先天性TORCH感染的治疗预后探讨

目的探讨先天性TORCH感染的预后,提出防治措施.方法对51例确诊HCMV、HSV、EBV、TOXO感染-甲组(各31、6、1及13例)分别采用α-干扰素(α-IFN)加静脉用人体免疫球蛋白(IVIG)治疗或用螺旋霉素及阿奇霉素治疗.另选30例足月正常新生儿为对照Z组.随访体格、神经系统发育.结果治疗结束后3或6个月复查血清相关TORCH IgM IgG或/和FQ DNA PCR均转阴性.甲组体格发育明显低于正常儿,精神及运动发育各低于乙组22分及21分.小头、智力低下、脑瘫各为9,19,17例.结论所述疗法对先天性HCMV,HSV,TOXO感染是有效而安全的.血清相关TORCH抗体及FQ DNA PCR治疗后转阴性,但不能完全修复宫内已形成的脑损伤及发育落后.     

先天性TORCH综合征的检测与预后

20年前把致宫内感染后表现为相似临床特征的那些病原体按单词首字母缩写为TORCH，其中T代表弓形虫（TosoPlasmagondii）、O代表其它（otheragents．梅毒螺旋体等）、R代表风疹病毒（rubellavirus）、C代表巨细胞病毒（cytomegalovirus，CMV）、H代表单纯癌疹病毒1型和2型（HerpessimPlexvirus，HSV，tyPesland2）。近年来将otheragents范围扩大·不仅包括海毒螺旋体，还包括乙型肝炎病毒、水痘一带状疮疹病毒（VZV）、肠道病毒、腮腺炎病毒、人类免疫缺陷病毒（HIV）和人细小病毒匕。、疟原虫、李斯特菌等。TORCH综合征是由这…     

先天性TORCH感染35例临床分析

为探讨先天性ＴＯＲＣＨ感染的早期临床表现,为尽早诊断提供依据,本文分析了我院新生儿病房１９９４年７月￣１９９８年７月收治的先天性ＴＯＲＣＨ感染３５例,占同期住院新生儿的１．８６％。在感染类型中,巨细胞病毒感染最常见,占７１．４２％,其次为弓形体感染,占１１．４３％。其临床表现以黄疸、贫血、肝肿大最多见,分别占９４．２９％,４５．７１％及２０％。合并感染以肺炎最多见占２５．７１％。提示先天性ＴＯＲＣ     

先天性TORCH感染的诊断及临床分析

胎儿宫内感染弓形体（TOX）、风疹病毒（RV）、巨细胞病毒（CMV）、单纯疱疹病毒（HSV）、梅毒螺旋体及李司忒菌等统称TORCH感染。TORCH感染可引起多系统损害,特别是神经系统的损害。由于TORCH感染早期临床表现不典型,常易引起误诊而延误治疗,提高对TORCH感染的认识具有很大的临床实用价值。现将我院66例先天性TORCH感染的新生儿进行分析如下。     

低出生体重儿TORCH先天性感染及影响因素的研究

２８１例出生体重＜２５００ｇ的早产儿和小于胎龄儿与母配对，用ＥＬＩＳＡ法和ＩＨＡ法分别检测ＣＭＶ、ＲＶ、ＨＳＶ－Ⅱ特异性ＩｇＭ抗体和Ｔｏｘ地特异性ＩｇＧ抗体。结果表明：ＴＧＯＲＣＨ先天性感染率早产儿组２７．５％，ＳＧＡ组为２０．１％，均明显高于对照组足月儿５．２％。     

住院患儿TORCH感染状况

目的了解中国医科大学附属盛京医院住院患儿的TORCH感染状况及临床特点。方法对2007年10月-2008年3月本院儿科住院的1652例患儿,应用化学发光免疫分析法检测其血清TORCH-IgM。对巨细胞病毒抗体(CMV)-IgM阳性的患儿,采用荧光定量聚合酶链反应检测其尿液CMV DNA。并将患儿按年龄分为1～28d组、29d～6个月组、7个月～3岁组、4～10岁组,应用SPSS13.0分析软件进行数据分析,率的比较采用χ2检验,分析TORCH感染患儿的临床特点。结果1.各年龄组患儿TORCH-IgM总阳性率为14.10%(233/1652例)。其中弓形虫、风疹病毒、CMV、单纯疱疹病毒阳性率分别为0.73%、0.48%、8.90%、4.0%。11例患儿为2种病原体混合感染。147例CMV-IgM阳性的患儿中,135例患儿尿液中能够检测到CMVDNA,2种方法检测CMV的符合率为91.84%。2.新生儿组患儿TORCH-IgM总阳性率明显低于其他年龄组患儿,有显著性差异(Pa<0.01)。3.TORCH-IgM阳性患儿的临床表现不典型,其疾病类型主要为支气管肺炎、巨细胞病毒性肝炎、血小板减少性紫癜及癫癎、病毒性脑炎等疾病。结论住院患儿TORCH感染较常见,其中以CMV感染最为普遍。由于TORCH病原体感染多缺乏典型症状,应对住院患儿开展全面TORCH检测,避免单一检测引起漏诊。     

TORCH感染与新生儿肝炎综合征

TORCH感染是指围产期慢性非细菌性感染 ,是引起胎儿宫内感染及新生儿出生缺陷的重要原因之一。本文对 34例新生儿肝炎综合征者进行血清 TORCH- Ig M抗体测定 ,现报告如下。对象与方法一、对象1 996年 4月～ 1 999年 2月我院新出儿病房收治确诊为新生儿肝炎综合征 34例 ,男2 1例 ,女 1 3例 ;早产儿 4例 ,足月小样儿 6例。起病年龄 1 2～ 2 1天 ,均有黄疸、肝大及肝损害。其中肝脾均大 6例、陶土样大便 1 0例。母婴配对 4例。二、方法采用 EL ISA法进行血清 TORCH- Ig M抗体测定 ,药盒由深圳晶美生物工程有限公司提供。阳性结果判断…     

TORCH感染与DNA损伤

ＴＯＲＣＨ感染 (包括 :巨细胞病毒、疱疹病毒、风疹病毒、柯萨奇病毒、乙肝病毒及弓形体感染等 )在母亲与胎儿间的垂直传播可引起流产、死产和胎儿的多发性畸形 ,而生殖细胞的形成阶段及胚胎早期发育阶段正是ＴＯＲＣＨ感染的敏感时期。ＴＯＲＣＨ所引起的病理改变是否以ＤＮＡ损伤作为其分子生物学基础 ,值得探讨。单细胞凝胶电泳试验 (ｓｉｎｇｌｅｃｅｌｌｇｅｌｅｌｅｃｔｒｏｐｈｅｒｏｓｉｓ,ＳＣＧＥ)又称彗星试验 (ｃｏｍｅｔａｓｓａｙ) ,是一种简便、快速、灵敏、直观检测细胞ＤＮＡ链断裂的技术。在荧光显微镜下观察到的单个Ｄ…     

PRIMARY AND SECONDARY MATERNAL CYTOMEGALOVIRUS INFECTIONS AND THEIR RELATION TO CONGENITAL INFECTION

ABSTRACT. 4382 new mothers were examined retrospectively with the enzymelinked immunosorbent assay (ELISA) for IgG activity to cytomegalovirus (CMV) during pregnancy. Some of them were also studied with the indirect immunofluorescence (IIF) test for CMV-IgM antibodies. All the infants had been studied for CMV excretion within the first week of life. Nineteen of them had been shown to be congenitally infected with CMV. 1218 (28 %) women lacked CMV-IgG activity at their first antenatal visit (usually in months III-IV). Fourteen of them seroconverted before parturition (primary infection). Thirteen of the seroconverters were shown to develop CMV-IgM activity. In 6 (43 %) cases the primary infection was transmitted to the offspring. The remaining 13 congenitally infected infants were born to mothers with a positive IgG-test at their first antenatal control. Only one of these mothers had a clearly positive IgM-test. She was shown to lack CMV-antibodies before conception (primary infection during the first trimester). Preconceptional sera were obtained from further 4 of the 13 seropositive mothers of congenitally infected infants; all 4 had CMV antibodies before pregnancy (secondary infection during pregnancy). The combined studies of the mothers and infants revealed that 21–63 % of the congenital infections could have been caused by secondary maternal infections. Prospectively performed, the study would only have disclosed one of the three fetal CMV infections that resulted in neurological sequelae.     

新生儿颅内出血的早期诊断和治疗探讨

为了降低新生儿颅内出血的病死率与伤残率,对1998年10月～1999年3月具有窒息、异常分娩、产前产时并发症者的患儿生后3～7天37例行颅脑超声检查、63例行头颅CT检查.100例中<37周32例.结果显示1.SAH60例(61.O%),SEH-ⅣH 34例(34.0%),IPH3例(3.0%),SDH 1例(1%);2.出生体重<2 500g者SEH-IVH明显高于≥2 500g而SAH≥2 500g者明显高于<2 500g.X2分别为39.628,26.789.P<0.01;3.不同类型ICH的临床表现SEH-ⅣH以抑制青紫为主,而SAH以兴奋为主.因此建议,对具有高危因素的患儿常规作床边颅脑超声,病情稳定者作CT检查可以及早发现ICH,对ⅣHⅢ～Ⅳ级患儿可考虑连续腰椎穿刺放脑脊液以减少脑积水的发生.     

SEROLOGICAL DIFFERENTIATION OF CONGENITAL AND ACQUIRED CYTOMEGALOVIRUS INFECTIONS DETECTED IN INFANCY

Abstract. A serological investigation on infants with incidentally detected cytomegalovirus (CMV) excretion was made in an attempt to differentiate between congenital and acquired infections. Generally, each of the patients, 0–12 months old at the detection of CMV-excretion, was studied by indirect immunofluorescence (IIF) test for IgM-antibodies in cord serum and by complement fixation (CF) test performed on cord serum and a number of sera drawn after the detection of CMV. Two out of 4 patients with virologically confirmed congenital CMV-infection, as shown by positive virus isolation within 1 week of age, had a positive CMV-IgM-test in cord serum. One of these two children also had a persistently high CMV-CF-titer from birth until 2 months of age, indicating congenital infection. In the remaining 46 cases, all with the CMV-excretion detected after 3 weeks of age, in half of the cases after 5 months, no positive IgM-reaction was recorded in cord serum. No persistently high CF-titer could be demonstrated among 13 out of the 46 patients from whom sera were drawn at birth and at 1–4 months. Six out of these 13 patients had a CF-titer rise after the period of 1–4 months, indicating acquired infection. However, also one of the congenitally infected children had a similar titer increase. Many patients lacked characteristic serological patterns, some of them in spite of access to sera drawn at birth, as well as at 1–4 months of age and later on. It could be concluded that the possibility of making a serological distinction of congenital and acquired infant CMV infection found, by chance, during infancy is limited.     

CONGENITAL HAEMANGIOENDOTHELIOSARCOMA OF THE LIVER

A case of haemangioendotheliosarcoma of the liver in a newborn boy is reported. The patient died 15 hours after birth. The autopsy findings are described, and the rare occurrence of this tumour is discussed. It does not appear to have been previously diagnosed immediately after birth. A few cases have manifested themselves in the 2nd-5th month of life. Recent improvement in the prognosis for patients with hepatic tumours treated by surgery is mentioned.     

重症胎粪吸入综合征呼吸机治疗的十年回顾

目的 探讨如何使用呼吸机对重症胎粪吸入综合征(MAS)进行合理治疗。方法 对近10年来我科NICU需机械通气的44例重症MAS患儿以1997年12月为界分为前期和后期两组,分析两组出生至上机时间、呼吸机使用时间、住院时间差异,比较两组持续肺动脉高压(PPHN)、缺氧缺血性脑病(HIE)、气胸、呼吸机相关性肺炎(VAP)、病死率。结果 前期组上机时间较后期组迟,两组分别为(31.5±7.2)h,(10.3±7.8)h;呼吸机使用时间分别为(145.0±26.4)h,(98.5±26.7)h;住院时间分别为(23.7±15.4)d,(14.4±6.0)d;均有非常显著差异,P<0.01。两组PPHN发生率分别为8例,3例;气胸分别为8例,4例;VAP分别为13例,9例,死亡分别为11例,7例,均有显著差异;HIE发生率分别为7例,5例;无显著差异;总体病死率40.9％。结论 对重症MAS患儿放宽上机指征,尽早上机,可大大缩短呼吸机使用时间和住院时间,减少并发症发生,降低病死率。     

新生儿化脓性脑膜炎及脑室炎治疗探讨

目的 探讨新生儿化脓性脑膜炎(新生儿化脑)及脑室炎的诊断及治疗。方法 回顾性分析1992年1月至2002年12月我科收治的新生儿化脑59例。结果 新生儿化脑缺乏特异性的症状和体征,临床表现复杂、多样化,一半以上表现为发热或体温不升,拒奶或吐奶,神萎及反应差,黄疸,前囟紧张和末梢白细胞增高等。血培养及脑脊液培养细菌阳性,大部份病人以青霉素/氨苄青霉素加头孢噻肟/头孢三嗪治疗有效,治愈率83.1％。脑室炎患儿还表现为:病程≥1周,发热>3天,频繁抽搐,前囟紧张及脑室扩大等。侧脑室穿刺注药治疗有效,治愈率66.6％。结论 新生儿化脑及脑室炎临床表现复杂、多样化,缺乏特异性,对出现上述临床表现的患儿要及时行腰穿及脑室穿刺,及时诊断治疗,大部分患儿以青霉素/氨苄青霉素加头孢噻肟/头孢三嗪治疗有效,合并脑室炎应侧脑室穿刺注药治疗。     

新生儿败血症260例临床分析

目的分析我所10年间新生儿败血症的临床和转归特点。方法对我所260例新生儿败血症患儿的临床资料和血培养阳性菌进行回顾性研究。结果新生儿败血症发病构成比和死亡构成比总体呈下降趋势。血培养结果显示凝固酶阴性葡萄球菌占44．7％，金黄色葡萄球菌14．9％，大肠埃希氏菌12．8％。病死率9．6％，发病日龄越小，病死率越高，≤3天发病者病死率高达22．5％。结论新生儿败血症的病死率仍然很高，防治工作有待进一步加强。     

THE EFFECT OF EARLY DIAGNOSIS OF CONGENITAL DISLOCATION OF THE HIP

Abstract. The effects of early diagnostic measures of congenital dislocation of the hip (CDH) in Malmo during the years 1956-1972 were investigated. Of 58759 newborns 548 were diagnosed as having CDH. Only 4 cases were missed at the initial examination. Thus, all, or almost all, children with CDH can be diagnosed at birth provided that the initial examination is undertaken within 24 or 48 hours.     

DNA PLOIDY AND PROGNOSIS OF NEUROBLASTOMA

Secondary carnitine deficiency may occur in some diseases including malnutrition. The present study examined the serum carnitine levels of children with cancer and their relationship with nutritional status. Fifty-one (mean age: 104 &;#45 23 months) patients with cancer were evaluated at diagnosis and 3 months after the initiation of the treatment. There were significant differences between the mean carnitine levels of patients before and during the treatment ( p : .004). Although initial carnitine levels of patients were similar to those in control groups, there was a significant difference between the mean carnitine levels of patients and those of the control group at the third month ( p : .02). The prevalence of malnutrition at the third month of the treatment (43%) was higher from the prevalence at diagnosis (33%) but this was not significant. No significant relationship was found between carnitine levels and nutritional status of patients either at diagnosis or during treatment. These results showed that inadequate intake of carnitine or its precursors could not be responsible for decrease in carnitine levels. Metabolic changes that result from therapy and/or from neoplastic process may be responsible for the decrease in carnitine levels. Detailed studies, including measurements of fractions of carnitine and urinary carnitine excretion according to individual drug, are necessary to determine real cause of this decrease.     

A PROSPECTIVE STUDY ON THE INCIDENCE AND SIGNIFICANCE OF CONGENITAL CYTOMEGALOVIRUS INFECTION

Abstract. Screening of 3060 neonates for congenital cytomegalovirus (CMV) infection by virus excretion in the urine showed an overall incidence of 0.4%. The incidence was about 1 % for mothers between 16 and 25 years and only 0.2% for mothers between 25 and 35. No mothers over 35 years of age gave birth to congenitally infected infants. The percentage of women in the child-bearing age susceptible to CMV infection was estimated by the absence of CMV complement-fixing antibodies in cord sera and ranged from 48% to 33% with increasing age. None of the infected infants showed obvious signs of congenital CMV infection at birth. At follow-up, two infants showed slight, but transient symptoms compatible with a foetal infection; a pair of premature twins exhibited retarded physical and psychomotor development, but this could just as well be ascribed to the prematurity itself. None of the infants had detectable CMV-IgM antibodies in cord sera, but a trend towards elevated total IgM concentration in cord sera and elevated virus excretion titres appeared in the infants with symptoms. With the very low incidence and no signs of sensomotor sequelae the preliminary conclusion is that foetal CMV infection in our population by no means has a significance to deserve routine screening or a vaccination programme.