菏泽市新生儿乙肝疫苗接种情况的调查

我国自1992年起将乙肝疫苗纳入计划免疫管理，2002年起将乙肝疫苗纳入计划免疫并免费接种。菏泽市以往乙肝调查人群HBsAg携带者达13．2l%。为了解、评价全市新生儿乙肝疫苗接种情况，于2004年10月25日～26日对全市计划免疫新生儿乙肝疫苗接种工作进行了调查，现将结果汇总如下。     

儿童急性淋巴细胞白血病治疗失败相关因素分析

目的 探讨儿童急性淋巴细胞白血病(ALL)治疗失败的相关因素。方法 随访2013年1月至2017年12月收治的初诊ALL患儿,对124例治疗失败患儿的临床资料进行回顾性分析,比较不同临床特征与复发时间及部位的关系,以及治疗失败的可能危险因素。结果 124例治疗失败患儿中男82例、女42例,初诊时中位年龄为8.0(3.3～13.0)岁,中位随访时间24.0(14.0～43.5)月。治疗失败原因包括复发(104例)、非复发性死亡(19例)及第二肿瘤(1例)。104例复发患儿的中位复发时间为17.7(3.0～57.2)月,其中复发时间以极早期复发为主(52例),复发部位以单纯骨髓复发为主(84例)。复发时间与初诊白细胞计数、免疫分型、不同融合基因及危险度分层相关(P<0.05);复发部位与初诊白细胞计数、免疫分型有关(P<0.05)。第33天的MRD水平是影响治疗失败生存(TFS)率和总生存(OS)率的独立危险因素(P<0.05)。结论 复发是儿童ALL治疗失败的最主要原因,密切监测早期治疗反应,积极预防、治疗极早期复发可降低治疗失败发生率,提高患儿OS率。     

儿童呼吸机撤离失败相关因素分析

目的 分析机械通气患儿呼吸机撤离失败率及失败的相关因素.方法 回顾分析我院2005年1月至2008年12月内科重症监护室收治的机械通气患儿214例,统计撤机失败率,分析撤机失败的相关因素.结果 141例患儿按计划撤机,成功122例,失败19例,撤机失败率13.5%.年龄＜6个月患儿撤机失败率较年龄＞6个月患儿高,但差异无显著性(15.0% vs9.8%,P＞0.05).因肺炎进行机械通气的患儿撤机成功率(78/86,90.7%)最高.机械通气时间对撤机成功与否无影响.撤机后皮质激素应用时间成功组短于失败组,差异有显著性[(12.35±9.69)h vs(18.63±12.17)h,P＜0.05).多元线性逐步回归(R2=0.093)分析提示呼吸道梗阻是撤机失败的高危因素(F=14.256,P＜0.001).结论 目前PICU中机械通气患儿的撤机问题还依赖于临床医生的经验和客观指标相结合,探索合理可行的撤机方案,尽早发现和去除引起撤机失败的因素是提高撤机成功率的关键.     

杭州市儿童乙肝疫苗接种免疫应答定量分析及强化免疫年龄探讨

目的探讨0～14岁儿童乙肝疫苗加强针接种的适合年龄。方法回顾性研究。分析2015年1月至2021年10月在杭州师范大学附属医院行乙型肝炎病毒血清学标志物定量检测的3 118例儿童的资料, 年龄0～14岁, 男1 702例, 女1 416例, 男女比例为1.20∶1.00。儿童按1岁为间距分为15个组别。采用化学发光微粒子免疫检测法定量检测乙型肝炎病毒表面抗体(Anti-HBs)滴度。应用χ2检验比较不同性别、各年龄组的Anti-HBs阳性率, 应用秩和检验比较不同性别、各年龄组乙肝免疫应答情况。结果共调查3 118例儿童, Anti-HBs滴度及有效应答率随着年龄增长而逐渐降低, 不同组别之间Anti-HBs滴度及有效应答率差异均有统计学意义(均P<0.01), 而不同性别之间Anti-HBs滴度及有效应答率差异均无统计学意义(均P>0.05)。3岁以上儿童Anti-HBs滴度中位数为58.49 IU/L(0～1 001.00 IU/L), 59.1%(1 477/2 497例)的3岁以上儿童处于无免疫应答及低免疫应答状态(即Anti-HBs滴度低于100 IU/L)。结论...     

小儿麻疹发病与疫苗接种情况分析

目的探讨小儿麻疹发病与疫苗接种情况的关系。方法回顾性分析麻诊患儿32例的临床资料，包括发病年龄、流行情况、临床特点及预后等，分析其与免疫接种的关系。结果农村发病22例，占68．8％；6个月至学龄前27例（84．4％）；无接种史及接种史不详者27例（84.4％）。多数病例临床特点典型，预后良好。结论农村及流动人口免疫接种率低是导致近年麻疹流行的重要原因，计划免疫初种及复种时间可适当提前，研发新型疫苗有重要意义。     

小儿急性肠套叠肠坏死相关因素分析

目的 分析肠套叠伴肠坏死的高危因素.方法 回顾性分析2007年9月至2009年9月温州医学院附属育英儿童医院收治的219例肠套叠手术患儿临床资料,其中肠坏死42例（肠坏死组）,非肠坏死177例（非肠坏死组）.对两组病程、年龄、白细胞计数等计量资料进行t 检验;对两组性别、肠套叠类型、B超提示肿块位置、套叠头部有无病变、有无肠间积液等进行x2检验;对差异有统计学意义的因素进行Logistic回归分析,了解影响肠套叠肠坏死的危险因素.结果 两组患儿在病程、年龄、肠套叠类型、B超提示肿块位置、有无肠间积液上比较差异有统计学意义;Logistic 回归分析提示肠套叠类型、病程以及B超提示肿块位置与肠坏死相关.结论 在小儿急性肠套叠的发病因素中,病程长短与B超提示肿块位置是影响肠坏死的主要因素.     

1～6岁儿童不同年龄组乙肝表面抗体调查

目的观察1—6岁儿童接种乙肝疫苗后的免疫效果。方法采用酶联免疫法对门诊和幼儿园检查的5800名儿童进行乙肝表面抗体检测。结果表面抗体阳性（32．1mIU／ml），阳性率为45．01％，其中1—2岁组为53．45％，3。4岁组为42．57％，5—6岁组为40．29％；1-2岁组阳性率与3—4岁组及5～6岁组差异有非常显著性（x^2=58．09，P〈0．01）。结论年龄越小、免疫效果越好。     

早产儿有创机械通气初次撤机失败相关危险因素分析

目的 研究早产儿有创机械通气初次撤机失败相关危险因素及不良预后。方法 回顾性纳入北京大学第三医院新生儿重症监护室收治的生后72 h内有创机械通气的早产儿,根据初次撤机后72 h内是否需要再插管分为撤机成功组和撤机失败组,分析初次撤机失败相关危险因素及不良预后。结果 共纳入282例早产儿,其中撤机失败组43例（15.2%）。撤机失败组胎龄、出生体重均低于撤机成功组（P < 0.05）,撤机失败组产房内插管率、动脉导管未闭（patent ductus arteriosus,PDA;内径≥2.5 mm）比例高于撤机成功组（P < 0.05）。撤机前应用≥2种血管活性药物（OR=2.48,95%CI：1.22~5.03）、PDA（≥2.5 mm）（OR=4.54,95%CI：2.02~10.24）为撤机失败的危险因素（P < 0.05）。撤机失败组患儿呼吸机相关性肺炎、中-重度支气管肺发育不良、败血症的发生率均高于撤机成功组（P < 0.05）,撤机失败组吸氧时间、住院时间长于撤机成功组（P < 0.05）。结论 撤机前使用≥2种血管活性药物、PDA（≥2.5 mm）是撤机失败的主要危险因素,撤机失败可能与住院早产儿不良结局有关。     

72例小儿病毒性脑炎预后相关因素分析

为了解病毒性脑炎（病毒脑）预后相关因素 ,现对１９８７年６月至１９９９年６月所收治的７２例符合病毒脑诊断标准的患儿分析如下。男３９例 ,女３３例 ;年龄＜１岁２１例（２９．２%） ,～３岁２３例（３１．９ %） ,～７岁１５例（２０．８ %） ,～１４岁１３例（１８．１ %）。采取信函和专科门诊方式随访 ,时间６月～１２年。记录有明显运动、语言、听力、视力障碍 ,癫发作、智能落后或死亡的病例 ,对可疑者作神经系统检查结合头颅ＣＴ、脑电图、智商测定和听力、视力检查确认。结果 :有后遗症２９例（４０．３ %） ,其中单纯运动障…     

儿童肺炎链球菌感染与疫苗

肺炎链球菌是儿童呼吸道感染中最常见的病原之一,也是导致儿童重症肺炎、肺炎并发症和死亡的主要致病菌.近年来,由于世界各地肺炎链球菌对抗生素的耐药不断增加和广泛传播,造成疾病的负担日益增加,也使临床诊治面临严峻挑战.疫苗的出现和推广在肺炎链球菌病的防治方面有着光明的前景.     

接种灭活卡介苗治疗婴幼儿哮喘疗效分析

目的探讨接种灭活卡介苗治疗婴幼儿哮喘的疗效及影响疗效的原因。方法对45例婴幼儿哮喘患儿接种灭活卡介苗治疗,评估治疗后的疗效,回顾性分析不同疗效与年龄、皮肤过敏原皮试、治疗前的哮喘发作程度、治疗前后IgE、嗜酸性阳离子蛋白（ECP）、IL-4、IFN-γ之间的关系。结果患儿治疗后疗效存在差异;不同疗效与患儿的皮肤过敏原皮试阳性率、治疗前哮喘发作程度及IgE水平、治疗后IgE和IL-4水平有关,治疗后IgE和IL-4水平是评价疗效的最主要因素。结论过敏体质和免疫失衡是导致灭活卡介苗接种治疗出现不同疗效的原因,提示临床对有明显过敏体质和免疫失衡的哮喘息儿,不宜应用灭活卡介苗及其他卡介苗衍生物进行治疗。     

Immunogenicity of hepatitis a vaccine in children with cancer

This study evaluated the immuned response of the hepatitis A vaccine in children with cancer who were receiving chemotherapy. Twenty-eight patients with lymphomas or solid tumors and who had negative serology for hepatitis A were enrolled. The median age was 4.7 years (range 2-16). The patients received 1440 IU hepatitis A vaccine at 0 and 6 months. Seroconversion rates at the first and seventh months were 60% (n = 17/28 patients) and 89% (n = 24/27 patients). No adverse effects were observed. The hepatitis A vaccine was found to be effective and safe in children with cancer.     

Measles vaccine in egg allergic children: poor immunogenicity of the Edmoston-Zagreb strain

Despite the fact that a number of recent studies have shown that measles/ mumps/rubella vaccine is safe for egg allergic children, many pediatricians are still concerned about immunization in egg allergic children. In Europe, a measles vaccine with the Edmoston-Zagreb strain (EZMV) grown in human fibroblast culture has been developed and recommended for children with egg allergy. However, some doubt arises on the efficacy of this strain due to its weak immunogenicity. The aim of this study was to investigate the immunogenicity of the EZMV in comparison to the measles vaccine with the Schwarz strain (SWMV) grown in a chick embryo fibroblast culture.
Thirty-nine children affected by severe immediate manifestations due to IgE mediated egg allergy were enrolled. The children received at random the SWMV (Morupar, Sclavo) or the EZMV (Triviraten, Berna) in one 0. 5 ml subcutaneous injection, and were checked for any immediate allergic reactions in the following 4 hours. Blood samples were taken for the detection of specific antibody response 5 months after the immunization. In SWMV seroconverted children (18/19) the geometric mean antibody liter was 3 times higher than that observed in EZMV seroconverted children (17/20) (p < 0.01). No allergic reactions occurred following the immunization with the two different vaccines. This data confirms the safety of SWMV in egg allergic children. In addition, the present study provides further data on the lower immunogenicity of the EZMV in comparison to the SWMV.     

Pilot study of influenza vaccine effectiveness in urban Australian children attending childcare

Background: Influenza outbreaks in the childcare setting are a significant cause of excess winter morbidity. This study explored methods of follow up and sample collection for a proposed randomised controlled trial of influenza vaccination in children attending childcare. Methods: The study was conducted in four Sydney childcare centres during 2007. Healthy children aged 6–59 months eligible for vaccination were recruited in two centres, with another two acting as controls. Data on influenza‐like illness (ILI: ≥37.8°C plus at least one respiratory symptom) occurrence were collected weekly. In those children with an ILI, parents were asked to collect nasal swabs and send via surface mail for viral polymerase chain reaction. Vaccine efficacy (VE) for ILI was estimated overall and for subgroups aged 6–23 and 24–59 months using the formula VE = 1 ? relative risk (RR). Results: Sixty‐three per cent (151/238) of eligible children had parents give consent. Sixty‐three children received influenza vaccine and 88 participated as controls. Of 26 specimens returned, a virus was detected in 18 (69%); none with influenza. Two symptomatic children had positive near‐patient influenza tests in general practice (one a vaccine failure). The RR with 95% confidence interval in all children and those aged 6–23 months were less than one, 0.56 (0.32–1.02) and 0.46 (0.15–1.45), respectively. Conclusions: This study demonstrated the feasibility and utility of parent‐collected and mailed respiratory specimens for VE research in the childcare setting. Two‐thirds of parent‐collected swabs proved positive for at least one virus. Finding ways to reduce reluctance of parents to submit samples could improve the representativeness of samples collected and the power of the study. No evidence was found for influenza VE, but point estimates were in the direction of protection.     

Prophylactic effect of inactivated influenza vaccine on young children

BACKGROUND: The effectiveness of inactivated influenza vaccine in healthy infants and young children has been controversial. The aim of this study was to determine the prophylactic effect of inactivated influenza vaccine in young children. METHODS: Eighty-six healthy infants and children younger than 7-years-old were immunized by a subcutaneous injection of inactivated influenza vaccine before the 1999/2000 influenza season. Ninety-four age-matched children were randomly assigned as the control. These children were followed-up from January to April, 2000. A diagnosis of influenza A virus infection was made rapidly by a positive result of the the enzyme immunoassay membrane test using enzyme-conjugated monoclonal antibodies specific for a conserved epitope of influenza A nucleoprotein. The incidence of influenza A infection was compared and statistically assessed. RESULTS: The prevalence of influenza A virus infection, diagnosed by the influenza A rapid detection test, was 5.8% in the vaccine group and 17.0% in the control group, that is significantly lower in the vaccine receiving group than the non-receiving group (P = 0.016). However, four out of five infected children in the vaccine group were younger than 2-years-old. CONCLUSION: We conclude that inactivated influenza vaccine reduces the incidence of influenza A virus infection in 2-6-year-old children.     

小儿血液透析应用特点和临床分析

探讨血液透析（HD）在儿科应用的特点及小儿肾功能衰竭HD的临床意义。方法对20例1a～14a危重肾功能衰竭及药物中毒患儿进行67次HD分析。结果所有病例在HD后肾功能明显改善,尿毒症症状减轻。痊愈、好转各6例,自动出院、死亡各4例,无1例死亡与透析直接有关。主要并发症为失衡综合征（11．9％）和低血压（10．5％）。结论HD成功的关键在于血管通路的建立、血容量的稳定及并发症的防治。HD抢救危重肾功能衰竭患儿疗效迅速、安全、可靠。     

Assessment of the immune response to trivalent split influenza vaccine in children with solid tumors

PURPOSE: To assess the immune response to influenza vaccine in children with solid tumors receiving chemotherapy or under the influence of chemotherapy. METHODS: Forty-five children (aged 1-18) with solid tumors on chemotherapy or within 6 months of completion of chemotherapy were included in the study. The children received two doses of intramuscular trivalent split influenza vaccine with 1 month apart in November-December 2003 (children <4 age 0.25 ml; >4 age 0.5 ml). Antibody titer was detected in the pre-vaccination and 4-week post-vaccination sera by hemagglutination inhibition (HI) method. Immune responses were measured as protective, geometric mean titers (GMT), and fourfold rises in HI titers. RESULTS: We revealed that the post-vaccination GMT for each of the three antigens in patients with solid tumors has increased significantly (P < 0.05). A fourfold rise in the percentage of post-vaccination antibody titers has been detected as 84.4% for H(1)N(1), 77.8% for H(3)N(2), 60% for B. Stratification of patients as on active chemotherapy or being within 6 months of completion of chemotherapy in terms of fourfold rise in antibody titers exposed a statistically significant difference for only B (P = 0.34). Post-vaccination protective rates were between 86 and 97%. CONCLUSIONS: Due to the interruptions in treatment caused by influenza infections, and economic benefits of the vaccine, we suggest that inactivated influenza vaccine should be applied as two doses annually in patients with solid tumor.     

小儿胃肠功能衰竭的早期诊断和预后

目的 探讨胃肠功能衰竭的早期临床特点和预后。方法 回顾分析５３例胃肠衰竭者的临床资料。结果 小儿胃肠衰竭的发生率为２．６８％,早期症状可为单纯腹胀、大便潜血强阳性、腹胀并大便潜血强阳性和明显上消化道出血;而肠鸣音可亢进、减弱、消失,甚至正常。胃肠衰竭小儿平均伴有器官衰竭的数目为１．８３个,病死率为６０．４％,且死亡者较存活者的血糖高、肾功能差、心肌酶高,酸中毒严重。结论 胃肠衰竭小儿早期诊断困难,