肠道病毒与小儿髋关节滑膜炎病因的研究

目的研究小儿髋关节滑膜炎与肠道病毒,特别是柯萨奇B组病毒(coxsarievivus CVB)感染的关系.方法采用酶联免疫吸附试验(ELISA法)对162例小儿髋关节滑膜炎患儿静脉血和其中的21例关节腔液进行特异性病毒IgM抗体检测,CVB阳性者进行血清学分型及病毒分离.结果在162例静脉血样本中特异性IgM阳性62例,占总检数的38.27%,CVB-IgM26例占16.05%,腺病毒(adenovirus, AdV)-IgM19例占11.73%,巨细胞病毒(cytomegalovirus,CMV)-IgM10例占6.17%,呼吸道合胞病毒(respiratory syncytial virus, RSV) - IgM4例占2.47%;在关节腔液中检出9例CVB阳性,血清学分型8例为CVB3,1例为CVB4,并分离出1例CVB3.结论 CVB是小儿髋关节滑膜炎感染的主要病毒,而且以CVB3为主.     

儿童暂时性髋关节滑膜炎与肠道病毒感染关系的研究

本研究旨在探讨儿童暂时性髋关节滑膜炎与肠道病毒感染的关系 ,现将结果报道如下。一、材料与方法武汉市儿童医院 1 998年 5月～2 0 0 0年 3月收治的患儿 1 62例 ,其中男91例 ,女 71例 ,年龄 9个月～ 1 3岁。患儿入院当日取静脉血 ,部分取关节腔液 1～ 2ｍｌ,作腺病毒 (ＡｄＶ)、巨细胞病毒(ＣＭＶ)、呼吸道合胞病毒 (ＲＳＶ)、柯萨奇病毒Ｂ组 (ＣＶＢ) 1 6型特异性ＩｇＭ抗体检测 ,酶联免疫吸附法ＣＶＢ1 6分型诊断试验 ;关节腔液经无菌取样后 ,在湖北省医学科学院病毒所作病毒分离并鉴定。二、结果在受检的 1 62例患儿血液标本中 ,共检…     

肝移植术后巨细胞病毒感染的防治研究

目的探讨肝移植患者术后巨细胞病毒 (CMV)感染情况及其与急性排斥反应的关系。方法应用PCR和ELISA方法检测 78例肝移植受体手术前后、78例供体及 70例接受上腹部手术的非肿瘤患者血清中的CMV DNA和CMV抗体 ,用免疫组织化学方法检测肝组织中CMV抗原。结果供、受体术中肝脏活体组织学检查的CMV早期抗原 (EA)和晚期抗原 (LA)全部为阴性。术前CMV DNA或CMV IgM阳性的受体术后均为阳性 ;术前CMV DNA或CMV IgM阴性的受体术后CMV DNA或CMV IgM转为阳性的分别有 2 6 %和 10 %。 78例受体CMV DNA阳性率由术前的 5 %增加到术后的 31% ,两者比较差异有显著意义 (P <0 0 5 )。 2 6例患者发生了 33次急性排斥反应 ,16次 (49% )CMV DNA检测阳性、11次 (33% )CMV IgM检测阳性 ,而在术后常规检测血CMV DNA和CMV IgM的阳性率分别不超过 13%和 9% ,两者比较差异有显著意义 (P <0 0 5 )。 2 6例发生急性排斥患者肝脏活体组织学检查CMV EA和CMV LA阳性者均为 9例 (2 7% ) ,与术后的常规肝脏穿刺结果比较差异有显著意义 (P <0 0 5 )。结论 1.肝移植术后CMV感染率明显升高。 2 .CMV感染可能是发生急性排斥反应的危险因素。 3.发生急性排斥反应时 ,应使用抗CMV药物 ;未感染CMV的受体接受感染供体的肝脏时应预防用药。     

病毒感染与新生儿肾损害的临床研究

目的：研究新生儿巨细胞病毒（CMV）,单纯疱疹病毒（HSV）,柯萨奇病毒（COXV）对肾脏影响。方法：用荧光定量聚合酶链反应（FQ－PCR）检测CMV,HSV,COXV,用尿N－乙酰β-D－氨基葡萄糖苷酶（NAG）,尿补体C3,α2巨球蛋白（α2－M）,尿分析,血尿素氨（BUN）,肌酐（Cr)指标检测肾功能,对76例病毒感染（感染组）,20例非病毒感染（对照组）进行比较分析。结果：感染组尿NAG酶显高于对照组（P＜0．01）,尿NAG酶变化与血基因拷贝数呈正相关（P＜0．01）,19例尿FQ－CMV－PCR阳性血基因拷贝数显高于阴性（P＜0．01）,前尿NAG酶显高于后（P＜0．01）,尿C3,α2－M,尿分析,血BUN,Cr两组对比无显差异（P＞0．05）,结论：新生儿病毒感染可引起肾损害,早期以肾小管功能损害为主,临床上应予重视。     

实时荧光定量聚合酶链式反应在获得性免疫缺陷综合征合并水痘-带状疱疹病毒感染中的应用

目的研究水痘-带状疱疹病毒（VZV）核酸检测技术对获得性免疫缺陷综合征（AIDS）合并带状疱疹的诊断价值。 方法收集AIDS合并带状疱疹患者的血液和疱疹液，进行病毒DNA检测，同时进行血清抗-VZV IgM及T细胞亚群检测。 结果纳入AIDS合并带状疱疹患者共32例，入组患者疱疹液VZV DNA检测均为阳性，其中28例患者血液VZV DNA检测为阳性；仅有7例AIDS患者血清抗-VZV IgM阳性；疱疹液VZV DNA载量显著高于血液VZV DNA水平，差异有统计学意义（t = 3.173、P = 0.0032），血液及疱疹液VZV DNA检测阳性率显著高于血清抗-VZV IgM检测阳性率（87.5%、100% vs. 21.8%，P < 0.001）。 结论VZV核酸检测技术对于AIDS合并水痘-带状疱疹病毒感染的病原学诊断具有重要价值。     

手足口病患儿T淋巴细胞亚群检测和分析

手足口病是一种常见的儿童传染病,全年均可发生,但多流行于夏秋季节。本病多发生于5岁以下的婴幼儿,可引起发热和手、足、口腔等部位的皮疹和溃疡,个别可引起心肌炎、肺水肿等致命性并发症,流行时可出现较高病死率H引。该病的病原主要为小RNA病毒科,柯萨奇病毒（A组16、4、5、7、9、10型及B组2、5、13型）,埃可病毒和肠道病毒71型,其中以柯萨奇病毒A16型及肠道病毒71型最为常见。     

异基因造血干细胞移植后巨细胞病毒的检测及临床意义

目的 为了降低异基因造血干细胞移植（allo-HSCT）后巨细胞病毒（CMV）感染的相关死亡率，寻求一种更快捷、更特异的诊断CMV感染的分子生物学方法。方法 2001年4月至2003年4月，从79例接受异基因造血干细胞移植的患者中采集了135份外周血标本。采用巢式聚合酶链反应（nested-PCR）方法检测患者外周血中CMVgB DNA，阳性标本做酶切分型，部分行序列测定。结果CMVgB DNA检测中有42例患者（53．9％）的66份标本（48．9％）阳性；对其中阳性患者的45份标本进行了酶切分型，结果 CMV gB1型21例（46．7％），CMV gB2型14例（31．1％），CMV gB3型7例（15．6％），CMV gB4型3例（6．7％）。先后有2种型别的CMV感染者有3例（3．8％）。经分析，CMV gB阳性和CMV gB阴性患者GVHD的发生率分别为81．0％和32．4％（P＜0.01）；CMV gB1、gB2、gB3以及gB4型Ⅱ～Ⅳ度急性GVHD及慢性GVHD的发生率分别为：81．0％、50．0％、42．9％和0。结论 Nested-PCR方法可快捷特异地检测CMV感染。CMVgB1、2型中，重度急性GVHD和慢性GVHD发生率较高。CMV gB基因分型检测可有效地指导临床抗病毒治疗，且对移植后患者的临床转归有一定的预测价值。     

医用臭氧治疗髋关节滑膜炎疗效分析

目的观察医用臭氧对髋关节滑膜炎的治疗效果。方法将57例髋关节滑膜炎患者随机分为两组,试验组32例患者采用髋关节穿刺抽液后医用臭氧5mL关节腔注射;对照组25例患者采用髋关节穿刺抽液后2%利多卡因1mL＋利美达松1mL混合液关节腔注射。结果试验组总有效率为90.6%（29/32）,对照组总有效率为92.0%（23/25）,两组比较差异无统计学意义（P〉0.05）。结论医用臭氧治疗髋关节滑膜炎是一种安全有效的治疗方法。     

肾移植术后口服伐昔洛韦预防巨细胞病毒性肺炎的观察

目的探讨口服伐昔洛韦（valaciclovir）预防肾移植术后巨细胞病毒（CMV）性肺炎的有效性和安全性。方法前瞻性研究121例肾移植的临床资料，其中供、受者血清CMV-IgG均为阳性（D＋R＋组）肾移植63例，供者血清CMV-IgG阳性、受者血清CMV-IgG阴性（D＋R-组）肾移植58例。上述两组受者随机再分为预防组和对照组，预防组口服伐昔洛韦，对照组不给予抗病毒药物。观察肾移植术后1年内CMV性肺炎的发生率。结果预防组的受者对口服伐昔洛韦有良好的耐受性。预防组CMV性肺炎发生率为8．06％，对照组为22．03％，两组比较，差异有统计学意义（P〈0．05）。结论对供者血清CMV-IgG阳性、受者血清CMV-IgG阴性或供、受者血清CMV-IgG均为阳性的肾移植，受者预防性口服伐昔洛韦可以安全有效地降低术后CMV性肺炎的发生率。     

肾移植术后巨细胞病毒感染的早期诊断与治疗

目的:提高肾移植术后巨细胞病毒(CMV)感染的早期诊断率和治愈率.方法:1999年3月～2003年12月共收治152例次肾移植患者,对其中所发生的16例CMV感染患者资料进行回顾性分析.结果:根据外周血CMV IgM阳性和(或)外周血巨细胞病毒抗原(CMV-Ag)阳性诊断为巨细胞病毒活动性感染.16例肾移植术后CMV感染患者的早期临床表现不典型,一旦出现高热、干咳等症状则很快出现呼吸衰竭,对上述患者进行多次痰细菌培养及血巨细胞病毒抗体检查,结果均呈阴性5例,单纯CMV感染4例,CMV并发细菌感染6例,CMV并发真菌感染3例,CMV并发寄生虫感染1例,胸片提示为肺间质性病变12例.经治疗后治愈11例,5例死亡.结论:①CMV感染为肾移植患者术后的主要死亡原因之一.②及早诊断与早期联合治疗可提高CMV感染的治愈率.③肾移植术后CMV感染在早期抗病毒、抗细菌、抗真菌治疗同时,减少或暂停免疫抑制剂,有利于提高感染的治愈率.     

Transient synovitis of the hip joint in children]

Etiology, pathology, clinical and radiological symptoms, and course of transient synovitis of the hip was discussed on the basis of authors observation of 144 children as well as on literature. It was found that unloading the joint by staying in bed with slightly flexed hip led to subsidence of pain and return of full range of movement in 10 to 21 days. Only in older children the symptoms may persist 4 to 5 weeks. Permanent consequences of transient synovitis of the hip as elongation of the extremity and coxa magna in X-ray pictures are rarely observed. Transient synovitis of the hip seems not to have etiological links with Perthes disease.     

Transient synovitis of the hip. Its incidence, epidemiology and relation to Perthes' disease

In a prospective five-year study, 294 episodes of acute transient synovitis of the hip were diagnosed in 275 children. The average annual incidence was 0.2% and the accumulated risk of suffering at least one episode was 3%. The risk of recurrence was 20 times greater than the risk of having a single episode. Perthes' disease was diagnosed from one to five months after the acute attack of synovitis in 10 cases (3.4%). Review of the initial radiographs revealed signs of avascular necrosis in three of the 10 cases, and an increased joint space in five. Only two cases had had completely normal radiographs. The value of routine radiographs taken after three months was minimal. Factors associated with the incidence of Perthes' disease included prolonged time in traction before the range of hip movement became normal, increase in joint space on the initial radiographs and the recurrence of hip symptoms after initial relief.     

Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm

BACKGROUND: A child who has an acutely irritable hip can pose a diagnostic challenge. The purposes of this study were to determine the diagnostic value of presenting variables for differentiating between septic arthritis and transient synovitis of the hip in children and to develop an evidence-based clinical prediction algorithm for this differentiation. METHODS: We retrospectively reviewed the cases of children who were evaluated at a major tertiary-care children's hospital between 1979 and 1996 because of an acutely irritable hip. Diagnoses of true septic arthritis, presumed septic arthritis, and transient synovitis were explicitly defined on the basis of the white blood-cell count in the joint fluid, the results of cultures of joint fluid and blood, and the clinical course. Univariate analysis and multiple logistic regression analysis were used to compare groups. A probability algorithm for differentiation between septic arthritis and transient synovitis on the basis of independent multivariate predictors was constructed and tested. RESULTS: Patients who had septic arthritis differed significantly (p < 0.05) from those who had transient synovitis with regard to the erythrocyte sedimentation rate, serum white blood-cell count and differential, weight-bearing status, history of fever, temperature, evidence of effusion on radiographs, history of chills, history of recent antibiotic use, hematocrit, and gender. Patients who had true septic arthritis differed significantly (p < 0.05) from those who had presumed septic arthritis with regard to history of recent antibiotic use, history of chills, temperature, erythrocyte sedimentation rate, history of fever, gender, and serum white blood-cell differential. Four independent multivariate clinical predictors were identified to differentiate between septic arthritis and transient synovitis: history of fever, non-weight-bearing, erythrocyte sedimentation rate of at least forty millimeters per hour, and serum white blood-cell count of more than 12,000 cells per cubic millimeter (12.0 x 10(9) cells per liter). The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized as less than 0.2 percent for zero predictors, 3.0 percent for one predictor, 40.0 percent for two predictors, 93.1 percent for three predictors, and 99.6 percent for four predictors. The chi-square test for trend and the area under the receiver operating characteristic curve indicated excellent diagnostic performance of this group of multivariate predictors in identifying septic arthritis. CONCLUSIONS: Although several variables differed significantly between the group that had septic arthritis and the group that had transient synovitis, substantial overlap in the intermediate ranges made differentiation difficult on the basis of individual variables alone. However, by combining variables, we were able to construct a set of independent multivariate predictors that, together, had excellent diagnostic performance in differentiating between septic arthritis and transient synovitis of the hip in children.     

The role of ultrasound in differentiating septic arthritis from transient synovitis of the hip in children

A total of 154 children admitted with septic arthritis (n=81) or transient synovitis (n=73) were studied retrospectively. Ultrasound findings for 127 patients were correlated with the final diagnosis. Sensitivity, specificity and positive predictive value of ultrasound for the diagnosis of pediatric septic hip were 86.4, 89.7 and 87.9%, respectively. Unsatisfactory outcome occurred more significantly in children, for whom treatment was initiated more than 4 days after the onset of symptoms and those who had a false-negative ultrasound study. Ultrasound cannot be used safely to distinguish between pediatric septic hip and transient synovitis. It may be a method of value to detect minimal hip effusion. A predictive algorithm using clinical, laboratory and ultrasound findings could be beneficial.     

Transient ischaemia of the proximal femoral epiphysis in the child. Interpretation of bone scintimetry for diagnosis in hip pain

99mTc-MDP-scintimetry was performed in 25 consecutive cases of radiographically silent transient synovitis of the hip in children. Fourteen cases had normal scintimetry; seven cases had an increased uptake in the epiphysis; four cases had markedly defective uptake in the epiphysis, indicating interrupted vascular supply. At repeat scintimetry 6 weeks later, the uptake was normal or increased in three of these four cases; the one case with a persistent defect was the only case in this series who later developed radiographic evidence of Legg-Calvé-Perthes' disease. In some cases presenting with clinical symptoms of synovitis of the hip, there is a transient, spontaneously recovering ischaemia of the proximal femoral epiphysis, not followed by radiographic evidence of necrosis. This should be considered in attempts to make a pre-radiographic diagnosis of Legg-Calvé-Perthes' disease by radionuclide methods.     

Transient ischaemia of the proximal femoral epiphysis in the child: Interpretation of bone scintimetry for diagnosis in hip pain

^99mTc-MDP-scintimetry was performed in 25 consecutive cases of radiographically silent transient synovitis of the hip in children. Fourteen cases had normal scintimetry; seven cases had an increased uptake in the epiphysis; four cases had markedly defective uptake in the epiphysis, indicating interrupted vascular supply. At repeat scintimetry 6 weeks later, the uptake was normal or increased in three of these four cases; the one case with a persistent defect was the only case in this series who later developed radiographic evidence of Legg-Calvé-Perthes' disease.

In some cases presenting with clinical symptoms of synovitis of the hip, there is a transient, spontaneously recovering ischaemia of the proximal femoral epiphysis, not followed by radiographic evidence of necrosis. This should be considered in attempts to make a pre-radiographic diagnosis of Legg-Calvé-Perthes' disease by radionuclide methods.     

Scintimetry in transient synovitis of the hip in the child

Fifty-five consecutive children presenting with transient synovitis of the hip were examined with 99mTc-MDP scintigraphy and pin-hole collimator technique. Quantitative assessment was performed along a profile of interest across the hip joint. The criteria for the normal scintimetric pattern in the child's hip were established and the pathologic pattern of uptake in the acute phase, as well as in the follow-up after synovitis, was described. A decrease in isotope uptake in the proximal femoral epiphysis was observed in 13 children. This was correlated with a reduced uptake in the growth-plate, indicating a disturbance of blood supply to these regions. A characteristic pattern of isotope uptake with duration of symptoms was observed: a decrease in uptake during the first week followed by rebound hyperemia within 1 month. One child developed osteonecrosis (Legg-Calvé-Perthes disease).     

Significance of laboratory and radiologic findings for differentiating between septic arthritis and transient synovitis of the hip

Although significant differences exist in the methods of treatment and prognoses of septic coxitis and transient synovitis in children complaining of acute hip pain, similar symptoms are present in these two diseases at the early stages, and differential diagnosis is difficult. To differentiate between these two diseases, the authors evaluated the clinical, serologic, and radiologic findings and tried to determine factors that could be used as diagnostic criteria. The authors performed a retrospective study by evaluating medical records, plain hip radiographs, and clinical findings in 97 patients with transient synovitis and 27 patients with septic arthritis. Univariate analysis showed significant differences in body temperature, serum WBC count, and ESR and CRP levels of the two patient groups. Plain radiographs showed a displacement or blurring of periarticular fat pads in all patients with acute septic arthritis, and multivariate regression analysis showed that body temperature >37 degrees C, ESR >20 mm/h, CRP >1 mg/dL, WBC >11,000/mL, and an increased hip joint space of >2 mm were independent multivariate predictors of acute septic arthritis. The authors conclude that the independent multivariate predictors are effective indices for the differential diagnosis of acute septic coxitis and transient synovitis.     

The limping child: epidemiology, assessment and outcome

We investigated the epidemiology, assessment and outcome of acute atraumatic limp in 243 children under the age of 14 years presenting to a paediatric accident and emergency department (AED) over a period of six months. Data were collected at presentation and medical notes were re-examined after 18 to 21 months. The incidence of limp was 1.8 per thousand. The male:female ratio was 1.7:1 and the median age 4.35 years. Limp was mainly right-sided (54%) and painful (80%); 33.7% of the children had localised pain in the hip. A preceding illness was found in 40%. The main diagnosis was 'irritable hip'/transient synovitis (39.5%); Perthes' disease accounted for 2%. Most patients (77%) were managed entirely in the AED. Acute atraumatic limp is a common problem in children presenting to the AED. Most can be safely managed there if guidelines are followed and will have a benign outcome. Further studies are needed to identify the role of preceding illness in the aetiology of acute atraumatic limp.     

Intracapsular pressure in transient synovitis of the hip

Fourteen consecutive children with symptoms of transient synovitis of the hip were examined with sonography regarding intracapsular effusion, with scintimetry regarding blood-flow in the proximal femoral epiphysis (PFE) and with intracapsular pressure recording and aspiration. All patients had an intracapsular effusion. Intracapsular pressure was found to depend on the position of the hip. The mean pressure with hips in extension and inward rotation was 22.6 kPa (170 mm Hg) whereas in 45 of flexion it was 2.3 kPa. In two cases scintimetry demonstrated reduced blood flow to the PFE; after aspiration, isotope uptake returned to normal, indicating that increased intracapsular pressure has a harmful effect on circulation to the PFE.

Children with transient synovitis should be treated with the hips in 45 of flexion to reduce intracapsular pressure. Forcing the hip in extension causes a risk of ischaemia of the PFE.