HCMV感染患儿HLA-DR、CD4+CD25+调节性T细胞及IL-17、IL-27表达水平与肝损害的相关性研究

目的 探讨人巨细胞病毒（HCMV）感染患儿HLA-DR、CD4⁺CD25⁺调节性T细胞（CD4⁺CD25⁺Treg）以及IL-17、IL-27的表达水平与肝功能损害的相关性。方法 以21例HCMV感染肝功能损害患儿和21例HCMV感染非肝功能损害患儿为研究对象。流式细胞术检测两组外周血CD4⁺CD25⁺Treg、HLA-DR细胞的表达;ELISA检测血浆IL-17及IL-27表达。结果 与非肝损组比较,肝损组患儿CD4⁺CD25⁺Treg比率较低,IL-17、IL-27表达水平较高,差异均有统计学意义（P < 0.05）。IL-17及IL-27水平与CD4⁺CD25⁺Treg细胞比率呈负相关（P < 0.01）。结论 CD4⁺CD25⁺Treg细胞介导的免疫耐受失衡及IL-17、IL-27等炎症因子过度激活可能参与HCMV感染肝功能损害发生。     

826例0岁至学龄前健康儿童外周血淋巴细胞亚群分布的调查分析

目的 调查分析0岁至学龄前健康儿童外周血淋巴细胞亚群的分布。方法 826例0岁至学龄前汉族儿童分为新生儿组、婴儿组、幼儿组、学龄前组,使用流式细胞术检测各组外周血淋巴细胞亚群。结果 CD3⁺细胞、CD3⁺CD4⁺细胞、CD3^-CD19⁺细胞和CD4⁺/CD8⁺在0岁至学龄前儿童不同性别之间的差异具有统计学意义（P < 0.05）,CD3^-CD19⁺细胞以女童较低,其他3个指标以女童较高;CD3⁺、CD3⁺CD4⁺及CD4⁺/CD8⁺均以新生儿组最高,其中CD3⁺CD4⁺及CD4⁺/CD8⁺含量随年龄增长逐渐降低,至学龄前最低（P < 0.05）;CD3^-CD19⁺和CD3^-CD16⁺CD56⁺细胞含量以新生儿组最低,随年龄增长而增高,CD3^-CD16⁺CD56⁺细胞以学龄前组最高,而CD3^-CD19⁺细胞含量在幼儿期达峰值后降低（P < 0.05）;CD3⁺CD8⁺细胞含量以学龄前组最高（P < 0.05）。不同年龄组男童的淋巴细胞亚群分布的变化趋势与不同年龄组儿童的规律一致;在女童中,CD3⁺CD4⁺及CD4⁺/CD8⁺含量也是以新生儿组最高（P < 0.05）。结论 淋巴细胞亚群在不同年龄、性别健康儿童之间的分布不同,建议按年龄、性别分别建立参考值。     

婴儿血液、尿液及母乳中病毒DNA检测在诊断人巨细胞病毒感染中的应用

目的 定量检测疑似人巨细胞病毒(HCMV)感染婴儿血液、尿液及对应母亲乳汁中的HCMV-DNA,评估三者在不同年龄组内辅助诊断HCMV感染的意义。方法 选取170例疑似HCMV感染婴儿,根据年龄分为两组:新生儿组(< 28 d, n=43)和28 d~5个月组(n=127),分别收集血液、尿液及母乳,应用荧光定量聚合酶链式反应法(FQ-PCR)检测HCMV-DNA。结果 新生儿组血液、尿液及母乳HCMV-DNA阳性检出率分别为65.1%、18.6%和93.0%,28 d~5个月组三者检出率分别为64.6%、92.9%和72.4%,28 d~5个月组尿液检出率显著高于新生儿组(P<0.01),而母乳检出率却显著低于新生儿组(P<0.01)。82例血液和尿液HCMV-DNA为阳性的患儿,其尿液HCMV-DNA拷贝数明显高于血液。结论 不同年龄组尿液及母乳中HCMV-DNA检出率不同,根据年龄选择合适的送检标本对提高检出率具有重要意义。     

SOCS低甲基化在儿童过敏性紫癜Th17/Treg细胞失衡中的作用研究

目的 通过研究细胞因子信号转导抑制因子（SOCS）低甲基化与过敏性紫癜（HSP）患儿Th17/Treg细胞失衡的关系,探讨HSP的免疫发病机制。方法 选取2014年5月至2015年1月32例急性期HSP住院患儿为研究对象,另选取行健康体检的28例儿童作为健康对照组。采用ELISA法检测血浆IL-6水平;流式细胞术检测外周血CD4⁺IL-17A⁺T细胞（Th17细胞）比例、CD4⁺CD25⁺调节性T细胞（Treg）比例和CD4⁺T细胞磷酸化STAT3（pSTAT3）蛋白平均荧光强度（MFI）;实时荧光定量PCR（RT-qPCR）技术检测CD4⁺T细胞SOCS1、SOCS3基因mRNA表达;高分辨率熔解曲线（HRM）分析法检测外周血单个核细胞SOCS1基因外显子2、SOCS3基因5'端非翻译区（5'-UTR）可能的STAT3结合位点CpG岛甲基化水平。结果 与健康对照组比较,HSP组血浆IL-6浓度、CD4⁺T细胞pSTAT3的MFI显著增加;HSP组Th17细胞比例显著上调,Treg细胞比例显著下调（P < 0.05）。HSP组患儿急性期外周血单个核细胞SOCS1 mRNA和SOCS3 mRNA水平均显著高于健康对照组（P < 0.05）;HSP组SOCS1 mRNA及SOCS3 mRNA表达均与Th17/Treg比值呈负相关（P < 0.05）。HSP组患儿急性期SOCS1基因外显子2、SOCS3基因5'-UTR区可能的STAT结合位点CpG岛呈低甲基化,而健康对照组呈完全去甲基化状态。结论 SOCS1、SOCS3基因低甲基化所致其相对表达不足可能是HSP患儿Th17/Treg失衡的因素之一。     

抽动障碍患儿T淋巴细胞亚群、血清神经元特异性烯醇化酶水平及意义

目的 探讨抽动障碍（TD）患儿T淋巴细胞亚群及血清神经元特异性烯醇化酶（NSE）水平与抽动症状严重程度、临床分型的关联性，分析其临床意义。方法 收集2020年6月至2021年6月就诊的TD患儿的临床资料，根据耶鲁综合抽动严重程度量表（YGTSS）将其分为轻度TD组和中重度TD组，根据临床分型标准将TD组分为短暂性抽动障碍（TTD）组、慢性运动或发声性抽动障碍（CTD）组及Tourette综合征（TS）组。与同期行常规体检健康儿童的T淋巴细胞亚群及NSE水平进行比较。结果 纳入180例TD患儿（TD组），男141例、女39例，年龄（7.3±2.3）岁；对照组150例，男115例、女35例，年龄（7.4±2.2）岁。TD组CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺均低于对照组，NSE水平高于对照组，差异有统计学意义（P<0.05）。轻度TD组（n=73）、中重度TD组（n=107）和对照组之间CD3⁺、CD3⁺CD4^+...     

婴幼儿常见下呼吸道感染性疾病与淋巴细胞亚群变化关系的研究

目的 探讨淋巴细胞亚群在儿童常见下呼吸道感染支气管炎、支气管肺炎和毛细支气管炎中的变化及临床意义。方法 选取111 例支气管炎、418 例支气管肺炎和83 例毛细支气管炎患儿为疾病组,同期健康婴幼儿235 例为对照组,用流式细胞仪检测各组淋巴细胞亚群。结果 支气管炎组总T 淋巴细胞、CD3⁺CD8⁺细胞低于对照组(P<0.05)。支气管肺炎组总T 淋巴细胞和CD3⁺CD8⁺ 细胞低于对照组、Th 和CD4/CD8 高于对照组,且Th 比例高于支气管炎组;与轻症肺炎组相比,重症肺炎组总T 淋巴细胞降低而B 淋巴细胞升高(P<0.05)。毛细支气管炎组Th 细胞和CD4/CD8 高于对照组、CD3⁺CD8⁺ 细胞低于对照组(P<0.01)。与对照组比,3 组下呼吸道感染患儿的B 淋巴细胞增高、NK 细胞比例降低(P<0.05)。结论 细胞免疫功能紊乱或低下以及体液免疫功能亢进参与了婴幼儿下呼吸道感染的发生和发展,并且变化程度与疾病类型及病情程度有关。     

以缺血性脑卒中为主要表现的儿童获得性免疫缺陷综合征1例

对2019年1月苏州大学附属儿童医院重症医学科收治的1例以缺血性脑卒中为主要表现的获得性免疫缺陷综合征患儿的临床资料进行回顾性分析。患儿,男,6岁4个月,既往有血小板减少性紫癜和反复呼吸道感染病史。主诉"右侧肢体乏力10余天"。头颅磁共振成像提示双侧额顶叶较广泛异常信号伴左侧丘脑、外囊软化灶形成。血常规示白细胞4.88×10⁹/L,淋巴细胞比例0.291,淋巴细胞计数1.42×10⁹/L,血红蛋白99 g/L,血小板23×10⁹/L。淋巴细胞亚群:CD3⁺84.1%,CD3⁺CD4⁺0.2%,CD3⁺CD8⁺61.4%,CD4⁺/CD8⁺0,CD3-CD19⁺9.2%,CD3-CD₁₆₊₅₆⁺6.1%,CD₁₉⁺CD₂₃⁺5.8%。输血前检查:人类免疫缺陷病毒(HIV)(⁺),余阴性。患儿父母双方均为HIV感染患者。本病例提示神经系统受累症状在HIV感染中并不少见,且脑卒中是HIV感染患儿出现临床局灶性神经功能缺损的最常见原因。高危患儿出现其他神经受累表现或认知改变,须尽早完善头颅磁共振检查。     

手足口病患儿淋巴细胞亚群和免疫球蛋白及补体C3、C4水平分析

目的 分析淋巴细胞亚群、免疫球蛋白及补体C3、C4在手足口病患儿免疫状态评估中的临床应用价值。方法 选取282例手足口病患儿为手足口病组,130例健康儿童为健康对照组;检测两组外周血CD3⁺、CD4⁺、CD8⁺T淋巴细胞、CD19+B淋巴细胞、CD56+自然杀伤细胞比例,CD4⁺/CD8⁺、IgA、IgM、IgG和补体C3、C4水平。结果 多因素分析显示,手足口病组CD3⁺、CD4⁺、CD8⁺T淋巴细胞比例及补体C3、C4水平低于健康对照组（P < 0.05）,CD56+自然杀伤细胞比例、IgG水平高于健康对照组（P < 0.05）。单独效应分析显示,0岁~手足口病组CD4⁺/CD8⁺高于健康对照组（P < 0.05）;0岁~及3岁~的男性手足口病组IgM水平高于健康对照组（P < 0.05）;3岁~男性及0岁~女性手足口病组IgA水平低于健康对照组（P < 0.05）。结论 手足口病患儿存在细胞免疫及体液免疫功能紊乱,监测淋巴细胞亚群、免疫球蛋白水平可以为手足口病患儿的免疫状态评估提供实验室依据。     

婴儿癫(癎)与人巨细胞病毒感染的关系

目的探讨婴儿癫癎与人巨细胞病毒(HCMV)感染的关系。方法采用荧光定量聚合酶链式反应法检测婴儿癫癎52例及健康儿童20例尿HCMV-DNA,比较HCMV阳性与HCMV阴性癫癎患儿头颅CT、脑干听觉诱发电位(BAEP)异常率。结果婴儿癫癎组HCMV-DNA检出率为59.62%(31例),对照组为30%(6例),二者比较有显著差异(P<0.05)。HCMV阳性癫癎组头颅CT、BAEP异常率(54.84%、25.81%)远高于HCMV阴性癫癎组(23.81%、4.76%)(Pa<0.05)。结论HCMV感染可能是婴儿癫癎的重要致病因子之一,其感染导致的脑组织损伤在婴儿癫癎的发生发展中可能起重要作用。     

婴儿期特发性血小板减少性紫癜与人巨细胞病毒感染的关系

目的探讨婴儿期特发性血小板减少性紫癜(ITP)与人巨细胞病毒(HCMV)感染及免疫功能的关系。方法对54例ITP患儿(病例组)及30例正常婴儿(对照组)采用酶联免疫吸附法(ELISA)行HCMV抗体检测,PCR法行HCMV DNA检测,并对病例组采用直接免疫荧光染色法行血T细胞亚群检测,比较两组差异。结果两组HCMV抗体、DNA阳性数比较,差异有显著性意义(P均<0.01)。病例组HCMV-IgM阳性与阴性者T细胞亚群CD4 、CD8 及CD4 /CD8 比较,差异有显著性意义(P均<0.01)。结论婴儿期HCMV感染可能为ITP发病的重要因素之一。免疫功能紊乱与ITP发生、发展密切相关。     

Quantitative detection of HCMV-DNA in saliva from infants and breast milk on real-time polymerase chain reaction

Background:  The role of breast milk in viral transmission has not been fully studied. To determine the effect of breast milk on the establishment of primary human cytomegalovirus (HCMV) infection in term infants, HCMV-DNA was measured in breast milk and infant saliva.
Methods:  The study population consisted of 48 healthy term infants and their mothers. The copy number of HCMV-DNA in the infants' saliva and mothers' milk was measured on quantitative real-time polymerase chain reaction (PCR).
Results:  HCMV-DNA was detected in both saliva and breast milk from 21 infant–mother pairs, in milk only from four pairs, in saliva only from 12 pairs, and in neither from 11 pairs. HCMV-DNA was first detected in the saliva of 10 infants at age 4 months, seven infants at 7 months, 13 infants at 10 months, and three infants at 12 months. The viral loads peaked 4–10 months after birth, and thereafter decreased or became negative. The peak copy number and rate of HCMV-DNA detection in saliva were significantly related to peak copy number and rate of detection in the corresponding breast milk.
Conclusion:  Thus, HCMV passed through breast milk 1–7 months after delivery affects the persistence and level of HCMV-DNA in infant saliva and is the most important route of primary infection.     

Transmission du cytomégalovirus par le lait maternel cru aux enfants prématurés : étude épidémiologique pilote

Transmission of cytomegalovirus (CMV) infection from mothers to preterm infants during breastfeeding may be symptomatic and long term consequences are unknown. This study evaluated the kinetics of CMV load in breastmilk and the rate of postnatal CMV transmission via breastmilk from mothers to their preterm infants.MethodsProspective study of mother-child pairs after preterm delivery before 33 weeks. Exclusion of donor breast milk and of CMV-seropositive blood products. Material used was maternal CMV serostatus, ear swab of the infant at birth, weekly screened breast milk and children's urine by rapid viral culture.ResultsDuring a 5-month period 28 mother-infant pairs with 34 preterm infants were studied. Eighteen women (64.3%) were CMV-seronegative at birth; breastmilk samples and the infants' urine remained CMV-negative. Eight of the 10 seropositive mothers, who had 11 preterm infants, excreted CMV into breast milk (80%). CMV excretion into breast milk was detected during the first week after delivery in 66% cases and was at its peaked between 3 to 5 weeks after delivery. Out of the 7 CMV-exposed infants, CMV transmission was confirmed in only one asymptomatic case. Total quantity of breast milk intake did not seem discriminative for CMV transmission.ConclusionIn CMV-seropositive mothers of preterm infants a high incidence of CMV excretion into breast milk was detected. Despite this high rate, symptomatic infection did not occur. However, potential risk and severity of infection may be difficult to establish. Because breastfeeding is beneficial, new procedures for gentle virus inactivation of seropositive breast milk should be assessed.     

Correlation of ribonucleic acid polymerase chain reaction, acid dissociated p24 antigen, and neopterin with progression of disease: A retrospective, longitudinal study of vertically acquired human immunodeficiency virus type 1 infection in children

Objective: We investigated the relationship between cell-free viral load, neopterin, age-adjusted CD4 ⁺ cell concentration, and clinical events in 49 children with vertically acquired human immunodeficiency virus type 1 infection.Study design: Viral load was measured by quantitating viral ribonucleic acid in serum by polymerase chain reaction and measurement of immune complex dissociated p24 antigen in serum and plasma. Children were followed for an average of 2 ½ years, with an average of 6 samples per child. Medical records were reviewed for weight, CD4 ⁺ cell count, and clinical events.Results: High virus copy number in serum was predictive of a decrease in weight-for-agezscore during the subsequent 6 months. High viral load, low CD4 ⁺ cell count, and high neopterin level were correlated with encephalopathy. High viral load correlated with opportunistic infections. All of these relationships held regardless of treatment status, although viral load decreased significantly after treatment was begun.Conclusions: Measurements of viral load were useful prognostic indicators for poor weight gain. Elevated serum virus levels and neopterin values and low CD4 ⁺ cell counts were all associated with encephalopathy. (J Pediatr 1997:130:898-905)     

Breastfeeding progression in late preterm infants from birth to one month

This study aimed to describe and compare breastfeeding progression, infants' feeding behaviours, maternal feeding difficulties, and mothers' usage of breastfeeding interventions for singleton late preterm (LPT) and term infants. A further aim was to identify associated factors for exclusive breastfeeding at breast at 1 month in LPT infants. This was a cohort study where mothers of LPT infants from a neonatal unit (n = 60), LPT infants from a maternity unit (n = 62), and term infants from a maternity unit (n = 269) answered a questionnaire approximately 1 month after delivery. Findings showed no significant differences in exclusive breastfeeding at breasts between LPT infants admitted to the neonatal unit compared with the maternity unit, during the first week at home (38% vs. 48%), or at 1 month of age (52% vs. 50%). Term infants were more likely to be exclusively breastfed at the breast (86% and 74%, p < 0.05) compared with LPT infants. Multiple regression analysis showed that usage of a nipple shield, not feeding breast milk exclusively during the first week at home, or feeding less than 10 times per day at 1 month were statistically significant for not exclusively breastfeed at the breast. A protective factor was the mothers' experience of having an abundance of milk during the first week at home. In conclusion, LPT infants are less likely to be exclusively breastfed at the breast than term infants, highlighting the need for further research to guide interventions aimed at optimising exclusive breastfeeding rates.     

连续血液净化对严重脓毒症患儿T细胞亚群的影响

目的 探讨连续血液净化（CBP）治疗对严重脓毒症患儿T 细胞亚群及预后的影响。方法 选择严重脓毒症患儿42 例,随机给予常规治疗（对照组,22 例）和常规治疗+CBP 治疗 （CBP 组,20 例）,分别于治疗前及治疗后3 d、7 d 动态测定外周血调节性T 细胞亚群的变化及相关临床指标。结果 CBP 组患儿PICU 入住时间及机械通气时间均明显短于对照组（均PP+、CD4+、CD8+ T 淋巴细胞百分比及PCIS 评分较治疗前明显升高,差异均有统计学意义（P+、CD4+、CD8+ T 淋巴细胞百分比及PCIS 评分明显高于对照组（P+、CD4+、CD8+ T 淋巴细胞百分比、CD4+/CD8+ 比值及PCIS 评分均较对照组明显升高（P结论 CBP 治疗可以提高严重脓毒症患儿受抑制的免疫功能,改善患儿预后。     

Factors associated with breast milk intake among 9–10‐month‐old Malawian infants

Exclusive breastfeeding is recommended during the first 6 months of life; thereafter, continued breastfeeding along with nutritious complementary foods is recommended. Continued breastfeeding contributes a substantial proportion of nutrient needs and promotes healthy growth and development, but the quantity of breast milk consumed may be highly variable and little is known about the factors associated with breast milk intake after 6 months of age. The present study was conducted to assess factors associated with breast milk intake of Malawian infants at 9–10 months of age. Breast milk intake was measured using the dose‐to‐mother deuterium oxide dilution method in a subsample of 358 Malawian infants who were participating in a randomized controlled trial of lipid‐based nutrient supplements. Regression analysis was used to assess associations between breast milk intake and several maternal and infant variables. Mean (standard deviation) breast milk intake was 752 (244) g day^–1. In multiple regression, breast milk intake was positively associated with infant weight (+62 g per kg body weight, P < 0.01) and maternal height (P < 0.01) and negatively associated with maternal education and age (P < 0.01). There was a non‐significant (P = 0.063) inverse association between energy from non‐breast milk sources and breast milk intake. In this rural Malawian population, infant weight is the main predictor of breast milk intake, even after the first 6 months of life.