OBJECTIVE:To investigate efficacy of standardized treatment for post-infectious bronchiolitis obliterans (PIBO) in infants and young children by evaluating changes in pulmonary function, and high-resolution computed tomography (HRCT) before and after treatment. METHODS:Thirty infants diagnosed with PIBO were treated with a two-phase protocol consisting of an intensive phase and a maintenance phase, including budesonide, azithromycin, montelukast, fluticasone propionate, and terbutaline sulfate. Pulmonary function was evaluated using TPTEF/TE, VPEF/VE, and impulse oscillometry (IOS). Imaging evaluation was performed using HRCT. RESULTS:Daytime respiratory symptoms significantly improved after 3 months of treatment (P < 0.05). Nocturnal symptoms and exercise-related limitations showed significant improvement after 6 months (P < 0.05) and 9 months (P < 0.05), respectively. The frequency of respiratory tract infections was significantly reduced after 12 months of continuous treatment (P < 0.05). Pulmonary function indices demonstrated significant improvement by the 9th month (P < 0.05). HRCT scores improved significantly, decreasing from 6 ± 1.08 at baseline to 4.5 ± 1.98 after 12 months of treatment (P < 0.05). Mosaic perfusion significantly improved at 6 months (P < 0.05), while emphysematous changes required 9 months of treatment to show significant improvement (P < 0.05). Structural abnormalities such as bronchiectasis, bronchial wall thickening, atelectasis, and peribronchial vascular bundle changes showed partial improvement after 12 months, but these differences did not reach statistical significance (P > 0.05). CONCLUSION:Standardized treatment for PIBO should be maintained for at least 9-12 months to achieve significant improvements in clinical symptoms, pulmonary function, and HRCT findings.

OBJECTIVES:To investigate the influencing factors for asthma management and asthma control level in children. METHODS:A total of 202 children with a confirmed diagnosis of asthma were enrolled. The questionnaire of asthma control level and family management was used to investigate the influencing factors for asthma control level and the indicators of family management. The awareness of childhood asthma and its management was analyzed among the parents, as well as the influence on asthma control level in children, and the association between them was analyzed. RESULTS:Compared with the non-complete control group, the complete control group had significantly longer course of asthma and treatment time (P<0.05). The proportions of asthma attacks ≥3 times and aerosol treatment for asthma attacks >3 times in one year in the complete control group were significantly lower than those in the non-complete control group (P<0.05). The complete control group had a significantly lower proportion of children with frequent respiratory infection, wheezing during respiratory infection, or a family history of allergic diseases (P<0.05). The parents in the complete control group had significantly stronger awareness of short-term escalation to asthma medication after respiratory infection and significantly enhanced management of maintenance medication (P<0.05). Compared with the complete control group, the non-complete control group had a significantly higher proportion of children with abnormal pulmonary function at the initial stage (P<0.05). The level of asthma control in children was associated with short-term escalation to asthma medication during respiratory infection and initial lung function (P<0.05). CONCLUSIONS:The level of asthma control in children is closely associated with the severity of asthma and the comprehensive management of childhood asthma. Early treatment and family management, especially escalation to asthma medication during the early stage of respiratory infection, are of great importance in asthma control. Citation:Chinese Journal of Contemporary Pediatrics, 2023, 25(1): 73-79.

目的 研究亚低温联合胞磷胆碱对新生儿窒息合并缺氧缺血性脑病的功能恢复及血浆神经元特异性烯醇化酶(NSE)的影响.方法 前瞻性选取2018年6月至2020年6月安徽医科大学附属安庆医院收治的106例新生儿窒息合并缺氧缺血性脑病患儿作为研究对象,按照数字表法随机分为对照组(n=53)和观察组(n=53).对照组行常规亚低温治疗,观察组在此基础上联合胞磷胆碱治疗,取10 mL 10％葡萄糖注射液+125 mg胞磷胆碱混合行静脉滴注治疗,1次/d,连续治疗10 d.比较两组临床疗效及体征恢复情况;对比两组治疗前后神经元特异性烯醇化酶(NSE)水平;分析两组不同时间点神经行为功能评分(NBNA)变化;观察两组神经系统后遗症发生率.结果 观察组患儿总有效率为94.34％,高于对照组的81.14％,差异有统计学意义(P<0.05).观察组患儿意识、吮吸、反射及肌张力恢复时间为(3.84±0.23)、(4.21±0.81)、(6.23±1.12)、(6.85±1.25)d,均低于对照组[(5.62±1.12)、(5.71±1.15)、(9.38±2.03)、(8.23±1.42)d],差异均有统计学意义(P<0.05).两组治疗后NSE水平均较治疗前降低,观察组治疗后NSE水平为(12.20±2.02)ng/mL,均低于对照组[(17.31±2.03)ng/mL],差异均有统计学意义(P<0.05).治疗后3、14 d,两组NBNA评分均较治疗前升高,观察组治疗后3、14 d的NBNA评分为(28.03±2.17)、(37.03±1.22)d,均高于对照组[(24.36±1.88)、(32.02±1.26)d],差异均有统计学意义(P<0.05).观察组神经系统后遗症发生率为7.52％,较对照组的3.76％比较,差异无统计学意义(P>0.05).结论 亚低温联合胞磷胆碱可提高新生儿窒息合并缺氧缺血性脑病患儿的临床疗效,有助于促进临床体征恢复,改善神经行为功能,值得推广.

目的:评价新生儿出生后72 h经皮胆红素(TcB)百分位曲线图结合临床相关风险因素,预测新生儿高胆红素血症的发生情况.方法:选择2018年1月-2019年12月在安徽理工大学第一附属医院出生的晚期早产儿和足月儿,使用经皮黄疸仪监测其黄疸值,绘制TcB百分位列线图,以新生儿出生后72 h内末次TcB值对应的风险区结合致病风险因素预测新生儿高胆红素血症发生的价值.结果:3818例新生儿出生后72h后高危区人数为278例(7.28％).TcB数值在4 h到48 h内上升最快,峰值出现在出生后 84h-120h,P40、P75 及 P95 峰值分别为 193.75 μmol/L,224.75 μmol/L 和 282.25 μmol/L,其中 P95 峰值出现最晚.新生儿出生后0-48 h内共计有244例TcB值处于高危险区,其中92例在72 h后仍处高危区,预测灵敏度为29.97％,特异度为95.67％;49-72 h内共计有269例新生儿TcB值处于高危区,其中116例新生儿在72 h后TcB值仍处高危区,灵敏度为36.48％,特异度为95.62％.多因素Logistic回归分析显示,相关致病危险因素有:胎龄、住院时间、分娩方式、胎膜早破及喂养方式(P＜0.05)072 h内TcB危险区的受试者工作特征(ROC)曲线下面积为0.75(95％CI:0.56-0.93),结合相关风险因素的ROC曲线下面积为0.93(95％CI:0.81-1.00),预测价值明显提高.结论:TcB百分位曲线图结合"高危因素"预测新生儿高胆红素血症准确性较高,操作简便,具有较好的临床价值.

目的 比较微创注入肺表面活性物质(LISA)技术与气管插管-肺表面活性物质-拔管(INSURE)技术治疗新生儿呼吸窘迫综合征(NRDS)的效果.方法 选取2019年12月至2021年1月阜阳市人民医院新生儿重症监护室收治的54例NRDS患儿为研究对象.采用随机数字表法将其分为LISA组和INSURE组,每组27例.LISA组在常规治疗的基础上采用LISA技术治疗,INSURE组在常规治疗的基础上采用INSURE技术治疗.比较两组患儿一般资料、用药过程相关指标〔包括插管所需时间和用药过程中经皮动脉血氧饱和度(SpO2)下降、心动过缓、药物反流发生情况及再次使用肺表面活性物质(PS)、72 h内机械通气情况〕、并发症发生情况、无创通气时间、住院时间.结果 LISA组患儿插管所需时间短于INSURE组,用药过程中SpO2下降、心动过缓、药物反流、72 h内机械通气者占比低于INSURE组(P<0.05).LISA组患儿并发症发生率低于INSURE组,无创通气时间、住院时间短于INSURE组(P<0.05).结论 相比于传统的INSURE技术,LISA技术可缩短NRDS患儿插管所需时间、无创通气时间、住院时间,降低机械通气使用率、并发症发生率,值得临床推广.

目的 研究新生儿呼吸窘迫综合征并发支气管肺发育不良的高危因素,为早产儿BPD的预防和治疗提供一定的理论支持.方法 选择2017年2月至2021年9月于我院住院治疗的173例患新生儿呼吸窘迫综合征的早产儿作为研究对象,根据其生后28天是否需要氧气支持分为BPD组(n=88)和非BPD组(n=85),回顾性分析这173例NRDS患儿的生后情况、母亲产科因素、治疗经过、并发症及结局,对各种BPD发生的可能因素行单因素和多因素分析.结果 患儿出生胎龄、体重、出生身长、Apgar 1 分钟≤7分、胎膜早破,在两组间比较差异有统计学意义(P<0.05);产后应用PS、机械通气时间、氧疗持续时间,在两组间比较差异有统计学意义(P<0.05).呼吸机相关性肺炎、PDA、败血症、高胆红素血症系BPD发生的危险因素(P<0.05);呼吸机相关性肺炎、PDA、高胆红素血症是BPD发生的独立危险因素.出生胎龄和出生体重为保护因素,胎膜早破和PS使用为BPD发生的独立危险因素.结论 避免低出生体重儿、预防出生时窒息、减少机械通气时间及用氧时间、及时关闭动脉导管、避免胎膜早破及感染、避免高胆红素血症,是预防NRDS新生儿发生BPD的重要方法.

1 病例资料 患儿,男性,日龄5 d,因"纳差2 d、反应差1 d"于2020年10月8日收入我院.患儿系胎龄41 +4周,第2胎第2产,顺产出生,出生体质量3300克,出生时无窒息缺氧病史,羊水清、量正常,Apgar评分1分钟8分、5分钟10分.患儿出生后为母乳喂养,出生2天内有呕吐现象,约每天3次,初期吐出清水样物质及不消化奶液、无咖啡色样物及胆汁,后吐出黄绿色物质;入院前2天出现吃奶差,未再呕吐,皮肤黄染较前逐渐加重,外院皮测胆红素18.3 mg/dL,入院当天反应差,无青紫,无抽搐,无尖叫,大便仍为胎便,小便量可.母亲年龄29 岁,血型为O型RhD阳性;父亲血型不详;家族无特殊疾病史.

目的 颅内出血是早产儿常见的并发症,可留下不同程度的神经系统后遗症,本文主要探讨早产儿颅内出血的高危因素,为早期干预提供理论依据.方法 选取2019年1月-2020年12月中国科学技术大学附属第一医院收治的早产儿共299例,出生后24h内入住新生儿病区,住院期间行头颅影像学检查(头颅彩超或头颅CT、磁共振).其中颅内出血早产儿114例为观察组,采用抽签法随机选取的同期住院的非颅内出血早产儿185例为对照组.采用单因素分析和多因素logistic回归分析探讨颅内出血的危险因素.结果 单因素分析显示孕母妊娠高血压疾病、孕晚期感染、胎膜早破、胎龄、出生体重、顺产、羊水污染、1 min和5 min Apgar评分、新生儿呼吸窘迫综合征(NRDS)、机械通气与早产儿颅内出血的发生有关(x2值分别为4.376、7.205、5.042、16.194、15.982、13.320、4.859、31.988、25.855、36.436、29.262,均P＜0.05);多因素logistic回归分析显示顺产、1 min Apgar评分、NRDS和孕晚期感染是早产儿颅内出血的独立危险因素(均P＜0.05).结论 早产儿颅内出血与孕母妊高症、孕晚期感染、胎膜早破、胎龄、出生体重、顺产、羊水污染、1 min和5 min Apgar评分、NRDS、机械通气等多种因素有关,临床工作中应综合评估,早诊断、早治疗.

目的 研究儿童重症腺病毒肺炎发生肺部后遗症的高危因素.方法 回顾性分析儿童重症腺病毒肺炎47例,其中有后遗症组18例,无后遗症组29例.对重症腺病毒肺炎发生后遗症的可能高危因素进行单因素分析,再对腺病毒肺炎发生肺部后遗症的危险因素进行多因素logistic回归分析.结果 后遗症组18例均表现为反复咳喘,影像学分析可见马赛克灌注征10例,剩余8例未见明显影像学改变.单因素回归分析结果显示,白细胞计数大于17×109/L、合并巨细胞病毒感染、住院时间大于13 d、使用丙种球蛋白是重症腺病毒肺炎发生后遗症的危险因素.多因素logistic回归分析结果提示,合并巨细胞病毒感染是重症腺病毒肺炎发生肺部后遗症的独立危险因素.结论 合并巨细胞病毒感染的重症腺病毒肺炎易发生肺部后遗症,值得儿科医生关注.

Background: The prevalence of pediatric asthma in China is approximately 3%, and asthma remains poorly controlled in many of these patients. This study assessed the rate of adherence to home nebulizer treatment in paediatric patients in China. Methods: The CARE study was a 12-week, multicentre, prospective, observational study across 12 tertiary hospitals in China. Patients were aged 0–14 years, clinically diagnosed with asthma and prescribed home nebulizer inhaled corticosteroid (ICS) therapy for ⩾3 months. The primary endpoint was electronically monitored treatment adherence. Patients attended onsite visits at 0, 4, 8 and 12 weeks to assess asthma control, severity and treatment adherence (recorded by electronic monitoring devices and caregivers). Results: The full analysis set included 510 patients. Median treatment adherence reported by electronic monitoring devices was 69.9%, and median caregiver-reported adherence was 77.9%. The proportion of patients with well-controlled asthma increased from 12.0% at baseline to 77.5% at visit 4. Increased time between asthma diagnosis and study enrolment was a significant predictor for better adherence [coefficient: 0.01, p = 0.0138; 95% confidence interval (CI): 0.00, 0.01] and asthma control (odds ratio = 1.001, p = 0.0498; 95% CI: 1.000, 1.002). Negative attitude to treatment by the caregiver was associated with poorer asthma control. Conclusions: Adherence to home nebulization, a widely used treatment for asthma, was high among Chinese pediatric patients. Asthma control improved with increasing treatment duration. These results suggest that home nebulization of ICS is an effective and recommendable long-term treatment for paediatric patients with asthma. Trial registration ClinicalTrials.gov identifier: NCT03156998 The reviews of this paper are available via the supplemental material section.

目的 分析儿童重症腺病毒肺炎的相关危险因素.方法 回顾性分析小儿腺病毒肺炎患儿111例,其中重症腺病毒肺炎48例,非重症腺病毒肺炎63例.单因素分析后,采用多因素logistic回归分析,找出与重症腺病毒肺炎相关的危险因素.结果 单因素回归分析显示,在起病3天内出现喘息(P=0.002)、有喘息史(P=0.010)、合并巨细胞病毒感染(P=0.000)、高热(P=0.041)是发生重症腺病毒肺炎的危险因素.多元logistic回归分析显示疾病起病3天内喘息(P=0.046)、合并巨细胞病毒感染(P=0.021)是重症腺病毒肺炎发生的独立危险因素.结论 当腺病毒肺炎患儿合并巨细胞病毒感染或者起病3天内出现喘息症状时,腺病毒肺炎更有可能发展为重症肺炎.对于合并以上特征的腺病毒肺炎患儿应早期积极干预.

OBJECTIVE:To study the significance of the level of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in serum and bronchoalveolar lavage fluid (BALF), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score in evaluating the conditions and prognosis of children with severe pneumonia. METHODS:A total of 76 children with severe pneumonia who were admitted from August 2017 to October 2019 were enrolled as the severe pneumonia group. According to the treatment outcome, they were divided into a non-response group with 34 children and a response group with 42 children. Ninety-four children with common pneumonia who were admitted during the same period of time were enrolled as the common pneumonia group. One hundred healthy children who underwent physical examination in the outpatient service during the same period of time were enrolled as the control group. The serum level of sTREM-1, APACHE II score, and SOFA score were measured for each group, and the level of sTREM-1 in BALF was measured for children with severe pneumonia. The correlation of the above indices with the severity and prognosis of severe pneumonia in children was analyzed. RESULTS:The severe pneumonia group had significantly higher serum sTREM-1 level, APACHEII score, and SOFA score than the common pneumonia group and the control group (P<0.05). For the children with severe pneumonia, the non-response group had significant increases in the levels of sTREM-1 in serum and BALF and SOFA score on day 7 after admission, while the response group had significant reductions in these indices, and there were significant differences between the two groups (P<0.05). Positive correlation was found between any two of serum sTREM-1, BALF sTREM-1, and SOFA score (P<0.05). APACHE II score was not correlated with serum sTREM-1, BALF sTREM-1, and SOFA score (P>0.05). CONCLUSIONS:The level of sTREM-1 in serum and BALF and SOFA score can be used to evaluate the severity and prognosis of severe pneumonia in children.

Objectives. To identify risk factors associated with the prognosis of pertussis-like coughing. Methods. A retrospective study on children hospitalized with pertussis-like coughing from 2018 to 2019. We collected all the case data from medical records including age, gender, vaccination, clinical symptoms, complication, pathogens, white blood cell (WBC) count, lymphocyte ratio, application of macrolide antibiotics, usage of sulfamethoxazole, and usage of inhaled glucocorticoids. Logistic regression was used in this study. Results. A total of 213 hospitalized children with pertussis-like coughing were included in this study. About 70 children were cured within 2 weeks. One120 children were cured from 2 weeks to 3 months, including cases of initial attack and relapse. Symptoms lasting longer than 3 months accounts for 10.8%. Bordetella pertussis, WBC count >20 × 109/L and lymphocyte ratio >60% were associated with poor prognosis (P < .05). Conclusions. Bordetella pertussis, WBC count, and lymphocyte ratio are independent risk factors for poor prognosis.

[目的]研究西藏自治区山南市儿童青少年结核病发病情况及临床特征,分析影响筛查结果的因素,为该市儿童青少年结核病防治策略的制定提供参考依据.[方法]采用随机整群分层抽样方法抽取西藏山南市儿童青少年5 063人,对其进行结核病筛查问卷调查;对问卷筛查阳性者进行结核菌素皮肤试验及胸部X线拍摄以确诊结核病.运用SPSS统计软件进行数据分析.[结果]对西藏山南市0～18岁儿童青少年共5 063人进行结核病筛查,筛出新发结核病患儿14例,其中0～6岁儿童1例,7～18岁儿童青少年13例.0～6岁儿童问卷筛查阳性的危险因素是居住地为农牧区(OR=9.908,P=0.005)、父亲为结核病患者(OR=120.000,P＜ 0.001);7～18岁儿童青少年问卷筛查阳性的危险因素为女性性别(OR=1.314,P=-0.015)、年龄组别为初中生(OR=1.324,P=0.041)、居住地海拔为4000m以上(OR=1.940,P＜0.001)、父亲为结核病患者(OR=4.829,P＜0.001).[结论]西藏山南市儿童青少年结核病发病率高于内地,居住环境、高海拔因素、营养状况、对预防结核病知识的欠缺是该地区结核病发病偏高的可能因素;反复呼吸道症状和消化道症状是筛查问卷阳性儿童青少年勾选最多的两个选项;山南市儿童青少年卡介苗接种率与内地儿童青少年相近.

Novel Coronavirus Pneumonia (NCP) is a class B infectious disease, which is prevented and controlled according to class A infectious diseases.Recently, children′s NCP cases have gradually increased, and children′s fever outpatient department has become the first strategic pass to stop the epidemic.Strengthening the management of the fever diagnosis process is very important for early detection of suspected children, early isolation, early treatment and prevention of cross-infection.This article proposes prevention and control strategies for fever diagnosis, optimizes processes, prevents cross-infection, health protection and disinfection of medical staff, based on the relevant diagnosis, treatment, prevention and control programs of the National Health and Health Commission and on the diagnosis and treatment experience of experts in various provinces and cities.The present guidance summarizes current strategies on pre-diagnosis; triage, diagnosis, treatment, and prevention of 2019-nCoV infection in common fever, suspected and confirmed children, which provide practical suggestions on strengthening the management processes of children′s fever in outpatient department during the novel coronavirus pneumonia epidemic period.

目的 探讨维生素D受体(VDR)基因多态性与青少年肺结核(PTB)易感性的关系,为青少年肺结核病的防治手段提供遗传学理论依据.方法 在合肥市及山南市共采集青少年肺结核病患者96例(病例组)、健康对照123例(对照组)的外周静脉血.应用限制性片段长度多态性聚合酶链反应(PCR-RFLP)分析方法检测VDR基因位点(ApaⅠ、BsmⅠ、FokⅠ、TaqⅠ)的基因型,并用x2检验分别分析两地区青少年VDR基因多态性与结核易感间的关系.结果 两地区病例组BsmⅠ位点基因型与对照组相应基因型比较,差异有统计学意义(合肥市:x2=19.948,P＜0.001,山南市:x2=38.485,P＜0.001);两地区病例组FokⅠ位点基因型与对照组相应基因型比较,差异有统计学意义(合肥市:x2 =7.231,P=0.027,山南市:x2=21.781,P＜0.001).而两地区病例组ApaⅠ及TaqⅠ位点基因型与对照组相应基因型比较,差异无统计学意义(P＞0.05).结论 VDR基因BsmⅠ及FokⅠ位点多态性与青少年肺结核易感有关,BsmⅠ位点Bb、bb基因型及FokⅠ位点Ff、ff基因型增加青少年肺结核病易感风险.

Objective:To evaluate the efficacy and safety of pharyngeal spraying recombinant human interfe-ron alpha 2b (rhIFNα2b) in the treatment of herpangina in children.Method:s A prospective, multicenter, rando-mized, opened and controlled study was carried out in 11 hospitals in Anhui province from August 2018 to March 2019.According to the time of admission, 180 patients diagnosed as herpangina were prospectively and randomly divided into rhIFNα2b treatment group and Ribavirin control group.On the basis of giving both groups the heat-clearing, detoxifying and anti-infection treatment, the patients in treatment group received pharyngeal spraying rhIFNα2b 9 g/L saline solution[1 million IU/mL, 0.1 million IU/(0.1 mL·press)], and the patients in control group were treated by pharyngeal spraying Ribavirin (0.5 mg RBV/press, 150 press), 3 presses per time, 4 times per day, continuous administration for 5 days for both groups.Those who recovered in advance were no longer given medication.All patients were observed to fully recover.The clinical efficacy and the disappearing time of symptoms and signs between two groups were compared, and the safety of pharyngeal spraying rhIFNα2b for patients was evaluated.Result:s All of the 180 patients completed the study, including 90 cases in the treatment group and 90 cases in the control group.There was no statistically significant difference in terms of gender, age, weight and course of illness before treatment between the two groups (all P>0.05), which had clinical comparability.The apparent efficiency of the treatment group [63.3% (57/90 cases)] was significantly higher than that in the control group [38.9% (35/90 cases)] and the difference was statistically significant( χ2=10.934, P=0.004); no significant difference in the total efficiency between the treatment group [96.7% (87/90 cases)]and the control group [92.2% (83/90 cases)]was observed ( χ2=2.924, P=0.169). The duration of fever[(32.59±20.73) h vs.(45.72±26.96) h], hyperemia[(76.48±23.12) h vs.(92.44±24.31) h], herpes[(72.99±25.77) h vs.(85.09± 26.62) h], salivation[(45.44±24.96) h vs.(54.42±31.20) h] and anorexia[(62.70±23.99) h vs.(78.71±30.54) h] in the treatment group were significantly shorter than those in the control group, and the differences were statistically significant(all P<0.05). Before treatment, the serum levels of tumor necrosis factor α(TNF-α) [(13.02±4.41) ng/L vs.(13.57±9.27) ng/L], interleukin-6(IL-6) [(26.48±11.31) ng/L vs.(30.15±15.55) ng/L] and C-reactive protein(CRP)[(19.34±14.11) mg/L vs.(19.83±14.57) mg/L]were not significantly different between the two groups (all P>0.05). After treatment, the serum levels of TNF-α and IL-6 were(7.26±1.99) ng/L and (2.42±0.73) ng/L in the treatment group, which were significantly lower than those in the control group [(12.09±6.39) ng/L and (7.32±11.51) ng/L](all P<0.05), but no significant difference in serum levels of CRP between the two groups was observed ( P>0.05). The comparison on positive rate of virus in pharyngeal swab between the treatment group [65.3% (32/49 cases) and 40.6% (13/32 cases) respectively] and the control group[66.7%(36/54 cases) and 41.0% (16/39 cases), respectively]before and after therapy showed no significant difference (all P>0.05). During the treatment, no serious adverse reactions were observed in the two groups.The incidence of adverse reactions was 1.1% (1/90 cases) in the treatment group and 5.6% (5/90 cases) in the control group.In addition, the serum hemoglobin level of children in the control group after treatment was significantly lower than that before treatment and that in the treatment group (all P<0.05). Conclusions:Compared with pharyngeal spraying ribavirin, pharyngeal spraying rhIFNα2b can greatly improve the clinical efficiency, accelerate the disappearance of clinical symptoms and signs, and shorten the total course of disease, and is more safe and worthy of clinical application.

OBJECTIVE:To study the characteristics of pulmonary function in children with pertussis-like coughing caused by different pathogen infections. METHODS:The data on etiology and tidal breathing pulmonary function were collected from 95 hospitalized infants and young children with pertussis-like coughing. The tidal breathing pulmonary function was compared between these children and 67 healthy children. According to the type of pathogen, the children with pertussis-like coughing were classified to 6 groups: pertussis (n=17), viral infection (n=23), tuberculosis infection (n=6), Mycoplasma infection (n=9), other bacterial infection (n=8), and unknown pathogen (n=32). RESULTS:Among the 95 children with pertussis-like coughing, 15 (16%) had mild obstructive ventilatory dysfunction, 30 (32%) had moderate obstructive ventilatory dysfunction, and 22 (23%) had severe obstructive ventilatory dysfunction. Compared with the normal control group, the children with pertussis-like coughing had significant reductions in inspiratory-to-expiratory time ratio, ratio of time to peak tidal expiratory flow to total expiratory time (tPF%tE), and ratio of volume to peak tidal expiratory flow to total expiratory volume (vPF%vE) (P<0.05). The tuberculosis infection and Mycoplasma infection groups had a significantly lower tidal volume than the normal control group (P<0.05). All pathogen infection groups except the tuberculosis infection group had significantly lower tPF%tE and vPF%vE than the normal control group (P<0.05). The pertussis group had significantly lower tPF%tE and vPF%vE than the other infection groups (P<0.05). CONCLUSIONS:Most of children with pertussis-like coughing have abnormal pulmonary functions. The children with Bordetella pertussis infection have the most severe pulmonary function impairment. Tidal breathing pulmonary function test may provide a reference for pathogen analysis of children with pertussis-like coughing.

OBJECTIVE:To explore the intervention measures to maintain clinical control in children with asthma in the remission stage when concomitant with acute upper respiratory infection (AURI). METHODS:A total of 100 asthmatic children who had achieved clinical control were randomly divided into observation group and control group. The two groups were both treated with a combination of inhaled corticosteroids and long-acting β2 receptor agonist (ICS/LABA) at the lowest dose every night. Conventional therapies were used for the two groups when suffering from AURI. In addition to conventional therapies, the observation group was given early short-term upgrade therapy, i.e., on the basis of maintenance therapy, the same amount of ICS/LABA complex preparation was inhaled every morning, which lasted for 7-10 days. Both groups were treated following asthma guidelines according to the severity of the disease at the time of acute attacks. The control rate of asthma, severity of acute attacks, changes in pulmonary function indices, and occurrence of adverse events were evaluated after 3, 6, 9, and 12 months of treatment. RESULTS:At each time point of follow-up, the rate of asthma control in the observation group was significantly higher than that in the control group (90% vs 80%; P<0.05). The severity of acute attacks in the observation group was significantly lower than that in the control group at all follow-up time points (P<0.05). Compared with the control group, the observation group had significantly improved pulmonary function indices of large and small airways (P<0.05) and significantly reduced mean amount of inhaled glucocorticoids and impact on family life (P<0.01). CONCLUSIONS:Early short-term upgrade therapy for children with asthma in the remission stage when concomitant with AURI can prevent acute attacks of asthma, raise the rate of asthma control and improve pulmonary function.

目的 了解先天性中性粒细胞减少症(CN)相关新突变基因及突变位点并阐述诊疗过程及病儿转归.方法 收集1例CN病儿疾病的发展、治疗、转归及血液系统异常相关单基因遗传病总筛查结果加并以分析总结.结果 病儿3月龄时因反复不明原因中性粒细胞减少行基因遗传病筛查,确诊先天性中性粒细胞减少症,后病儿因反复感染住院接受抗感染及升白等治疗,治疗过程中病儿临床症状可部分缓解,但白细胞及中性粒细胞较前无明显上升.现病儿密切随访中,病情暂且稳定,建议转入血液科进一步行造血干细胞移植治疗.结论 血液系统异常相关单基因遗传病总筛查提示病儿系ELANE基因突变,核酸突变c.197T>G(外显子2),氨基酸突变DM66R,查阅文献显示该突变位点目前暂无报道.