以消化道出血、鼻衄为主要表现的湿疹-血小板减少-免疫缺陷综合征一例

患儿男,5岁1个月.因反复消化道出血5年、鼻衄3年,加重半年于2010年4月26日人我院.患者出生后40 d出现呕血和便血,呕鲜红色血块和解鲜红色大便,量不多,到当地医院就诊,血常规提示血小板18×109/L,诊断为特发性血小板减少性紫癜,给予规则糖皮质激素治疗半年,并每隔20 d到医院给予丙种球蛋白冲击治疗共1年余.在此治疗期间患儿血小板波动于11×109/L～70×109/L,偶有大便出血及呕血,每次量不多,大便出血约2～3次/年,呕血约1～2次年.     

儿童原发性十二指肠胃反流对胃黏膜损伤的作用

目的 观察儿童原发性十二指肠胃反流(DGR)对胃黏膜的损伤作用,并初步探讨DGR与临床症状、幽门螺杆菌感染和胃内酸度的关系.方法 对81例因腹痛、饱胀、恶心、呕吐等上消化道症状就诊的患儿,进行临床症状评分、胃镜检查、胃窦黏膜组织病理学检查和24 h胃内胆红素监测,其中51例同步行24 h胃内pH监测.以胆汁反流总时间百分比作为胆汁反流程度的指标.根据胃窦黏膜的胃镜下改变以及组织病理学特征变化有无进行分组,分别比较2组的胆汁反流程度.并对胃内胆汁反流与临床症状评分、胃内酸度以及Hp感染等进行相关性分析.结果 胃窦黏膜有充血者[17.1%(0.5%～53.2%)]较无充血者[6.5%(0～58.6%)](Z=-1.980),有黄染者[19.8%(0.5%～58.6%)]较无黄染者[8.8%(0-38.0%)](Z=-2.956),胆汁反流总时间百分比高,差异均有统计学意义(P＜0.05或0.01);胃窦黏膜组织病理学检查,有肠化组胆汁反流总时间百分比[29.0%(1.9%～58.6%)]较无肠化组[14.3%(0～53.7%)]长,差异有统计学意义(Z=-2.026,P＜0.05).有慢性炎症组与无慢性炎症组、有活动性组与无活动性组相比,胆汁反流程度差异无统计学意义(P＞0.05).胆汁反流严重度与饱胀症状正相关(r=0.258,P＜0.05),与Hp感染(r=0.016)和胃内酸度(r=0.124)元明显相关性(P均＞0.05).结论 原发性DGR可致儿童胃窦黏膜损伤,胃镜下主要表现为胃窦黏膜充血和黄染,病理组织学变化上与肠上皮化生有关,与炎症细胞浸润无关.DGR与Hp感染和胃内酸度均无关,DGR可能是一个独立的致病因素,与Hp感染和胃酸一起共同对胃黏膜造成损伤.     

巨细胞病毒性肝炎28例肝脏病理改变

巨细胞病毒（CMV）性肝炎是婴儿肝炎综合症的主要病原。对肝胆系统的损害明显。本文对28例临床诊断为CMV性肝炎的患儿进行肝穿刺活检术取肝组织检查，所见病理学改变，报告如下。     

儿童幽门螺杆菌感染时T淋巴细胞亚群的变化

目的研究儿童幽门螺杆菌(H.pylori)感染时的T淋巴细胞亚群变化。方法流式细胞仪直接免疫荧光法测定38例［H.pylori+慢性浅表性胃炎(CSG)12例；H.pylori+十二指肠溃疡(DU)5例；H.pylori-CSG 21例］儿童胃窦黏膜及外周血T淋巴细胞亚群。各组患儿均在内镜检查下取胃窦黏膜作快速尿素酶试验、组织学检查及淋巴细胞提取，同时抽取外周肝素抗凝静脉血2mL。提取的淋巴细胞经CD3 FITC、CD4 PE、CD8 PerCP染色后行流式测定。其中，胃黏膜T淋巴细胞亚群的检测以CD3设门。结果(1)胃黏膜CD+3(%)细胞的检出率分别为：H.pylori-CSG组3.14±2.03,H.pylori+CSG组4.58±2.30,H.pylori+DU组为6.49±4.49；(2)胃黏膜CD+3细胞中CD+4(%),CD+8(%)的相对比例及CD+4/CD+8值分别为：H.pylori-CSG组为19.81±9.25,47.30±12.83,0.43±0.19，H.pylori+CSG组为40.66±12.52,29.25±8.58,1.42±0.31,H.pylori+DU组为31.98±14.02,49.52±19.00，0.72±0.43。H.pylori+CSG组局部胃窦黏膜CD+4细胞、CD+4/CD+8比值明显高于H.pylori-CSG组，CD+8细胞则低于H.pylori-CSG组(P<0.01)。H.pylori+DU组CD+4、CD+4/CD+8比值也高于H.pylori-CSG组(P<0.05)，但CD+8细胞无统计学差异。H.pylori+DU组CD+8细胞高于H.pylori+CSG组而CD+4细胞无统计学差异，CD+4/CD+8比值则低于H.pylori+CSG组(P<0.01)。(3)外周血T淋巴细胞亚群的变化在三组之间并无明显的差异。结论H.pylori+DU与H.pylori+CSG的宿主的T淋巴细胞反应并不相同，而局部胃窦黏膜的T淋巴细胞亚群的异常可能在儿童H.pylori感染的免疫致病机制中起一定的作用。     

轮状病毒病毒血症与肠道外脏器损伤的研究

目的：研究杭州地区急性轮状病毒肠炎患儿中病毒血症的发生情况，及其与肠道感染的严重程度、肠道外脏器损伤的关系。方法：对2002年10月-2003年3月在本院住院治疗的83例急性轮状病毒肠炎患儿进行前瞻性研究，取患儿急性期血及粪便，用套式-逆转录PCR方法检测轮状病毒RNA（RV—RNA）。将血RV—RNA阳性病例设为观察组，阴性病例设为对照组。比较两组患儿肠道感染的严重程度及肠道外脏器损伤的情况。结果：83例患儿中大便RV—RNA阳性82例，血RV—RNA阳性16例（19．3％）。观察组（16例）与对照组（67例）相比在发热、腹泻、水电解质酸碱平衡紊乱程度及心肌损害发生率无显著性差异（P〉0．05）。而肝功能损害、皮疹、下呼吸道感染、中枢神经系统损害发生率明显高于对照组（P〈0．05）。结论：轮状病毒肠炎患儿病程中存在病毒血症，其可能是轮状病毒引起肠道外脏器损害的重要机制之一。     

Clinical features of children with colorectal polyps and the efficacy of endoscopic treatment: an analysis of 1 351 cases北大核心CSCD

Objective To study the clinical features of children with colorectal polyps and the efficacy of endoscopic treatment. Methods A retrospective analysis was performed on the medical data of 1 351 children with colorectal polyps who were admitted and received colonoscopy and treatment in the past 8 years, including clinical features and the pattern and outcomes of endoscopic treatment. Results Among the 1 351 children, 893 (66.10%) were boys and 981 (72.61%) had an age of 2-<7 years, and hematochezia (1 307, 96.74%) was the most common clinical manifestation. Of all the children, 89.27% (1 206/1 351) had solitary polyps, and 95.77% (1 290/1 347) had juvenile polyps. The polyps were removed by electric cauterization with hot biopsy forceps (6 cases) or high-frequency electrotomy and electrocoagulation after snare ligation (1 345 cases). A total of 1 758 polyps were resected, among which 1 593 (90.61%) were pedunculated and 1 349 (76.73%) had a diameter of <2 cm. Postoperative complications included bleeding in 51 children (3.77%), vomiting in 87 children (6.44%), abdominal pain in 14 children (1.04%), and fever in 39 children (2.89%), while no perforation was observed. The children aged <3 years had the highest incidence rates of postoperative bleeding and fever (P<0.0125), and the children with a polyp diameter of ≥2 cm had significantly higher incidence rates of postoperative bleeding, vomiting, and fever (P<0.05). Conclusions Solitary polyps, pedunculated polyps, and juvenile polyps are common types of pediatric colorectal polyps. Electric cauterization with hot biopsy forceps or high-frequency electrotomy and electrocoagulation after snare ligation can effectively remove colorectal polyps in children, with good efficacy and few complications. Younger age and larger polyp diameter are associated with a higher risk of postoperative bleeding. © 2022 Xiangya Hospital of CSU. All rights reserved.     

麻醉状态下儿童择期结肠镜检查肠道准备专家共识

正1适用和应用人群1.1肠道准备适用人群不明原因腹泻,不明原因腹痛,下消化道出血,不明原因贫血,肛周病变(肛周脓肿、肛瘘),体重不增及生长发育迟缓者,发热待查考虑消化道疾病可能者,疑似黑斑息肉综合征者,其他系统疾病累及下消化道者,慢性肠病随访评估者,各种结肠镜下治疗及随访者。1.2肠道准备相对禁忌人群活动性出血,不完全性肠梗阻,凝血功能障碍,吸入风险,肾功能不全等。1.3肠道准备绝对禁忌人群肠梗阻,肠穿孔,严重的坏死性肠炎,中毒性巨结肠危象,生命体征不平稳等。     

沙利度胺治疗儿童难治性克罗恩病研究进展

儿童克罗恩病是一种可累及全消化道的慢性肉芽肿性炎症病变,好发于末段回肠及升结肠,病变可贯穿肠壁各层,呈节段性、非对称性分布。其病因目前尚不明确,可能与感染、遗传、环境、免疫因素有关。儿童克罗恩病的发病率近年来显著增加,尤其是10~18岁的儿童[1-2],患病率高达43/100 000[3]。