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。     

婴幼儿肺功能检测及气道反应性测定

儿童时期的肺功能测定对于临床及科研均非常重要。婴幼儿肺功能检测包括潮气呼吸、阻断、体描以及快速胸腹腔挤压。其中最常用的是潮气呼吸肺功能检测,其主要参数为达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE),是反映气道阻塞的2个非常重要的参数。支气管激发试验可以协助哮喘的诊断,判断治疗的效果。经典的是6岁以上儿童和成人做的以1秒量FEV1(也可以用呼气峰流速PEF)为判断指标的支气管激发试验。近15年来,出现了以脉冲振荡原理监测平静呼吸时吸入支气管激发剂时气道阻力的变化,以最小激发累积剂量(Dmin)为判断指标的激发试验方法。此方法可应用于4岁以上的儿童,明显扩大了检测范围,为临床提供了更为便捷的手段。     

运动激发试验与药物激发试验用于气道高反应性检测的比较及临床价值评估

目的 比较运动激发试验与药物激发试验用于气道高反应性检测的优劣,以得出更佳、更安全的用于气道高反应性的检测方法。方法 选择经哮喘正规治疗后拟停药的哮喘患儿47 例,对每名受试患儿先后进行运动和药物两种激发试验检测,并与金标准(PD20)相比较得出各自的敏感度,记录和观察两种激发试验过程中支气管痉挛症状发生情况。结果 以PD20 作为金标准,药物激发试验对中、重度气道高反应性患儿的检出敏感度(61%)明显高于运动激发试验(9%)(Pκ=0.614),而运动激发试验与金标准的一致性较差(κ=0.006);但药物激发试验中,哮喘患儿支气管痉挛症状发生率高,与咳嗽和胸闷发生率呈正相关(P结论 测定经哮喘正规治疗后拟停药的患儿气道高反应性时,药物激发试验较运动激发试验敏感度高,但副反应发生率亦较高。     

Biomarkers of diagnosis and resolution of food allergy

Food allergy is increasing in prevalence, affecting up to 10% of children in developed countries. Food allergy can significantly affect the quality of life and well-being of patients and their families; therefore, an accurate diagnosis is of extreme importance. Some food allergies can spontaneously resolve in 50%-60% of cow’s milk and egg-allergic, 20% of peanut-allergic and 9% of tree nut-allergic children by school age. For that reason, food-allergic status should be monitored over time to determine when to reintroduce the food back into the child’s diet. The gold-standard to confirm the diagnosis and the resolution of food allergy is an oral food challenge; however, this involves the risk of causing an acute-allergic reaction and requires clinical experience and resources to treat allergic reactions of any degree of severity. In the clinical setting, biomarkers have been used and validated to enable an accurate diagnosis when combined with the clinical history, deferring the oral food challenge, whenever possible. In this review, we cover the tools available to support the diagnosis of food allergies and to predict food allergy resolution over time. We review the latest evidence on different testing modalities and how effective they are in guiding clinical decision making in practice. We also evaluate predictive test cut-offs for the more common food allergens to try and provide guidance on when challenges might be most successful in determining oral tolerance in children.     

Normative Two-Minute Walk Test Distances for Boys and Girls 3 to 17 Years of Age

Aims: To provide normative reference values for the 2-minute walk test (2MWT) for children and adolescents. Methods: A population-based sample of 2,631 boys and girls (3–17 years) contributed data to this 2011 study which was part of the NIH Toolbox for the Assessment of Neurological and Behavioral Function Norming Project. The 2MWT was performed over a 50 foot (15.2 meter) out-and-back course. Results: Overall, the mean (standard deviation) distance walked by the participants was 186.2 (33.9) meters. As a general linear model demonstrated that gender (F = 11.0, p =.001) and age (F = 127.6, p <.001) affected 2MWT distance, separate norms are provided for each gender and age stratum (e.g., 3-year-old boys,16-year-old girls). Based on these findings and correlational and regression analysis, separate explanatory equations for 2MWT distance for boys and girls are provided. The separate equations for boys and girls include age, age squared, height, and body mass as variables that explain around 40% of the variance in 2MWT distance. Conclusions: The study presents norms for the 2MWT performed by American boys and girls. The norms can be used to determine the presence of limitations in walking endurance in this population.     

Interactions of task and subject variables among continuous performance tests

BACKGROUND: Contemporary models of working memory suggest that target paradigm (TP) and target density (TD) should interact as influences on error rates derived from continuous performance tests (CPTs). The present study evaluated this hypothesis empirically in a typically developing, ethnically diverse sample of children. The extent to which scores based on different combinations of these task parameters showed different patterns of relationship to age, intelligence, and gender was also assessed. METHODS: Four continuous performance tests were derived by combining two target paradigms (AX and repeated letter target stimuli) with two levels of target density (8.3% and 33%). Variations in mean omission (OE) and commission (CE) error rates were examined within and across combinations of TP and TD. In addition, a nested series of structural equation models was utilized to examine patterns of relationship among error rates, age, intelligence, and gender. RESULTS: Target paradigm and target density interacted as influences on error rates. Increasing density resulted in higher OE and CE rates for the AX paradigm. In contrast, the high density condition yielded a decline in OE rates accompanied by a small increase in CEs using the repeated letter CPT. Target paradigms were also distinguishable on the basis of age when using OEs as the performance measure, whereas combinations of age and intelligence distinguished between density levels but not target paradigms using CEs as the dependent measure. CONCLUSIONS: Different combinations of target paradigm and target density appear to yield scores that are conceptually and psychometrically distinguishable. Consequently, developmentally appropriate interpretation of error rates across tasks may require (a) careful analysis of working memory and attentional resources required for successful performance, and (b) normative data bases that are differently stratified with respect to combinations of age and intelligence.     

血清特应性变应原及总IgE抗体与抽动障碍发病的关系

目的抽动障碍(TD)病因尚不明确,通过对TD患儿血清总IgE及特应性变应原IgE进行检测,探讨TD与过敏反应的关系。方法本研究对62例TD患儿进行血清总IgE抗体和特应性变应原检测。收集TD患儿静脉血3 mL,采用欧蒙医学实验诊断股份公司的特应性变应原中国组合3检测试剂盒(欧蒙印迹法)进行总IgE抗体、吸入性和食物变应原特异性IgE抗体(sIgE)检测。结果本研究中TD患儿90.32%以眨眼、挤眼等眼部表现和鼻咽部抽动症状起病。患TD儿童血清总IgE抗体阳性者52例,阳性率为83.87%。血清特异性变应原sIgE检测阳性44例,阳性率为70.97%。吸入性变应原sIgE阳性率高于食物变应原,TD患儿常见变应原有屋尘、树组合(榆树/梧桐树/柳树/杨树/柏树)、尘螨组合(屋尘螨/粉尘螨)、牛奶/巧克力混合、海鲜组合(蟹,扇贝,虾,蛤)。总IgE等级分布与病程长短无关。结论血清特应性变应原及高总IgE抗体可能是引起TD的一个重要原因。     

抗体释放试验与新生儿高胆红素血症发生率关系探讨

目的 探讨抗体释放试验不同的检验结果与新生儿高胆红素血症发生率的关系.方法 按检验操作规程,对1 013例母/子血型O/A(B)组合的新生儿脐血进行溶血性疾病血型血清学检验.按检验结果分组调查其出生7 d内高胆红素血症的发生率.结果 (1)抗体释放试验阳性患儿高胆红素血症发生率显著高于对照组的新生儿(P＜0.01).(2)在抗体释放试验阳性结果中,红细胞凝集程度不同的三组患儿高胆红素血症发生率差异有显著性(P＜0.01).(3)抗体释放试验阳性患儿是否存在IgG抗-A+B的两组患儿高胆红素血症发生率差异无显著性(P＞0.05);是否存在游离抗体的两组患儿高胆红素血症发生率差异有显著性(P＜0.01).结论 抗体释放试验不同的检验结果对判断新生儿能否发生高胆红素血症有一定的临床意义.     

踏车运动试验对疑似小儿心肌炎及功能性早搏的诊断价值探讨

目的　报告踏车试验 (EET)临床应用的结果 ,探讨EET在儿科应用的指征和价值。方法　用EGM ⅢC型踏车心功量仪对 2 6 8例 4～ 14岁患儿进行亚极量运动负荷试验 ,以心电图作为主要检测指标。结果　 36例判断为阳性 (13 4% ) ;2 9例为可疑阳性 (10 8% )。EET总阳性率在有心源性症状者为 2 1 4% ,心肌炎恢复期为 32 5 % ,功能性早搏为 36 4% ,与对照组比较差异均有显著性 (P <0 0 1)。结论　EET对儿童心血管症状体征和心功能的评价都有相当的价值 ,应进一步规范化并扩大临床应用     

中国儿童过敏原检测临床应用专家共识(2021版)

儿童过敏性疾病发病率呈逐年上升趋势,罹患哮喘、过敏性鼻炎和湿疹等过敏性疾病不仅降低了儿童生活质量,而且增加家庭与社会的经济负担。过敏原检测可以明确致敏变应原,为个体化管理过敏性疾病提供依据。常用的过敏原检测方法包括过敏原皮肤点刺试验和血清特异性IgE检测。不同过敏原检测方法的适应证及其结果判断在儿科临床亟待规范。本共识以儿童过敏原检测相关的临床常见问题为导向,查阅相关文献,经多学科临床专家通过德尔菲投票方法达成共识,形成10个临床问题的推荐建议。     

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当结核分枝杆菌(Mtb)进入人体后,巨噬细胞将其黏附并吞噬,通过溶菌酶、蛋白水解酶等发挥杀菌作用,活力差的Mtb被杀死,活力强的Mtb则可通过其保护机制能够生长繁殖并刺激宿主产生细胞反应而构成感染,少数免疫能力差、感染严重者可发生临床结核病,大多数感染者的免疫作用能控制Mtb的进一步繁殖,并杀死多数Mtb,未被杀死的少数     

Skin test and RAST in children allergic to common allergens

Ninety children with bronchial asthma were evaluated for the presence of house dust, house dust mite. Aspergillus fumigatus and milk allergy in vivo by prick test (skin test) and in vitro by RAST. Of the 20 children tested for house dust allergy 12 were positive by skin test and six by RAST. Only six were positive by both methods. Of 25 children tested for house dust mite, 16 were positive by skin test, 13 by RAST and 11 by both methods. Of 35 children tested for aspergillus fumigatus, 25 were positive by skin test, 19 by RAST and 11 were positive by both methods. In the case of 10 children under three years of age with known hypersensitivity to milk, all were negative by prick test and three were moderately positive by RAST method. The correlation of skin test with RAST was 65% for house dust, 72% for house dust mite, 37% for aspergillus fumigatus and 70% for milk. Overall correlation of skin test with RAST was 56·7%.     

DIAGNOSTIC VALUE OF SUCROSE TOLERANCE TEST IN CHILDREN EVALUATED BY BREATH HYDROGEN MEASUREMENT

Abstract. Douwes, A. C., Fernandes, J., Jongbloed, A. A. (Sophia Children's Hospital and Neonatal Unit, Academic Hospital of the Erasmus University, Rotterdam, The Netherlands). Diagnostic value of sucrose tolerance test in children, evaluated by breath hydrogen measurement. Acta Paediatr Scand, 69:79, 1980.—An oral sucrose tolerance test was performed in a group of 103 children, aged between 3 months and 15 years because of episodic diarrhea and/or abdominal pains. Sucrose malabsorption defined as an abnormal increase in expired hydrogen, was found in only 3 children who suffered from congenital sucrase-isomaltase deficiency. This 1% incidence of sucrose malabsorption was lower than the incidence of lactose malabsorption found in this group (33 %). Mean rise in blood glucose during the sucrose test was higher (3.4 ± 1.4 vs. 2.4 ± 1.2 mmol/l, p < 0.0001) and the occurrence of false flat blood glucose curves was lower (3% vs. 12.8%, p < 0.05) than during the lactose test. These findings are consistent with the higher sucrase activity in the small bowel mucosa compared to lactase. In contrast to the lactose tolerance test, sucrose tolerance test should not be used as a screening procedure for secondary disaccharidase deficiency in children     

新生儿早发型败血症10年病原菌变迁及药敏分析

目的　了解广东省佛山地区近 10年新生儿早发型败血症 (EONS)病原菌的变迁及药敏结果变化。方法　对 1993年 1月至 2 0 0 2年 12月广东佛山市妇儿医院 342例EONS病例血培养检出菌、药敏试验结果进行回顾性调查 ,将前后 5年两组资料对比分析。结果　共检出病原菌 38种 ,382株。后 5年与前 5年比较 ,检出构成比凝固酶阴性葡萄球菌 (CNS)、大肠埃希菌及肺炎克雷伯菌增高 ;金黄色葡萄球菌 (简称金葡菌 )及链球菌属降低。青霉素、苯唑青霉素对金葡菌 ,青霉素、氨苄青霉素、苯唑青霉素、红霉素和丁胺卡那霉素对CNS ,氨苄青霉素对大肠埃希氏菌的敏感率均显著下降 ;头孢唑啉的敏感率 10年来无显著改变 ;万古霉素对金葡菌、CNS敏感率 10 0 %。结论　CNS和大肠埃希菌为当前佛山地区新生儿早发型败血症常见的致病菌 ,常用抗生素对其敏感性显著下降。     

Immune status of children and responses to DPT vaccination against Diphtheria as judged by schick test and indirect hemagglutination test

Immune status of 172 children aged between 6 months and two years was studied, using Schick and indirect hemagglutination test (IHA). Schick test was done in all and IHA in 84 of them. Schick negativity rate was found to be 84.3 percent, whereas IHA test showed protective titers in 55.9 percent of subjects. Immunity to diphtheria by IHA could be confirmed only in 68 percent of schick negative children. Response to even a single dose of DPT was significant (p< 0.01) in comparison to unimmunized children. There was no difference in two dose and three dose schedules (75 percent and 80 percent of subjects, had protective titers respectively), of primary immunization against diphtheria as judged by IHA test. Primary immunization followed by a booster provided 100 Percent protection in recently immunized children as judged by IHA test. It is recommended that Schick test along with IHA should be used to study the immunity to diphtheria. This is a part of Study Supported by ICMR Scheme No. 3/1/2/79 (232)/38-RB     

Functional Reach and Lateral Reach Tests in Turkish Children

Aims: The functional reach test (FRT) and lateral reach test (LRT) provide important measures of postural stability. The aims of this study were to (1) establish the normative values for FRT and LRT, and (2) examine the effects of age, gender, and various anthropometric measurements on FRT and LRT. Methods: Two hundred eighty children, aged 6–12 years, completed the study. One hundred fifty-two subjects were females. The mean age was 9.0 ± 2.0 years. Each child performed two trials of FRT and LRT. Results: No significant differences were detected in any age group between males and females. The normal values of FRT ranged between 23.0 and 36.5 cm, and that of LRT between 18.0 and 28.0 cm. Height, length of upper and lower extremity, and arm span had a higher correlation with FRT. Age and weight showed a good correlation with FRT. Age, height, weight, length of upper and lower extremity, and arm span showed good correlation with LRT. Conclusions: These normative data will be useful for clinicians in the assessment of balance of individual children and in the diagnosis of potential balance deficits at an early age in the Turkish population.     

Asthma and allergy among schoolchildren in a mountainous,dry, non‐polluted area in Norway

The aim of this study was to assess prevalence of asthma and allergy in the non‐polluted mountain area of Upper Hallingdal, Norway. All schoolchildren (7–16 years) who in a previous questionnaire survey (n = 1177) reported ‘sometime’ asthma were enrolled in group I (n = 80), the 59 who reported asthma‐like symptoms in the past 12 months formed group II, and 77 of the healthy controls were randomly selected as group III. All 216 children underwent clinical examination, skin prick test, spirometry, bronchial provocation (PD₂₀ metacholine) and treadmill exercise test. Subsequently they were reclassified as (1) healthy, never had asthma or symptoms, (2) symptoms not confirmed as asthma, (3) previous asthma, now healthy, (4) current asthma. Lifetime asthma prevalence was 10.2%. Based upon clinical examination, the specificity and sensitivity of the questionnaire for asthma diagnosis were 0.88 and 0.74, respectively. Forced vital capacity was significantly higher among the asthmatics (group 4 versus 1), whereas forced expiratory volume in one second (FEV₁) and forced expiratory flow at 50% of vital capacity were similar in all groups. More than 10% reduction in FEV₁ following treadmill‐run was found in 20% of children. Children with current asthma compared to controls had significantly; lower mean values of PD₂₀ (9.1 versus 16.5 µmol), higher eosinophil cationic protein (13.4 versus 7.7 µmol) and more frequent sensitization to animal dander (56% versus 10%). In conclusion, despite a favorable climate, little mite sensitization and low outdoor pollution, asthma prevalence was surprisingly high in Upper Hallingdal. Sensitization to animal dander was the most important contributing factor for current asthma.     

哮喘儿童支气管舒张试验中大小气道功能指标变化对比研究

目的 探讨儿童哮喘发作时支气管舒张试验中大小气道功能指标变化的临床意义.方法 选择2012年10月至2014年4月哮喘初次发作患儿51例,采用Master Screen肺功能仪,在雾化吸入硫酸沙丁胺醇前、后进行肺功能检测;比较用力肺活量(FVC)、呼气峰流速(PEF)、1秒用力肺活量(FEV1)、1秒率(FEV1/FVC)、最大呼气中段流量(MMEF)、用力呼气流速(FEF)25、FEF50、FEF75的变化.结果 51例患儿的平均年龄(7.30±2.33)岁.患儿哮喘发作时支气管舒张试验总阳性率58.8%,并有随病情加重而升高的趋势;与舒张试验前比较,舒张试验后大小气道各指标的绝对值、占预计值百分比均明显增加,差异有统计学意义(P均<0.01);以代表大气道指标的FEV1改善率≥12%判定为舒张试验阳性,阳性率58.8%;以代表小气道指标的MMEF改善率≥25%判定为舒张试验阳性,阳性率70.6%,两者比较差异无统计学意义(P=0.214).结论 哮喘发作患儿FEV1基础值>70%亦可行支气管舒张实验,同时结合大、小气道指标以判断气道可逆性可以更全面反映哮喘的病情严重程度.     

儿童肺功能临床研究和应用进展

肺功能检测对于早期发现呼吸系统疾病、评估严重程度和预后、评估药物及其他疗法治疗效果,鉴别呼吸困难原因、病变部位,评估手术耐受力等中均必不可少.随着儿童肺功能检测方法的改进及各种感染性与非感染性疾病肺功能研究的探讨,儿童肺功能检测将逐渐广泛应用于儿科的临床研究与实践.该文就国内外儿童肺功能检测方法和临床应用作一综述.