Renal Biopsy and Family Studies in 65 Children with Isolated Hematuria

ABSTRACT. We have investigated 65 children with isolated hematuria persisting for at least a year. Renal biopsy specimens were studied by light microscopy, electron microscopy and immunofluorescence with antisera specific against basement membrane components. The majority of the biopsies (62/65) showed variable histologic abnormalities. Four categories could be distinguished on combined histological and clinical criteria: Alport syndrome (n=8), benign hematuria (n=33, familial in 23), IgA nephropathy (n = 16) and increase in mesangial cells and matrix (n=5). On the basis of our results, we suggest that a renal biopsy can establish diagnosis and prognosis in those children with isolated hematuria where the family history is negative. If the family has adult male individuals with isolated hematuria, a biopsy can usually be avoided, since this family history effectively excludes Alport syndrome. The use of antisera against basement membrane components did not allow a differentiation between Alport syndrome and benign hematuria. Goodpasture serum immunofluorescence was variable in the former and normally present in the latter.     

门诊儿童秋季腹泻病的轮状病毒检测

目的 对儿科轮状病毒腹泻病进行秋季实时监测,减少门诊抗生素滥用,提高门诊小儿病毒性腹泻病的鉴别能力.方法 选择2006年9-11月本院儿科门诊腹泻儿童75例,分别留取新鲜粪便标本,送临床体液室进行粪便常规显微镜检查有形成分,潜血检查采用金标法试条目测.轮状病毒试条采用免疫层析金标法目测.结果 儿童轮状病毒感染性腹泻发病率为34.7%.9、10和11月份监测结果 分别为32.0%、28.0%和44%.结论 轮状病毒金标试条快速检测为儿科感染性腹泻病因早期甑别提供了可靠依据.     

重型腹泻病并高钠血症的预后

目的探讨小儿重型腹泻病并高钠血症的预后影响因素。方法回顾性分析重型腹泻病及高钠血症患儿的临床资料,对63例重型腹泻病并高钠血症的血钠峰值、病情严重程度、治疗策略和预后的关系进行相关分析。结果本组重型腹泻病患儿高钠血症的发生率为37.28%,占危重患儿高钠血症74.12%;生存组和死亡组的危重病例评分(PCIS)分别为(75.50±6.83)和(60.75±5.34)分,两者比较有非常显著性差异(t=5.86 P<0.001);生存组和死亡组血钠峰值分别为(164.12±10.52)mmol/L和(168.64±12.22)mmol/L,两者比较无显著性差异(t=1.11 P>0.05);血钠下降速度在0.5~1.0 mmol/(L.h)患儿均治愈,而1.2~2.4 mmol/(L.h)的8例在补液过程中均出现脑水肿,其中5例死亡。结论小儿重型腹泻病并高钠血症较常见,是引起危重患儿高钠血症的主要原因,病情严重程度和合理的治疗措施是决定预后的关键。     

Hematologic Findings in Children with Rotavirus-Positive and -Negative Diarrhea

The authors studied neutropenia in 101 children hospitalized for gastroenteritis between 1 December 2000 and 30 June 2001 and identified children tested for rotavirus by reviewing their laboratory records. Rotavirus-positive and rotavirus-negative subjects did not differ significantly in their white blood cell counts, absolute neutrophil counts, or frequency of neutropenia (defined as an absolute neutrophil count <1.0 &#50 10 9 /L), which accompanied 8.6% of rotavirus-positive cases and 9.3% of rotavirus-negative cases of gastroenteritis. The authors conclude that mild neutropenia accompanying diarrhea does not require further evaluation unless it persists or is associated with other factors such as sepsis.     

轮状病毒肠炎患儿尿半乳糖测定的意义

目的 了解轮状病毒肠炎患儿乳糖不耐受的发生率及乳糖不耐受者的病情变化.方法 收集4～20个月大便轮状病毒检测均阳性的腹泻患儿30例.按要求留取尿标本检测,采用半乳糖氧化酶法测定尿半乳糖,同时记录腹泻患儿的临床症状.治疗7 d追踪腹泻症状变化情况.结果 轮状病毒肠炎患儿约56.67%(17/30例)尿半乳糖试验阳性.尿半乳糖试验阳性患儿腹泻病程较尿半乳糖试验阴性患儿略延长,但二组比较无统计学差异.结论 尿半乳糖测定可检测轮状病毒肠炎患儿乳糖酶缺乏情况,为指导临床治疗提供依据.     

Echocardiographic Follow-Up of Children with Isolated Discrete Subaortic Stenosis

This study evaluates the progression of stenosis, onset and progression of aortic regurgitation (AR), and the results of surgical outcomes in children with isolated discrete subaortic stenosis (SAS). The medical records of 108 patients (mean age, 5.5 ± 3.8 years; range, 3 days to 18 years) with isolated discrete SAS were reviewed. Patients with lesions other than AR were excluded. Very mild stenosis was defined as Doppler peak systolic instantaneous gradient (PSIG) less than 25 mmHg, mild stenosis as 25–49 mmHg, moderate stenosis as 50–75 mmHg, and severe stenosis as more than 75 mmHg. Seventy-eight of 108 patients were followed for 2 months to 14 years (mean, 4.8 ± 3.7 years; median, 5 years) with medical treatment alone. In these patients, the mean PSIG at last echocardiogram was higher than the mean PSIG at initial echocardiogram (39 ± 19 vs 31 ± 12 mmHg, respectively; p < 0.001). Among 24 patients with very mild stenosis at initial echocardiogram, 10 had mild and 2 had moderate stenosis after a mean period of 5.6 years. Among 46 patients with mild stenosis at initial echocardiogram, 11 had moderate and 5 had severe stenosis after a mean period of 4.1 years. Only 1 patient among the 8 patients with moderate stenosis at initial echocardiogram had severe stenosis after a mean period of 2.7 years. Thirty-nine patients (50%) had AR (13% trivial, 33% mild, and 4% moderate) at initial echocardiogram. After a mean period of 4.8 years, 77% of the patients had AR (10% trivial, 53% mild, 9% mild–moderate, and 5% moderate). Twenty-four patients underwent surgery. Preoperatively, mean Doppler PSIG and AR incidence were 64 ± 17 mmHg and 91% (22/24), respectively. The mean Doppler PSIG was 30 ± 19 mmHg and AR was present in all of the patients a mean period of 4.1 years after surgery. Two patients underwent reoperation for recurrent SAS and AR. Patients with very mild or mild stenosis may be followed noninvasively every year. One patient of the 8 patients with moderate stenosis progressed to severe stenosis, and moderate AR developed in 2 patients after a mean of 2.7 years. We recommend that patients with moderate stenosis undergo careful evaluation to determine whether surgery is necessary due to the severity of stenosis and AR.     

伴或不伴呕吐的急性腹泻患儿的循证治疗指南

无论是社区诊所还是医院,小儿腹泻均很常见,但其诊治并不规范。本指南基于循证原则,由澳大利亚儿童健康指南制定小组针对发病7d以内的急性腹泻患儿,制订了适合社区诊所和医院的诊治流程和规范化治疗方案,着重于脱水的评估和补液治疗。现介绍如下。     

小儿腹泻病治疗新进展

针对小儿腹泻病因复杂、治疗困难的特点,介绍全球有关小儿腹泻方面的新治疗方法;详细论述病原治疗、微生态制剂治疗、支持疗法、疫苗研究和应用等治疗方法及其作用机制、治疗特点;并介绍国外针对小儿腹泻的临床试验案例,分析主观因素的影响和中药治疗方法.     

小儿慢性腹泻病的营养治疗

小儿慢性腹泻病（chronic diarrhea disease，CDD）是导致小儿营养不良的重要原因，而营养不良又常会加重CDD患儿病情，严重影响患儿生长发育，因此若想减轻或避免腹泻引起的营养不良和提高患儿生存质量，合理地作好CDD患儿营养治疗是非常必要和必须的。     

Zinc and Copper in Hair and Plasma of Children with Chronic Diarrhea

ABSTRACT. Zinc and copper status was evaluated in nineteen children with chronic diarrhea. An intestinal biopsy suggested that eight of these patients had celiac disease and eleven suffered chronic diarrhea without malabsorption and had normal villi or minimal changes. They were studied for malabsorption and compared with two control groups consisting of nineteen healthy and eleven malnourished children. Plasma zinc was depressed in the celiac disease group when compared with the normal children, but was similar to that of the malnourished children. Hair zinc was also depressed for the chronic diarrhea groups (23.2± 15.2 and 34.4±21.9 μg/g for those with or without malabsorption respectively, vs. 97.9± 15.2 for the healthy group). Plasma and hair copper values were diminished in both groups with chronic diarrhea. A significant correlation was found between plasma carotene levels after oral carotene overload, and both plasma zinc and hair copper values ( r =0.62, P <0.01 and r =0.56, p <0.05, respectively). There was also a significant correlation between plasma zinc and plasma protein ( r =0.54, p <0.05). Hair determinations seem to be more sensitive than plasma values to changes in zinc or copper status in chronic diarrhea. Chronic diarrhea in children is associated with lower levels of zinc and copper, especially when accompanied by malabsorption.     

南京儿童医院腹泻患儿轮状病毒感染情况

目的分析南京儿童医院腹泻患儿中轮状病毒(RV)的感染情况。方法收集南京儿童医院2004年1月-2006年12月门诊及住院非细菌性感染性腹泻患儿粪便标本,经聚丙烯酰胺凝胶电泳(PAGE)或酶联免疫吸附试验(ELISA)检测RV。结果3 324例标本中共检出RV阳性1 406例,检出率为42.30%。其中6~11个月、1~2岁和2~3岁3个年龄段RV检出率分别为43.4%、47.1%和51.2%;RV腹泻年龄最高为6~11个月年龄段,达41.2%;全年检出RV比较,秋冬季(9~12月份)为检出高峰,占56.2%;1 035例RNA阳性标本中,RNA长型占819例(79.13%)。结论南京儿童医院RV腹泻中6个月~2岁婴幼儿是RV的易感人群。以秋冬季(9~12月份)为流行高峰,基因组以长型为主。     

慢性、难治性腹泻病的诊断与治疗进展

腹泻指每天大便排出量增加 ,通常与肠道水、电解质转运被破坏而引起大便中水分含量增加有关。小儿胃肠道处理 2 85mL/ (kg·d)液体而排出 5～ 10g/ (kg·2 4h)大便 ,如排大便量超过 10g/ (kg·2 4h)则为腹泻[1,2 ] 。症状持续 2周或以上称为慢性腹泻 ,常与下列因素有关 :1.急性     

表现为慢性腹泻的儿童艾滋病7例

目的 探讨以慢性腹泻为主要表现的儿童获得性免疫缺陷综合征(艾滋病,AIDS)的临床特点,分析其原因.方法 1999年1月-2006年12月北京儿童医院共确诊AIDS儿童17例,其中表现为慢性腹泻患儿7例.男4例,女3例.对其腹泻时间、腹泻程度、大便特点、伴随症状及各项实验室检查结果等临床资料进行回顾性分析.结果 发病年龄2～9岁,平均6岁.腹泻时间1～16个月,平均6个月.以慢性腹泻就诊4例,以发热、咳嗽、消瘦就诊3例.腹泻出现时间:病程开始即出现6例,仅1例是病程第9个月出现.7例均有营养不良,其中2例为中度,5例为重度;7例患儿均有贫血,其中轻度4例,中度3例;6例体质量、身高分别位于同年龄同性别正常儿童的第3百分位以下.大便常规:阴性5例,阳性2例(白细胞2～15/HP,红细胞0～60/HP);7例大便涂片均未见寄生虫虫卵、滋养体及真菌孢子;大便普通培养:3例多次培养均阴性;大便真菌培养:2例阴性,1例培养出白色念珠菌(2次).检测CD系列的全部患儿CD4均明显降低,CD4/CD8降低5例.伴低钾血症及代谢性酸中毒5例;发热4例.结论 儿童AIDS中的腹泻症状较常见,病程相对较长,且多伴生长发育迟缓、营养不良及贫血,与机会性感染及人类免疫缺陷病毒感染相关.     

儿童链球菌感染分离株emm分型及超抗原基因谱的变迁

目的通过对1993-1994年和2005-2006年359株儿童A族溶血性链球菌(GAS)分离株进行emm分型及8种超抗原基因检测,探讨不同时期儿童GAS感染分离株emm分型及超抗原基因的变化。方法采用PCR法对2个时期359株儿童GAS分离株进行emm分型及8种超抗原基因扩增。结果 emm1和emm12在不同时期均为主要流行型,其他型别不断变化。与1993-1994年比较,2005-2006年GAS菌株emm型较集中,emm1和emm12显著增多(Pa<0.01)。携带6种或6种以上超抗原基因的GAS分离株从46.53%(1993-1994年)增加到78.39%(2005-2006年),ssa,speH和speJ基因的携带率明显增加(P<0.05),而speA基因的携带率显著下降(P<0.05)。超抗原emm基因谱与emm分型之间有密切关系,相同的emm型在不同的时期携带不同的超抗原基因,emm型的分布和超抗原基因谱与GAS感染性疾病之间无显著性联系。结论儿童链球菌感染分离株emm分型及超抗原基因谱随年代变迁。此数据为制备符合我国GAS感染的疫苗提供依据。