BACKGROUND: Human rhinovirus (hRV) is a critical viral pathogen implicated in bronchiolitis in children. However, there is no study on hRV bronchiolitis in children from Southeast China. The aim of this study was to determine the incidence and clinical features of hRV bronchiolitis in Southeast China.METHODS: The study was carried out in Children’s Hospital of Soochow University on children admitted with the diagnosis of bronchiolitis from January 2013 to December 2014. hRV was tested using reverse-transcription polymerase chain reaction.RESULTS: hRV was identified in 140 of 797 specimens (17.6%). hRV was detected with a highest rate in June and August. The hRV positive rate in patients younger than 6 months of age was significantly lower than that in other age groups (P<0.01). The most common radiological finding was hyperinflation (51.4%). Patients with hRV infection were older and more likely to have eczema than those with RSV.CONCLUSIONS: The hRV was an important viral pathogen associated with bronchiolitis in children with an epidemic peak in summer. Most of patients were between 6 to 24 months and with a high presence of eczema.

目的 分析苏州地区住院儿童呼吸道卡他布兰汉菌(MC)感染流行病学特点及药敏变迁情况,以期为临床合理使用抗生素提供指导.方法 收集2008年1月至2020年12月因呼吸道感染住院患儿的鼻咽分泌物标本细菌培养结果,根据年龄、季节、基础疾病情况等进行分组,监测MC感染流行特点并动态观察MC药敏变迁情况.结果 近13年共收集27472例呼吸道感染患儿的鼻咽分泌物标本,其中742份标本培养出MC,MC总检出率为2.7％.2008年至2020年MC的年度检出率差异有统计学意义(P<0.01),以2017年度检出率较高.不同年龄组间MC检出率差异有统计学意义(P<0.01),以3～5岁检出率较高,>5岁检出率较低.春、夏、秋、冬各季节MC检出率差异有统计学意义(P<0.01),检出率以秋季较高,夏季较低.27472例患儿中有基础疾病者占18.9％.有基础疾病组MC检出率为1.8％,低于无基础疾病组(2.9％),差异有统计学意义(P<0.01).总结2013—2020年的药敏试验结果,发现MC对利福平、氯霉素、头孢噻肟、四环素和左氧氟沙星高度敏感,8年间药敏试验敏感率差异有统计学意义(P<0.05).MC对阿莫西林、复方新诺明也有较高的敏感率.结论 苏州地区MC感染患儿以<5岁人群为主,秋季为好发季节,MC对多种抗生素维持较高的敏感率;儿童呼吸道MC感染建议首选阿莫西林治疗.

Objective:To study the macrolides resistance of Mycoplasma pneumoniae(MP) in Suzhou area, and try to explore the relationship between drug resistance and refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods:From a series of hospitalized children who were diagnosed as Mycoplasma pneumoniae pneumonia (MPP) from October 2013 to September 2014 in Suzhou area, 48 children were treated with Azithromycin (10 mg/kg, once a day, intravenous drip for 5-7 days), and the clinical symptoms and chest imaging were still progressing so they were clinically diagnosed as RMPP, and 34 children who were successfully treated with macrolides antibiotics (MA) were clinically diagnosed as general MPP (GMPP). MP DNA was extracted from the airway secretion of children in the two groups, and the point mutations of 2063 and 2064 of 23S rRNA were sequenced, and according to the MP 23S rRNA sequencing results, the children were divided into macrolides antibiotic resistant MP group (MRMP) and macrolides antibiotic sensitive MP group (MSMP). The clinical characteristics of the two groups were compared. Results:In the MRMP group, the incidence of RMPP was 62.2% (46/74 cases), while in MSMP group, the incidence of RMPP was 25.0% (2/8 cases). The point mutation of MP 23S rRNA had no significant effect on the occurrence of RMPP ( χ2=2.719, P=0.099). Compared with MRMP group, MSMP group presented shorter fever time and less glucocorticoid use.No significant differences between the two groups were found in chest imaging examination, as well as some laboratory results, including the total number and classification of white blood cell (WBC), C-reactive protein (CRP), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and creatine kinase isoenzyme (CK-MB). Conclusions:The fever duration of MPP lasted more than 1 week, suggesting the possibility of macrolides resistance of MP, but macrolides resistance did not aggravate the occurrence of RMPP.It is unreliable to judge the MRMP by chest imaging features and laboratory results.

目的 探讨不同年龄患儿肺炎支原体(MP)感染致大叶性肺炎后的临床表现及适应性性免疫功能特点.方法 收集2018年3月～2020年2月收住我院的414例1个月～14岁MP大叶性肺炎患儿的临床资料,根据年龄分为≤3岁组和>3岁组,比较两组患儿在临床表现及适应性免疫功能方面的差异.结果(1)与>3岁组患儿相比,≤3岁组患儿热程较短,出现心肌损害比例高,肺部喘鸣音更多见,差异均有统计学意义(P<0.05).两组患儿消散前期阿奇霉素疗程无差异,但≤3岁患儿消散后期所需阿奇霉素疗程更长[(9.20±3.61)d vs(7.73±2.70)d,P<0.05),住院病程更较长.(2)≤3岁组患儿血清IgG、IgA、IgM含量及CD3+、CD8+T淋巴细胞比例均明显低于>3岁组患儿(P<0.05).结论 不同年龄MP大叶性肺炎患儿临床表现及适应性免疫功能均存在一定差异,婴幼儿MP大叶性肺炎不容忽视.

目的:探讨百日咳综合征住院患儿的临床特点及影响住院危险因素，提高临床诊治水平。方法:回顾性分析2014年至2019年在苏州大学附属儿童医院呼吸科住院的489例百日咳综合征患儿的病史、症状、体征、实验室检查及病原学等资料，总结其临床特点及影响住院危险因素。结果:年龄<3个月占53.17%，3～6个月占24.13%，>6个月占22.70%。患儿均有痉挛样咳嗽，其他症状发生率依次为喘息32.11%、咳嗽后青紫7.16%、呼吸困难3.27%、咳嗽后吸气性回声2.04%。实验室检查中白细胞升高占75.05%，淋巴细胞比例升高占73.62%，CRP升高占13.29%，血小板计数升高占85.89%。病原学检测阳性率61.15%，病毒检出率为35.58%，细菌检出率为30.47%，肺炎支原体检出率为13.70%，单一病原排序前5位是鼻病毒(24.57%)、肺炎支原体(16.46%)、肺炎链球菌(10.57%)、呼吸道合胞病毒(8.85%)、流感嗜血杆菌(8.11%)；混合感染占17.79%，其中病毒混合细菌占62.07%，病毒混合肺炎支原体占19.54%，细菌混合肺炎支原体占13.79%，病毒、细菌及肺炎支原体混合占4.60%。季节以春、夏季最为多见，占73.00%，其次为秋季19.02%，冬季7.98%。住院≥14 d的患儿中重症肺炎、先天性气道发育畸形、先天性心脏病、胃扭转、喘息发生率均明显高于住院<14 d患儿，差异均有统计学意义( χ 2＝54.920、13.986、4.770、19.966、6.891， P均<0.05)。 结论:百日咳综合征多见于6个月以下患儿，以春夏季多见，痉挛样咳嗽是特征性临床表现，血常规提示以淋巴细胞为主的白细胞升高，感染病原依次是病毒、细菌和肺炎支原体，前3位病原体依次是鼻病毒、肺炎支原体和肺炎链球菌，年龄<1岁易发生混合感染。有喘息症状、病情重、有先天性气道发育异常、先天性心脏病、胃扭转是住院时间延长的危险因素。

目的 分析坏死性肺炎儿童的临床特征、治疗及预后,提高对其认识和诊治水平.方法 回顾性分析2014年1月至2019年12月在苏州大学附属儿童医院诊断为坏死性肺炎患儿的病因、临床表现、实验室检查、影像学改变、并发症、治疗方法、随访情况.结果 80例儿童坏死性肺炎患儿,男39例,女41例,年龄为3.4(1.5,8.2)岁.所有患儿均有高热、咳嗽、咳痰,热峰为39.9(39.2,40.0)℃,热程为13.4(7.0,16.0)d,住院时间为20.0(16.0,29.8)d.外周血白细胞计数为18.3(13.0,22.6)×109/L,中性粒细胞比例为83.5 (75.7,89.5)％,C反应蛋白为105.0(41.8,183.3) mg/L,降钙素原为0.4(0.2,2.9) ng/L,血沉为21.0(10.3,47.8) mm/h,乳酸脱氢酶为525.4(365.3,792.0) U/L,纤维蛋白原为5.2(3.8,6.3) g/L,D-.二-聚体为2040.5(890.0,5351.3) μg/L.病原体检出率为71.3 ％(57/80),其中细菌为41.3％(33/80),肺炎支原体为28.8％(23/80),病毒为25.0％ (20/80),前5位的病原体依次为肺炎支原体占28.8％(23/80)、肺炎链球菌占27.5％(22/80)、金黄色葡萄球菌占11.3％ (9/80)、博卡病毒和鼻病毒各占7.5％(6/80)、腺病毒占6.3％(5/80).混合感染率为26.3％(21/80),以肺炎链球菌混合流感病毒常见.55例患儿出现肺部并发症,主要是胸腔积液、脓胸、支气管胸膜瘘、气胸,经抗生素、糖皮质激素、丙种球蛋白等药物治疗,支气管肺泡灌洗、胸腔闭式引流等对症支持治疗,临床症状缓解出院.62.5％(50/80)的患儿随访了3个月～1年,患儿均无明显呼吸道症状,复查胸部CT或胸片,10例有少许斑片影,2例遗留纤维条索影,3例遗留肺空腔病变,其余肺部病灶均消失.结论 儿童坏死性肺炎常见病原菌为肺炎支原体、肺炎链球菌、金黄色葡萄球菌,少数为博卡病毒、腺病毒、流感病毒,其病情重,常合并胸腔积液,经积极抗感染、抗炎及对症支持等治疗,预后良好,极少部分遗留肺结构的破坏.

目的:探讨miR-29b、B7-H3调控巨噬细胞极化从而对CD4+T分化产生影响的机制.方法:(1)收集在苏州大学附属儿童医院就诊的哮喘患儿及正常儿童外周血分离外周血单个核细胞(PBMC),提取RNA并进行逆转录,采用实时定量聚合酶链式反应(Q-PCR)技术测定miR-29b、B7-H3mRNA的表达,并收集患儿的哮喘家族史、变应性疾病史等.(2)THP-1细胞诱导为巨噬细胞后,用LV526、LV527和NC病毒侵染诱导成功的巨噬细胞形成miR-29b干扰、miR-29b过表达以及正常对照组,培养24 h后收集细胞检测STAT3和B7-H3基因及蛋白水平的表达.(3)验证STAT3为miR-29b的靶基因:接种THP-1细胞,加终浓度为50 ng/mL的PMA培养6 h后,换无PMA完全培养基继续培养24 h,然后用LV526、LV527和NC病毒侵染诱导成功的巨噬细胞形成miR-29b干扰、miR-29b过表达以及正常对照组,48 h进行荧光素酶分析来验证STAT3为miR-29b的靶基因.构建STAT3-3′-UTR荧光素酶报告基因质粒,并分为3组"miR-29b+STAT3-3′-UTR"、"miR-29b+STAT3-mut-3′-UTR"、"miR-29b+荧光素酶空载".(4)不同处理方式的巨噬细胞与初始T细胞共培养3 d,Q-PCR检测T-bet、GATA3、ROR-γt的相对表达量.结果:(1)哮喘急性发作期组患儿的变应性疾病发生率高于其他两组(P=0.032),对照组的哮喘家族史远低于其他两组,差别具有统计学意义(P=0.001).(2)哮喘急性发作期组PBMC中B7-H3表达量高于哮喘非急性发作期组与对照组,对照组PBMC中miR-29b表达量明显高于哮喘患儿非急性发作期组与急性发作期组(P<0.0001),哮喘非急性发作期组miR-29b表达量高于哮喘急性发作期组,差异有统计学意义(P=0.007).(3)沉默表达miR-29b后巨噬细胞IL-4Rα、IL-4、IL-5、IL-13、CD206明显升高,而IFN-γ下降,提示miR-29b可以促进巨噬细胞向M2极化.(4)巨噬细胞过表达miR-29b,STAT3、B7-H3基因水平及蛋白水平表达下降;抑制miR-29b,STAT3、B7-H3基因水平及蛋白水平表达上升.(5)巨噬细胞STAT3与B7-H3mRNA的表达成显著正相关(r=0.9737,P<0.0001).(6)STAT3是miR-29b的靶基因.(7)巨噬细胞与CD4+T细胞共培养,可促进初始T细胞即Th0细胞向Th2方向分化,其中下调miR-29b的巨噬细胞促进作用更明显.结论:哮喘患儿PBMC中miR-29b表达量低于对照组儿童,而B7-H3高于对照组儿童,初步猜想miR-29b对于哮喘儿童具有保护作用,而B7-H3加重炎症反应.在巨噬细胞中下调miR-29b,可促进巨噬细胞向M2极化,巨噬细胞B7-H3及STAT3表达增加,使Th0细胞向Th2细胞分化,加重哮喘患者炎症反应.

目的 分析喘息性疾病患儿病原体感染的临床特征.方法 回顾性分析伴有喘息表现的2824例呼吸道感染住院患儿的临床资料,分析病原体感染与年龄、季节及住院时间的关系.结果 2046例(72.45％)患儿在呼吸道分泌物中可检出病原微生物.其中,病毒感染率为49.36％,细菌感染率为31.83％,肺炎支原体(MP)感染率为11.86％.病毒感染引起的喘息主要发生在1岁以下患儿.细菌可能是1岁以上喘息患儿最常见病原体,主要是肺炎链球菌(SP)感染.MP感染在1岁以上喘息患儿中随年龄增长有上升趋势.小年龄组易出现混合感染,3岁以下多为细菌和病毒混合感染,3岁以上出现多重细菌混合感染.不同年龄喘息患儿病原体感染的季节性不同.呼吸道合胞病毒冬季检出率最高,痰鼻病毒主要在夏季检出,博卡病毒秋季检出率最高,MP的夏、秋季检出率高,SP冬季检出率最高.混合感染中≥2种病毒混合感染患儿的住院时间最长,未检出病原体患儿和单纯细菌感染患儿的住院时间短.结论 病毒、细菌及MP感染均可导致儿童喘息性疾病.小年龄组容易出现混合感染.不同年龄喘息患儿病原体感染的季节性不同,不同病原体感染的季节性也不同.患儿住院时间越长,多重感染的可能性越大.

Objective:The epidemiological characteristics and drug susceptibility changes of Pseudomonas aeruginosa(PA) infection in the respiratory tract of children in suzhou were analyzed in order to provide guidance and suggestions for the rational use of antibiotics in this region. Methods:Bacterial culture results of nasopharyngeal secretions from 21 176 children admitted to the Department of Respiratory, Children′s Hospital Affiliated to Soochow University for respiratory tract infections from January 2008 to December 2017 were collected.According to age, season, underlying disease conditions and the presence of intensive care units (ICU) during the hospitalization, these children were divided into different groups.The epidemic characteristics of PA infection were monitored, and changes in PA drug sensitivity were dynamically observed.Results:Among 21 176 nasopharyngeal secretions from children with respiratory tract infection, 191 cultures were detected with PA, and showing a positive detection rate of 0.90% (191/21 176 cases). The annual detection rate was different.The highest detection rate was 2.24% (50/2 234 cases) in 2009 and the lowest was 0.41% (9/2 207 cases) in 2014.The detection rate of PA in children with in >6 months to 1-year-old group was the highest (1.52%, 53/3 497 cases), and the lowest was 0.57%(11/1 934 cases) in the >5-year-old group.The detection rates of PA in spring, summer, autumn, and winter were 1.11% (60/5 420 cases), 1.21% (61/5 046 cases), 0.81% (46/5 670 cases), and 0.48% (24/5 040 cases), respectively.The difference of PA detection rates between summer (the highest rate) and the winter (the lowest rate) was statistically significant ( χ2=18.611, P<0.001). Among the 21 176 children, 18.89% (4 000/21 176 cases) had basic diseases, and the PA detection rate in such kind of patients was 1.28% (51/4 000 cases), which was higher than that in patients without basic diseases (0.82%, 140/17 176 cases). The PA detection rate in the ICU group was 4.41% (15/340 cases), which was significantly higher than that in the general group (0.84%, 176/20 836 cases) ( χ2=7.678, 47.623, all P<0.05). There were no strains susceptible to Ampicillin, Ampicillin/Sulbactam and compound Sulfamethoxazole, and no strains susceptible to Ceftriaxone from 2010 to 2017.The susceptibility rate to Imipenem was low from 2012 to 2015, and the lowest was only 66.7% in 2014.The sensitivity rate to Aztreonam fluctuated significantly from year to year.Strains were all highly sensitive to Piperacillin, Piperacillin Tazobactam, Ciprofloxacin, Levofloxacin, Gentamicin, and Tobramycin. Conclusions:PA infection is prone to occur in young children with basic diseases and relatively severe illness.Summer is a high-incidence season.PA is generally highly resistant to commonly used antibiotics.

Objective:To investigate the clinical characteristics and risk factors of bronchiolitis obliterans (BO) after adenovirus pneumonia.Methods:Clinical data of 266 children with adenovirus pneumonia hospitalized in Children′s Hospital of Soochow University from January 2011 to December 2017 were retrospectively analyzed.Accor-ding to whether they developed BO, children with adenovirus pneumonia were divided into the BO group and the non-BO group.Clinical features of the BO group and the non-BO group were compared by t test, rank sum test or chi square test.Risk factors were analyzed by Logistic regression approach. Results:Among 266 children with adenovirus pneumonia included, 37 patients were developed into BO group, and their age was significantly younger than that of the non-BO group [12.0(8.0, 17.5) months vs.32.0(13.0, 48.0) months, P<0.001]. Compared with the non-BO group, there were more proportion of preterm infants[10.8%(4/37 cases) vs.3.1%(7/229 cases), P=0.028], more instances of comorbidities [21.6%(8/37 cases) vs.4.4%(10/229), P<0.001] and more children with allergic diseas[35.1%(13/37 cases) vs.20.1%(46/229 cases), P=0.041] in the BO group, and the difference was statistically significant.The duration of fever in the BO group was significantly longer than that of the non-BO group [10(4.0, 13.5) d vs.6(4.0, 9.0) d, P=0.011] children with symptoms of wheezing, shortness of breath, and hypoxemia in the BO group were significantly more than the non-BO group[81.1%(30/37 cases) vs.27.9%(64/229 cases), P<0.001; 64.9%(24/37 cases) vs.5.7%(13/229 cases), P<0.001; 59.5%(22/37 cases) vs.6.6%(15/229 cases), P<0.001]. The platelet count, IgG level, and CD3 -CD 19+ lymphocyte percentage were significantly higher in the BO group than the non-BO group [(364±104)×10 9/L vs.(297±105)×10 9/L, P=0.001; 6.74(4.92, 10.16) g/L vs.5.93(1.00, 8.04) g/L, P=0.016; (33.5±15.3)% vs.(26.1±10.2)%, P=0.008]. In contrast, the percentage of CD3 + CD4 + lymphocytes in the BO group was lower than the non-BO group[(29.1±8.0)% vs.(32.5±9.4)%, P=0.044], the difference was statistically significant.The BO group had a higher rate of mixed bacterial infection than the non-BO groups[37.8%(14/37 cases) vs.16.6%(38/229 cases), P=0.003]. An age<26 months, comorbidities, premature birth history, wheezing, shortness of breath, and hypoxemia were independent risk factors for BO after adenovirus pneumonia( OR=4.808, 30.667, 7.558, 3.909, 8.842, 8.607, all P<0.05). Conclusions:An age of less than 26 months, a history of premature delivery comorbidities, wheezing, shortness of breath and hypoxemia, are independent risk factors for BO after adenovirus pneumonia.Children with above manifestations should receive high resolution CT as soon as possible to determine whether it is BO.

目的 探讨支气管镜及肺泡灌洗术在婴幼儿反复喘息性疾病诊疗中的作用及价值.方法 收集415例1～36月龄反复喘息患儿支气管镜检结果及肺泡灌洗液(BALF),采用直接免疫荧光法检测7种常见呼吸道病毒,荧光定量PCR法检测肺炎支原体、肺炎衣原体及博卡病毒,RT-P C R法检测鼻病毒及偏肺病毒等,并行细菌培养及细胞形态学检查.选取同期因支气管肺炎或大叶性肺炎伴有肺不张表现住院并行支气管镜及肺泡灌洗的106例非喘息患儿作为对照组,收集其BALF行细胞形态学检查.结果 415例喘息患儿中,男317例、女98例,支气管镜下表现为支气管内膜炎症405例,占97.6％,其次为气管软化69例,占16.6％.BALF检出病原体以肺炎支原体最常见,159例,占38.3％;其次为细菌74例,占17.8％,以肺炎链球菌和流感嗜血杆菌为主;病毒69例,占16.6％,以人博卡病毒为主.反复喘息患儿BALF中性粒细胞及嗜酸性细胞比例高于非喘息患儿,而吞噬细胞比例低于非喘息患儿,差异均有统计学意义(P<0.05).结论 支气管镜检查可以为反复喘息患儿的早期诊断和治疗提供有效帮助

Objective:To explore the clinical characteristics of plastic bronchitis (PB) in children after pneumonia and the value of electronic bronchoscopy in diagnosis and treatment of PB after pneumonia.Methods:A total of 3 865 children with lower respiratory infectious diseases who had been treated by bronchoscope and met the diagnosis and treatment criteria of bronchoscope in the Department of Respiratory, Children′s Hospital Affiliated to Soochow University from June 2017 to May 2019 were studied.The children were divided into 3 groups, the PB group, the phlegm embolism blockage group, and the control group [including children with no secretion blocking the bronchial cavity under bronchoscope and no plastic secretion found in bronchoalveolar lavage fluid (BALF)]. The results of laboratory examinations such as clinical characteristics, etiology, immune function and imaging were compared and analyzed.Results:There was no significant difference in the gender distribution among the 3 groups ( P=0.382). The average age of the PB group and phlegm embolism blockage group was significantly older than that of the control group.All the 3 groups had cough.The proportions of coughing children with asthma in the control group and phlegm embolism blockage group [25.06% (924/3 687 cases) and 21.00% (21/100 cases), respectively] were significantly larger than that in the PB group [5.13% (4/78 cases)]. The PB group had the highest ratio of children with fever [93.59% (73/78 cases)], followed by the phlegm embolism blockage group [83.00% (83/100 cases)] and the control group [71.93% (2 652/3 687 cases)] successively.The difference among the 3 groups was significant( χ2=23.571, P<0.05). The fever peaks of the PB group, phlegm embolism blockage group and control group were (39.65±0.6)℃, (39.57±0.64)℃ and (39.27±0.76)℃, respectively; the fever duration of the above 3 groups were (10.32±3.87) days, (9.46±5.13) days and (6.89±4.06) days, respectively.The PB group had a higher fever peak and longer fever duration than the control group (all P<0.01). Before the electronic bronchoscopy, 3 865 children′s chest imaging examination showed pneumonia.The proportions of patients with lobar pneumonia and pleural effusion were the highest in the PB group [79.49% (62/78 cases) and 41.03% (32/78 cases), respectively], followed by the phlegm plug group [65% (65/100 cases) and 27% (27/100 cases), respectively]. C reactive protein (CRP) and D-dimer levels were the highest in the PB group, followed by the phlegm embolism blockage group and the control group successively.The difference was significant.In T lymphocyte subsets, the PB group had a significantly lower percentage of CD4 + lymphocytes and a significantly higher percentage of CD8 + lymphocytes than the control group.The first pathogen detected in the 3 groups was Mycoplasma pneumonia (MP), but the detection rate of MP in the PB group [84.62% (66/78 cases)] was significantly higher than that in the phlegm embolism blockage group [60% (60/100 cases)] and that in the control group [55.68% (2 053/3 687 cases)]. Conclusions:Older children are prone to PB after pneumonia and fever in the course of disease.The imaging manifestations are lobar pneumonia, pleural effusion, atelectasis, elevated CRP and D-dimer in venous blood laboratory examinations.MP is the first pathogen detected in children with PB after pneumonia.Bronchoscopic alveolar lavage is an effective and safe treatment for PB in clinical practice.

可诱导共刺激分子配体(ICOSL)及其受体可诱导共刺激分子(ICOS)在免疫应答和调节中发挥重要作用.ICOSL参与T淋巴细胞和B淋巴细胞的活化,诱导Th1细胞和Th2细胞的细胞因子产生,ICOS/ICOSL共刺激通路在炎症反应性疾病及肿瘤相关疾病中起重要作用.本文对ICOSL的研究进展进行综述,以期提高对多种免疫相关性疾病的认识.

Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired pneumonia in children. Recent studies demonstrated that the incidence of severe or fatal M. pneumoniae was gradually increasing, which may be related to the excessive inflammation. However, the exact pathogenesis of excessive inflammation in Mycoplasma pneumoniae pneumonia(MPP) is still unclear. This study aimed to reveal the role of miR-29c/B7-H3/Th17 axis in children with MPP. Children hospitalized in Respiratory Department during Jan. 2014 to Dec. 2015 were enrolled. All children enrolled was confirmed with MP infection using real-time PCR and ELISA. Children were excluded if they were co-infected with other pathogens. A total of 52 children with MPP and 26 controls were enrolled. miR-29c expression in monocytes of children with MPP was determined by real-time PCR and soluble B7-H3 (sB7-H3) and IL-17 were determined by ELISA, and explore their clinical significance. miR-29c overexpression and silencing technology and luciferase reporter assay were performed to confirm whether B7-H3 is the direct target of miR-29c. The levels of transcription factor ROR-γt in CD4+ T cells and cytokine IL-17A in supernatant were detected after stimulated by different concentrations of B7-H3 fusion protein in vitro. Of all 52 children with MPP, the mean age of the children were 77 ± 33 months, and 23 cases were male accounting for 44.2%. Nineteen cases had pleural effusion accounting for 36.5%. Children with MPP had significantly lower level of miR-29c and higher level of sB7-H3 and IL-17 compared to controls (both P < 0.05). The level of miR-29c significantly increased during convalescent phase compared to that of acute phase while sB7-H3 and IL-17 significantly decreased during convalescent phase (both P < 0.05). There was a positive correlation between the level of sB7-H3 and IL-17 in children with MPP during acute-stage (r = 0.361,P = 0.009). Children with MPP combined with pleural effusion had significantly higher level of sB7-H3 compared to those without pleural effusion (9952.3 ± 3065.3 vs. 7449.7 ± 2231.5, pg/ml), and the levels of sB7-H3 was positively correlated with the number of days of fever. The level of miR-29c was negatively correlated with M. pneumoniae specific IgG, IgM level. High concentrations of B7-H3(15μg/ml) could enhance ROR-γt expression and increase IL-17A. Functional studies based on luciferase reporter assay and immunofluorescence staining suggested that B7-H3 is the direct target of miR-29c, and miR-29c silencing or overexpression could up- or down-regulate the expression of B7-H3 in THP-1 cells. The axis of miR-29c/B7-H3/Th17 plays a vital role in children with MPP through excessive inflammation. miR-29c and B7-H3 may be the new target for the prevention and treatment of MPP, and may be the novel and potential biomarkers for the assessment of prognosis.

Objective To study the epidemiological and clinical features of viral pathogen of acute respiratory tract infection(ARTI)in children in Suzhou. To provide the evidence-based medicine for early warning,diagnosis and treatment of respiratory tract infection in children. Methods The study population comprised of all the children ranging from 28 days to 15 years old with ARTI admitted to Department of Respiration,the Childrenˊs Hospital Affiliated to Soo-chow University,between January 2006 and December 2015. The study cases were divided into 4 age groups based on ages(28 days to <1 year old,1- <3 years old,3- <5 years old and ≥5 years old). The nasopharyngeal aspirates and medical history were obtained by qualified medical personnel. Seven kinds of common respiratory virus were detec-ted by using the direct immunofluorescence. Mycoplasma pneumonia(MP),chlamydia pneumonia(CP)and human bo-cavirus(hBoV)were detected by adopting fluorescence quantitative PCR. Human rhinovirus(HRV)and human metap-neumovirus(hMPV)were detected by means of reverse transcriptionpolymerase chain reaction( RT -PCR). Sputum was cultured for bacteria. Results In 21 624 cases,17 618 cases were detected,and the positive detection rate of virus was 30. 74%(5 416 cases). The highest detection rate of virus was 44. 25%(881/1 991 cases)in 2011 in the 10 years. There were 3 317 cases of single virus pathogen infection,accounting for 18. 83%. Among them,respiratory syn-cytial virus(RSV)was the first with 9. 42%(1 660/17 618 cases),followed by HRV(5. 17%,278/5 372 cases), hBoV(3. 12%,351/11 263 cases),Pinf 3(2. 17%,383/17 618 cases),and the lowest rate was Pinf 2 with 0. 05%(8/17 618 cases). There were 2 099 cases of overlap infection,accounting for 11. 91%. The virus combined with bacte-rial infection accounted for 7. 86%(1 384/17 618 cases),which had the most positive cases. With the increase of age, the single virus pathogen infection rate gradually dropped. The highest detection rate was 22. 82%(1 976/8 656 cases) in the group between 28 days and <1 year old,and the lowest detection rate was 7. 81%(159/2 035 cases)of children over 5 years of age. The virus positive rate of the four seasons was 18. 28%(833/4 556 cases),13. 86%(625/4 508 cases),5. 91%(684/4 298 cases),27. 68%(1 178/4 256 cases),respectively,and detection rate in winter was the highest,and the least in summer. In the single virus infection,bronchiolitis had the highest percentage(36. 32%,25/69 cases),and the least rate was 5. 83%(63/1 080 cases)of lobar pneumonia. Conclusions Monitored for 10 years of the virus respiratory infection in Suzhou area,RSV,HRV and hBoV turned out to play an important role in respiratory tract infection in children. The children less than 3 years old are the most susceptible to virus infection. The epidemic season of each virus is different and characteristic.

Objective To explore the relationship between different pathogenic infections and characteristic clinical manifestations in the children with refractory pneumonia.MethodsBronchoalveolar lavage fluid (BALF) pathogen detection results and clinical data of 1109 children with refractory pneumonia were retrospectively analyzed.According to the positive results of different pathogens, children were divided into four groups of A [simple Mycoplasma pneumoiae (MP) infection, 489 cases], B (simple bacterial infection, 65 cases), C (simple virus infection, 88 cases) and D (a mixture of two or more infection pathogens, 130 cases).Clinical features and laboratory tests were compared among the four groups.Results The pathogen positive rate of BALF specimens from 1109 children with refractory pneumonia was 69.61％.The positive rate of MP was 52.39％.The positive rate of bacteria was 12.80％, of which streptococcus pneumoniae was the first bacterial pathogen.The positive rate of virus was 15.33％, of which bocavirus was the first viral pathogen.Mixed infections accounted for 11.72％ and MP mixed virus infection was the most common.In group A, the patients were older, coughed more frequently, and had longer duration of fever.The incidence of elevated creatine kinase isoenzyme MB was higher.The main pulmonary radiographic presentation was labor pneumonia and atelectasis.In group B, more patients had specific constitution.The levels of neutrophils proportion and the incidence of C-reaction protein greater than 40 mg/L were higher.In group C, the incidence of elevated ALT was higher and the main pulmonary radiographic presentations were bronchopneumonia (74.70％).In group D, the patients were younger and had more serious illness and longer duration of hospitalization.Blood level of lactate dehydrogenase was higher.The proportion of atelectasis in pulmonary radiographic presentation was significantly higher.ConclusionMP, bacteria, viruses and mixed infections can all lead to refractory pneumonia, of which MP is the first pathogen of refractory pneumonia.Refractory pneumonia caused by different pathogens has certain characteristic clinical manifestations.

目的:探讨肺炎支原体肺炎(MPP)患儿血浆中可溶性B7-H1(sB7-H1)的表达水平及其与各细胞因子的关系及临床意义.方法:选取2015年在苏州大学附属儿童医院呼吸科住院治疗的MPP患儿87例,并选取同期外科择期手术的31例患儿作为对照组.采用酶联免疫吸附试验(ELISA)分别检测MPP患儿血浆中sB7-H1、IFN-γ、IL-4、IL-17、IL-36α及GM-CSF的表达水平.结果:MPP组的sB7-H1水平为(1 045+356.50)pg/mL,高于对照组的(294.16±218.33)pg/mL,且经治疗后sB7-H1水平下降(P＜0.01).MPP患儿sB7-H1水平与IL-36α呈正相关,而与IFN-γ、IL-4、IL-17、GM-CSF无显著相关性.结论:sB7-H1在MPP患儿具有高表达,可能在过度免疫反应中起一定的作用.

Objective To analyze the infection composition and drug resistance to Gram-negative (G-) bacilli in children's respiratory tract in Suzhou,in order to provide evidence for rational use of antibiotics clinically.Methods G-bacilli culture samples were collected from 21 561 cases of nasopharyngeal secretions from patients with respiratory tract infection admitted at the Department of Respiratory,Children's Hospital of Soochow University from January 2007 to December 2016,including 21 246 cases in general wards,and 315 patients who were transferred to the respiratory department after treatment in the Intensive Care Unit(ICU),and the children were divided into the general ward group and the ICU group,and the pathogens were compared and the changes in bacterial susceptibility were dynamically observed between the 2 groups.Results The primary G-bacteria for respiratory infection was Haemophilus influenzae,followed by Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii.The detection rates of Klebsiella pneumoniae and Pseudomonas aeruginosa in the ICU group were 16.8％ (21/125 strains) and 14.4％ (18/125 strains),respectively,which were significantly higher than those in the general ward group [10.0％ (208/2 071 strains),9.2％ (190/2 071 strains)].The detection rates of G-bacteria in the ICU group were 33.7％ (106/315 cases),which were significantly higher than those in the general ward group [9.4％ (1 997/21 246 cases)],and the difference was statistically significant (x2 =210.325,P ＜ 0.001).The rare G-bacillus such as Stenotrophomonas maltophilia,Acinetobacter junii and Burkholderia onion were higher in the ICU group [17.6％ (22/125 strains)] than that in the general ward group [6.4％ (132/2 071 strains)].The rate that of G bacteria with two or more mixed infection in ICU group [17.0％ (18/106 cases)] was significantly higher than in the general ward group [3.4％ (68/1 997 cases)],and the difference was statistically sigmficant(x2 =47.3,P ＜0.05).For the mixed infection,the ICU group was mainly composed of Klebsiella pneumoniae mixed with Pseudomonas aeruginosa or Escherichia coli,while the general ward group was composed of Haemophilus influenzae mixed with Pseudomonas aeruginosa or Escherichia coli.The sensitivity of Haemophilus infiuenzae to Ampicillin,Sultamicillin,Cefuroxime,Cefaclor and Azithromycin decreased,and the sensitivity to Chloramphenicol,Tetracycline and Trimethoprim + Sulfamethoxazole increased year by year,and there were statistically significant differences in different years (all P ＜ 0.05).The sensitivity to Escherichia coli to Ceftazidime decreased year by year,and the sensitivity to Ampicillin and Levofloxacin increased year by year,and there were statistically significant differences in different years (all P ＜ 0.05).The sensitivity to Klebsiella pneumoniae to Cefoperazone/Sulbactam and imipenem decreased,and the sensitivity to Ciprofloxacin and Levofloxacin increased,and there were statistically significant differences in different years (all P ＜ 0.05).The sensitivity to Pseudomonas aeruginosa,Cefoperazone/Sulbactam and Ceftriaxone decreased year by year,and the sensitivity to Levofloxacin increased,and there were statistically significant differences in different years (all P ＜ 0.05).The detection rate of carbapenem-resistant strains of Klebsiella pneumoniae and Pseudomonas aeruginosa showed an increasing trend,and there were statistically significant differences in different years (all P ＜ 0.05).Conclusions The primary G-bacteria for respiratory infections is Haemophilus influenzae,G-bacilli especially,the mixed infection of G-bacilli,is more likely to cause severe and critical respiratory infections.The resistance rate of G-bacteria infection in children's respiratory tract to commonly used antibiotics is generally on the rise.

目的:分析苏州地区儿童难治性肺炎支原体肺炎(RMPP)流行病学特征,为临床合理诊疗提供参考.方法:收集2011年1月至2015年12月苏州地区11 064例肺炎住院患儿的痰标本,采用荧光定量PCR法检测MP-DNA;同时在入院24 h内及治疗7 ～10 d采集静脉血,ELISA法检测血清特异性MP抗体IgG、IgM,结合临床表现分析RMPP流行状况.结果:RMPP在MPP中的总发生率为14.30％,其中男性发生率为13.12％,女性发生率为15.90％,女性患儿RMPP发生率明显高于男性患儿(x2=5.918,P＜0.05).＜4岁患儿RMPP发生率为6.83％,4～7岁为20.86％,≥7岁为40.84％,RMPP发生率随着年龄的增大逐渐升高(x2=365.233,P＜0.01).春季RMPP发生率为14.39％,夏季为16.93％,秋季为12.56％,冬季为12.88％,夏季RMPP发生率最高(x2=10.426,P＜0.05).2011-2015年住院患儿RMPP在MPP中的发生率逐年升高(x2=52.709,P＜0.01).结论:苏州地区2011-2015年RMPP在MPP中的发生率为14.30％,女性患儿RMPP发生率高于男性,随着年龄的增大RMPP发生率逐渐升高,夏季为RMPP高发季节,RMPP有逐年升高的趋势.

OBJECTIVE:To study the effect of the leukotriene receptor agonist montelukast combined with methylprednisolone on inflammatory response and peripheral blood lymphocyte subset content in children with mycoplasma pneumonia.METHODS:Seventy-four children were enrolled and randomly divided into a standard treatment group and a montelukast plus methylprednisolone group. Serum levels of inflammatory cytokines and corresponding cytokines of T lymphocyte subsets were measured, and peripheral blood was collected to determine the T cell subset content.RESULTS:At 3 days and 7 days after treatment, serum MCP-1, PCT, ICAM-1, CXCL8, CRP, IFN-γ, and IL-17 levels and peripheral blood Th1 and Th17 content were significantly decreased in both groups, while serum IL-4 and TGF-β levels and peripheral blood Treg and Th2 content were significantly increased. However, serum MCP-1, PCT, ICAM-1, CXCL8, CRP, IFN-γ, and IL-17 levels and peripheral blood Th1 and Th17 content were significantly lower while serum IL-4 and TGF-β levels and peripheral blood Treg and Th2 content were significantly higher in the montelukast plus methylprednisolone group compared with the control group.CONCLUSION:Montelukast combined with methylprednisolone for the treatment of mycoplasma pneumonia can inhibit inflammatory responses and regulate levels of Th1/Th2 and Th17/Treg cells.