67例反复喘息婴幼儿电子支气管镜检查分析

目的：探讨婴幼儿反复喘息常见原因,并进一步指导临床诊治。方法：对常规诊治无明显好转的持续或频繁反复喘息的67例患儿行电子支气管镜检查。结果：镜下见气管支气管内膜炎19例,内膜炎伴有炎性狭窄的11例;支气管异物11例;气管、支气管软化19例;支气管肺发育不良3例,支气管内膜结核1例,会厌囊肿1例,喉乳头状瘤1例,管外受压(胸腺)1例。结论：对反复多次咳喘或常规治疗效果欠佳的喘息患儿应积极寻找病因并进一步检查,除炎症以外,气管、支气管软化及支气管异物也是相对多见的原因,电子支气管镜检查是进一步明确此类患儿病因的有效方法。［中国当代儿科杂志,2010,12（6）：447-449］     

Association of higher adiposity and wheezing in infants with lower respiratory illnesses

Aim: The incidences of asthma and obesity have been steadily increasing over the past two decades, with several studies showing a relationship between these conditions. We investigated the influence of higher weight for height (WFH) Z‐score on wheezing in infants with lower respiratory tract infections (LRTI). Methods: We reviewed the medical charts of all infants younger than l year of age who were admitted with the first episode of LRTI between 2000 and 2008. Subjects were classified into six groups according to WFH Z‐score. Results: Wheezing was more frequent in infants with higher WFH Z‐scores. Especially, wheezing infants aged 3–6 months and 6–9 months had significantly higher WFH Z‐scores than had their non‐wheezing counterparts (p = 0.05 and p < 0.01 respectively). Multivariate logistic regression showed that age (OR = 0.76, p < 0.001), male gender (OR = 1.61, p = 0.005) and WFH Z‐score (OR = 1.12, p = 0.007) were independently associated with wheezing. Conclusion: In this study we could show that a higher WFH Z‐score was independently associated with wheezing in infancy. Attainment of appropriate weight for age may reduce the risk of wheezing in infants with respiratory diseases.     

大环内酯类抗生素佐治毛细支气管炎临床分析

目的：观察以红霉素为代表的大环内酯类抗生素治疗毛细支气管炎的疗效及平喘作用。方法：全部患者选自2010年1月～2011年1月在本院住院的50例毛细支气管炎的患儿,年龄2个月～2岁。观察组男15例,女10例,对照组男14例,女11例。两组均给予氧疗、利巴韦林雾化吸入,及抗病毒常规治疗,观察组在此基础上加用红霉素30mg/（kg·d）分3次口服,疗程7～14d,平均用药8d观察疗效。结果：观察组总有效率为96%（24/25）,临床显效占56%（14/25）,对照组总有效率为88%（22/25）,临床显效占32%（8/25）,观察组明显优于对照组（P〈0.05）。观察组喘憋的发生率为16%,明显低于对照组的52%。结论：随着红霉素的平喘作用已逐渐被发现,临床上毛细支气管炎患儿益早期应用以红霉素为主的大环内酯类抗生素。     

婴幼儿喘息性疾病92例临床分析

目的：探讨婴幼儿喘息性疾病的临床特点。方法：选择反复喘息患儿42例,毛细支气管炎患儿24例,肺炎患儿26例,入院当日至第五天取外周血常规分析,同时行病原学检查。结果：3组患儿中肺炎组白细胞入院当日明显高于治疗第五天。肺炎组白细胞及中性分类高于毛细支气管炎组和喘息组。嗜酸性粒细胞毛细支气管炎组和反复喘息组高于肺炎组,差异有显著性。3组患儿病原学检测痰培养、血培养均以肺炎组阳性率高,分别达25%和22.2%。肺炎支原体检测3组阳性率均高,但3组间差异无显著性。结论：婴幼儿喘息性疾病多为病毒感染所致,且与过敏因素密切相关,肺炎支原体感染亦是婴幼儿喘息性疾病的常见病原。     

A US postmarketing evaluation of the frequency and safety of live attenuated influenza vaccine use in nonrecommended children younger than 5 years: 2009-2010 season

The 2007 US approval for use of Ann Arbor strain live attenuated influenza vaccine (LAIV) in children aged 24 through 59 months included precautions against use in (1) children <24 months and children aged 24 through 59 months with (2) asthma, (3) recurrent wheezing, and (4) altered immunocompetence. Results from the third season (2009-2010) of a 3-year study postmarketing commitment to monitor LAIV vaccination rates and frequency of hospitalizations or emergency department visits within 42 days after LAIV are reported here. As in the first 2 seasons, LAIV usage in cohorts 1, 2, and 4 were low relative to those in LAIV-recommended populations. The only numerically increased risk observed was for respiratory events in children aged <24 months administered LAIV, compared to those administered trivalent inactivated influenza vaccine (TIV). The number of children vaccinated with LAIV was small and precluded precise quantification of rare event.     

Association between personal exposure to volatile organic compounds and asthma among US adult population

Objectives There is growing concern about adverse respiratory health effects from exposure to indoor air pollution. The purpose of this study was to analyze association between exposure to volatile organic compounds (VOC) and asthma in adults. Methods This study utilized passive personal exposure data on ten VOC collected as part of the National Health and Nutrition Examination Survey (NHANES) 1999–2000. A total of 550 subjects who were of non-Hispanic whites, Mexican-Americans, or non-Hispanic Blacks race/ethnicity were included in this analysis. The primary outcome variable was physician-diagnosed asthma and the secondary outcome variable was presence of wheezing in the previous 12 months among those without physician-diagnosed asthma. Exploratory factor analysis was used to generate factor scores to group VOCs, which were included as indicator variables in the analyses. Associations between exposure to VOCs, physician-diagnosed asthma, and wheezing in the previous 12 months were evaluated using multiple logistic regression analyses. Odds ratios are for 1-U increase in level of exposure. Results Seven of the ten VOC variables loaded on two factors, “aromatic compounds” and “chlorinated hydrocarbons.” The geometric mean concentration of VOCs varied from as low as 0.03 μg/m³ for trichloroethene to as high as 14.33 μg/m³ for toluene. Mexican-Americans had the highest personal exposures to benzene (geometric mean = 2.38 μg/m³) as compared to non-Hispanic whites (geometric mean = 1.15 μg/m³) and non-Hispanic Blacks (geometric mean = 1.07 μg/m³). The odds of physician-diagnosed asthma were significantly higher among those exposed to aromatic compounds (Adjusted OR = 1.63, 95% CI: 1.17–2.27). Among those subjects never diagnosed by a physician to have asthma, a significantly increased odds of one to two wheezing attacks were observed for aromatic compounds (Adjusted OR = 1.68, 95% CI: 1.08–2.61) and chlorinated hydrocarbons (Adjusted OR = 1.50, 95% CI: 1.01–2.23) as compared to no wheezing. No association with three wheezing attacks or more was observed in the study. Conclusion In this cross-sectional study of a representative sample of the US population, environmental exposures to VOCs, especially aromatic compounds, were associated with adverse respiratory effects. An erratum to this article can be found at     

5岁以下喘息儿童鼻咽分泌物嗜酸性粒细胞和IL-17测定的临床意义

目的：探讨5岁以下喘息儿童鼻咽分泌物中嗜酸性粒细胞(EOS)计数和白介素-17（IL-17）水平在喘息评估中的临床意义。方法：53例5岁以下反复喘息患儿,分为有特应性体质的喘息Ⅰ组27例,非特应性体质的喘息Ⅱ组26例;非感染性疾病术前患儿20例作为对照组,分别收集鼻咽分泌物并处理后,显微镜下计数各组鼻咽分泌物中细胞数,用ELISA方法检测上清液中IL-17水平。结果：喘息Ⅰ组鼻咽分泌物中EOS计数明显高于喘息Ⅱ组和对照组（P＜0.05、P＜0.01);喘息喘Ⅱ组鼻咽分泌物中EOS计数和对照组比较差异无统计学意义（P＞0.05）;喘息Ⅰ组和喘息Ⅱ组患儿鼻咽分泌物中IL-17表达均高于对照组（P＜0.01）,其中喘息Ⅰ组IL-17水平高于喘息Ⅱ组,差异有统计学意义(1 474±974 pg/mL vs 788±132 pg/mL; P＜0.05);喘息Ⅰ组IL-17水平和EOS呈正相关（r=0.62,P＜0.05)。结论：检测鼻咽分泌物中EOS和IL-17可以作为识别5岁以下有发展为哮喘倾向的喘息儿童的指标,并给予早期临床干预和治疗。［中国当代儿科杂志,2010,12（2）：113-116］