儿童抗N-甲基-D-天冬氨酸受体脑炎

抗N-甲基-D-天冬氨酸受体(N-methyl-D-asparate receptor,NMDAR)脑炎是免疫介导的中枢神经系统综合征,主要临床表现有精神症状、运动障碍、抽搐发作等,常被误诊为病毒性脑炎,与肿瘤尤其卵巢畸胎瘤关系密切;儿童患病率高,抗NMDAR抗体是其较特异的检查;治疗主要为免疫抑制,一线治疗为激素、免疫球蛋白、血浆置换,二线治疗主要包括生物制剂、细胞毒药物;早期诊断及治疗对神经系统的恢复至关重要,总体预后良好.     

Tularemia in children

Objective  Tularemia, an infection caused by the coccobacilus Francisella tularensis, can be a difficult disease process to diagnose and treat. The aim of this study was to evaluate an epidemic of tularemia in Bursa. Methods  In this study, we included only pediatric cases. All the cases were diagnosed on clinical and serological grounds. Results  During an epidemic of tularemia in a village of Bursa on December 2004, 70 people (60 adults, 10 children) fell ill. In children with tularemia, the oropharyngeal form predominated which was diagnosed 70% of cases. Most of the patients (80%) who had older than 10 years old, were treated with doxycycline. All patients recovered without complications. Conclusion  The epidemic was thought to be waterborne. The vehicle of the infections was inadequately treated water which was used by the patient in the village.     

我国艾滋病高危人群基数估计方法研究及其在流行形势分析中的应用

目的研究适合我国艾滋病疫情的高危人群估计方法,并进行流行形势分析,为制定防治政策提供科学依据。方法通过试点研究确定不同类别高危人群基数估计的适宜方法。结果研究形成了不同类别高危人群基数估计的适宜方法和流程;确定了适于我国流行特点的疫情估计方法和参数;清晰阐明了我国艾滋病流行现状及特点。结论研究形成的方法,对准确掌握现存活感染人数起到关键作用;对艾滋病流行形势有了准确判断;促进了监测系统的完善和检测工作的加强;推动了“四免一关怀”政策的形成。     

地塞米松对病毒性脑炎患儿CD4+、CD8+淋巴细胞水平的影响

目的观察地塞米松(DEX)对病毒性脑炎(病脑)患儿CD4 、CD8 淋巴细胞的影响。方法对82例轻中度病脑患儿应用DEX治疗,用流式细胞仪动态测定其CD4 、CD8 细胞数变化。结果1.治疗前DEX治疗组和无DEX治疗组与正常儿童比较,CD4 淋巴细胞数减少,CD8 淋巴细胞数增加,有显著差异(F=14.3 P<0.05)。2.治疗1周两组与治疗前比较,CD4 淋巴细胞数进一步减少,CD8 淋巴细胞数进一步增加,这些变化DEX治疗组较无DEX治疗组更明显,有显著性差异(P均<0.05)。3.治疗后4周两组CD4 、CD8 、CD4 /CD8 比值均较治疗前和治疗后1周时恢复,但DEX治疗组仍未恢复到对照组水平,差别仍有显著意义(P均<0.05)。结论DEX治疗病脑可抑制CD4 细胞增生,使CD4 细胞数延迟恢复正常,从而促使继发感染的人数增多。对轻中度病脑患儿应用DEX弊大于利,应慎用。     

Herpes simplex-Encephalitis bei Neugeborenen

Premature twins both affected with generalized herpes simplex infection including CNS involvement were treated with 5-Iodo-2′-deoxyuridin (IDU). Therapy was started 6 days and 5 days respectively, after appearance of the first symptoms. Nevertheless both babies died, twin A at the age of 24 and twin B at the age of 28 days. Herpes virus was cultured from all organs in twin A. The literature shows a decrease in mortality in children treated with IDU for herpes simplex encephalitis. The percentage of survivors with ultimate severe CNS damage, however, is very high and remains in treated or untreated patients the same. The institution of IDU therapy in neonates with manifest HSV encephalitis is therefore not unequivocally justified.     

Changes in immune parameters and their correction in human cases of tick-borne encephalitis

Tick-Borne Encephalitis virus (TBEV) causes dangerous central nervous system diseases in humans. General infection leads to the development of meningitis or encephalitis, which is characterized by swelling of the brain due to inflammation. Tetracyclines may act locally to moderate inflammation in the CNS. In this study, we investigated the potential clinical benefits of administering tetracycline hydrochloride to patients hospitalized due to suspected TBEV infection presenting with fever and evidence of a recent tick bite. We also characterized an acute immune response to TBEV by profiling certain cytokines and soluble receptors in Tetracycline-treated and untreated patients. Increased serum levels of TNF-alpha, IL-1 alpha and IL-6 were found in all patients at admission. Soluble receptors presented in the serum of patients in a magnitude higher levels than the corresponding cytokines and were increasing during first weak of hospitalization. Levels of IL-10 were also rising during that period. In our study tetracycline hydrochloride acted as an immunomodulator, which was able to reduce manifestations of inflammation response during TBE course; this action led to quicker improvement of symptoms and, consequently, to a faster clinical recovery. The positive result of tetracycline hydrochloride treatment was accompanied by certain particularities in the dynamics of studied cytokines and receptors: the concentrations of IL-6, IL-1 beta, TNF-alpha dropped quicker and reached lower levels, and the concentrations of sIL-6R, IL-1RA, sTNFR1 increased faster and reached higher maximum levels in the tetracycline-treated groups. Children had the highest levels of IL-6, which were not neurotoxic.     

2007年宁南县麻风病疫点与家庭发病情况调查

[目的]为制定麻风病防制策略提供科学参考。[方法]2007年,对宁南县全部现存麻风病患者及历年治愈者(现存者)进行疫点与家庭发病情况调查。[结果]调查全部现存者218例,占全县人口的0.12%,占调查疫点人口的2.08%,占调查家庭人口的17.94%。MB病例所占比例,全县为58.26%(127/218),调查疫点为63.77%(44/69),调查家庭为62.92%(56/89);调查疫点继发率为146.43%,调查家庭继发率为117.07%,MB率分别为63.41%和41.67%。[结论]疫点人群和家庭人群是麻风病防制的监视人群。     

病毒性脑炎患儿神经元特异性烯醇化酶的水平变化及临床意义

目的:探讨病毒性脑炎患儿脑脊液(CSF)及血清中神经元特异性烯醇化酶(NSE)水平的变化及临床意义。方法:以28例病毒性脑炎患儿作为观察组,选择同期住院怀疑中枢神经系统疾病但脑脊液正常、最后确诊为上呼吸道感染的患儿作为对照组,两组患儿均于入院后24~48 h行腰椎穿刺取脑脊液,同时抽取静脉血,用酶连免疫吸附法(ELISA)检测脑脊液和血清中的NSE浓度。结果:病毒性脑炎患儿脑脊液和血清中NSE水平分别为(23.16±5.93)μg/L和(17.80±4.27)μg/L,对照组分别为(8.96±1.03)μg/L和(7.78±0.94)μg/L,两组有显著性差异(P均<0.01),且血清中NSE浓度与脑脊液中NSE浓度呈正相关(r=0.84,P<0.01)。结论:病毒性脑炎患儿脑脊液和血清中NSE浓度明显升高,脑脊液和血清中NSE可作为判断病毒性脑炎患儿脑组织损伤的客观指标之一。     

儿童行为问题的元分析

目的:总结近15年国内关于儿童行为问题的流行病学的调查研究结果。方法:对1993—2006年公开发表的67篇关于儿童行为问题发生率的性别差异、城乡差异、地区差异的研究结果进行元分析。结果:儿童行为问题在性别方面存在显著性差异,即男生更易出现行为问题(P<0.01);在城乡之间存在显著性差异(P<0.01);在不同地区间也存在显著性差异(P<0.01)。结论:不同性别、不同地区的儿童存在着不同程度的行为问题。