慢性活动性EB病毒感染临床诊断与治疗进展

慢性活动性EB病毒(Epstein-Barr virus,EBV)感染(chronic active EBV infection,CAEBV)是一种与EBV相关的进行性的淋巴增殖性疾病,其特征是在无明确免疫功能低下的个体中,出现EBV阳性的淋巴细胞克隆性增殖,导致长时间或反复出现的传染性单核细胞增多症(infectio...     

综述急慢性EB病毒感染特点及预后影响因素

EB病毒(EBV)是人类发现的第一种与肿瘤密切相关的病毒,是8种已知的人疱疹病毒(HHV)中的一种。EBV感染可引起一系列临床综合征,包括传染性单核细胞增多症(IM)、EBV相关的噬血淋巴组织细胞增生症(EBV-HLH)、慢性活动性EBV感染(CAEBV),预后不良。在一些情况下,EBV感染可以引起致命性的IM或HLH,出现爆发性肝炎、重症肺炎、血细胞减低、低纤维蛋白血症及凝血异常等危及生命的并发症。近年来CAEBV报道逐渐增加,该病预后差,常发展为淋巴瘤。了解EBV相关知识,不但对感染科医师非常重要,对于消化科、血液科及呼吸科等专科医师也很重要。本文就EBV感染引起的除淋巴瘤等恶性肿瘤以外的疾病特点、诊治及预后影响因素做一概述。     

EB病毒感染与儿童肝损害

EB病毒(Epstein-Barr virus,EBV)与许多疾病相关.在儿科,EBV感染疾病主要包括传染性单核细胞增多症(infectious mononucleosis,IM)、慢性活动性EBV感染(chronic active Epstein-Barr virus infection,CAEBV)、EBV相关噬血细胞性淋巴组织细胞增生症(Epstein-Barr virus-related hemophagocytic lymphohistiocytosis syndrome,EBV-HLH)等,这些疾病多伴有肝脏损害,出现肝脏肿大、肝功能异常和黄疸.本文将对儿童EBV 感染及其肝脏损害进行概述.     

超声造影剂注射用六氟化硫微泡致过敏性休克1例

[摘要]? EB病毒（Epstein-Barr virus, EBV）属于疱疹病毒γ亚科，是导致传染性单核细胞增多症、慢性活动性EBV感染（chronic active Epstein-Barr virus infection, CAEBV）、多种淋巴细胞和上皮细胞相关恶性肿瘤的病原体。CAEBV属于EBV阳性T细胞或NK细胞增生性疾病，发病机制尚未明确，治疗方法有限，预后差。本文就CAEBV发病中相关基因改变的最新研究进展进行综述，为CAEBV的进一步研究和诊治提供依据。     

慢性活动性EB病毒感染

EB病毒(Epstein-Barr virus,EBV)感染后出现慢性或复发性传染性单核细胞增多症样症状,伴随EBV抗体的异常改变和外周血高EBV-DNA载量,称为慢性活动性EBV感染(chronic active Epstein-Barr virus infection,CAEBV)。其发病机制尚未明确,尚无确切治疗方案,预后差,病死率高。本文就CAEBV发病机制、临床表现、实验室检查及诊治进行综述,以提高临床对CAEBV的诊疗水平。     

EB病毒肺炎一例

正EB病毒(Epstein-Barr virus,EBV)是Epstein和Barr于1964年在非洲儿童Burkitt淋巴瘤细胞中发现的人类疱疹病毒。成人感染EBV后临床表现和转归多种多样,可有原发急性感染、慢性活动性感染、淋巴增殖性疾病、肿瘤等[1]。无论宿主的免疫功能如何,EBV肺炎是罕见的[2],我们通过血清抗体和肺组织病理诊断1例EB病毒间质性肺炎,现报道     

再生障碍性贫血并发滤泡性淋巴瘤病例报告及文献复习

正再生障碍性贫血(简称再障)的发病机制目前仍未完全清楚,多数患者是T-淋巴细胞介导的自身免疫性疾病,在长期免疫抑制剂治疗后有发生淋巴增殖性疾病(lymphoproliferative disorders,LPDs)危险[1],特别是合并EBV(Epstein-Barr virus,EBV)、HBV感染的患者~([2])。再障可先于、同时、或继发于LPDs。本文报道1例慢性再障患者免疫抑制剂治     

EB病毒与淋巴瘤

EB病毒(Epstein-Barr virus,EBV)是一种嗜人类淋巴细胞的疱疹病毒,感染了世界上90%以上的人群。人体初次感染EBV后将成为病毒的终生携带者。在正常人体内,感染EBV的B细胞能被自然杀伤(NK)细胞和细胞毒性T细胞(CTLs)控制[1]。最初的CTLs细胞免疫反应并不能清除EBV感染的B细胞,EBV随着这些B细胞的分化增殖而产生大     

EB病毒引起慢性活动性肝炎的早期诊断和治疗

非嗜肝病毒如Epstein-Barr病毒(EBV)在人群中的感染率高，具有感染-潜伏-活化的生物学特性，可引起传染性单核细胞增多症(IM)、慢性活动性EBV感染(CAEBV)及EBV相关肿瘤等多种疾病。EBV相关疾病临床表现复杂、多样，无论是急性感染、慢性感染或是相关并发症均可导致不同程度的肝损伤。CAEBV可以诱发慢性活动性EBV肝炎(CAEBVH)，甚至出现肝衰竭，患者预后差，病死率高。早期识别诊断及多学科协作治疗CAEBVH是改善患者预后的关键。文章将就CAEBVH的诊断、治疗进展进行综述，为临床医生早期诊断，规范治疗CAEBVH提供参考。     

EB病毒对不同分化程度胃癌细胞的易感性

目的建立携带EB病毒(EBV)的人胃癌细胞株,探讨EBV对不同分化程度胃癌细胞的易感性。方法用携带EBV的B95-8细胞系制备EBV,感染胃癌细胞BGC823、MKN45及MKN28,用有限稀释法对感染细胞进行克隆,观察细胞形态,并用PCR法检测未感染及感染细胞中EBV编码核抗原EBNA1、EBNA2、潜伏感染膜蛋白LMP1、LMP2A、裂解感染早期基因BARF1、晚期基因BLLF1及Bc LF1的表达状况。结果已感染细胞的形态由原来的梭形变为多形态,并检测到EBNA1、BARF1及Bc LF1的表达,而未检测到EBNA2、BLLF1、LMP1及LMP2A的表达。结论不同分化程度的胃癌细胞对EBV都易感,并且EBV感染可改变细胞的表型,提示不同分化程度的胃癌细胞系可作为EBV感染的靶细胞。     

儿童巨细胞病毒感染诊治进展

巨细胞病毒(cytomegalovirus,CMV)在我国人群中感染广泛,免疫力低下的婴儿易受侵害。该病毒为引起先天畸形最常见的一种病原体,与婴儿非遗传性感音神经性耳聋、神经系统发育落后密切相关。CMV感染最常见的靶器官是肝脏,此外还可侵犯呼吸系统、神经系统、血液系统等,是致残、致死的重要病因,但目前针对CMV感染的诊断、治疗问题国内外尚无统一意见。     

儿童自身免疫性肝病

儿童自身免疫性肝病是一种由自身免疫反应介导的慢性进行性肝脏疾病,包括自身免疫性肝炎、自身免疫性硬化性胆管炎、肝移植后新发自身免疫性肝炎。近年来儿童自身免疫性肝病的发病率逐渐上升,但临床表现缺乏特异性,有不同于成人的临床特点,现有的IAIHG积分系统并不适合儿童患者,故临床上容易误诊或漏诊。及时应用免疫抑制剂治疗至关重要,可明显改善预后。本文主要对该病的诊治研究进展进行综述。     

Mycobacterium examination system at the National Jewish Center in the States

Impressions on visit to Mycobacteriology Laboratory of National Jewish Center for Immunology and Respiratory Medicine are reported. The BACTEC and Gen-Probe Method are introduced to the laboratory system on mycobacterial examinations such as detection, identification, drug susceptibility and minimal inhibitory concentration test.     

Stem cells and cell therapies in lung biology and lung diseases

The University of Vermont College of Medicine and the Vermont Lung Center, with support of the National Heart, Lung, and Blood Institute (NHLBI), the Alpha-1 Foundation, the American Thoracic Society, the Emory Center for Respiratory Health,the Lymphangioleiomyomatosis (LAM) Treatment Alliance,and the Pulmonary Fibrosis Foundation, convened a workshop,‘‘Stem Cells and Cell Therapies in Lung Biology and Lung Diseases,’’ held July 26-29, 2009 at the University of Vermont,to review the current understanding of the role of stem and progenitor cells in lung repair after injury and to review the current status of cell therapy approaches for lung diseases. These are rapidly expanding areas of study that provide further insight into and challenge traditional views of the mechanisms of lung repair after injury and pathogenesis of several lung diseases. The goals of the conference were to summarize the current state of the field, discuss and debate current controversies, and identify future research directions and opportunities for both basic and translational research in cell-based therapies for lung diseases.     

羊膜腔穿刺术对HBV携带孕妇胎儿宫内感染风险的研究

目的探讨羊膜腔穿刺术对HBV携带孕妇胎儿宫内感染风险的影响,为产前诊断提供科学指导。方法选取2015年1月—2019年1月就诊于青岛市妇女儿童医院的504例HBV携带孕妇作为研究对象,其中,将126例行羊膜腔穿刺术的孕妇设为观察组,其余未行羊膜腔穿刺术的378例孕妇设为对照组。对比分析不同HBeAg携带状态、HBVDNA载量、穿刺术中出血状况、操作者资质和经验下观察组与对照组胎儿宫内感染的发生情况。结果504例HBV携带孕妇中胎儿宫内感染的总发生率为4.17%(21/504),其中,观察组感染率为7.14%(9/126),对照组感染率为3.17%(12/378);在HBeAg(+)与HBVDNA>1.0×10^7cps/ml2种情况下,观察组胎儿宫内感染发生率分别为15.38%(6/39)、70.00%(7/10),均显著高于对照组(P均<0.05);在HBeAg(-)与HBVDNA为l.0×10^3~1.0×10^7cps/ml情况下,观察组和对照组胎儿宫内感染发生率差异均无统计学意义(P均>0.05)。此外,穿刺出血情况、操作者资质和经验、分娩方式等对羊膜腔穿刺术后胎儿宫内感染发生率的影响差异均无统计学意义(P均>0.05)。Logistic回归分析显示,HBeAg(+)、HBVDNA载量>1.0×10^7cps/ml、羊膜腔穿刺术是HBV携带孕妇胎儿宫内感染的危险因素。结论HBeAg(+)、HBVDNA载量>1.0×10^7cps/ml、羊膜腔穿刺术是HBV携带孕妇胎儿宫内感染的危险因素。当HBV携带孕妇的HBeAg(+)、HBVDNA>1.0×10^7cps/ml时,羊膜腔穿刺术可能增加胎儿宫内感染的风险。HBV携带孕妇需要在产前诊断前对HBeAg状况和HBVDNA载量进行评估,以决定是否行羊膜腔穿刺术。     

Retrospective comparison of respiratory syncytial virus and metapneumovirus clinical presentation in hospitalized children

Respiratory syncytial virus (RSV) and Human metapneumovirus (hMPV), members of Pneumoviridae family are common causes of acute respiratory tract infections (ARTI) among children. Study material includes routine nasopharyngeal samples obtained during 8-year period for hMPV and one single season for RSV in children hospitalized for ARTI between 0 and 15 years at the Center Hospitalier Universitaire (CHU) Saint Pierre in Brussels. Positive samples for RSV or hMPV identified by viral culture, lateral flow chromatography test for RSV or direct fluorescent assay for hMPV were selected retrospectively. Characteristics of children hospitalized for RSV or hMPV infections were compared. Children hospitalized for RSV infection were significantly younger and requiring more respiratory support, longer hospital stay and transfers in Pediatric intensive Care Units than those hospitalized for hMPV infection. Pneumonia diagnostic and antibiotics therapies were more significantly associated with hMPV infections. In conclusion, despite their genetic similarities, RSV, and hMPV present epidemiological and clinical differences in pediatric infections. Our results should be confirmed prospectively.     

基于中国医院知识总库手足口病的文献计量学分析

目的运用文献计量学方法对国内医院手足口病(hand-foot-mouth disease,HFMD)的相关文献进行分析,总结文献的分布状态、手足口病的防治现状及研究热点,为该领域的进一步研究提供思路,为患者就医提供参考。方法以中国医院知识总库(China hospital knowledge database,CHKD)为主数据源,同时纳入中国生物医学文献数据库(China biology medicine disc,CBM),检索关键词为“手足口病”的相关文献,利用BitExcel软件去重,Note Express 3.0软件建立“手足口病”文献阅读数据库,CitespaceV软件分析发文量、关键词共现、文献引用、核心作者等情况并进行计量;用Excel软件提取数据并制作图表。分析HFMD的防治现状、热点主题和研究方向。结果入组文献16202篇(基金资助1735篇),博硕论文372篇。2009—2011年年度文献数量变化呈上升趋势,2011—2015年是HFMD研究的高峰期,2016年后文献量逐渐减少;文献的刊载量集中在《现代预防医学》《中国医药指南》《职业与健康》等期刊;中国疾病预防控制中心、河南省疾病预防控制中心等是国内HFMD防控领域的核心机构;郑州市儿童医院、湖南省儿童医院、昆明市儿童医院等在治疗HFMD中积累了丰富的临床经验;HFMD的防治依据《手足口病诊疗指南(2018版)》。研究热点集中在HFMD的治疗、病原学、流行病学及护理等方面。结论HFMD的防治、研究热点和研究方向受到医务人员的关注,此领域的核心期刊、核心机构、核心作者已形成,尚需要更多的基金支持才能保持主题研究的持续性。     

Corticosteroid Timing and Length of Stay for Children with Asthma in the Emergency Department

Objective. The aim of this study was to evaluate the relationship between time of corticosteroid administration to children with asthma exacerbations in the Emergency Department (ED) and length of stay (LOS). We hypothesized administration within 60 minutes would be associated with a 10- minute or greater decrease in mean LOS. Methods. A retrospective chart review of 882 patients was conducted. Children between the ages of 2 and 18 years presented to the Connecticut Children’s Medical Center’s (CCMC’s) ED with an acute asthma exacerbation were included. Children were excluded if they did not receive oral corticosteroids in the ED, had significant co-morbidities, were currently taking corticosteroids, or had taken them within the past 7 days. Children receiving corticosteroids within 60 minutes of triage were compared with children receiving corticosteroids for 61 minutes or later. The primary outcome was mean LOS. Results. Children treated with corticosteroids within 60 and 61 minutes or later had similar age, gender, insurance, and disposition. Children treated with corticosteroids within 60 minutes had a 25-minute decrease in LOS compared with children treated for 61-minute or later (95% CI: 15–35), p < .0001. Conclusions. Administering corticosteroids to pediatric asthma patients in the ED within an hour of triage is associated with a 25-minute mean decrease in LOS. With large numbers of asthma visits, a 25-minute decrease in LOS for each child could have a significant impact on patient throughput in the ED.     

Comparison of real-time polymerase chain reaction with the COBAS Amplicor test for quantitation of hepatitis B virus DNA in serum samples

AIM： To compare the clinical performance of a real-time PCR assay with the COBAS Amplicor Hepatitis B Virus （HBV） Monitor test for quantitation of HBV DNA in serum samples. METHODS： The reference sera of the Chinese National Institute for the Control of Pharmaceutical and Biological Products and the National Center for Clinical Laboratories of China, and 158 clinical serum samples were used in this study. The linearity, accuracy, reproducibility, assay time, and costs of the real-time PCR were evaluated and compared with those of the Cobas Amplicor test. RESULTS： The intra-assay and inter-assay variations of the real-time PCR ranged from 0.3% to 3.8% and 1.4% to 8.1%, respectively. The HBV DNA levels measured by the real-time PCR correlated very well with those obtained with the COBAS Amplicor test （r = 0.948）. The real-time PCR HBV DNA kit was much cheaper and had a wider dynamic range. CONCLUSION： The real-time PCR assay is an excellent tool for monitoring of HBV DNA levels in patients with chronic hepatitis B.     

The Tennessee Children's Respiratory Initiative: Objectives,design and recruitment results of a prospective cohort study investigating infant viral respiratory illness and the development of asthma and allergic diseases

Background and objective: The ‘attack rate’ of asthma following viral lower respiratory tract infections (LRTI) is about 3–4 fold higher than that of the general population; however, the majority of children who develop viral LRTI during infancy do not develop asthma, and asthma incidence has been observed to continuously decrease with age. Thus, we do not understand how viral LRTI either predispose or serve as a marker of children to develop asthma. The Tennessee Children's Respiratory Initiative has been established as a longitudinal prospective investigation of infants and their biological mothers. The primary goals are to investigate both the acute and the long‐term health consequences of varying severity and aetiology of clinically significant viral respiratory tract infections on early childhood outcomes. Methods: Over four respiratory viral seasons, 2004–2008, term, non‐low birth weight previously healthy infants and their biological mothers were enrolled during an infant's acute viral respiratory illness. Longitudinal follow up to age 6 years is ongoing. Results: This report describes the study objectives, design and recruitment results of the over 650 families enrolled in this longitudinal investigation. The Tennessee Children's Respiratory Initiative is additionally unique because it is designed in parallel with a large retrospective birth cohort of over 95 000 mother–infant dyads with similar objectives to investigate the role of respiratory viral infection severity and aetiology in the development of asthma. Conclusions: Future reports from this cohort will help to clarify the complex relationship between infant respiratory viral infection severity, aetiology, atopic predisposition and the subsequent development of early childhood asthma and atopic diseases.