肺炎患儿白细胞变形能力和粘附功能的变化及临床意义

肺炎患儿白细胞变形能力和粘附功能的变化及临床意义林荣军１刘成玉２潘玉娟３徐丽园研究表明，白细胞与急性肺组织损伤有密切关系［１］，白细胞在肺内聚集是产生急性肺损伤的重要环节，而细胞粘附分子（ｃＡｍｓ）介导的各种白细胞的粘附，特别是中性粒细胞粘附和跨膜转...     

Soluble suppression of tumorigenicity-2 predicts pneumonia in patients with inhalation injury: Results of a pilot study

IntroductionSeveral mechanisms play a role in the development of pneumonia after inhalation injury. Our aim was to analyze whether higher concentrations of inflammatory markers or of biomarkers of epithelial injury are associated with a higher incidence of pneumonia in patients with inhalation injury.Material and methodsSecondary analysis of a single-center prospective observational cohort pilot study, performed over a two-year period (2015–2017) at the Burns Unit of the Plastic and Reconstructive Surgery Department of Vall d’Hebron University Hospital. All patients aged 18 with suspected inhalation injury undergoing admission to the Burns Unit were included. Plasma biomarkers of the lung epithelium (RAGE and SP-D), inflammation markers (IL6, IL8), and IL33, as well as soluble suppression of tumorigenicity-2 (sST2) levels, were measured within the first 24 h of admission.ResultsTwenty-four patients with inhalation injury were included. Eight (33.3%) developed pneumonia after a median of 7 (4–8) days of hospital stay. Patients with pneumonia presented higher plasma concentrations of sST2 (2853 [2356–3351] ng/mL vs 1352 [865–1839] ng/mL; p < 0.001), IL33 (1.95 [1.31–2.59] pg/mL vs 1.26 [1.07–1.45] pg/mL; p = 0.002) and IL8 (325.7 [221.6–430.0] pg/mL vs 174.1 [95.2–253.0] pg/mL; p = 0.017) on day 1 of inclusion. Plasma sST2 concentration in the first 24 h demonstrated excellent diagnostic accuracy for predicting the occurrence of pneumonia in patients with smoke inhalation (AUROC 0.929 [95%CI 0.818–1.000]). A cutoff point of ≥2825 ng/mL for sST2 had a sensitivity of 75% and a specificity of 100%. The risk ratio of pneumonia in patients with sST2 ≥ 2825 ng/mL was 7.14 ([95% CI 1.56–32.61]; p = 0.016).ConclusionsPlasma sST2 in the first 24 h of admission predicts the occurrence of pneumonia in patients with inhalation injury.     

Detection of Mycoplasma pneumoniae in serum specimens from patients with mycoplasma pneumonia by PCR

There are few data on detection of Mycoplasma pneumoniae from blood, serum or plasma, and systematic studies on this diagnostic approach in community-acquired pneumonia (CAP) are scarce. Compared to testing respiratory specimens, this approach has the advantages that it is less dependent on proper specimen collection, serum is easily stored and handled, and the pathogen is detected in a primary sterile site, where colonization can be ruled out. In this study, acute-phase serum specimens from 29 patients of Vienna University Hospital (treated between 11/1994 and 6/2004; female: 14, male: 15; median age: 31 years, range: 15-66 years) with CAP and serologically verified M. pneumoniae infection, who had not received anti-mycoplasma therapy prior to serum collection, were tested for M. pneumoniae by conventional PCR and real-time PCR. Conventional PCR yielded negative results for all specimens, but real-time PCR detected M. pneumoniae in 15/29 patient sera (52%). These findings indicate that M. pneumoniae is present in the bloodstream of a substantial proportion of patients with mycoplasma pneumonia. Despite the possible adherence of M. pneumoniae to human erythrocytes, the pathogen can be detected from serum, if a method with enhanced sensitivity is applied. However, the negative predictive value of PCR from serum with regard to etiological diagnosis is low. With regard to the potential clinical benefit of blood-based PCR diagnosis of mycoplasma pneumonia the diagnostic accuracy of this approach using either serum or whole-blood specimens should be addressed by large-scale studies.     

血清25-羟维生素D和白细胞介素-22对急性肺炎患儿病情的诊断价值

目的 探究血清25-羟维生素D[25(OH)D]和白细胞介素-22(IL-22)对急性肺炎患儿病情的诊断价值。方法 选取2021年3月至2022年3月自贡市第一人民医院收治的96例急性重症肺炎患儿作为重症肺炎组,另选96例普通肺炎患儿作为普通肺炎组、96例体检健康儿童作为健康对照组。采用化学发光微粒子免疫检测法检测血清25(OH)D水平,采用酶联免疫吸附法（ELISA）检测IL-22水平;采用Pearson法分析重症肺炎患儿血清25(OH)D、IL-22水平与急慢性健康状况评分Ⅱ（APACHEⅡ评分）、序贯器官衰竭评分（SOFA评分）的相关性;采用受试者工作特征（ROC）曲线评估25(OH)D、IL-22对重症肺炎患儿危重症的诊断价值。结果 重症肺炎患儿血清25(OH)D与APACHEⅡ评分及SOFA评分呈负相关（r=-0.521、-0.484,P<0.05）,血清IL-22与APACHEⅡ评分及SOFA评分呈负相关（r=-0.614、-0.419,P<0.05）。ROC曲线显示,25(OH)D对危重症诊断的曲线下面积（AUC）为0.745,IL-22对危重症诊断的AUC为...     

肺炎支原体感染伴心肌受累(附46例分析)

近年来国内外陆续有对肺炎支原体 (MP)肺外脏器受累和心脏受累的报道 ,为了进一步研究证实我地区该病的心脏受累情况及发生率。方法 :对 30 7例门诊及住院确诊为MP感染的患儿进行临床、心电图、胸部X线检查 ,并记录有关症状和体征 ,必要时测心肌酶谱 ,对发现有心脏受累者除按MP感染治疗外尚给予心脏支持疗法 ,并定期随访。结果 :有心脏受累者 46例、占 1 4 9% ,平均年龄 9 8±S1 72a。结论 :本文心脏受累者占MP感染的发生率较文献报道 (4 9% )明显为高 ,可能与多数患儿发病年龄较大存在再感染有关。我们认为凡MP感染的患儿应把心电图检查做为常规检查项目。     

肺炎支原体肺炎患儿血清心肌酶活性的变化

目的：探讨血清心肌酶在肺炎支原体肺炎急性期是否有心肌损害的参考价值及病情较重的关系。方法：采取肘静脉血分别测定５０例肺炎支原体肺炎急性期患儿血液中心肌酶的变化,并对其中心肌酶异常的３９例患儿在恢复期进行复查,与２０例健康儿童做对照。结果：急性期ＣＰＫ－ＭＢ、ＬＤＨ、ＣＰＫ、ＡＳＴ显著高于对照组（Ｐ〈０．０１）并与病情轻重呈正比,恢复期血清ＣＰＫ－ＭＢ、ＬＤＨ、ＣＰＫ、ＡＳＴ明显下降,但仍高于对照组     

Epidemiology and risk factors of pneumonia in critically ill patients

Risk factors for pneumonia were analysed in a large population of critically ill patients, collected in two prospective multicentre pneumonia studies in Italy. Twenty-three intensive care units were involved and the study time was 150 unit months. Only patients without previous pulmonary infection, with intensive care unit stay 48 hours and no rapidly irreversible illness at admission were included. The incidence of pneumonia in the 1475 selected patients was 15% (220 cases). 239 patients died in ICU; the mortality rate was significantly higher in patients developing pneumonia (p<0.0001); pneumonia was found to be an independent highly significant risk factor for death in critically ill patients (OR = 3.88; p<0.0001).Multivariate analysis of seven risk factors for pneumonia showed a significantly higher risk in patients with neuromuscular disease (OR = 3.8, p<0.002), impairment of airway reflexes at admission (OR = 2.93, p<0.0001), and 24h respiratory assistance (OR=3.05, p<0.0001). Impairment of airway reflexes at admission to the emergency room or intensive care unit identifies the population who will experience 3/4 of the overall lower respiratory tract infections.Rapid recognition of at-risk patients seems clinically important and may improve awareness programs and preventive approaches.Intensive Care Unit Group for Infection Control (I.C.U.G.I.C.), a list of participating physician co-authors of the paper is reported at the endCorresponding author.     

婴儿肺炎肺炎衣原体感染的血清免疫荧光法诊断及临床分析

目的　探讨肺炎衣原体 (Cpn)在婴儿肺炎中的感染情况。 方法　对符合肺炎诊断标准的 1岁以内患儿 2 6 9例 ,使用荧光免疫方法检测Cpn抗体 ,并进行统计学分析。 结果　 2 6 9例肺炎患儿中 ,急性Cpn感染的感染率为 15 2 % ,既往感染的感染率为 2 4 5 % ,。 1999年检测 134例中 ,Cpn急性感染为 4 5 % ,既往感染为2 5 4% ;2 0 0 0年检测 135例中 ,Cpn急性感染为 2 5 9% ,既往感染为 2 3 7%。两年度比较 ,Cpn既往感染率接近(P >0 0 5 ) ,而Cpn急性感染率差异有非常显著意义 (P <0 0 1) ,2 0 0 0年急性感染率比 1999年明显增高。结论　Cpn是婴儿肺炎的重要病原之一 ,且具有流行性。     

新生儿先天性心脏病186例分析及部分随访

目的：探讨新生儿先天性心脏病(先心病)的诊治经验，以便更好地与家长沟通配合治疗及随访。方法：回顾性分析重医儿童医院新生儿病房1999年1月～12月收治的186例新生儿先天性心脏病的类型、临床特点及并发症，52例随访其转归。结果：新生儿期严重的先天性心脏病及复合畸形多见，常表现为气急、青紫及心衰，常合并难治性肺炎，预后差，而单纯性房间隔缺损或室间隔缺损部分有望自愈。结论：新生儿先心病杂音常有不典型，不稳定的特点，严重复合畸形及心衰的患儿可以听不到杂音，不能因听不到杂音而排除先心病的存在。新生儿先心病合并心衰时以洋地黄类药物为首选，一般有流出道梗阻的先心病禁用洋地黄，严重复合畸形宜早期采用介入治疗、早期手术。