Serum free fatty acid level in children with primary hypertension北大核心CSCD

目的研究儿童原发性高血压血清游离脂肪酸(free fatty acid,FFA)的水平,探讨其在儿童原发性高血压发病和防治中的临床意义。方法回顾性选取2021年1—6月首都儿科研究所附属儿童医院初治的34例原发性高血压儿童为高血压组,以同期体检的血压正常儿童32例为对照组。比较2组的空腹血清FFA、空腹血清三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)和非高密度脂蛋白胆固醇(non-high-density lipoprotein cholesterol,non-HDL-C)水平。采用多因素logistic回归分析探讨血清FFA对原发性高血压发病的影响。结果高血压组体重指数(body mass index,BMI)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)高于对照组,差异有统计学意义(P<0.05)。高血压组血清FFA、TG、LDL-C、non-HDL-C高于对照组,而血清HDL-C低于对照组,差异均有统计学意义(P<0.05)。高血压组血清FFA升高(女性>0.45 mmol/L,男性>0.60 mmol/L)率和传统血脂异常(血清TG、TC、LDL-C、HDL-C、non-HDL-C中至少一项异常)率均高于对照组,差异有统计学意义(P<0.05)。纳入年龄、性别、BMI、血清FFA升高、传统血脂异常等指标构建多因素logistic回归方程,结果显示血清FFA升高是儿童原发性高血压的独立危险因素(OR=17.560,95%CI:1.964~157.003,P<0.05)。结论原发性高血压儿童血清FFA明显升高;血清FFA升高可增加儿童原发性高血压的发病风险。     

The role of bronchoscopy in slide tracheoplasty in children北大核心CSCD

目的 总结支气管镜在儿童Slide气管成形术中的作用。方法 回顾性分析2017—2020年湖南省人民医院收治的4例气管狭窄患儿的诊疗经过,总结支气管镜在Slide气管成形术术前评估、术中定位与测量及术后创面评估和治疗中的作用。结果 Slide气管成形术术前支气管镜评估显示,4例患儿中3例存在完全气管环,2例合并肺动脉吊带,2例存在多处狭窄。3例在该院完成Slide气管成形术,术中支气管镜下判断狭窄段中点及测量狭窄段长度,协助离断气管狭窄段,术后灌洗明确病原;1例外院Slide气管成形术术后9个月出现瘢痕牵拉,经支气管镜下介入治疗好转。2例术后第4天支气管镜下发现气管黏膜改变,调整治疗方案;2例术后1个月出现肉芽增生,经支气管镜下冷冻治疗好转。1例因吻合口坏死放弃治疗死亡,存活的3例随访6个月以上,预后可,但均存在气管支气管软化。结论 支气管镜可用于气管狭窄患儿Slide气管成形术的管理,有助于术后康复及随访。     

Recent research on inherited metabolic diseases in children北大核心CSCD

随着遗传代谢病（inherited metabolic diseases,IMD）研究水平和诊治技术的提高,我国儿童IMD的研究取得了很大进步,但相比于国际水平仍有一定距离。同时由于我国幅员辽阔,医疗资源分布不均,IMD尚没有明显的地域特征,在早期诊断和治疗上仍存在诸多的问题与困难。因此,提高儿科医生对儿童IMD认识的广度和深度,以期在提高整体专业诊治水平的同时,更好地做到对儿童IMD的早发现、早诊断、早治疗,更有效地降低IMD患儿的病死率与致残率。该文就我国儿童IMD的研究进展进行综述,并就其中具有代表性的IMD进行分析。     

Clinical features of children with coronavirus disease 2019 complicated by acute encephalitis and related research advances北大核心CSCD

2019年底以来,新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)在世界范围内大流行,该病出现神经系统症状的报道不断增加。其中,脑炎被认为是COVID-19严重的神经系统并发症,但国内报道缺乏。合并急性脑炎患儿症状重,如未能早期识别、及时治疗,病死率高,预后差。目前全球疫情仍在流行期间,有必要对COVID-19儿童神经系统重症表现予以关注。因此该综述通过文献检索及详细病案分析,探讨COVID-19合并急性脑炎的临床特点,旨在为临床医生应对可能出现的COVID-19合并急性脑炎病例提供参考。     

Clinical and genetic analyses of Joubert syndrome in children北大核心CSCD

目的 分析儿童Joubert综合征(Joubert syndrome,JS)的临床特征及遗传学特点。方法 回顾性分析2017年1月—2022年7月郑州大学第三附属医院儿童康复科诊断的20例JS患儿的临床资料、遗传学结果及随访资料。结果 20例JS患儿中,男11例,女9例。患儿临床表现以发育迟缓(20例,100%)、眼球运动异常(19例,95%)、肌张力低下(16例,80%)多见,5例(25%)出生时呼吸节律异常,3例(15%)面容异常(包括前额突出、耳位低、三角口),所有患儿均无肢体畸形。20例(100%)患儿头部影像学均有典型的“磨牙征”、“中线裂征”,6例(30%)患儿眼部检查异常。完成基因检测7例,发现6个致病基因(CPLANE1、RPGRIP1L、MKS1、CC2D2A、CEP120、AHI1基因)。结论 对于发育迟缓患儿,尤其是伴随眼球运动异常、肌张力低下症状,建议完善头部影像学检查明确有无“磨牙征”、“中线裂征”等特征,以排查JS,避免漏诊、误诊。JS有多种致病基因,全外显子组测序可协助诊断。     

Efficiency of Rituximab in treating children with refractory nephrotic syndrome北大核心CSCD

目的评价利妥昔单抗(RTX)在难治性肾病综合征患儿中维持缓解的有效性。方法回顾性研究。将2018年11月至2020年11月华中科技大学同济医学院附属武汉儿童医院肾内科诊断为难治性肾病综合征的22例患儿纳入研究, 予RTX治疗。外周血中CD19+B淋巴细胞≥1%总淋巴细胞者追加1剂RTX(375 mg/m2), 每例患儿使用3~4剂, 早期停用钙调神经磷酸酶抑制剂(CNI), 后续使用霉酚酸酯治疗。采用Kaplan-Meier法对RTX治疗后患儿的蛋白尿无复发率和无频复发肾病综合征或激素依赖肾病综合征发生率进行分析, 采用Wilcoxon秩和检验对使用RTX前后的复发次数进行分析。采用秩和检验对RTX治疗前后患儿的体质量指数(BMI)及身高进行比较。结果 22例患儿中, 20例患儿完成治疗方案, 1年和2年的蛋白尿无复发生存率分别为85%和40%, CNI停用后复发频率降低。所有患儿BMI及身高在使用RTX治疗前与使用RTX 1年后、2年后比较, 差异均有统计学意义(均P<0.05), 使用RTX后1、2年比较, 差异均无统计学意义(均P>0.05)。结论使用RTX在停用激素和其他免疫抑制剂情况下也可有效降低难治性肾病综合征的复发率, 同时可使患儿BMI及身高得到明显改善。RTX治疗难治性肾病综合征患儿安全有效。     

儿童自身免疫性脑炎2020年诊断标准的单中心临床验证北大核心CSCD

目的评价儿童自身免疫性脑炎(AE)2020年诊断标准(Cellucci标准)在单中心疑似AE患儿中的应用价值。方法回顾性收集和分析2019年10月至2021年10月在郑州大学第一附属医院住院治疗且疑似AE的121例患儿的临床资料,参照"中国自身免疫性脑炎诊治专家共识"和Graus标准进行临床诊断,分为确诊的抗体阳性AE组、拟诊的抗体阴性AE、可能的AE组和非AE组。再根据Cellucci标准作出新诊断,与临床诊断比较,评价其诊断价值。组间比较采用Mann-WhitneyU检验、Kruskal-Wallis检验和χ^(2)检验,Cellucci标准的效能采用灵敏度和特异度评价。结果 121例患儿中男72例、女49例,起病年龄10.3(6.5,14.0)岁。临床诊断99例AE(男58例、女41例),包括确诊的抗体阳性AE组43例、拟诊的抗体阴性AE组14例和可能的AE组42例,非AE组22例(男14例、女8例)。99例AE患儿首发症状前2位为癫痫发作(53例,53.5%)、精神行为异常(35例,35.4%),病程中以精神行为异常(77例,77.8%)和癫痫发作(64例,64.6%)常见。不同诊断4组间病程中意识障碍、自主神经功能障碍发生率以及住院时间差异均有统计学意义(χ^(2)=21.63、13.74,H=22.60,均P<0.05)。96例患儿行AE相关抗体检测,45例(46.9%)抗体阳性。应用Cellucci标准诊断确诊的抗体阳性AE 42例、拟诊的抗体阴性AE 34例和可能的AE 14例;参照临床诊断,Cellucci标准诊断上述3类AE的灵敏度依次为93.02%、92.86%、87.88%,特异度依次为96.23%、74.39%、86.36%。结论 Cellucci标准在疑似AE患儿临床诊疗中诊断可能的AE和确诊的抗体阳性AE时有较高的灵敏度和特异度,诊断拟诊的抗体阴性AE时灵敏度高而特异度较低,建议临床实践中根据实际情况选择性应用,尤其是在诊断拟诊的抗体阴性AE时。     

Clinical efficacy of combined therapy in children with stage 4 neuroblastoma北大核心CSCD

目的 观察4期神经母细胞瘤联合治疗的早期疗效,探讨提高生存率及改善生活质量的治疗方案。 方法 对2016年1月至2021年6月在香港大学深圳医院确诊的14例4期神经母细胞瘤患儿的临床资料、治疗及随访情况进行回顾性分析。 结果 14例患儿中位发病年龄为3岁7.5个月。骨髓检查阳性9例,N-Myc基因扩增4例,神经元特异性烯醇化酶增高13例,尿香草扁桃酸增高7例。病理结果：分化型6例,未分化型1例,混合型1例,分化差型6例。N7方案化疗10例（含2例N7方案+三氧化二砷化疗患儿）,Rapid COJEC方案化疗4例。手术13例;自体造血干细胞移植14例;放疗10例。Ch14.18/CHO免疫治疗8例,其中1例因在治疗过程中出现过敏性休克而停止免疫治疗;其余7例完成治疗,期间未观察到严重不良反应。完成免疫治疗患儿中1例复发后进行3次Lu177 Dotatate治疗,目前仍在化疗中。14例患儿中位随访时间为45个月。2年内复发4例,2年内总生存率100%;3年内复发4例,3年内无病存活7例。 结论 儿童4期神经母细胞瘤建议选择多学科联合方案治疗,使4期神经母细胞瘤患儿获得更好的生存及预后。     

Main causes of aplastic anemia misdiagnosed as immune thrombocytopenia in children北大核心CSCD

目的归纳曾被误诊为免疫性血小板减少症(ITP)的50例儿童再生障碍性贫血(再障)的主要原因和鉴别诊断经验,以供临床参考。方法参照儿童再障和ITP诊断标准,回顾性分析2007年1月至2020年12月上海市同济医院儿科收治的外院误诊病例的病初资料和本院复诊检测结果,归纳误诊原因和鉴别诊断要点。结果在同期收治的165例儿童再障中,共有50例(30.3%)曾被误诊为ITP。分析归纳主要误诊原因为:1.临床表现不符合典型ITP,未按照国际指南标准行必要的骨髓检查以明确诊断,共22/50例。2.骨髓检测结果解读有误。在28例初诊行骨髓涂片检查者中,6例(21%)骨髓显示典型再障骨髓象,但仍被诊断为ITP。3.骨髓涂片结果不典型者,未行骨髓活检以助诊断(15/28例,54%)。4.初诊时符合ITP诊断标准,但经糖皮质激素等治疗无效后,未行必要复查以核实诊断(7/28例,25%)。结论临床应严格参照执行相关疾病诊断标准,以避免经验性错误。诊断ITP需要慎重,尤其是临床表现不典型,或一线药物无效者,必须进行骨髓检查(必要时行骨髓活检),并按诊断标准正确解读检测结果,以避免临床误诊或漏诊。     

Recent research on the application of defoamers in children undergoing digestive endoscopy北大核心CSCD

内镜是诊断和治疗儿童消化道疾病的常见手段。胃肠道内存在气泡,是影响内镜视野清晰度的重要因素之一。祛泡剂的应用,可显著减少肠道内气泡,提高胃肠道准备质量,进一步提高疾病检出率。现关于儿童内镜检查前的胃肠道准备各有研究,但缺乏对应用祛泡剂的统一方案。故该文就儿童消化内镜检查前祛泡剂的使用情况及研究进展作一总结,并指出对祛泡剂的现有研究样本量少,用药选择和时机仍存在争议,为以后祛泡剂的深入研究提供借鉴。     

Analysis of the inhalant allergen spectrum in 4488 children with allergic rhinitis in Tianjin北大核心CSCD

目的探讨天津地区儿童过敏性鼻炎(AR)吸入性变应原种类及特点,为儿童AR预防与诊疗提供依据。方法回顾性收集2016年3月至2022年2月天津医科大学第二医院儿科哮喘和过敏专病门诊AR患儿4488例的临床资料,分析儿童AR的吸入性变应原分布特点,探讨吸入性变应原阳性率及变应原种类与性别、年龄以及共患其他过敏性疾病的关系。采用UniCAP100系统(荧光酶联免疫法)测定血清变应原特异性IgE(sIgE)。计数资料以例数及百分率(%)表示,组间比较采用χ^(2)检验。结果1.4488例AR患儿中吸入性变应原阳性3116例,阳性率69.43%。单一变应原阳性比例28.47%(887/3116)、双重变应原阳性比例25.22%(786/3116)、3种变应原阳性比例19.67%(613/3116)、4种及4种以上变应原阳性比例26.64%(830/3116)。最常见吸入性变应原为霉菌类(45.72%,2052/4488),其次依次为粉尘螨(34.71%,1558/4488)、艾蒿(33.95%,313/922)、屋尘螨(31.13%,1397/4488)、豚草(30.97%,227/733)等。2.学龄前组、学龄组、青少年组吸入性变应原阳性率依次为56.15%(1132/2016)、79.26%(1624/2049)、85.11%(360/423)(χ^(2)=309.72,P<0.001)。在学龄前组、学龄组首位吸入性变应原均为霉菌类(40.23%、50.85%),在青少年组首位吸入性变应原为粉尘螨(56.74%),其次为屋尘螨(53.66%)、霉菌类(47.04%)。3组吸入性变应原阳性种类比较差异有统计学意义(χ^(2)=466.99,P<0.001)。在学龄前期组以单一变应原阳性为主,学龄组、青少年组吸入性变应原阳性种类增多,以4种及4种以上变应原为主。3.男童组吸入性变应原阳性率达73.28%(2139/2919),明显高于女童组阳性检出率62.40%(979/1569)(χ^(2)=58.28,P<0.001),男童和女童组常见吸入性变应原前3位均为霉菌类、艾蒿、粉尘螨。吸入性变应原阳性种类在男童与女童组比较差异有统计学意义(χ^(2)=75.02,P<0.001),女童组以单一变应原为主(20.78%),男童组变应原阳性种类增多,以4种及4种以上变应原阳性为主(20.45%)。4.AR共患支气管哮喘和特应性皮炎组吸入性变应原阳性率最高,达79.21%,其次AR共患支气管哮喘阳性率73.67%,AR共患特应性皮炎组阳性率61.05%,单纯AR组阳性率57.05%,组间比较差异有统计学意义(χ^(2)=178.57,P<0.001)。结论天津地区儿童AR主要吸入性变应原依次为霉菌类、粉尘螨、艾蒿、屋尘螨、豚草,不同年龄、性别及共患不同过敏性疾病吸入性变应原分布特征存在差异。应尽早为AR患儿检测变应原,做到提前预防,减少药物使用量,也为开展变应原免疫治疗提供依据。     

儿童上消化道溃疡173例临床分析北大核心CSCD

目的 探讨儿童上消化道溃疡的临床表现和胃镜特点。方法 对2011年1月至2021年5月于中国医科大学附属盛京医院内镜中心完成胃镜检查并首次发现上消化道溃疡的0~14岁患儿进行回顾性研究。根据病因不同分为原发性溃疡组(简称原发组,n=148)和继发性溃疡组(简称继发组,n=25)。比较两组患儿的临床资料。结果 共纳入173例上消化道溃疡患儿,男女比例3.9∶1。与女孩相比,男孩的上消化道溃疡中十二指肠溃疡和原发性溃疡的占比较高(P<0.05)。与6岁以下儿童相比,6~14岁儿童十二指肠溃疡和原发性溃疡占比较高,巨大溃疡和多发溃疡少见。原发组148例患儿中,幽门螺杆菌的感染率为64.2%(95例);腹痛是最常见的临床症状,共101例(68.2%);十二指肠溃疡多见(115例,77.7%),其次为胃溃疡(25例,16.9%)及食管溃疡7例(4.7%);多发溃疡32例(21.6%);出现并发症的有70例(47.3%),其中最常见的为出血(63例,43.6%)。继发组25例患儿中,最常见的临床症状也是腹痛(9例,36%),但较原发组发生率低(P<0.05);引发继发性溃疡最常见的原因是消化道异物,共17例(68%),其次是腹型过敏性紫癜5例(20%)及克罗恩病3例(12%);出现多发溃疡及巨大溃疡的比例较原发组高(P<0.05)。结论 儿童上消化道溃疡男孩多发,且男孩多为十二指肠溃疡和原发性溃疡。年长儿的上消化道溃疡多为十二指肠溃疡和原发性溃疡,巨大溃疡和多发溃疡相对少见。原发性溃疡临床表现多样,以腹痛为主,十二指肠溃疡多见,并发症以出血为主;继发性溃疡的临床症状及内镜表现与其原发病因密切相关,并且更易诱发巨大溃疡和多发溃疡。     

Surgical options for esophageal stenosis in children北大核心CSCD

Objective To explore the clinical efficacy of progressive individualized options for esophageal stenosis (ES) in children. Methods From January 2017 to December 2022, retrospective review was conducted for 106 ES children with regular follow-ups. There were 59 boys and 47 girls with an age range of (3.00 ± 0. 75) year and a body weight of (9.00 ± 1. 25) kg. The causes were anastomotic (n: 58), corrosive (n: 47) and congenital (n: 1). Sequential treatments of direct balloon dilation under gastroscope, submucosal injection of drugs into esophagus, esophageal stenting and surgical procedures were applied. After interventions, degree of ES was observed by esophagography and gastroscopy along with dysphagia grade for evaluating clinical efficacy. Differences were compared by I or yr test. Results All of them were discharged uneventfully. After balloon dilatation, the outcomes were excellent under direct gastroscopic view alone (n: 55). Among 35 children with balloon dilation plus esophageal submucosal drug injection, the outcomes were excellent (n: 25) and esophageal stenting (n: 10). Among 25 children with esophageal stenting, the outcomes were excellent (n:21) and additional surgery (n: 4). Surgical procedures were performed with excellent outcomes (n:5). Conclusions The clinical outcomes progressive individualized options of direct visualization balloon dilation under gastroscope, balloon dilation plus submucosal injection of drugs into esophagus, esophageal stenting and surgical procedure are precise, convenient and efficacious for ES in children. © 2023 Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.     

Investigation on serum pertussis toxin antibody levels in children aged 0-14 in Hangzhou北大核心CSCD

Objective To investigate the serum antibody level in children with pertussis in Hangzhou city, and to evaluate the incidence of pertussis in children and the immunization effect of vaccine. Methods A retrospective study was conducted.The pertussis toxin IgG antibody levels in 1 486 children aged 0-14 who received physical exa-mination in Hangzhou Children′s Hospital from January to December 2018 of were collected and analyzed.Serum antibody level ≥30 IU/mL was considered seropositive.The children enrolled were divided into the 0-3-year-old, 4-6-year-old, 7-9-year-old and 10-14-year-old groups; then the children under 3 years old were subdivided into groups of 0-<3 months, 3-<6 months, 6-<9 months, 9-<12 months, 12-<18 months, and 18-≤ 36 months; finally, the children were grouped according to their vaccination times, the pertussis toxin IgG antibody level and the infection rate of pertussis were compared among different groups by Mann-Whitney U, Kruskal-Wallis and χ2 tests. Results The overall positive rate of the pertussis toxin IgG antibody was 23.62% (351/1 486), and the median antibody concentration was 6.60 IU/mL.Among children aged 0-14, the 0-3-year-old children had the highest positive rate of the pertussis toxin IgG antibody and the highest median antibody concentration, which were 24.58% (29/118) and 6.95 IU/mL, respectively.There was no significant difference in the antibody positive rate and the median antibody concentration among different age groups (all P>0.05). Among different subgroups of children aged 0-3, the pertussis toxin IgG antibody positive rate and the median antibody concentration were statistically significant (all P<0.05). It was predicted that the pertussis infection rate in children over 3 years old in Hangzhou was about 45.99%.The patients receiving more than 3 doses of vaccination accounted for 87.48% (1 300/1 486), and their antibody positive rate was 25.46% (331/1 300). After excluding unvaccinated children, the comparison results suggested that there was statistical significance in the antibody positive rate and median antibody concentration among different vaccination groups (χ2=24.467, 67.438, all P<0.001). Conclusions The serum pertussis toxin IgG antibody positive rate in children aged 0-14 in Hangzhou is low, but their predicted pertussis infection rate is higher.Children aged 0-14 are easy to become a main source of infection.Therefore, it is necessary to pay attention to and strengthen the vaccination plan and research, enhance the monitoring of the infection source, and prevent the " recurrence of pertussis" . © 2022 Authors. All rights reserved.     

Long-term trajectories of lung function and risk factors in children with bronchial asthma北大核心CSCD

目的建立支气管哮喘(哮喘)患儿肺功能长期变化的发展轨迹, 确定哮喘患儿出现长期肺功能损伤的危险因素。方法采用回顾性队列研究, 纳入2019年1月至12月在首都儿科研究所附属儿童医院定期随诊, 并完成肺功能检测的14岁以上哮喘患儿, 收集其肺功能资料及临床信息。采用潜变量增长模型(LCGM)拟合哮喘患儿肺功能发展轨迹, 建立不同的轨迹组, 组间比较采用t检验、方差分析或χ2检验, 确定肺功能长期变化危险因素采用多分类Logistic回归分析。结果共纳入哮喘患儿173例, 年龄6~17岁, 获得肺功能测定1 160例次。拟合4条1秒率(FEV1/FVC)潜分类轨迹:持续高水平组、高于平均水平组、低于平均水平组、持续低水平组, 其病例数分别为27例(15.6%)、66例(38.1%)、66例(38.1%)、14例(8.1%)。不同轨迹组患儿的FEV1/FVC在每一年龄组间的差异均有统计学意义(均P<0.05)。持续高水平组各年龄段的FEV1/FVC均在90%以上, 其余各轨迹组FEV1/FVC随年龄变化整体呈下降趋势, 低于平均水平组的FEV1/FVC在青春期后下降至80%以下;持续低水平组的FEV1/FVC均值在学龄期后即下降至80%以下, 至青春期接近70%。最大用力呼气中段流量(MMEF)的轨迹和波动情况与FEV1/FVC相似。危险因素分析显示, 与持续高水平组相比, 典型哮喘患儿肺功能轨迹处于低于平均水平组的风险是咳嗽变异性哮喘患儿的11.940倍(P=0.008);多重致敏患儿的肺功能轨迹处于低于平均水平组的风险是单一致敏的7.462倍(P=0.015);未规律用药患儿肺功能处于持续低水平组的风险是规律用药者的6.337倍(P=0.035);男童肺功能轨迹处于低于平均水平组的风险是女童的6.186倍(P=0.002)。结论 6~17岁哮喘患儿的长期肺功能变化可确定4条不同轨迹:持续高水平、高于平均水平、低于平均水平、持续低水平;近半数患儿的长期肺功能轨迹处于低水平, 较多患儿在青春期, 少数患儿在学龄期出现持续性气流受限;典型哮喘、多重致敏、未规律用药、男性是哮喘患儿长期肺功能降低的危险因素。     

Features of unintentional injury in children under the impact of coronavirus disease 2019北大核心CSCD

目的探究新型冠状病毒肺炎疫情下儿童意外伤害的特征,旨在为疫情背景下儿童意外伤害的防治提供参考。方法回顾性分析2019年7月—2022年6月上海交通大学附属医学院新华医院收治的意外伤害患儿2526例的病例资料,按时间段分为5个阶段:疫情前(2019年7—12月)、武汉疫情期(2020年1—4月)、全国疫情平稳期(2020年5月—2022年2月)、上海疫情期(2022年3—5月)、上海疫情平稳期(2022年6月)。比较不同时间阶段和年龄阶段儿童意外伤害发生情况,并进一步对其中107例患儿进行问卷调查,探讨儿童意外伤害的特征。结果5个时间阶段意外伤害患儿的性别构成、年龄、年龄分布及多种类型意外伤害构成比的比较,差异均具有统计学意义(P<0.05)。武汉疫情及上海疫情期因意外伤害就诊的人数明显减少。外伤相关意外伤害患儿在各个阶段占比均超过50%,其中武汉疫情期及上海疫情期外伤相关意外伤害人数占比分别为63.9%和82.0%。意外伤害多见于学龄期及学龄前期儿童(1823例,72.17%)。与2021年同期相比,上海疫情期发生意外伤害患儿年龄更小(中位数7岁vs 11岁),外伤相关意外伤害患儿占比增加(97%vs 69%),差异均有统计学意义(P<0.05)。结论新型冠状病毒肺炎疫情背景下儿童意外伤害病例数减少,而外伤相关意外伤害占比增加。学龄前期及学龄期儿童意外伤害更常见。     

Mental health problems in children with atopic diseases北大核心CSCD

Child atopic disease is a global public health problem. Because it can cause various mental health problems,it is getting more and more attention. In recent decades,the prevalence of child atopic diseases is dramatically increasing,and children's physical and mental health are affected to different degrees. There are several hypotheses about the potential mechanism between atopic diseases and psychological problems. Herein, the psychological and behavioral problems in children with atopic diseases and the associated mechanism will be discussed. Furthermore, it suggests that the professionals should pay more attention to the children's psychosomatic diseases,and pay more attention to the interactive effect between atopic diseases and mental health problems. It is important for the diagnosis,prevention and intervention of children with the psychosomatic diseases. © 2019 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.     

Causes of death in 15 children with omphalocele北大核心CSCD

Objective To summarize the major causes of death for congenital omphalocele so as to optimize its treatments in children. Methods Retrospective review was performed for the clinical data of 15 children dying from omphalocele from June 2015 to June 2022. There were 8 boys and 7 girls. Term was premature (n: 5) and mature (n: 10). Gestational week, gender, weight, soma totype, complicated malformations and causes were analyzed. Results Size was giant (n: 13) and small (n: 2). The associated conditions were pulmonary hypertension (n: 13), patent ductus arteriosus (n: 13), atrial septal defect (n: 15), ventricular septal defect (n: 9), congenital diaphragmatic hernia (n: 1), non-compaction of ventricular myocardium, bronchopulmonary dysplasia (n: 4), Merkel's diverticulum (n:3) and congenital intestinal malrotation (n:9). Neonatal necrotizing enterocolitis (n: 1), respiratory syncytial virus infection (n: 2) and pneumorrhagia (n: 2) occurred during treatment. Eight deaths were due to pulmonary hypertension. Two cases were abandoned due to complicated malformations, one death occurred without repairing congenital diaphragmatic hernia, two deaths were caused by respiratory syncytial virus infection, one child died from heart failure due to non-compaction of ventricular myocardium and another from heart failure after double-outlet RV surgery. Conclusions Children with congenital omphalocele may die from various causes. And pulmonary hypertension is a major cause. Other diseases and complications should be aggressively managed during hospitalization. © 2023 Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.     

Diversity and functional prediction of gut microbiota in children with autism spectrum disorder北大核心CSCD

目的分析孤独症谱系障碍(autism spectrum disorder,ASD)儿童肠道菌群结构和多样性,并预测分析菌群的代谢功能。方法采集30例ASD儿童(ASD组)和20例正常发育(typically developing,TD)儿童(TD组)的粪便样本。提取基因组DNA,PCR扩增16S rDNA V4区,使用Illumina NovaSeq6000平台进行高通量测序。分析2组肠道菌群的构成和分布特征,并预测分析菌群的代谢功能。结果ASD组和TD组儿童肠道菌群的α多样性指数(Chao1、Shannon和Simpson)比较差异均无统计学意义(P>0.05)。在门和纲水平,2组儿童肠道菌群的结构差异无统计学意义(P>0.05)。在属水平,ASD组巨单胞菌属、巴恩斯氏菌属、小杆菌属、巨球菌属、瘤胃球菌属扭链群及梭杆菌属的丰度大于TD组(P<0.05)。功能预测分析显示,ASD组肠道菌群的色氨酸降解、谷氨酸降解及丁酸盐生成等代谢功能的丰度低于TD组(P<0.05),而γ-氨基丁酸降解功能的丰度高于TD组(P<0.05)。结论ASD儿童和TD儿童肠道菌群的α多样性无显著差异,但属水平物种构成不同,菌群的代谢功能有差别。     

Clinical and laboratory results of 270 children with infectious mononucleosis北大核心CSCD

Objective To summarize the clinical and laboratory characteristics of infectious mononucleosis (I M) in children. Methods Clinical features and laboratory results of 270 cases with IM admitted to the Department of Pediatrics in Strategic Support Force Medical Center of People's Liberation Army from January 2012 to December 2020 were retrospectively analyzed. χ2 test was used for comparison between groups. Results IM mainly occurred in children aged 5 months to 18 years old in autumn and spring. The highest incidence rate (105 cases, 38.9 %) was 3 - <6 years old (preschoolers). There were 253 cases (93.7%) with fever, 266 cases (98.5 %) with adenopharyngitis, 196 cases (72.6%) with tonsil pseudomembrane or exudation, 248 cases (91.9%) with cervical lymphadenopathy, 92 cases (34.1%) with eyelid edema, 202 cases (74.8%) with nasal obstruction, 124 cases (45.9%) with nasal obstruction and snoring, 24 cases (8. 9 %) with rash, and 112 cases (41.5%) with splenomegaly. A total of 225 cases (83.3%) presented with typical triplets of IM (fever, adenopharyngitis and cervical lymphadenopathy). Sixty - two IM patients were complicated with pulmonary infections and 3 cases with diarrhea. The main co - infection pathogens in children with IM were Mycoplasma pneumonia (M P) (79 cases, 29.3%), influenza A or B virus (34 cases, 12.6%), Streptococcus pneumonia (S P) (18 cases, 6.7%), adenovirus (22 cases, 8.1%) and cytomegalovirus (3 cases, 1.11%). A total of 46 cases (17.0%) had multiple infections. Laboratory test results suggested that absolute lymphocyte count 5. 0 x 109/L was found in 199 cases (73.7%), and abnormal lymphocyte ratio > 0.10 was found in 225 cases (83.3%). Some children had elevated transaminase levels. Epstein - Barr virus capsid antigen - immunoglobulin M (EBV - VCA - IgM) was positive in 249 cases (92.2%), Epstein - Barr virus capsid antigen - immunoglobulin G (EBV - VCA - IgG) was positive in 238 cases (88.1%), and Epstein - Barr virus nuclear antigen - immunoglobulin G (EBV - NA - IgG) was negative in all cases. EBV - VCA - IgG showed low affinity in all cases (< 40%). EBV DNA tests of peripheral blood plasma were carried in 153 cases, of which 118 cases (77.1%) were positive. Conclusions EBV related IM mainly attacks preschoolers. Most patients are presented with typical triplets of IM. Eyelid edema, nasal obstruction, snoring, splenomegaly and elevated transaminase levels are prevalent in IM children. Most cases have a favorable prognosis. © 2022 ＣｈｉｎＪＡｐｐｌＣｌｉｎＰｅｄｉａｔ. All rights reserved.