76例儿童传染性单核细胞增多症及其并发症临床特征分析

目的探讨传染性单核细胞增多症及其并发症患儿的临床特征。方法对76例传染性单核细胞增多症患儿的临床资料进行回顾性分析。结果76例患儿中42．1％有发热、咽峡炎、肝脾大、淋巴结大、皮疹等典型症状;早期淋巴细胞≥50％者26例(34．2％),单核细胞 淋巴细胞≥60％者39例(51．3％),异型淋巴细胞≥5％者68例(89．4％);消化系统主要表现为肝脏酶学改变：乳酸脱氢酶升高57例(75％),天冬氨酸转氨酶升高52例(68．4％),丙氨酸转氨酶升高47例(61．8％),总胆汁酸升高34例(44．7％);呼吸系统表现为支气管炎和支气管肺炎30例;抽搐3例。对临床表现类似传染性单核细胞增多症,但EBV-VCA-IgM阴性或嗜异凝集试验阴性的患者需进一步作CMV病毒特异性抗体检测。结论传染性单核细胞增多症是累及多系统的全身性疾病,临床表现多样,主要表现为感染相关性淋巴或淋巴样腺体组织反应性改变和多器官功能所损。大多数传染性单核细胞增多症呈良性临床经过,预后良好。     

1例成人传染性单核细胞增多症合并红皮病的护理

传染性单核细胞增多症是由EB病毒引起的自限性疾病,累及全身各器官,临床表现多样[1].常感染儿童及青少年,疾病早期发热明显.传染性单核细胞增多症合并红皮病在临床上实属罕见.     

小儿急性传染性单核细胞增多症16例临床分析

目的:探讨小儿传染性单核细胞增多症的临床特点及实验室检查特点,提高该病的诊断率。方法:回顾分析收治的16例小儿传染性单核细胞增多症临床表现和实验室检查资料。结果:小儿急性传染性单核细胞增多症临床表现较为复杂,实验室检查结果受发病时间、患儿年龄等因素的影响。结论:小儿传染性单核细胞增多症临床表现多样,需要结合相关实验室检查综合考虑。     

1例成人传染性单核细胞增多症合并红皮病的护理

传染性单核细胞增多症是由EB病毒引起的自限性疾病。累及全身各器官．临床表现多样。常感染儿童及青少年，疾病早期发热明显。传染性单核细胞增多症合并红皮病在临床上实属罕见。红皮病多损害内脏，常以肺炎多见．其次为败血症及心、肝、肾损害。2007年1月我科收治1例传染性单核细胞增多症合并红皮病病人。现将临床护理体会总结如下。     

儿童传染性单核细胞增多症并发心肌炎的临床分析

目的探讨儿童传染性单核细胞增多症并发心肌炎的临床特点。方法回顾分析56例儿童传染性单核细胞增多症的临床表现、实验室检查及预后转归。结果并发心肌炎者达7.14%,临床上除有发热、咽峡炎等外,尚出现精神萎靡、心慌、心累、面色苍白、心音低钝等临床表现;3种心肌细胞损伤标志物及心肌酶谱升高;心电图异常等临床特点。结论儿童传染性单核细胞增多症是全身性疾病,绝大多数患儿预后良好,但重症病例预后差。对于起病急,进展快,多系统损害者,应积极排除并发心肌炎的可能。     

儿童传染性单核细胞增多症12例诊治及误诊分析

传染性单核细胞增多症(infectious mononucleosis,I M)主要是主要由EB病毒引起的一种单核巨噬细胞系统急性增生性传染病[1],累及多个脏器或系统,临床表现多样,其症状与体征的多样性和不典型性给早期诊断及治疗带来困难。我院自2005-03-2010-02共收治儿童传染性单核细胞增多症12例,初诊误诊7例,分析如下。     

儿童传染性单核细胞增多症110例临床分析

目的分析儿童传染性单核细胞增多症临床特点。方法回顾性分析2015年1月-2018年1月收住的110例传染性单核细胞增多症患儿临床资料,总结并分析其临床特点。结果 110例患儿中男74例(67.3%)、女36例(32.7%),男女之比2.1∶1;年龄分别为2～3岁29例(26.4%)、3～6岁67例(60.9%)、6～13岁14例(12.7%);症状表现有发热101例(91.8%)、咽峡炎100例(90.9%)、淋巴结肿大95例(86.4%)、眼睑浮肿79例(71.8%)、脾脏肿大55例(50.0%)、肝脏肿大37例(33.6%);病程中合并肺炎61例(55.5%)、心肌损害53例(48.2%)、中性粒细胞减少35例(31.8%)、血小板减少性紫癜4例(3.6%);EB病毒指标检测结果:衣壳抗原IgG抗体阳性率88.2%、衣壳抗原IgM抗体阳性率43.6%,早期抗原IgM抗体阳性率31.8%,核抗原IgG抗体阳性率56.4%;外周血异型淋巴细胞阳性率46.4%。结论儿童传染性单核细胞增多症多发于男性且以3～6岁常见,临床症状表现多样,肺炎以及心肌损害为主要合并症,EB病毒指标检测与血清学检测有助于诊断工作。     

儿童传染性单核细胞增多症42例临床分析

目的 探讨儿童传染性单核细胞增多症的临床特点.方法 对2006年1月至2012年1月诊治的42例儿童传染性单核细胞增多症患儿的临床资料进行回顾性分析.结果 发病年龄10个月～12岁,3～7岁儿童最常见.发热、咽峡炎、皮疹、淋巴结肿大和肝脾肿大为本病的主要典型症状及体征.结论 传染性单核细胞增多症临床表现多样,易误诊,多数预后好,但也可引起严重并发症,甚至死亡.尽早检查外周血异型淋巴细胞和EB病毒抗体IgM有助于诊断.     

儿童传染性单核细胞增多症20例临床分析

目的 综合分析儿童传染性单核细胞增多症的临床特征及并发症，提高本病的诊治水平。方法 统计我院5年来收治的传染性单核细胞增多症的临床表现及治疗转归。结果 本病主要表现为发热、咽痛、肝脾淋巴结肿大，外周血异形淋巴细胞比例增高，亦有相当一部分患儿表现为双眼睑水肿，皮疹，肝功能异常，应用更昔洛韦和阿昔洛韦有一定疗效，预后大都良好。结论 传单是全身性疾病，临床表现复杂多样，临床医生需提高对本病的诊治水平，防止误诊、漏诊、延误治疗：并警惕EBV相关性嗜血细胞综合征的可能。     

传染性单核细胞增多症33例

传染性单核细胞增多症(以下简称传单)是由EB病毒引起的单核-巨噬细胞系统急性血液系统传染病,为儿童常见的传染病之一.现将我科收治的33例传单分析如下.     

合并肺炎支原体感染的儿童EB病毒传染性单核细胞增多症的临床特点及高危因素分析

目的分析EB病毒传染性单核细胞增多症(EBV-IM)合并肺炎支原体(MP)感染患儿的临床特点及高危因素,为临床及时准确的治疗提供依据。方法回顾性收集2018年1月1日至2019年12月31日在首都医科大学附属北京友谊医院儿科因EBV-IM住院患儿的临床及实验室检查资料,按是否存在MP感染,分为单纯EB病毒感染组(IM组)62例及合并MP感染组(MP-IM组)36例。比较2组患儿的一般资料(性别、年龄、发病季节)、临床表现(热峰、热程)以及实验室检查结果。结果MP-IM组的患儿平均年龄大于IM组的患儿,其中学龄期儿童占比明显高于IM组,差异有统计学意义(P<0.05)。MP-IM组的患儿热程明显长于IM组,差异有统计学意义(P<0.05)。2组患儿在实验室检查方面:MP-IM组的患儿中性粒与淋巴细胞比值(NLR)、C反应蛋白、IgG、IgM水平明显高于IM组患儿,差异有统计学意义(P<0.05)。年龄和热程是合并MP感染的独立危险因素,年龄大于6.085岁、热程大于9.5 d具有较高的诊断价值。结论在EBV-IM儿童的诊治过程中,合并MP感染的患儿病情及炎症反应相对较重,体液免疫紊乱更为明显。对于发热时间长、学龄期的儿童需进行MP的检测,及早进行抗感染治疗。     

The clinical value of immunological markers of EBV infection in children with infectious mononucleosis

A hundred and sixteen patients aged 1 to 14 years who had infectious mononucleosis (IM) caused by the Epstein-Barr virus (EBV) were followed up in its acute phase and 3, 6, and 12 months after the disease experienced by them. The clinical significance of the markers of EBV infection was assessed in children with IM. The high diagnostic capacity of detection of EBV DNA in the lymphocytes was established in patients with IM. It was shown that it is necessary to use the serological markers of EBV infection to monitor the course of this disease in children.     

The Use of Antibiotics to Prevent Serious Sequelae in Children at Risk for Occult Bacteremia: A Meta-analysis

Objective: To determine whether antibiotics prevent serious bacterial infections in children at risk for occult bacteremia.
Methods: Meta-analysis of randomized controlled trials involving children aged 3 months to 36 months without a focus of infection and randomized into 2 treatment groups: 1) no antibiotic vs antibiotic or 2) IM ceftriaxone vs oral antibiotic.
Results: The use of either an oral antibiotic or IM ceftriaxone did trend toward a reduced risk of serious infection, although neither reached statistical significance (OR = 0. 60; 95% CI 0. 10, 3. 49; and OR = 0. 38; 95% CI 0. 12, 1. 17, respectively). It would be necessary to treat 414 patients to prevent 1 serious bacterial infection. When only children with proven occult bacteremia were analyzed, the use of IM ceftriaxone was statistically significant in preventing serious bacterial infections (OR = 0. 25; 95% CI 0. 07, 0. 89).
Conclusions: Clinical judgment should not be replaced by widespread antibiotic use in the approach to a child with fever. If rapid methods to identify children with occult bacteremia, such as polymerase chain reaction, could be improved and become widely available, then antibiotics could be used judiciously on initial visits. Antibiotic use in all children at risk for occult bacteremia implies the treatment of many children unlikely to benefit from such therapy.     

传染性单核细胞增多症124例临床分析

目的探讨小儿传染性单核细胞增多症 (IM)的临床特征、诊断与治疗方法。方法回顾分析 12 4例确诊为IM患儿的临床资料和治疗效果。结果IM发病 3岁以下占 5 1.6 % ;发热、咽峡炎、肝脾及淋巴结肿大典型临床表现发生率均在 90 %以上 ,而鼻塞、眼睑水肿、皮疹、尿少等不常见临床表现发生率也较高 (约占 10 %～ 32 % ) ;外周血异形淋巴细胞 >10 % 92例 (72 .6 % ) ,嗜异性凝集试验阳性 2 2 .9% (2 5 / 10 9) ,VCA IgM阳性 76 .7% (2 3/ 30 ) ,EBV DNA阳性 16例(16 / 4 3) ,合并支原体感染 32 .4 % (12 / 37)。干扰素或更昔洛韦治疗组均较利巴韦林和莪术油组的临床症状、体征恢复快 (P <0 .0 5 )。结论IM发病年龄呈提前趋势 ,且合并支原体感染者增多 ,其临床表现既相对集中 ,又呈多样性。VCA IgM和EBV DNA检测可提高对不典型IM的早期诊断。干扰素、更昔洛韦明显提高IM近期疗效。     

4G4G genotype of the plasminogen activator inhibitor-1 promoter polymorphism associates with disseminated intravascular coagulation in children with systemic meningococcemia

BACKGROUND: Meningococcal disease may present as sepsis, meningitis or a combination of both. Impaired fibrinolysis and massive elevation of the plasminogen activator inhibitor-1 (PAI-1) is a characteristic feature of meningococcal sepsis. We and others have reported an association between mortality and the functional 4G/5G promoter polymorphism of the PAI-1 gene in children with meningococcal sepsis. OBJECTIVE: Multicenter study to investigate the association of the 4G/5G PAI-1 polymorphism and disseminated intravascular coagulation (DIC) in children with meningococcal disease in a Central European population. PATIENTS/METHODS: Blood samples and clinical information of 326 previously healthy children with meningococcal infection were collected from 95 pediatric hospitals in Germany, Switzerland, Italy, and Austria from 2000 to 2002. RESULTS: DIC, defined as platelet counts below 100 G L(-1), increased D-dimer levels and prolonged prothrombin time, was significantly associated with the 4G4G genotype [31 of 63 (49%) vs. 55 of 175 (31%), P = 0.014], resulting in a hazard ratio (HR) of 1.5 (95% confidence interval 1.1-2.1) to develop DIC. Carriers of the 4G4G genotype showed significantly lower platelet counts (183 G L(-1) vs. 227 G L(-1), P = 0.009) on admission. Fibrinogen and C-reactive protein levels were not associated with the PAI-1 4G/5G polymorphism, nor were white blood cell counts. CONCLUSIONS: Our data show a correlation between the 4G4G genotype of the PAI-1 gene and development of DIC in meningococcal infection.     

IL2RA,IL-10基因单核苷酸多态性与儿童EBV-HLH相关性的研究

目的:探讨IL2RA,IL-10基因单核苷酸多态性(SNPs)与儿童EBV-HLH发病的关系及关联SNPs对患儿预后的影响。方法:对EBV-HLH组(51例),EBV相关传染性单核细胞增多症(EBV-IM)组(48例)和EBV血清阳性的健康儿童组(52例),用SNaPshot基因分型检测技术检测IL2RA基因的rs2104286、rs12722489、rs11594656位点和IL-10基因的rs1800896、rs1800871、rs1800872位点的基因型,分析各SNP的基因型频率、等位基因频率在每组的分布差异;以关联SNPs进行生存分析。结果:IL-10基因rs1800896位点AA基因型在EBV-HLH组的出现频率高于IM组(58.8%vs 25.0%)和健康对照组(58.8%vs 26.9%);A等位基因在EBV-HLH组的出现频率高于IM组(74.5%vs 54.2%)和健康对照组(74.5%vs 57.7%)。IL-2RA基因rs2104286位点AA基因型在EBV-HLH组的出现频率高于IM组(54.9%vs 27.1%)及健康对照组(54.9%vs 25.0%);A等位基因在EBV-HLH组的出现频率高于IM组(70.6%vs 51.0%)及健康对照组(70.6%vs 46.2%)。不同基因型的EBV-HLH患儿的Kaplan-Meier生存曲线,差异无统计学意义。结论:IL-10基因rs1800896位点及IL-2RA基因rs2104286位点多态性可能与儿童EBV-HLH发病相关,两位点的AA基因型、A等位基因可能是儿童EBV-HLH的易感危险因素。     

Droperidol vs. Prochlorperazine for Benign Headaches in the Emergency Department

OBJECTIVE: To compare the efficacy of droperidol with that of prochlorperazine for the treatment of benign headaches in emergency department (ED) patients. METHODS: Prospective, randomized clinical trial in an urban ED. Patients were given either droperidol, 5 mg intramuscular (IM) or 2.5 mg intravenous (IV), or prochlorperazine, 10 mg IM or 10 mg IV. Measurements included side effects and the patient's pain perception as measured on a 100-mm visual analog scale (VAS) at baseline, 30, and 60 minutes after the medication was given. Data were analyzed using chi-square, two-tailed t-tests, and two-way analysis of variance (ANOVA) when appropriate. RESULTS: During an eight-month period, 168 patients were enrolled. Eighty-two (48.8%) of the patients received droperidol; 86 (51.2%) received prochlorperazine. In the droperidol group, 49 (59.6%) received IM administration and 33 (40.4%) IV. In the prochlorperazine group, 57 (66.3%) received IM administration and 29 (33.7%) IV. Sixty minutes after the medication, the mean decrease in the VAS scores was 81.4% for droperidol and 66.9% for prochlorperazine (p = 0.001). At 30 minutes, 60.9% of the patients receiving droperidol and 44.2% of the patients receiving prochlorperazine had obtained at least a 50% reduction in their VAS scores (p = 0.09). At 60 minutes, 90.2% of the patients receiving droperidol and 68.6% of the patients receiving prochlorperazine had at least a 50% reduction in their VAS scores (p = 0.017). No difference between IM dosing and IV dosing was detected. Side effects, including dystonia, akathisia, and decreased level of consciousness, were seen in 15.2% of the patients receiving droperidol and 9.61% of the patients receiving prochlorperazine. No significant or persisting morbidity was detected. CONCLUSIONS: Droperidol was more effective than prochlorperazine in relieving pain associated with benign headaches.     

Pilot Study: Concordance of Disposition for Hypothetical Medical Patients in the Emergency Department

Objectives: Emergency physicians (EPs) make dispositions for every patient in the emergency department (ED) and often require agreement from inpatient services to admit medical patients to the hospital. Sometimes disagreements arise. The authors sought to determine in their institution disposition concordance between EPs and admitting medical services of hypothetical ED patients. A second objective was to describe additional information requested by each service. Methods: Within a two‐week period, physicians from emergency medicine (EM), family practice (FP), and internal medicine (IM) voluntarily completed anonymous questionnaires asking them to disposition hypothetical ED patients. Eleven case scenarios were followed by three disposition choices (admit, discharge, or cannot tell) from given information (followed by a free‐text area). Results: A total of 105 questionnaires were returned: 42 from EM (12 attending physicians/30 residents), 33 from FP (14 attending physicians/19 residents), and 30 from IM (4 attending physicians/26 residents). Admission rates were statistically different for EM (68% attending physicians/65% residents/66% total) when compared with FP (42% attending physicians/54% residents/49% total) (p < 0.01) and IM (36% attending physicians/53% residents/51% total) (p < 0.01). Discharge rates were also statistically different for EM (8% attending physicians/19% residents/16% total) versus FP (29% attending physicians/29% residents/28% total) (p < 0.01) and IM (27% attending physicians/28% residents/28% total) (p < 0.01). “Cannot tell” rates were not significantly different between groups (p > 0.05) for EM (23% attending physicians/16% residents/18% total) versus FP (25% attending physicians/14% residents/19% total) and IM (36% attending physicians/16% residents/18% total). The proportion of additional tests requested in the “cannot tell” disposition by attending EPs was about half that of the other groups. Dispositions between FP and IM were not different at any level (p > 0.05). Conclusions: In the authors' institution, when presented with identical hypothetical ED patients, EPs would admit more, discharge less, and ask for fewer additional tests than FP or IM physicians. The FP and IM physicians surveyed disposition patients in a similar manner.     

三叶因子Ⅰ、Ⅱ、Ⅲ在胃癌及癌前病变中的表达及意义

目的：探讨三叶因子Ⅰ（trefoil factor1，TFF1）、Ⅱ（trefoil factor2，TFF2）、Ⅲ（trefoil factor3，TFF3）在正常胃黏膜、癌前病变、胃癌中的表达及临床病理意义。方法：应用免疫组织化学S-P法检测20例正常胃黏膜、20例萎缩性胃炎伴肠化生、20例不典型增生、60例胃癌组织中TFF1、TFF2、TFF3的表达。结果：（1）TFF1在正常胃黏膜、萎缩性胃炎伴肠化生、不典型增生、胃癌组织中阳性表达率分别为100．0％、80．0％、75．0％、50．0％，呈下降趋势（P〈0．05）；其阳陛表达与分化程度、分期有关（P〈0．05）。（2）TFF2在上述组织中阳性表达率分别为100．％、85．0％、70．0％、38．3％，呈下降趋势（P〈0．05）；其阳性表达与分期有关（P〈0．05）。（3）TFF3在上述组织中阳性表达率分别为5．0％、30．3％、45．0％、58．3％，呈上升趋势（P〈0．05）；其阳性表达与浸润深度、淋巴结转移、分期有关（P〈0．05）。结论：在胃癌的演进过程中TFF1、TFF2的表达进行性丢失，TFF3进行性上升，三者可能共同参与胃癌的发生、发展、浸润及转移。     

First-postgraduate-year Resident Clinical Time Use on Three Specialty Rotations

OBJECTIVE: To compare in-hospital time uses by first-postgraduate-year (PGY1) residents during rotations in emergency medicine (EM), internal medicine (IM), and surgery (S). This article reports the clinical components of residency time use. METHODS: A cross-sectional, observational study of the clinical activities of EM PGY1 residents was performed while the residents were on duty during the three specialty rotations. The activities were recorded by an observer using a log with predetermined categories for clinical activities. A time-blocked, convenience sample of resident shifts was observed for each service rotation. The sample was proportional to the total number of hours for which a PGY1 resident was expected to be in the hospital during a rotation on that service. No attempt was made to sample the same resident at all time periods or on all rotations. Proportions were compared by chi2; alpha = 0.0001. RESULTS: Twelve PGY1 residents were observed for a total of 166 hours on S, 156 hours on IM, and 120 hours on EM. These hourly amounts were representative of a typical two-week span of service on each rotation for the residents. On average, the residents spent 57% of their time on clinical or service-oriented activities. During EM and IM rotations, the residents spent most of their time performing clinical information gathering and engaging in case management and data synthesis (52% of total clinical effort). Within this category, residents on EM were more involved with case discussion and review of ancillary test results than on IM (34% vs 20% of time in this category). Conversely, proportionately less time in this category was devoted to documentation on the EM vs IM rotation (56% vs 80%; p < 0.0001). The greatest opportunity to perform procedures was on the S rotation (31% of total clinical time vs 6% for other specialties; p < 0.0001). CONCLUSION: Awareness of the clinical activities performed on PGY1 rotations can help residency directors anticipate educational needs to balance their residents' experience. Since 29% and 42% of total clinical time on PGY1 EM and IM rotations, respectively, is focused on documentation, efforts to enhance charting skills and efficiency are warranted. Also, efforts to enhance PGY1 procedural experience outside of the S rotation appear warranted.