Background:Mycoplasma pneumoniae pneumonia (MPP) is one of the leading causes of hospitalization and death in children. Epidemiological studies have confirmed that single blood indicators such as the neutrophil-to-lymphocyte ratio (NLR), lactic dehydrogenase (LDH), and albumin (Alb) levels are associated with the prognosis and length of stay (LOS) of patients with MPP. In this study, we aim to evaluate the association of the GRIm score with the LOS and compare its strength of association with that of its individual components. Methods:We recruited 786 children with MPP who were admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine during the period between 2014 and 2021. The end of follow-up was discharge. Univariate and multivariate logistics regression models were used to explore the association between the NLR, LDH, Alb as well as the GRIm score with the LOS among our cohort, with odd ratios (ORs) and 95% confidence intervals (CIs). The receiver operating characteristic (ROC) curve, the net reclassification improvement (NRI) index, and the integrated discrimination improvement (IDI) index were used to compare the predictive efficacy of the GRIm score with the NLR and LDH and in predicting the LOS among children and adolescents with MPP. Results:After the application of the inclusion and exclusion criteria, 389 eligible children and adolescents with MPP were included, with a mean age of 5.21 (±2.59 years). After adjusting for covariates, we found that LDH and the GRIm score were positivity associated with the LOS (LDH: β = 0.40, 95% CI: 0.00-0.80; GRIm score: β = 0.33, 95% CI: 0.07-0.58). The high GRIm score was associated with an LOS ≥7 or 11 days (≥7 days: OR = 0.635, 95% CI: 0.585-0.685; ≥ 11 days: OR = 0.622, 95% CI: 0.543-0.700). The area under the curve (AUC), NRI, and IDI all showed that the GRIm score had excellent ability in predicting the LOS of children with MPP compared with single indicators such as LDH, the NLR, and Alb. Conclusion:The GRIm score showed a significant association with the prolonged LOS in children with MPP, and the strength of this association was higher than its individual components. However, these findings still need to be confirmed by further large multicenter prospective cohort studies.

围绕儿童病毒性肺炎进行文献检索,依照中医临床诊疗指南编写规则,完成2轮专家问卷调查和专家意见征求,最终形成《小儿病毒性肺炎中医临床诊疗指南(修订)》,明确指南适用范围、规范性引用文件、术语和定义、诊断、辨证、治疗、预防和调护,旨在为儿童病毒性肺炎中医临床实践、诊疗规范等提供重要参考.

目的 比较中西医结合方案与西医方案治疗儿童社区获得性肺炎(CAP)的临床疗效及安全性.方法 采用前瞻性队列研究方法,收集国内13家三级甲等儿科专科医院及中医药大学附属医院儿科就诊的CAP患者,根据患儿应用治疗方案不同分为西医组及中西医结合组,采用倾向性评分匹配(PSM)的方法计算基线资料中两组比较有统计学意义的变量和混杂因素分值,按照1:1最近邻近匹配法进行匹配,共424例病例匹配成功,每组212例.采用重复测量方差分析、Kaplan-Meier生存分析、Log Rank检验等方法评价两组治疗方案的疾病痊愈率、疾病积分下降趋势、症状/体征消失率和消失时间、住院费用和住院时间等的差异.结果 国内大型医院治疗CAP时中西医结合方案实际应用比率为77.4％;西医机构应用中西医结合治疗方案时多使用中成药,中成药使用占比74.3％.中西医结合组治疗CAP第7天痊愈率为54.72％优于西医组的44.34％(P＜0.05),但14天内疾病积分下降趋势组间比较差异无统计学意义(P＞0.05);第7天主要症状与体征消失率及消失时间比较,两组患儿在咯痰症状、肺部湿啰音方面差异有统计学意义(P＜0.05),中西医结合组听诊湿啰音的消失率更高且消失时间更短,而西医组咯痰的消失率与消失时间更优.两组患儿住院时间差异无统计学意义(P＞0.05);中西医结合组不良反应发生率较西医组更低(P＜0.05);中西医结合组在真实世界的经济成本较西医组更低(P＜0.05).结论 中西医结合治疗方案能更快速、有效地改善患儿肺部湿啰音体征,且安全性与经济性均优于西医治疗方案.

目的 观察童心康合剂治疗小儿毒瘀互结、气阴两虚型病毒性心肌炎的疗效,并应用网络药理学探讨其作用机制.方法 将99例病毒性心肌炎患儿随机分为童心康合剂组(童心康组)和玉丹荣心丸组(玉丹组),治疗4周后比较两组心肌酶、临床证候积分等指标.基于网络药理学,通过TCMID、TCMSP及DrugBank数据库检索童心康合剂的有效成分及靶点,利用Cytoscape软件构建药物有效成分-基因靶点网络;最后利用R语言安装多个工具包进行基因本体(GO)功能富集分析和京都基因与基因组百科全书(KEGG)通路富集分析.结果 童心康合剂可改善病毒性心肌炎患儿临床症状及心肌酶.其机制可能与调控T细胞受体信号通路、抑制细胞凋亡等有关.结论 童心康合剂治疗毒瘀互结、气阴两虚型小儿病毒性心肌炎安全有效,其作用机制是多靶点、多途径的.

BACKGROUND:Bronchial Asthma is a chronic, hyperreactive inflammation of the airway that involves a variety of inflammatory cells. Due to the persistence of airway hyperresponsiveness, lung function is progressively damaged, making asthma more stubborn and difficult to heal. In recent years, the prevalence of childhood asthma is still on an increasing trend. Repeated asthma attacks not only affect children's life and learning, but also bring greater economic and mental burden to children's families, and even threaten children's lives. Traditional treatment methods such as oral western medicine, atomization therapy has obvious limitations, and the complementary and alternative therapy is an effective method to treat asthma in children. This study will evaluate the efficacy and safety of various complementary and alternative therapies for children with asthma by means of mesh meta-analysis. In order to provide the basis for clinical rational use. METHODS:Use the computer to search the self-built database until January 2021, the China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journals Database, China Biomedical Literature Database, PubMed, Cochrance Library, EMBASE, Web of Science, Clinical Trials and other electronic databases to collect RCT studies on complementary and alternative therapies for for children with asthma. We will screen the relevant literature included in the systematic review/meta analysis. At the same time, Revman 5.3 software will be used for meta-analysis, and grade will be used to grade the quality of evidence in the network meta-analysis. RESULTS:This study will compare the efficacy and safety of different complementary and alternative therapies to treat childhood asthma, and evaluate and rank different interventions. CONCLUSION:The combined use of complementary and alternative therapies for childhood asthma on the basis of conventional basic treatment can improve clinical efficacy, reduce the occurrence of adverse reactions, improve the quality of life of children, and provide strong support for the rational use of clinicians. INPLASY REGISTRATION NUMBER:INPLASY202120005.

目的:应用网络药理学方法探讨三拗汤对治疗小儿支气管炎的作用网络与潜在机制.方法:运用中药系统药理学分析平台(Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform,TCMSP)检索三拗汤全方3味中药的有效活性成分及其所对应的有效靶点,通过人类基因组注释数据库(Gene Cards)检索小儿支气管炎相关的疾病靶点,与中药的有效成分进行维恩(Venny)分析,确定交集靶点的靶向关系;运用Cytoscape软件构建药物有效成分-基因-靶点网络;然后运用String数据库构建化合物疾病共同靶点的蛋白互作分析(Protein Protein Interaction,PPI).结果:筛选出三拗汤共144个有效活性化合物和118个药物预测靶点,小儿支气管炎靶点1168个,通过维恩图得到共同靶点53个.通过构建PPI蛋白互作网络及提取核心基因涉及的关键靶点包括非表皮生长因子受体(Epidermal Growth Factor Receptor,EGFR)、胱天蛋白酶3(Caspase-3,CASP3)、血管内皮生长因子A(Vascular Endothelial Growth Factor A,VEGFA)、G1/S-特异性周期蛋白-D1(CyclinD1,CCND1)、IL6、丝裂原激活蛋白激酶8(Recombinant Mitogen Activated Protein Kinase 8,MAPK8)、MYC、酪氨酸激酶受体2(V-erb-b2 Avian Erythroblastic Leukemia Viral Oncogene Homolog 2,ERBB2)、鼠双微体2(Murine Double Minute 2,MDM2)、RELA.结论:三拗汤可能通过靶向作用关键蛋白和重要通路等综合调节达到防治小儿支气管炎的效用,有望对中药复方防治小儿支气管炎提供新的证据和研究思路.

Abstract Background: Bronchial Asthma is a chronic, hyperreactive inflammation of the airway that involves a variety of inflammatory cells. Due to the persistence of airway hyperresponsiveness, lung function is progressively damaged, making asthma more stubborn and difficult to heal. In recent years, the prevalence of childhood asthma is still on an increasing trend. Repeated asthma attacks not only affect children's life and learning, but also bring greater economic and mental burden to children's families, and even threaten children's lives. Traditional treatment methods such as oral western medicine, atomization therapy has obvious limitations, and the complementary and alternative therapy is an effective method to treat asthma in children. This study will evaluate the efficacy and safety of various complementary and alternative therapies for children with asthma by means of mesh meta-analysis. In order to provide the basis for clinical rational use. Methods: Use the computer to search the self-built database until January 2021, the China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journals Database, China Biomedical Literature Database, PubMed, Cochrance Library, EMBASE, Web of Science, Clinical Trials and other electronic databases to collect RCT studies on complementary and alternative therapies for for children with asthma. We will screen the relevant literature included in the systematic review/meta analysis. At the same time, Revman 5.3 software will be used for meta-analysis, and grade will be used to grade the quality of evidence in the network meta-analysis. Results: This study will compare the efficacy and safety of different complementary and alternative therapies to treat childhood asthma, and evaluate and rank different interventions. Conclusion: The combined use of complementary and alternative therapies for childhood asthma on the basis of conventional basic treatment can improve clinical efficacy, reduce the occurrence of adverse reactions, improve the quality of life of children, and provide strong support for the rational use of clinicians. INPLASY registration number: INPLASY202120005

目的 研究养心活血解毒方对CVB3小鼠心肌损伤的保护作用.方法 建立CVB3诱导的病毒性心肌炎小鼠模型.设立正常组、模型组、利巴韦林组、中药高剂量组、中剂量组和低剂量组,连续灌胃给药14天.观察各组小鼠一般情况、HE染色观察各组心肌细胞损伤程度,免疫组织化学法检测FAS、FASL蛋白水平,蛋白免疫印迹法检测JAK2、STAT3蛋白表达.结果 与Ctrl组比较,模型组各组心肌组织受损明显,与 心肌细胞凋亡相关因子显著升高(P＜0.01);与CVB3组比较,LBWL组和中药各组心肌细胞形态相对正常,心肌纤维排列整齐;FAS、FASL蛋白表达显著低于CVB3组(P＜0.01),高剂量组效果显著;JAK2、STAT3蛋白表达显著低于CVB3组(P＜0.01).结论 养心活血解毒方通过下调Fas/FasL蛋白的表达,抑制心肌细胞凋亡,同时降低JAK2、STAT3蛋白表达,可能在病毒性心肌炎的治疗中发挥作用.

小柴胡汤最早见于《伤寒杂病论》,其作为“和法”的代表方,以其疗效显著、理论独特,受到中医学者及临床医家的青睐.并因其制方巧妙、功能独特、适用广泛,成为现代经方研究的热点.李燕宁教授为山东省名老中医,医学博士,博士生导师,国家二级教授,应用小柴胡汤深得堂奥、屡有显效.李燕宁教授即善用《伤寒论》小柴胡汤条文,又善于分析临床各类疾病病机,实践中强调治病应抓主症,并详察病因病机实情而随证加减衍化,方能灵活用之.基于李燕宁教授临床案例,对李燕宁教授运用小柴胡汤加减及其合方治疗各种疑难疾病案例观察,分析小柴胡汤临床应用病因病机、加减及合方运用,为扩展小柴胡汤加减临床应用及疗效提供经验支持和理论依据.

李燕宁教授认为"痰瘀互结"是儿童哮喘慢性持续期的病机关键,"津血同源"的生理关系必然伴随"痰瘀互结"的病理关系."痰"是哮喘发病的"宿根",贯穿哮喘的始终.哮喘慢性持续期以无形之痰为主,当以"涤痰"治之;然"津血同源""久病多瘀",痰浊日久,阻滞脉络,阻塞不通而致"瘀","瘀"是哮喘慢性持续期的重要病理因素.笔者从痰瘀同源角度,总结李燕宁教授论治儿童哮喘慢性持续期的经验,探讨其独特的病因病机与辨证治疗方法,丰富哮喘治疗理论依据,为临床诊疗提供新思路.

随着对小儿肺炎认识的不断深入,越来越多的医家认为"瘀"贯穿小儿肺炎的全过程,笔者认为在小儿肺炎不同病程阶段,造成血瘀的病机亦不同,可分期概括之:早期邪郁,中期痰阻、毒闭,后期正虚邪恋.本文通过结合小儿肺炎早、中、后期不同阶段的特点进行分期论治,系统阐释了小儿肺炎不同疾病阶段"瘀"的病机演变过程,论证了"瘀"贯穿小儿肺炎发生、发展、恢复的全过程,只是轻重程度不同这一观点.

目的 分析在儿童哮喘缓解期采取中药穴位敷贴疗法治疗的临床效果.方法 选取2018年6月—2019年6月我院就诊的68例哮喘期患儿作为研究对象,根据抽签法进行分组,将患儿分为实验组(n＝34)和参照组(n＝34).参照组患儿采取常规西药治疗,实验组采取中药穴位敷贴疗法治疗,对比两组患儿的治疗有效率以及治疗前后相关症状改善情况.结果 实验组患儿的治疗有效率97.06%高于参照组的76.47%,差异有统计学意义(P＜0.05);实验组患儿治疗后哮喘发作程度、发作频率、反复感冒及自汗积分均分别低于参照组患儿的症状积分,差异有统计学意义(P＜0.05).结论 对处于哮喘缓解期的患儿采取中药穴位敷贴疗法治疗具有较显著的治疗效果,能够有效改善患儿的相关症状,促进其身体的快速恢复,值得临床推广.

目的 分析治疗发热的中成药剂型、用药规律、功能主治.方法 收集《中华人民共和国药典》(2015版)中治疗发热的中成药处方信息,借助中医传承辅助平台软件进行药物数据挖掘.结果 符合要求的中成药有153个制剂,包括105种14个剂型,剂型中颗粒剂、片剂、口服液、丸剂多见.成药中涉及195种中药饮片,甘草、黄芩、连翘、桔梗、薄荷、金银花、荆芥、防风、杏仁使用频次较高;核心中药组合为银翘散加减,新方分析得到潜在关联的新方5首.功能主治中风热感冒占绝对数量.结论 《中华人民共和国药典》(2015版)中治疗发热的中成药处方、剂型丰富,基本涵盖临床常见发热疾病,中药西药的科学化配制有利于临床应用,为了更好地发挥药物疗效,应充分结合中西医理论进行深入研究.

目的 基于网络药理学探讨甘草治疗小儿肺炎的潜在活性成分和可能作用机制.方法 将中药系统药理学分析平台(TCMSP)筛选的甘草活性成分与药物数据库(Genecard数据库)检索的小儿肺炎靶点进行对比分析,归纳总结出甘草活性成分中对小儿肺炎治疗作用的主要潜在靶点.结果 得到小儿肺炎疾病基因靶点1110个,药物有效成分92个,通过uniprot数据库筛选出目前已知有意义的靶点105个,利用Cytoscape 3.7.0软件构建药物-疾病基因靶点网络图,并对其进行分析,取得44个药物-疾病基因靶点,登陆string数据库,输出药物-疾病基因靶点分析得到疾病蛋白-基因互作PPI网络,筛选蛋白-疾病交集最多的30个基因,通过GO富集分析,筛选出与疾病最相关的20个富集过程.通过KEGG通路富集分析得到6条通路.结论 甘草对小儿肺炎治疗作用的发挥是基于多成分、多通路和多靶点的整体药效效应,挖掘了甘草治疗小儿肺炎的潜在作用机制,为进一步实验研究提供了理论基础.

儿童肾系疾病包括水肿、血尿、蛋白尿、泌尿系结石、肾病综合征、脑瘫、咳嗽、哮喘、新生儿硬肿症、IgA肾病、紫癜、儿童多动症等多种疾病.这些疾病可单独出现也可结合出现,具体疾病表现形式更是多种多样.临床治疗肾系疾病时疗效反复、疗程较长,体现了肾系疾病的复杂性.儿童肾系疾病的复杂性使其成为一大类疑难杂症,疑难杂症从痰瘀论治早已经成为一种思维模式.中医临床家对肾系具体疾病从瘀论治进行了大量的有效案例报道及经验总结.同时,随着现代医学检测技术手段的发展,现代中医临床医生在秉承中医理论及治法的同时,又充分运用现代医学诊疗技术.通过这些现代医学诊疗技术,临床医生发现罹患肾系疾病儿童的凝血全套、血液流变学、甲襞微循环等检查表现出血瘀状态结果.为了系统总结临床上从瘀论治儿童肾系疾病的可行性、有效性和必要性,本文试从儿童肾脏和血液的特点、儿童肾脏与瘀血形成的关系、活血化瘀法在儿童肾系疾病的应用三方面进行阐述.

目的 评价抗病毒口服液治疗普通型小儿手足口病肺脾湿热证的有效性及安全性.方法 采用随机、双盲、安慰剂平行对照、多中心临床试验方法,计划纳入288例患儿,按1:1的比例随机分为试验组和对照组.试验组服用抗病毒口服液,对照组服用安慰剂,剂量均为1～2岁5 mL/次、3～6岁10 mL/次,3次/d,疗程5d.以完全退热时间为主要有效性指标.结果 实际入组287例,其中试验组144例、对照组143例.试验组完全退热中位时间为24 h(PPS数据集,下同),对照组为48 h,两组比较差异有显著性(P＜0.05);试验组皮疹/疱疹开始消退中位时间为24 h、对照组为40 h,试验组皮疹/疱疹完全消退中位时间为96 h、对照组为112h,试验组中医证候疗效总愈显率为92.62％、对照组为72.32％,两组比较,差异均有统计学意义(P＜0.05).试验组与对照组不良事件发生率分别为4.35％和2.99％,组间比较,差异无统计学意义.结论 抗病毒口服液治疗小儿手足口病普通型肺脾湿热证,可以缩短退热时间、皮疹/疱疹消退时间,促进口腔黏膜疱疹/溃疡愈合,改善中医证候,临床使用有效、安全.

OBJECTIVE:To investigate the use of antibiotics in children with community-acquired pneumonia (CAP) in multiple regions of China, and to provide a reference for CAP standard treatment and rational antibiotic use in children. METHODS:The medical data of 1 383 children with CAP who were hospitalized in the department of pediatrics in 10 grade A tertiary hospitals from 9 cities between April 14, 2014 and January 1, 2016 were reviewed, to analyze the status of antibiotic use in hospitalized children in North China, Northeast China, East China, and South China. RESULTS:The overall rate of antibiotic use in children with CAP was 89.08%, with 88.7% in North China, 95.5% in Northeast China, 83.3% in East China, and 86.6% in South China. The main types of antibiotics used were cephalosporins, macrolides, compound preparations of β-lactam antibiotics, polyphosphoric broad-spectrum antibiotics and other β-lactam antibiotics. The selection of antibiotics was generally rational, but antibiotics were still used in some patients with viral infection alone or a combined use of ≥2 kinds of antibiotics were noted in some patients with infection caused by one kind of pathogen. Irrational antibiotic use was observed in 131 children (10.63%). CONCLUSIONS:There are high rates of antibiotic use and irrational use of antibiotics among children with CAP. Standard management of antibiotic use in children with CAP should be strengthened.

目的:基于中医传承辅助平台,总结中国知网(CNKI)数据库中中医药治疗小儿腺样体肥大的组方用药规律.方法:收集CNKI数据库中治疗小儿腺样体肥大的方剂,录入中医传承辅助系统,分析处方用药规律.结果:筛选出符合要求的方剂81首,涉及中药129味,分析处方中药物出现的频次,主要的关联规则.发现核心药物组合14组,挖掘新处方7首.结论:通过数据分析,发现CNKI数据库中中医药治疗小儿腺样体肥大的药物以具有宣发鼻窍、活血化瘀、健脾利湿、清热散结功效药物为主,为临床治疗小儿腺样体肥大提供参考依据.

目的:了解儿童肺炎不同呼吸道病原感染情况及其分布特征.方法:采用随机对照方法收集201 1年6月至2013年6月中国5个城市6个儿童诊疗中心的429例肺炎住院患儿的血清和鼻咽分泌物,采用直接免疫荧光法检测呼吸道合胞病毒(RSV)、腺病毒(ADV)、流感病毒A、B型(IVA、IVB)、副流感病毒1-3型(PIV-1、PIV-2、PIV-3)、柯萨奇B3病毒(CVB3)8种呼吸道病毒抗原,采用被动凝集法检测支原体(MP)抗体.结果:6个月-1岁、1-3岁年龄段,RSV阳性检出率最高(71.4％、55.6％);3-5岁年龄段,ADV阳性检出率最高(42.9％).沈阳、大连、北京地区,ADV阳性检出率最高(64.7％、82.4％、34.5％);广州、上海、山东地区,RSV阳性检出率最高(67.6％、29.7％、58.7％).不同病原在中医证型间的分布,以RSV和ADV分布在风热闭肺、痰热闭肺间具有统计学意义(P＜0.05).结论:RSV和ADV是5岁以下儿童非细菌性肺炎的常见病原.

OBJECTIVE To study the effect of Tongxinkang mixture on myocardial fibrosis in rats with experimental autoim mune myocarditis (EAM).METHODS Sixty Lewis rats were randomly divided into 6 groups,including normal group,EAM group,Yudanrongxin pill group,high dose,medium dose and low dose Tongxinkang mixture groups.Each group had 10 rats.The survived rats were killed after 56 days,and then myocardial pathological changes,myocardial fibrosis and MMP-9/TIMP 1 expression were observed.RESULTS The myocardial pathological scores of high dose and medium dose Tongxinkang mixture group,and Yudanrongxin pill group were significantly lower than those of low dose Tongxinkang mixture group and EAM group (P＜0.05).High dose and medium dose Tongxinkang mixture could more significantly inhibit myocardial fibrosis than Yudanrongxin pill (P＜0.05).Medium dose Tongxinkang mixture could upregulate the expression of MMP-9 and downregu late the expression of TIMP-1.CONCLUSION This research shows that Tongxinkang mixture can reduce myocarditis in EAM rats.Tongxinkang mixture can protect myocardium and suppress myocardial fibrosis by regulating the expression balance of MMP-9 and TIMP-1.