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??Immaturity of the immune system and exposure to infectious agents contribute to the susceptibility of RRTIs in children?? and RRTIs are usually treated with immunomodulating agents. The administration of probiotics plays a role in modulation of immune responses by various methods, including colonization resistance?? increased number and activity of natural killer cells?? release of cytokines?? and enhanced antibody response?? et al. Data show that probiotics may be bene?cial to preventing respiratory tract infections??RTIs???? reducing the number of episodes of RTIs?? diminishing the severity of infection symptoms?? and reducing duration of episodes?? antibiotic use and the number of days absent from day care/school. Probiotics appear to be a feasible way to decrease the incidence of RTIs in children??but further well-designed studies are needed to evaluate the strains?? dosing?? and frequency in the use of probiotics for RRTIs.     

反复呼吸道感染患儿T细胞功能性极化状态

目的观察反复呼吸道感染患儿间歇期外周血T细胞功能性极化状态。方法以反复呼吸道感染患儿外周血及健康儿童外周血为研究对象,采用全血PHA刺激培养,四色荧光标记流式细胞仪检测Th1(Tc1)及Th2(Tc2)百分比。结果反复呼吸道感染患儿Th1较正常降低(P<0.05),Th2升高、Th1/Th2比值下降(P<0.01);Tc1降低、Tc2升高、Tc1/Tc2比值下降(P>0.05)。结论反复呼吸道感染患儿间歇期存在Th功能性极化异常,Th2占优势;Tc功能性极化无明显异常。     

新菌灵与美欧卡霉素对照治疗小儿以呼吸道感染为主的疾病

目的探讨小儿呼吸道感染性疾病的药物治疗。方法呼吸道感染性疾病等患者５４例，随机分为治疗组和对照组。治疗组２７例，用新菌灵（ＣＸＭ－Ａ）治疗。＜５岁服ＣＸＭ－Ａ１２５ｍｇ，每日２次，＞５岁服ＣＸＭ－Ａ２５０ｍｇ。每日２次。对照组２７例，用美欧卡霉素治疗，剂量为每公斤体重３０ｍｇ，分（３～４）次口服。结果治疗组总有效率为９６％，而对照组为８１．４８％（Ｐ＜０．０５）。新菌灵治疗上呼吸道感染、气管炎及支气管炎、肺炎的有效率分别为１００％、１００％和５０％。结论新菌灵治疗小儿呼吸道感染性疾病效果优于美欧卡霉素。     

IgG subclasses in children with recurrent respiratory tract infections in an allergy practice

Isolated or combined deficiencies of immunoglobulin G (IgG) subclasses have been recognized in children with recurrent infections. In our allergy practice, there are a subset of children with recurrent respiratory tract infections. To investigate the presence of immunoglobulin G subclass deficiency (IgGSD), 60 children with atopy and 14 children without atopy suffering from recurrent respiratory tract infections were studied in an attempt to determine whether atopy is associated with a certain IgG subclass pattern. Ten atopic children were found to have isolated or combined IgG subclass deficiencies: one with IgG1, two with IgG2, four with IgG3 and three children had IgG2–IgG3. Neither IgG subclass concentration nor the frequency of children with high or low IgG subclasses showed any difference between atopic and non-atopic groups. Except for a week correlation with IgG3, no correlation existed between IgE and other IgG subclasses. It was concluded that childhood respiratory diseases complicated by recurrent respiratory tract infections may be associated with IgG subclass deficiencies. Although there have been reports noting some IgG subclass patterns in atopic disorders, in the present study, no distinctive feature between atopics and non-atopics with respect to IgG subclass concentrations and patterns was observed.     

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目的了解反复呼吸道感染(RRTI)儿童血清甘露聚糖凝集素(MBL)水平及第一外显子54密码子的突变率,探讨血清MBL水平与RRTI的关系。方法用ELISA方法检测2000～2003年在重庆医科大学附属儿童医院就诊的65例RRTI儿童和238名正常儿童血清MBL水平,测定其中11例低MBL血症的RRTI儿童的免疫学指标(IgG、IgA、IgM、C3、C4),并用聚合酶链反应(PCR)限制性内切酶片段长度多态性分析(RFLP)方法与55名正常儿童MBL第一外显子54密码子基因多态性进行分析。结果RRTI儿童出现低血清MBL水平频率明显多于正常儿童(χ2=6.96,P<0.05),其MBL54密码子突变率亦明显增高(P<0.05),低血清MBL血症导致RRTI主要在2岁以前,血清MBL水平越低,感染频率越高,其C3、C4水平也越高。结论儿童MBL54密码子突变导致低MBL血症在2岁以前有反复呼吸道感染的倾向,MBL水平越低,感染机率越高。     

儿童反复呼吸道感染指南执行情况分析

目的评估儿童反复呼吸道感染(RRTIs)指南执行情况。方法收集2013-2016年中国知网发表的RRTIs论文。按RRTIs指南定义确定纳入和排除标准。结果检索到15篇论文,包括1740例RRTIs患儿被纳入评估;其中仅3篇论文按照指南年龄分类和病因归类要求进行研究。临床常规性治疗可能对RRTIs有缓解作用,但并不利于RRTIs的病因学针对性治疗。结论 RRTIs患儿的诊断和治疗有待讨论和深入了解。     

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??Objective To evaluate the efficacy and safety of bacterial lysates in the treatment of recurrent respiratory infections with asthma in children less than or equal to 5 years old. Methods A total of 40 children with recurrent respiratory tract infections and asthma admitted between January 2013 and December 2014 in Jing’an District Centre Hospital of Shanghai were randomly divided into the treatment group??n=20?? with bacterial lysates??and the control group??n=20?? with placeto. The clinical efficacy was observed and secretory immunoglobulin A??sIgA?? in the saliva samples and percentages of eosinophils in peripheral blood were detected at the indicated time point after treatment of 0?? 3?? 6 and 12 months. Results The clinical symptom of asthma and the incidence of infection were significantly less in treatment group than those in control group. The level of sIgA was obviously increased in the saliva samples of treatment group and had negative correlation with percentage of eosinophils in peripheral blood. There was not any adverse event. Conclusion Bacterial lysates can be an effective adjuvant therapy for recurrent respiratory infections with asthma in children less than or equal to 5 years old by increasing the immunity?? decreasing respiratory tract symptom and reducing the incidence of asthma.     

舌下滴入多价细菌疫苗对支气管哮喘合并反复呼吸道感染儿童疗效观察

目的　探讨支气管哮喘合并反复呼吸道感染(RRI)经规律吸入糖皮质激素(ICS)控制不理想的儿童联用多价细菌疫苗(兰菌净)的临床疗效及安全性。方法　采用随机、双盲法将2 0 0 1年6月至2 0 0 2年6月在广州医学院第一附属医院及呼吸病研究所收治的4 8例哮喘合并RRI经系统ICS治疗控制不佳的患儿分为2组,分别给予舌下滴入兰菌净或安慰剂治疗,观察两组患儿RRI及哮喘临床症状、血清IgA及唾液分泌型IgA(sIgA)水平及可能出现的不良反应。血清IgA及唾液sIgA采用单向免疫扩散法检测。结果　与安慰剂组比较,兰菌净组呼吸道感染次数、发热天数、抗生素使用天数、咳嗽及气喘发作天数均减少,差异有显著性(P均<0 0 5 )。兰菌净组治疗后血清IgA及治疗后第1、2、3个月唾液sIgA与治疗前比较均显著升高(均P <0 . 0 5 ) ,而治疗后第6个月唾液sIgA与治疗前比较差异无显著性(P >0 .0 5 )。安慰剂组治疗后血清IgA及唾液sIgA与治疗前比较差异均无显著性(均P >0 . 0 5 )。两组不良事件发生率及脱落率差异均无显著性(均P >0. 0 5 )。结论　哮喘合并RRI经ICS控制不理想儿童联用多价细菌疫苗(兰菌净)能有效预防RRI ,从而减少哮喘发作的次数,减轻哮喘严重程度。多价细菌疫苗(兰菌净)安全性好、使用方便,值得推广应用。     

Combined IgA and alpha-1-antitrypsin deficiency in a boy with severe respiratory tract infections and asthma

A five-year-old boy is described, who at 3 months of age presented with severe respiratory tract infections and later om developed signs of bronchial asthma and radiologic evidence of chronic emphysema and bronchiectasis. IgA was absent in his serum and saliva, and low serum alpha-l-antitrypsin levels with the phenotype PiMZ were found in the patient. Such dual deficiencies appear to be unusual. However, the association of IgA and alpha-l-antitrypsin deficiency should be considered in the evaluation of children with severe respiratory tract infections.     

Free secretory component as a standardization protein for nasopharyngeal specimens from children with upper respiratory tract infection

Free secretory component (FSC) has been recommended as a reliable protein for correction of the unknown dilution in tracheal aspirate samples from preterm infants. To investigate whether FSC would also provide a valid standardization protein for samples of nasopharyngeal secretions, this study determined the intersubject variation and the alteration over time in the concentrations of FSC in nasal secretions from 35 children (median age 14 months) who participated in an antibiotic efficacy trial. Nasopharyngeal aspirates were obtained at enrolment and after 2-3 d. FSC in the specimens was quantified by a direct enzyme immunoassay. The concentrations of FSC in the nasal secretions ranged from 0.08 to 189.6 μg ml^-1 (median 12.3 μg ml^-1); the ratio of the highest to the lowest concentrations was 2370, the difference between the 90th and 10th percentile concentrations was 189-fold and the difference between the 75th and 25th percentile values was 26. FSC concentrations were significantly lower in children aged ≤12 months (median 2.2 μg ml^-1) than in the older children (median 21.5 μg ml^-1; p = 0.035). Between the first and the follow-up specimens, 65% of the children had ≥2-fold difference in the levels of FSC in the secretions. Because an optimal standardization protein should show minimal variation between individuals and over time, FSC may not be a suitable protein for correction of the unknown dilution of nasopharyngeal specimens from children with upper respiratory tract infection.     

Subacute zinc deficiency in children with recurrent upper respiratory tract infection

Serum, urine and hair zinc levels in 20 patients with recurrent upper respiratory tract infection are compared with those of age- and sex-matched controls. Lower hair zinc (1.44 vs 2.00 mmol/g hair,P=0.004) and higher urinary zinc levels (2.2 vs 1.6 mmol/mol creatinine,P=0.05) were found, but no difference in serum zinc. The patients had lowernormal height for age (SD-score 0.2 vs 0.7,P=0.031), there was no difference in weight for height. No correlation was found between the zinc values and the duration of the complaints.     

儿童肺炎支原体肺炎后发生反复呼吸道感染的多因素分析

目的探讨肺炎支原体(MP)肺炎治愈一年内儿童发生反复呼吸道感染(RRTI)的情况及其影响因素。方法选择MP肺炎治愈并完成一年随访的133例患儿为研究对象,检测其治愈出院时及出院后3、6、9、12个月时MPIg M、MP-Ig G双抗体滴度,免疫功能,并记录是否发生呼吸道感染及呼吸道感染部位,一年内用药情况,并进行分析。结果完成随访的133例患儿中,治愈后一年内RRTI发生率为31.58%。多元logistic回归分析结果显示,年龄为3~6岁(OR=2.29,95%CI:1.13~4.64);抗体持续阳性或者阴转阳(OR=4.47,95%CI:1.47~13.65);CD4/CD8降低(OR=10.26,95%CI:3.30~31.90);Ig A低下(OR=1.90,95%CI:1.06~3.40)是发生RRTI的独立危险因素;使用免疫增强剂(OR=0.29,95%CI:0.11~0.78)是预防发生反复呼吸道感染的独立保护因素。在MP抗体持续阳性和阴转阳的85例患儿中,40例无临床症状应用抗生素,16例(40.00%)发生RRTI;45例未用抗生素,18例(40.00%)发生RRTI,两组间差异无统计学意义(P0.05)。结论 MP肺炎治愈后一年内免疫功能紊乱的患儿容易发生RRTIs,使用免疫增强剂可降低RRTI发生率。MP抗体持续阳性和阴转阳患儿,在无临床症状时应用抗生素不能预防RRTI。     

甘露聚糖联合胸腺肽治疗小儿反复呼吸道感染160例临床观察

目的 观察临床应用甘露聚糖联合胸腺肽治疗小儿反复呼吸道感染疗效及对免疫功能的影响.方法 160例反复感染的患儿随机分为对照组和治疗组,对照组给予一般的抗炎及对症治疗.治疗组在常规治疗的基础上给甘露聚糖联合胸腺肽.结果 治疗组160例,效果明显优于对照组156例(P＜0.01).治疗后治疗组的Ig值有明显的提高.结论 甘露聚糖联合胸腺肽治疗小儿反复呼吸道感染有很好的效果.     

急性呼吸道感染儿童两亚型呼吸道合胞病毒检测分析

目的 了解2006-2007年度重庆地区住院急性呼吸道感染(ARTIs)儿童两亚型呼吸道合胞病毒(RSV)的感染特点及流行规律.方法 收集2006年4月至2007年3月全年在重庆医科大学附属儿童医院呼吸科住院的部分ARTIs患儿的鼻咽深部吸取物390份,针对RSV G基因保守区序列设计分型引物,采用RT-PCR方法检测标本中RSV的基因组RNA.结果 390例标本中RSV阳性例数为133例(133/390,阳性率为34.10%).阳性标本中A亚型阳性129例,B亚型阳性4例.RSV阳性患儿中,84.9%为2岁以下小儿.2006年11月～2007年1月为RSV高发季节,RSV检测阳性率为55.6%～62.3%,2006年12月RSV检测阳性率最高.B亚型出现于本地区RSV感染低发季节(4、5、6月).RSV感染的临床表现主要为发热(56.4%)、咳嗽(98.5%)、喘息(63.9%)、气促(76.7%)、紫绀(84.9%).临床诊断依次为毛细支气管炎(33.1%),支气管肺炎(27.8%),间质性肺炎(18.1%),重症肺炎伴呼吸衰竭(10.5%),喘息性支气管炎(5.3%),支气管哮喘(4.5%).结论 本研究初步阐明了重庆地区两亚型RSV感染的流行病学特点,证实RSV是重庆地区冬春季婴幼儿ARI的重要病原,2006-2007年度以A亚型RSV流行为主.今后的研究将纳入门诊及社区惠儿并进行多年度连续监测以进一步阐明重庆地区两亚型RSV流行规律及病毒进化特点.     

反复呼吸道感染患儿IgG亚类及维生素A水平的关联研究

目的：反复呼吸道感染（RRTI）是儿科的常见病之一。目前研究发现其发病与维生素A缺乏,免疫功能异常有关。该研究检测了RRTI患儿IgG 亚类及维生素A水平,并对该类病人维生素A缺乏与IgG亚类缺陷之间的关系进行了初步的探讨。方法：采用ELISA方法检测血清IgG 亚类;采用高效液相色谱分析Miller改良法进行维生素A的测定。结果：RRTI患者血清IgG2,4水平及维生素A水平均低于健康对照组,差异具有显著性（P<0.05）。结论：RRTI患者虽IgG正常,但是可能存在IgG亚类异常。RRTI患者存在维生素A水平低于正常儿童,而且IgG2,4水平的降低可能与维生素A水平有关。［中国当代儿科杂志,2007,9（6）：557-558］     

重庆地区急性呼吸道感染儿童肠道病毒检测结果分析

目的 了解2006-2007年度重庆地区住院急性呼吸道感染(ARTIs)儿童中肠道病毒(EV)的感染率和临床特点.方法 前瞻性收集2006年4月至2007年3月在重庆医科大学附属儿童医院呼吸科住院的部分ARTIs患儿鼻咽深部吸取物390份,应用针对EV 5′端非编码区(5′-NCR)保守序列设计引物,采用套式逆转录PCR方法检测标本中EV.结果 390例标本中检出EV 63例,阳性率16.2%.年龄分组中2～5岁组和>5岁组患儿EV阳性率分别为32.8%和28.6%,<2岁组为12.2%.EV感染几乎全年散发,2006年7～11月为EV感染的高发季节,EV检测阳性率为19.2%～31.3%.2006年8月EV检测阳性率最高.EV感染的临床表现主要为发热(38.1%)、咳嗽(92.1%)、喘息(33.3%)、气促(71.4%)、腹泻(28.6%)和皮疹(17.5%).EV阳性患儿中,临床诊断依次为支气管肺炎30例(47.6%),间质性肺炎17例(27.0%),毛细支气管炎6例(9.5%),重症肺炎4例(6.3%),喘息性支气管炎3例(4.8%),支气管哮喘3例(4.8%).结论 EV是重庆地区儿童急性下呼吸道感染较为常见的病毒病原,夏秋季为流行高峰.     

反复呼吸道感染患儿血清免疫球蛋白、IgG亚类及细胞免疫水平

目的探讨反复呼吸道感染(RRTI)与免疫球蛋白、IgG亚类及细胞免疫的关系,为临床治疗反复呼吸道感染提供一定的理论依据。方法RRTI患儿28例,男18例,女10例,平均年龄(3.70±1.44)岁;对照组30例,男15例,女15例,平均年龄(3.98±1.18)岁。采用免疫散射比浊法检测血清IgG﹑IgA、IgM及IgG亚类水平;采用流式细胞术检测CD3、CD4、CD8、CD19及CD16+56的表达。结果RRTI患儿血清IgG﹑IgA水平与对照组相比差异均无统计学意义(P均>0.05);IgM水平低于对照组(Z=3.149,P<0.01);RRTI患儿血清IgG2和IgG4水平较对照组明显降低(t=2.107,Z=2.916;P均<0.05);RRTI患儿淋巴细胞CD3﹑CD4较对照组明显降低(t=2.319,2.44,P均<0.05),余CD分子与对照组相比差异无统计学意义(P均>0.05)。结论RRTI患儿存在一定程度的体液免疫和(或)细胞免疫功能紊乱;对RRTI患儿同时检测总IgG、IgG亚类及细胞免疫功能具有重要的临床意义。     

儿童反复呼吸道感染部分相关影响因素分析

目的：探讨反复呼吸道感染与其部分相关影响因素的关系。方法用病例对照的研究方法，调查分析反复呼吸道感染与其部分影响因素的关系。结果儿童反复呼吸道感染和母乳喂养、微量元素缺乏(锌缺乏)、营养不良、环境因素(室内装修、被动吸烟、饲养宠物)、使用糖皮质激素存在相关性，但与母乳喂养这种相关性只在5岁以下的儿童中发现。还发现了不管出生前或出生后，二手烟与反复呼吸道感染的相关只是在男孩中发现，而在女孩中却不相关。家居装修、微量元素缺乏(锌缺乏)、营养不良、母乳喂养与反复呼吸道感染相关只是在女孩中发现，而在男孩中却不相关，提示各个影响因素对男孩和女孩的影响是不一样。结论反复呼吸道感染是受多因素影响的，而不同的影响因素对性别的影响也不同。