感染性腹泻患儿炎前细胞因子检测及临床意义

目的 探讨炎前细胞因子水平变化对儿童急性感染性腹泻患儿诊断的临床意义.方法 2006年1月至2007年12月,采用ELISA方法测定183例急性感染性腹泻患儿炎前细胞因子白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、白介素8(IL-8)水平,并与32名健康儿童对照组进行比较.结果 入院时无论是细菌性肠炎还是病毒性肠炎,炎前细胞因子均高于对照组,炎前细胞因子参与了儿童急性感染性腹泻的致病过程;当病情好转,进入恢复期时血清炎前细胞因子水平又趋于正常.结论 临床可依炎前细胞因子水平的及时、准确地快速检潮来观察儿童急性感染性腹泻病情的阶段,有针对性地取有效的治疗措施,并且有助于了解患儿病情及免疫状况.     

感染性腹泻息儿检测血清白细胞介素-6的临床意义

本文采用放射免疫法测定26例感染性腹泻患儿血清白细胞介素-6(IL-6)含量。其中细菌性痢疾16例,病毒性肠炎10例。结果:腹泻组明显高于正常对照组(P<0.001);菌痢组明显高于病毒性肠炎组(P<0.001);急性期组明显高于恢复期组;提示IL-6参与了腹泻的发病过程,其含量随感染性腹泻的病原而改变,测定血清IL-6含量,对感染性腹泻患儿的治疗有指导意义。     

血清降钙素原联合可溶性髓样细胞触发受体-1对儿童细菌性腹泻和病毒性腹泻的鉴别诊断价值

目的 探讨血清降钙素原（PCT）联合可溶性髓样细胞触发受体-1（STREM-1）对儿童细菌性腹泻与病毒性腹泻的鉴别价值。方法 回顾性分析2018年2月至2019年5月入院接受治疗的细菌感染性腹泻患儿73例（细菌组）、病毒感染性腹泻患儿68例（病毒组）的临床资料。采用受试者工作特征（ROC）曲线分析血清PCT和STREM-1对细菌感染性腹泻与病毒感染性腹泻的诊断效能。结果 细菌组患儿粪便红细胞及脓液检出率分别为79%、51%，高于病毒组的43%、19%（P < 0.05）。细菌组患儿血清PCT和STREM-1水平均显著高于病毒组（P < 0.05）。ROC分析结果显示，血清PCT、STREM-1对儿童细菌性感染与病毒性感染腹泻鉴别的截断值分别为0.97?ng/mL、15.66?ng/mL；曲线下面积（AUC）分别为0.792、0.889。二者联合诊断的AUC为0.955，其诊断效能高于两单独指标（P < 0.05）。结论 细菌性腹泻患儿血清PCT和STREM-1水平高于病毒性腹泻患儿；血清PCT和STREM-1均可作为儿童细菌性腹泻与病毒性腹泻的鉴别指标，二者联合检测可提高鉴别诊断效能。     

感染性腹泻患儿检测血清白细胞介素—6的临床意义

本文采用放射免疫法测定２６例感染性腹泻患儿血清白细胞介素－６（ＩＬ－６）含量，其中细菌性痢疾１６例，病毒性肠炎１０例。结果：腹泻组明显高于正常对照组（Ｐ〈０．００１）；菌痢组明显高于病毒性肠炎组（Ｐ〈０．００１）；急性期组明显高于恢复期组；提示ＩＬ－６参与了腹泻的发发病过程，其含量随感染性腹泻的病原而改变，测定血清ＩＬ－６含量，对感染性腹泻患儿的治疗有指导意义。     

细胞炎前因子测定对感染性腹泻诊断的价值

目的 探讨细胞炎前因子水平变化对小儿急性感染性腹泻的意义。方法 采用酶联免疫吸附法（ELISA法）测定173例急性感染性腹泻患儿细胞炎前因子IL-6、TNF—α、IL-8水平，并与32名健康儿童对照组进行比较。结果 无论是细菌性肠炎还是病毒性肠炎，细胞炎前因子均高于对照组；且TNF—α在细菌组增高较病毒组增高明显，有显著差异（t=7．460P〈0．01）；IL-6在病毒感染时明显增高，其增高程度与细菌组比较有显著差异（t=2．073P〈0．05）；IL-8在细菌和病毒组均较对照组升高，但二者比较无显著差异（t=1．80P〉0．05）。结论 当临床不易鉴别小儿腹泻感染病原时，可借此检测来作辅助诊断，以指导临床医师选择正确的治疗方案。     

血清CRP在小儿感染性休克中临床意义的探讨

目的　探讨血清C反应蛋白 (CRP)在感染性休克患儿中诊断及疗效观察中的临床意义。方法　选择符合诊断标准的 5 1例感染性休克患儿为实验组 ,其中好转存活患儿 2 5例 ,死亡患儿 2 6例 ;2 5例一般感染患儿为对照组。测定各组患儿入院及经治疗 3d、7d的血清CRP水平 ,进行回顾性研究。结果　入院时CRP值 ,死亡组、存活组与一般感染组相比有显著性差异 (P <0 0 1 ) ;存活组入院治疗 3d与入院时比较无显著性差异 ,而治疗 7d较前均明显降低 ,有显著性差异 (P <0 0 1 ) ;死亡组治疗 3dCRP水平与入院时相比有显著性差异 (P <0 0 1 )。结论　血清CRP值的高低与感染性休克危重症严重程度有关 ,CRP越高 ,病情越重 ,预后越差。血清CRP水平可作为感染性休克病情发展及疗效评价的指标。     

轮状病毒肠炎患儿血锌水平变化及补锌治疗效果

目的 探讨轮状病毒(RV)肠炎患儿血清锌水平变化及补锌治疗对RV肠炎的疗效.方法 收集1183例健康儿童(健康对照组)空腹静脉血清,按年龄分组测定血清锌水平,记录并经统计学处理,将该值作为东莞地区该年龄段儿童血锌正常值.收集近2 a因急性水样腹泻起病2 d内在门诊经大便RV抗原检测阳性确诊为RV肠炎的143例患儿,随机分为补锌治疗组72例,常规治疗组71例.检测二组患儿血锌水平.常规治疗组患儿给予蒙脱石散剂及补液等常规治疗;补锌治疗组在常规治疗的基础上口服葡萄糖酸锌片20 mg/d(6个月以下者10 mg/d),连续治疗14 d.检测治疗后血锌水平.结果 RV肠炎患儿血锌水平明显低于本地区同龄健康儿童血锌水平,差异有显著性意义(P<0.01).补锌治疗组总有效率95.8%,常规治疗组为81.6%,二组差异有显著性意义(x2=18.88 P<0.01).补锌治疗组患儿治疗后血锌值与健康对照组比较差异无显著性意义(P0.05).结论 RV肠炎患儿血清锌水平明显降低,在腹泻常规治疗的基础上佐以补锌治疗对提高RV肠炎的疗效有良好的作用.WHO推荐补锌的剂量和疗程同样适合中国小儿RV肠炎的辅助治疗.     

运脾化湿方治疗婴幼儿轮状病毒性肠炎继发乳糖不耐受的临床观察

目的观察运脾化湿方治疗婴幼儿轮状病毒性肠炎继发乳糖不耐受的疗效。方法将符合诊断标准的72例患儿分为观察组和对照组,观察组根据辨证分型予运脾化湿中药汤剂口服;对照组予蒙脱石散(思密达)口服,疗程5d。在治疗前、后进行大便次数、腹胀等症状评分及大便乳糖改良班氏试剂法定性检测。结果观察组临床总疗效优于对照组;患儿乳糖不耐受症状及大便乳糖含量检测改善方面,观察组均优于对照组(P<0.01);无副反应发生。结论运脾化湿方具有良好的治疗小儿轮状病毒性肠炎继发乳糖不耐受的作用。     

黄芪注射液与蒙脱石散治疗婴幼儿轮状病毒性肠炎102例临床观察

目的观察黄芪注射液与蒙脱石散治疗婴幼儿轮状病毒性肠炎的临床效果。方法随机将轮状病毒性肠炎住院患儿102例分为两组,观察组58例在常规治疗的基础上加用黄芪注射液静脉滴注与蒙脱石散口服治疗,对照组44例以常规治疗,3～5d为1个疗程。观察两组患儿病情变化及副反应。结果观察组总有效率为96.5%,显著高于对照组77.3%,两组总有效率比较差异有统计学意义(P<0.01)。结论黄芪注射液与蒙脱石散治疗轮状病毒性肠炎,可改善症状,缩短疗程,值得临床推广。     

黄连素联合蒙脱石散保留灌肠治疗轮状病毒性肠炎疗效观察

目的观察黄连素联合蒙脱石散保留灌肠治疗轮状病毒性肠炎的疗效。方法将190例轮状病毒性肠炎患儿随机分为观察组和对照组各95例。观察组给予黄连素联合蒙脱石散保留灌肠,对照组静脉滴注利巴韦林注射液,治疗7 d,对比两组疗效。结果观察组主要症状、体征消失时间低于对照组,总有效率高于对照组,差异均有统计学意义(P<0.05)。结论黄连素联合蒙脱石散保留灌肠可改善轮状病毒性肠炎急性期症状及提高疗效,是治疗轮状病毒性肠炎有效的方法。     

锌制剂辅助治疗婴幼儿轮状病毒性肠炎的疗效观察

目的 探讨口服锌制剂对婴幼儿轮状病毒性肠炎的治疗效果及对后续3个月内再发腹泻的预防作用。方法 103例轮状病毒性肠炎患儿随机分为补锌治疗组 （51例）及常规治疗组 （52例）。两组均采用相同的综合治疗方案,在此基础上,补锌治疗组加服葡萄糖酸锌颗粒10 d。观察两组治疗72 h后的疗效、阳性症状消失所需的时间和肠道外脏器损害的恢复情况;同时随访观察两组患儿在后续3个月内再次腹泻的发生率。结果 补锌治疗组总有效率显著高于常规治疗组 （90% vs 75%,P < 0.05）。补锌治疗组治疗后高热、呕吐以及腹泻的持续时间均短于常规治疗组 （P < 0.05）。后续3个月内补锌治疗组再次腹泻以及严重腹泻的发生率均明显低于常规治疗组 （P < 0.05）。结论 口服锌制剂辅助治疗婴幼儿轮状病毒性肠炎有显著疗效,同时可降低患儿后续3个月再次发生腹泻的可能性以及减轻再发腹泻的严重程度。     

益生菌调节轮状病毒肠炎患儿肠道菌群的动态变化

目的 观察益生菌治疗轮状病毒肠炎时肠道菌群的动态变化,探讨益生菌能否减轻轮状病毒肠炎腹泻病情、缩短病程及减少继发肠道细菌感染的概率.方法 100例轮状病毒肠炎患儿(年龄3个月～2.2岁)来自本院门诊及住院患儿,采用随机对照试验方法,按就诊顺序随机均分为2组:对照组(蒙脱石散口服+口服或静脉补液对症治疗),益生菌治疗组(双歧杆菌乳杆菌三联活菌片口服+蒙脱石散口服+口服或静脉补液对症治疗).分别于腹泻病程1～2 d、3～4 d、5～6 d、7～8 d、9～10 d、11～14 d,收集6次粪便,进行粪便涂片菌群分析,监测肠道菌群紊乱程度变化过程,记录腹泻频次及继发肠道细菌感染情况.结果 腹泻高峰期时(3～4 d),对照组肠道菌群紊乱状况为菌群失调Ⅰ度 42%,Ⅱ度8%,Ⅲ度6%;益生菌治疗组分别为38%、10%、4%,2组比较差异无统计学意义(Pa>0.05).病程中对照组18%的患儿发生继发肠道细菌感染,益生菌治疗组为4%,2组比较差异有统计学意义(P<0.05).在腹泻病程早期(1～2 d),益生菌治疗组菌群紊乱发生比率、大便频次及继发肠道细菌感染概率与对照组比较差异均无统计学意义(Pa＞0.05);自干预治疗的3 d起,益生菌治疗组菌群紊乱状况及大便频次较对照组显著改善(Pa＜0.05).益生菌治疗组及对照组病程分别为(5.50±1.57) d及(5.80±1.68) d,2组比较差异无统计学意义(P>0.05).结论 益生菌治疗对轮状病毒肠炎有效,能在轮状病毒肠炎病程后期明显缓解肠道菌群紊乱状况,减轻腹泻次数,降低继发肠道细菌感染风险.但益生菌制剂起效缓慢,需3 d左右逐渐显效,且不能缩短轮状病毒肠炎病程.     

益生菌与口服免疫球蛋白辅助治疗儿童轮状病毒肠炎的疗效比较

目的：比较益生菌及口服免疫球蛋白对儿童轮状病毒肠炎的疗效。方法：150例轮状病毒肠炎患儿随机分为3组,每组50例。3组患儿在给予基础治疗的同时给予不同的干预治疗方案。对照组予安慰剂治疗,益生菌组予双歧杆菌乳杆菌三联活菌治疗,免疫球蛋白组予抗轮状病毒鸡卵黄IgY口服治疗。每日记录大便次数、大便性状等临床症状,并于治疗后1、3、5、7、9、11?d收集新鲜大便标本,镜检行大便菌群紊乱分度,放射免疫法检测大便SIgA水平,双抗体夹心酶联免疫法检测大便轮状病毒排泄量。结果：与对照组比较,益生菌治疗组干预用药3 d后菌群失调改善,大便频次减少,继发肠道细菌感染发生率降低（P0.05）。免疫球蛋白组用药1 d后大便SIgA水平显著高于对照组（P<0.05）,治疗3 d后腹泻频次及大便病毒排泄量均低于对照组（P<0.05）。免疫球蛋白组病程较对照组显著缩短（4.5±1.0?d vs 5.8±1.7?d,P<0.05）。结论：对儿童轮状病毒肠炎,益生菌能缓解菌群紊乱及预防继发感染,但缓解临床症状较慢,且不能缩短病程。口服免疫球蛋白显效快,能快速清除病毒及促进机体SIgA生成,且能缩短病程。     

Effect of glutamine supplementation on diarrhea, interleukin-8 and secretory immunoglobulin A in children with acute diarrhea

OBJECTIVE: Glutamine is an important fuel for rapidly dividing cells such as enterocytes and lymphocytes. Exogenous glutamine supplementation in catabolic states preserves intestinal mucosal structure and function, decreases bacterial translocation, and supports normal immunologic responses. This study was planned to assess the effect of glutamine supplementation on duration and severity of diarrhea and to assess its immunomodulatory effect by measuring serum interleukin-8 (IL-8) and salivary immunoglobulin A (sIgA) in children with acute diarrhea. METHODS: In this placebo-controlled, double-blind and randomized trial, 6- to 24-month-old otherwise healthy children admitted to the Diarrheal Diseases Training and Treatment Center with acute diarrhea received either 0.3 g/kg/day of glutamine (n = 63) or placebo (n = 65) for 7 days. Serum IL-8 and sIgA levels were determined on admission and 7 days later. All cases were followed until the diarrheal episode ended. Anthropometric measurements and history of subsequent infectious diseases were monitored monthly for 3 months after treatment. RESULTS: Mean duration of diarrhea in the glutamine treated group was significantly shorter than that of the placebo group (3.40 +/- 1.96 days, 4.57 +/- 2.48 days, respectively; P = 0.004). No differences in serum IL-8 and sIgA were found between groups on admission or 1 week later. During 3 month follow-up, mean weight gain and incidence of infectious diseases were similar in both groups. CONCLUSION: Duration of diarrhea was shorter in children supplemented with glutamine. The beneficial impact of glutamine supplementation seems to be through effects on gastrointestinal mucosa rather than the host immune response.     

儿童抗生素相关性艰难梭菌腹泻的病例对照研究

摘要 目的：探讨儿童抗生素相关性腹泻（AAD）中艰难梭菌感染（CDI）的发生情况及临床特点,为抗生素相关CDI的诊治提供依据。方法：纳入2016年6月1日至2017年10月1日在复旦大学附属儿科医院行CD毒素A/B检测和CD厌氧培养且符合AAD诊断标准的住院患儿,排除＜1月龄、粪便常规细菌培养和病毒检测等临床信息不完整的病例,重复病例仅纳入首次诊断AAD时的临床信息。毒素A/B检测阳性或结肠镜检查提示假膜性肠炎者CDI组;余为非CDI组。单人从病志中采集一般资料,基础疾病,出现AAD相关腹泻症状前2个月内的抗生素使用情况,1个月内的治疗和药物使用情况,实验室指标等。结果：符合本文纳入标准的AAD患儿150例,年龄40 d至15岁2月,中位年龄1.4岁,男103例(68.7%)。CDI组24例（16.0%）,非CDI组126例。①CDI组急性腹泻22例（中位腹泻天数8 d）,因克罗恩病导致的慢性腹泻急性加重1例;因结肠息肉导致的迁延性腹泻急性加重1例,发热11例（45.8%）,呕吐8例（33.3%）,腹痛2例（8.3%）,腹胀1例（4.2%）;1例（1/5,20%）结肠镜显示为伪膜性肠炎。②CDI组和非CDI组发病年龄,性别,基础疾病,腹泻前2个月内抗生素应用情况,腹泻前1个月内手术或糖皮质激素、免疫抑制剂和抑酸药应用情况,实验室指标差异无统计学意义(P＞0.05)。多因素logistic分析显示CDI和非CDI临床表现和常规实验室检测指标差异无统计学意义(P＞0.05)。③AAD的主要治疗措施为停用广谱抗生素,益生菌辅助治疗,CDI患儿症状无好转时加用甲硝唑（应用5~7 d后未见明显好转改口服万古霉素）。CDI组腹泻均好转或痊愈,非CDI组117例（94.4%）腹泻症状好转,9例死于腹泻外的其他原因。结论：儿童AAD中 CDI发生率为16.0%,发热、呕吐为最常见的临床表现,经治疗后预后良好,仅凭临床表现和实验室检测指标不能区分儿童ADD中CDI和非CDI。     

Spectrum of post-enteritic reactive arthritis in childhood

Eleven children (7 boys and 4 girls) suffered from reactive arthropathies following an enteritis. Mean age at onset of disease was 9.7 years (range 3.3-14.5 years). Six children had a classical Reiter's syndrome and two a juvenile spondyloarthritis diagnosed earlier. In 10/11 children, onset of disease was within 5 weeks following a febrile enteritis. The enteritis was confirmed in all 6 cases examined during the first three months after onset of disease. The arthritis was predominantly oligoarticular and affected mostly the joints of the lower extremities and toes. Recurrent enthesopathies and arthralgias occurred in most children. HLA-B27 was positive in 9 (82%). During a follow-up of 0.9 to 6.7 years, arthritis relapsed in most of the patients and 4 children had severe arthritis, and 5 sacroiliitis. Urethritis and occular signs relapsed frequently, but there were no noticeable disabilities. Two other girls had self-limited arthralgia and erythema nodosum following a febrile enteritis. This disease may represent the first stage of the broad clinical spectrum of the reactive arthropathies. In our outpatient clinic of paediatric rheumatology, 9% of 127 patients had reactive arthropathies. They show close relationships to each other and to other HLA-B27-associated spondyloarthropathies. The differentiation of this group of diseases from the juvenile rheumatoid arthritis is possible and relevant.     

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??Abstract??Objective??To study the epidemiology??clinical and electrophysiological characteristics of the children with Guillain-Barré syndrome. Methods??Retrospectively analyze the electrophysiological and clinical data of 77 children wtih GBS in our hospital. Results??According to clinical and electrophysiologic findings??32 patients manifested acute inflammatory demyelinating polyradiculoneuropathy??AIDP???? 34 had acute motor axonal neuropathy??AMAN????4 had acute motor and sensory axonal neuropathy??ASMAN???? 4 were inexcitable?? 2 were unclassified and 1 had Miller-Fisher syndrome. The 77 patients included 53 boys and 25 girls.There were 27 boys and 5 girls in AIDP group and 18 boys and 16 girls in AMAN group. The AMAN group wer clearly seasonal ??June 4 to August 28?? .The mean time from the onset of illness to nadir was 7.09±3.17 days in the AIDP group and 4.94±1.59 days in the AMAN group. The mean disability score at nadir by the Hughes scale of 12 cases in AIDP group and 9 cases in AMAN group was ≤3??and 20 cases in AIDP group and 25 cases in AMAN group was ≥4.The number of cases in the respiratory muscle paralysis?? cranial nerve palsy and autonomic symptoms in the AMAN was more than in the AIDP group??but there was no statistical significance. In the sensory nerve involvement?? the AIDP was obviously more severe than in the AMAN group. Conclusion??The incidence of the AMAN and the AIDP group is similar in north Chinese children.Compared with AIDP group??the AMAN group has seasonal characteristics and gender differences. Between the two groups?? besides sensory nerve involvement ??there was no significant difference in the clinical feature and severity. However?? the clinical progress of the AMAN is faster than the AIDP group.     

布拉氏酵母菌散剂联合阿奇霉素序贯治疗肺炎支原体肺炎继发腹泻患儿的临床研究

目的 探讨布拉氏酵母菌散剂联合阿奇霉素序贯治疗肺炎支原体肺炎继发腹泻患儿的效果。方法 选取2015年6月至2017年3月肺炎支原体肺炎继发腹泻患儿88例为研究对象,随机数字表法分为对照组（n=44）和研究组（n=44）。对照组采取常规治疗+阿奇霉素序贯治疗,研究组在对照组基础上口服布拉氏酵母菌散剂,用药至阿奇霉素序贯治疗结束。疗程结束后统计比较两组临床症状改善时间、住院时间,以及临床疗效、治疗前后大便次数、肠道菌群失调情况、不良反应发生率。结果 研究组临床症状改善时间及住院时间较对照组缩短（P < 0.05）;研究组治疗有效率高于对照组（P < 0.05）;治疗第3天及第5天研究组患儿大便次数较对照组明显减少（P < 0.05）;两组肠道菌群失调率比较,研究组较对照组低（P < 0.05）;两组不良反应发生率比较差异无统计学意义（P > 0.05）。结论 采用布拉氏酵母菌散剂联合阿奇霉素序贯治疗肺炎支原体肺炎继发腹泻,可有效改善患儿临床症状,缩短住院时间,减少大便次数,改善肠道菌群失调情况,提高治疗效果,且不会增加不良反应发生风险。     

Gender analysis in acute bronchiolitis due to respiratory syncytial virus

It is reasonable to compare immune reactions between boys and girls because many infections in the early stages are predominant in males. A relationship between immunomodulatory effects of sex hormone surge in boys at early months and infectious diseases is still unclear. We compared clinical features between boys and girls who suffered from wheezing that was initially triggered by acute respiratory syncytial virus (RSV) bronchiolitis. For systemic immune response evaluation, white blood cell (WBC) count, blood eosinophil count, and serum C-reactive protein (CRP) were measured. For local inflammation evaluation, scores for eosinophils and neutrophils in sputum were evaluated microscopically. Patients consisted of 90 boys and 51 girls. Most children were under 6 months of age. WBC counts and serum CRP levels were significantly increased in girls compared with boys. Blood eosinophilia at the acute stage was rarely observed in children after 6 months of age. For local response evaluation, sputum specimens obtained from 42 boys and 29 girls were microscopically examined. Sputum eosinophil score of 2+ and more was observed in boys (6/42) exclusively. In contrast, sputum neutrophilia was commonly observed in boys and girls. From a follow-up study, we confirmed that 28 children with RSV bronchiolitis showed wheezing episodes afterwards. However, their blood and sputum eosinophilia during RSV bronchiolitis did not reflect their subsequent wheezing. We speculated that gender-specific responses to RSV infection might account for male susceptibility. Differences in RSV pathogenicity between boys and girls should be further investigated in terms of asthma progression.