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目的分析不同年龄段、不同部位小儿消化道出血的病因、定位诊断,探讨相应治疗方案。方法对2005年1月至2008年6月中国医科大学附属盛京医院因消化道出血住院的患儿病例174例进行分组、分析,归纳总结。结果小儿上消化道出血中以胃溃疡或十二指肠球溃疡、急性胃黏膜损伤及慢性浅表性胃炎或十二指肠球炎多见;下消化道出血中以过敏性紫癜、肠息肉和Meckel憩室或肠重复畸形合并异位胃黏膜常见。28d至<1岁组急慢性腹泻病为最常见病因,1~<4岁组及4~<7岁组直结肠息肉为最常见病因,7~14岁组过敏性紫癜为最常见病因。不同年龄组间比较,牛奶过敏合并慢性腹泻,维生素K1缺乏所导致的消化道出血更常见于28d至<1岁组,过敏性紫癜导致的消化道出血更常见于7~14岁组,其他疾病在不同年龄组间的比较差异无统计学意义。结论对于消化道出血患儿的诊断应详细采集病史,完善胃镜,结肠镜,发射型计算机断层成像(ECT)等全面的辅助检查,积极给予补液,止血,抑酸等治疗,大部分预后良好。     

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糖皮质激素是临床上皮肤科医生处方最多的外用药物之一,自20世纪50年代问世以来,糖皮质激素极大改善了皮肤病的治疗效果,被誉为皮肤科药物治疗学的里程碑。但随着新型外用糖皮质激素不断问世和广泛应用,其在治疗疾病的同时不可避免带来了更多副反应。与抗生素一样,外用糖皮质激素是目前临床上滥用最为严重的药物之一。由于儿童生理和皮肤组织结构特点,外用糖皮     

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??Objective To explore the clinical features of infective endocarditis and the factors related to efficacy. Methods The clinical data of 33 patients with infective endocarditis admitted to our hospital from november 2013 to november 2015 were retrospectively analyzed??including the pathogenic characteristics??underlying diseases??vegetation distributions??treatment program and prognosis. Results The pathogen detection rate of those cases was 75.76%??and the rate of being with underlying disease was 93.94%. The vegetation laid mainly in the heart valves??63.64%????followed by implant artificial material??the impact place of residual shunt and blood flow. For all the cases??the combination of the surgery with the full course of antibiotic therapy had good effect. Conclusion The positive blood culture in patients of infective endocarditis is high. The disease is more common in children with basic heart diseases. The combination of the early radical surgery and the full course of antibiotic therapy are the key to the treatments.     

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??Objective??To investigate the clinical features??diagnosis??treatment and prognosis of eosinophilic cystitis in pediatric population. Methods??The records of four patients who had been diagnosed and treated for eosinophilic cystitis from January 2012 to May 2015 in Shengjing Hospital were retrospectively reviewed. Results??All the four patients were boys whose age ranged from 6 to 8 years. The main symptoms of the 4 cases were frequent micturition??odynuria??dysuria??suprapubic pain and hematuria.All of the 4 cases had significant peripheral eosinophilia and increased bladder wall thickness. All of the patients were diagnosed with biopsy. Bladder interstitial eosinophil infiltration was revealed by histopathology. The clinical symptoms??peripheral eosinophilia and bladder imaging changes were relieved after steroids and antihistamines treatment. Three cases developed recurrence. Total course of oral corticosteroids ranged from 3 months to 18 months. One case remained persistent remission for 2 years??two cases had are recurrence and one case had two recurrences. Conclusion??Bladder biopsy is essential to establishing the diagnosis of eosinophilic cystitis. Patients with peripheral eosinophilia and the increased bladder wall thickness should be considered with eosinophilic cystitis. Steroids is effective as medical therapy for eosinophilic cystitis and close long-term follow-up is necessary.     

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??Objective To investigate the clinical characteristics and treatment of hypereosinophilic syndrome??HES?? in children. Methods The clinical manifestations?? laboratory examinations??gastroscopy and imaging features??pathological results and therapy experience in 13 HES children admitted in Beijing Children’s Hospital??Capital Medical University from January 2009 to February 2016 and related literatures were analyzed retrospectively. Results Of the 13 patients evaluated?? 7 were male??54%?? and 6 were female??46%??. The median age at diagnosis was 9.6 years old??ranging 3 to 14 years old??. The median course of disease was 23 months??ranging 1 to 72 months??. The peripheral eosionophil counts ranged ??4.5—29.2??×109/L??mean 13.5×109/L??. Gastrointestinal tract was the most commonly involved organ?? and was reported in 92%??12/13?? of patients. It was followed in frequency by urinary system??84%????pulmonary??53%????cardiac??23%????and skin??8%?? and liver??8%??. A total of 2 sites were involved in 6 patients??3 sites were involved in 5 patients and 4 sites were involved in 2 patients. Treatment of oral prednisone therapy was given and follow-up of 10 patients had no clinical symptoms??2 patients had stopped prednisone??. But eosionophil counts still increased to varying degrees. Three patients were lost to follow-up. Conclusion HES in children is more common in school age and adolescent children. Gastrointestinal tract??urinary system and pulmonary involvement are more common. Glucocorticoid treatment is effective??which requires to be maintained in small dose in the long term.     

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现将我院2001年12月至2004年6月收治的5例慢性炎症性脱髓鞘性多发性神经病(CIDP)进行分析。本组5例,男2例,女3例,年龄2~13岁,病程2~12个月,病前有上呼吸道感染史2例,3例无明显诱因。2例为慢性复发型,另3例均为缓慢起病,进行性加重。临床表现:首发症状以行走不稳起病2例,双下肢乏力起病1例,四肢活动障碍起病1例,双侧髋关节活动受限1例。体检:对称性双下肢肌力减退4例,肌力2~4级,另1例双上肢肌力减退,肌力0级;双下肢肌萎缩1例。5例均有腱反射减弱或消失,双侧巴氏征阴性,1例咽反射减弱。所有病例均无明显感觉障碍及自主神经功能障碍。实验室…     

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目的 探讨血浆脑钠素(BNP)、肌钙蛋白Ⅰ(cTnI)质量浓度的变化在心力衰竭(简称心衰,CHF)患儿的临床诊断、预后评估中的意义.方法 2003-02-2005-02于青岛市海慈医院住院诊断心衰的患儿41例,同时选健康体检者41例作为正常对照组,采用放射免疫分析法分别检测其血BNP及cTnI的水平.结果 心衰早期BNP、cTnI即开始升高,心衰期达高峰,恢复期逐渐下降,但仍高于正常对照组(P＜0.01);心衰早期、恢复期BNP阳性率(92.7%,90.2%)较cTnI阳性率(63.4%,58.5%)差异有显著性(P＜0.01);BNP持续高于500 ng/L的心脏事件发生率(66.7%)较BNP＜500 ng/L的心脏事件发生率(21.4%)高,差异有显著性(P＜0.01).结论 心衰患儿血浆BNP、cTnI质量浓度明显升高,BNP、cTnI可反映其心肌损伤;血浆BNP在心衰早期诊断方面,其敏感性及特异性均优于cTnI,可作为诊断小儿心衰的一项重要指标;血浆BNP则可作为判断预后的一个重要参考依据.     

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目的通过复习文献、结合病例总结儿童髓质海绵肾的临床特点,提高对本病的认识,以达早期诊断和治疗,改善预后。方法对苏州大学附属儿童医院2005年1月至2010年12月收治的11例儿童髓质海绵肾患儿的临床资料进行回顾分析。结果 11例患儿中男3例,女8例。年龄48d至17岁,其中<1岁6例,>3岁5例。临床表现无特异性,均由影像学确诊为双侧髓质海绵肾。表现反复尿路感染5例、远端肾小管酸中毒7例、肾结石1例、高血压2例、发育迟缓6例、肾衰竭2例、肾上腺皮质功能亢进1例。结论髓质海绵肾儿童期发病临床症状无特异性,表现形式多样化,早期诊断依靠辅助检查,影像学检查B超、CT可作首选,存在合并症时合理治疗可改善预后。     

Infectious endocarditis in children

Summary With the object of analyzing current characteristics of infectious endocarditis (IE) in children, we carried out a retrospective study of 23 cases of IE in children under 15 years of age seen at the Hospital Ramón y Cajal in Madrid (Spain) between 1977 and 1985.The incidence was high (1.3 cases per 1000 children admitted). The male/female ratio was 21. Eight patients were under 2 years of age and 15 over 2 years, the majority being adolescents. The two groups presented marked etiological and prognostic differences. Congenital heart disease was the predisposing factor in 20 of the 23 cases.Streptococcus viridans (nine cases) andStaphylococcus aureus (eight cases) were the most frequent organisms. Fourteen cases were on a native valve and nine were secondary (seven of these on prosthetic patches).In spite of advances in therapy, IE continues to be a severe illness: the mortality rate in our series was 26%. Factors associated with a poor prognosis were: age less than 2 years,Staphylococcus aureus as the causative agent, and the presence of prosthetic material.     

83例传染性单核细胞增多症的实验室检查和并发症

目的 　分析传染性单核细胞增多症 (传单 )患儿的实验室检查与并发症 ,利于减少临床漏诊与误诊。方法　回顾性分析 1 995年 1月～ 2 0 0 2年 1 2月我科收治的83例传单患儿的实验室检查特点和并发症的发生情况。结果 　异型淋巴细胞比例增高见于 89 2 %的病例 ,提示为诊断传单简便有效的筛查手段 ,其增高程度与疾病的病情无关。EBV -VCA -IgM的阳性率为 88 5%对传单诊断有重要意义。 36 9%的病例心肌酶谱升高 ;6 8 1 %的病例血沉增快 ;53 9%的病例C -反应蛋白轻度增高 ;73 5%病例发生于 7岁以下儿童 ,7月份及 9份月为发病高峰 ;并发症发生率 78 3%尤以肝脏损害最常见。其次为肺部感染。结论 　大多数传单呈良性临床经过 ,且多具有较典型的临床表现 ,本病并发症常见且多样 ,可累及多种器官。对EBV -VCA -IgM阴性而临床高度怀疑该病病例可采用EBV -PCR扩增技术协助诊断。提高对本病实验室检查特点和并发症的认识 ,有助于减少临床误诊和漏诊。     

感染性心内膜炎28例

目的 总结小儿感染性心内膜炎(IE)临床表现特点及治疗经验,以利于早期诊断和治疗。方法对1980~2002年住院28例IE患儿的临床表现、诊断、治疗、及预后进行回顾性分析。结果 临床表现以发热、心脏杂音多变、心力衰竭、贫血、白细胞增高和血沉加快为主.血培养阳性9例(32.1％)。发现心内赘生物22例(78.6％)。6例行外科手术治疗,手术后均治愈。治愈20例(71.4％),自动出院2例,死亡6例。结论 先天性心脏病(CHD)患儿出现不明原因长时间发热,无基础心脏病感染发热患儿发现心脏杂音,均应及时做连续规范血培养及超声心动图检查,以利于早期诊断和治疗。IE患儿经抗生素治疗后心内赘生物不消失或出现顽固性、进行性心衰时应进行外科手术治疗,及时采用手术治疗对改善这类患儿预后有重要意义。     

单中心十年收治感染性心内膜炎患儿临床分析

目的 探讨单中心10年来收治的感染性心内膜炎(infective endocarditis,IE)患儿的临床特点、病原菌分布等情况,为临床诊治提供参考.方法 回顾性分析中国医科大学附属盛京医院2006年10月至2016年10月儿科病房住院治疗的30例确诊 IE 患儿的临床及病原学资料.结果30例IE 患儿中,男18例,女12例,年龄2个月~13岁.IE就诊原因分别为发热21例(70.0%),呼吸系统症状4例(13.3%),神经系统症状4例(13.3%),水肿2例(6.7%),新发心脏杂音1例,心前区不适1例,血三系减少1例.基础疾病所占比例最高的是先天性心脏病17例(56.7%),其中6例为先天性心脏病术后患儿.30例患儿心脏彩超均发现赘生物,血细菌培养阳性15例(50.0%),病原菌分布:金黄色葡萄球菌6例(40.0%),肺炎链球菌4例(26.7%),粪肠球菌2例(13.3%),血链球菌1例,咽颊炎链球菌1例,表皮葡萄球菌1例.入院时C-反应蛋白升高25例(83.3%),其中8例C-反应蛋白>100 mg/L.结论 IE早期临床症状多不典型,发热是IE的常见就诊原因,先天性心脏结构异常易并发IE,革兰阳性球菌是主要致病原,单纯抗感染治疗效果不佳者可联合手术治疗.     

Infective endocarditis in children

Between January 1977 and December 1982, 34 patients below the age of 20 years (age range 1.9–20 yr, mean 12.3 years) were treated for 38 episodes of infective endocarditis (IE). Twenty three patients (68%) had rheumatic heart disease (RHD), while 11 had congenital heart disease (CHD). Echocardiography was diagnostic of IE in 10 of 12 patients (83%) in whom it was performed. Blood culture was positive in only 15 instances (40%), staphylococcus being the most common organism isolated. Twenty eight (74%) episodes of IE resulted in a cure by medical treatment. Ten patients (26%) died during the medical treatment 9(90%) because of relentless congestive heart failure and 1(10%) due to cerebral embolism. Infective endocarditis in children is an important therapeutic problem. Culture negative endocarditis is frequent in our setting.     

儿童EB病毒相关性传染性单核细胞增多症

EB病毒相关性传染性单核细胞增多症(EBV-IM)是EB病毒原发感染后引起的急性单核-巨噬细胞系统增生性疾病.目前此病的发病率有所升高,且重症病例增多,因此特异性细胞免疫的作用机制及新的治疗方法、疫苗的研制日益成为研究热点.     

小儿食管异物71例临床分析

目的：探讨小儿食管异物及其并发症的特点及治疗方法以指导临床诊治。方法对2009年1月至2014年12月我院耳鼻喉科收治的71例食管异物患儿的临床资料进行回顾性分析。结果食管异物患儿71例,其中男42例,女29例;年龄2个月~14岁,1~3岁发病率最高。在食管内异物存留时间短者2 h,长者15 d。吞入金属性异物43例,植物性异物12例,动物性异物9例,化学性异物7例;异物位于食管上段51例,中段9例,下段7例,食管入口上3例,入胃1例。71例患儿中发生并发症9例。71例患儿治愈69例,好转2例,治愈率为97.2%,平均治愈时间4 d。结论及早诊治、避免食管穿孔是预防小儿食管异物并发症的关键,及时准确处理食管穿孔等并发症是提高治愈率的有力举措。     

儿童感染性心内膜炎临床表现与治疗对策

目的分析儿童感染性心内膜炎的临床特征、治疗和预后。方法回顾性分析1998—2012年收治的83例感染性心内膜炎患儿的临床资料。结果共83例患儿,男53例、女30例,平均年龄(6.8±4.6)岁,临床特征以发热(77.1%)、轻中度贫血(71.1%)、C反应蛋白升高(67.5%)、红细胞沉降率增高(60.2%)、白细胞增高(47.0%)为主;出现栓塞症状20例(24.1%);血培养阳性56例(67.5%),以革兰阳性菌为主,链球菌属及葡萄球菌属占89.3%;万古霉素等敏感抗生素治疗有效;超声检查检出赘生物68例(82%)。55例(66.2%)患儿接受心脏手术,最终死亡7例(8.4%)。结论近年来感染性心内膜炎的病原菌变迁,缓症链球菌及金黄色葡萄球菌成为主要病原菌,需万古霉素等敏感抗生素治疗;心脏超声检出赘生物阳性率较高。     

小儿传染性单核细胞增多症218例临床特点分析

目的通过分析传染性单核细胞增多症(IM)患儿的临床特点与实验室检查结果,以提高临床诊断水平。方法回顾性分析2010年1月～2012年3月我院儿科收治的218例IM患儿的临床特点和实验室检查结果。结果本组患儿≤7岁者占86.5%,重症病例25例,死亡2例。临床症状多种多样,以发热、咽峡炎、颈淋巴结炎最常见,肝脏肿大者占61.5%,脾脏肿大占55.5%,眼睑及眶周水肿占25.7%,皮疹占22.5%。实验室检查:95.6%的患儿血液学指标有改变,异型淋巴细胞比例>10%者占91.4%,35.1%的患儿出现血液系统并发症,肝功能损害占61.5%,心肌酶学改变占19.7%,尿常规异常者占16.5%。结论小儿IM临床表现与实验室检查表现复杂,部分病例临床表现不典型,提高对本病实验室结果与临床特点的认识,可减少临床误诊和漏诊。     

儿童传染性单核细胞增多症血浆蛋白质组学分析

目的 通过对比分析传染性单核细胞增多症(infectious mononucleosis, IM)患儿与同龄健康儿童(对照组)的血浆蛋白质组图谱的差异表达,初步探索IM 特异表达或异常表达的血浆“分子标志物”以协助临床诊断。方法 采用双向电泳技术(2-DE)结合质谱技术对IM 患儿与对照组的血浆全蛋白进行比较蛋白质组学分析。结果 比较蛋白质组学分析发现IM 患儿组与对照组比较具有明显差异表达蛋白质共有7 个:血色素结合蛋白(Hpx)、VitD3 结合蛋白(DBP)、胎球蛋白A(fetuin A)、C- 反应蛋白(CRP)、载脂蛋白A(Apo A)、结合珠蛋白(HPT)、甲状腺运载蛋白(TTR),其中, HPT 表达量较对照组明显升高,其余蛋白的表达量均较对照组明显降低。结论 IM 患儿与对照组比较存在明显差异表达的蛋白质,这些差异蛋白表达量的改变均与肝脏的急性损伤有关,提示儿童IM 常伴有肝脏的急性损伤。若对这些差异表达的蛋白进一步分析,可望能够找到为IM 临床诊断和治疗提供一定参考价值的血浆特异性标志物。