小儿肺炎血清中粒细胞集落刺激因子水平测定及其临床意义的研究

应用抗粒细胞集落刺激因子（Ｇ－ＣＳＦ）单克隆抗体，采用酶联免疫吸附法对６１例小儿肺炎患儿血清中Ｇ－ＣＳＦ水平进行了测定，并观察了Ｇ－ＣＳＦ水平与患儿体温、白细胞总数、中性粒细胞比例，Ｃ－反应蛋白试验（ＣＲＰ）及治疗后Ｇ－ＣＳＦ水平的动态变化。结果显示：（１）６１例肺炎患儿Ｇ－ＣＳＦ阳性率为６２．２９％；（２）发烧组Ｇ－ＣＳＦ水平较不发烧组为高；（３）Ｇ－ＣＳＦ阳性者中其白细胞总数８９．４１％为正常     

足月新生儿脐血清粒细胞集落刺激因子水平的研究

本文应用抗粒细胞集落刺激因子（Ｇ－ＣＳＦ）的单克隆抗体、采用间接免疫吸附法对１４８例足月新生儿脐血清中Ｇ－ＣＳＦ水平进行了测定，并与４１例正常小儿及５０例成人血清相比较，同时观察了Ｇ－ＣＳＦ水平与其性别、出生体重、白细胞总数、中性粒细胞绝对计数的关系。结果显示１１例（７．４％）脐血清Ｇ－ＣＳＦ水平低于０．５ｎｇ／ｍｌ，１３７例（８９％）Ｇ－ＣＳＦ均高于０．５ｎｇ／ｍｌ，其平均值为３．４ｎｇ±０．０     

急性感染时血清粒细胞集落刺激因子的检测

目的探讨急性感染时血清粒细胞集落刺激因子（Ｇ－ＣＳＦ）水平的变化规律，为急性感染的诊断提供依据。方法肺部感染、消化道感染及全身感染患者共７０例，入院当天均作血清Ｇ－ＣＳＦ血培、养及血常规检测。Ｇ－ＣＳＦ的测定采用双抗体夹心酶联免疫法。对测定结果进行统计学处理。结果７０例急性感染患者，Ｇ－ＣＳＦ阳性者４４例，阳性率为６２．８５％，细菌培养３４例阳性，阳性率为４８．５７％。肺部感染、消化道感染及全身感染，Ｇ－ＣＳＦ的阳性率分别为３０％、６９％、８３％。７０例患者血培养阳性者１８例（２５．７％）。与Ｇ－ＣＳＦ阳性率相比，差异非常显著（Ｐ＜０．００１）。４４例Ｇ－ＣＳＦ阳性患者抗感染治疗前后中性粒细胞绝对值（ＡＮＣ）分别为（８．３８±３．３９）×１０９／Ｌ和（４．１２±１．４７）×１０９／Ｌ（ｔ＝７．６１，Ｐ＜０．００１）。结论急性感染患者血清中Ｇ－ＣＳＦ水平显著升高。测定血清Ｇ－ＣＳＦ可作为判断细菌感染的敏感指标，与血培养及血常规检查相比，其敏感度、阳性率高，但特异性较差。     

新生儿感染性疾病血清白细胞介素—8和粒细胞集落刺激因子水平 …

本文测定９６例新生儿感染患儿血清白细胞介素－８（ＩＬ－８）和粒细胞集落刺激因子（Ｇ－ＣＳＦ），并与正常新生儿对照组比较。结果表明：感染急性期ＩＬ－８与Ｇ－ＣＳＦ均高于恢复期及对照组，对照组与恢复期间无显著差异。此外，中性粒细胞计数与Ｇ－ＣＳＦ存在正相关，而与ＩＬ－８无相关性。本文结合提示：ＩＬ－８和Ｇ－ＣＳＦ作为炎症介质参与了新生儿感染疾病过程，是反映新生儿感染的重要指标。     

rhG—CSF治疗白血病及肿瘤化疗后白细胞减少的疗效观察

２０例小儿白血病、肿瘤患儿在强烈化疗后致粒细胞减少时应用基因重组人粒细胞集落刺激因子（ｒｈＧ－ＣＳＦ），当其化疗后外周血白细胞计数低于２．０×１０＾９／Ｌ或中性粒细胞低于０．５×１０＾９／Ｌ时予皮下注射ｒｈＧ－ＣＳＦ２－５μｇ／ｋｇ·日，５－１０天，并与１２例同期住院病情、病种相似、年龄相当的化疗后白细胞减少患儿不予ｒｈＧ－ＣＳＦ仅给抗感染、输血等对症支持治疗进行比较。结果显示：ｒｈＧ－ＣＳＦ组白     

AIN婴儿血清G-CSF水平并不增高

自身免疫性中性粒细胞减少症（ＡＩＮ）在婴儿的发病率为１／１００　０００，高于先天性或获得性中性粒细胞减少症。该病由循环中抗中性粒细胞抗体致网状内皮系统对外周血中性粒细胞破坏增多所致．粒细胞集落刺激因子（Ｇ－ＣＳＦ）可调节造血细胞尤其是中性粒细胞的生成和分化，提高先天性、周期性及化疗所致中性粒细胞减少症的中性粒细胞数。该文采用酶联免疫吸附试验（ＥＬＩＳＡ）和增殖试验检测Ｇ－ＣＳＦ水平，以评价其在婴儿ＡＩＮ中的作用。方法对５７例ＡＩＮ患儿采集血样．ＡＩＮ的诊断经免疫荧光法和／或凝集试验检测粒细胞特异…     

国产rhG-CSF致儿童类白血病样改变10例

基因重组的人粒细胞集落刺激因子（ｒｈＧ－ＣＳＦ）是近年来在临床推广使用的一种造血因子,具有白细胞动员和促进中性粒细胞增殖,分化及增强其抗菌机能的作用。但ｒｈＧ－ＣＳＦ可否促使白血病的复发是患者、临床医师普遍关注的问题。ｒｈＧ－ＣＳＦ用后引起外周血出现大量幼稚细胞,类似于白血病改变。此现象文献报告少,我们使用瑞血新（国产ｒｈＧ－ＣＳＦ）后１０例儿童呈现此现象,现报告如下： 一、临床资料 １．一般资料１０例均为我院住院的急性白血病患儿。其中,急性淋巴细胞白血病（ＡＬＬ）８例,急性髓细胞白血病（ＡＭＬ）…     

中性粒细胞弹性蛋白酶是诊断小儿肾盂肾炎的敏感标志物

该研究的目的是弄清中性粒细胞弹性蛋白酶－α１－抗胰蛋白酶复合物（Ｅ－α１－Ｐｉ）对小儿急性肾盂肾炎的诊断价值． 对象和方法以初诊为尿路感染症状的２５天－１４岁患儿共８３例（男２９,女５４）纳入前瞻性研究对象,５７例健康小儿作为对照组．所有小儿均做二巯基丁二酸（ＤＭＳＡ）扫描和膀胱尿道排泄造影。住院当天和用抗生素３天后进行Ｅ－α１,－Ｐｉ和Ｃ反应蛋白（ＣＲＰ）、血沉（ＥＳＲ）、中性粒细胞计数、尿Ｎ－乙酰－β－氨基葡萄糖合成酶（ＮＡＧ）、ＮＡＧ－ｂ、肌酐（Ｃｒ）检测。对照组做相同检查． 结果８３例患儿…     

哮喘患儿血浆P物质、降钙素基因相关肽的测定及意义

目的：探讨Ｐ物质（ＳＰ）、降钙素基因相关肽（ＣＧＲＰ）在哮喘病发生和发展中的作用。方法：采用放射免疫分析的方法测定了３２例哮喘发作期、３０例哮喘缓解期患儿和２２例正常儿童血浆中非肾上腺素能非胆碱能兴奋性（ＮＡＮＣ－ｅ）神经递质ＳＰ和ＣＧＲＰ的含量。结果：哮喘发作期患儿血浆ＳＰ、ＣＧＲＰ含量均明显高于缓解期和正常对照组儿童，且与最大呼气峰流速（ＰＥＦＲ）占预计值百分比呈显著负相关。结论：哮喘患儿可能存在ＮＡＮＣ－ｅ神经功能亢进，ＳＰ、ＣＧＲＰ参与了哮喘发病过程，其含量对哮喘病情判断有参考价值。     

中性粒细胞减少症的治疗进展

本文主要复习了近年来造血细胞生长因子和静注ｒ－球蛋白治疗儿童中性粒细胞减少症的进展情况。Ｇ－ＣＳＦ、ＧＭ－ＣＳＦ及ｒｈＩＬ－３临床应用效果比较显著，其中Ｇ－ＣＳＦ无炎症反应，副作用少，可以首先选用。静注ｒ－球蛋白主要用于重症自身免疫性中性粒细胞减少症，为避免发生快速减敏（ｔａｃｈｙｈｙｌａｘｉｓ），柯采用２日短程治疗方法。     

呼吸道感染患儿粒细胞集落刺激因子的测定意义

目的：探讨粒细胞集落刺激因子(G-CSF)在呼吸道感染个体中的变化。方法：采用双抗夹心酶联免疫法和免疫单扩法对189例呼吸道感染急性期及50例治疗后5～7 d患儿和30例健康儿童进行血G-CSF和C反应蛋白(CRP)检测,同步外周血白细胞计数。结果：血G-CSF阳性105/189例(55.56%),CRP阳性68/189例(35.98%),同一病人G-CSF和CRP重叠阳性45/189例(23.81%)。治疗后5～7 d复查50例CRP全部转阴,G-CSF 16/50例(32%)持续阳性。结论：G-CSF水平在急性感染时增高,对临床有一定指导意义。     

门诊急性呼吸道感染患儿肺炎支原体、衣原体病原学监测及临床意义

摘要 目的 了解门诊急性呼吸道感染患儿中肺炎支原体（MP）和肺炎衣原体(CPn）的病原学情况。方法 定期选择首都儿科研究所儿内科门诊临床拟诊急性呼吸道感染的患儿行咽拭子MP、CPn的nPCR检测。共纳入314例患儿，其中男183例，女131例，年龄2个月至14岁。结果 314例患儿中MP和CPn阳性50例，总阳性率15.9％（50/314）。其中MP感染46例，阳性率14.6％（46/314）；CPn感染4例，阳性率1.3％（4/314）。男女感染比例1.3∶1。感染患儿年龄为4个月至12岁。MP感染并发呼吸道病毒感染占MP感染的21.7％（10/46）；其中90.0％（9/10）为急性上呼吸道感染。本组MP感染患儿临床表现以发热、咳嗽和流涕为主，个别有头痛、肌痛及胃肠道症状；有8例（17.4％，8/46）患儿仅以发热、扁桃体红肿为体征就诊。4例CPn感染患儿均有发热，伴有咳嗽和流涕。所观察的MP、CPn感染以急性上呼吸道感染为主，占80.0％(40/50)。MP感染以冬、春季节发病较高，并存在混合感染。CPn感染为9、10和12月份散发。结论 MP和CPn感染也是儿科急性上呼吸道感染中的重要病原之一。发病年龄有小年龄化趋势。MP、CPn感染与其他病原体所致呼吸道感染在临床上并无特殊之处。采用nPCR的方法，可以提供早期病原学诊断的依据。     

肺炎支原体肺炎患儿发生后遗症的危险因素研究

目的 探讨肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)患儿发生后遗症的相关危险因素,以指导临床治疗,减少后遗症的发生.方法 回顾性分析北京儿童医院2002年1月-2006年10月1 705例住院MPP患儿的临床资料,根据急性期后2个月胸片或肺CT表现分为后遗症组(144例)和对照组(190例).记录两组患儿的年龄、性别、热程、喘息、胸腔积液、肺外并发症,肺CT(或胸片)病变部位、肺部病变类型,WBC(N%、L%)、ESR、CRP,发病后开始应用大环内酯类抗生素的时间及开始应用丙种球蛋白、糖皮质激素的时间;对两组上述各项指标进行组间对照研究,先行单因素分析,对单因素分析结果P＜0.2的指标进一步行多因素Logistic回归分析.结果 Logistic回归分析结果显示,热程＞10 d(P＜0.05,OR=1.987)、胸腔积液(P＜0.01,OR=7.724)、病变部位位于右上肺(P＜0.01,OR=3.547)、病变类型为大片状阴影(P＜0.01,OR=2.009)、肺外并发症(P＜0.05,OR=2.232)为肺炎支原体肺炎后遗症的独立危险因素,胸腔积液是较强危险因素.结论 热程、胸腔积液、病变部位、病变类型、肺外并发症均与肺炎支原体肺炎后遗症的发生相关.     

Procalcitonin in children admitted to hospital with community acquired pneumonia.

AIMS: To assess the sensitivity, specificity, and predictive value of procalcitonin (PCT) in differentiating bacterial and viral causes of pneumonia. METHODS: A total of 72 children with community acquired pneumonia were studied. Ten had positive blood culture for Streptococcus pneumoniae and 15 had bacterial pneumonia according to sputum analysis (S pneumoniae in 15, Haemophilus influenzae b in one). Ten patients had Mycoplasma pneumoniae infection and 37 were infected with viruses, eight of whom had viral infection plus bacterial coinfection. PCT concentration was compared to C reactive protein (CRP) concentration and leucocyte count, and, if samples were available, interleukin 6 (IL-6) concentration. RESULTS: PCT concentration was greater than 2 microg/l in all 10 patients with blood culture positive for S pneumoniae; in eight of these, CRP concentration was above 60 mg/l. PCT concentration was greater than 1 microg/l in 86% of patients with bacterial infection (including Mycoplasma and bacterial superinfection of viral pneumonia). A CRP concentration of 20 mg/l had a similar sensitivity but a much lower specificity than PCT (40% v 86%) for discriminating between bacterial and viral causes of pneumonia. PCT concentration was significantly higher in cases of bacterial pneumonia with positive blood culture whereas CRP concentration was not. Specificity and sensitivity were lower for leucocyte count and IL-6 concentration. CONCLUSIONS: PCT concentration, with a threshold of 1 microg/l is more sensitive and specific and has greater positive and negative predictive values than CRP, IL-6, or white blood cell count for differentiating bacterial and viral causes of community pneumonia in untreated children admitted to hospital as emergency cases.     

Problems in determining the etiology of community-acquired childhood pneumonia

Fifty-seven children ages 1 month to 12 years hospitalized because of community-acquired pneumonia were compared with age-matched controls who had acute asthma without pneumonia to test the value of rapid bacterial antigen detection and clinical and radiographic criteria for diagnosis of bacterial pneumonia. Bacterial pneumonia, defined on the basis of positive cultures of blood or pleural fluid, was diagnosed in 4 children (7%), 1 of whom also had viral pneumonia. Viral pneumonia, defined as a positive nasopharyngeal sample or positive serology, was diagnosed in 20 children (35%). Serum and concentrated urine were tested by latex agglutination (Wellcogen) for Haemophilus influenzae type b and pneumococcal antigens and by countercurrent immunoelectrophoresis for pneumococcal antigens. Pneumococcal antigen could not be detected in serum or urine from 3 children with culture-proved pneumococcal pneumonia, indicating poor sensitivity of the tests. In contrast apparent H. influenzae type b antigenuria was detected by latex agglutination in 4 of 40 children with pneumonia but also in 5 of 57 controls, and a sensitive enzyme-linked immunosorbent assay for polyribosyl ribitol (PRP) phosphate antigen showed that all 9 cases were false positives. The specificity of H. influenzae type b antigen detection was thus poor. Children with viral and bacterial pneumonia could not be distinguished by radiographic or clinical criteria (symptoms, fever) or by total or differential white blood cell counts, serum C-reactive protein or nasal or serum interferon levels. It is not possible to distinguish reliably childhood viral from bacterial pneumonia clinically or by rapid diagnostic tests.     

Is procalcitonin useful in early diagnosis of serious bacterial infections in children?

AIM: To compare diagnostic accuracy of procalcitonin for early diagnosis of serious bacterial infection (SBI) in children presenting with fever and no focus of infection. METHODS: Prospective, observational study involving 72 children (1-36 mo) presenting to the paediatric units of two university hospitals. All children had blood cultures, urine cultures, white blood cell counts (WBC), chest X-ray, C-reactive protein (CRP) and procalcitonin (PCT) done at presentation. RESULTS: Eight (11.1%) children had SBI (1 pneumonia, 2 meningitis, 4 septicaemia/occult bacteraemia, 2 pyelonephritis), 19 (26.4%) had possible bacterial infection (received antibiotic treatment, but no organism grown) and 45 (62.5%) had viral or possible viral infection (virus isolated and/or uneventful recovery without antibiotics). PCT (>2 ng/l), CRP (>50 mg/l) and McCarthy's score (<9) had sensitivities and specificities of 50%/85.9%, 75%/68.7% and 87.5%/67.2%, respectively. Negative and positive likelihood ratios for CRP (>50 mg/l), PCT (>2 ng/l), white blood cells (>15 x 10(5)/l) and McCarthy's score (<9) were 0.36/2.4, 0.58/3.5, 0.94/1.1 and 0.19/2.7, respectively. A combination of PCT, CRP and WBC generated a positive likelihood ratio of 10.6, changing the post-test probability to 54%. CONCLUSION: For early diagnosis of SBI in children presenting with fever and no focus of infection, the diagnostic utility of procalcitonin is similar to the traditional markers infection and clinical scoring. While a low procalcitonin level cannot be used to exclude SBI in this population, a combination of PCT, CRP and WBC may be more useful in predicting SBI.     

Procalcitonin in children admitted to hospital with community acquired pneumonia

AIMS—To assess the sensitivity, specificity, and predictive value of procalcitonin (PCT) in differentiating bacterial and viral causes of pneumonia.METHODS—A total of 72 children with community acquired pneumonia were studied. Ten had positive blood culture for Streptococcus pneumoniae and 15 had bacterial pneumonia according to sputum analysis (S pneumoniae in 15, Haemophilus influenzae b in one). Ten patients had Mycoplasma pneumoniae infection and 37 were infected with viruses, eight of whom had viral infection plus bacterial coinfection. PCT concentration was compared to C reactive protein (CRP) concentration and leucocyte count, and, if samples were available, interleukin 6 (IL-6) concentration.RESULTS—PCT concentration was greater than 2 µg/l in all 10 patients with blood culture positive for S pneumoniae; in eight of these, CRP concentration was above 60 mg/l. PCT concentration was greater than 1 µg/l in 86% of patients with bacterial infection (including Mycoplasma and bacterial superinfection of viral pneumonia). A CRP concentration of 20 mg/l had a similar sensitivity but a much lower specificity than PCT (40% v 86%) for discriminating between bacterial and viral causes of pneumonia. PCT concentration was significantly higher in cases of bacterial pneumonia with positive blood culture whereas CRP concentration was not. Specificity and sensitivity were lower for leucocyte count and IL-6 concentration.CONCLUSIONS—PCT concentration, with a threshold of 1 µg/l is more sensitive and specific and has greater positive and negative predictive values than CRP, IL-6, or white blood cell count for differentiating bacterial and viral causes of community pneumonia in untreated children admitted to hospital as emergency cases.     

中性粒细胞CD64在儿童社区获得性肺炎诊断中的价值

目的：探讨外周血中性粒细胞CD64的表达在儿童社区获得性肺炎（CAP）诊断中的价值。方法：依据病原体不同将98例社区获得性肺炎患儿分为细菌感染组（48例）、病毒感染组（29例）以及支原体感染组（21例）;另设健康对照组（20例）。细菌感染组依据患儿的入院情况分为轻症感染组（36例）和重症感染组（12例）。采用流式细胞术检测外周血中性粒细胞CD64的表达,同时免疫比浊法检测外周血C反应蛋白（CRP）的水平。结果：治疗前细菌感染组CD64指数和CRP水平显著高于其他3组,差异有统计学意义（P<0.05）。重症组CD64指数和CRP水平较轻症组显著增高,差异有统计学意义（P<0.05）。细菌感染组经过有效的抗菌治疗后,CD64表达水平下降,和治疗前相比差异有统计学意义（P<0.05）。相关分析结果显示CD64指数与CRP呈正相关（r=0.545,P＜0.01）。 ROC曲线分析结果显示CD64、CRP最佳临界值分别为2.8和8 mg/L,CD64指数的特异性（90%）远高于CRP（74%）。结论：外周血中性粒细胞CD64测定有助于肺部细菌感染的早期诊断,并可以判断病情的严重程度及疗效。     

儿童腺病毒肺炎并发噬血细胞综合征7例临床分析

目的 探讨儿童腺病毒肺炎并发噬血细胞综合征（HLH）的临床特征。方法 回顾性分析2019年3~9月7例腺病毒肺炎并发HLH患儿的临床资料。结果 患儿年龄11个月至5岁，其中2岁以下5例，男性5例，均无基础疾病。患儿均以持续高热伴咳嗽住院，热峰在39~41℃之间。随着疾病进展，出现肝大7例，脾大6例。血常规两系或三系减少，伴血清铁蛋白（SF）、C反应蛋白（CRP）、降钙素原（PCT）、乳酸脱氢酶（LDH）升高。吞噬血细胞现象6例。肺部影像学提示肺炎改变。7例均经病原学宏基因检测鉴定为人腺病毒7型感染，同时HLH基因检测无异常，确诊为继发性HLH。7例均采用人免疫球蛋白治疗，地塞米松+依托泊苷化疗4例，单用地塞米松3例，血浆置换4例。死亡2例，好转出院5例。与5例存活患儿相比，2例死亡病例血常规中三系降低更明显，CRP、PCT、SF、LDH升高更明显。结论 腺病毒肺炎并发HLH的主要临床特征为持续高热，外周血出现进行性两系或三系降低及肝脾肿大等其他器官系统受累。CRP、PCT、SF、LDH显著升高可能提示预后不良。     

细菌和病毒混合感染对儿童社区获得性肺炎的影响

目的探讨细菌和病毒混合感染对儿童社区获得性肺炎(CAP)的影响。方法对204例CAP患儿行痰细菌、病毒、非典型病原体检测,有支气管镜检指征的患儿行支气管镜下肺泡灌洗(BALF),并进行定量培养和胞内菌检测。所有患儿给予抗菌药物序贯疗法治疗。结果 204例患儿中122例检出病原菌,检出率59.80%,检出病原菌153株,其中30例细菌和病毒混合感染。70例BALF菌培养,阳性8例,BALF标本可诱导共刺激分子(ICOS)阳性5例,以BALF定量培养作为对照,ICOS在CAP诊断中的灵敏度为37.50%,特异度为96.77%。30例细菌和病毒混合感染患儿中,5岁27例(90.00%),其热程10 d的比例高于非混合感染组,更容易发生胸腔积液,更易出现肺大片状阴影,白细胞水平、C反应蛋白、BALF中性粒细胞比例更高,中性粒细胞比值则较低,平均住院时间高于非混合感染组,差异均有统计学意义(P均0.05)。所有患儿均好转出院。结论儿童CAP合并细菌和病毒混合感染可致热程和住院时间延长,合并症增加,影像学表现、实验室指标也与非混合感染患儿存在差异。