肺炎支原体感染与儿童哮喘关系分析

目的肺炎支原体感染与儿童哮喘关系分析。方法选取2011年1月至2012年1月门诊诊治的儿童哮喘168例（哮喘组）选取同期门诊儿童132例（观察组）进行血清肺炎支原体抗体（MP-IgM）检测。结果哮喘组血清肺炎支原体抗体阳性53.57%,显著高于观察组血清肺炎支原体抗体阳性33.33%,经统计学分析P〈0.05,具有统计学意义。结论肺炎支原体感染与儿童支气管哮喘有着密切关系,对哮喘有诱发作用,并且对儿童支气管哮喘疾病进展有着促进作用。     

奎屯地区儿童肺炎支原体感染调查

肺炎支原体是引起儿童呼吸道感染常见的病原体之一,近年来由肺炎支原体引起的感染有增多的趋势,为了解本地区儿童肺炎支原体感染情况,对1306例患儿进行血清肺炎支原体抗体（MP-IgM）检测,现将结果报告如下。     

儿童肺炎支原体抗体检测与肺炎支原体培养对照研究

目的：分析儿童肺炎支原体抗体检测与肺炎支原体培养的对照研究，总结儿童支原体抗体的检测方法。方法：选取2014年6～12月我院收治的600例因呼吸道感染住院的儿童患者为研究对象，采用肺炎支原体抗体检测以及肺炎支原体培养。结果：600例患者通过肺炎支原体抗体检测的阳性率为44.7%，阴性率为55.3%；通过肺炎支原体培养的阳性率为37.3%，阴性率为62.7%。两种方法的检查结果差异具有统计学意义（P＜0.05）。结论：将两种检测方法共同运用在肺炎支原体的检测中，可以有效地提高检出率，防止出现漏诊的情况。使患者能及时地接受针对性地治疗，促进患者尽早康复。     

92例反复呼吸道感染儿童肺炎支原体感染临床调查

目的探讨反复呼吸道感染儿童肺炎支原体感染发病率。方法对92例反复呼吸道感染的儿童进行肺炎支原体监测并与92例普通呼吸道感染患儿对照。两组采用颗粒凝聚法测定MP—IgM抗体。结果反复呼吸道感染者肺炎支原体MP—IgM阳性43例（46．74％）,普通呼吸道感染者肺炎支原体MP—IgM阳性12例（13．04％）,差异有极显著性（P〈0．01）。结论反复呼吸道感染与肺炎支原体感染关系密切,临床中应予以重视。     

肺癌化疗后患者肺部支原体感染的检测

目的 检测对肺癌化疗后患者呼吸道中肺炎支原体感染情况。方法 选择明确诊断的接受过2～4个周期的化疗后肺癌患者47例和对照组患者45例，取患者血清进行肺炎支原体抗体（IgM）检测，咽拭子进行肺炎支原体病原体PCR扩增。结果 化疗后肺癌患者47例中肺炎支原体感染率25．6％，明显高于对照组患者6．67％（P〈0．05）。低年龄组和高年龄组感染率无明显差别（P〉0．05）。结论 化疗后肺癌患者肺炎支原体感染率明显高于对照组患者，应选择含有大环内酯和喹诺酮类抗生素的方案，以兼顾肺炎支原体的治疗。     

儿童呼吸道感染中肺炎支原体抗体检测结果分析及临床意义

目的 分析儿童呼吸道感染者中肺炎支原体抗体的阳性率以及性别、年龄分布、发病季节性等特点,为临床治疗及预防提供依据。方法 回顾性分析2018年7月至2019年6月于安庆市第二人民医院就诊的1 256例呼吸道感染儿童的临床资料,均进行肺炎支原体抗体滴度检测,根据试剂盒说明书判读结果的阴阳性并注明滴度。分析不同性别、年龄及季节间儿童肺炎支原体抗体阳性率的差异。结果 1 256例呼吸道感染儿童肺炎支原体抗体阳性332例,阳性率26.4%。从性别分布看,男童肺炎支原体抗体阳性率24.6%,女童28.7%,女童阳性率高于男童,但差异无统计学意义（P>0.05）。从年龄分布看,0岁~组阳性率最低（3.6%）,7岁~组阳性率最高（44.8%）,不同年龄组阳性率差异有统计学意义（P<0.05）。从季节分布看,肺炎支原体一年四季都可感染,其中冬、春季阳性率较高,分别为31.0%、29.0%,夏、秋季阳性率较低,分别为20.2%、20.8%,不同季节阳性率差异有统计学意义（P<0.05）。结论 呼吸道感染儿童进行肺炎支原体抗体滴度检测显示,冬季感染阳性率最高,不同性别和年龄儿童肺炎支原体感染阳性率也不尽相同。     

细胞支原体抗原检测在肺部感染中临床意义

目的探讨呼吸系统肺炎支原体感染的早期诊断。方法采用免疫荧光法（IFA），检测呼吸系统感染患者的上呼吸道脱落细胞肺炎支原体抗原和血清IgM抗体。结果上呼吸道脱落细胞肺炎支原体抗原和血清IgM抗体的阳性率分别为17％和20％，这些患者符合肺炎支原体感染的临床特点。结论上呼吸道脱落细胞肺炎支原体抗原的检测简单易行，可用于呼吸系统肺炎支原体感染的早期诊断，同时检测血清IgM抗体可进一步提高诊断的阳性率。     

肺炎支原体感染与儿童支气管哮喘的相关性研究

目的 对肺炎支原体感染与儿童支气管哮喘的相关性进行探讨.方法 对比75例支气管哮喘患儿与75名健康儿童的血清肺炎支原体抗体(MP-IgM).结果 支气管哮喘患儿中,59例肺炎支原体抗体检测为阳性,16例肺炎支原体抗体检测阴性,肺炎支原体抗体阳性率为78.7％,远高于健康组肺炎支原体抗体阳性率(16.0％),两组差异有统计学意义(P＜0.05).结论 支气管哮喘患儿的肺炎支原体感染率是健康儿童的4.9倍,肺炎支原体感染与儿童支气管哮喘有很大关系,可能是导致诱发儿童支气管哮喘的重要因素之一.     

血清巨细胞病毒与肺炎支原体抗体MP-IgM、MP-IgG检测用于小儿呼吸道感染的诊断价值分析

目的：探讨血清巨细胞病毒与肺炎支原体抗体MP-IgM、MP-IgG检测用于小儿呼吸道感染的诊断价值。方法选取呼吸道感染患儿103例作为试验组,收集同期同年龄段于该院体检的健康小儿志愿者103例作为对照组。比较2组血清巨细胞病毒和肺炎支原体抗体阳性率,评价血清巨细胞病毒与肺炎支原体抗体MP-IgM、MP-IgG检测用于小儿呼吸道感染的诊断价值。结果2组在巨细胞阳性感染率和肺炎支原体抗体阳性感染率方面差异均无统计学意义（ P>0.05）;而试验组巨细胞病毒和肺炎支原体抗体双阳性检出率高于对照组,差异有统计学意义（ P<0.05）。结论单纯血清巨细胞病毒检测或肺炎支原体抗体MP-IgM、MP-IgG检测对小儿呼吸道感染的诊断意义不明显,但两者联合诊断且诊断结果双阳性对小儿呼吸道感染的确诊具有显著意义。     

MP-IgM、MP-IgG抗体以及MP-DNA联合检测诊断儿童支原体肺炎的临床价值

目的 探讨MP-Ig M、MP-Ig G抗体以及MP-DNA联合检测诊断儿童支原体肺炎的临床价值。方法 将2019年1月至2019年10月我院收治的158例疑似肺炎支原体肺炎患儿设为试验组,将同期160名在我院进行保健检查的健康儿童设为正常对照组,均应用化学发光法（CLIA）检测MP-IgM、MP-IgG抗体,并采用荧光半定量PCR法检测MP-DNA,比较两组检测结果。结果 试验组的MP-IgM、MP-IgG、MP-DNA阳性率均显著高于正常对照组（P <0.05）。在试验组中,就诊当日的MP-IgM阳性检出率为32.91%,在治疗2周后达高峰,随后逐渐降低;MP-IgG就诊当日阳性检出率为3.16%,在治疗4周后达高峰;MP-DNA就诊当日的阳性检出率为75.95%,随着病程的延长,其阳性率逐渐下降。上述3项指标的阳性检出率在不同病程比较差异均有统计学意义（P <0.05）。结论 在肺炎支原体感染患儿不同病程时期应用化学发光法同时检测MP-IgM、MP-IgG抗体以及MP-DNA可实现优势互补,有效提高儿童支原体肺炎的诊断效能,减少漏诊、误诊情况的发生,对于本病早期诊治具...     

肺炎患儿九种血清酶的改变

目的 观察肺炎患儿的九种常见血清酶的改变及其临床意义。方法 检测肺炎组25例患儿及对照组25例体检正常儿童的血清相关酶活性,所得数据统计采用独立样本t检验。结果 AST、GGT、LD、CK、CK-MB、HBDH升高有显著性意义（P〈0．01）,与正常对照组差异明显,而ALT、ALP、LDl升高无显著性意义（P〉．05）。结论 肺炎患儿存在不同程度的脏器损伤,但主要以心肌损伤为主,故应对,心肌进行保护性治疗。     

Anti-cyclic citrullinated peptide antibodies in type 1 autoimmune hepatitis

BACKGROUND: Besides the autoantibodies included in the diagnostic criteria of type 1 autoimmune hepatitis, many other autoantibodies have been described in this condition. Recently, antibodies against cyclic citrullinated peptide have been validated as specific diagnostic and prognostic markers of rheumatoid arthritis. AIM: To assess whether these antibodies are part of the autoantibody repertoire of type 1 autoimmune hepatitis and correlate with rheumatological manifestations. METHODS: Antibodies against cyclic citrullinated peptide were tested by a commercially available enzyme-linked immunosorbent assay. RESULTS: The antibodies were found in 12 of 133 (9%) type 1 autoimmune hepatitis, two of 49 (4%) with primary biliary cirrhosis, one of 80 (1%) with hepatitis C virus-related chronic liver disease and 53 of 89 (60%) with rheumatoid arthritis serum samples. High titres were found only in rheumatoid arthritis and type 1 autoimmune hepatitis. No clinical (in particular rheumatological manifestations), biochemical or immunoserological differences were detectable between antibodies against cyclic citrullinated peptide positive and negative type 1 autoimmune hepatitis sera, with the exception of rheumatoid factor, always negative in the positive ones. CONCLUSIONS: Antibodies against cyclic citrullinated peptide can be detected in a subgroup of patients with type 1 autoimmune hepatitis. They might be part of the wide range of autoantibody production characteristic of this condition and/or, less probably, be predictive of future rheumatoid arthritis development.     

Methotrexate in juvenile rheumatoid arthritis

Children with juvenile rheumatoid arthritis (JRA) have been reported to require higher doses (per kg body weight) of methotrexate (MTX) than adults with rheumatoid arthritis to control their disease. The purpose of the present study was to characterise the plasma pharmacokinetics of MTX and its major metabolite, 7-hydroxymethotrexate (7-OHMTX) in children, and to compare the results with those previously obtained in adults. Thirteen patients (age 5–16 y) with JRA (median disease duration 5.5 y) were studied after once weekly oral administration of MTX (median 0.21 mg·kg^–1).The analytical method was sufficiently sensitive to permit determination of plasma and urinary concentrations of MTX and 7-OHMTX during the entire dose interval in most of the patients.The dose normalized area under the plasma concentration versus time-curve (AUC) of MTX increased with the age of the children and was lower than previously found in adults. The dose normalized AUC of 7-OHMTX was not dependent on age. No correlation was found between the AUCs of MTX and 7-OHMTX.The results suggest that the age-dependence of the pharmacokinetics of MTX might explain the observation that at least some children require higher doses of MTX than adults to obtain a sufficient therapeutic effect.     

Role of lipid-lowering pharmacotherapy in children

For patients with coronary artery disease and healthy middle-aged or older individuals with elevated cholesterol levels, treatment with cholesterol-lowering drugs reduces morbidity and sometimes mortality. Treatment reverses established atherosclerotic lesions within a relatively short period of time, suggesting that starting cholesterol-lowering drugs in adulthood is adequate for most people at risk. Children with genetic lipid disorders, including familial hypercholesterolaemia and familial combined hyperlipidaemia, may be candidates for earlier therapy. A complete assessment of risk factors should be undertaken to determine which children are at highest risk. Treatment should start with diet, because diet is an important independent protective factor for disease. The bile acid sequestrants (resins) are the only drugs approved for children and may reduce low density lipoprotein (LDL)-cholesterol levels by 15 to 20% at best. Long term tolerability is good, but many children will not take the resins because they find them unpalatable. Tablet formulations have higher acceptability. Some children require supplementation with fat soluble vitamins or folate. Although hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have not been tested in long term studies in children, safety records are excellent in adults. Short term studies show that HMG-CoA reductase inhibitors reduce LDL-cholesterol levels similarly in children and in adults. Thus, the drugs may be used in low dosages to treat some adolescents with exceptional risk of disease.     

Symptoms and quality of life in obese children and adolescents with non‐alcoholic fatty liver disease

Aliment Pharmacol Ther 31 , 396–406

Summary

Background Data on the quality of life (QOL) of children with non‐alcoholic fatty liver disease (NAFLD) are needed to estimate the true burden of illness in children with NAFLD. Aim To characterize QOL and symptoms of children with NAFLD and to compare QOL in children with NAFLD with that in a sample of healthy children. Methods Quality of life and symptoms were assessed in children with biopsy‐proven NAFLD enrolled in the NASH Clinical Research Network. PedsQL scores were compared with scores from healthy children. For children with NAFLD, between‐group comparisons were made to test associations of demography, histological severity, symptoms and QOL. Results A total of 239 children (mean age 12.6 years) were studied. Children with NAFLD had worse total (72.8 vs. 83.8, P < 0.01), physical (77.2 vs. 87.5, P < 0.01) and psychosocial health (70.4 vs. 81.9, P < 0.01) scores compared with healthy children. QOL scores did not significantly differ by histological severity of NAFLD. Fatigue, trouble sleeping and sadness accounted for almost half of the variance in QOL scores. Impaired QOL was present in 39% of children with NAFLD. Conclusions Children with NAFLD have a decrement in QOL. Symptoms were a major determinant of this impairment. Interventions are needed to restore and optimize QOL in children with NAFLD.     

The pharmacokinetics of diclofenac sodium in patients with active rheumatoid disease

Summary Pharmacokinetic data for diclofenac sodium has been well established in healthy volunteers, whereas in patients with rheumatoid arthritis very little information is available in the literature. A single oral dose of enteric-coated diclofenac sodium was given to 10 patients with active rheumatoid disease, adopting the same procedures used for a group of 10 healthy volunteers in whom pharmacokinetic data was already available. Plasma specimens were collected over a period of 8h following administration and concentrations of diclofenac determined by GLC. Resulting plasma concentration curves were similar to those obtained in the healthy subjects in that areas under curves and terminal half-lives were comparable. However, peak concentrations of diclofenac were significantly reduced in the rheumatoid patients. The lower peak concentrations were correlated with the lower serum albumin levels in the patients which are associated with active rheumatoid disease.     

哮喘儿童行为特征及家长心理健康状况调查

目的：了解哮喘儿童行为特征及家长心理健康状况特点。方法：采用Achenbach儿童行为评定量表（CBCL）,对92例年龄在7～14岁的哮喘儿童进行行为测试分析,与同年龄的正常健康儿童比较,采用90项症状自评量表（SCL-90）分别对上述儿童家长进行心理卫生状况调查。结果：哮喘儿童CBCL各因子分值均高于正常儿童,其中以躯体诉述、焦虑或抑郁、社交问题、注意缺陷、违纪行为得分最明显;哮喘家长SCL-90各项因子分均高于对照组,以抑郁、焦虑、躯体诉述及恐怖网子得分最明显（P〈0．05）。结论：哮喘儿童存在不同程度的行为问题．其家长的心理健康问题亦不容忽视,应该引起高度重视,积极进行干预。     

血清降钙素原和血常规测定对细菌性肺炎的指导意义

目的探讨血清降钙素原(PCT)和血常规(BR)在细菌性肺炎诊断中的应用价值,旨在为细菌性肺炎的诊治提供理论参考。方法选取中南大学湘雅三医院2011年1月至11月在呼吸、急诊、ICU住院的细菌性肺炎患者64例,同期健康对照组32例,血清PCT采用Brahms快速半定量法(PCT-Q)测定,同期检测血常规。结果细菌性肺炎组中,PCT、白细胞计数对诊断的敏感性分别为78%和63%,特异性分别为97%和70%,细菌性肺炎组较健康对照组PCT水平显著增高,相比较有显著性差异(P<0.05)。细菌性肺炎组抗生素治疗前和好转后,血清PCT水平显著下降,相比较有显著性差异(P<0.05)。结论血清PCT的测定对细菌性肺炎有鉴别诊断价值,特别是可反应抗生素治疗效果,值得临床推广应用。     

儿童手足口病流行病学与临床特点分析

目的分析儿童手足口病的流行病学特征及其临床特点,为降低该病发病率提供有效意见。方法选取在2009年至2012年期间本县诊治的患有手足口病的儿童共690例,将其临床诊治资料进行回顾性分析调查。结果该病患者大部分为6个月以上,5岁以下的婴幼儿。个体性的发病儿童主要集中于6个月至2岁,而群体发病主要为集中在3至5岁的儿童。该病发病季节主要集中夏秋季,即5月至7月,临床表现多为轻微症状,且治疗后效果良好。结论在手足口病流行的季节应加大对于该病的宣传力度,提高人们意识,保护婴幼儿,迅速隔离患者,积极治疗患者,减少该病发病率。     

孙丽平教授从肺脾论治气虚质小儿反复呼吸道感染经验

小儿反复呼吸道感染是儿科临床常见病及多发病,严重影响儿童的生长发育和身心健康。孙丽平教授从小儿体质特点出发,指出气虚质是反复呼吸道感染患儿的常见体质,其本质为元气虚弱,气的功能长期低下导致脏腑气血阴阳失衡,故疾病反复发作。孙教授以五行学说为指导,提出气虚质小儿反复呼吸道感染当从肺脾论治,祛邪以治标,扶正以固本。同时注重"治未病"思想在临床中的应用,通过调节患儿体质,从根本上降低了小儿反复呼吸道感染的发生率。附案例1则,以资验证。