希舒美治疗小儿呼吸道肺炎支原体感染的疗效判断

目的：评价希舒美治疗小儿呼吸道肺炎支原体感染的治疗作用。方法：总结分析159例分别应用希舒美口服治疗、红霉素静脉滴注、希舒美口服+红霉素静脉滴注3种方案治疗的肺炎支原体感染患儿的疗效。结果：三方案对支原体非肺炎感染的临床症状改善及支原体的清除作用无明显差异,而对支原体肺炎组,红霉素静脉滴注、希舒美口服+红霉素静脉滴注方案亦无明显差异。结论：在轻症肺炎支原体感染患者,希舒美可替代红霉素静脉注射进行安全有效的治疗,而在支原体肺炎组,亦能部分替代红霉素静脉注射。     

门冬阿奇霉素与红霉素治疗小儿支原体肺炎疗效的比较

目的比较门冬氨酸阿奇霉素与红霉素治疗小儿支原体肺炎的疗效和不良反应。方法将诊断为支原体肺炎的患儿65例随机分成2组。34例采用门冬氨酸阿奇霉素10mg/(kg.d)静脉滴注,用药5d;31例采用红霉素15~30mg/(kg.d)静脉滴注,用药7~14d。治疗后根据疗效评价比较2组疗效和不良反应。结果门冬氨酸阿奇霉素组的痊愈率(79.41%)明显高于红霉素组(48.39%)(χ2=6.82,P<0.05);不良反应明显较少(χ2=10.52,P<0.01)。结论门冬氨酸阿奇霉素治疗小儿支原体肺炎疗效好、疗程短、不良反应少,值得推广。     

1026例儿童肺炎支原体感染及耐药情况分析

目的：了解儿童呼吸道感染患者肺炎支原体感染及耐药情况,为临床诊断和治疗提供有力依据。方法：对2010年9月到2011年9月于我院儿科门诊就诊和儿科病房住院的3529例呼吸道感染患儿进行咽拭子肺炎支原体培养,并检测对阿奇霉素、罗红霉素、红霉素、乙酰螺旋霉素、克拉霉素的药物敏感性。结果：在3529例患儿中,肺炎支原体培养阳性者1026例,总阳性率为29.07%。季节分布方面,一年四季均有不同程度肺炎支原体感染病例,夏秋季节感染率高于冬春季,季节间阳性率差异有统计学意义（P<0.05）。性别方面,女性阳性率（30.43%）高于男（28.32%）,但差异无统计学意义。随患儿年龄增大,阳性率逐渐下降,且各年龄组间阳性率差异有统计学意义（P<0.05）。药敏试验结果显示,适宜儿童使用的大环内酯类抗生素耐药性由高到低依次为罗红霉素、红霉素、乙酰螺旋霉素、克拉霉素和阿奇霉素。肺炎支原体培养阳性菌株对5种抗生素的耐药情况差异有统计学意义（P<0.01）。结论：呼吸道感染患儿中肺炎支原体感染率较高,学龄期儿童发病率较低,易发季节为夏秋季。对呼吸道感染的患儿应尽早进行肺炎支原体咽拭子培养及药敏检测,使患儿得到及时正确的治疗,减少耐药株出现。     

门冬氨酸阿奇霉素与红霉素治疗儿童支原体肺炎的对照研究

目的比较门冬氨酸阿奇霉素与红霉素治疗儿童支原体肺炎的疗效和不良反应。方法符合诊断标准的支原体肺炎患儿80例。用抽签法分为两组,40例采用门冬氨酸阿奇霉素10 mg/(kg.d)静脉滴入,连用3 d,停3 d,再用3 d;40例采用乳糖酸红霉素30 mg/(kg.d),分2次,Q12 h静脉滴入,连用14 d。用专用表格记录患儿治疗前的病情和在疗程中逐日观察记录症状、体征的变化及不良反应,并于治疗前后做有关的实验室检查和拍X线胸片,按疗效判断标准比较两组的疗效和不良反应。结果门冬氨酸阿奇霉素组的痊愈率(90%)明显高于红霉素组(56.8%),χ2=3.85,P<0.05;症状、体征消失较快(P均<0.05);而不良反应明显较少,χ2=12.58,P<0.01。结论门冬氨酸阿奇霉素治疗儿童支原体肺炎疗效好,疗程短,用法简便,不良反应少,值得推广。     

节段性肺炎支原体肺炎69例

目的 探讨节段性肺炎支原体肺炎(SMPP)的临床特点、肺外并发症和诊治措施.方法 对有呼吸道症状和体征、胸片呈节段性肺炎改变、血清肺炎支原体抗体(MP-IgM)阳性的SMPP患儿69例(男35例,女34例;年龄6个月～14岁)的临床表现、实验室及胸片检查、肺外并发症、治疗与转归进行回顾性分析.结果 发病多集中在学龄前及学龄期儿童,其中>5～10岁33例.发热55例;持续性咳嗽65例.其中喘息8例,干咳45例,早期表现流鼻涕7例;右肺肺炎38例,左肺肺炎23例,同时累及双肺8例.并发症:并胸膜炎9例、胸腔积液1例;32例有肺外并发症,其中有消化和泌尿系统并发症各8例(11.6%),心血管系统并发症3例(4.3%),出现神经系统症状和皮肤改变各4例(5.8%),血液系统并发症5例(7.2%),多脏器损害8例(11.6%).59例先予静脉滴注红霉素,后改阿奇霉素口服治疗,10例仅口服阿奇霉素治疗.33例痊愈,36例好转.结论 SMPP好发于学龄儿童,SMPP肺外并发症较严重,红霉素、阿奇霉素序贯治疗安全、疗效尚满意.有必要提高对SMPP的认识,以便尽早诊断和采取合适治疗.     

小儿肺炎支原体肺炎168例临床特点回顾性分析

目的总结小儿肺炎支原体肺炎的临床特点,并评价其疗效。方法回顾性分析168例小儿肺炎支原体肺炎的临床特点、影像学表现、血清学抗体检测及治疗与转归。结果本病以冬、春季发病率高,发病年龄≤3岁49例(29.00%),4~7岁70例(42.00%),8~14岁49例(29.00%)。98%患儿有发热,所有患儿均有咳嗽。胸片X线及胸部CT检查以斑片状病灶及大片状病灶为主,可为单侧或双侧,大片状肺实质性病变及肺叶实质性病变占72.00%(121例)。血清学检测肺炎支原体抗体全部阳性。所有病例均使用阿奇霉素静脉缓慢输注2~3个疗程,后改为口服罗红霉素分散片或阿奇霉素片巩固治疗。4周后复查肺炎支原体抗体阴性。随访3个月160例(95.00%)患儿肺部病灶完全吸收。结论小儿肺炎支原体肺炎高发于学龄前儿童,病灶以大片状病灶及肺实质性病变居多。大环内酯类类抗生素效果佳,但疗程较长,远期随访效果理想。     

热毒宁注射液佐治小儿肺炎支原体肺炎85例疗效观察

目的观察阿奇霉素联合热毒宁注射液治疗小儿肺炎支原体肺炎的临床疗效。方法将164例肺炎支原体肺炎患儿随机分为观察组85例和对照组79例,两组均使用阿奇霉素粉针静脉滴注,观察组在此基础上加用热毒宁注射液静脉滴注治疗,观察两组临床退热时间、咳嗽明显好转时间、平均住院时间及副反应。结果观察组在退热时间、咳嗽明显好转时间及平均住院时间均短于对照组,差异有统计学意义(P<0.05),且未发现不良反应。结论阿奇霉素联合热毒宁注射液治疗小儿肺炎支原体肺炎有较好疗效。     

阿奇霉素序贯疗法治疗肺炎支原体肺炎

目的探讨阿奇霉素序贯疗法对小儿肺炎支原体肺炎(MPP)的疗效。方法将92例MPP患儿随机分为2组:治疗组47例,对照组45例。2组患儿除均予综合治疗外,对照组静脉滴注注射用乳糖酸红霉素治疗,30 mg.kg-1.d-1,应用10～14 d;治疗组采用阿奇霉素序贯疗法治疗,即静脉滴注阿奇霉素(10 mg.kg-1.d-1,应用3～5 d)后口服阿奇霉素干混悬剂(10 mg.kg-1.d-1,应用7 d)。比较2组疗效、不良反应发生情况体征消失时间以及住院时间。结果对照组总有效率为77.78%,治疗组总有效率为95.74%,治疗组疗效显著优于对照组(P<0.05)。治疗组不良反应发生率为21.28%,对照组不良反应发生率为55.56%,治疗组不良反应的发生率显著低于对照组(P<0.05);治疗组体征消失时间和住院时间均显著少于对照组(Pa<0.05)。结论采用阿奇霉素序贯疗法治疗小儿MPP的效果显著。     

环酯红霉素干混悬剂治疗儿童急性呼吸道感染的疗效

目的评价环酯红霉素干混悬剂对小儿急性呼吸道感染的疗效及不良反应。方法将急性呼吸道感染患儿63例随机分为A组(29例)和B组(34例)。A组予环酯红霉素干混悬剂口服,每次15 mg·kg-1,2次·d-1。B组予阿奇霉素干混悬剂口服,每次10 mg·kg-1,1次·d-1。对2组患儿的发热时间、临床表现进行随访观察,比较2组临床痊愈率、有效率及不良反应情况,并对结果进行统计学分析。结果 A组和B组痊愈率分别为51.72%和61.76%,2组比较差异无统计学意义(P>0.05)。A组和B组有效率分别为89.66%和88.24%,2组比较差异无统计学意义(P>0.05)。比较2组发热、咳嗽等变化,结果显示差异无统计学意义。仅A组1例患儿出现恶心、呕吐、食欲下降等胃肠道反应,但可耐受,未影响继续治疗。结论环酯红霉素干混悬剂治疗小儿急性呼吸道感染安全有效,与阿奇霉素干混悬剂的疗效无明显差异。     

阿奇霉素-米诺环素转换疗法治疗肺炎支原体肺炎的疗效

目的了解米诺环素对肺炎支原体(MP)的抑制作用,观察阿奇霉素-米诺环素转换疗法治疗肺炎支原体肺炎(MPP)的效果。方法应用体外药敏试验测定米诺环素对MP的最小抑菌浓度(MIC),根据药敏试验结果设计临床观察方案。选择2008年12月-2009年12月在首都医科大学附属北京友谊医院儿科住院MPP患儿60例。随机分为治疗组和对照组,初期均静脉滴注阿奇霉素10 mg.kg-1.d-1,连用3 d,治疗组转换口服米诺环素50 mg,每12 h 1次,持续至发热症状消失24～48 h;对照组序贯口服阿奇霉素10 mg.kg-1.d-1,1次.d-1,静脉及口服共7～10 d为1个疗程,可根据病情需要重复疗程。观察2组患儿在发热时间、住院时间、肺外并发症、临床疗效等方面的差异。结果米诺环素对MP标准株的最小抑菌质量浓度为0.1 mg.L-1,对耐大环内酯药物株的最小抑菌质量浓度为0.025～1.000 mg.L-1;2组患儿性别、年龄、住院前病程有可比性;治疗组患儿的发热时间(P=0.000)、住院时间(P=0.002)均短于对照组,且差异有统计学意义;治疗组并发症发生率较对照组低、有效率高,但差异无统计学意义(P=0.196,0.605)。结论米诺环素对MP有良好的抑制作用;应用阿奇霉素-米诺环素转换疗法治疗8岁以上儿童MPP可缩短发热时间、住院时间。     

Age-dependency of alpha- and beta-adrenoceptors on thrombocytes and lymphocytes of asthmatic and nonasthmatic children

Among the possible mechanisms which may cause wheezing or asthmatic episodes a genetically determined -adrenoceptor blockade and a hyperresponsiveness of -andrenoceptors has been postulated. Evidence to support this hypothesis stems from an increased bronchial sensitivity to -blockers, a reduced formation of cyclic AMP in response to -adrenergic stimulation and enhanced -adrenergic responses in asthmatic subjects. The recent development of techniques for measuring the specific, high-affinity binding of radiolabeled -and -adrenergic antagonists made it possible to study - and -adrenoceptors in vitro. Based upon the assumption that a change in the number and/or affinity of adrenergic receptors might be a general phenomenon, we have performed - and -receptor binding studies on lymphocytes and platelets from wheezing infants and asthmatic children as well as of infants, children, and adults not suffering from these diseases.Using ¹²⁵[I]-cyanopindolol (ICYP) and ³[H]-yohimbine (HYOH) as highly specific ligands for - and -adrenoceptors, the following results were obtained: (1) Lymphocytes and platelets from control subjects and asthamatics bound similar amounts of ICYP and HYOH and thus showed no differences either in the number or the affinity of - and -adrenoceptors. Lymphocytes and platelets of wheezing and nonwheezing infants also bound the same amounts of the radioligands. (2) In asthmatic children receiving 4×2 puffs salbutamol -adrenoceptor were down-regulated and this may mimic -adrenoceptor blockade. (3) When subjects were divided into four categories according to age (0–5, 5–10, 10–20 years, adults) the number of -adrenoceptor binding sites showed an age-dependent increase. The number and affinity of -adreneceptor binding sites on platelets was neither influenced by age nor disease.It is concluded that the - and -adrenoceptors of wheezing infants and asthmatic children at least on blood cells are normal. However the -adrenoceptors show an age-dependent maturation process, which may account for an unresponsiveness to -adrenoceptor agonists in wheezing infants.Supported by a grant from the Ministerium für Wissenschaft und Forschung, NRWPresented at the 19th Workshop for Pediatric Research, University of Göttingen, March 10–11, 1983     

Specifics of histopathological and genetical diagnosis and classification of lymphomas in children and adolescents

Malignant lymphoma along with leukemias account for nearly half of all malignancies arising in childhood and adolescence. The correct tissue-based histopathological diagnosis of lymphomas results from a close interdisciplinary exchange between pediatric oncologists and hematopathologists. We describe here relevant features of lymphoma subtypes arising in the young age group, Burkitt lymphoma, precursor/lymphoblastic lymphomas, anaplastic large cell lymphoma and diffuse large B-cell lymphoma as well as primary mediastinal B-cell lymphoma and the rare pediatric follicular lymphomas. Special focus is put on specific diagnostic difficulties as well as new insights into biological features of pediatric lymphomas in comparison with their adult counterpart. In addition the relevance of newly defined lymphoma entities of the WHO-classification 2008, e.g. greyzone lymphomas, will be discussed for the young age group.     

小阴茎、小睾丸的诊断与治疗

小阴茎、小睾丸的病因复杂,临床诊断较为困难。下丘脑-垂体-性腺轴及雄激素合成和转化过程中任何一个环节出现异常,皆会影响阴茎和睾丸的发育。治疗应在明确诊断的基础上予以个体化方案。提倡重视小青春期内的早期诊断,以期早期治疗,使病变的危害降至最低。