目的:本研究基于"真实世界"数据和生物信息学技术并依据HIS系统对PNS住院患儿中药处方资料进行统计分析用药规律,探讨原发性肾病综合征(PNS)的发病机制及用药特点.方法:从NCBI、OMIM、Disgenet数据库中获取PNS相关靶点,通过DAVID、STRING数据库获得KEGG通路与蛋白互作网络筛选关键基因,通过Symmap数据库与山东省中医院HIS系统,寻找治疗PNS的核心中药.结果:筛选得到13个PNS核心靶点,如TNF、EGFR、VEGFA等;18味核心中药,如桂枝、黄芪、茯苓等利水渗湿、温阳益气类药物.结论:本研究初步探索了PNS的发病机制,探寻中医药治疗PNS的用药特点及规律,为PNS的精准治疗提供了理论依据.

小儿抽动障碍是单一或多种致病因素长期作用的结果,近年来,我国儿童抽动障碍患病率逐日上升.西医对本病无特效疗法,多以镇静法等对症治疗,中医常从肝论治.文章从"脾常不足"出发,将脾的功能与抽动障碍病因病机相互联系,运用整体观念与"治未病"思想探究食疗调护方法对疾病的防治作用,为小儿抽动障碍的治疗开拓了新的思路和方法.

真性红细胞增多症发病率低、症状复杂,在诊治时常遇到"无法可循"的困境,本文以"选取主症,视症为病,探求病因,辨证选方"为思路,选取犀角地黄汤加减治疗,效果显著,印证了中医辨证论治的有效性,也为罕见病、疑难病的中医治疗拓宽了思路和方法.

PAN Yueli believed that the pathogenesis of gan Qi type malnutrition was due to the failure of spleen-Yang to rise,obstruction of stomach-collaterals,and liver-Qi deficiency leading to the disappearance of fluids and stagnation of Qi and blood.The treatment focused on the flexible use of promoting Yang Qi,clearing up the collaterals Qi,and activating stagnation Qi to regulate the spleen,stomach,and liver.It advocated identifying the urgency of the disease,treating both the symptoms and the root cause,and adding and subtracting medicine according to the symptoms.Clinical prescriptions should be in accordance with the principles of promoting spleen-Yang and not over-supplementing,promoting stomach-collaterals and not over-stasis,and de-stagnating liver-Qi according to the changes of the disease,it achieved significant treatment results.A test case was attached to support this.

张介宾在《景岳全书》中倡言"阳非有余,阴常不足",强调并阐述了命门水火和阴阳互根理论,纠正寒凉时弊.其中《小儿则》部分以温补理论为基础对张介宾诊治儿科疾病的治则治法和用药特点进行了论述.文中结合张介宾对小儿生理病理特点的认识,从谨慎用药、酌用苦寒、善用温补、巧施清凉、重视气血、顾护脾肾、剂型多样七个方面深入探讨张介宾在儿科方面的用药特色,以期为今世儿科临床用药提供参考和指导.

目的:基于Citespace分析近10年中医药治疗支原体肺炎的研究现状,以此分析和探索该领域的研究热点和趋势.方法:检索中国知网数据库关于中医药治疗支原体肺炎的相关文献,将其导入Citespace知识图谱,对作者、机构、关键词进行可视化分析.结果:共纳入915篇相关文献.发文量基本稳定,总体呈上升趋势.作者合作图谱共纳入315位作者其中核心作者37位,2个合作团队初步形成.机构合作图谱共纳入257个机构,未形成明显的跨域合作.关键词图谱共纳入291个关键词,近3年突现词为免疫功能、炎性因子、炎症因子、穴位贴敷.结论:中医药治疗支原体肺炎研究热点主要为儿童,免疫功能、作用机制、中医证型等方面.穴位贴敷为新的研究方向.

1 病例介绍 王某,男,21岁,2021年3月2日初诊. 反复口腔溃疡1年,再次发作12天,加重2天.患者近1年大约每间隔1个月发作1次口腔溃疡,多于考试前或心情焦虑时复发,查血常规及组织活检均未见异常.西医诊断为复发性阿弗他溃疡(RAU),并予抗炎、补充维生素、外敷冰硼散等治疗,效果不佳,缠绵难愈.

目的 利用Citespace分析近10年中医药治疗肾病综合征(Nephrotic syndrome,NS)的文献研究状况,探讨此领域的研究热点和研究趋势.方法 检索中国知网数据库关于中医药治疗NS的相关文献,将其导入Citespace知识图谱,对作者、机构、关键词进行可视化分析.结果 共纳入1332篇相关文献.发文量基本稳定,总体呈下降趋势.作者合作图谱共有413位作者纳入,其中核心作者有55位,6个合作团队内部初成规模.机构合作图谱共有320个机构被纳入,形成2个跨区域合作团队.关键词图谱共有479个关键词被纳入,其中高中心性(>0.1)关键词有36个,近3年突现的关键词为加味防己黄芪汤、脾肾阳虚证.结论 中医药治疗NS研究热点主要为难治性NS和儿童NS的中西医结合治疗,研究趋势可能为深入研究经方的治疗机制、筛选脾肾阳虚型NS的核心靶点并进行早期干预.

BackgroundThis article is objected to explore the value of machine learning algorithm in predicting the risk of renal damage in children with Henoch-Schönlein Purpura, and to construct a predictive model of Henoch-Schönlein Purpura Nephritis in children and analyze the related risk factors of Henoch-Schönlein Purpura Nephritis in children.MethodsCase data of 288 hospitalized children with Henoch-Schönlein Purpura from November 2018 to October 2021 were collected. The data included 42 indicators such as demographic characteristics, clinical symptoms and laboratory tests, etc. Univariate feature selection was used for feature extraction, and Logistic regression, support vector machine, decision tree and random forest algorithm were used respectively for classification prediction. Last, the performance of four algorithms are compared using accuracy rate and recall rate.ResultsThe accuracy rate, recall rate and AUC of the established random forest model were 0.83, 0.86 and 0.91 respectively, which were higher than 0.74, 0.80 and 0.89 of the Logistic regression model; higher than 0.70, 0.80 and 0.89 of support vector machine model; higher than 0.74, 0.80 and 0.81 of the decision tree model. The top 10 important features provided by random forest model are Persistent purpura≥4weeks, Cr, Clinic time, ALB, WBC, TC, TG, Relapse, TG, Recurrent purpura and EB-DNA.ConclusionThe model based on random forest algorithm has better performance in the prediction of children with allergic purpura renal damage, indicated by better classification accuracy, better classification effect and better generalization performance.

目的:观察茵栀黄口服液联合熊去氧胆酸片治疗胎黄湿热蕴蒸证的疗效.方法:62例随机分为观察组及对照组各31例.两组均给予熊去氧胆酸片口服,观察组加用茵栀黄口服液治疗.结果:观察组胆红素水平降低速度快于对照组(P＜0.05)、总有效率高于对照组(P＜0.05).结论:茵栀黄口服液联合熊去氧胆酸片治疗胎黄效果较好.

吴鞠通著《温病条辨》倡三焦辨证,形成了以卫气营血、三焦为核心的温病辨证体系,其中卷六《解儿难》结合温病理论阐释了其对儿科疾病和治疗用药的独特见解.吴鞠通解小儿"纯阳"为"稚阳未充,稚阴未长",其易于感邪、易于传变,治疗用药需谨慎.本文结合吴鞠通对小儿生理病理特点的认识,从谨慎选药、慎用苦寒、多甘少酸、巧用辛温、善用辛凉、重视脾胃、辅以食疗七个方面阐释吴鞠通儿科方面的用药特点,以期为儿科临床用药提供参考.

潘月丽教授治疗小儿疾病注重脾胃后天之本,擅用消食药.根据消食药的性味归经,升降浮沉等药性,辨证配伍其他方药治疗小儿诸病,一则助运药力;二则调节脾胃升降纳化功能;三则对证治疗.本文总结其辨证配伍鸡内金治疗小儿水肿、尿频,麦芽治疗小儿乳蛾、紫癜,莱菔子治疗小儿哮喘、鼻渊等六则病例,以飨读者.

This article is objected to explore the value of machine learning algorithm in predicting the risk of renal damage in children with IgA vasculitis by constructing a predictive model and analyzing the related risk factors of IgA vasculitis Nephritis in children. Case data of 288 hospitalized children with IgA vasculitis from November 2018 to October 2021 were collected. The data included 42 indicators such as demographic characteristics, clinical symptoms and laboratory tests, etc. Univariate feature selection was used for feature extraction, and logistic regression, support vector machine (SVM), decision tree and random forest (RF) algorithms were used separately for classification prediction. Lastly, the performance of four algorithms is compared using accuracy rate, recall rate and AUC. The accuracy rate, recall rate and AUC of the established RF model were 0.83, 0.86 and 0.91 respectively, which were higher than 0.74, 0.80 and 0.89 of the logistic regression model; higher than 0.70, 0.80 and 0.89 of SVM model; higher than 0.74, 0.80 and 0.81 of the decision tree model. The top 10 important features provided by RF model are: Persistent purpura ≥4 weeks, Cr, Clinic time, ALB, WBC, TC, Relapse, TG, Recurrent purpura and EB-DNA. The model based on RF algorithm has better performance in the prediction of children with IgA vasculitis renal damage, indicated by better classification accuracy, better classification effect and better generalization performance.

文章介绍了古今医家对过敏性紫癜的病因病机、辨证论治的认识,如八纲辨治、分期辨治及其它辨治过敏性紫癜的相关认识探讨,并总结了中医防治过敏性紫癜的相关认识,以期尽可能预防过敏性紫癜的发生,达到未病先防,既病防变之效.

敷和汤出自陈无择《三因极一病证方论》.本文从运气理论出发,多个方面探讨己亥年运用敷和汤治疗肾病综合征的疗效.己亥年厥阴风木司天,少阳相火在泉,气候变化剧烈,小儿更易受外邪侵扰,肾病综合征每因小儿感受外邪而复发.应用敷和汤加减可祛风清热,体现了中医学"异病同治"理念,印证了运气方的有效性.

目的:了解儿童过敏性紫癜(HSP)的临床特点,探讨肾脏损害的相关危险因素,初步构建紫癜性肾炎(HSPN)的风险预测模型.方法:选取2016年01月～2018年01月我院收治的HSP患儿192例,根据尿检结果将患儿分为HSPN组和NHSPN组.采用单因素及多因素分析方法筛选肾脏受累高危因素并建立预测模型.采用ROC曲线下面积(AUC)等来评价模型预测效能.结果:年龄、皮疹反复≥4周、复发、ALB降低和Cys升高是影响HSPN发生的独立危险因素.建立的预测模型为P=1/1 +e-z(Z=0.101 +0.912×年龄+1.125×皮疹反复≥4周+1.047×复发-0.143 ×Alb+6.000 × Cys-C).AUC为0.79(95％CI:0.71～0.86).结论:本研究所建的预测模型可定量评估HSPN风险,对HSPN的早期诊断有一定参考价值.

目的:详细了解小儿腹型过敏性紫癜的临床表现及诊断依据,学习中西医结合治疗经验.方法:以1例初诊主诉为“阵发性腹痛12天,双下肢瘀点7天”的腹型过敏性紫癜患儿为研究对象,在研究相关文献的基础上,对其发病的病因病机、临床症状、检查结果、诊断鉴别以及中西医结合治疗方案等进行全面的阐述与分析.结果:患儿在确诊及给予中西医结合治疗后,症状控制良好,并好转出院.结论:过敏性紫癜是儿科常见的一种由免疫因素介导的全身血管炎性疾病,而腹型过敏性紫癜虽不典型,但对于小儿而言,病情较为危急,故明确诊断及积极治疗尤为重要,研究结果表明中西医结合治疗该病疗效较好.

目的:探讨儿童过敏性紫癜(HSP)临床特点与中医证型的关系.方法:对192例HSP患儿临床资料行回顾性分析,总结其证候分布规律,并比较患儿发病特点等在各证型分布上的差异.结果:(1)192例患儿中,7岁以上儿童108例,男女之比为1.88∶1,冬春两季多发,农村患儿多见,感染为主要诱因.(2)辨证分型上,风热伤络证27例(14.06％)、血热妄行证47例(24.48％)、湿热内蕴证104例(54.17％)、阴虚火旺证9例(4.69％)及气不摄血证5例(2.60％).(3)各证型患儿在性别、年龄、居住地、白细胞计数、超敏C反应蛋白、纤维蛋白(原)降解产物水平分布上差异均无统计学意义(P＞0.05);在发病季节、肾损害、血小板计数、血清白蛋白、血浆D-二聚体水平分布上差异有统计学意义(P＜0.05).结论:HSP中医辨证分型以风热伤络证、血热妄行证、湿热内蕴证为主,其中风热伤络证以皮肤紫癜为主;血热妄行证、湿热内蕴证多并见腹痛、关节痛表现,且多伴有低蛋白及高凝表现,更易出现肾损害.

目的 系统评价我国儿童发生难治性支原体肺炎(RMPP)的主要危险因素,为RMPP的预防决策提供参考.方法 通过检索中国知网、中国生物医学文摘数据库、维普、万方、Pubmed、Web of Science数据库中2010～2018年发表的中国儿童RMPP危险因素的文献,提取数据,采用Revman5.3及Stata 12.0软件进行Meta分析.结果 纳入文献23篇,累计患儿4702例,其中RMPP患儿1674例、普通MPP患儿3028例,NOS评分6～8分.Meta分析示中国儿童RMPP的主要危险因素为WBC水平(OR=1.48,95％CI:1.11～1.85)、CRP水平(OR=37.54,95％CI:26.56～48.52)、ESR水平(OR=12.53,95％CI:9.25～15.81)、LDH水平(OR=1.98,95％CI:1.07～2.90)、大环内酯类药物应用时间(OR=2.51,95％CI:(1.44～3.58)、肺大片状病变(OR=23.24,95％CI:8.27～65.31)、肺下叶病变(OR=7.186,95％CI:5.17～9.98)和发热≥10 d(OR=12.13,95％CI:5.66～25.99).结论 MPP进展为RMPP多伴有WBC、CRP、ESR、LDH水平升高、大环内酯类药物应用延迟、肺大片状病变、肺下叶病变和发热≥10 d等因素,可作为早期评估RMPP的危险因素.

目的:探讨过敏性紫癜(HSP)患儿发生肾脏损害的相关危险因素,初步构建儿童紫癜性肾炎(HSPN)的风险预测列线图.方法:选取192例HSP患儿为研究对象,根据尿检结果将患儿分为HSPN组(59例)和NHSPN组(133例).采用单因素及多因素分析方法筛选肾损害高危因素并建立列线图,采用ROC曲线下面积(AUC)来评价模型预测效能.结果:年龄、皮疹反复≥4周、ALB降低、Cys-C升高和夹瘀证是影响HSPN发生的独立危险因素(P＜0.05).对列线图模型的预测概率行ROC曲线分析,AUC为0.74(95％CI:0.71～0.86).结论:本研究基于年龄、皮疹反复≥4周、ALB降低、Cys-C升高和夹瘀证这5项独立危险因素,首次建立了预测HSPN发生风险的列线图模型,可定量评估肾脏受累风险,有助于HSPN的早期识别,更具临床实用性.