急性白血病儿童缓解前后血T淋巴细胞嗜银蛋白检测的意义

目的通过对急性白血病(AL)儿童T淋巴细胞(T细胞)增殖活性的rDNA和rRNA的核仁组成区嗜银蛋白(Ag-NORs)测定,以了解患儿T细胞功能状态。方法分别对42例初发AL儿童化疗前与临床完全缓解后及30例正常儿童(对照组),用图像分析法测定血T细胞Ag-NORs(银染区)/细胞核面积(I.S%)。结果AL化疗前I.S%为5.06%±1.36%,与对照组7.51%±1.06%比较有显著差异(t=8.238 P<0.001),但在完全缓解后I.S%升至7.17%±0.98%,与化疗前比较(t=7.073 P<0.001);与对照组比较无差异(t=1.403 P>0.05)。结论在初发未化疗AL儿童中,Ag-NORs水平降低,提示患儿有T细胞免疫功能下降。     

传染性单核细胞增多症患儿血T细胞亚群变化的意义

目的检测传染性单核细胞增多症(IM)患儿血T细胞亚群变化,探讨其免疫功能与疾病的关系。方法采用流式细胞仪对18例IM患儿进行T细胞亚群测定。对其中10例进行治疗2周T细胞亚群的动态观察。随机抽取20例健康儿童作为对照。结果IM患儿CD4、CD4/CD8均明显下降(Pa<0.001);CD8明显升高(P<0.01)。10例2周后血T细胞亚群与入院时比较也有显著差异(P<0.001)。结论机体免疫功能改变是IM发病的关键。早期诊断、早期治疗、长期随访有积极意义。     

恶性肿瘤患儿外周血T淋巴细胞嗜银核仁形成区酸性非组蛋白表达活性研究

目的　观察恶性肿瘤患儿外周血T淋巴细胞嗜银核仁形成区 (Ag NORs)酸性非组蛋白表达活性的改变及其与T淋巴细胞亚群的关系。方法　对肿瘤组 30例 ,正常组 30例应用细胞培养及普通细胞银染技术进行外周血淋巴细胞染色 ,通过KL型肿瘤免疫图像分析系统测定Ag NORs银染面积与核面积的比值 (IS % ) ;应用流式细胞仪测定T淋巴细胞表面抗原。结果　肿瘤组患儿的CD4及CD4 /CD8降低 ,CD8升高 ,与正常组比较具有显著性差异 (t =3 85 ,4 6 0 ,- 2 4 5 ,P均 <0 0 5 ) ,淋巴细胞IS %均值低于正常组 (t =7 14 ,P <0 0 1) ,其变化与CD3、CD4、CD8、CD4 /CD8比较无明显相关性 (相关系数r分别为 - 0 16 37,- 0 172 6 ,0 32 4 5 ,- 0 32 19,均为P >0 0 5 )。结论　恶性肿瘤患儿T淋巴细胞嗜银核仁形成区酸性非组蛋白表达活性下降 ,T细胞免疫功能低下     

儿童传染性单核细胞增多症T细胞亚群变化

目的 探讨传染性单核细胞增多症(infectious mononucleosis,IM)患儿T细胞亚群的变化.方法 选取2005年1月至2010年12月在我院住院确诊为Epstein-Barr( EB)病毒感染引起的IM患儿60例为IM组,同期来我院门诊健康体检患儿36例为对照组.所有患儿行血常规、血涂片、T细胞亚群、肝肾功能及病毒抗体、肝炎病毒抗体检测.T细胞亚群检测包括CD3、CD4、CD8、CD4/CD8.结果 与对照组比较,IM组患儿CD3( 81.55％±9.04％)、CD8 (58.13％±13.35％)比例较对照组(53.58％±5.97％)、(31.22％±8.72％)明显升高(P＜0.05);CD4( 18.19％±7.61％)、CD4/CD8(0.37±0.33)比值较对照组(36.98％±5.32％、1.98±0.41)明显降低(P＜0.05).IM组患儿白细胞计数、异型淋巴细胞比值及谷丙转氨酶与CD4/CD8的下降无相关性(P均＞0.05).结论 EB病毒感染引起IM患儿免疫功能显著低下,可早期进行免疫干预治疗.     

毛细支气管炎患儿红细胞免疫及T细胞亚群变化的研究

目的：探讨毛细支气管炎患儿红细胞免疫和T细胞亚群的变化及意义。方法：对45例毛细支气管炎患儿和30例正常儿童的红细胞免疫功能和T细胞亚群进行检测。检测外周血红细胞免疫复合物花环率（RBC-ICR）、红细胞C3b受体花环率（RBC-C3bRR）;采用流式细胞术检测CD3+、CD4+、CD8+细胞亚群。结果：毛细支气管炎患儿RBC-C3bRR［（13.6±6.2）%］、CD8+细胞百分比［（21.6±4.4）%］ 较对照组的（18.0±7.4）% 和 (25.6±5.2)%减低（P<0.01）;CD3+［（59.9±6.7）%］和CD4+细胞百分比［（53.5±6.2）%］及RBC-ICR［（8.3±3.5）%］均高于对照组的（52.1±8.3）%、（46.8±4.9）% 和（6.1±2.5）%（P<0.01）。毛细支气管炎患儿RBC-ICR和CD4+细胞百分比存在正相关（r=0.63,P<0.05）,RBC-C3bRR和CD4+细胞百分比存在负相关（r=-0.82,P<0.01）。结论：毛细支气管炎患儿存在T淋巴细胞、红细胞免疫功能障碍,可能在毛细支气管炎的发病机制中起到一定作用。     

病毒性肺炎患儿自然杀伤细胞亚群、T细胞亚群及血IL-2、IL-4、INF-γ变化的研究

目的 探讨病毒性肺炎患儿自然杀伤(NK)细胞亚群、T细胞亚群及血IL-2、IL-4、INF-γ的动态变化及临床意义.方法 采用流式细胞术测定32例病毒性肺炎患儿急性期(肺炎起病2?d内)、恢复期(肺炎起病5?d内)外周血NK细胞亚群、T细胞亚群,用ELISA法测定血IL-2、IL-4、INF-γ水平,用乳酸脱氢酶释放法测定NK细胞活性变化,并与30例健康对照组儿童进行比较.结果 (1) 病毒性肺炎患儿CD16+CD56+、CD16+NK细胞在急性期分别为(0.73±0.17)%、(0.39±0.2)%,恢复期分别为(1.47±0.22)%、(0.89±0.14)%;急性期与恢复期比较,恢复期CD16+CD56+、CD16+NK细胞明显升高(P<0.01),但均显著低于对照组(P<0.01).两组NK细胞亚群变化与其活性改变呈正相关.病毒性肺炎患儿CD56+NK细胞与健康儿童差异无显著性(P>0.05).(2) 与对照组相比,病毒性肺炎患儿的急性期、恢复期IL-2、IL-4均无明显改变,差异无显著性(P>0.05);急性期INF-γ无明显改变,差异无显著性(P>0.05),而恢复期INF-γ[(28.10±1.38)?μg/L]明显高于急性期[(22.78±1.19)?μg/L],差异有非常显著性(P<0.01).(3) 与对照组相比,病毒性肺炎患儿CD4+、CD4+/CD8+T细胞计数在急性期与恢复期均无明显改变,差异无显著性(P>0.05).病毒性肺炎急性期、恢复期CD8+T细胞均低于对照组,差异有显著性(P<0.05),但病毒性肺炎急性期、恢复期间差异无显著性(P>0.05).结论 病毒性肺炎患儿NK细胞活性降低,活性与亚群数目呈正相关;病毒性肺炎患儿抑制性T细胞功能低下.病毒性肺炎急性期NK细胞激活是多因素共同作用的结果 .     

支气管哮喘患儿血T辅助淋巴细胞的变化

目的探索支气管哮喘儿童细胞免疫状况的变化。方法采用流式细胞仪检测支气管哮喘儿童急性期及正常对照组外周血T辅助淋巴细胞1(Th1)和Th2的百分率、CD4 、CD3、CD8、NK细胞、B细胞百分率及CD4/CD8比值。对10例哮喘缓解期患儿复查淋巴细胞亚群。结果支气管哮喘患儿发作期外周血Th1细胞百分率[(16.28±9.83)%]明显低于正常对照组[(20.77±6.89)%](P<0.05);哮喘组Th2细胞百分率[(5.44±1.96)%]较对照组[(4.21±2.12)%]明显增高(P<0.05)。Th1/Th2比值,哮喘组为3.41±2.56,对照组为5.91±3.24,两组比较有非常显著性差异(P<0.01)。但哮喘组B细胞、NK细胞百分率、CD3、CD4、CD8及CD4/CD8与正常对照组比较均无统计学差异(P均>0.05)。10例哮喘缓解期患儿淋巴细胞亚群结果表明,B细胞百分率显著下降(P<0.05),其他各项指标在发作期与缓解期无明显差异。结论支气管哮喘儿童最重要的免疫异常是Th1/Th2细胞比例和功能失衡,主要表现为Th2细胞应答优势存在,Th1/Th2显著降低。     

反复扁桃体炎患儿缓解期T细胞亚群及辅助性T淋巴细胞亚群的功能状态

目的探讨反复扁桃体炎(RT)患儿缓解期T淋巴细胞亚群及辅助性T淋巴细胞(Th)亚群功能状态。方法采用免疫荧光标记和流式细胞仪技术检测27例RT缓解期和21例健康对照组儿童外周血T细胞亚群的表面分子表达情况;同时采用双抗夹心ELISA法检测两组外周血单个核细胞(PBMC)培养上清液中IFN-γ和IL-4水平。结果RT患儿与对照组比较,CD4 和CD3 细胞的表达率均显著下降(P均<0.01),CD4 /CD8 比值失调(P<0.01);与Th1细胞功能相关的IFN-γ细胞因子表达水平显著降低(P<0.01),Th1/Th2比值失调(P<0.01);而CD8 细胞及与Th2细胞功能相关的IL-4细胞因子水平与对照组比较差异均无显著意义(P均>0.05)。结论RT患儿缓解期存在T细胞功能紊乱;Th1亚群功能低下以及Th1/Th2平衡的紊乱可能在RT的发病中起更重要的作用。     

慢性活动性EB病毒感染外周血淋巴细胞免疫亚群变化特征的研究

目的 研究慢性活动性EB病毒感染(CAEBV)宿主细胞免疫功能的变化.方法 应用流式细胞仪检测2004年3月至2008年4月住院的CAEBV患儿、急性EBV感染(acute EBVinfection,AEBV)患儿以及正常儿童外周血淋巴细胞免疫亚群.结果 CAEBV组外周血白细胞[3325×106/L,中位数(下同)]、淋巴细胞(1078×106/L)、NK细胞(68×106/L)、B细胞(84×106/L)、总T细胞(684×106/L)、CD4+T细胞(406×106/L)和CD8+T细胞(295×106/L)计数均高于AEBV组(P<0.05).CAEBV组CD4+功能、亚群的比例(94.5%)低于正常组(98.7%)(P<0.05),但高于AEBV组(74.0%)(P<0.05);而CD8+功能哑群的比例(40.7%)与正常组(48.3%)比较差异无统计学意义,但高于AEBV组(21.0%)(P<0.05).CAEBV组的调节亚群比例(5.0%)虽高于正常组(4.6%)(P<0.05),但低于AEBV组(5.8%)(P<0.05).CAEBV组初始T细胞比例(32.3%/37.5%)低于正常组(58.3%/56.6%)(P<0.05),其效应记忆T细胞的比例(23.9%/15.1%)低于较AEBV组(36.5%/69.8%)(P<0.05),而CD8+假初始T细胞(17.5%)的比例高于其他两组(12.0%和9.2%)(P<0.05).CAEBV组CD8+激活亚群(84.4%/34.0%)高于正常组(44.1%/16.7%)(P<0.05),但低于AEBV组(96.0%/95.0%)(P<0.05).结论 CAEBV患儿体内存在淋巴细胞亚群失衡和细胞免疫功能紊乱,可能与CAEBV的慢性活动性有关.检测外周血淋巴细胞亚群有助于CAEBV的诊断和鉴别诊断.     

手足口病患儿外周血T细胞亚群分析

目的 探讨手足口病患儿细胞免疫功能的变化.方法 以1375例手足口病患儿和150例同期健康儿童为研究对象,手足口病患儿根据病情分为普通病例组、重症组、危重症组.采用流式细胞术进行CD3+T细胞(CD3+)、CD4+T细胞(CD3+ CD4+)、CD8+T细胞(CD3+ CD8+)的相对计数的检测,计算CD4+ T/CD8+T细胞比值,分析各组之间T细胞亚群水平差异.结果 病例组CD3 +T细胞、CD4+T细胞、CD8+T细胞相对计数及CD4+ T/CD8+T细胞比值均显著低于对照组,差异具有统计学意义(P＜0.05).危重症组CD3+T细胞相对计数为(55.98±12.15)％,显著低于普通病例组[(60.47±11.03)％]及重症组[(58.83±10.97)％],差异具有统计学意义(P＜0.05).～3岁年龄组患儿CD3+T细胞相对计数[(58.88±11.35)低于～6岁年龄组(62.27±9.95)％],差异具有统计学意义(P＜0.05).男性患儿CD8+T细胞[(23.61±13.27)％]高于女性患儿[(22.13±7.76)％],CD4+T/CD8+ T细胞比值(1.45±0.75)低于女性患儿(1.60±1.02),差异具有统计学意义(P＜0.05);病原学组间比较,差异无统计学意义(P＞0.05).结论 重症手足口病患儿细胞免疫功能减低,随病情加重免疫功能下降明显.早期监测手足口病患儿T细胞亚群,结合年龄、性别之间的差异,对判断手足口病患儿病情及预后、指导重症手足口病治疗具有重要作用.     

Medical experts and the law: Safeguarding children,the public and the profession

Paediatricians working in child protection are sometimes required to act as expert witnesses in legal proceedings. Given the significant influence of opinion evidence on the jury, it is imperative that they understand their responsibilities to the court in this medico‐legal interface and recognise their boundaries of expertise. Recent cases in the United Kingdom and in Australia have thrown the spotlight on paediatricians working as forensic experts in legal proceedings which has led to much public scrutiny and intervention by medical disciplinary bodies placing practice sanctions on child protection paediatricians. These decisions have had a significant impact on the workforce, with fewer paediatricians and those in training now willing to work in the field because of fears of disciplinary sanctions being instigated by those adversely affected by unfavourable forensic opinions. This article includes a detailed summary of these cases including excerpts from legal judgments, which highlight critical issues for the expert witness, which have had a significant impact on individuals, the profession and impacted on public confidence in the profession. In Australia, it is timely that we reflect on these lessons learnt and look to development of educational standards and forensic credentialing to enable continuity of a skilled paediatric workforce in child protection.     

A world tailored for children and the young. The children and the young around us and the child and the adolescent within each of us

Towards the end of the nineteenth century in America, a court that normally dealt with animal abuse found itself facing a very special problem: it had to discuss for the very first time a case of child abuse. It might seem a paradox to many that a matter of this nature should be discussed in a court set up for a quite different purpose, but it was not an error arising out of the lack of room in the civil court nor an error of competency: it happened to be the only place judged to be appropriate to discuss the rights of a child, mistreatment of whom was handled on a par with abuse of animals. In spite of the section expressly dedicated to children in the Universal Declaration of Human Rights of 1789, the world had to wait for the Geneva Convention of 1924 before the first declaration of children's rights was promulgated. There were five main principles: the right to a healthy psychophysical development, the right to be nourished, cared for, returned to a normal life if demoralised, looked after and aided in the case of orphans. But only with the international Convention of children's rights of New York in 1989 was it possible to draft a text for the full, more comprehensive protection of infancy, two centuries after the first pronouncement on the occasion of the universal declaration of human rights. Two centuries of struggles and growing awareness of the problem of children (and at the same time of women and mothers) in the world, two centuries that have produced all over the world the complete idea of the child as having rights and being an active part of contemporary society. But the examination of the current situation brings us to the main problem: if a virtuous circle is not established between rights, infant culture and duties of adults, then the declarations of this century will have to wait many years more before becoming a practical part of our society. What then should be done to make sure that the declarations and conventions on rights do not remain a mere expression of principles? There can be no evolution in children's living conditions, nor protection of their rights, if we do not create a culture of infancy based on two premises: the rights of children and the duties of adults with respect to children. Today an exact and comprehensive knowledge of the rights of children is necessary above all starting with their right to freedom, experience, opinion, equal opportunity for development and education, defence against all types of abuse, and their right to a family. But at the same time it is necessary to act in the area of the duties of parents and adults: the question is one of building up a cultural system that includes the rights whereby the prerogatives of children are matched with corresponding duties of adults, a culture of values that responsibilises adults by way of a process of personal awareness and parent training. The adult must find himself personally in harmony in his relationship with life so as not to compromise on child training: the idea of a vulnerable future must be avoided; a future that is insecure and defenceless for children and adolescents who are future adults. A third factor must cater for this, namely modern society whose task it is to build structures (interconnected by means of an interdisciplinary project and through the possibility that modern technology also offers them) to supply opportunities and laws that favour and protect the personality of both child and adult. In this case considerable value would be taken on by the drafting of a "Charter of Duties of adults with respect to children and adolescents" that favours the birth of new standards and national and international conventions aimed at a new conception of society understood as a set of several parts, children, adolescents, adults, each subject of rights. By this approach the commitment of individual associations, organisations and institutions would start a process of social development which as of today is the last and on]y real revolution possible to improve the conditions of life of the person as such, and not the person as such, and not only of the person as a citizen of one nation or another. In conclusion: no development is possible if we do not take steps as an international community to protect the first citizens of the world who are and always will bc children. 1n this sense, psychoanimation, which is a psychopedagogic-cultural intervention methodology based on a holistic approach and employs cognitive, creative, corporeal techniques to foster, in the individual and in the group, that 'growth', that "awareness', that "responsibility' which have their "roots' in self-awareness and in the possibility of acquiring cultural instruments that are scientifically and humanistically suitable to 'act' individually and collectively, the "change' in human societies sets itself the diffusion of a Culture of Infancy and of Adolescence as an objective. In fact for Psychoanimation that means: ('give soul to the soul' employing all languages in interdisciplinary fashion for communication and social integration) in order to authentically permit knowledge, communication and exchange among human beings) the last 'possible revolution" is that connected with the success, all over the world, of a Culture of Infancy and of Adolescence. What is the possibility that this converts into: 'a world made to the measure of children': the children around us and the chi]d within us!     

Muslim patients and health disparities in the UK and the US

This article provides a framework for understanding how Muslim identity, and the current social and political contexts in which it is shaped, affects the health of Muslims in the UK and the US, and the quality of health care they receive. Key medical and public health literature that addresses health concerns related to Muslim communities in the UK and the US is reviewed. Few data exist specific to health disparities for Muslim minorities. However, the article focuses on emerging studies concerning the consequences of "Islamophobia" for the physical and mental health and health care of Muslim families and children. We argue that, despite substantive structural differences in the health care systems of the UK and the US, social structural and political forces play similar roles in the health of Muslim children in both countries. Finally, we call for significant cultural and institutional adjustments in health care settings and further research studies to provide specific data to address health disparities for these growing and diverse populations.