结核感染T细胞斑点试验、涂片检查和结核菌素试验在儿童结核病诊断中的价值

目的评价结核感染T细胞斑点试验(T-SPOT.TB)、涂片检查和结核菌素试验(TST)在儿童结核病中的诊断价值。方法对2015年1月—12月299例疑似结核病住院患儿回顾性研究,比较三种检测方法在儿童结核病中的诊断价值。结果 299例患儿中,结核病患儿135例(确诊52例和临床诊断83例),非结核病患儿164例;T-SPOT.TB、涂片检查和TST诊断结核病的灵敏度分别为78.20%、24.24%、42.98%(P0.001),特异度分别为97.56%、100%、96.52%(P=0.107);约登指数分别为75.76%、24.24%、39.50%;阳性预测值分别为96.30%、100%、96.52%;阴性预测值分别为84.66%、55. 36%、68. 14%。≤5岁组灵敏度T-SPOT.TB、涂片检查、TST分别为67. 35%、20. 83%、51. 28%, 5岁组分别为84. 52%、38. 67%、26. 19%。在肺结核组及肺外结核组, T-SPOT.TB灵敏度分别为86. 02%、60%,其次为TST 44. 71%、37. 93%,涂片仅为27. 96%、18. 42%。仅肺结核组及含肺结核的多脏器结核组中,T-SPOT.TB灵敏度分别为83. 87%、90. 32%,TST 53. 45%、25. 93%,涂片检查27. 41%、29. 03%。结论 T-SPOT.TB具有较高的灵敏度、特异度、约登指数、阳性预测值及阴性预测值。在不同年龄组、肺结核或肺外结核儿童T-SPOT.TB均有较高的敏感性。     

结核病

003992 pCR一TB和TB一Ab在儿童结核性脑膜炎早期诊断中的价值评价/唐成和,二//临床儿科杂志一2000,18(3).一1 40一141 结果结脑组与对照组比较:脑脊液PcR一TB一DNA、TB一Ab及血PCR一TB一DNA、TB一Ab的阳性率有高度显著性差异(P<。.01)。单项指标以脑脊液PCR一TB一DNA最好,敏感度92.6%,特异度84.8%、准确率88.3%。多项指标脑脊液和血 PCR一‘rB一DNA同时阳性敏感度95.45%、特异度76.3%、准确率83.3%。脑脊液和血TB一Ab同时阳性敏感度90.5%、特异度71.8%、准确率78.3%。4项指标同时阳性敏感度10。%、特异度。、准确率36.4…     

组织因子途径抑制物及前降钙素在新生儿败血症诊断中的价值

目的 了解组织因子途径抑制物(TFPI)、前降钙素(PCT)在新生儿败血症诊断中的价值.方法 通过检测48例败血症新生儿及30例健康新生儿血TFPI、PCT、C-反应蛋白(CRP)浓度,比较各炎症指标对诊断败血症的灵敏度、特异度、阳性预测值、阴性预测值和约登指数,评价它们对该病的早期诊断价值.结果 (1)以TFPI≥30μg/L、CRP≥8 mg/L、PCT≥2 ng/ml为阳性标准,三指标对诊断败血症的灵敏度分别为86.92%、89.83%、87.50%,差异无显著性(P＞0.05),其中PCT的特异度96.67%、阳性预测值97.50%、阴性预测值83.32%、约登指数0.84;(2)在败血症组中,20例血培养阳性患儿的TFPI值为(35.5±4.5)μg/L,28例血培养阴性患儿的TFPI值为(34.3±3.2)μg/L,差异无显著性(P＞0.05);但是相对于正常对照组(26.9±5.24)μg/L,败血症组的TFPI值明显升高(P＜0.05).结论 TFP≥30μg/L对诊断新生儿败血症是一个具有较高灵敏度(86.92%)、中度特异度(59.3%)的指标;TFPI对新生儿败血症早期诊断有一定的价值,但均不及PCT及CRP,所有检测指标中PCT特异度、阳性预测值、阴性预测值、约登指数均最高.     

不同中枢神经系统感染患儿脑脊液肝细胞生长因子水平变化的意义

目的通过观察病毒性脑炎、细菌性脑膜炎及结核性脑膜炎患儿脑脊液肝细胞生长因子(HGF)水平变化,探讨其是否可以作为一个鉴别诊断的生化指标,为临床疾病的诊断提供依据。方法选择临床确诊病毒性脑炎30例、细菌性脑膜炎21例、结核性脑膜炎19例及对照组24例,采用酶联免疫吸附试验双抗体夹心法检测各组患儿脑脊液HGF水平。同时将HGF水平分别与脑脊液中白细胞计数和蛋白定量进行直线相关分析,观察脑脊液中HGF水平与脑脊液中白细胞计数和蛋白定量的关系。结果细菌性脑膜炎组、结核性脑膜炎组脑脊液HGF水平高于病毒性脑炎组和对照组,结核性脑膜炎组高于细菌性脑膜炎组患儿,细菌性脑膜炎组、结核性脑膜炎组及病毒性脑炎组与对照组患儿比较均有显著性差异(Pa<0.05),病毒性脑炎组与对照组患儿比较差异无统计学意义(P>0.05)。结论 HGF有可能成为鉴别细菌性脑膜炎、结核性脑膜炎及病毒性脑炎的指标之一。     

小儿结核性脑膜炎不同检测方法诊断价值研究

目的探讨不同实验室检查方法对小儿结核性脑膜炎(TBM)的诊断价值,为其早期诊断寻求方法。方法收集2009年3月至2011年2月新乡医学院第一附属医院结核内科和小儿内科的TBM住院患儿30例,另将同期在该院小儿内科诊断为非结核菌感染的脑炎、脑膜炎或其他脑部病变的30例住院患儿设为对照组。对两组患儿运用荧光定量PCR(FQ-PCR)技术检测脑脊液(CSF)中结核DNA、结核抗体、抗酸杆菌涂片、结核菌培养、腺苷脱氨酶(ADA)活性5种方法进行检测,并将结果进行比较分析。结果 FQ-PCR阳性率与抗酸杆菌涂片、结核菌培养、结核抗体检测差异均有统计学意义(P<0.05);30例TBM患者ADA值升高14例,对照组有6例升高,敏感性与FQ-PCR差异无统计学意义,但特异性(80%)低于FQ-PCR(100%),差异有统计学意义。涂片法和培养法对脑脊液检出率差异无统计学意义。FQ-PCR和ADA两种方法的TBM组和对照组之间差异均有统计学意义。结论 FQ-PCR检测脑脊液结核DNA,简便、快速、敏感性高、特异性强,有助于早期诊断。     

宏基因组二代测序技术在儿童细菌性脑膜炎病原诊断中的价值北大核心CSCD

目的:探讨宏基因组二代测序技术在儿童细菌性脑膜炎病原诊断中的应用价值。方法:回顾性分析2019年1月1日至2020年12月31日复旦大学附属儿科医院住院诊断为“细菌性脑膜炎”或“化脓性脑膜炎”或“中枢神经系统感染”的189例患儿的病原学检测结果。分别采用培养和宏基因二代测序检测方法检测细菌性脑膜炎患儿的脑脊液,分析2种检测方法病原检出率的差异。根据就诊时患儿年龄分为新生儿组(≤28日龄)和非新生儿组(>28日龄),采用χ^(2)检验进行组间比较。以脑脊液培养为金标准,分析宏基因组二代测序技术在儿童细菌性脑膜炎诊断中的灵敏度和特异度。结果:189例细菌性脑膜炎患儿中男116例、女73例。血和(或)脑脊液培养共检出76株病原菌,其中革兰阳性菌50株(65.8%),检出率较高的致病菌有无乳链球菌18株(23.7%)、大肠埃希菌17株(22.4%)、肺炎链球菌15株(19.7%)。非新生儿组革兰阳性菌感染率高于新生儿组[76.0%(38/50)比50.0%(13/26),χ^(2)=5.24,P=0.020]。48例患儿脑脊液同时送检宏基因二代测序检测和培养,宏基因二代测序检测的病原检出率高于培养方法[20例(41.7%)比12例(25.0%),χ^(2)=16.45,P<0.001]。脑脊液宏基因二代测序和培养检测结果的一致性为79.2%(38/48),其中同时阳性的11例患儿均检出同一种病原菌。以脑脊液培养结果为金标准,宏基因组二代测序技术在细菌性脑膜炎的诊断中的灵敏度为91.7%,特异度为75.0%。结论:宏基因组二代测序技术可提高儿童细菌性脑膜炎的病原检出率,且与脑脊液培养检出结果一致性较高。在诊断细菌性脑膜炎时,尤其在疑似诊断患儿中传统病原学无法明确病原时应尽早完善宏基因二代测序检测。     

脑脊液二代测序对5例结核性脑膜炎患儿精准诊断价值研究

目的 探讨脑脊液病原菌二代测序(NGS)技术在结核性脑膜炎(TBM)早期精准诊断中的应用价值.方法 收集华中科技大学同济医学院附属武汉儿童医院神经内科2019-01-01-2019-12-15确诊的TBM 5例患儿,5例均检验了脑脊液病原菌NGS 1～2次,分析相关临床资料、血液及脑脊液检验结果、结核相关检验指标、颅脑...     

早期头颅磁共振成像联合脑脊液指标预测足月儿细菌性脑膜炎预后的价值

目的探讨早期头颅MR联合脑脊液指标预测足月新生儿细菌性脑膜炎预后的价值。方法回顾性队列研究。以住院的细菌性脑膜炎足月儿为研究对象,设出院结局为队列终点(预后良好组和预后不良组),以早期头颅MR半定量评分系统和/或脑脊液检查(WBC数、蛋白、葡萄糖)为预测指标,评估不同方法预测足月新生儿细菌性脑膜炎预后的价值。结果符合本研究纳入和排除标准的189例细菌性脑膜炎足月儿纳入分析,男108例(57.1%)、出生胎龄37～42.3周、出生体重2 100～5 000 g、经阴道分娩132例(69.8%)、发病日龄1～28 d、住院天数4～129 d。预后良好和预后不良组分别为162例(85.7%)和27例(14.3%),2组患儿出生胎龄、出生体重、性别、分娩方式、发病日龄和发病至头颅MR检查时间差异均无统计学意义。头颅MR和脑脊液指标预测足月新生儿细菌性脑膜炎预后的ROC曲线下面积(AUC)由大到小依次是头颅MR评分+脑脊液蛋白(0.902 4)、头颅MR评分(0.875 2)、脑脊液蛋白(0.787 6)、脑脊液WBC数(0.728 4)、脑脊液葡萄糖(0.247 9)。头颅MR评分的诊断界值为17分、脑脊液蛋白的诊断界值为2 316 mg·L~(-1)时,头颅MR评分与脑脊液蛋白AUC差异无统计学意义;头颅MR评分+脑脊液蛋白与脑脊液蛋白AUC差异有统计学意义,与头颅MR评分差异无统计学意义。头颅MR评分+脑脊液蛋白和头颅MR评分的敏感度分别为88.9%(95%CI:84.4%～93.4%)和77.8%(95%CI:71.9%～83.7%),特异度分别为80.9%(95%CI:75.3%～86.5%)和82.7%(95%CI:77.3%～88.1%)。结论早期头颅MR评分联合脑脊液蛋白,提高了预测足月新生儿细菌性脑膜炎预后的准确性。     

脑脊液置换联合鞘内注射药物治疗中晚期儿童结核性脑膜炎的疗效

目的 探讨脑脊液置换联合鞘内注射药物治疗中晚期儿童结核性脑膜炎的疗效.方法 选择2005年1月-2010年 4月本院收治住院的64例中晚期结核性脑膜炎患儿,随机分为治疗组和对照组各32例.对照组予常规抗结核药物治疗,治疗组在常规抗结核药物治疗基础上行脑脊液置换,并鞘内注射抗结核药物,治疗8周后对比2组治疗效果.结果 治疗组治愈24例,好转 5例,无效 2例,死亡1例,总有效率为90.6%;对照组治愈17例,好转5例,无效7例,死亡2例,总有效率为68.8%.2组总有效率比较差异有统计学意义(χ2=4.729,P<0.05).结论 脑脊液置换联合鞘内射注药物治疗中晚期儿童结核性脑膜炎疗效好,且不良反应少.     

结核病

05 1 5 0 5　小儿结核性脑膜炎早期诊断 /卢　鸣…∥临床儿科杂志 .-2 0 0 4,2 2 (7) .-44 6～ 44785例结核性脑膜炎 (TBM)患儿中≤ 3岁者 47例 ,5 1例 (60 % )有明确结核接触史 ,47例 (5 5 % )未接种卡介苗。临床表现主要是发热、头痛、抽搐、消瘦、盗汗、活动障碍、昏迷及颅神经损害等。 5 4例 (63 .6% )合并肺结核 ,77例(90 .6% )脑脊液 (CSF)符合 TBM典型改变。 CSF培养、CSF聚合酶链反应 (PCR)、头颅 CT及 MRI检查阳性率依次为 1 4.1 %、75 .4%、82 .7%和 93 .3 %。强化 CT主要表现 5种类型 :渗出型 ,脑室系统扩张积水型、脑…     

Role of nutrients in the regulation of in vivo protein metabolism in humans

Nutrients regulate protein metabolism both in an acute fashion and on a long-term basis. The ingestion of meals is associated with a dramatic switch from an overall catabolic state to a state of net protein anabolism. The acute response of protein metabolism to meal ingestion is mediated, in part, by an increase in insulin secretion, itself a consequence of glucose absorption. Whereas insulin may primarily suppress rates of proteolysis, amino acids are responsible for the stimulation of protein synthesis that follows food intake. In the long run, the effects of nutrition on protein metabolism depend on the energy supply, the source of the energy (carbohydrate versus fat) and dietary protein intake. Finally, specific amino acids, such as glutamine, may play an additional role as protein anabolic agents.     

氨磷汀在儿童肿瘤化疗中的应用

目的研究氨磷汀在儿童肿瘤化疗中的作用及不良反应。方法随机选择肿瘤32例患儿,采用自身对照,观察患儿在同一化疗方案中使用氨磷汀辅助治疗后黏膜损伤、骨髓抑制时间、发热持续时间、抗生素及刺激因子应用时间及氨磷汀的不良反应。结果氨磷汀辅助治疗组发生黏膜溃疡4例,明显低于对照组9例;中性粒细胞<0.5×109/L持续时间缩短,血小板<5×109/L持续时间缩短;发热持续时间、抗生素和刺激因子应用时间缩短。两组化疗过程中均未出现低体温、皮疹、低血压等情况,化疗后肾功能、心电图均正常;对肝功能影响程度相似;氨磷汀组低钙血症尤其是低钙性抽搐发生率高。结论氨磷汀能够有效保护正常组织细胞,不良反应较低,可在儿童肿瘤患者化疗中应用。     

Determinants of pregnancy in adolescents in Nepal

Objective : Social factors and prevalent norms in the community determine the proportion of teenage pregnancy in the community. In the light of high risk associated with teenage pregnancy, the socio-cultural determinants, which influence the conception among teenagers in Nepal, need to be understood. These determinants may be modified by suitable interventions to reduce teenage pregnancy. Aim of this study was to examine the socio-cultural determinants of teenage pregnancy in eastern Nepal.Methods : A case-control study design was selected for comparing the education, economic status, family support and freedom towards conception among teenagers as compared to higher age group women.Result : Seventy adolescent pregnant women were compared with seventy primigravida women in the 20 to 29 years age group. The teenage pregnant women were less educated, had poor economic background, more likely to have accidental pregnancies as compared to the other group and more likely to have love marriages. Husbands were more likely to decide about continuation of pregnancy. They had less psychological and social support from the family.Conclusion : Marriage at young age and pregnancy during teens are associated with less social acceptance and poor support in the family.     

Role of nutrients in the regulation of in vivo protein metabolism in humans

Nutrients regulate protein metabolism both in an acute fashion and on a long-term basis. The ingestion of meals is associated with a dramatic switch from an overall catabolic state to a state of net protein anabolism. The acute response of protein metabolism to meal ingestion is mediated, in part, by an increase in insulin secretion, itself a consequence of glucose absorption. Whereas insulin may primarily suppress rates of proteolysis, amino acids are responsible for the stimulation of protein synthesis that follows food intake. In the long run, the effects of nutrition on protein metabolism depend on the energy supply, the source of the energy (carbohydrate versus fat) and dietary protein intake. Finally, specific amino acids, such as glutamine, may play an additional role as protein anabolic agents.     

他汀类药物在儿童家族性高胆固醇血症治疗中的研究进展

家族性高胆固醇血症(FH)是一种常染色体显性遗传的脂质代谢障碍疾病,由于FH早期就可引起动脉粥样硬化病变,增加患者严重心血管疾病的患病风险和死亡风险,因此目前越来越强调患者自儿童期就使用他汀类药物进行治疗,以改善远期预后。文章综述他汀类药物治疗儿童FH的必要性、有效性和安全性,同时也提出目前存在的一些问题和思考。     

皮质激素在癫痫治疗中的应用

皮质激素在癫痫中的应用已有近50a的历史，现已证明其对某些癫痫综合征如婴儿痉挛症、Landau—Kleffner综合征、Rassmussen综合征、具有睡眠中癫痫性电持续状态的癫痫综合征等具有肯定的治疗作用，其确切的作用机制尚不清楚。在皮质激素应用过程中应注意其不良反应。     

Diagnosis of Chlamydia pneumoniae in community-acquired pneumonia in children in Chile

The incidence of Chlamydia pneumoniae in community-acquired pneumonia in children was studied prospectively in 112 children aged 1 mo to 14 y. Diagnosis of C. pneumoniae was performed by polymerase chain reaction (PCR) on nasopharyngeal aspirates and serology by the microimmunofluorescence test on a single serum specimen. Three (2.7%) cases of pneumonia due to this agent were diagnosed by both PCR and serology. C. pneumoniae was not found in any of 62 children below 5 y of age. In the age group 5-8 y, only 1/30 (3%) was found positive, and in the age group 9-14 y, C. pneumoniae was diagnosed in 2/20 (10%) children. Conclusion: Although the number of enrolled patients is small, and the diagnostic techniques used may have some limitations, the results of this study suggest that C. pneumoniae plays a minor role in the aetiology of pneumonia in children less than 9 y of age in our country. However, it should be considered as a potential agent in pneumonia in older children.     

Efficacy of amphotericin B in multi-drug resistant kala-azar in children in first decade of life

Fifty children in the first decade of life, and suffering from multiple drug resistant kala-azar, confirmed by demonstration of amastigotes in aspirates of bone marrow or spleen were treated with amphotericin B in gradually increasing dosage to a total dose of 20 mg/kg. All patients had classical features of severe kala-azar, and had taken more than one course of antimony and pentamidine, and three patients had taken one additional course of ketoconazole besides many courses of antimony and pentamidine. The clinical response started just after first infusion in 8 patients, and the patients became afebrile. By 5th infusion, all looked better and 18 patients became afebrile. By 15th infusion all patients were afebrile and cheerful. Their spleens became smaller and body weights and total white cell counts increased. Forty eight patients had parasitological cure at the end of treatment, and only 2 patients required an additional 5 infusions for parasitological cure. All patients were ultimately cured. No one relapsed within six months of follow up. All patients had shivering, rigor and rise of temperature on the day of infusion, which could be minimized with prior administration of low dose of hydrocortisone, but could not be eliminated. Eighteen patients had loose motions during treatment, while 14 patients had decrease in appetite which improved quickly when the treatment was over. Fourteen patients had transient rise of blood urea, in six patients serum creatinine also increased and 16 patients had a minor fall in serum potassium. It is concluded that amphotericin B is a very effective drug for multidrug resistant kala-azar in children, and should be used without hesitation in all such cases in children, but under close medical supervision.