轮状病毒感染致婴幼儿腹泻临床分析

目的:对274例婴幼儿腹泻患者进行粪便轮状病毒抗原检测,了解其感染的年龄段,药物治疗效果及基本临床表现。方法:对本院2010年11月～2012年4月274例腹泻患儿粪便进行轮状病毒抗原检测。结果:274份腹泻粪便共检出轮状病毒抗原阳性96株;高发年龄为6月龄～2岁,检出率为43.75%,占58.33%;采用相应的抗生素治疗和利巴韦林静滴及葡萄糖酸锌口服,总有效率分别可达97.75%和97.92%;RS与NRS两组患儿发热、呕吐、脱水以及惊厥和肠梗阻的发生情况无明显差异(P>0.05);RS组酸中毒比例(70.83%)明显高于NRS组(38.76%),两组比较差异明显(P<0.05);CK-MB升高者RS组80例与NRS组79例明显较高,两组比较差异明显(P<0.05)。结论:轮状病毒是婴幼儿腹泻的主要病原体,金标法检测轮状病毒具有简单、快速、特异性高的特点,适合在各级医疗单位推广应用。     

人轮状病毒的流行病学研究

目的 调查儿童轮状病毒腹泻的流行状况及其影响因素.方法 采集腹泻婴幼儿粪便样品,采用金标法对腹泻婴幼儿进行轮状病毒抗体检测.结果 478份腹泻婴幼儿粪便标本中,242份检测结果为阳性,阳性率为50.63%.结论 笔者所在医院收治的轮状病毒腹泻病例流行状况与国内外情况基本一致,秋冬季节为高峰期.     

小儿急性腹泻粪便中A群轮状病毒检测结果分析

目的:分析A群轮状病毒(RV)引起小儿急性腹泻特征.方法:采用RV诊断试剂分别在秋冬季节对216份急性腹泻婴儿的粪便,采用金标快速试剂盒检测RA.结果:在216例有腹泻症状的婴幼儿粪便中检出78例RV阳性标本36.2%,其中8-10月份检出40例RV阳性粪便占51 27%(40/78)0.5-2岁年龄段RV阳性59例占78.38%(59/78),检出男性RV阳性病例59例阳性率36.42%(59/162)女性RV阳性19例阳性率为35.18%(19/54).结论:由A群RV引起的婴儿急性腹泻集中在8-10月份6个月-2岁的婴幼儿为A群RV感染的高峰期.     

轮状病毒性腹泻患儿全血锌水平及补锌治疗效果观察

目的:探讨轮状病毒性腹泻患儿全血锌的变化以及葡萄糖酸锌治疗轮状病毒性腹泻的疗效。方法:选取1258轮状病毒感染性腹泻患儿和1263例健康儿童分别进行全血锌检测,并随机将1258轮状病毒感染性腹泻患儿分成常规组626例和治疗组632例,两组均常规治疗,治疗组在常规治疗的基础上加用葡萄糖酸锌片。结果:轮状病毒感染性腹泻患儿血锌水平低于同期健康儿童,两组比较差异有显著性,有统计学意义(P<0.01)。补锌治疗组总有效率90.9%,常规治疗组为72.3%,二组差异有显著性意义(P<0.01)。结论:轮状病毒感染性腹泻患儿血锌水平低于同期健康儿童,在常规治疗基础上补锌治疗可提高疗效。     

1例溃疡性结肠炎患者行粪菌移植的护理

对1例溃疡性结肠炎致严重腹泻、菌群失调患者行粪菌移植治疗,移植过程中出现鼻肠管导致的会厌部感染,经对症处理好转。提出做好供体选择、受体肠道准备,供体粪便标本采集、粪悬浮液制备及输注护理等,可提高治疗效果。     

急性腹泻婴幼儿胃肠道病毒感染现状与临床特征分析

目的 了解浙江省宁波市北仑区婴幼儿急性腹泻的临床特征及其胃肠道病毒的感染情况.方法 选择2012年7月至2013年7月在北仑区人民医院儿科门诊的900例急性腹泻婴幼儿病例(≤5岁),分析婴幼儿急性腹泻的临床特征并采集粪便样本,用PCR方法检测A/B/C型轮状病毒(Rotavirus,RV)、肠道腺病毒(Enteric adenovirus,AdV)、星状病毒(Astrovirus,AstV)、札如病毒(Sapovirus,SV)及诺如病毒(Norovirus,NV),并采用x2检验对不同性别和年龄段患者病毒检出情况进行比较.结果 900份腹泻患儿粪便样本中369份呈阳性结果,其中单一病毒感染的291份,混合病毒感染78份.在单一病毒感染病例的样本中,NV检出率为19.4％(GⅠ型为4.9％,GⅡ型14.6％),RV-A为8.2％,未检出B型及C型RV,SV为2.9％,AstV为1.0％,AdV为0.8％.在混合感染病例的样本中,以RV-A与NV混合感染最多,为5.8％.2岁以下(含2岁)患儿的病毒总检出率(51.0％)显著高于＞2 ～5岁的患儿(22.1％,x2=70.404,P＜0.01).369例病毒检测阳性的患儿中,24.1％伴有发热,35.2％伴有呕吐症状.单一病毒感染病例发热、呕吐以及发热合并呕吐的发生率均低于混合感染病例(x2=17.878,21.869和14.155,P＜0.01).结论 NV和RV-A是浙江省宁波市北仑区婴幼儿急性腹泻的主要胃肠道病毒,2岁以下婴幼儿是这两种病毒的易感人群.     

两种动脉血标本采集部位的效果比较

目的:探讨动脉血气分析检查标本采集的最佳部位。方法:将呼吸内科240例需行动脉血气分析检查的危重患者随机分为两组(A、B组),各120例。A组选用股动脉采集动脉血标本,B组选用桡动脉采集动脉血标本。观察两组动脉血标本一次性采集的成功率和并发症的发生率。结果:A组动脉血标本采集一次成功率97.50%,B组动脉血标本采集一次成功率83.33%,A组明显高于B组;误入静脉、血肿、感染等并发症发生率,两组无明显差异。结论:股动脉是动脉血气分析检查标本采集的最佳部位。     

儿童肝移植术后轮状病毒感染特点及临床分析

目的总结儿童肝移植术后轮状病毒感染特点及治疗方法。方法回顾性分析2014年10月至12月在首都医科大学附属北京友谊医院的儿童肝移植术后患儿39例,其中6例发生肝移植术后轮状病毒感染。分析6例患儿感染的症状、合并症、治疗和转归特点。结果 6例患儿中,诊断轮状病毒感染时间为肝移植术后8~197 d(中位数22 d),其中3例临床主要表现为高热、腹泻、呕吐,余3例主要表现为腹泻。发生感染距离肝移植的时间越长,轮状病毒感染的症状相对越轻。6例患儿中,5例合并EB病毒、巨细胞病毒或呼吸道合胞病毒感染,2例合并肝或心功能异常。治疗方法主要为减少FK506剂量,部分患儿给予丙种球蛋白提高免疫力;给予对症调节肠道菌群,止泻治疗,口服抗生素及补液支持治疗后均痊愈。2例合并严重心、肝功能异常的患儿给予对症处理后心、肝功能指标均恢复正常。结论儿童肝移植术后轮状病毒感染症状较重,严重时合并心、肝等脏器功能损伤,经合理治疗能逐步恢复正常。     

北京地区2008年儿童轮状病毒腹泻的流行病学研究

目的：探讨北京地区2008年儿童轮状病毒（RV）腹泻的流行病学特征。方法：采集2008年1—12月来我院肠道门诊就诊的急性腹泻患儿的粪便标本,以免疫层析双抗体夹心法定性检测A群RV抗原,分析RV腹泻在性别、年龄、发病季节及地域等方面的分布特点。结果：受检患儿共9843例,检出RV感染患儿共2249例,总检出率为22．8％,男女检出率比为1．6：1。男孩检出率为22．2％（1385／6226例）,女孩检出率为23．9％（864／3617例）,二者之间差异无显著性（P〉0．05）。将受检患儿分为〈6个月、6个月～2岁、2～3岁和〉3岁共4组,其RV检出率分别为19．7％、25．0％、22．7％和11．3％,3岁以下各组的检出率均高于〉3岁组（P〈0．05或P〈0．01）,而3岁以下各组之间的检出率差异无显著性（P〉0．05）。RV腹泻病例终年未断,检出率在3月份（37．1％）和11月份（58．8％）呈现两个高峰,最低为9月份（7．5％）。检出率较高的区域主要分布于北京西部和北部的区县。经粪培养证实RV合并肠道致病菌感染者10例,混合感染率为0．4％（10／2249例）,均为6个月～2岁婴幼儿。结论：北京地区3岁以下儿童为A群RV的易感人群,其中6个月～2岁婴幼儿为RV与细菌混合感染的易感人群;2008年RV腹泻全年均有发生,在春季和秋冬季出现两个发病高峰,应根据流行病学特点适时为儿童接种RV疫苗预防RV腹泻。     

益生菌预防机械通气患者肠内营养相关性腹泻

目的观察益生菌对机械通气患者肠内营养相关性腹泻的预防作用。方法将120例机械通气患者随机分为观察组与对照组各60例。观察组在胃肠内注入瑞能肠内营养剂加益力多,对照组常规加入瑞能肠内营养剂,观察两组患者7d内腹泻的发生率及粪便球杆比值。结果观察组患者腹泻发生率为10.0%,对照组为36.7%,两组比较,差异有统计学意义(P0.01);粪便细菌油镜观察两组球杆比值比较,差异有统计学意义(P0.01)。结论益生菌可以帮助恢复失衡的肠道微生态,有效预防机械通气患者胃肠内营养过程中腹泻的发生,有利于肠内营养治疗的顺利进行。     

0至3岁婴幼儿轮状病毒感染流行病学特点及危险因素

目的探究0～3岁婴幼儿轮状病毒（RV）感染的流行病学特点及相关危险因素。 方法以2015年1月至2017年7月广东省农垦中心医院儿科住院并确诊的50例0～3岁轮状病毒感染腹泻患儿为研究对象,同时选取50例健康儿童作为对照组,对轮状病毒感染者的流行病学指标进行描述。采用针对本研究自制调查表对患者基本信息、生活习惯和生活行为进行调查,通过单因素和多因素统计学方法分析导致RV感染的危险因素。 结果描述统计学发现RV引起的腹泻于5～7月份和11～12月份为高月份,相对应季节分别为夏季和冬季,在RV感染引起的不同年龄段和性别腹泻患儿数量差异无统计学意义（χ² = 0.622、0.519,P = 0.419、0.617）,不同分子类型RV感染所致腹泻临床症状差异无统计学意义（χ² = 1.011、0.219、0.948、0.628、0.435,P = 0.315、0.640、0.330、0.428、0.509）;按时接种疫苗（OR = 0.52,95%CI：0.21～0.84）、良好洗手习惯（OR = 0.35,95%CI：0.19～6.48）和母亲喂奶前洗手行为（OR = 0.45、95%CI：0.21～0.93）均为患儿感染RV腹泻的保护因素,而小儿吮手指习惯（OR = 3.37,95%CI：1.58～6.21）、腹泻患者接触史（OR = 2.95,95%CI：1.87～4.05）及食用生冷不洁食物（OR = 2.53,95%CI：1.09～8.75）为危险因素。 结论0～3岁婴幼儿RV感染所致腹泻全年均可发生,夏、冬季节为高发季节,按时接种疫苗、良好洗手习惯、纠正小儿吮手指习惯、不与腹泻患者接触及不食用生冷不洁食物可降低RV感染的发生。     

Rotavirus infection and intussusception in Tunisian children: implications for use of attenuated rotavirus vaccines

Background

A licensed rotavirus vaccine was withdrawn from use because of an increased risk of intussusception. The association of rotavirus vaccination with intussusception raised concerns about a potential link between natural rotavirus disease and intussusception. The objectives of the present study were to determine whether an epidemiological association with natural rotavirus infection existed.

Methods

From 1984 to 2003, all children younger than 5 years with intussusception were retrospectively identified by medical charts, and from 1995 to 2003, a prospective surveillance study of rotavirus infection in children younger than 5 years was independently conducted. Epidemiological characteristics of intussusception and rotavirus infection were then compared.

Results

A total of 533 cases of intussusception and 146 cases of rotavirus infection were identified. The incidence of intussusception for infants younger than 1 year was 62/100,000 child-years. The age distributions of intussusception and rotavirus gastroenteritis overlapped, and a masculine predominance was noted in both cases. No significant association was observed between the monthly distribution of intussusception and rotavirus infection.

Conclusion

The present study has not convincingly shown that rotavirus diarrhea plays a major role in intussusception. However, data about age and sex distributions supported the biologic plausibility of such an association.     

山莨菪碱治疗小儿秋季腹泻的疗效观察

目的评价山莨菪碱治疗急性轮状病毒肠炎的效果。方法选择64例急性轮状病毒肠炎患儿随机分组,治疗组33例给予口服山莨菪碱,对照组31例给予口服维生素B1。结果治疗6d后,治疗组治愈54.5,改善36.4,无效9.1,总有效率90.9;对照组治愈45.2,改善35.5,无效19.3,总有效率80.6。总有效率比较差异有统计学意义（P〈0.01）。结论山莨菪碱能改善婴幼儿秋季腹泻症状,缩短病程。     

Rotavirus Infection in Adult Small Intestine Allografts: A Clinicopathological Study of a Cohort of 23 Patients

Rotavirus enteritis (RVE) is increasingly recognized as a cause of small bowel allograft dysfunction but its significance in adult patients is unknown. We have studied 23 adult small bowel transplant patients aged 19.8–59 years (mean = 38.2 years), who were presented with diarrhea and tested positive for rotavirus by enzyme‐linked immunosorbent assay methods. Serial follow‐up biopsies, as well as clinical data, are documented and analyzed. These patients were followed up for an average of 168 days (range 33–534 days). Mean time of rotavirus diagnosis from transplant day was 794 days (range 38–2907 days). Self‐limited diarrhea lasting 6–13 days (mean = 9 days) was the main presentation. Sixteen (69.6%) patients developed acute cellular rejection either concurrently with (i.e. six patients) or after (10 patients) RVE, often characterized by prominent mucosal plasmacytosis at an average of 22 days (range 0–94 days) from the day RVE was diagnosed. One‐third of patients with acute rejection (i.e. five out of 16) required muromonab‐CD3 rescue therapy. Two patients experienced graft loss (one from chronic rejection, another from sepsis). Rotavirus infection is a cause of diarrhea in adult small bowel transplant patients. The infection appeared to trigger cellular rejection that was associated with mucosal plasmacytosis, and sometimes required aggressive rescue therapy.     

福田区肠道传染病实验室监测结果的分析

目的探讨深圳市福田区腹泻病例中病菌感染现况,分析其流行病学特征并提出防治措施。方法哨点医院采集门诊未使用抗生素腹泻监测患者的大便样本、肛拭子或呕吐物标本,进行致病菌的分离培养,对阳性菌株进行分子生物学特征分析。结果福田区腹泻病例监测中肠道致病菌感染率为11.45（115/1004）,检测出沙门菌、副溶血弧菌、EPEC、EIEC、ETEC,在不同年龄段均有显著性差异（均P〈0.01）,病例以致泻性大肠埃希菌感染为主。EPEC、EIEC、ETEC感染季节分布无明显差异（P〉0.05）;沙门菌、副溶血弧菌感染情况在不同季节有明显差异（P〈0.05）,沙门菌、副溶血弧菌感染在夏季较多见;常住与暂住人群的感染构成比有显著差别（P〈0.01）;男女性别比无明显差异（P〉0.05）。结论福田区要重点加强辖区内致泻性大肠埃希菌感染的防治,在夏季要加强沙门菌、副溶血弧菌的监测与防治,注重暂住人群的肠道传染病防治知识宣教。     

原发性肝癌组织RASSF1A异常甲基化与DNMTs及HBV的关系

目的探讨原发性肝癌ras相关结构域家族1A（ras association domain family 1A,RASSF1A）异常甲基化与肿瘤组织中DNA甲基转移酶（DNA methyltransferases,DNMTs）转录水平变化及HBV感染的关系.方法采用甲基化特异性PCR（methylation specific PCR,MSP）技术检测61例原发性肝癌组织RASSF1A基因异常甲基化情况,RT-PCR法检测其中三种主要DNA甲基转移酶（DNMT1、DNMT3A、DNMT3B）水平的变化.结果61例肝癌标本中RASSF1A基因启动子区异常甲基化45例（73.8%）;HBV感染者47例（77.1%）,其中MSP阳性32例;无HBV感染者14例,其中MSP阳性13例,RASSF1A基因异常甲基化与HBV感染之间的关系无统计学意义（x2=2.260,P=0.133）.肝癌组、肝癌细胞系组及HBV感染组DNMTs表达水平与正常对照组相比均显著升高;组内比较显示肝癌组中DNMT3A、DNMT3B在MSP阳性患者中较阴性患者升高（分别为t=3.494,P＜0.01;t=4.258,P＜0.01）,而DNMT1下降（t=3.221,P＜0.05）;HBV感染组中,MSP阳性组织其DNMT3B较阴性者升高（t=12.171,P＜0.01）.结论肝癌组织DNMTs水平变化与RASSF1A异常甲基化有密切关系;HBV感染与DNMT3B转录水平变化相关.     

Asymptomatic rotavirus infections among normal Indian children in Chatsworth, Durban

During a 27-month survey in Chatsworth, Durban, serum from 1,041 normal Indian children, ranging in age from birth up to 13 years, was tested for the presence of anti-rotavirus antibodies by means of a complement fixation test. It was found that from an initial high positivity rate of 47.7% in the newborn, there was a sharp drop to 23.8% in the 1-2-month age group (P = 0.0009). This low positivity rate was maintained up to the age of 9-11 months, after which it rose to 46.4% in the 12-17-month age group (P = 0.0006). There was a further significant rise between the 2-3-year and 4-5-year age groups, probably reflecting rotavirus infections in nursery school and/or in the home, the latter being nosocomially acquired from younger siblings. Stool samples were obtained from 829 of the above subjects: overall, 16.2% were positive for rotavirus antigen by enzyme-linked immunosorbent assay; the highest rate (29.5%) of asymptomatic rotavirus infection was in the 12-14-month age group. The data indicate that asymptomatic infection with rotavirus is not uncommon in this community and that older children continue to be exposed to and become infected with rotavirus.     

Rotavirus in Organ Transplantation: Drug‐Virus‐Host Interactions

Although rotavirus is usually recognized as the most common etiology of diarrhea in young children, it can in fact cause severe diseases in organ transplantation recipients irrespective of pediatric or adult patients. This comprehensive literature analysis revealed 200 cases of rotavirus infection with 8 related deaths in the setting of organ transplantation been recorded. Based on published cohort studies, an average incidence of 3% (187 infections out of 6176 organ recipients) was estimated. Rotavirus infection often causes severe gastroenteritis complications and occasionally contributes to acute cellular rejection in these patients. Immunosuppressive agents, universally used after organ transplantation to prevent organ rejection, conceivably play an important role in such a severe pathogenesis. Interestingly, rotavirus can in turn affect the absorption and metabolism of particular immunosuppressive medications via several distinct mechanisms. Even though rotaviral enteritis is self‐limiting in general, infected transplantation patients are usually treated with intensive care, rehydration and replacement of nutrition, as well as applying preventive strategies. This article aims to properly assess the clinical impact of rotavirus infection in the setting of organ transplantation and to disseminate the interactions among the virus, host and immunosuppressive medications.     

Breast feeding may protect children against Campylobacter jejuni associated diarrhoea

To investigate the bacterial etiology of infant diarrhea in Karachi, Pakistan, 180 rectal swab samples collected from diarrhea patients under 5 years of age and 30 samples from age- and sex-matched healthy children were analyzed. Enteropathogenic organisms were isolated from 70 case samples (38.9%). The two most common etiologic agents were Campylobacter jejuni (19.4%) and Aeromonas hydrophilia (6.1%). Salmonella, Shigella, and Yersina appear to have a limited incidence in this age group. None of the control specimens yielded any enteropathogen. Breast-fed infants had a significantly lower risk of enteric infection. A pathogen was isolated in 26.0% of samples from breast-fed children with diarrhea compared with 46.8% of samples from bottle-fed diarrhea patients. All C jejuni infections identified in this study involved bottle-fed children. Boiled water was used to prepare infant formula in only 31.1% of these patients. These findings are consistent with those of other studies showing a decreased rate or severity of diarrhea in breast-fed infants. Mothers should be encouraged to breast feed their infants or, if this is not possible, to use boiled water for the preparation of infant formula.