乳铁蛋白联合标准疗法治疗儿童幽门螺杆菌感染的疗效

目的观察乳铁蛋白联合幽门螺杆菌(H.pylori)标准三联疗法对儿童H.pylori感染根除率的影响及其不良反应。方法将2012年1月至2013年1月确诊且未接受过根除治疗的H.pylori感染患儿90例随机分为两组,对照组45例接受标准三联疗法治疗,观察组45例在接受标准三联疗法同时联合应用乳铁蛋白,记录治疗过程中的不良反应,以及疗程结束后4周的H.pylori根除率。结果观察组H.pylori根除率为(91.11%,41/45),高于对照组的根除率(73.33%,33/45);观察组不良反应率为(4.44%,2/45),低于对照组的不良反应率(20.00%,9/45),差异均有统计学意义(P均0.05)。结论乳铁蛋白能提高H.pylori根除率,减少不良反应的发生。     

不同治疗方案对儿童幽门螺杆菌感染的临床疗效评价

目的评价4种幽门螺杆菌(H.pylori)感染根除方案:序贯疗法、三联疗法、序贯合用乳酸菌及三联合用乳酸菌疗法的疗效。方法 416例H.pylori感染患者随机分为4组:序贯疗法(102例)、三联疗法(100例)、序贯合用乳酸菌(109例)及三联合用乳酸菌(105例)组。分析4组患儿的临床疗效、H.pylori根除率、成本/效果比值及不良反应发生率等。结果 4组治疗方案的疗效以序贯合用乳酸菌或三联合用乳酸菌组的疗效较好(P0.05)。4种治疗方案显效率及H.pylori根除率均以序贯合用乳酸菌组最高,其次为三联合用乳酸菌组,三联疗法组最低(P0.05)。4组患儿的成本/效果比值以序贯疗法组最低、序贯合用乳酸菌组次低,三联合用乳酸菌组最高(P0.01)。不良反应发生率最低的是序贯合用乳酸菌组,次低为三联合用乳酸菌组,最高的为三联疗法组。结论序贯合用乳酸菌疗法为最佳儿童幽门螺杆菌感染根除治疗方案。     

幽门螺杆菌感染家庭内聚集和根除治疗相关性探讨

目的研究幽门螺杆菌(H.pylori)感染儿童家庭内聚集现象,探讨根除H pylori感染的相关性治疗.方法经胃镜检查、病理切片、快速尿素酶试验(RUT)、PCR-UreA-DNA确诊H pylori感染患儿226例,对其383位父母及部分家庭成员进行流行病学调查.应用洛赛克+克拉霉素+羟氨苄青霉素三联1周疗法,治疗92例患儿,分成与感染的父母同治组和未同治组,观察对照2组H pylori根除率差异性.结果 226个家庭383位父母及部分家庭成员中H pylori总阳性检出率为83.8%.41例患儿菌株血清基因型与73位父母基因型符合率为89%(65/73).与父母同治组H pylori根除率为95.2%(40/42);未同治组H pylori根除率为80%(40/50),χ2=4.67,P<0.05,二组间差异有显著性意义.结论 H.pylori感染有突出的家庭内聚集现象,父母及有密切接触的其他家庭成员是儿童感染的重要传染源;与感染父母或家庭成员的同步治疗,对提高患儿H pylori根除率与预防再感染有重要意义.     

序贯疗法和标准三联疗法根除儿童幽门螺杆菌的疗效观察

目的评估序贯疗法在儿童幽门螺杆菌感染根治治疗中的疗效及可行性。方法将有上消化道症状,经13C-尿素呼气试验(13C-UBT)检测H.pylori为阳性的患儿100例随机分为3组:序贯治疗组、PAC组和PAM组。序贯治疗组:前5 d二联疗法即奥美拉唑+阿莫西林,后5 d三联疗法即奥美拉唑+克拉霉素+甲硝唑;PAC组予以奥美拉唑+阿莫西林+克拉霉素,共10 d;PAM组予以奥美拉唑+阿莫西林+甲硝唑,共10 d。均为每日2次,早晚口服。所有患儿停药至少4周后复查13C-UBT,判断H.pylori根除率。结果三组患儿H.pylori根除率的符合方案数据分析(PP)分别为:序贯治疗组91.18%,PAC组68.97%,PAM组76.67%;序贯治疗组和PAC组比较,差异有统计学意义(χ2=5.01,P<0.05);序贯治疗组和PAM组比较,PAC组和PAM组比较,差异均无统计学意义(χ2=2.55、0.44,P均>0.05)。结论 10日序贯疗法根除H.pylori疗效明显优于10日标准三联疗法,10日序贯疗法可能为一有效的根除儿童H.pylori感染的新方案。     

儿童新诊断免疫性血小板减少症与幽门螺杆菌感染的相关性研究

目的明确幽门螺杆菌(H.pylori)感染对儿童新诊断免疫性血小板减少症(ITP)的影响。方法选取2011年1月至2013年12月间首次住院并新诊断为ITP的495例患儿为病例组;随机选取无血小板减少及其他血液系统疾病的普通呼吸道感染住院患儿123例作为对照组。依据年龄将两组患儿分为1岁组(n=219)、1岁~组(n=161)、3岁~组(n=76)和7~14岁组(n=39)。回顾性分析各年龄段患儿H.pylori感染率,以及H.pylori感染阳性及阴性ITP患儿经过相同治疗后的预后情况。结果病例组中H.pylori感染率随着ITP患儿年龄的增长而增加,与对照组各年龄段H.pylori感染率比较差异均无统计学意义(均P0.05)。H.pylori感染阳性ITP患儿均未接受针对H.pylori的相关治疗,而针对血小板减少经丙种球蛋白和/或激素治疗后缓解率随着年龄的增长而呈现逐渐下降趋势,与各年龄段H.pylori阴性的ITP患儿治疗后缓解率比较差异均无统计学意义(均P0.05)。结论 H.pylori感染可能不是ITP患儿发病的一个主要致病因素;是否治疗H.pylori并不影响儿童急性ITP的治疗效果。     

儿童结节性胃炎幽门螺杆菌耐药性分析

目的分析儿童结节性胃炎幽门螺杆菌(H.pylori)的耐药情况,探讨H.pylori耐药菌株的抗生素合理使用方法。方法 2013年1月至2014年6月因上消化道症状就诊行胃镜检查的结节性胃炎患儿473例,收集患儿的胃窦黏膜2块,分别行H.pylori快速尿素酶试验和培养。用琼脂稀释法和E-test法检测H.pylori对阿莫西林、克拉霉素、甲硝唑、莫西沙星和左氧氟沙星的耐药情况。结果 473例结节性胃炎患儿,258例H.pylori培养阳性,H.pylori菌株对阿莫西林、克拉霉素、甲硝唑、莫西沙星、左氧氟沙星的耐药率分别为6.2%、34.9%、49.2%、8.9%、5.0%。对克拉霉素和甲硝唑双重耐药率为23.3%。473例患儿中,405例家长有H.pylori感染。结论结节性胃炎是儿童H.pylori感染的一种特殊征象。H.pylori感染有明显家族聚集性。儿童结节性胃炎H.pylori对阿莫西林的耐药率较低,应作为根除H.pylori的主要药物;克拉霉素的耐药率较高,在H.pylori高耐药地区,应在药敏结果指导下实施三联抗H.pylori治疗。     

幽门螺杆菌感染儿童厌食机制研究

目的探讨Ghrelin表达以及不同幽门螺杆菌(H.pylori)毒力基因型在H.pylori感染患儿厌食发病机制中的作用。方法 H.pylori感染患儿60例,根据临床表现分为厌食(n=30例)和非厌食(n=30例)组。应用RT-PCR方法检测胃黏膜Ghrelin mRNA表达水平,比较两组患儿以及厌食患儿在H.pylori根治前后的差异。同时采用PCR方法检测所有患儿的H.pylori毒力cagA/vacA基因并分型。结果 H.pylori感染厌食患儿胃黏膜GhrelinmRNA表达低于非厌食患儿,两组差异有统计学意义(P<0.01);厌食患儿H.pylori根治后Ghrelin mRNA表达明显升高,与根治前比较差异有统计学意义(P<0.05);同时患儿食欲改善,体质量增长显著。厌食与非厌食患儿感染的H.pylori均为Ⅰ型毒力株,厌食患儿的cagA m1阳性率高于非厌食患儿,厌食患儿的H.pylori基因型以s1/m1多见。结论 Ghrelin在H.pylori感染厌食患儿中表达降低,而H.pylori根治后表达升高,H.pylori可能通过影响Ghrelin分泌而导致厌食;毒力较强的H.pylori ...     

三联疗法联合布拉氏酵母菌治疗儿童幽门螺杆菌感染的临床研究

目的 探讨以质子泵抑制剂（PPI）为基础的三联疗法联合布拉氏酵母菌对幽门螺杆菌（Hp）根除率和副作用的影响,以寻求更有效且副作用小的Hp 根除方案。方法 采用前瞻性随机对照研究,选取确诊为Hp 感染的患儿240 例,随机分为三联疗法组和益生菌组,每组120 例。三联疗法组给予阿莫西林[40 mg/（kg·d）,Tid]、克拉霉素[15 mg/（kg·d）,Bid]和奥美拉唑[0.7~0.8 mg/（kg·d）,Qd]进行治疗,益生菌组在三联疗法的基础上增加布拉氏酵母菌（250 mg,Bid）,疗程均为14 d。治疗过程中由患儿家长记录不良反应。停药4 周后复查13C 呼气试验评估Hp 根除情况,比较两组根除率及副作用的发生率。结果 治疗后三联疗法组Hp 根除率为75.8%（91/120）,益生菌组为85.0%（102/120）,差异无统计学意义（P>0.05）。治疗过程中副反应发生率比较：恶心、呕吐、腹痛在益生菌组稍低于三联疗法组,但差异无统计学意义（均P>0.05）;口腔炎、便秘、腹泻在益生菌组的发生率明显低于三联疗法组（均P<0.05）。结论 三联疗法联合布拉氏酵母菌并不能显著提高Hp 的根除率,但能明显降低治疗过程中口腔炎、便秘及腹泻的发生率。     

过敏性紫癜伴幽门螺杆菌感染患儿肠道菌群变化的研究

目的 研究过敏性紫癜(HSP)伴有幽门螺杆菌(H.pylori)感染患儿肠道菌群的变化.方法 随机收集40例HSP患儿及40例正常儿童的粪便标本,先用快速免疫检测卡进行粪便幽门螺杆菌抗原(HpSA)检测,判定有无H.pylori感染.然后提取两组粪便标本目标细菌DNA,采用16SrRNA荧光定量PCR技术对两组粪便标本中的双歧杆菌和大肠杆菌进行定量分析和比较.并计算双歧杆菌/大肠杆菌(B/E)比值.结果 HSP患儿H.priori检出率为50.0%,正常儿童为27.5%(x2=4.266.P<0.05).双歧杆菌在HSP伴H.Pylori感染组和HSP非H.pylori感染组分别与正常儿童H.pylori感染组和非H.pylori感染组相比,数鼍明显减少(P<0.008 3);大肠杆菌在正常儿童H.pylori感染组和非H.pylori感染组分别与HSP非H.pylori感染组相比,数量明显升高(P<0.008 3),在HSP伴H.pylorii感染组与HSP非H.pylori感染组相比,数量明显升高(P<0.008 3).B/E值在HSP伴H.pylori感染组分别与HSP非H.pylori感染组、正常儿童H.priori感染组和正常儿童非H.pylon感染组相比,数值明显降低(P<0.008 3).结论 HSP患儿H.pylori检出率较正常儿童明显增多,HSP发病可能与H.pylori感染有关.HSP伴H.pylori感染和HSP非H.pylori感染患儿肠道双歧杆菌均较正常儿童减少,HSP伴H.pylori感染患儿肠道大肠杆菌较HSP非H.pylori感染息儿升高,HSP伴H.pylori感染患儿B/E值明显降低,提示HSP患儿肠道菌群失调明显.     

幽门螺杆菌感染与儿童再发性腹痛关系的中文文献meta分析

目的探讨幽门螺杆菌感染与儿童再发性腹痛的关系。方法采用meta分析方法对国内有关幽门螺杆菌与儿童再发性腹痛关系的病例对照研究结果进行定量综合分析,估计合并OR值及其95%可信区间(95%CI)。结果纳入的8个研究具有一致性,选择固定效应模型进行Meta分析,OR值为2.80(95%CI:2.26～3.47)。结论 H.pylori感染与儿童再发性腹痛相关,是儿童再发性腹痛的致病因素之一。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.