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目的观察碳酸钙混悬液治疗儿童原发性胆汁反流性胃炎的疗效。方法2004-10—2006-10,对浙江大学医学院附属儿童医院经胃镜和24h动态胆红素监测仪(Bilitec 2000)确诊为原发性胆汁反流性胃炎的32例患儿,随机分成两组:A组15例,给予碳酸钙混悬液治疗4周;B组17例,给予碳酸钙混悬液加多潘立酮治疗4周,分别于治疗前及治疗2周、4周时观察患儿腹痛、腹胀、恶心、呕吐等症状积分变化,并于治疗4周后停药3d复查胃内24h胆汁反流情况。结果两组治疗4周后各症状积分较治疗前均有明显下降,差异有统计学意义(P<0.05);两组间治疗后各症状积分下降值比较,差异无统计学意义(P>0.05)。两组患儿治疗4周后24h胃内胆汁反流监测各指标与治疗前相比差异均无统计学意义(均为P>0.05)。结论碳酸钙混悬液对缓解儿童原发性胆汁反流性胃炎症状有明显疗效,但不能有效阻止胆汁反流,合用多潘立酮并无增效作用。     

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??Bronchiolitis is the most common lower respiratory inflammation in infants younger than 5 years. Pathogens are variable, and the majority of bronchiolitis were caused by infection. The radiological presentations of bronchiolitis include direct signs ??bronchiol-ectasis??tree-bud??central lobular nodules?? and indirect signs??air trapping??Mosic sign??. Bronchiolitis caused by different entities will present different presentations. The combination of clinical information and radiological findings will provide evidence for correct diagnosis.     

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??Abstracts??Familial growth hormone deficiency is caused by genetic mutations and has three inherited modes: autosomal recessive, autosomal dominant and X-linked recessive. Genetic diagnosis is based on detailed history, a clear clinical phenotype and rational application of molecular biology methods.     

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儿童慢性肾脏病(CKD)不再是一个少见病,其已发展成为严重危害广大人民群众身心健康的疾病。目前世界上超过5亿人患有慢性肾功能不全,大约有150万人依赖透析延缓生命,等待肾移植。每年超过百万人死于与慢性肾功能不全相关的心脑血管疾病,CKD已成为继心脑血管病、肿瘤、糖尿病之后威胁人类健康的重要疾病。因此,应     

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??Bacterial pneumonia is the main cause of severe pneumonia in children. It is difficult to collect the samples of children’s respiratory tract infection??especially the acquisition of lower respiratory tract specimens is a challenge for the primary pediatricians??and it also affects the etiological diagnosis of children’s respiratory tract infection. Among children under 5??bacterial pathogens include Streptococcus pneumoniae??Staphylococcus aureus and Streptococcus pyogenes. Streptococcus pneumoniae infection is more common in healthy children aged 5 and above. The etiology of bacterial pneumonia in children was reviewed in this paper.     

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目的了解慢性胃炎患儿胃固体排空功能。方法对2008年1月至2012年1月首都儿科研究所附属儿童医院6～17岁因反复上腹部(或脐周)疼痛、上腹部不适伴有腹胀、嗳气、恶心、呕吐、早饱等消化道症状持续2个月以上,并且每周至少发作1次的儿童需要做胃镜检查者,进行电子胃镜常规检查,同时取病理活检并进行幽门螺杆菌(HP)检测。对确诊慢性胃炎的65例患儿行钡条胃固体排空试验,计算5h胃排空情况,收集服用钡条后24h的临床症状和体征。结果 HP感染总阳性率为27.7%,5h胃排空异常率HP阳性者占11.1%,HP阴性者占21.3%,两者差异无统计学意义(P>0.05)。HP阳性者无论是否有胃排空异常,其胃黏膜病理中-重度炎症者占66.7%。慢性胃炎患儿5h胃排空率<50%者占18.5%,胃排空率<75%者占23.1%。慢性胃炎患儿服用钡条后24h内均无任何异常症状和体征。结论部分慢性胃炎患儿存在胃动力障碍,临床症状不能完全反映胃固体排空情况。对于6～17岁儿童服用钡条行胃固体排空功能检查安全并符合自然生理状态。HP阳性者中-重度慢性胃炎发生率高。     

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??Objective To assess retrospectively the diagnostic roles of methylene blue test observed by bronchoscopy in congenital tracheoesophageal fistulas??TEFs?? in children. Methods We collected the clinical data of 5 patients??two of whom were diagnosed with congenital H-TEF and three of whom were diagnosed with recurrent TEF??rTEF?? over the past 8 months in Shenzhen Children’s Hospital. We respectively analysed and compared the results of contrast esophagography??regular bronchoscopy??methylene blue test observed by bronchoscopy and chest MDCT??all of which were performed on the above 5 patients. Results Each of these five cases was observed by bronschoscopy that methylene blue came out from the fistula of the trachea when methylene blue was injected into esophagus. Although all cases were examined by regular bronchoscopy??two recurrent TEFs cases weren’t found the fistulas. Four cases were examined by contrast esophagography??but only one rTEF case was diagnosed. None of these 4 cases could be diagnosed by the results of chest MDCT??but air trapping in the lower esophagus could be seen in chest MDCT in these cases. Conclusion Methylene blue test observed by bronchoscopy is reliable in the diagnosis of congenital TEFs in children??which is the first recommendation. Both of esophagography and regular bronchoscopy can miss the diagnosis in congenital TEFs in children. The diagnostic value of MDCT is limited for this disease??but air trapping in the lower esophagus in MDCT implicates the possibility of congenital TEFs.     

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目的 探讨功能性消化不良(FD)患儿胃黏膜肥大细胞(MC)的密度及其活化状态与胃电图之间的相互关系。方法 按罗马Ⅲ标准选择2007年1月至2010年1月于中山大学附属第一医院就诊的FD患儿40例,取胃窦黏膜1块,通过免疫组化法检测MC数及其脱颗粒数,然后行胃电图检测。结果 (1)FD患儿的胃黏膜MC脱颗粒指数均值为(65.7±23.9)%,其中>50%者占82.5%;(2)与胃电节律正常组相比,胃电节律异常组的MC密度显著升高(P<0.05);(3)与MC平均密度正常组相比,MC平均密度异常组在餐前正常慢波百分比明显降低(P=0.005);与MC峰密度正常组相比,MC峰密度异常组的餐前正常慢波百分比明显降低(P=0.01);(4)MC脱颗粒指数与胃电无明显关系;(5)餐前正常慢波百分比与MC平均密度及MC峰密度呈负相关(P<0.05)。结论 FD患儿的胃电异常与MC密度升高有关,MC可能通过影响胃电介导了儿童FD的发生和发展。     

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??TheinfectionrateofHelicobacterpyloriisincreasingyearby year??whiletheeradication rateisdeclining. The paper explains the difficult problems in the treatment of Helicobacter pylori infection from strain??host and environment. Through combination of recent research advances and clinical experiences??the authors provide some solutions to the above problems in order to increase the eradication rate and reduce recurrence.     

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??Abstract??The symptoms of pediatric chronic gastritis and peptic ulcer may be atypical and diagnosis should be based on the correlative consideration of the patient’s history?? endoscopic findings and histological pathology. Helicobacter pylori ??Hp?? is a potential cause of gastritis and peptic ulcer in children. This paper describes the diagnostic procedure of pediatric Hp infection and its therapeutic regimens. Problems related to increasing detection and cure rates?? reduction in recurrences and controlling drug resistance need to be further investigated.     

有上消化道症状患儿幽门螺杆菌感染调查

目的了解门诊有上消化道症状患儿幽门螺杆菌感染率。方法对1997年7月至2009年9月,2 161例有上消化道症状的门诊患儿行空腹13C-尿素呼气试验(UBT)。结果 2 161例有上消化道症状患儿中男1 138例,女1 023例,年龄4～16岁,平均(9.2±5.1)岁。H.pylori阳性608例,占28.14%,其中男361例(31.72%),女247例(24.14%),差异有统计学意义(χ2=15.299,P<0.001)。1997年7月—2000年共检测821例,H.pylori阳性256例(31.18%),2001年—2004年检测713例,H.pylori阳性202例(28.33%),2005年—2009年9月检测627例,H.pylori阳性154例,(24.56%),感染率有逐年下降趋势,差异有统计学意义(χ2=7.675,P=0.022)。结论门诊中有上消化道症状儿童H.pylori感染率有逐年下降趋势。     

幽门螺杆菌感染与儿童特发性血小板减少性紫癜

特发性血小板减少性紫癜(ITP)是以自身抗体介导的血小板破坏为特征的一组疾病,近年来许多研究显示部分成年人ITP的发生与幽门螺杆菌(Hp)感染密切相关,清除Hp后ITP患者的血小板数量有明显提高.研究认为Hp相关的ITP与抗原交叉反应有关,但其确切机制目前尚不明确;儿童ITP是否需要清除Hp治疗,国内外也存在争议.     

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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。     

Helicobacter pylori infection in children

Helicobacter pylori colonizes the human stomach, especially during childhood. However, a variety of H. pylori strains exists, with major differences in virulence characteristics which probably account for different clinical symptoms, and the majority of infected subjects remains asymptomatic. Helicobacter pylori infection is correlated with socioeconomic conditions and hygienic circumstances, resulting in an extremely high prevalence in children in developing countries. Commercial screening tests are not capable of separating the more virulent strains (type I with vacuolating toxin VacA and CagA protein) from the less virulent strains (type II, VacA and CagA negative). Type I strains, but not type II, are associated with an increased risk for duodenal ulcer and gastric cancer. Therefore, future screening tests and vaccinations should focus on the type I strains.     

有消化道症状儿童幽门螺旋杆菌现症感染的调查

目的：了解有消化道症状的儿童幽门螺杆菌（H. pylori）现症感染状态,并调查H. pylori感染的危险因素。方法：选择有上消化道症状的376例患儿进行胃镜检查,同时取3块胃黏膜分别作快速尿素酶及病理组织学检查。部分患儿行13C-尿素呼气试验。上述3种方法中2项或2项以上阳性者诊断为H. pylori感染。同时对患儿居住环境、家庭经济状况、父母文化程度、消化道疾病家族史进行问卷调查。结果：376例患儿中,H. pylori现症感染率为44.9%（169例）。男女H. pylori感染率差异无统计学意义（P>0.05）。3岁~、8岁~、13~16岁年龄组H. pylori阳性率分别为39.5%（47/119）、41.0%（55/134）、54.5% (67/123）,不同年龄组间患儿H. pylori感染率差异有统计学意义（χ2=6.76,P<0.05）。儿童全托及中小学生寄宿、集体居住及用餐者H. pylori阳性率高于非集体居住及用餐者（53.6% vs 40.6%, P<0.05）。家庭经济收入高者H. pylori阳性率低于中低收入者（36.9% vs 48.3%,P<0.05）。父母文化程度高者H. pylori阳性率低于父母文化程度较低者（39.5% vs 50.8%,P<0.05）。有胃炎或消化性溃疡病家族史者H. pylori感染率高于无家族史者（52.9% vs 41.2%,P<0.05）。结论：随着年龄的增长,H. pylori感染率逐渐增加。集体居住、共同用餐、家庭低收入、父母受教育程度低以及有上消化道疾病家族史的患儿有较高的H. pylori感染率,因此以上因素是儿童感染H. pylori的危险因素。     

幽门螺杆菌感染与过敏性紫癜相关性的研究

目的　研究幽门螺杆感染与过敏性紫癜的关系并指导治疗。方法　对1 0 2例过敏性紫癜患儿全部进行幽门螺杆菌的检测,阳性者在常规治疗的基础上进行抗幽门螺杆菌治疗。结果过敏性紫癜患儿中4 3 1 4 %感染幽门螺杆菌,给与对抗HP正规治疗,过敏性紫癜症状控制快,复发少。结论　幽门螺杆菌感染是过敏性紫癜的诱因之一     

儿童幽门螺杆菌感染与白细胞介素-8含量的关系

目的：白细胞介素-8(IL-8)作为趋化因子,可引起粒细胞在局部组织聚集,介导炎症反应。该文探讨小儿幽门螺杆菌(Hp)感染与胃粘膜及血清IL-8含量的关系。方法：53例患儿进行胃镜检查,采集胃粘膜标本用快速尿素酶试验及病理组织学方法检测胃粘膜Hp,同时用双抗体夹心酶联免疫吸附试验法(ELISA)测定其胃粘膜及血清中IL-8的含量。结果：53例患儿中29例Hp阳性,24例阴性;Hp感染患儿胃粘膜中IL-8含量显著高于非Hp感染患儿,差异有显著性(P<0.01),而血清IL-8含量在Hp感染组与非Hp感染组无显著差异(P>0.05),经根治Hp治疗后,Hp感染患儿胃粘膜中IL-8含量下降,差异有显著性(P<0.01),而血清IL-8含量无显著变化(P>0.05)。结论：Hp感染可以诱导胃粘膜炎症细胞合成IL-8,IL-8在Hp相关性胃十二指肠疾病的发病机制中起着重要作用。     

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目的探讨儿童幽门螺杆菌(H.pylori)感染及抗H.pylori治疗对儿童肠道菌群状态的影响。方法将浙江大学医学院附属儿童医院2004年410月门诊收治的68例慢性胃炎、十二指肠球炎患儿分为H.pylori阳性组36例、H.pylori阴性组32例二组。称取68例患儿新鲜粪便1.0g,分别进行需氧和厌氧培养,分离肠道菌群中最有代表性的三种需氧菌(肠杆菌、肠球菌、酵母菌)和四种厌氧菌(双歧杆菌、乳杆菌、类杆菌、产气荚膜梭菌),菌落记数,同时计算B/E比值来代表定植抗力。对36例H.pylori阳性组中的26例患儿进行“三联”抗H.pylori治疗1周后留取新鲜粪便进行肠道菌群分析,5例患儿在停药1个月后再次进行肠道菌群分析。结果H.pylori阳性组和H.pylori阴性组上述三种需氧菌和四种厌氧菌的菌落检出率比较,差异无统计学意义(P>0.05)。抗H.pylori治疗1周后双歧杆菌、乳杆菌、类杆菌菌落数量较治疗前明显降低(P<0.05),B/E值明显下降(P<0.01),酵母菌的检出率明显增加(P<0.05),产气荚膜梭菌检出率下降(P<0.05)。5例患儿在停药1个月后,乳酸杆菌数量仍继续下降,肠杆菌数量继续增加,双歧杆菌、类杆菌数量有所恢复,但仍低于治疗前。结论儿童H.pylori感染后对肠道菌群影响不大;三联疗法抗H.pylori治疗对儿童肠道菌群产生明显的影响,因此在治疗H.pylori感染时须考虑到大量抗生素治疗后可能对患儿的副作用及潜在的危险。