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目的比较儿科消化专业临床常用的几种H·pylori诊断方法的准确性,并对新的快速血液学诊断法作考核和评价。方法对2004-12—2005-03上海交通大学医学院附属瑞金医院儿内消化专科门诊100例3~16岁患儿做胃镜检查、13C-UBT、胃镜检查时在胃窦部取黏膜组织作尿素酶试验、组织学检查,并同时抽血做H·pylori抗体测定。结果100例患儿中,55例感染H·pylori(感染率为55%),尿素酶、组织学、13C-UBT、血金标法的敏感性分别为:81·48%、75·93%、96·30%、94·50%,特异性为86·96%、80·43%、100%、91·11%。金标法血清与全血测定结果显示敏感性、特异性几乎相同。结论尿素酶试验和组织学检查能直接检测胃黏膜中的H·pylori,有较高的敏感性与特异性,但需经胃镜取胃黏膜才能完成。13C-UBT能反映全部胃黏膜的感染情况,敏感性、特异性最高,是目前临床诊断的金标准之一,且非侵入性。血液金标法检测,操作方便,仅需1滴血,便可反映出H·pylori的感染状况,可作为H·pylori的流行病学检查及筛查。     

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晕厥(syncope)是指由于大脑一过性供血不足所致的短暂性意识丧失,常伴有肌张力丧失而不能维持自主体位。接近晕厥(pre-syncope)指一过性黑矇,肌张力丧失或降低,但不伴意识丧失。晕厥和近乎晕厥是儿童和青少年的常见病症,可由许多原因引起。女孩比男孩发病率高。在青少年发病的高峰年龄为15～19岁。约有15%的18岁前儿童及青少年发生过至少1次晕厥。而且晕厥患儿占所有儿科急诊患儿的1%。一项在平均年龄为20岁的医学生     

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??Objective To observe the changes of red cell distribution width ??RDW?? in children with heart failure secondary to dilated cardiomyopathy??DCM????and to explore the correlations between RDW and the common parameters of cardiac function. Methods Totally 68 children with heart failure secondary to DCM were enrolled. According to the modified Ross scoring system??the children were divided into 3 subgroups?? mild??moderate and severe heart failure subgroups. Fifty healthy children were selected as control group. RDW levels were compared among the groups. The correlation analysis was performed between RDW and plasma N-terminal brain natriuretic peptide ??NT-proBNP??as well as left ventricular ejection fraction??LVEF??. Results RDW levels in children with heart failure secondary to DCM were significantly higher than the control group ??P??0.01??.With increasing heart failure grade??NT-proBNP levels were elevated gradually and LVEF were decreased gradually ??both P??0.01????RDW levels had no significant difference among the heart failure groups??P??0.05??. RDM was not correlated with NT-proBNP or LVEF??r??0.144??r??-0.158??P??0.05??. Conclusion In children with DCM??RDW can be used as a new diagnostic marker of heart failure??but it can not reflect the severity of heart failure.     

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??Objective??To investigate the change of the platelet state and function in acute lymphocytic leukemia. Methods??The changes of platelet indices??PLT??PCT??MPV??PDW????immature platelet fraction??IPF%????immature platelet counts??IPC????granule membrane glycoprotein of platelet ??CD62p?? and PAC-1 were obtained by using automatic blood cell analyzer and whole blood flow cytometry??FCM?? respectively??in children with acute lymphocytic
leukemia??ALL????ALL in first complete remission ??ALL-CR1?? and children undergoing elective surgical procedure??control group??. Results????1??Without addition of platelet agonists ADP??expression of platelet surface activated CD62p and PAC-1 in ALL was higher than that in control group??P??0.05????while expression of platelet surface activated PAC-1 in ALL-CR1 was higher than that in control group??P??0.05????and lower than that in ALL??P??0.05??????2??With addition of platelet agonists ADP??expression of platelet surface activated CD62p and PAC-1 in ALL was lower than that in control group??P??0.05????while expression of platelet surface activated PAC-1 in ALL-CR1 was lower than that in control group??P??0.05????and higher than that in ALL??P??0.05??????3?? PLT??PCT and MPV in ALL was lower than that in control group and ALL-CR1 ??P??0.05??????4?? IPF% in ALL was higher than that in control group and ALL-CR1??P??0.05????and IPC was lower than that in control group and ALL-CR1??P??0.05??. Conclusion??The children who are newly diagnosed with acute lymphocytic leukemia have peripheral platelet reactivity and platelet function defects. Platelet indices and platelet membrane glycoprotein can be used as effective indicators to judge the effect on ALL.     

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目的评价胶囊内镜检查在儿科应用的有效性和安全性。方法对2007年9月至2010年12月福建医科大学附属漳州市医院28例临床疑诊小肠疾病的患儿进行胶囊内镜检查。观察胶囊内镜通过胃的平均时间、通过小肠的平均时间、成功率和失败率、小肠病变检出率及患儿的耐受性和并发症。结果 28例患儿均成功吞服胶囊内镜并完整排出,检查过程患儿耐受良好。胶囊内镜通过胃的时间20～280min(中位数64min),通过小肠的时间93～380min(中位数255min),检出病变20例(20/28,71.43%)。结论对疑诊小肠疾病,胶囊内镜检查是的一种有效和安全的方法。     

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??Objective To investigate the effect and safety of single dose of dezocine for anesthesia in children with cyanotic complex congenital heart disease on cardiac catheterization??and compare it with ketamine. Methods Sixty-four children with cyanotic complex congenital heart disease undergoing cardiac catheterization??under 6 years old?? between January 2014 and April 2015 in the First Hospital of Tsinghua University were randomly divided into intravenous dezocine??0.2 mg/kg?? group ??group D??n = 32?? and intravenous ketamine??2.0 mg/kg?? group ??group L??n = 32?? as soon as arriving at OR. All patients were inserted the laryngeal mask??LMA??after the same intravenous induction and the initial end-tidal concentration of sevoflurane was 2.0% to 2.5%. The time to lose consciousness??T1????mask assisted ventilation time??T2????anesthesia recovery time??T3????and such adverse reactions as airway spasm??respiratory depression??dysphoria??pain??nausea and vomiting were recorded. Results T1 of group D was significantly longer than that of group L??P??0.05??. T3 of group D was significantly shorter than that of group L??P??0.05??. The cases whose drop of SPO2 during induction and after extubation was greater than 20% and who needed suction more than twice in group D were fewer than in group L??P??0.05??. Conclusion Single dose dezocine of 0.2 mg/kg can be safely used in children with cyanotic complex congenital heart disease on cardiac catheterization??providing satisfactory sedation and analgesia??and the incidence of airway adverse reaction is lower than that of ketamine.     

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目的初步了解肠道病毒(EV)在小儿急性呼吸道感染(ARI)中的流行概况。方法2003-09—2005-04,于首都儿科研究所就诊的815例ARI患儿,取其鼻咽深部分泌物,用病毒分离及逆转录聚合酶链反应(RT-PCR)法检测EV,用病毒分离和间接免疫荧光法检测呼吸道合胞病毒(RSV)等7种呼吸道病毒。取144例患儿双份血清,用酶联免疫吸附试验检测EV抗体。结果病毒总检出率50.9%,RSV阳性率最高(24.9%),其次为EV(16.9%)。EV在不同月份阳性率为0~34.2%,冬季阳性率最低。RT-PCR、双份血抗体检测和病毒分离3种检测EV方法的阳性率分别为16.2%、7.6%和1.0%。332例急性喘息患儿中,EV阳性率20.8%,仅次于RSV(42.5%);3岁以上喘息患儿中,EV阳性率最高(33.9%),而3岁以下患儿中,RSV阳性率最高(48.7%)。结论在住院ARI患儿中,EV是仅次于RSV的常见病原,也是引起小儿急性喘息性疾病的主要病原之一。EV在年长儿中阳性率相对较高,冬季阳性率较低。RT-PCR法检测EV,快速、敏感、特异,可用于小儿EV感染的诊断。     

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目的 了解昆明地区呼吸道合胞病毒(RSV)在小儿急性下呼吸道感染中的发生率和临床特征.方法 对昆明市儿童医院2006年4月至2007年4月临床诊断为急性下呼吸道感染的住院患儿1112例行痰间接免役荧光法检测呼吸道合胞病毒抗原.结果 1112例标本中,阳性276例,阳性率24.82%,其中男190例(17.09%),女86例(7.73%),男女发病比例为2.21∶1.全年均可检出RSV,发生率最高的是10～12月份(30.15%),最低的是4～6月份(10.93%).RSV感染多见于3岁以下,尤以6个月以下患儿感染率最高(36.22%).结论 呼吸道合胞病毒是引起昆明地区小儿急性下呼吸道感染的主要病原,特别是婴幼儿感染率最高.     

重视儿童继发性肾损害的临床研究

近十多年来,我国儿童继发性肾损害有增多趋势,目前在这一领域的研究较原发性肾疾病相对薄弱。因此在重视研究儿童原发性肾脏疾病的同时, 也应关注继发性肾损害的研究。现从临床上常见继发于系统性疾病的肾损害、感染后肾损害及药物性肾损害三方面讨论目前我国儿童继发性肾损害的研究现状及展望。     

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随着糖尿病发病率增高,糖尿病肾小球硬化症(简称糖尿病肾病Diabetic Nephropathy,DN)病例也日益增多,DN是慢性肾病(Chronic Kidney Disease,CKD)和终末期肾病(End-Stage Renal Disease,ESRD)常见原因之一。DN导致ESRD比例逐年升高。据美国糖尿病协会(American Diabe-tes Association,ADA)统计ESRD54586例中DN为1970例,占36·25%。又据报道1亿0~14岁儿童中,每年约有1万例发生糖尿病,其中10%~30%最终发生DN[1]。中华儿科学会肾脏学组报告国内91家儿科1990-01—2002-12共收治慢性肾功能功衰竭(CRF)1658例,其中DN仅为3例(占0…     

儿童肾性高血压的诊断和治疗

儿童时期的高血压以继发性高血压为多 ,约占所有高血压患儿的 80 % ,继发性高血压中以肾性高血压为主。肾性高血压分肾实质性高血压和肾血管性高血压两大类 ,肾实质性高血压约占所有继发性高血压的 80 % ,肾血管性高血压约占继发性高血压的 12 % ,其中以肾动脉狭窄最常见。新生儿高血压中约 93%为肾血管性疾病 ,有人认为与近年来较多地采用保留脐动脉导管引起脐动脉血栓有关[1] 。1　临床表现儿童肾性高血压在临床上有时常无明显症状 ,患儿血压增高多于体格检查或肾脏病常规检查时才被发现。当血压明显持续增高时 ,可出现头晕、头痛、恶心、…     

儿童风湿病临床研究进展

1 幼年特发性关节炎 目前,幼年特发性关节炎(JIA)发病机制仍然不明确,已知中性粒细胞在类风湿关节炎关节中大量存在,推测是中性粒细胞分泌酶类和氧化剂损害了组织.Hallett等[1]通过基因敲除动物模型证实了中性粒细胞移动至关节,在类风湿关节炎发病机制中起重要作用.该研究利用反义RNA敲除鼠细胞磷脂酶A-Mpha的表达,使中性粒细胞移动至关节过程受到影响,从而减少了模型动物组织炎症水肿和损伤,此研究为利用中性粒细胞抑制剂治疗类风湿关节炎奠定了基础.     

小儿心血管疾病临床研究进展

2008年,我国小儿心血管疾病临床与基础研究取得了长足的进步,临床关键诊治技术得到不断的发展与实践,小儿心血管疾病的发病理论也不断深化,开创性的研究工作不断涌现.下面通过总结2008年在主要核心期刊上发表的相关论文,对主要学术进展做一简要介绍.     

儿童消化系统疾病临床研究进展

1 功能性胃肠病与胃肠动力性疾病 2008年召开了第二届全国小儿胃肠动力学术会议,有力地推动了我国小儿功能性胃肠病与胃肠动力性疾病的临床研究.吴燕等[1]认为,24 h食管pH监测对食管裂孔疝患儿的术前病情评估、术后疗效观察及预后判断具有较高的价值.34例患儿中30例有胃食管反流(CER),在术后1个月内40%(12/30)的患儿仍存在GER.经适当的药物治疗及睡眠时体位的调整,术后3个月复查,仅有7%(2/30)存在反流.     

儿童呼吸系统疾病临床研究进展

2008年我国小儿呼吸系统疾病的研究取得了较大进展,儿童慢性咳嗽、反复呼吸道感染以及支气管哮喘诊治指南的推出,标志着对这些疾病的认识进一步深化.重症手足口病在一些省市的流行,使广大儿科医生充分认识了神经源性肺水肿.其他疾病的研究也较前拓展.现将2008年小儿呼吸系统疾病的主要研究进展阐述如下.     

儿童血液系统疾病临床研究进展

2008年中国充满了机遇,也充满了挑战.儿童血液专业顺应时代的要求,在血液肿瘤、贫血及出血性疾病等方面取得了一定的临床研究进展.现将2008年我国儿童血液系统疾病的工作概述如下.     

儿童过敏性和免疫性疾病临床研究进展

2008年我国过敏性和免疫性疾病的研究有显著的进步,在上海举办了过敏性疾病专题研讨会和国际早期营养与免疫会议,上海和重庆分别组织了小型国际儿科免疫研讨会,在杭州召开了过敏性疾病早期预防学术会.北京大学和美国Jeffrey Modell基金会在三亚联合召开了国际原发性免疫缺陷病学习班.