θ�����Զ�ͯ����������������ϼ�ֵ�о�

目的 探讨儿童过敏性紫癜(HSP)胃镜下黏膜病变特点及胃镜检查在其早期诊断中的价值。方法 回顾性分析2009年1月至2010年5月重庆医科大学附属儿童医院79例HSP患儿的胃镜结果。结果 HSP胃镜表现为胃肠道黏膜弥漫性充血水肿,广泛多发糜烂、溃疡、出血,尤其是黏膜类似于皮肤紫癜改变的出血点比较特异;胃镜检查发现病变沿上消化道越深入越明显,尤以十二指肠降部病变程度最严重;胃镜检查深入到达空肠输入端1例。结论 典型的胃镜下表现有助于HSP的早期诊断,尤其是无皮疹的HSP;胃镜检查可以明确胃肠道病变程度,指导临床治疗;在儿童HSP的早期诊断中,胃镜检查深入到空肠输入端十分必要。     

�����ݸ˾���Ⱦ���ͯ����θ��θ�Ĥ����仯��ϵ�о�

目的探讨幽门螺杆菌(HP)感染对不同年龄组儿童慢性胃炎胃黏膜病理变化的影响。方法 2007年1月至2010年12月,对上海交通大学医学院附属瑞金医院1634例反复上消化道症状儿童行电子胃镜检查,取胃窦部黏膜组织检测HP,按1996年悉尼标准进行病理评分,分析HP感染与炎症严重程度及活动性的关系。并根据年龄分为4组:<4岁组69例,4～<7岁组313例,7～<11岁组706例,11～18岁组546例,比较各组HP感染率、活动性病变发生率以及淋巴滤泡检出率的差异。结果 1634例患儿中HP阳性524例(32.1%),阳性率随年龄增长而升高。HP阳性患儿活动性炎症、中重度炎症、中性粒细胞浸润、淋巴细胞重度浸润和淋巴滤泡的检出率均高于阴性者(P<0.01)。胃黏膜病理示慢性浅表性胃炎(CSG)中、重度炎症及慢性萎缩性胃炎(CAG)中度炎症的发生率,HP阳性患儿均高于阴性者(P<0.01)。除婴幼儿组外,各年龄组HP感染患儿的活动性病变发生率和淋巴滤泡检出率均显著高于HP阴性者(P<0.05)。结论儿童HP感染率随年龄增长而升高。HP感染与胃黏膜炎症严重程度、活动性炎症发生率以及滤泡样改变均密切相关,与慢性胃炎不同病理类型的严重程度也密切相关。     

��ʳ֢Ѫ������ ����Y θ������θ�ſչ�ϵ���о�

目的 探讨厌食症患儿血浆瘦素、神经肽Y、胃动素与胃排空的关系.方法 2007年9月至2008年8月在广州医学院荔湾医院门诊就诊符合厌食症诊断标准的患儿40例作为厌食组,采用放免法检测血浆神经肽Y(Neuropeptide Y,NPY)、胃动素(Motilin)及用ELISA法检测血浆瘦素(Leptin,LP),并进行B超胃液体排空功能试验.同时以30名健康儿童作为对照组行相应检查.结果 厌食组血浆LP水平低于对照组,NPY、胃动素水平也较对照组明显降低,差异有统计学意义(P<0.01).厌食组胃液体排空功能试验示,餐后60、90和120min时胃窦残留率均明显高于对照组,差异有统计学意义(P<0.01),餐后30min胃窦残留率与对照组比较,差异无统计学意义.结论 厌食症患儿血浆抑制食欲因子LP降低不是导致厌食的主要原因;血浆食欲促进因子NPY降低导致胃动素不足,胃排空障碍,胃潴留增加;厌食症患儿血浆LP与NPY之间的反馈调节机制可能存在障碍.     

��������������θ�Ĥ�ʴ� ϸ����θ��ͼ��ϵ�о�

目的 探讨功能性消化不良(FD)患儿胃黏膜肥大细胞(MC)的密度及其活化状态与胃电图之间的相互关系。方法 按罗马Ⅲ标准选择2007年1月至2010年1月于中山大学附属第一医院就诊的FD患儿40例,取胃窦黏膜1块,通过免疫组化法检测MC数及其脱颗粒数,然后行胃电图检测。结果 (1)FD患儿的胃黏膜MC脱颗粒指数均值为(65.7±23.9)%,其中>50%者占82.5%;(2)与胃电节律正常组相比,胃电节律异常组的MC密度显著升高(P<0.05);(3)与MC平均密度正常组相比,MC平均密度异常组在餐前正常慢波百分比明显降低(P=0.005);与MC峰密度正常组相比,MC峰密度异常组的餐前正常慢波百分比明显降低(P=0.01);(4)MC脱颗粒指数与胃电无明显关系;(5)餐前正常慢波百分比与MC平均密度及MC峰密度呈负相关(P<0.05)。结论 FD患儿的胃电异常与MC密度升高有关,MC可能通过影响胃电介导了儿童FD的发生和发展。     

ע��ȱ�ݶද�ϰ�����θ�����ͷ�����������̬�Ե��о�

??Abstract??Objective??To study the GRPR polymorphisms in ADHD children and analyze the sequence of the second exon of GRPR. Methods??The DNA was taken from the periphery blood. The PCR of the second exon of 120 children with ADHD and 126 normal children was sequenced. We used Chi-square test to know difference of genotype and haplotype between ADHD and normal control group?? and among inattention?? hyperactivity and impulsivity compound group. Result??There were TT?? CC and TC polymorphisms in the second exon of GRPR in 661 and 450 sits. There was no difference between ADHD and normal control group??χ2 = 0.30??0.52??1.34??0.30??all P > 0.05??. There was no difference among inattention?? hyperactivity and impulsivity compound group??χ2 = 0.37??0.49??0.63??all P > 0.05??. Conclusion??The research has not proved the relationship between ADHD and the second exon of GRPR.     

��������񰻼��θ���Ĥ���ϱ仯�о�

目的探讨过敏性紫癜(HSP)患儿胃肠黏膜屏障变化。方法选取2007年9月至2008年8月昆明医学院第一附属医院儿科收治的过敏性紫癜患儿60例及正常儿童30名的血浆进行二胺氧化酶(DAO)、D-乳酸和内毒素检测。结果HSP组治疗前血浆DAO、D-乳酸及内毒素测定结果均升高,与正常对照组比较,差异有统计学意义(P<0.01)。有消化道症状HSP组治疗前血浆DAO、D-乳酸及内毒素测定结果,较无消化道症状HSP组及正常对照组高,两两比较差异有统计学意义(P<0.01)。HSP组治疗前后血浆DAO、D-乳酸及内毒素测定结果比较,除无消化道症状组差异无统计学意义外(t≤1.753,P>0.05),其他组均有统计学意义(t≥2.556,P<0.01)。结论HSP患儿存在肠黏膜屏障功能损伤,有消化道症状组较为明显,经治疗后其肠黏膜屏障存在修复过程。     

��ͯԭ���Ը����ۺ�����������ή����θ��1�������׸�ϰ

目的提高对儿童原发性干燥综合征(pSS)并发慢性萎缩性胃炎(CAG)的认识。方法报告北京协和医院儿科收治1例儿童pSS并发CAG的病例,并复习相关文献。结果儿童pSS亦可并发CAG,而部分CAG可发生癌变,因此确诊CAG后应及时治疗并定期随访。对于胃镜组织病理学检查呈重度肠上皮化生和不典型增生者,应考虑手术切除。结论对于儿童pSS内脏受累应加强认识,争取早期诊断,及时进行治疗,以改善预后。     

��ͯ��������ϸ����θ����

??The eosinophilic gastroenteritis of children is a rare gastrointestinal disease??and its pathogenesis remains unclear. It’s very difficult to make early diagnosis because it can occur at any age with complicated clinical manifestations and no specifity. The diagnosis mainly depends on endoscopic biopsy and multi-point mucosal biopsy. Dietary therapy and glucocorticoids are the most common treatment for the disease. The cognition of eosinophilic gastroenteritis in children should be improved so as to guide clinical diagnosis and treatment.     

��ʹ����Թ�����θ����

??The clinical diagnosis of children with functional gastrointestinal disorders??FGIDs?? is based primarily on complaints of children and their parents. The committee showed that this symptom-based classification would better serve the clinician??especially for excluding abdominal pain-related FGIDs with organic factors. This paper is to state physiopathology mechanisms?? and diagnosis and treatment of abdominal pain-related FGIDs.     

����P���ʶԸ�����¶�¢��ͷ�����Ƥϸ����Ӱ�켰����ϸ�����źŵ��ڼ�ø�ź�ת��ͨ·��ϵ�о�

??Abstract Objective??To investigate the regulatory mechanism of neuropeptide substance P??SP?? in lung injury induced by hyperxia and the relationship between SP and extracellular signal-regulated protein kinase??ERK??signal transduction pathway. Methods??The primary premature rats type II alveolar epithelial cells??AEC?? were isolated and purified.They were randomly divided into 3 groups?? including air group?? hyperxia group and SP intervention group. Air??21% oxygen?? group and hyperxia??95% oxygen?? group were placed in the closed oxygen chamber for 48 h respectively. With regard to SP intervention group?? SP??1×10-6 mol/L?? was added before the exposure.As following?? the group was exposed to 21% and 95% oxygen for 48 h respectively. Sample of each group was obtained at 12??24 and 48 h and morphologic change of AEC?? was observed under electron microscope.MTT and flow cytometry was employed to detect the growth rate and apoptosis rate respectively.Dynamic change of phosphorylated ERK was determined using Western blot. Results??Growth rate of AEC?? in hyperxia group decreased signifcantly and the apoptosis rate increased remarkbly compared to air group.The growth rate increased notablely and the apoptosis rate decreased obviously after the intervention of SP.Meanwhile?? the morphologic injure improved signifcantly.Hyperxia stimulation could result in activation of ERK phosphorylation??and the expression of phosphorylated ERK increased remarkbly in the impaired AEC?? induced by hyperxia.Nevertheless??the expression of ERK increased notably after the intervention of SP. Conclusion??SP could promote the proliferation and inhibit the apoptosis of AEC?? exposed to hyperxia via suppressing activation of ERK signal and then inhibiting the apoptosis??which has a protective effect on AEC??under oxidative stress.     

��ͯ�����ݸ˾����������θ�������������������

??Abstract??The symptoms of pediatric chronic gastritis and peptic ulcer may be atypical and diagnosis should be based on the correlative consideration of the patient’s history?? endoscopic findings and histological pathology. Helicobacter pylori ??Hp?? is a potential cause of gastritis and peptic ulcer in children. This paper describes the diagnostic procedure of pediatric Hp infection and its therapeutic regimens. Problems related to increasing detection and cure rates?? reduction in recurrences and controlling drug resistance need to be further investigated.     

慢性胃炎患儿部分胃肠激素的检测

目的 了解慢性胃炎患儿空腹及餐后部分胃肠激素的变化情况,深入探讨其病理生理学变化。方法 应用放射免疫分析法检测30例慢性胃炎患儿及20例健康儿童空腹及餐后1h外周血部分胃肠激素水平。结果 空腹:慢性胃炎组胃泌素为156.61±45.65pg/ml,胃动素为239.30±73.59pg/ml,生长抑素为106.38±72.03pg/ml;健康对照组依次为:124.92±50.25pg/ml,326.31±58.23pg/ml,68.13±37.65pg/ml。慢性胃炎组血清胃泌素和血浆胃动素较健康对照组有显著变化(P<0.05),而血浆生长抑素两组无统计学差异(P>0.05)。餐后:慢性胃炎组胃泌素176.64±25.25pg/ml,胃动素274.32±102.91pg/ml,生长抑素143.55±60.96pg/ml;健康对照组依次为:137.22±59.64pg/ml,373.93±139.93pg/ml,102.72±41.82pg/ml。与对照组比较,慢性胃炎组血清胃泌素和血浆生长抑素均显著增高(P<0.05);但两组胃动素无统计学意义(P>0.05)。餐前餐后比较:两组胃泌素、胃动素、生长抑素餐后较餐前有所增高,但前两者增高无显著差异(P>0.05),生长抑素增高两组均有显著差异(P<0.05)。结论 慢性胃炎患儿血胃泌素、胃动素及生长抑素水平异常,提示这些胃肠激素的改变可能参与其病理生理变化。     

Helicobacter pylori infection, histopathological gastritis and gastric epithelial cell apoptosis in children

AIM: Features of gastritis and gastric epithelial cell apoptosis in children infected with Helicobacter pylori genotypes are seldom studied. Therefore, we investigated the relationship between vacA genotypes and the severity of gastritis, and gastric epithelial cell apoptosis in H. pylori-infected children. METHODS: Antral biopsies from 52 children infected with H. pylorivacA genotypes (s1a/m1 = 17, s1a/m2 = 21 and s2/m2 = 14) were analysed for severity of gastritis on histopathology. Fifteen biopsies infected with different vacA genotypes were studied for gastric epithelial cell apoptosis by terminal uridine deoxynucleotidyl nick-end labelling. RESULTS: Children infected with the s1a/m1 and s1a/m2 vacA genotypes had higher severity of chronic inflammation than the s2/m2 genotype (s1a/m1 vs s2/m2, p=0.05; s1a/m2 vs s2/m2, p=0.01). The vacA s1a allele was more independently associated with severe chronic inflammation than the s2 allele (p=0.02). Children infected with the s1a/m1 and s1a/m2 strains had higher gastric epithelial cell apoptosis than the s2/m2 strain (s1a/m1 or s1a/m2 vs s2/m2, p<0.0001). CONCLUSION: The s1a/m1 and s1a/m2 H. pylorivacA genotypes have significantly higher association with severe chronic gastritis and gastric epithelial cell apoptosis than the s2/m2 genotype in children. The role of H. pylorivacA genotypes and their allelic subtypes in relation to pathogenicity and disease potential in children needs further studies.     

Nature and extent of gastric lesions in symptomatic Chilean children with Helicobacter pylori-associated gastritis

Chile has one of the highest rates of gastric cancer in the world and most children and adolescents in the country are colonized by Helicobacter pylori. This study assessed the nature and extent of the gastric lesions in 73 consecutive patients aged 5-17 y, referred for upper gastrointestinal endoscopy. Their H. pylori-associated gastric pathology was characterized and these data were compared with their sociodemographic status. Endoscopic assessment was normal in 43 patients while in 30 there was a variety of mucosal lesions. Sixty patients (83%) had histological chronic gastritis of the antrum and in 45 (63%) the lesions also involved the gastric corpus; 90% of patients with chronic gastritis were colonized by H. pylori. Although most of these patients had epithelial erosions and dedifferentiation of the pit epithelium, atrophy and metaplasia were not found. Patients' socioeconomic status was inversely correlated with their rate of colonization by H. pylori (p < 0.005), the frequency of gastric lesions on endoscopy (p < 0.01) and the frequency of involvement of antral and corpus mucosa by chronic gastritis (p < 0.002). This latter feature was positively correlated with age (p < 0.001). Conclusion: This study shows a high frequency of extensive lesions of H. pylori-associated chronic gastritis in young Chilean patients. This histological picture is consistent with the hypothesis of a H. pylori-associated progressive gastric pathology which may represent a major factor in the high local rate of gastric cancer.     

儿童结节性胃炎幽门螺杆菌耐药性分析

目的分析儿童结节性胃炎幽门螺杆菌(H.pylori)的耐药情况,探讨H.pylori耐药菌株的抗生素合理使用方法。方法 2013年1月至2014年6月因上消化道症状就诊行胃镜检查的结节性胃炎患儿473例,收集患儿的胃窦黏膜2块,分别行H.pylori快速尿素酶试验和培养。用琼脂稀释法和E-test法检测H.pylori对阿莫西林、克拉霉素、甲硝唑、莫西沙星和左氧氟沙星的耐药情况。结果 473例结节性胃炎患儿,258例H.pylori培养阳性,H.pylori菌株对阿莫西林、克拉霉素、甲硝唑、莫西沙星、左氧氟沙星的耐药率分别为6.2%、34.9%、49.2%、8.9%、5.0%。对克拉霉素和甲硝唑双重耐药率为23.3%。473例患儿中,405例家长有H.pylori感染。结论结节性胃炎是儿童H.pylori感染的一种特殊征象。H.pylori感染有明显家族聚集性。儿童结节性胃炎H.pylori对阿莫西林的耐药率较低,应作为根除H.pylori的主要药物;克拉霉素的耐药率较高,在H.pylori高耐药地区,应在药敏结果指导下实施三联抗H.pylori治疗。     

Long-term aspects of nodular gastritis in children

BACKGROUND: Close association of nodular gastritis and Helicobacter pylori infection has been initially proved by various studies. There have been some studies reporting microscopic and histologic recovery in a short time after eradication therapy. But there is not enough data about the long-term course of this condition. The aim of this study is to document current clinical conditions, presence of H. pylori and results of endoscopic and histologic examination, after a long-term period, in children with endoscopically diagnosed antral nodularity. METHODS: A total of 35 patients diagnosed as nodular antral gastritis by upper gastrointestinal endoscopy during a 2 year period, were invited for re-evaluation and re-endoscopy after 3 years. Histopathologically, H. pylori detected ones had been treated with standard triple eradication therapy. In total, 27 patients were accepted for enrollment in the study. Repeated endoscopy could be performed in all 27 patients. RESULTS: The persistence of antral nodularity was detected in 18 of 27 patients. Decrease in symptoms, absence of symptoms and presence of H. pylori infection were detected in 6, 8 and 16 (89%) of them, respectively. There was no statistical significance between the first and last endoscopic biopsies when activity, atrophy, intestinal metaplasia and presence of follicles were regarded. Malt lymphoma could not be detected in any of the patients. CONCLUSION: There is a strong association between nodular gastritis and H. pylori. Presence of antral nodularity in the long-term period may be related to H. pylori re-infection. New therapeutic approaches are required for treatment and management of the patients diagnosed as nodular gastritis and living in areas endemic for H. pylori infection.     

Histologic Findings in '“Ex– Helicobacter pylori'” Gastric Biopsies of Pediatric Patients

Long-term sequelae of Helicobacter pylori–associated chronic gastritis (HpCG) have been described in adult patients. In the present study we report the histology of gastric mucosa biopsies in 6 asymptomatic pediatric patients (5 male and 1 female; mean age 9.5 years) with previous HpCG. Preceding H. pylori was histologically proved and confirmed by culture, direct visualization, and/or serology before delivering treatment. In 5 of 6 cases the HpCG followed a protracted clinical course, with various therapeutic series needed before H. pylori eradication. Time from final treatment for HpCG to actual biopsy ranged from 3 months to almost 3 years. Gastric mucosa showed mild chronic gastritis with absence of H. pylori organisms (6 of 6), focal loss of gland units with collagenous replacement (6 of 6), serrated foveolae (3 of 6), regenerative changes at elongated glandular necks with cells having enlarged and hyperchromatic nuclei (5 of 6), lymphoid aggregates (2 of 6), and presence of sulfomucins in isolated epithelial cells of glands and foveolae (2 of 6). None of these features were noticed in 10 normal gastric mucosa biopsies used as controls. The referred findings in “ex– H. pylori” pediatric patients may represent very early sequelae from HpCG at this age.     

幽门螺杆菌与小儿慢性胃炎的研究

为探讨幽门螺杆菌（ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，Ｈｐ）与小儿慢性胃炎关系，应用细菌培养及组织病理学技术，对７３例具有消化道症状行胃镜检查患儿胃粘膜标本进行研究，并测定患儿血清抗幽门螺杆菌抗体ＨｐＩｇＧ、ＨｐＩｇＡ。结果显示，７３例患儿中Ｈｐ总检出率为３７％（２７／７３），在慢性胃炎者中检出率为４４％（２７／６１），与组织学检查正常者比较差异有非常显著意义（精确概率Ｐ＝０．００２１）；Ｈｐ的检出与胃粘膜炎症程度相关，表明Ｈｐ可能是慢性胃炎的一种致病因素。细菌学Ｈｐ阳性组和阴性组ＨｐＩｇＧ、ＨｐＩｇＡ抗体水平比较，阳性组高于阴性组，差异有非常显著意义（ｔ＝６．９３６，Ｐ＜０．０１）。提示与胃粘膜Ｈｐ检查相对照，ＨｐＩｇＧ有较好的敏感性、特异性，有助于Ｈｐ感染的诊断，ＨｐＩｇＡ抗体水平在两组间重叠较多。