大剂量维生素C对川崎病急性期肱动脉血流介导扩张反应影响的临床观察

目的 观察大剂量维生素C(VitC)对川崎病(KD)急性期肱动脉血流介导的扩张反应(FMD)的影响，探讨VitC对KD急性期血管内皮功能障碍是否有改善作用。方法 采用高分辨率多普勒超声仪测定2001年1月至2002年12月在华中科技大学同济医学院附属同济医院儿科住院的36例KD急性期患儿(KD组)及15名健康儿童(正常对照组)肱动脉FMD，并比较KD组静脉滴注大剂量VitC(200mg/kg，最大量为4g)和安慰剂(10%葡萄糖)前后肱动脉FMD的变化。结果 KD组肱动脉FMD明显低于正常对照组(P<0.001)；KD组静滴大剂量VitC后肱动脉FMD明显增加(P<0.01)，静滴安慰剂后肱动脉FMD无明显增加(P>0.05)。结论 大剂量VitC能明显改善KD急性期肱动脉FMD，其对KD急性期血管内皮功能障碍可能有显著改善作用。 Abstract Objective To observe the effect of high dose vitamin C on flow mediated vasodilation(FMD) of brachial artery in acute phase of Kawasaki disease(KD) and investigate whether high dose vitamin C could improve vascular endothelial dysfunction in KD.Methods Using high resolution vascular ultrasound,we measured FMD of the brachial artery of 36 patients who were admitted to our hospital from Jan.2001 to Dec.2002. in acute phase of KD and 15 matched healthy subjects as controls.Studies were performed before and after intravenous infusion of high dose vitamin C (200mg/kg，max≤4g) or placebo in KD group.Results The FMD of the brachial artery in KD group was significantly lower than that in the control group (3.55±3.00% vs 10.34±4.29%，P<0.001).Intravenous infusion of vitamin C significantly increase the FMD of the brachial artery in 18 KD patients (6.97±2.93% vs 3.51±2.01%，P<0.01),while after administration of placebo in the other 18 patients,there was no significantly increased in the FMD(4.12±2.21% vs 3.75±3.00%，P>0.05).Conclusion Intravenous infusion of high dose vitamin C can increase the FMD of the brachial artery,and it can improve vascular endothelial dysfunction in KD. Key words Kawasaki disease;Vitamin C;Flow mediated vasodilation;Endothelial dysfunction     

Survivin在儿童急性白血病中的表达和P53的相关性及其临床意义

目的探讨Survivin在儿童急性白血病(AL)中的表达及其与抑癌基因P53的相关性，同时观察Survivin与急性淋巴细胞白血病(ALL)临床分型的关系。方法应用免疫组织化学链霉亲和素-生物素-过氧化物酶复合物(SABC)方法，检测华中科技大学同济医学院附属同济医院儿科2004年1~7月收治的37例儿童AL骨髓细胞Survivin和P53的表达，对照组为10例非恶性血液病且骨髓正常患儿。结果在37例AL患儿中，Survivin蛋白表达阳性率为35.14%，P53表达阳性率为32.43%，显著高于正常骨髓组织(P均<0.05)，Survivin和P53表达呈强相关性(P<0.05)，Survivin在高危(HR)ALL患儿的表达为46.15%，在标危(SR)ALL患儿的表达为0，差异有显著性意义(P<0.05)。结论(1)Survivin在儿童AL中异常表达，且与ALL的临床分型有关，提示其在判定儿童ALL预后中有意义；(2)抑癌基因Ｐ53的失活与Survivin的表达可能在AL发生中起协同作用。 Abstract Objective To investigate the expression of Survivin in pediatric acute leukemia and its relationship with expression of P53 and clinical significance.Methods The expression of Survivin and P53 proteins were detected by immunohistochemical assay in 37 acute leukemia children.The control included 10 children with normal bone marrow.Results Survivin protein expression rate was 35.14% and P53 protein expression rate was 32.43% in 37 AL children.Both of them were significantly higher than that in control group (P<0.05).The expression of Survivin and P53 being strongly related (P<0.05).The expression rate of Survivin was 46.15% in HR ALL and 0% in SR ALL,the difference was statistically significant(P<0.05).Conclusion (1)Survivin protein expression rate is abnormal and is associated with the clinical typing of ALL.It may play an important role in the prognosis of ALL.(2)Expression of Survivin and de activation of anti oncogene P53 might play synergetic roles in the process of genesis of AL. Key words Survivin;P53;Children;Acute leukemia     

儿童急性白血病细胞周期蛋白D3、E的表达

目的 探讨细胞周期蛋白D3、E的表达与儿童急性白血病(AL)的关系。方法 采用免疫组织化学法，对广西医科大学第一附属医院儿科2002年1月至2004年5月收治的50例初发或复发儿童AL，其中急性淋巴细胞白血病(ALL)30例(高危ALL 12例，标危ALL 18例)，急性非淋巴细胞白血病(ANLL)20例，和26例完全缓解AL(AL CR)患儿，以及23例同期住院的非恶性疾病患儿(对照组)，检测其骨髓细胞中细胞周期蛋白D3、E的表达情况。结果 AL组中细胞周期蛋白D3、E阳性率分别为54%和46%，高于AL-CR组和对照组(P<0.01)；在ALL和ANLL间差异无显著性(P>0.05)。高危ALL细胞周期蛋白D3阳性率明显高于标危ALL(P<0.01)。化疗前细胞周期蛋白D3、E表达阳性率明显高于化疗缓解后(P<0.01)。细胞周期蛋白D3、E在AL组中的表达呈正相关(r=0.298，P<0.01)。结论 细胞周期蛋白D3、E与儿童AL发病有关，它们的表达存在相关性，可作为疗效观察的指标；细胞周期蛋白D3可能与患儿不良预后有关。 Abstract Objective To investigate the relationship between the expression of cyclin D3，cyclin E and childhood acute leukemia(AL).Methods The expression of cyclin D3 and cyclin E was detected in bone marrow cells from 50 cases of newly diagnosed or relapsing AL，in whom there were 30 cases of acute lymphoblastic leukemia(ALL，including 12 cases of high risk ALL and 18 cases of standard risk ALL ) and 20 cases of acute non lymphocytic leukemia(ANLL)，26 cases of complete remission AL(AL CR) patients and 23 cases of control group(no malignant disease) using immunohistochemical assay.Results 54% AL cases were positive for cyclin D3，and 46% for cyclin E，both being remarkably higher than that of AL CR group and control group(P<0.01).There was no difference between ALL and ANLL in the expression of cyclin D3 and cyclin E(P>0.05).The positive expression of cyclin D3 was higher in high risk ALL than that in standard risk ALL(P<0.01).The expressions of cyclin D3 and cyclin E before chemotherapy were significantly higher than that after remission using chemotherapy(P<0.01).There was significantly positive correlation between the expression of cyclin D3 and cyclin E in AL (r=0.5298，P<0.01).Conclusion In childhood AL，the expression of cyclin D3 and cyclin E is quite high，which is related to the development of AL and might be index of treatment effect.There is positive relation between cyclin D3 and cyclin E.Cyclin D3 might be related to poor prognosis. Key words Acute leukemia;Cyclin;Immunohistochemistry     

地塞米松、γ-干扰素对毛细支气管炎患儿免疫调节作用的观察

目的 观察地塞米松、γ-干扰素对毛细支气管炎患儿T细胞细胞免疫和T细胞体液免疫比值(TH1/TH2)的作用。方法将60例2002年11月至2004年4月在青岛市第八人民医院儿科住院的毛细支气管炎患儿，按入院顺序分成地塞米松组和γ-干扰素组，并选择15例健康婴儿为正常对照组。检测毛细支气管炎患儿治疗前血清IgE水平及细胞因子IFN-γ、IL-4水平，然后分别用地塞米松、γ-干扰素治疗，出院时复查血清IgE、IFN-γ及IL-4水平。结果 正常对照组和毛细支气管炎组血清IgE水平及细胞因子IFN-γ、IL-4、IFN-γ/IL-4水平差异有非常显著意义(P<0.001)。γ-干扰素组和地塞米松组治疗前血清IgE和细胞因子IFN-γ、IL-4、IFN-γ/IL-4差异均无显著性意义(P>0.05),但治疗后,以上指标差异均有非常显著意义(P<0.001)。出院后随访12个月，统计喘息反复发生的例数，γ-干扰素组3例，地塞米松组10例，经卡方检验差异有显著意义(P<0.05)。结论 毛细支气管炎患儿血清IgE水平高，TH1/TH2失衡。地塞米松短期内可起到抗炎、平喘作用，止喘起效快，但TH1/TH2治疗前后无差异，反复感染、喘息反复出现、容易发展成婴幼儿哮喘。 Abstract Objective To observe the effect of dexamethasone and IFN γ on the function of TH1/TH2 in lower respiratory tract infections.Methods Sixty patients with lower respiratory tract infections were divided randomly into 2 groups:group I with dexamethasone treatment,group II with IFN γ treatment.Normal group of 15 cases was as control.Serum levels of IgE,IFN γ and IL 4 were detected before and after treatment.Results Compared with normal control,there was significant difference in the serum level of IgE,IFN γ,IL 4,IFN γ/IL 4 in group Ⅰ and group Ⅰ,P<0.001.There was no difference in the serum level of IgE,IFN γ,IL 4,IFN γ/IL 4 between group I and group Ⅱ before treatment(P>0.05).But there was significant difference after treatment(P<0.001).After being followed up for 12 months,3 cases suffered from asthma in group Ⅰ,10 cases in group Ⅱ.There were outstanding meanings by square examination,P<0.05.Conclusion In patients with lower respiratory tract infections,the serum level of IgE rises.Humoral immunity is relatively increased and cell immunity decreased.So the TH1/TH2 is out of balance.With the treatment of dexamethasone,the body’s immune system is suppressed.In short time,the infection and asthma can be controlled,but TH1/TH2 can’t change after treatment.IFN- γ can interfere the duplication of virus,increase the level of IFN-γ in body,furthermore it can strengthen the cell immune function,lower cell immunologial answer of TH2 and recover the balance of TH1/TH2 The follow up suggests IFN γ has an important meaning in preventing infant asthma. Key wordsLow respiratory tract infections;IFN dexamethasone;Cell immunity;Humoral immunity     

反复呼吸道感染儿童血清甘露聚糖结合凝集素水平及54密码子基因突变筛查

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MBL 54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MBL 54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。 Abstract Objective To detect the mannose binding lectin (MBL) serum levels and the mutation on code 54 of MBL in children with recurrent respiratory tract infections(RRTI),and to find the relationship between MBL serum levels and recurrent respiratory tract infections(RRTI).Methods To detect the serum MBL level of 238 normal people and 65 children with RRTI through the methods of enzyme linked immunoadsordent assay,then compare the immune data(IgG,IgA,IgM,C3,C4) of 11 children with low serum MBL level and compare the rate of the mutation on code 54 through the methods of polymerase chain reaction(PCR) restriction fragment length polymorphism (RFLP) with 55 normal children.Results The rate of low serum MBL level in the children with RRTI was higher than that in the normal population(χ2=6.96,P<0.05),the same went for the frequency of mutation of code 54 (P<0.05).RRTI caused by low serum MBL level occurred mostly among children under 2 years of age,and the rate of respiratory tract infection in the individuals with MBL level under 100μg/L was more than that in children with levels ranged from 100μg/L to 200μg/L (P<0.05),and was associated with reverse chang of serum levels of C3,C4(P<0.05).Conclusion Under 2 years of age,the children with the low serum MBL levels caused by mutation on MBL 54 show the susceptivity to IRRTI,and the low serum MBL level is parallel to high serum levels of C3，C4，and the lower the level the more possible infection. Key words Mannose binding lectin;Repeated respiratory tract infections;Gene;Polymorphism;Child     

新生儿血培养中凝固酶阴性葡萄球菌细胞间粘附基因A和D的检测及临床意义

目的 探讨细胞间粘附基因(ica)A和icaD在新生儿凝固酶阴性葡萄球菌(CNS)败血症中的诊断意义。方法 收集北京儿童医院新生儿病房2001年11月至2003年3月间血培养为CNS的患儿为研究入选病例。通过应用聚合酶链反应(PCR)方法检测icaA及icaD的存在。结果 在80例入选患儿中，血培养均分离出CNS。根据新生儿败血症的诊断标准，临床诊断败血症27例(33.8%)，其中早产儿7例，足月小样儿2例。在菌种的分布上，表皮葡萄球菌18例(66.7%)，溶血葡萄球菌7例(25.9%)，人葡萄球菌2例(7.4%)。对90株CNS菌株应用PCR方法检测icaA及icaD，共有8株阳性，均为表皮葡萄球菌，并且icaA和icaD同时阳性。在经PCR扩增后所产生的图谱中，icaA在814bp，icaD在282bp。在ica阳性的8例病例中，临床诊断为败血症7例，一致率为87.5%，在临床排除败血症的53例患儿中，仅有1例ica阳性(1.8%)。ica的阳性预测值为259%，阴性预测值为981%。结论 ica基因PCR检测是临床诊断CNS败血症或导管相关感染的一种潜在的实验室方法。 Abstract Objective The purpose of this study was to assess whether the person making the clinical decision may benefit from the detection of icaA and icaD genes encoding putative virulent factors.Methods From Nov.2001 to Mar.2003,we detected the icaA and icaD genes in 80 neonates with a collection of clinical isolates from blood cultures by using a simple,rapid,and reliable PCR method.Results An overall total of 80 neonates with CNS strains from blood cultures were identified.There were 27 cases(33.8%)diagnosed neonatal sepsis clinically according to the standard,of which 7 were premature,2 were small for gestational age of full term infants.The distribution of species among the clinical CNS strains,18(66.7%)cases were Staphylococcus epidermidis,which was the leading cause,and then S.hemolyticus (n=7),S.hominis (n=2).There was a statistical difference in them.Of the 90 strains,eight were positive to icaA and icaD genes,with PCR products being obtained for the icaA and icaD genes in all of these strains,a 814 bp band for the icaA gene and a 282 bp band for the icaD gene.All of them were Staphylococcus epidermidis.Among 8 cases with positive ica genes,7 were diagnosed as sepsis clinically.The coincidence rate was 87.5%.Positive predictive value of the ica genes were 25.9%，and negative predictive value were 98.1%.Conclusion Ica genes may potentiate the clinical criteria used for the diagnosis of neonatal sepsis,and may discriminate between contamination and infections. Key words Coagulase negative staphylococcus;PCR;Newborn     

Analysis of the human zona pellucida during culture: Correlation with diagnosis and the preovulatory hormonal environment

Purpose: The objective of this study was to analyze sequentially the human zona pellucida changes in an in vitro fertilization program as it relates to several variables. Methods: The zona pellucida thickness was measured daily in zygotes and cleavage-stage embryos on a Nikon inverted microscope equipped with Hoffman modulation contrast optics, using an ocular micrometer. A total of 512 embryos from 96 patients was evaluated. Results: There was a highly significant direct correlation between zona thickness and preovulatory estradiol and basal day 3 FSH levels (P < 0.02 andP < 0.0006, respectively). This relationship showed a rapid reversal following 48 hr of culture; embryos from patients with the highest FSH levels had thinner zonae prior to transfer (P < 0.0007). The zonae from patients with unexplained infertility were thicker (19.4 ± 2.7 μm) than those from patients with endometriosis (17.7 ± 2.2 μm), tubal (17.5 ± 2.4 μm), or male-factor infertility (16.4 ± 2.7 μm) (P < 0.0001) on the first day of culture. Conclusions: We hypothesize that the thickness of the human zona pellucida is influenced by the preovulatory hormonal environment and diagnosis. These factors should be considered as part of the embryo quality evaluation prior to transfer or when assessing the possibility of using assisted hatching. More studies are needed to understand the factors regulating the thickness of the human zona pellucida.     

早产儿支气管肺发育不良危险因素分析及防治措施

目的 分析早产儿支气管肺发育不良(BPD)的发生率和危险因素，探讨防治BPD的措施。方法 回顾性分析中山大学第一附属医院新生儿科1999年6月至2004年6月期间胎龄≤32周且出生体重≤2000g，存活时间>28d的早产儿72例，比较机械通气治疗中15例BPD(BPD组)和31例非BPD(对照组)患儿性别、胎龄、出生体重、生前使用糖皮质激素、生后使用肺表面活性物质、肺透明膜病、机械通气时间、呼吸支持条件、胃食管反流、动脉导管未闭、生后早期液体摄取量、反复肺部感染情况。结果早产儿BPD的总发生率为20.83%(15/72)，其中<1500g早产儿BPD的发生率为38.71%(12/31)；BPD组FiO2、PIP、PEEP和MAP与对照组差异无显著性意义(P>0.05)；多因素Logistic回归显示，胎龄<30周、体重<1250g、机械通气≥10d和反复肺部感染是发生BPD的独立危险因素(P<0.05)，而性别、生前使用糖皮质激素、生后使用肺表面活性物质、肺透明膜病、胃食管反流、动脉导管未闭、生后早期液体摄取量没有统计学意义(P>0.05)。结论 避免低体重早产、长时间机械通气和有效控制肺部感染是防治BPD的关键。 Abstract Objective To study the incidence,risk factors,prophylaxis and treatment for bronchopulmonary dysplasia (BPD) in premature.Methods From June 1999 to June 2004 seventy two prematures with gestational age less than 32 weeks,birth weight less than 2000 grams and surviving more than 28 days were enrolled in the study.Fifteen prematures with BPD were compared to thirty one prematures without BPD in terms of sex,gestational age,birth weight，usage of prenatal steroids,usage of postnatal surfactant,hyaline membrane disease,duration of mechanical ventilation,supportive conditions for ventilation,gastroesophageal reflux,patent ductus arteriosus,fluid intake in the first few days and recurrent pneumonia.Results The overall incidence of BPD in preterm newborns was 20.83%,and 38.71% in those infants weighting <1500g at birth；Fio2,PIP,PEEP and MAP were all not statistically significant between BPD group and control (P>0.05)；Multivariate logistic analysis revealed that gestational age less than 30 weeks,birth weight less than 1250 grams,prolonged mechanical ventilation (≥10days) and recurrent pneumonia were independent risk factors for BPD (P<0.05).Other factors including sex,usage of prenatal steroids,usage of postnatal surfactant,hyaline membrane disease,gastroesophageal reflux and excessive fluid intake in the first few days of life were not statistically significant (P>0.05).Conclusion Preventing small gestational age and low birth weight prematurity,shortening the duration of mechanical ventilation and controlling pneumonia were effective in preventing BPD. Key words Premature;Bronchopulmonary dysplasia;Risk factors     

新生儿肺部疾病支气管肺泡灌洗液肺表面活性蛋白A的检测及意义

目的 探讨新生儿常见肺部疾病支气管肺泡灌洗液肺表面活性蛋白A(BAL SP-A)水平及其与临床的关系。方法 收集2000年1月至2003年2月在广州市儿童医院新生儿重症监护室住院的需行机械通气治疗的新生儿重症肺炎、胎粪吸入综合征(MAS)、急性呼吸窘迫综合征(ARDS)以及新生儿呼吸窘迫综合征(RDS)患儿共57例。测定其BAL SP-A水平，监测血气、PaO2/FiO2水平。结果重症肺炎组与MAS组患儿BAL SP-A水平无明显差异，但MAS组患儿PaO2、PaCO2及PaO2/FiO2水平较重症肺炎组明显降低(P值<0.01,<0.05,<0.05)；ARDS及RDS组患儿BAL SP-A水平均较上述两组低(P值均<0.001)，而RDS组患儿BAL SP-A水平较ARDS组低(P<0.001)，但ARDS组患儿PaO2水平较RDS组患儿低(P<0.05)。PS治疗组患儿的病死率较非PS治疗组明显降低(P=0.049)，其PaO2/FiO2与BAL SP-A水平密切相关(r=0.741,P=0.000)。结论 与重症肺炎患儿比较胎粪吸入综合征患儿BAL SP-A水平无明显降低；ARDS及RDS患儿BAL SP-A水平明显降低；BAL SP-A水平能反映新生儿肺损伤的严重程度，对于新生儿肺部疾病预后的判断有一定意义。 Abstract ObjectiveTo investigate the bronchoalveolar lavage (BAL) SP-A concentrations from newborn infants with lung disease,and to study the relationship between BAL SP-A and clinical outcome.Methods 57 cases of newborn infants with lung disease were admitted in our NICU between Jan.2000 and Feb.2003.BAL SP-A concentrations,PO2 value,PCO2 value,and PaO2/FiO2 ratio were measured.ResultsBAL SP-A concentrations did not differ between severe pneumonia group and MAS group,but the value of PaO2、PaCO2 and PaO2/FiO2 ratio in MAS group were significantly lower than that in severe pneumonia group (p respectively<0.001,<0.05,<0.05).BAL SP-A concentrations in RDS and ARDS groups were significantly lower than that in aforesaid groups ( all P<0.05).BAL SP-A concentrations in RDS group were significantly lower than that in ARDS group,but PaO2 value in ARDS group was lower significantly than that in RDS group( P<0.05).The mortality of infants treated with PS was significantly lower than that of infants treated without PS (P=0.049).PaO2/FiO2 ratio for the cohort was related to their BAL SP A concentrations ( r=0.741,P=0.000).Conclusion Surfactant protein A content in MAS is not different from that of severe pneumonia.BAL SP-A concentrations of neonates with ARDS or RDS decrease significantly.BAL SP-A concentrations can evaluate the severity of lung injury and the prognosis of neonatal lung disease. Key wordsInfant,newbornLung disease;Bronchoalveolar lavae;Surfactant protein A     

圆锥动脉干畸形室间隔缺损的三维超声定量研究

目的 探讨三维超声心动图(3DE)在圆锥动脉干畸形(CTD)室间隔缺损(VSD)定量研究中的准确性及其临床意义。 方法 2000年5月至2003年11月在上海儿童医学中心住院且二维超声心动图(2DE)、经胸3DE、心血管造影及手术等定量测量结果完整的CTD患儿共63例，将3DE测量结果与2DE、造影及手术测值对比。 结果 方差分析、SNK均数间两两比较及相关分析显示，3DE VSD长径测值为1.69cm(从右室面)和1.63cm(从左室面)，虽较手术测值(1.84cm)低估，但低估程度小于2DE测值(1.27cm)及造影测值(1.12cm)；3DE与手术测值的相关性(r=0.74)明显高于2DE(r=0.39)及造影测值(r=0.25)。3DE VSD短径测值与造影测值相接近，两者比较无统计学差异(P＞0.05)。3DE VSD短径测值与2DE及造影测值的相关性(r=0.45，r=0.54)高于3DE VSD长径测值与2DE及造影测值的相关性(r=0.37，r=0.44)。3DE VSD面积测值与手术测值呈良好相关(r=0.57)。 结论 3DE可作为CTD VSD定量分析的又一无创手段，能提供较2DE更准确的定量诊断。 Abstract Objective To evaluate the accuracy and clinical value of transthoracic three dimensional echocardiographic (3DE) quantitative analysis in ventricular septal defect (VSD) of conotruncal defects (CTD).Methods From May 2000 to November 2003 in Shanghai Children Medical Center,there were 63 inpatients of CTD with all quantitative findings measured by 3DE,two dimensional echocardiography (2DE),angiocardiography and surgical findings.Their measurements of VSD sizes and areas with 3DE were compared with those with 2DE,angiocardiography and surgical findings.Results From the analysis of variance,Student Newman Keuls (SNK) test and correlation analysis,the measurements of VSD long diameter (mean 1.69cm in en face view of ventricular septa from right ventricle and 1.63 cm in en face view of ventricular septa from left ventricle) with 3DE was less than the measurements of VSD diameter (mean 1.84 cm) with surgical findings,but they were better correlated with those with surgical findings (r=0.74) than the measurements of VSD diameter (mean 1.27 cm) with 2DE (r=0.39) and those (mean 1.12 cm) with angiocardiography (r=0.25).However,the measurements of VSD short diameter with 3DE was close to those with angiocardiography,and there was no significant difference (P>0.05) between them.The measurements of VSD short diameter with 3DE were better correlated with those with 2DE and angiocardiography than the measurements of VSD long diameter with 3DE.Meanwhile,the measurements of VSD area with 3DE were well correlated with the measurements of VSD diameter with surgical findings (r=0.57).Conclusion 3DE can provide more accurate quantitative diagnosis in CTD VSD than 2DE. Key words Conotruncal defects;Three dimensional echocardiography;Two dimensional echocardiography;Ventricular septal defect     

Do infants in the neonatal intensive care unit diagnosed with urinary tract infection need a routine voiding cystourethrogram?

Objective: To determine if infants diagnosed with urinary tract infection (UTI) in the neonatal intensive care unit (NICU) require a routine voiding cystourethrogram (VCUG).

Study design: Retrospective data analysis from three centers for infants admitted to the NICU born between 2000 and 2013 and diagnosed with UTI.

Results: One hundred twenty-six infants from three centers were diagnosed with UTI during their hospitalization. Renal ultrasound (RUS) was performed in 115 infants (91.2%), of which 69 (60%) were abnormal. Mild to moderate hydronephrosis or pelviectasis were the most common abnormalities identified (n?=?34, 30%). There were 14 infants (12%) with severe abnormalities on RUS. VCUG was performed in 71 infants (56%), of which 3 (4%) were interpreted as abnormal with grade 2 vesicoureteral reflux (VUR) or less (two infants were with normal RUS and one infant was with abnormal RUS).

Conclusions: More than 50% of infants with a UTI had an abnormal RUS but severe abnormalities were found only in 11% of infants. Only 4% of infants with UTI had VUR; none of these infants had severe VUR on VCUG. A routine VCUG after UTI in the NICU has a low yield and may be reserved for infants with severe or persistent abnormalities on RUS.     

2008年至2010年新生儿感染常见致病菌及其耐药性变迁

目的 了解本院新生儿科感染常见致病菌的种类及耐药现状,以指导临床合理用药。方法 收集本院新生儿科2008年7月至2010年6月收治的体液标本培养阳性的患儿2306例的病历资料,分析致病菌的构成及其耐药性变化。 结果共送检各种体液标本10 017份,检出80种共计2306株病原菌,以肠杆菌为主,1241株(53.8％),主要是肺炎克雷伯菌肺炎亚种430/1241(34.6％)和大肠埃希菌341/1241(27.5％),其产超广谱β内酰胺酶菌株检出率分别为68.1％(293/430)和59.5％(203/341),较2003年至2005年78.1％(118/151)和82.6％(76/92)下降(U=-2.32和-4.11,P均＜0.05)。葡萄球菌中耐甲氧西林金黄色葡萄球菌检出率8.5％(23/272),较2004年至2006年的17.7％(15/85)下降（U=-2.4,P＜0.05）;耐甲氧西林凝固酶阴性葡萄球菌检出率63.5％(157/247),较2004年至2006年的32.6％(97/298)显著增加(U= 7.54,P＜0.05)。医院感染病原菌主要为肺炎克雷伯菌肺炎亚种、大肠埃希菌、鲍曼不动杆菌及铜绿假单胞菌;社区感染主要为金黄色葡萄球菌、肺炎克雷伯菌肺炎亚种和大肠埃希菌。医院感染肺炎克雷伯菌肺炎亚种、大肠埃希菌、金黄色葡萄球菌及表皮葡萄球菌的多重耐药菌株较社区感染显著增加。药敏结果显示,肺炎克雷伯菌肺炎亚种、溶血性葡萄球菌、鲍曼不动杆菌耐药性尤为明显。 结论机会致病菌及耐药菌株感染日益增加,耐甲氧西林凝固酶阴性葡萄球菌显著增加及鲍曼不动杆菌的耐药现象应引起高度重视。采取综合措施可减少产ESBLs菌的产生;应尽量根据药敏试验结果调整抗生素。     

继发不孕患者阴道常见致病菌及耐药性分析

目的:分析继发不孕患者下生殖道的致病菌感染及耐药情况,明确导致女性下生殖道感染的主要致病菌及其对常用抗菌素的敏感状况,以有效指导临床抗感染用药。方法:收集确诊为继发不孕且阴道分泌物培养菌阳性的606例患者的临床资料,回顾分析其致病菌分布及抗菌素耐药情况,研究从该人群中病原体的高分离率与女性生殖道的并发症是否存在联系。结果:继发不孕患者中,引起生殖道炎症的病原菌排名前三者为大肠埃希菌、粪肠球菌和白色念珠菌,支原体培养阳性率为48.8%。大肠埃希菌、肺炎克雷伯菌等肠杆菌科细菌对氨苄西林、头孢噻肟、头孢他啶、复方新诺明等耐药率较高,而对亚胺培南、美洛培南、阿米卡星等耐药率低。革兰阳性球菌等对万古霉素、呋喃妥因、利奈唑烷等有较高的敏感性,粪肠球菌对氨苄西林的敏感性较高,解脲支原体对多西环素/强力霉素和美满霉素等敏感性高。结论:万古霉素、呋喃妥因、利奈唑烷等可作为革兰阳性菌球菌治疗的首选;氨苄西林可作为粪肠球菌治疗的首选;多西环素/强力霉素和美满霉素可作为治疗支原体感染的一线药物。     

Trends and antimicrobial resistance of pathogens causing bloodstream infections among febrile neutropenic adults with hematological malignancy.

BACKGROUND AND PURPOSE: The microbiological spectrum in cancer patients with febrile neutropenia has changed over the past several decades in western countries. The growing incidence of antimicrobial resistance is an inevitable consequence of the widespread use of antibiotics in medical settings. The aim of this study was to clarify the trends and antimicrobial resistance among pathogens causing bloodstream infections in febrile neutropenic adults with hematological malignancies. METHODS: The characteristics of pathogens causing bloodstream infection isolated from patients with febrile neutropenia who were treated at National Taiwan University Hospital from 1996 to 2001 were reviewed. A total of 1174 pathogens were isolated from 3093 admissions to a hematological ward during this period. Among them, 738 isolates were recovered from patients with febrile neutropenia. RESULTS: The majority (93%) of these neutropenic febrile patients had underlying acute leukemia or lymphoma. Gram-negative bacteria accounted for 57% of isolated pathogens, followed by Gram-positive bacteria (32%), fungi (7%), and anaerobes (3%). In decreasing frequency, Escherichia coli (13%), Klebsiella pneumoniae (12%), Enterobacter cloacae (7%), Pseudomonas aeruginosa (6%), and Acinetobacter baumannii (5%) were the predominant Gram-negative bacteria, while coagulase-negative staphylococci (13%), viridans group streptococci (4%), and Staphylococcus aureus (4%) were the major Gram-positive pathogens. Two-thirds (20/30) of S. aureus isolates were resistant to oxacillin. No vancomycin-resistant enterococci were isolated. Resistance to cefotaxime was found in 63% of E. cloacae, 13% of K. pneumoniae and 10% of E. coli. Overall, 33% of E. coli and 13% of K. pneumoniae were resistant to ciprofloxacin. CONCLUSIONS: This study indicates that the microbiological spectrum of microorganisms causing bloodstream infections in neutropenic febrile patients with hematological malignancies at National Taiwan University Hospital is different from western countries in that Gram-negative bacteria remain the predominant pathogens. Antimicrobial resistance among these pathogens is high and E. coli and K. pneumoniae isolates with resistance to third-generation cephalosporins and ciprofloxacin are increasing.     

宝鸡市区儿童下呼吸道感染细菌病原和药物敏感性的多中心研究

目的总结宝鸡市区小儿急性下呼吸道感染(ALRI)细菌病原谱的构成和细菌药敏情况。方法收集2010-08/2011-07宝鸡市三区五大医院儿科住院的急性下呼吸道感染患儿6234例的痰细菌培养鉴定和药物敏感试验结果进行汇总分析。结果 (1)6234例送检标本中,1827例份结果阳性,阳性率29.31%。共培养出致病菌1882株23种,检出前5位致病菌分别为大肠埃希菌(20.72%)、肺炎克雷伯菌(17.48%)、肺炎链球菌(16.84%)、铜绿假单胞菌(6.59%)、金黄色葡萄球菌(6.32%)。(2)宝鸡市区AL-RI致病菌66.05%是G-菌,其中绝大多数是肠杆菌科细菌占86.56%,且大肠埃希菌、肺炎克雷伯菌高居前2位占57.84%;而G+球菌共占29.05%;真菌位居第7位。(3)大肠埃希菌、肺炎克雷伯菌,对阿莫西林/克拉维酸、替卡西林/棒酸、头孢西丁、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦均高度敏感,可作为经验治疗首选的抗菌药物。所有G-杆菌对亚胺培南均无耐药。铜绿假单胞菌在本地区对头孢他啶高度敏感。肺炎链球菌对青霉素耐药率为70.57%,对一至四代头孢菌素、阿莫西林/克拉维酸等均高度敏感。本地区儿童下呼吸道痰葡萄球菌检出者,主要是金黄色葡萄球菌和凝固酶阴性葡萄球菌(CNS),对苯唑青霉素耐药率依次为92.69%、82.69%,在本地区链球菌属导致的儿童细菌性ALRI仅占到3.03%,对青霉素类抗生素高度敏感,仍是首选抗生素。(4)作为导致儿童ALRI占主要病原的肠杆菌科细菌耐药情况严重,条件致病菌、机会致病菌感染率有增高趋势。结论宝鸡市区儿童ALRI细菌病原谱复杂,有其明确的地域性和时代性特点。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、肺炎链球菌这4类细菌是宝鸡市区0～14岁儿童各年龄组ALRI的常见致病菌;致病菌以革兰阴性肠杆菌为主,各年龄组又各有其特点;对抗菌药物敏感性也有明显的特点,耐药问题也很严峻。     

新生儿肺炎克雷伯菌败血症与大肠埃希菌败血症临床特点及耐药性的比较

目的 对新生儿肺炎克雷伯菌败血症与大肠埃希菌败血症临床特点及耐药性进行对比分析,为临床早期诊断和合理治疗提供理论依据.方法 对2000年1月至2009年10月在我院新生儿重症监护病房住院治疗并确诊为肺炎克雷伯菌败血症(n=42)和大肠埃希菌败血症患儿(n=50)的病历资料进行回顾性分析,比较其临床特征、实验室检查、治疗转归情况.同时将不同发病日龄肺炎克雷伯菌败血症与大肠埃希菌败血症(发病日龄≤3 d为早发型败血症、发病日龄＞3 d为晚发型败血症)对抗生素的耐药情况进行比较分析.结果 (1)临床特点比较:肺炎克雷伯菌败血症比大肠埃希菌败血症新生儿气促、呼吸暂停的发生率高(61.9%和6.0%,x2=17.34,P＜0.05),在更短的时间内发展至多器官功能障碍综合征和弥漫性血管内凝血[(40±28)h和(89±26)h](t=-3.17,P＜0.05);但并发化脓性脑膜炎比例低(4.8%和30.0%,x2=9.65,P＜0.05).(2)非特异性实验室检查结果:肺炎克雷伯菌败血症与大肠埃希菌败血症相比较,白细胞＞25×109/L(42.9%和22.0%,x2=4.60,P＜0.05)、血小板＜100×109/L(52.4%和18.0%,x2=12.07,P＜0.05)、C反应蛋白＞8 mg/L(95.2%和76.0%,x2=6.55,P＜0.05)的比例较高.(3)抗生素耐药情况:对头孢菌素类抗生素肺炎克雷伯菌耐药率高于大肠埃希菌(81.8%～100.0%和17.2%～63.2%,x2=6.97～11.92,P＜0.05);晚发型肺炎克雷伯菌败血症对阿莫西林/棒酸、头孢哌酮/舒巴坦耐药率高于晚发型大肠埃希菌败血症(75.0%和0.0%,x2=26.67;83.3%和0.0%,x2=12.53,P均＜0.05);对亚胺培南均未发现耐药.晚发型大肠埃希菌败血症与肺炎克雷伯菌败血症产超广谱于内酰胺酶菌株检出率均较早发型高(65.0%和17.8%,x2=11.06;100.0%和30.0%,x2=20.22,P均＜0.05),其中晚发型肺炎克雷伯菌败血症产超广谱β-内酰胺酶菌株检出率高于晚发型大肠埃希菌败血症(100.0%和65.0%,x2=9.16,P＜0.05).(4)病死率:肺炎克雷伯菌败血症病死率高于大肠埃希菌败血症(21.4%和4.0%,x2=6.59,P＜0.05).结论 新生儿肺炎克雷伯菌败血症病情比大肠埃希菌败血症重,可迅速发展至多器官功能障碍综合征和弥漫性血管内凝血,病死率高.肺炎克雷伯菌和大肠埃希菌的产超广谱β-内酰胺酶菌株快速增长,临床应合理使用抗生素.

Abstract：

Objective To compare the clinical characteristics and antibiotics resistance of neonatal sepsis caused by Klebsiella pneumoniae and Escherichia coli in order to provide guidance for early diagnosis and appropriate treatment. Methods Forty-two newborns with Klebsiella pneumoniae sepsis and 50 newborns with Escherichia coli sepsis in the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical College from January 2000 to October 2009 were enrolled into this study. The clinical data, laboratory examinations and prognosis of these newborns were retrospectively analyzed and compared. The antibiotic resistance data of different onset age of the two diseases were compared. Early-onset sepsis was defined as the age at the onset ≤3 days, and late-onset sepsis was defined as the age at the onset ＞3 days. Results (1) Comparison of clinical characteristics: Klebsiella pneumoniae sepsis caused higher incidence of apnea or gasp compared with Escherichia coli sepsis (61.9% vs 6.0% ,x2= 17. 34, P＜0. 05); the time of developing to multiple organ dysfunction syndrome or disseminated intravascular coagulation of the newborns with Klebsiella pneumoniae sepsis [(40±28) h] was shorter than that of the newborns with Escherichia coli sepsis [(89±26) h] (t= -3.17, P＜0.05); while the incidence of purulent meningitis of Klebsiella pneumoniae sepsis was lower ( 4. 8% vs 30. 0 %, x2 = 9.65, P ＜ 0. 05 ). ( 2 ) Comparison of non-specific laboratory examinations: compared with Escherichia coli sepsis, Klebsiella pneumoniae sepsis caused higher incidence of the leucocyte count ＞ 25 × 109/L (42. 9% vs 22.0%, x2 = 4. 60,P＜0. 05), platelet count ＜ 100 × 109/L (52.4% vs 18.0%, x2 = 12.07, P＜0. 05) and C-reaction protein ＞8 mg/L (95.2% vs 76.0% ,x2 =6. 55, P＜0. 05). (3) Comparison of results of antibiotic resistance: the resistance rate of Klebsiella pneumoniae (81.8%00-100. 0%) to Cephalosporins was higher than that of Escherichia coli (17. 2%-63. 2%) (x2 =6.97-11.92, P＜0. 05); the resistance rates of late-onset sepsis of Klebsiella pneumoniae to Amoxicillin/clavulanic-acid and Cefoperazone/sulbactam were higher than those of Escherichia coli (75.0% vs 0.0%, x2 =26.67, P＜0. 05;83. 3%vs 0. 0%, x2 = 12.53, P＜0. 05 respectively); no resistance to Imipenem were found. The percentages of extended spectrum β-lactamases (ESBLs) positive Escherichia coli and Klebsiella pneumoniae were obviously higher in neonates with late-onset sepsis than those early-onset ones (65.0% vs 17. 8%,x2 = 11.06, P＜0. 05; 100. 0 % vs 30. 0 %, x2 = 20. 22, P＜0. 05 respectively); and positive ESBLs rate of the late-onset Klebsiella pneumoniae sepsis was higher than that of Escherichia coli sepsis (100. 0% vs 65.0%, x2 =9.16, P＜0. 05). (4) Comparison of mortality rate: the mortality rate of Klebsiella pneumoniae sepsis was higher than that of Escherichia coli sepsis (21.4% vs 4. 0%,x2=6.59, P ＜ 0. 05 ) . Conclusions Compared with Escherichia coli septicemia, Klebsiella pneumoniae septicemia has more severe symptoms, developed to multiple organ dysfunction syndrome or disseminated intravascular coagulation quicker, and has higher mortality rate. The percentage of ESBLs positive Escherichia coli and Klebsiella pneumoniae increased rapidly. The clinical use of antibiotics should be rationale.     

女性泌尿系统细菌性感染的菌种构成与耐药性分析

目的 了解我国女性泌尿系统细菌性感染患者菌种分布及耐药性.方法 采用纸片法、稀释法或浓度梯度琼脂扩散试验(E试验)检测最小抑菌浓度,测定细菌对抗生素的敏感性,使用WHONET 5.4软件进行分析,对卫生部全国细菌耐药性监测网所属86家三级甲等医院于2006年6月1日至2007年5月31日分离的临床女性泌尿系统细菌性感染尿培养菌株进行分析.结果 共收集6071株病原菌,其中细菌5958株,分离量最多的依次为大肠埃希菌3529株(59.23%)、肠球菌属细菌938株(15.74%)和肺炎克雷伯菌394株(6.61%);大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶的发生率分别为35.7%和34.0%,两者对氟喹诺酮类药物的耐药率分别约为70%和40%.屎肠球菌对多数抗菌药物的耐药率高于粪肠球菌,粪肠球菌、屎肠球菌对万古霉素的耐药率分别为0.9%、3.8%,对替考拉宁的耐药率分别为2.7%、4.8%;表皮葡萄球菌导致的女性泌尿系统细菌性感染较金黄色葡萄球菌多,两者对头孢西丁的耐药率分别为79.1%和75.0%,未发现对糖肽类中介或耐药的金黄色葡萄球菌,表皮葡萄球菌对替考拉宁的中介率为4.9%.随着患者年龄的增长,致病菌对喹诺酮类药物的耐药率呈增加的趋势;重症监护室(ICU)的致病菌耐药率高于普通病房和门、急诊.结论 我国女性泌尿系统感染主要致病菌耐药现象严重,临床抗菌药物不合理应用需要加以纠正,参照细菌敏感性选择抗菌药物具有非常重要的意义.     

2002年至2007年成都市儿童医院新生儿常见病原菌分布及耐药趋势

目的 探讨成都市儿童医院新生儿感染性疾病病原菌分布及耐药趋势变化规律. 方法从成都市儿童医院2002年至2007年住院的感染性疾病新生儿痰液、血液、脑脊液、尿液、脓/分泌物、胸腹腔积液、局部穿刺液等标本中分离病原菌1050株,进行细菌培养、药敏试验及耐药表型检测分析,并进行前3年(2002年至2004年)与近3年(2005年至2007年)的比较. 结果 2002年至2007年新生儿常见病原菌中革兰阴性(G-)菌713株(67.9%),革兰阳性(G+)菌337株(30.8%),酵母样菌14株(1.3%).前3年与近3年相比,G-菌和G+菌比例的总体趋势相似,新生儿病原菌排序发生变化(χ2=18.654,P=0.009);常见病原菌耐药趋势呈多态性变化,耐甲氧西林金黄色葡萄球菌检出率分别为10.0%和18.4%(U=1.090,P>0.05),耐甲氧西林凝固酶阴性的葡萄球菌菌株检出率分别为4.9%和53.1%(U=2.169,P<0.05),大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶菌株合计检出率分别为25.0%和60.6%(U=5.281,P<0.01),流感嗜血杆菌产β-内酰胺酶率分别为1/6和40.3%(U=1.144,P>0.05). 结论成都市儿童医院新生儿感染病原菌流行分布及耐药趋势与国内其他地区比较存在着差异,近3年与前3年相比常见病原菌排序发生变化,病原菌常见耐药表型检出率明显增加,耐药性呈多态性变化.动态监测新生儿感染病原菌分布及耐药趋势变化对指导临床合理使用抗菌药物、防止新生儿抗菌药物滥用以及减少患者耐药菌株终身携带十分必要.     

Causes of urinary tract infection in pregnant women

Data of etiology characteristics of uroinfections with pregnant women are presented treated at University Hospital of Obstetrics and Gynecology "Maichin dom" in three periods. Gram negative species of microorganisms (E. coli, proteus, Klebsiella) are the agens of uroinfections in 95.4% of cases in the period 1988/89. After 10-year period gram (-) are the uroinfection in 66.1% of the cases. The growing etiologycal importance of Gram positive species of microorganisms (S. aureus, Enterococcus, GBS) is 33,9% in the period 1997/98 and it is preserved in june 2001/may 2003 too. In cases of long lasting hospitalization or after repeated treatment with antibiotics the probability grows that the agents of uroinfections be polyresistant strains. In the period june 2001/may 2003 in 7% of the cases polyresistant E. coli are isolated, in 2.6% MRSaureus, in 7.6% Ampicillin - R Enterococcus spp. That suggest exact identification of the agen and therapy according to sensitivity to antibiotics.     

儿童细菌性腹泻病原菌10年变迁与药敏分析

摘要：目的　探讨近10年儿童细菌性腹泻病原菌的变迁及近年菌株的耐药情况。 方法　收集北京儿童医院1998—2007年粪便细菌培养阳性的细菌性腹泻患儿859例,对其临床资料进行回顾性研究,统计学处理用SPSS13.0软件进行。结果　（1）859株检出菌中,包括志贺菌585株,沙门菌89株,大肠埃希菌56株,变形杆菌92株,金黄色葡萄球菌37株。（2）志贺菌构成比由1998年的82.5%降为2007年的52.9%。金黄色葡萄球菌、大肠埃希菌分别自2001年、2002年开始检测,渐升至2007年的9.4%和14.1%。（3）夏秋季为发病高峰（73.9%）,沙门菌、大肠埃希菌、条件致病菌在小年龄组检出率高。（4）肠道病原菌对青霉素类、复方磺胺耐药率均在50%以上。除大肠埃希菌外,肠道病原菌对喹诺酮类、三代头孢、亚胺培南耐药率低,分别为13.0％～24.2%、5.9％～62.5%、0。大肠埃希菌对丁胺卡那霉素及亚胺培南耐药率分别为7.5％、0,对其他抗生素耐药率均在50%以上。 结论　儿童细菌性腹泻病原菌构成及耐药谱在不断发生变化,临床应注重病原及药敏监测,合理选用抗生素。