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目的探讨甲型H1N1流感患儿感染后细胞免疫功能的变化。方法回顾性分析2009年10月至2010年1月苏州大学附属儿童医院收治的86例甲型H1N1流感确诊病例(分成危重组和重症组)的临床资料;采用流式细胞仪检测患儿外周血T淋巴细胞、B淋巴细胞和NK细胞亚群比例。以23例外科住院患儿的淋巴细胞亚群作为对照组来观察甲型H1N1流感患儿的细胞免疫功能变化特征。结果 (1)CD3+、CD3+CD4+、CD3+CD8+亚群百分比:重症组和危重组较对照组明显降低,而该两组之间差异无统计学意义;(2)CD3-CD19+、CD19+CD23+亚群百分比统计结果示危重组>重症组>对照组,各组间比较有统计学意义(P<0.05);(3)CD3-CD16+CD56+亚群百分比在重症患儿和对照组之间差异无统计学意义,危重组较其他两组均有显著下降;(4)CD4+/CD8+比值在各组之间差异无统计学意义。结论甲型H1N1流感患儿感染后细胞免疫功能存在明显紊乱:T淋巴细胞受到全面抑制,B淋巴细胞激活参与病毒的清除,NK细胞比例的降低与危重患儿的病情相关。     

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。     

Analysis of the cellular immunity features in children with EV71 hand-foot-mouth disease

目的 探讨EV71型手足口病(HFMD)患儿细胞免疫功能的变化.方法 采用流式细胞仪检测EV71型HFMD患儿外周血T淋巴细胞、B淋巴细胞和NK细胞亚群的百分比.结果 共检测90例HFMD患儿,其中56例为普通患儿,34例为重症患儿;以23例腹股沟斜疝患儿作为对照组.EV71型HFMD患儿的CD3+、CD3+CD4+以及CD3-CD16+CD56+淋巴细胞亚群的百分比均较对照组下降,且重症患儿低于普通患儿,差异均有统计学意义(P均＜ 0.05);HFMD患儿的CD3-CD19+和CD19+CD23+淋巴细胞亚群百分比均较对照组升高,差异有统计学意义(P ＜ 0.05),重症患儿与普通患儿之间的差异无统计学意义.结论 EV71型HFMD患儿存在细胞免疫功能紊乱.     

婴幼儿常见下呼吸道感染性疾病与淋巴细胞亚群变化关系的研究

目的 探讨淋巴细胞亚群在儿童常见下呼吸道感染支气管炎、支气管肺炎和毛细支气管炎中的变化及临床意义。方法 选取111 例支气管炎、418 例支气管肺炎和83 例毛细支气管炎患儿为疾病组,同期健康婴幼儿235 例为对照组,用流式细胞仪检测各组淋巴细胞亚群。结果 支气管炎组总T 淋巴细胞、CD3⁺CD8⁺细胞低于对照组(P<0.05)。支气管肺炎组总T 淋巴细胞和CD3⁺CD8⁺ 细胞低于对照组、Th 和CD4/CD8 高于对照组,且Th 比例高于支气管炎组;与轻症肺炎组相比,重症肺炎组总T 淋巴细胞降低而B 淋巴细胞升高(P<0.05)。毛细支气管炎组Th 细胞和CD4/CD8 高于对照组、CD3⁺CD8⁺ 细胞低于对照组(P<0.01)。与对照组比,3 组下呼吸道感染患儿的B 淋巴细胞增高、NK 细胞比例降低(P<0.05)。结论 细胞免疫功能紊乱或低下以及体液免疫功能亢进参与了婴幼儿下呼吸道感染的发生和发展,并且变化程度与疾病类型及病情程度有关。     

婴儿麻疹急性期免疫状态的临床研究

目的 探讨婴儿麻疹急性期的T细胞亚群、自然杀伤细胞(NK)和CD19+T细胞改变及其发病机制,为指导临床治疗提供理论依据.方法 采用直接免疫荧光法,应用流式细胞仪检测25例麻疹患儿外周血T细胞亚群、NK和CD19+T细胞,并与对照组和儿童麻疹组比较.结果 (1)婴儿麻疹急性期淋巴细胞绝对数明显减少,但亚群中CD3+、CD4+T细胞未见减少;(2)婴儿麻疹感染急性期CD19+T细胞均明显低于对照组和儿童麻疹感染急性期[(14.67±8.70)%vs(24.18±6.72)%vs(24.02±8.83)%](P＜0.01).结论 婴儿期麻疹感染时,CD3+、CD4+T细胞抑制不明显,CD19+T细胞受到严重的抑制.     

急性白血病患儿外周血T淋巴细胞亚群和NK细胞水平测定及临床意义

为探讨急性白血病患儿外周血T淋巴细胞亚群和NK细胞水平及意义 ,采用流式细胞技术测定 90例急性白血病患儿外周血T淋巴细胞亚群和NK细胞水平。结果 ,急性白血病患儿外周血T淋巴细胞亚群中CD3+ 、CD4+ 、CD4+ CD8+ 均明显低于对照组水平 (P <0 0 1) ,CD8+ 高于对照组水平 (P <0 0 1) ,NK细胞 (CD1 6+ 56+ )明显低于对照组水平 (P <0 0 1) ,经治疗缓解者T淋巴细胞亚群和NK细胞达正常水平。结果表明 ,T淋巴细胞亚群和NK细胞可作为急性白血病辅助诊断指标 ,为临床治疗提供实验依据     

CD4+CD25high+CD127low调节性T 细胞在毛细支气管炎患儿外周血中的表达改变及其临床意义

目的：探讨CD4+CD25high+CD127low调节性T 细胞（regulatory T cell, Treg）在毛细支气管炎患儿外周血中的数量变化及其临床意义。方法：随机选取31例2岁以下毛细支气管炎患儿作为毛细支气管炎组,同期住院的同年龄段支气管肺炎患儿25例和患有疝气、肾结石等非感染性疾病患儿25例分别作为支气管肺炎组和对照组,采用流式细胞术检测3组患儿外周血中CD4+CD25high+CD127lowTreg 占CD4+T 细胞百分比。结果：毛细支气管炎组患儿外周血中CD4+CD25high+CD127lowTreg 占总CD4+T 细胞的8.0%±2.1%,低于支气管肺炎组（9.6%±2.6%）及对照组（11.3%±2.9%）,差异有统计学意义（P<0.05）。结论：毛细支气管炎患儿外周血CD4+CD25high+CD127lowTreg水平可能是一个较好的反映毛细支气管炎患儿免疫功能状态的参考指标,其在外周血中数量下降提示Treg细胞可能参与毛细支气管炎的发生发展。     

EV71型手足口病患儿细胞免疫变化

目的探讨EV71型手足口病(HFMD)患儿细胞免疫功能的变化。方法采用流式细胞仪检测EV71型HFMD患儿外周血T淋巴细胞、B淋巴细胞和NK细胞亚群的百分比。结果共检测90例HFMD患儿,其中56例为普通患儿,34例为重症患儿;以23例腹股沟斜疝患儿作为对照组。EV71型HFMD患儿的CD3+、CD3+CD4+以及CD3-CD16+CD56+淋巴细胞亚群的百分比均较对照组下降,且重症患儿低于普通患儿,差异均有统计学意义(P均<0.05);HFMD患儿的CD3-CD19+和CD19+CD23+淋巴细胞亚群百分比均较对照组升高,差异有统计学意义(P<0.05),重症患儿与普通患儿之间的差异无统计学意义。结论 EV71型HFMD患儿存在细胞免疫功能紊乱。     

手足口病患儿外周血淋巴细胞亚群变化的临床研究

目的 探讨手足口病(HFMD)患儿外周血T淋巴细胞亚群、B淋巴细胞、NK细胞的变化特点.方法 将41例HFMD患儿分为一般病例组23例,重症病例组18例,选择20例健康儿童作为对照组,采用流式细胞仪检测外周血T淋巴细胞亚群、B淋巴细胞、NK细胞.结果 CD3~+与CD4~+细胞表达:HFMD重症组、一般病例组、对照组依次显著降低(P＜0.01);CD8~+细胞表达:HFMD重症组、一般病例组、对照组依次显著降低(P＜0.05);NK细胞表达:HFMD重症组与一般病例组相似(P＞0.05),皆高于对照组(P＜0.05);B淋巴细胞表达:HFMD重症组、一般病例组、对照组依次升高(P＜0.01).结论 HFMD患儿免疫系统功能紊乱,其中细胞免疫有不同程度的抑制,体液免疫反应亢进.     

呼吸道合胞病毒毛细支气管炎患儿T细胞亚群检测的临床价值

目的：呼吸道合胞病毒(RSV)感染所致的毛细支气管炎日后发展为哮喘的机率很高,由于哮喘患儿机体存在明显的免疫功能紊乱,而RSV毛细支气管炎在这方面的研究不多,为此该研究探讨毛细支气管炎患儿T细胞亚群的变化及其临床意义。方法：采用流式细胞术对21例RSV毛细支气管炎患儿及20例正常儿童T细胞亚群进行检测。结果：RSV毛细支气管炎组与对照组外周血T细胞亚群CD4,CD8差异无显著性(P>0.05),CD4/CD8比值RSV毛细支气管炎组高于对照组,差异有显著性(P<0.05)。结论：RSV毛细支气管炎患儿存在与哮喘相似的T细胞亚群变化相关的免疫功能紊乱,提示两者在发病机制上存在一定的联系。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.