儿童腺病毒肺炎防治进展

腺病毒肺炎是儿童病毒性肺炎常见的感染类型,具有呼吸道症状明显、易发展为重症肺炎、并发症多、病死率高等特点.迄今为止,对腺病毒仍缺乏有效的抗病毒药物.因此,了解儿童腺病毒肺炎流行病学特点,对于预防病毒性肺炎发生、降低群体发病率、减少重症患者发生率尤为重要.本文就近年来儿童腺病毒肺炎的流行特点、治疗进展及预防措施进行概述.     

腺病毒肺炎患儿发生重症的影响因素分析

目的 分析腺病毒肺炎患儿发生重症的危险因素,以期达到早期识别、针对性治疗、提高疗效的目的。方法选取2019年5月至10月柳州市妇幼保健院收治的97例腺病毒肺炎患儿作为研究对象,回顾性分析其重症肺炎的发病率及相关危险因素。结果 97例腺病毒肺炎患儿中诊断为重症肺炎者29例,占29.9%。单因素分析显示,重症肺炎和非重症肺炎患儿的年龄、发热时间、基础疾病、肺部实变、合并细菌感染、血红蛋白比较,差异有统计学意义（P<0.05）。多因素logistic分析结果显示,年龄≤2岁（P=0.006,OR=9.003,95%CI:1.892～42.829）、肺部影像学提示肺部实变（P<0.001,OR=29.704,95%CI:6.284～142.305）的是发生重症肺炎的独立危险因素。结论 腺病毒肺炎患儿应根据自身情况进行个性化干预,尤其对于年龄≤2岁、肺部实变的患儿应给予更多关注。     

儿童重症腺病毒肺炎研究进展

腺病毒感染在小儿呼吸道感染中占12％～20％[1],6个月～5岁儿童多见,其中部分发展为重症.腺病毒具有较广泛的组织易噬性,除累及呼吸系统外,还可引起咽结膜热、脑炎、肝炎、心肌炎、胃肠炎、尿路感染等,免疫功能不全患者可出现严重的侵袭性感染.重症腺病毒肺炎病情进展快,病死率高,腺病毒是导致肺炎患儿死亡的首要病原,部分存活患儿预后不良,14％～60％可遗留不同程度的后遗症[2].本文就重症腺病毒肺炎相关研究进展作一综述.     

冬春季儿童肺炎感染病原分析

目的：分析冬春两季儿童肺炎感染病原学构成,为儿童肺炎的防治提供依据。方法以我院2013年11月-2014年4月肺炎患儿1943例为研究对象,进行痰培养、7种呼吸道病毒抗原及巨细胞病毒、肺炎支原体、肺炎衣原体检测,并对检测结果进行回顾性分析。结果1943例肺炎患儿中,病原阳性946例,阳性率48.7%,感染病原中病毒感染633例（66.9%）,细菌感染195例（20.6%）,支原体感染147例（15.5%）,衣原体感染39例（4.1%）,混合感染221例（23.4%）。病毒感染以呼吸道合胞病毒阳性率最高（62%）,其次是巨细胞病毒（30.2%）,流感/副流感（9.3%）,腺病毒（5.5%）。细菌病原以肺炎链球菌最多见（12.5%）,其次为流感嗜血杆菌（9.8%）。1岁以下肺炎感染病原阳性率（64.8%）高于其他年龄段,以RSV、CMV感染为主,肺炎支原体是3岁以上儿童肺炎主要感染病原。重症肺炎218例,病原阳性146例,阳性率67.0%,以RSV感染为主,占62.2%,重症肺炎混合感染多,占24.3%。结论儿童肺炎发病以1岁以下儿童常见,病毒是冬春两季儿童肺炎最常见感染病原,且主要以RSV感染为主,多种病原混合感染率高,尤其是重症肺炎更为明显。     

儿童细菌性重症肺炎病原菌的临床分析

目的:对儿童细菌性重症肺炎的病原菌及药物敏感结果进行分析,以指导临床合理使用抗生素。方法:对重庆医科大学附属儿童医院重症监护室(PICU)2005年1月～2008年12月儿童细菌性重症肺炎的病原菌及药敏结果进行回顾性分析。结果:166例重症肺炎患儿中痰菌培养阳性者70例,检出率为42.16%。共检出病原菌102株,其中革兰阴性杆菌61株,占59.8%,以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌为主;革兰阳性球菌51株,占40.2%,以金黄色葡萄球菌、肺炎链球菌为主。药敏结果显示各种病原菌对青霉素类及头孢类抗生素有较高的耐药率,而对亚胺培南-西司他丁(泰能)有较高的敏感率,达80%以上,革兰阳性球菌对万古霉素敏感率达85%以上。结论:革兰阴性菌是小儿重症肺炎的主要致病菌,故重症肺炎早期治疗的抗生素应选用碳青霉烯类、第四代头孢菌素和加有β-内酰胺酶抑制剂的第三代头孢菌素。     

小剂量肝素治疗婴幼儿重症肺炎

肺炎是5岁以下儿童死亡的首位疾病,重症肺炎84·5%属危重症病例。在寒冷地区发病率与死亡率更高,重症肺炎占婴幼儿危重症的45·3%,列首位,病死率高达21·97%。最近全球统计资料表明:每年5岁以下小儿死亡1000万,发展中国家占99%。70%由感染引起,其中肺炎占感染因素的首位,每年肺     

西多福韦治疗重症腺病毒肺炎患儿1例

世界卫生组织资料显示,2016年肺炎造成92万5岁以下儿童死亡,其中98%来自发展中国家。肺炎也是当前我国5岁以下儿童死亡的主要原因之一,其中绝大部分儿童肺炎为社区获得性肺炎(CAP)。CAP中重症难治性支原体肺炎和腺病毒肺炎等遗留的气道闭塞,是造成儿童患慢性气道疾病、影响生命质量的重要原因。     

呼吸道合胞病毒肺炎的探讨

1989午3～5月,二个月时间,对住院102例支气管肺炎,随机抽样75例,重点的研究了合胞病毒肺炎。证实了14例占18.7%为合胞病毒肺炎,己有2例占2.6%为腺病毒肺炎,腺病毒肺炎与三年前同期相比由24%降低到2.6%。由此可见腺病毒肺炎发病率明显下降,而合胞病毒肺炎有占优势的趋向。     

肺炎支原体肺炎患儿血清干扰素-γ白细胞介素-6及白三烯水平的变化

<正>肺炎支原体肺炎(MPP)是儿童常见的非典型肺炎,好发于学龄儿童,其发病率近年来有明显增高的趋势,且发病年龄有逐年减小趋势,非流行年间肺炎支原体(MP)感染约占小儿肺炎病原的10%~20%,流行年份则高达30%以上[1]。MP已成为中国儿童呼吸道感染的重要病原,是儿童社区获得性肺炎的常见病原体之一。MPP与儿童慢性咳嗽、支气管哮喘的发病密切相关,少数病例甚至可发展为闭塞性细支气管炎,还可以出现多种肺外并发症,严重危害儿童健康。本研究     

静脉用丙种球蛋白辅助治疗小儿重症腺病毒肺炎的临床效果

目的 探讨静脉用丙种球蛋白辅助治疗小儿重症腺病毒肺炎的临床效果.方法 收集本院儿科病房2014年1～9月共80例诊断为重症腺病毒肺炎的儿童为研究对象,按随机数字表法分为研究组和对照组各40例.两组患者均予抗病毒和(或)抗生素治疗以及对症治疗,研究组在上述治疗基础上加用丙种球蛋白.比较两组的机械通气时间、住院期间并发症发生率及临床疗效.结果 研究组机械通气时间短于对照组、住院期间并发症发生率低于对照组、治疗总有效率高于对照组,差异有统计学意义(P＜0.05).结论 丙种球蛋白配合抗病毒治疗重症腺病毒肺炎不仅可缩短机械通气时间,减少并发症的发生,还可提高治疗效果.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.