博利康尼及普米克令舒吸入治疗毛细支气管炎疗效观察

目的:观察博利康尼及普米克令舒压力驱动吸入治疗毛细支气管炎(毛支)的疗效。方法:将90例毛支患儿随机分成观察组(42例)和对照组(48例),观察组采用常规治疗加博利康尼、普米克吸入疗法,对照组采用常规疗法。结果:观察组在缓解喘憋、缩短啰音及咳嗽持续时间上均明显优于对照组(P<0.05)。结论:博利康尼和普米克令舒吸入疗法治疗毛细支气管炎有效、方便、安全。     

布地奈德和盐酸氨溴索雾化吸入佐治毛细支气管炎的疗效观察

目的 观察布地奈德和盐酸氨溴索雾化吸入辅助治疗婴儿毛细支气管炎的临床疗效.方法 总结2005年9月至2009年12月我院儿科142例诊断为毛细支气管炎患儿的临床资料,随机分为两组,对照组66例,常规应用糜蛋白酶、地塞米松雾化吸入,同时给予抗感染治疗;治疗组76例,在对照组常规抗感染治疗的基础上应用布地奈德和盐酸氨溴索雾化吸入,观察患儿临床症状、体征消失时间.结果 治疗组显效率明显高于对照组,平均咳嗽消失时间、肺部喘鸣音消失时间、肺部湿啰音消失时间均比对照组明显缩短.结论 布地奈德和盐酸氨溴索雾化吸入辅助治疗婴儿毛细支气管炎疗效显著. Abstract： Objective To observe the effects of budesonide and ambroxol hydrochloric inhalation in treatment of infant bronchiolitis. Methods One hundred and forty-two cases of pediatric bronchiolitis from September 2005 to December 2009 in our hospital were randomly divided into two groups. Control group(66 cases) were treated by chymotrypsin, dexamethasone inhalation as routine, while giving the anti-infective treatment; Treatment group(76 cases) were given budesonide and ambroxol hydrochloric inhalation based on anti-infective thenxpy.To observe the disappearance time of clinical symptoms and signs in the two groups. Results In the treatment group had significantly higher efficiency, the average time of disappearance of cough, chest wheezing disappearance time and lung wet rales disappearance time were significantly shorter than those in the control group. Conclusions Budesonide and ambroxol hydrochloric inhalation has good efficacy for infants with bronchiolitis.     

呼吸道合胞病毒毛细支气管炎患儿中性粒细胞活化及蛋白酶平衡的研究

目的 探讨呼吸道合胞病毒毛细支气管炎(毛支)气道局部中性粒细胞活化及蛋白酶平衡状况.方法 收集符合毛支诊断标准的住院患儿30例,根据入院Lowell评分,≥10分为重度组(11例),<10分为轻度组(19例);20例治疗7～12 d后症状缓解采取标本作为恢复组,细菌性肺炎(肺炎)组24例,对照组15例.测定各组鼻咽吸出物中性粒细胞弹性蛋白酶(NE)、白细胞介素(IL)-8浓度、α1抗胰蛋白酶(α1AT)和蛋白酶抑制力.结果 毛支组中性粒细胞比例、NE、IL-8浓度(0.528、6.39×107kg/L、13.62×109kg/L)均明显高于对照组(0.074、2.53×107kg/L、2.64×109kg/L,均P<0.05)和恢复组(0.306、1.23×107kg/L、5.95×109kg/L,均P<0.05).恢复组中性粒细胞比例和IL-8浓度仍高于对照组(均P<0.05),重度毛支组该两项指标均高于轻度组(均P<0.05).毛支组α1AT表达高于恢复组(0.49比0.09,P<0.05),与对照组(0.26)比较差异无统计学意义.毛支组出现游离NE活性为6/30,与肺炎组7/24比较,差异无统计学意义(P>0.05).结论 呼吸道合胞病毒毛支气道局部存在大量中性粒细胞聚集活化和蛋白酶系统失衡,并可能在其发病中起重要作用.     

中药贴片经皮给药辅助治疗毛细支气管炎疗效观察

目的：观察经皮给药辅助治疗毛细支气管炎的临床疗效及安全性。方法：106例患儿随机分成治疗组56例和对照组50例。对照组常规抗感染及雾化吸入治疗,治疗组在对照组治疗的基础止联合中药贴片经皮给药治疗,1次／d,连用3～5d,观察两组临床效果。结果：治疗组治疗后咳嗽、喘憋、肺部哮鸣音、湿啰音的消失时间均短于对照组,差异均有统计学意义（P〈0．05）;治疗组总有效率为98．2％,对照组总有效率为86．O％,两组治愈率及总有效率比较差异均有统计学意义（P〈0．05）,治疗期间未见明显不良反应发生。结论：常规治疗加中药贴片经皮给药治疗毛细支气管炎疗效优于常规治疗。     

转化生长因子β1诱导肌纤维母细胞分化机制的研究

目的 探讨肺移植后闭塞性细支气管炎中转化生长因子β1（TGF-β1）诱导肌纤维母细胞分化的机制。方法 闭塞性细支气管炎动物模型采用Smad3野生型和基因敲除小鼠进行的同种异体异位气管移植,并采用原代培养的气管纤维母细胞,通过免疫组化、免疫荧光、Western Blotting、逆转录聚合酶链反应和DNA凝胶电泳迁移率检测等手段,检测肌纤维母细胞分化的标志物α平滑肌肌动蛋白（αSMA）的表达,以及Smad3、p38和ERK1／2的激活。结果 在闭塞性细支气管炎的受累气道中,发现有αSMA的大量表达。对纤维母细胞进行的离体研究,发现TGF-β1诱导Smad3激活,表现为蛋白磷酸化、细胞核转位和DNA结合。TGF-β1引起肌纤维母细胞分化增加,表现为αSMA在转录和蛋白水平的表达增加;而在缺乏Smad3的纤维母细胞中,TGF-β1诱导的肌纤维母细胞分化明显减少（t=2,080,P=0．027;t=1．982,P=0．032）,但未完全消除。TGF-β1可通过激活p38和ERK1／2来促进少量肌纤维母细胞的分化。结论 TGF-β1可通过激活Smad3依赖性和非依赖性信号传导途径,主要是Smad3依赖性途径,来促使纤维母细胞向肌纤维母细胞的转化,最终导致闭塞性细支气管炎的发展。     

A systematic review of predictive modeling for bronchiolitis

PurposeBronchiolitis is the most common cause of illness leading to hospitalization in young children. At present, many bronchiolitis management decisions are made subjectively, leading to significant practice variation among hospitals and physicians caring for children with bronchiolitis. To standardize care for bronchiolitis, researchers have proposed various models to predict the disease course to help determine a proper management plan. This paper reviews the existing state of the art of predictive modeling for bronchiolitis. Predictive modeling for respiratory syncytial virus (RSV) infection is covered whenever appropriate, as RSV accounts for about 70% of bronchiolitis cases.MethodsA systematic review was conducted through a PubMed search up to April 25, 2014. The literature on predictive modeling for bronchiolitis was retrieved using a comprehensive search query, which was developed through an iterative process. Search results were limited to human subjects, the English language, and children (birth to 18 years).ResultsThe literature search returned 2312 references in total. After manual review, 168 of these references were determined to be relevant and are discussed in this paper. We identify several limitations and open problems in predictive modeling for bronchiolitis, and provide some preliminary thoughts on how to address them, with the hope to stimulate future research in this domain.ConclusionsMany problems remain open in predictive modeling for bronchiolitis. Future studies will need to address them to achieve optimal predictive models.     

Winter air pollution and infant bronchiolitis in Paris

Respiratory syncytial virus (RSV) is one of the most common respiratory pathogens in infants and young children. It is not known why some previously healthy infants, when in contact with RSV, develop bronchiolitis whereas others have only mild symptoms. Our study aimed to evaluate the possible association between emergency hospital visits for bronchiolitis and air pollution in the Paris region during four winter seasons. We included children under the age of 3 years who attended emergency room services for bronchiolitis (following standardized definition) during the period 1997-2001. Two series of data from 34 hospitals, the daily number of emergency hospital consultations (n=50857) and the daily number of hospitalizations (n=16588) for bronchiolitis, were analyzed using alternative statistical methods; these were the generalized additive model (GAM) and case-crossover models. After adjustments for public holidays, holidays and meteorological variables the case-crossover model showed that PM10, BS, SO2 and NO2 were positively associated with both consultations and hospitalizations. GAM models, adjusting for long-term trend, seasonality, holiday, public holiday, weekday and meteorological variables, gave similar results for SO2 and PM10. This study shows that air pollution may act as a trigger for the occurrence of acute severe bronchiolitis cases.     

毛细支气管炎患儿血清乳酸脱氢酶水平的变化及临床意义

目的探讨毛细支气管炎患儿血清乳酸脱氢酶(LDH)水平及其临床意义。方法将131例毛细支气管炎患儿按临床症状分为重症组和轻症组两组,并与正常对照组进行比较。结果与正常对照组比较,毛细支气管炎患儿LDH显著升高(P<0.05);入院时,轻症组与重症组LDH分别为316.3±84.6 IU/L、567.8±101.5 IU/L(P<0.05),经过1周治疗后轻症组与重症组LDH分别为188.6±59.5 IU/L、195.4±63.3 IU/L(P<0.05);而且治疗1周后轻症组临床症状均缓解,而重症组有7例患儿临床症状无缓解甚至加重,LDH水平进一步升高。结论毛细支气管炎患儿血清LDH的改变可以提示临床症状轻重,对预后判断也具有临床意义。     

Acute bronchiolitis during the COVID-19 pandemic

IntroductionThe autumn and winter bronchiolitis epidemics have virtually disappeared in the first year of the COVID-19 pandemic.Our objectives were characterised bronchiolitis during fourth quarter of 2020 and the role played by SARS-CoV-2.MethodsProspective multi-centre study performed in Madrid (Spain) between October and December 2020 including all children admitted with acute bronchiolitis. Clinical data were collected and multiplex PCR for respiratory viruses were performed.ResultsThirty-three patients were hospitalised with bronchiolitis during the study period: 28 corresponded to rhinovirus (RV), 4 to SARS-CoV-2, and 1 had both types of infection. SAR-CoV-2 bronchiolitis were comparable to RV bronchiolitis except for a shorter hospital stay. A significant decrease in the admission rate for bronchiolitis was found and no RSV was isolated.ConclusionSARS-CoV-2 infection rarely causes acute bronchiolitis and it is not associated with a severe clinical course. During COVID-19 pandemic period there was a marked decrease in bronchiolitis cases.