���Ժ�������Ⱦ8172��סԺ������ԭѧ����

目的分析急性呼吸道感染住院患儿的病原学特点。方法对2005年10月至2009年9月苏州大学附属儿童医院呼吸科8172例急性呼吸道感染住院患儿,采用无菌负压吸引法采集其新鲜痰液,分别用直接免疫荧光法、RT-PCR检测7种常见病毒抗原和人类偏肺病毒基因(6599例),细菌培养检测细菌(6404例),ELISA法检测血清肺炎支原体(7842例),检出的阳性病例入选,分析其病例资料。结果 8172例标本中检出1种或1种以上病原4756例(58.2%),6404例细菌检测标本中阳性1883例(29.4%),6599例病毒检测标本中阳性1886例(28.2%),7842例肺炎支原体检测标本中阳性2630例(33.5%)。细菌病原中肺炎链球菌(10.8%)最多见。病毒中以呼吸道合胞病毒(15.8%)最常见。病原混合感染率为16.9%,以细菌及病毒混合感染为最常见。呼吸道合胞病毒冬季检出率最高,人类偏肺病毒冬春季、副流感病毒3夏季检出率较高,流感病毒A夏季检出率较低,肺炎支原体检出率夏秋季较高,冬春季较低;副流感病毒1,2季节差异不明显。结论肺炎支原体是本地区儿童急性呼吸道感染最常见的病原,病毒次之,细菌是混合感染的常见病原。细菌和病毒感染多见于1岁以下婴儿,而支原体感染多见于3岁以上儿童。各病原的流行季节各异。     

��ͯ�����Է���֧ԭ�����ҽԺ��Ⱦ��ԭ���ص㼰Σ�����ط���

??Objective??To explore the pathogen characteristics and risk factors of nosocomial infection in children with refractory pneumonia caused by Mycoplasma pneumoniae. Methods??A total of 160 children??nosocomial infection??45 cases?? as observation group??no nosocomial infection??115 cases?? as control group?? with refractory MPP who were admitted from January 2015 to January 2018 were selected for pathogen detection and pathogen species analysis. Analyze the differences of two groups to detect the risk factors of hospital infection by means of univariate and multivariate logistic analysis. Results??According to the analysis of the pathogens??32 of them were bacterial infections??71.1%????and Gram-negative bacteria were the main pathogens??including Haemophilus influenza??9 cases????Klebsiella pneumonia??7 cases????Escherichia coli ??5 cases?? and Legionella pneumophila??2 cases????13 of them were viral infections??28.9%????including influenza B virus??6 cases????respiratory syncytial virus??5 cases??and adenovirus??2 cases??. After univariate and multivariate logistic analysis??no differences were found in sex??age??congenital heart disease or anemia between observation group and control group??P??0.05??. However??the length of hospitalization??season of onset??invasive procedures??non-single ward??and the irrational use of antibiotics in the two groups had significant differences??P??0.05??. Conclusion??The main infection pathogen of children with refractory MMP in nosocomial infection is Gram-negative bacteria. The risk factors of nosocomial infection are the length of hospitalization?? season of onset??invasive procedures??non-single ward??and the irrational use of antibiotics.     

����֧ԭ���Ⱦ�¼���ƫ̱1����12�����׸�ϰ

??Objective To study the effect of Mycoplasma pneumoniae infection on the blood circulation of central nervous system. Methods Data of a child with Mycoplasma pneumoniae infection who developed acute hemiplegia??including clinical manifestations and therapy??was collected??analyzed and the literature of 12 similar cases was reviewed. Results Totally 13 cases were reported from 2001 to 2010 home and abroad ?? including 10 children and 3 adults?? female accounting for the larger part. There were 5 cases in China who are children??one at right middle cerebral artery and right vertebral artery??female????one at right middle cerebral artery??female????one at left internal carotid artery??anterior cerebral artery??middle cerebral artery bole and left middle cerebral artery??female????one at right internal carotid artery and right middle cerebral artery??male?? and the last one at left internal carotid artery??female??.There also reported a four-year child from Taiwan??bilateral internal carotid artery and proportion vertebral artery????a seven-year old girl from Turkey??left internal carotid artery????a child from Greece ??posterior cerebral artery????and an adult male from Japan??left middle cerebral artery??. Conclusion It is indicated that clotting system may be activated by Mycoplasma pneumoniae infection. This may enhance the occurrence of thrombosis??which leads to hemiplegi and other ischemic attacks.     

��ͯ�����º�������Ⱦ������ԭѧ�о�

目的 了解儿童急性下呼吸道感染(ALRTI)病毒病原学特点.方法 2007年3月至2008年2月,在北京儿童医院内科就诊及住院治疗的临床诊断为ALRTI的患儿共572例.对每例患儿在就诊当日或次日采集鼻咽吸取物1份,采用逆转录(RT)-PCR方法进行常见呼吸道病毒核酸检测,包括呼吸道合胞病毒(RSV)、鼻病毒(RV)、副流感病毒(PIV)1～4型、甲型及乙型流感病毒(IFA、IFB)、腺病毒(AdV)、肠道病毒(EV)、冠状病毒(HCoV)、偏肺病毒(hMPV)及博卡病毒(HBoV).结果 572例患儿标本中,444例检出至少1种病毒,总检出率77.6%.各种病毒中,RSV检出率最高,占48.3%,其次是RV(27.1%)和PIV(13.3%).不同年龄组病毒的总检出率差异有统计学意义,<3岁组检出率较高,≥5岁组病毒检出率明显降低.不同年龄组JLRTI病原谱有所不同,<5岁各组主要是RSV、RV、PIV,而≥5岁组则主要为RV、IFV、RSV.572例中,158例(27.6%)检出2种或2种以上病毒,<1岁惠儿混合感染率最高,为40.2%,随年龄增长混合感染率逐渐下降,≥5岁患儿混合感染率仅为14.0%.结论 就诊于北京儿童医院的ALRTI患儿中,5岁以下者ALRTI的主要病毒病原是RSV、RV、PIV;≥5岁则主要为RV、IFV、RSV.     

��������Է���סԺ������ϸ�Ⱦ�о�

??Objective??To study the mixed infections in hospitalized children with community-acquired pneumonia ??CAP??. Methods??We retrospectively reviewed the medical records of CAP patients admitted to Children’s Hospital of Soochow University from January 2015 to December 2015. Samples were tested for multiple pathogens.Results??One or more pathogens was detected in 647??76.5%?? of 846 cases??34.63?? cases were considered mixed infection. The rates of mixed infection in ??6-month????1-year????3-year????5-year?? ≥5-year group were 24.2%??43.5%??43.8%??36.8% and 27.3% respectively. The most frequent combinations of pathogens were those of virus plus bacteria in ??6-month and ??1-year group??virus plus MP in ??3-year and ≥ 5-year group?? and MP plus bacteria in??5-year group??Rhinovirus-H.influenzae was the most commonly found combination of virus and bacteria. The most frequent etiological agent in virus coinfected with MP was rhinovirus. S.pneumoniae was the most important pathogen for bacteria coinfected with MP. No significant difference in clinical characteristics??complications??PICU admission or hospital stay was observed between the patients with mixed infections and those with monomicrobial CAP. Conclusion??Mixed infections account for certain proportion in the cause of CAP. The positivive rate in patients in??1-year and ??3-year groups is significantly higher than that in other age groups. Patients of different ages present with different combinations of pathogens. Mixed infections have no relationship with CAP patients’ mortality.     

��ͯ��л�ۺ�����ԭ���Ը�Ѫѹ�������𺦵Ĺ�ϵ

??Objective??To study the relationship between metabolic syndrome and target organ damage of essential hypertension in children. Methods??One hundred and sixty-five children older than 10 years were retrospectively enrolled??who were diagnosed with essential hypertension. All children received examinations of target organ damage. All children were divided into group with metabolic syndrome??Group A??58?? and group without metabolic syndrome??Group B??107??. All data were collected and analyzed using statistic methods. Results??In all recruited adolescents??58 patients were diagnosed with metabolic syndrome with the rate of 35.2%. The incidence of target organ damage in Group A??49/58?? was significantly higher than Group B??65/107????84.5% vs. 60.7%??P??0.05??. The incidence of cardiovascular damage in Group A??28/58?? was much higher than Group B??33/107????48.3% vs. 30.8%??P??0.05??. The incidence of target organ damage in patients with impaired glucose tolerance was 86.1%??31/36????which was significantly higher than that of patients without it with the rate of 64.3%??83/129????P??0.05??. According to the results of multiple factors Logistic regression analysis?? metabolic syndrome??course of disease longer than 6 months and elevated average diastolic pressure??≥80 mmHg?? were independent risk factors for target organ damage. Conclusion??Essential hypertension children complicated with metabolic syndrome have a much higher incidence of target organ damage than those without metabolic syndrome. Metabolic syndrome is an independent risk factor for target organ damage. The routine examination of metabolic index is beneficial for early diagnosis of target organ damage and effective interference can be performed.     

D�����������֧ԭ��������س̶�����Է���

??Objective To investigate the significance of D-dimer in the clinical evaluation of children with mycoplasma pneumoniae pneumonia??MPP??. Methods Retrospective analysis of clinical data of 165 cases of MPP hospitalized children from January 2015 to June 2015 was made??and the relationship of plasma D-dimer level with clinical manifestation??imaging features and inflammatory markers in children with MPP was studied. Results 1.Among 165 cases of MPP children??95 cases were severe??while 70 cases were mild. The level of D-dimer in the severe cases was higher than that in the mild??the difference being statistically significant??P??0.01??. 2.D-dimer levels of the cases who had the image feature of lung patchy shadow??95 cases????pleural effusion??68 cases????and atelectasis??35 cases?? were obviously higher than those who had not ??P??0.01??respectively??. 3.The plasma D-dimer level in cases with extrapulmonary complications??27 cases?? was higher than that in cases without extrapulmonary complications??and the difference was statistically significant??P??0.01??. 4.Positive correlation was found between level of D-dimer and fever procedure??white blood counts??WBC????neutrophile granulecyte ratio??N%????C-reactive protein??CRP????as well as erythrocyte sedimentation rate??ESR?? ??all P??0.01??. Conclusion The level of D-dimer in MPP patients can reflect the severity of the disease. Detection of D-dimer levels is helpful to evaluate the condition of MPP??which has important clinical significance.     

�����������������������ϲ���Ӧ�Ա��׻���������Ч��Ӱ�������о�

??Objective To understand the dynamic changes of early clinical curative effect in children with asthma and allergic rhinitis who received the dust mite specific immunotherapy??and to discuss the influencing factors of the efficacy. Methods A total of 70 cases with mild or moderate persistent asthma combined with allergic rhinitis who received the dust mite specific immunotherapy combined with drug therapy between February 2012 and November 2012 in Beijing Children’s Hospital were adopted in the case-self-control study. Results Totally 54 cases completed treatment of 12 months. The clinical response rates to SIT ??effective cases?? at 3??6??9 and 12 months after SIT were 72.2%??39????75.9%??41????81.5%??44?? and 87.0%??47???? respectively. After one year of treatment??the average daily SMS and VAS score were all decreased ??5.28±2.28 vs. 2.87±1.96??5.59±3.35 vs. 4.04±3.68?? P??0.05??. PEF% pred was improved???95.41±15.18?? vs. ??99.24±16.24????P??0.05??. Conclusion The effective rate of SIT increases gradually with prolonged treatment. When children with asthma and allergic rhinitis received immunotherapy combined with drug therapy??the patients with higher baseline SMS??shorter asthma history and lower PEF%pred respond more effectively to SIT.     

��ͯ�����º������ϰ�������һ��Ⱦ���ϸ�Ⱦ�����о�

??Objective To investigate the clinical relevance of multiple viral infections in children with acute lower respiratory disease. Methods A total of 1722 children with clinical diagnosis of lower respiratory tract infection ??ALRTI?? during the period of October 2007 to September 2011 were involved in our study. One nasopharyngeal aspirate specimen was collected from each patient. ??RT?? PCRs were performed to detect common respiratory tract viruses including respiratory syncytial virus ??RSV?? ?? rhinovirus ??RV?? ?? influenza virus type A and B?? parainfluenza virus ??PIV?? type 1-4?? adenovirus ??enterovirus?? human coronavirus?? human metapneumonia virus and human bocavirus. Results Totally 206 children had single RSV infection?? 124 children had dual infections ??RSV co-infected with an additional virus?? and 40 children had multiple infections along with a RSV infection. Out of the 124 patients?? 68??54.8%?? were co-infected with RV?? 24 with PIV. There was a statistically significant difference between the dual viral infections group and the RSV-infected group in hospital stay??P??0.001??. Compared to patients in the single RSV infected group?? patients in the multiple viral infection group had significantly more frequency in fever ??P??0.017???? duration of fever longer??P??0.015???? hospital stay also longer??P??0.001????and they received more intravenous steroid therapy during hospitalization??P??0.005??. There was no significant difference in oxygen therapy?? respiratory support and use of bronchodilators. Conclusion Multiple viral infections are linked to more frequency in fever?? longer fever days?? longer hospital stay?? and more frequent use of intravenous steroid therapy during hospitalization. Mixed respiratory virus infection may affect the patient's disease severity and prognosis.