检测的病毒抗体种类按照临床医生的申请进行.结果 1 016例病毒性脑炎患儿占住院总人数的1.0%,男女比例为2.21,年龄(6.4±4.0)岁.血清和(或)脑脊液病毒抗体阳性的病例共380例(38.5%),其中肠道病毒抗体阳性病例最多(44.7%),其次是流行性腮腺炎病毒(35.3%),单纯疱疹病毒(15.5%),风疹病毒(4.5%),乙型脑炎病毒(2.9%).1 016例中,有3例死亡.结论 肠道病毒、流行性腮腺炎病毒和单纯疱疹病毒是北京地区儿童病毒性脑炎最常见的病原.该研究中62.6%的病例仍然缺乏病原学证据,因此需要建立针对更多病毒的快速敏感的检测方法从而为病毒性脑炎的诊断和治疗提供病原学证据.     

急性腹泻儿体内分离出致病菌L型及意义

探讨腹泻儿童肠道致病菌Ｌ型的分离、菌型及临床意义。研究方法８９例腹泻标本和１３２例健康儿童标本经常规法和过滤返祖法（ＦＲＣ－Ｌ）处理，逐日观察至第３１天，取可疑Ｌ型菌常规返祖培养鉴定和药物敏感试验。结果８９例腹泻标本中分离出Ｌ型菌５６株，２６株（４６．４％）经返祖鉴定为致病菌株并具耐药性；ＦＲＣ－Ｌ病原菌分离率（２９．２％）优于常规法（１０．１％）。尤其在２例准备出院的儿童体内检出２株致病菌Ｌ型。健康组儿童体内未检出致病性Ｌ型。结论ＦＲＣ－Ｌ有利于从腹泻标本中分离致病菌Ｌ型和致病菌，与腹泻病程、好发年龄组和流行菌株相关，且分离率优于常规法。部分肠道致病菌能转为Ｌ型并残留在儿童体内。上述研究有助于扩大对腹泻病原菌的认识。     

迁延性慢性腹泻病患儿回肠末端纹状缘肽酶及双糖酶活性的初步研究

摘要 目的 测定迁延性慢性（迁慢性）腹泻病患儿回肠末端纹状缘肽酶及双糖酶活性水平，探讨回肠末端黏膜组织学形态与纹状缘肽酶、双糖酶活性水平的关系。方法 收集结肠镜检查患儿回肠末端黏膜标本行病理学检查，以迁慢性腹泻病及非腹泻病组患儿为观察对象，两组中病理学检查为慢性炎症者为慢性炎症组，余为黏膜正常组。非腹泻病组中病理学检查结果正常者为对照组，测定回肠末端黏膜标本中纹状缘肽酶和双糖酶活性水平。结果 2007年7月至2008年3月在广州医学院附属广州市儿童医院共收集到27例回肠黏膜标本，光镜下见其绒毛形态均正常，病理学检查10/27（37.0％）例有慢性炎症。迁慢性腹泻病组纹状缘肽酶及双糖酶活性水平与对照组差异均无统计学意义（P>0.05），慢性炎症组纹状缘肽酶及双糖酶活性水平与黏膜正常组差异均无统计学意义（P>0.05）。结论 回肠末端黏膜绒毛正常的迁慢性腹泻病患儿，其纹状缘肽酶及双糖酶活性水平无明显变化。慢性炎症且绒毛正常的回肠末端黏膜，其纹状缘肽酶活性及双糖酶无明显变化。     

锌对儿童腹泻的治疗价值与差异

补锌可缩短腹泻的持续时间,降低腹泻再发率及腹泻病死率,但补锌不能减少排便次数和粪便量.锌对6个月龄以下婴儿腹泻无治疗作用,并因腹泻病程、病原体、锌盐类型、补锌剂量不同而存在差异.锌与铁同补可降低效果,与维生素A或液盐同补有协同作用.基础血锌浓度高低对补锌效果无明显影响,现有锌剂的依从性欠佳.病程较长、单独补锌、营养不良...