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目的评价1994—2005年中医、西医及中西医结合治疗小儿肺炎临床疗效类文献的质量。方法收集1994—2005年国内医学期刊上公开发表的中医、西医及中西医结合治疗小儿肺炎的临床疗效观察文献,录入到《小儿肺炎现代文献数据录入系统》中,之后对符合文献纳入标准的文献进行质量评价。结果1994—2005年期间发表了关于中医、西医及中西医结合治疗小儿肺炎文献2318篇,试验设计采用随机对照盲法的23篇,采用随机对照的1204篇,采用对照而未随机的336篇,未采用随机对照盲法的755篇。文献质量评分0~3分2317篇,4~7分仅1篇。结论在今后的关于小儿肺炎疗效的文献研究过程中,要加强随机化、对照、盲法等措施的科学严谨性,加强对RCT各环节的质量控制;同时应对样本的基本特征及征候特点详加描述。     

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目的了解单次小剂量(0.4g/kg)静脉输注免疫球蛋白(IVIG)提升初发免疫性血小板减少性紫癜(ITP)患儿血小板至安全范围(≥30×109/L)的作用。方法研究对象为北京大学第一医院儿科2008-04-01—2011-04-01收治初发ITP患儿62例,其中2008-04-01—2009-10-01收治的30例为激素组,初始接受常规剂量醋酸泼尼松治疗;2009-10-02—2011-04-01就诊的32例为IVIG组,初始接受0.4g/(kg·d)IVIG治疗1～5d,每天复查血常规,血小板升至安全范围则规范停用。比较两组治疗第1、3、5天时血小板升至安全范围比例及长期随访结果。结果治疗前,激素组和IVIG组血小板中位值分别是10×109/L和6×109/L。治疗1d后两组血小板升至安全范围的比例分别是3.33%和43.75%,差异有统计学意义(P<0.01)。随访7～42个月后激素组和IVIG组分别有3.45%和3.23%血小板未升至正常(≥100×109/L)。所有患儿均无颅内出血发生及死亡。结论单次小剂量IVIG可使近半数初治ITP患儿血小板升至≥30×109/L相对安全范围,明显高于常规剂量醋酸泼尼松疗效。     

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病毒性心肌炎(VMC)较为常见,由于其诊断中缺乏特异指标,治疗中缺少特效措施,故在诊治中存在一些有争议的问题,使得临床医师无所适从。本文选择临床上经常遇到且争议较大的八大问题,通过介绍国内外文献以及个人研究结果,提出自己的观点,供临床参考。1VMC诊断中的争议1.1早搏与VMC的关系早搏与VMC的关系有不同看法,有些医生认为早搏就是心肌炎,有些认为部分频发早搏(尤其是室性早搏,以下简称室早)与VMC有关,有些认为早搏与VMC完全无关。国外心脏病专著中提出,既往无     

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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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??As a special group of neonates??small-for-gestational-age infants have a higher rate of morbidity and mortality during perinatal period. Even those who have survived also have increased risk of growth and developmental disorders in later life.Recent studies have showed a strong association between being born small for gestational age and increased risk of diabetes mellitus??metabolic syndrome and heart diseases in adulthood. Hence??rational nutritional support is needed for improving the survival rate??promoting growth and reducing the long-term risk of intellectual impairment and metabolic risks.     

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??Abstracts?? Neonatal alloimmune thrombocytopenia??NAIT??is a leading cause of neonatalthrombocytopenia andone of the main reasons for thedisease and full-term infantswith intracranial hemorrhage.This paperisfocusedon the NAIT pathogenesis??clinical features??auxiliary examination??diagnosis and intervention and treatment.     

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目的 研究我国小于胎龄儿(SGA)的现状.方法 调研我国22个省、自治区、直辖市的86所医院提供的2005-01-01 T00:00:00至2005-12-31 T00:00:00出院的产科出生的新生)L(45 014例)中SGA的发生率,总结分析该86所医院新生儿科住院患儿(54466例)中SGA的临床资料.结果 (1)产科出生的新生儿中SGA的发生率为6.61%,其中早产儿中SGA发生率(13.10%)高于足月儿(6.05%);(2)新生儿科住院患儿中SGA的比例为9.19%;(3)SGA中窒息、呼吸窘迫综合征(RDS)、肺出血、呼吸暂停、缺氧缺血性脑病(HIE)、胃潴留、消化道出血、坏死性小肠结肠炎(NEC)、寒冷损伤综合征、先天畸形的构成比高于适于胎儿(AGA)和大于胎龄儿(LGA);(4)在SGA的转归中,治愈、好转率分别为57.47%和27.41%,自动出院占13.17%,病死率为1.95%.其中SGA病死率明显高于AGA和LGA,而治愈好转率(84.88%)则明显低于AGA和LGA.结论 我国新生儿科住院患儿中SGA的患病率和病死率较高,加强围生期监测和干预以减少SGA发生、积极防治SGA并发症仍是我国目前围产工作的重点.     

小肠镜检查技术在儿童小肠病变中的诊断及治疗价值

小肠镜在成人小肠疾病中有很高的诊断和治疗价值,是一种安全有效的检查和治疗手段。但小肠镜在儿童中应用较少,目前小肠镜被用于儿童不明原因消化道出血、小肠息肉、克罗恩病、小肠狭窄、胆道狭窄等的诊断和治疗,该文介绍了小肠镜检查技术在儿童小肠疾病中的临床应用。     

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??Objective To study the characteristics of etiology and the distribution of age and season of wheezing children in Children’s Hospital Affiliated to Soochow University. Methods A total of 3596 cases of children hospitalized because of wheezing were collected from January 2011 to December 2014??including their medical history and sputum specimen. Multiple pathogenic joint detection was used to detect pathogens and analyze the data by combining with their medical history. Seven kinds of common respiratory virus ??respiratory syncytial virus??adenovirus??influenza virus A?? influenza virus B?? parainfluenza 1?? parainfluenza 2?? parainfluenza 3?? were detected by the direct immunofluorescence. MP?? CP and HBoV were detected by fluorescence quantitative PCR. HRV and HMPV were detected by RT-PCR. Sputum was cultured for bacteria. Results Wheezing occured mainly in children under three years old??especially in those under one year old. The incidence of wheezing was the highest in winter?? followed by spring and autumn. Summer was the lowest. Total etiology detection rate of 3596 wheezing children was 63.0%??2264/3596??. Virus was detected positive in 1458 cases??40.5%??. MP was detected positive in 342 cases??9.5%??. Bacteria were detected positive in 1052 cases??29.3%??. The virus detection rate of wheezing children gradually declined with age??P??0.001??. The MP detection rate of wheezing children increased with age??P??0.001????but the bacteria detection rate had no obvious difference ??P??0.05??. Conclusion Wheezing occurs mainly in children under the age of three years old??and the incidence of wheezing is the highest in winter. The pathogen detection of wheezing children has obvious seasonal and age characteristics. Virus is the major pathogen in the younger group. Bacteria and MP are common in the elder group.     

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??Abstract??Objective??To observe the change of NT-proBNP in incomplete Kawasaki disease and study the value in the diagnosis of incomplete Kawasaki disease. Methods??From Mar. 2007 to Feb. 2009 in department of paediatrics??Provincial Clinical Medical College of Fujian Medical University??we detected the acute- and restoration-stage plasma NT-proBNP level in 36 children with typical Kawasaki disease??TKD?? and 20 with incomplete Kawasaki disease ??IKD??respectively and 30 children with respiratory tract infection and 30 healthy children?? and made a mutual comparison. Meanwhile ultrasound cardiogram examination was made in Kawasaki disease. Results??There was no statistical significance in the difference of plasma NT-proBNP between TKD group and IKD group. Acute-stage plasma NT-preBNP in TKD group and in IKD group was clearly higher than that in restoration stage and control group??respiratory tract infection group and healthy children group??. Coronary lesion in IKD group was significantly higher than that in TKD. Conclusion??The plasma NT-proBNP can be used as a reference index in early diagnosis of IKD.     

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??Objective??To investigate the changes and clinical significance of serum ferritin??SF??levels in children with systemic lupus erythematosus??SLE??. Methods??The serum ferritin levels of 58 children with SLE were measured by Chemiluminescence before and after treatment??and serum ferritin levels were measured in 30 normal children. Results??The serum ferritin levels were significantly higher in children with SLE than those in healthy controls as well as in active children than in inactive children with SLE.And the serum ferritin leveis were significantly decreased after treatment??Moreover?? the serum levels of ferritin were positively correlated with anti-ds-DNA antibody levels and SLEDAI??SLE Disease Activity Index??in children with SLE. Conclusion??The serum ferritin levels in children with SLE are significantly higher than those in normal children. Serum ferritin levels aree positively correlated with disease activity in children with SLE.Therefore serum ferritin levers can be a useful laboratory marker to diagnose SLE in children.     

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??Abstract??Objective??To discuss the clinical features and realizations of severe influenza A??H1N1?? virus infection in children. Methods??Analyzed the clinical features?? laboratory examinations and imaging data of 5 children with severe influenza A??H1N1?? virus infection. Results??5 children with severe influenza A??H1N1?? virus infection do not have special symptoms and signs?? just have flu-like symptoms such as fever?? cough?? headache?? some children are also accompanied with digestive symptoms such as abdominal pain?? vomit and diahorrea. When the patients’ conditions worsen?? they have bad coughs?? breathing difficulties?? wet rales in the lungs?? high heart rates?? poor peripheral circulation?? drowsiness or dysphoric and so on. The patients often experience MODS?? among them the lungs are prominent. In laboratory examinations?? white blood cells counts normal?? low or high?? most patients experience abnormal function of the liver?? kidney and coagulation. The main x-ray manifest that many parts of the lungs are damaged. Conclusion??Severe influenza A??H1N1?? virus infection in children develop at an alarming rate?? the risk of death is high. Early recognization?? early diagnosis and early treatment is the key to decrease the death rate of severe influenza A??H1N1?? virus infection.     

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目的比较儿童青少年腰围与体重指数(BMI)在代谢综合征(MS)诊断中的实用价值。方法采用随机抽样的方法于2009年6月至2010年10月从南宁市14所中小学中抽取6～18岁儿童青少年7893人,分析腰围、BMI与MS各检测指标的相关性。以中华医学会糖尿病学分会(CDS)及国际糖尿病联盟(IDF)(2007)建议的MS标准应用受试者工作特征曲线(ROC),比较腰围及BMI的ROC曲线下面积,反映腰围及BMI诊断MS的准确性大小。结果 (1)除高密度脂蛋白胆固醇(HDL-C)均值随肥胖增加而降低外,MS的各检测指标均值比较[除外空腹血糖(FBG)和天冬氨酸转移酶(AST)]均为肥胖组>超重组>正常组,3组间差异有统计学意义(P<0.05)。(2)腰围、BMI均与臀围、腰臀比、收缩压(SBP)、舒张压(DBP)、FBG、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)呈正相关,与HDL-C呈负相关,其中腰围与FBG、TG、HDL-C、FINS、HOMA-IR的相关程度较BMI密切。(3)腰围检出MS各组分异常的灵敏性明显高于BMI,阳性预测值(除外HDL-C异常)均相对好于BMI。(4)腰围及BMI的ROC曲线下面积在CDS标准下分别为0.949和0.951;在IDF标准下分别为0.941和0.921。结论儿童青少年MS的诊断中,腰围较BMI更具诊断价值,腰围测量有助于儿童青少年MS的筛查。     

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??Abstract??Objective??To observe the correlation between the expression of Toll-like receptor 4??TLR4??in monocytes and the concentration of TNF-αin children with dilated cardiomyopathy ??DCM ????in order to explore the relationship between TLR4 and the occurrence and development of children with DCM. Methods??In 18 children with DCM?? TLR4 level in monocytes was measured by flow cytometry?? the concentration of TNF-αin serum was determined by ELISA??left ventricular ejection fraction??LVEF????left ventricular end-diastolic volume??LVEDV???? left ventricular end-systolic volume??LVESV?? and left ventricular mass??LVmass?? were detected by echocardiography. Seventeen healthy children served as controls. Results??The mean fluorescence intensity?? MFI ??of TLR4 in monocytes was higher in children with DCM at preliminary diagnosis?? compared to that of treatment of one year . TNF-αhad a similar result??P < 0.05??.Moreover??they were both higher in chidren with DCM compared with controls. The improvement of LVEF?? LVEDV?? LVESV and LV mass in children with DCM correlated with the decrease of TLR4MFI and with the concentration of TNF-α. Conclusion??Upregulation of TLR4 in monocytes of children with DCM may play a critical role in the mechanism of cardiac damage through the secretion of inflammatory factors??which mediates the development and progression of children with DCM.     

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??Abstract?? Objective To evaluate effectiveness and safety of treatment for children’s acute bronchiolitis by nebulized recombinant human interferon α 1b in a multicenter clinical study??and to recommend a reasonable clinical dosage for children. Methods Withthe design of a randomized, controlled, multi-center study, totally 330 children who were hospitalized from December 2012 to May 2013 for acute bronchiolitis were randomly divided into three groups. The control group had routine and symptomatic treatment. Therapy groups inhaled human recombinant interferon α1b 2 μg/kg and 4 μg/kg respectively, twice a day plus routine treatment, for 5 to 7 days. We used four-level-scoring method to evaluate disease conditions and performed pathogen detections. Results ??1??The total improvement rates of low and high dose group were 92.3% and 95.0%, respectively, which were significantly higher than control group ??85.3%, P<0.05??. High dose group had obviously improved primary index ??wheezing, wheezing rale and three depression sign?? compared with low dose group. The disappearance time of symptoms was shortened significantly ??P<0.05??, and the improvement of three depression signs was obvious ??P<0.01??.??2??Treatments within and after 72 h were both effective, but the total improvement rate within 72 h was better.??3??The effectiveness of interferon α1b in RSV positive children was significantly better than in RSV negative children. Effectiveness of treatment group was superior to that of control group.??4??All children did not show irritation symptoms in local respiratory tracts, and no serious adverse reactions was observed. Conclusion The treatment for acute bronchiolitis in young children by nebulized human recombinant interferon α1b is effective, which shortened the duration of symptoms, with no safety problem. The effect is better when used in the early stage.     

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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。     

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??There is strong evidence implicating the intestinal flora disturbance in developing allergicdisease including allergic rhinoconjunctivitis??asthma??eczema and food allergy. Experimental studies with animal model of allergy have shown that probiotics can improve allergic manifestations by induceing immune regulation Treg cell??inhibiting the secretion of allergen-induced IgE and Th2 cytokines??attenuating eosinophils infiltration and allergic inflammation in target organs. Probiotics have been proved effective in treatment of IgE-mediated eczema;however??because of the conflicting results??probiotics are recommended for prevention of allergy only in populations at high risk of allergy.