Background:Neonatal sedation depth monitoring is critical yet depends on the subjective Ramsay scale when used and lacks objective biomarkers. Although auditory evoked potential (AEP) wave VI disappearance is linked to reduced consciousness, its use for neonatal sedation monitoring remains underexplored. We aimed to determine whether wave VI could function as an objective indicator of sedation levels in neonates. Methods:This prospective, double-blind, randomized trial enrolled 100 neonates requiring hearing screening. Participants were randomly assigned in a 4:1 ratio to either the treatment group (n = 80; 50 mg/kg oral chloral hydrate) or the control group (n = 20; 0.9% saline placebo). The treatment group was further divided into three subgroups according to Ramsay sedation scores, namely, level 4 (n = 22), level 5 (n = 23), and level 6 (n = 35), while the control group was divided into level 3 (n = 5), level 4 (n = 12), and level 5 (n = 3). All neonates received a standardized AEP test performed by an experienced audiologist. Sedation depth was evaluated using the Ramsay scale, and the latency and disappearance rate of wave VI were recorded and correlated with sedation levels. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of wave VI latency in deep sedation, analyzing its sensitivity, specificity, and predictive values. Results:In the treatment group, wave VI disappearance rates increased in a sedation-dependent manner across the Ramsay Sedation Scale: 0% at level 4, 26% at level 5, and 68.6% at level 6 (p < 0.05). No wave VI disappearance was observed in the control group. ROC analysis demonstrated that wave VI latency predicted deep sedation (Ramsay ≥ 5) with an area under the curve of 0.861 (95% confidence interval: 0.746-0.975). The optimal latency cutoff was 8.465 ms (72.7% sensitivity, 86.2% specificity). Conclusion:AEP wave VI latency and disappearance are objective, sensitive, and specific indicators of sedation depth in neonates. With further validation, wave VI has the potential to become a reliable neurophysiological tool for precise sedation monitoring in neonates. Clinical Trial Registration:https://www.chictr.org.cn/index.html, identifier ChiCTR2300068407.

Exploring the characteristics of serum inflammatory cytokine changes during acute exacerbations of pediatric allergic asthma, and analyzing factors influencing poor asthma control and predictive indicators. Forty children with acute exacerbations of allergic asthma, either outpatients or inpatients, were selected as the observation group, and 40 healthy children undergoing physical examinations during the same period served as the control group. Flow cytometry was used to analyze the characteristics of blood inflammatory cytokines in both groups. Logistic multiple regression was used to analyze the influencing factors of poor asthma control, and ROC curve analysis was used to evaluate the indicators for predicting poor asthma control. There were statistically significant differences in the levels of IL-2, IL-4, IL-10, IL-13,IFN-γ, TNF-α, as well as the ratios of IL-2/IL-4, IL-2/IL-5, IL-2/IL-10, IL-2/IL-13, IFN-γ/IL-4, IFN-γ/IL-5, IFN-γ/IL-13, TNF-α/IL-4, TNF-α/IL-5, TNF-α/IL-6, TNF-α/IL-13 in the peripheral serum, and the expression of CD86, CD206, and CD86/CD206 in peripheral blood mononuclear cells (PBMCs) between the observation group and the control group (P < 0.05). Univariate analysis indicated that respiratory infections, exposure to allergens, irregular use of inhaled corticosteroids (ICS), and peripheral blood eosinophil counts may be associated with poor asthma control (P < 0.05). Receiving Subcutaneous Specific Allergen Immunotherapy (SCIT) may serve as a protective factor against poor asthma control (P < 0.05). Logistic multiple regression analysis showed that respiratory infections and irregular use of ICS were independent risk factors for poor asthma control (P < 0.05), while SCIT was an independent protective factor against poor asthma control (P < 0.05). ROC curve analysis shows that IL-13 has a high accuracy in predicting poor asthma control, with areas under the curve of 0.741. In pediatric allergic asthma exacerbations, there is a decrease in the activity of Th1 cytokines and an increase in the activity of Th2 cytokines in the peripheral blood, accompanied by enhanced polarization of macrophages towards the M2 phenotype. Respiratory infections and irregular use of ICS are independent risk factors for poor asthma control, whereas SCIT is an independent protective factor against poor asthma control. IL-13 has high accuracy in predicting poor asthma control.

To analyze the clinical characteristics of Mycoplasma pneumoniae pneumonia in children with 23 S rRNA mutations in Domain V and to explore the optimal timing of glucocorticoid therapy when fever persists despite macrolide antibiotic treatment. This study retrospectively analyzed clinical data from 350 children hospitalized with Mycoplasma pneumoniae pneumonia (MPP) between November 2022 and October 2023. Patients were stratified into a mutation-positive group (n = 286) and a mutation-negative group (n = 64) based on the presence of 23 S rRNA Domain V mutations in Mycoplasma pneumoniae. The clinical characteristics, laboratory results and imaging manifestations of the two groups were compared first. In this retrospective study, children with mutation-positive MPP treated with azithromycin were further grouped by persistent fever duration at the time of glucocorticoid initiation: Group A (n = 60, 3 days), Group B (n = 63, 5 days), and Group C (n = 64, 7 days). All received glucocorticoids after the respective fever milestones, with outcomes compared across groups. Furthermore, Receiver Operating Characteristic (ROC) curves were constructed using laboratory indicators to identify predictive markers for severe MPP (SMPP). There were statistically significant differences between the 23 S rRNA Domain V mutation-positive and negative groups in 24/48/72-hour defervescence rates, pulmonary consolidation rate, white blood cell count, neutrophil count, high-sensitivity C-reactive protein (hs-CRP), serum amyloid A (SAA), SAA/hs-CRP ratio, lactate dehydrogenase (LDH), D-dimer, fever duration, and hospital stay (P < 0.05). Both Group A and Group B showed significantly higher 48/72-hour defervescence rates than Group C (P < 0.05), while Group A had shorter fever duration and hospital stay than Groups B and C (P < 0.05). Additionally, Group A had a lower severe pneumonia rate than Group C (P < 0.05), which suggested that early glucocorticoid therapy may be associated with potentially improved clinical outcomes. ROC curve analysis demonstrated that hs-CRP, LDH, D-dimer, and their combined detection had high predictive value for SMPP. The 23 S rRNA Domain V mutation shows significant association with clinical characteristics of pediatric MPP. Timely glucocorticoid intervention can substantially improve patient outcomes. Furthermore, combined measurement of hs-CRP, LDH, and D-dimer demonstrates significant predictive value for early identification of SMPP. Not applicable. This retrospective analysis was conducted using existing data and did not involve direct intervention with participants.

BACKGROUND:Acromicric dysplasia (AD) is a rare skeletal dysplasia. Its incidence is < 1/1000000, and only approximately 60 cases are reported worldwide. It is a disease characterized by severe short stature, short hands and feet, facial abnormalities, normal intelligence, and bone abnormalities. Unlike other skeletal dysplasia, AD has a mild clinical phenotype, mainly characterized by short stature. Extensive endocrine examination has not revealed a potential cause. The clinical effect of growth hormone therapy is still uncertain. CASE SUMMARY:We report a clinical phenotype of AD associated with mutations in the fibrillin 1 (FBN1) (OMIM 102370) gene c.5183C>T (p. Ala1728Val) in three people from a Chinese family. A 4-year-old member of the family first visited the hospital because of slow growth and short stature for 2 years, but no abnormalities were found after a series of laboratory tests, echocardiography, pituitary magnetic resonance imaging, and ophthalmological examination. Recombinant human growth hormone (rhGH) was used to treat the patient for > 5 years. The efficacy of rhGH was apparent in the first year of treatment; the height increased from -3.64 standard deviation score (SDS) to -2.88 SDS, while the efficacy weakened from the second year. However, long-term follow-up is required to clarify the efficacy of rhGH. CONCLUSION:FBN1-related AD has genetic heterogeneity and/or clinical variability, which brings challenges to the evaluation of clinical treatment. rhGH is effective for treatment of AD, but long-term follow-up is needed to clarify the effect.

BackgroundInfectious mononucleosis (IM) is an acute infectious disease, caused by Epstein-Barr virus (EBV) infection, which can invade various systemic systems, among which hepatic injury is the most common. In this study, ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was used to detect serum bile acid spectrum in IM children quantitatively, and to investigate its role in the early assessment of hepatic injury.MethodsThis case-control study was conducted at Yuhuan People's Hospital. A total of 60 IM children and 30 healthy children were included in the study. Among 60 children with IM, 30 had hepatic injury, and 30 without hepatic injury. The clinical and laboratory data were analyzed, and the serum bile acid spectrum and lymphocyte subsets were evaluated in the three groups.ResultsThere were statistically significant differences in cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA), lithocholic acid (LCA), glycochenodeoxycholic acid (GCDCA), glycodeoxycholic acid(GDCA), glycolithocholic acid (GLCA), taurocholic acid (TCA), taurochenodeoxycholic acid (TCDCA), taurodeoxycholic acid (TDCA), ursodeoxycholic acid (UDCA), glycoursodeoxycholic acid (GUDCA), tauroursodeoxycholic acid(TUDCA), percentage of NK cells, CD4+ and CD8+ in IM hepatic injury group, without hepatic injury group, and the healthy control group (P < 0.05). The percentage of NK cells was positively correlated with TCA (P < 0.05); it was negatively correlated with CDCA, DCA, LCA, GCDCA, GDCA, GLCA, TDCA, UDCA, GUDCA, TUDCA (P < 0.05). CD4+ was positively correlated with CA, TCA and TCDCA (P < 0.05); it was negatively correlated with CDCA, DCA, LCA, GCDCA, GDCA, GLCA, TDCA, UDCA, GUDCA and TUDCA (P < 0.05). CD8+ was positively correlated with CDCA, DCA, LCA, GCDCA, GDCA, GLCA, TDCA, UDCA, GUDCA and TUDCA (P < 0.05); it was negatively correlated with CA, TCA and TCDCA (P < 0.05). ROC curve analysis showed that CD8+, GDCA and GLCA had high predictive value for hepatic injury in IM patients.ConclusionsUPLC-MS/MS method can sensitively detect the changes in serum bile acid spectrum before hepatic injury in children with IM, which is helpful for early assessment of hepatic injury in children with IM. The changes in lymphocyte subsets in IM children are related to some bile acid subfractions, which may be related to IM hepatic injury.

县域健共体建设的重要内容是构建区域医防融合服务体系,新生儿疾病筛查集儿童保健、健康教育、临床医学、组织管理于一体的健康管理服务全过程,成为提供探索和实践医防协同融合的重要载体.本研究基于县域健共体运行体系,将新生儿听力和耳聋基因联合筛查系统管理融入区域医防协同服务的健康管理一体化运行平台,建立适合本地区的联合筛查及随访综合管理模式,已在优化服务内容、提高筛查指标质量及实现遗传性耳聋的早发现、早诊断、早干预、早预警等方面取得了初步成效.该模式提升了新生儿疾病筛查系统管理的整体效能,同步建立的筹资、考核与激励等方面的支撑机制,有利于推进区域医防融合服务体系的进一步完善和可持续.

目的 探讨儿童反复喘息与4位点哮喘基因预测模型的关系，分析反复喘息的危险因素。方法 选取2019年1月—2021年3月在玉环市人民医院住院或门诊就诊的喘息儿童91例，根据哮喘预测指数（API）是否阳性，分为API阳性组55例，API阴性组36例，同时选择健康体检儿童30例为对照组。比较3组儿童4位点哮喘基因预测模型的高危率；将反复喘息儿童进行单因素及多因素Logistic回归分析。结果 API阳性组4位点哮喘基因预测模型的高危率较API阴性组及对照组显著升高（χ~2=12.487,P＜0.05）;API阳性组4位点哮喘基因预测模型的高危风险是API阴性组的2.54倍，是对照组的5.32倍。单因素分析儿童反复喘息与4位点哮喘基因预测模型的高危型、过敏史、过敏疾病家族史、吸入过敏原阳性、食入过敏原阳性、被动吸烟、嗜酸性粒细胞计数升高及呼吸道合胞病毒感染等因素有关（χ~2=13.831,22.817,25.475,20.573,6.373,11.487,10.790,10.789,P＜0.05）,而与居住环境无关（P＞0.05）。多因素Logistic回归分析显示4位点哮喘基因预测模型的高危型（OR=5.535,95%CI:1.928～15.893）、过敏史（OR=4.921,95%CI:1.661～14.577）、过敏疾病家族史（OR=4.460,95%CI:1.560～12.749）、吸入过敏原阳性（OR=13.105,95%CI:2.436～70.503）、被动吸烟（OR=3.704,95%CI:1.304～10.521）为喘息的独立危险因素。结论 反复喘息儿童，尤其是API阳性儿童，4位点哮喘基因预测模型的高危率显著升高；反复喘息与多种因素有关，其中4位点哮喘基因预测模型高危型是一个重要原因。

目的 分析反复喘息儿童miRNA-155的表达量,探讨miRNA-155与喘息及Th1/Th2细胞平衡的可能关系.方法 选取2019年1月—2020年10月在玉环市人民医院住院的反复喘息40例儿童为观察组,同期在该院健康体检儿童40例为对照组.检测2组儿童外周血miRNA-155、IFN-γ及IL-4水平.结果 观察组miRNA-155表达量为5.24(3.42,7.45),对照组miRNA-155表达量为6.52(4.51,12.88),观察组miRNA-155表达量显著低于对照组,2组比较差异有统计学意义(P＜0.05).观察组IFN-γ/IL-4值为0.73±0.09,对照组IFN-γ/IL-4值为0.82±0.10,观察组IFN-γ/IL-4值显著低于对照组,2组比较差异有统计学意义(P＜0.05).观察组miRNA-155表达量与喘息次数呈负相关关系(r=-0.557,P＜0.05).观察组miRNA-155表达量与IFN-γ/IL-4值无相关关系(r=0.223,P＞0.05).结论 miRNA-155表达量可能与儿童喘息发生呈负相关关系,miRNA-155表达量下降可能会增加儿童喘息发生的风险;IFN-γ与IL-4比值下降可能会增加儿童喘息发生的风险,但未发现miRNA-155表达量与Th1/Th2细胞平衡存在明显相关性.

目的 探析新生儿遗传性耳聋基因筛查对迟发性耳聋早期识别和干预的临床意义.方法 在新生儿家长知情同意原则下,抽取新生儿脐带血,采用聚合酶链式反应(PCR)结合导流杂交法检测中国人常见的4个耳聋易感基因[GJB2、SLC26A4、线粒体DNA(mtDNA)和GJB3]的13个突变位点,并对筛查阳性个体进行听力学监测和随访评估.结果 570例新生儿经遗传性耳聋基因筛查共检出27例易感基因携带者,基因突变携带率为4.737％.其中GJB2基因突变携带率为2.632％(15/570),以235 del C杂合突变为主;SLC26A4基因突变携带率为1.579％(9/570),以IVS7-2 A>G杂合突变为主;mtDNA 12S rRNA 1555 A>G均质性突变3例,基因突变携带率为0.526％;未检出GJB3538 C>T基因突变.27例基因突变携带者未通过听力复筛的仅为1例,随访中经听觉脑干诱发电位(ABR)检测发现轻度听力损失3例.结论 对新生儿进行遗传性耳聋基因热点突变位点的筛查可高效检出常见致聋基因携带者,以此早期识别并对具有此遗传易感性风险的新生儿和幼儿提出早期预警及干预性指导,对延缓听力损失和预防迟发性耳聋的发生有着重要的临床意义.

目的：探讨临床路径在新生儿高胆红素血症中的应用价值。方法：将2018年10月—2019年9月在玉环人民医院住院的380例高胆红素血症新生儿，随机分为临床路径组190例和对照组190例。临床路径组按电子临床路径文本进行诊断和治疗；对照组采用常规方法治疗；比较两组住院时间、住院费用及药品费用差异。结果：临床路径组患儿平均住院时间较对照组缩短，平均住院费用及药费均较对照组明显减少，显示了临床路径管理的优越性。

OBJECTIVE To study brainstem auditory evoked potential (BAEP) in neonates with hyperbilirubinemia using short auditory stimuli (60 dBnHL), and to investigate the differences in the inter-aural latency difference (ILD) of wave V between neonates with different total serum bilirubin (TSB) levels. METHODS A prospective study was conducted in neonates with hyperbilirubinemia who were admitted to the Department of Neonatology, Yuhuan People's Hospital of Zhejiang Province, from May 2019 to October 2020. The neonates were divided into a severe group (n=50) and a mild group (n=50) according to their TSB levels. The mild group was divided into two subgroups: 7-10 days (n=20) and 11-14 days (n=20) according to their age. ILD was compared between the neonates with different TSB levels, and its diagnostic value was analyzed. RESULTS Compared with the mild group, the severe group had significantly higher proportions of neonates with abnormal hearing threshold and abnormal ILD (P < 0.05) and a significantly larger ILD of wave V (P < 0.05). The latency of wave V (left ear) in the 7-10 days subgroup was significantly longer than that in the 11-14 days subgroup (P < 0.05), but there was no significant difference in the ILD of wave V between the two groups (P > 0.05). The receiver operating characteristic (ROC) analysis showed that ILD had predictive value for hearing impairment caused by neonatal hyperbilirubinemia (P < 0.05), with an area under the ROC curve of 0.727 as well as a sensitivity of 52.4% and a specificity of 90.9% at the optimal cut-off value of 0.365 ms. CONCLUSIONS Serum bilirubin in neonates affects the ILD of BAEP wave V, especially in those with severe hyperbilirubinemia. ILD at the optimal cut-off value of ≥0.4 ms shows potential value in the diagnosis of hearing impairment caused by neonatal hyperbilirubinemia.

目的 分析IL-13、IL-4、MS4A2、ADRB2基因多态性与年幼儿反复喘息发作疗效及临床转归的相关性.方法 选择2018年1月至2019年6月玉环市人民医院儿科门诊及住院部121例喘息性支气管炎反复喘息发作患儿为研究对象,跟踪随访其疗效及临床转归,分析IL-13 rs20541、IL-4 rs2243250、MS4A2 rs569108、ADRB2 rs1042713单核苷酸多态性(SNP)与患儿疗效及临床转归的相关性.结果 各基因位点基因型的实际频数与理论频数无显著差异(P>0.05).IL-13 rs20541、ADRB2 rs1042713不同基因型的治疗总有效率比较,差异具有统计学意义(P<0.05),其中纯合型的治疗总有效率低于野生型和杂合型.IL-13 rs20541、ADRB2 rs1042713不同基因型的临床转归比较,差异具有统计学意义(P<0.05),其中纯合型发生持续性喘息的风险高于野生型和杂合型.结论 IL-13 rs20541、ADRB2 rs1042713 SNP与患儿的疗效及临床转归相关,其中纯合型可能为患儿持续性喘息的危险因素.

目的 分析miRNA-155在哮喘预测指数(API)阳性和阴性反复喘息儿童中的表达水平,探讨微小RNA-155(miRNA-155)与喘息及嗜酸性粒细胞计数的关系.方法 选取2019年1月—2020年10月在玉环市人民医院住院治疗的反复喘息儿童40例为喘息组,其中API阳性儿童27例,API阴性儿童13例;同时选择健康体检儿童40例为对照组.检测喘息组和对照组儿童外周血miRNA-155、嗜酸性粒细胞、IFN-γ和IL-4水平.结果 喘息组miRNA-155水平、IFN-γ/IL-4值显著低于对照组(t=2.307,3.839,P＜0.05),喘息组嗜酸性粒细胞数明显高于对照组(t=5.278,P＜0.05);喘息组中API阳性儿童miRNA-155水平、IFN-γ/IL-4值显著低于API阴性及对照组儿童(H=13.580,F=9.731,P＜0.05),喘息组中API阳性儿童嗜酸性粒细胞明显高于API阴性及对照组儿童(F=22.303,P＜0.05);喘息组中API阳性儿童miRNA-155水平与喘息次数呈负相关(r=-0.566,P＜0.05),喘息组miRNA-155水平与嗜酸性粒细胞计数呈负相关(r=-0.630,P＜0.05).结论 miRNA-155水平下降可能是喘息发生的危险因素,且miRNA-155在喘息发生发展中的作用可能与嗜酸性粒细胞有关.

目的 探讨不同病因早期新生儿黄疸足跟血胆汁酸谱的变化及其临床意义.方法 选取2018年6月至2020年4月在我院产科正常分娩的新生儿250例,出生72 h用干血纸片法采集足跟血样标本备检.根据小时龄胆红素值将纳入新生儿分为溶血性组(20例)和观察组(118例),再按照病因将观察组分为生理性组(50例),母乳性组(42例)和感染组(26例).采用超高效液相色谱-串联质谱法(UPLC-MS/MS)对备检标本的15种胆汁酸亚组分进行定量分析.结果 各组血标本中15种胆汁酸亚组分均有表达,其中胆酸(CA)、鹅脱氧胆酸(CDCA)、熊脱氧胆酸(UDCA)、甘氨石胆酸(GLCA)和牛磺石胆酸(TLCA)水平在各组间均存在显著差异(P<0.05).结论 不同病因的新生儿黄疸早期胆汁酸代谢谱呈现出不同的变化趋势和特征,有助于新生儿可能发展为高胆红素血症的风险预测及其相关病因的分析.

目的 采用超高效液相色谱-串联质谱(UPLC-MS/MS)法早期检测新生儿母乳性黄疸的胆汁酸含量,了解其血清胆汁酸谱的特征,探讨胆汁酸谱预测母乳性黄疸的价值.方法 选择2018年6月一2019年2月在玉环市人民医院产科分娩的正常新生儿320例,依据新生儿小时胆红素列线图,经皮胆红素水平低于75百分位的新生儿,在出生72 h采集足底血样标本,晾干后密封冷藏包装备检和随访.根据随访结果,将新生儿分为母乳性黄疸组(36例)与正常新生儿组(48例),以UPLC-MS/MS方法检测备检标本的15种胆汁酸浓度.结果 母乳性黄疸组与正常新生儿组血胆汁酸谱有一定差异,2组的甘氨石胆酸水平、甘氨石胆酸/熊脱氧胆酸比值、熊脱氧胆酸/总熊脱氧胆酸比值分别为(0.41±0.31)nmol/L和(0.58 ±0.39)nmnol/L、O.11 ±0.19和0.30±0.51、0.28±0.23和0.19±0.14,差异均有统计学意义(均P ＜ 0.05).母乳性黄疸组和正常新生儿组胆酸、脱氧胆酸、石胆酸、鹅脱氧胆酸、熊脱氧胆酸、甘氨胆酸、甘氨脱氧胆酸、甘氨鹅脱氧胆酸、甘氨熊脱氧胆酸、牛磺胆酸、牛磺脱氧胆酸、牛磺石胆酸、牛磺鹅脱氧胆酸、牛磺熊脱氧胆酸、总胆汁酸和胆酸/鹅脱氧胆酸水平比较,差异均无统计学意义(均P＞0.05).结论 UPLC-MS/MS方法可以敏感地发现新生儿母乳性黄疸在高胆红素血症出现前血胆汁酸谱的变化特点,有助于早期预测高胆红素血症及其病因的分析研究.

目的:建立一种基于超高效液相色谱串联质谱法以同时测定干血片中15种胆汁酸的定量检测方法.方法:干血片经萃取、冻干、复溶后,采用超高效液相色谱-串联质谱联用(UPLC-MS/MS)技术,用ACQUITY UPLC BEH C18色谱柱分离后在MRM模式下进行定性定量分析.结果:15种胆汁酸在其线性浓度范围内的相关系数均>0.99;方法 定量下限<2 nmol/L;平均加标回收率为82.81％～119.10％.结论:超高效液相色谱串联质谱法前处理简单、分析速度快、定量准确,可满足滤纸干血片中胆汁酸含量测定的要求,为特殊群体(如新生儿)胆汁酸相关疾病的诊疗提供依据.

目的 了解台州地区儿童急性呼吸道感染中肺炎支原体(MP)的感染情况及其对大环内酯类药物耐药情况.方法 在台州市第一人民医院、台州医院、温岭市第一人民医院和玉环人民医院4家医院儿科2016年1月～2017年12月进行多中心调查,共收集4395例0～14岁急性呼吸道感染患儿的呼吸道标本,采用Real-time PCR法检测MP阳性率及耐药基因(23S rRNA)的突变情况,并对临床资料进行统计分析.结果 Real-time PCR结果显示,在4395例急性呼吸道感染患儿中,MP感染742例,感染率为16.88％,其中有422例23S rRNA突变,突变率为56.87％.不同季节MP感染率比较,差异有统计学意义(P＜0.05),夏季最高为23.56％;不同年龄组间MP感染率比较,差异有统计学意义(P＜0.05),且随着年龄的增长而升高;不同性别患儿MP阳性率比较,差异无统计学意义(P＞0.05);不同季节、不同性别患儿23S rRNA突变率比较差异无统计学意义(P＞0.05);不同年龄患儿23S rRNA突变率比较,差异有统计学意义(P＜ 0.05).结论 多中心联合研究结果显示,MP感染可能与气候、年龄相关,MP感染夏季多发,大龄儿童多见,同时,MP对大环内酯类药物的耐药率较高.

目的 研究维生素A、维生素E水平与儿童呼吸道感染的相关性,分析玉环海岛地区儿童反复呼吸道感染(recurrent respiratory tract infection,RRTI)的相关危险因素.方法 将2017年8月-2018年4月在玉环市人民医院住院或门诊就诊的452例儿童分为RRTI组142例,支气管肺炎组158例,健康体检组152例.比较3组维生素A、维生素E缺乏率、贫血率;比较3组维生素A、维生素E和血红蛋白水平差别;将RRTI进行单因素及多因素Logistic回归分析.结果 RRTI组维生素A缺乏率较支气管肺炎组及健康体检组显著升高(均P＜0.05),支气管肺炎组维生素A缺乏率较健康体检组显著升高(P＜0.05).3组维生素E缺乏率比较差异无统计学意义(均P＞0.05).RRTI组贫血率较健康体检组显著升高(P=0.002).3组维生素A、血红蛋白水平比较差异有统计学意义(均P＜0.05),3组维生素E水平比较差异无统计学意义(P＞0.05).单因素分析的基础上进行多因素Logistic回归分析显示维生素A缺乏、被动吸烟、早产、贫血、经常输液及幼托为RRTI的独立危险因素(均P＜0.05),母乳喂养为独立保护因素(P＜0.05).结论 玉环海岛地区儿童维生素A缺乏率较高,维生素E缺乏不明显;儿童RRTI与多种因素有关,其中维生素A缺乏是一个重要原因.

Objective To assess the efficacy and safety of nebulized hypertonic saline solution in infant with bronchiolitis.Methods From January 2014 to January 2016,95 patients at 3-13 months old in our hospital who diagnosed as bronchiolitis were randomly divided into three groups.On the basis of conventional suit support treatment,the observation group A was given nebulized 3％ hypertonic saline (n =32),the observation group B was given nebulized 3％ hypertonic saline and salbutamol (n =32),and the control group C was given nebulized normal saline (0.9％) and salbutamol (n =31),this therapy was repeated every 6 hours until discharge.The Lowell score,clinical symptoms remission time,days of hospitalization and incidence rate of adverse reaction of the three groups were compared.Results After treatment,the symptoms and signs of the three groups were all improved.The Lowell scores were lower in the two observation groups compared to the control group C in 24,48,72 hours after treatment[(5.81 ±1.53) points and (5.85 ± 1.37) points vs.(6.61 ± 1.54) points,(4.75 ± 1.34) points and (4.72 ± 1.30) points vs.(5.52 ± 1.29) points,(3.19 ± 1.15) points and (3.22 ± 1.16) points vs.(3.90 ± 1.01) points,Z =-1.999,-2.241,-2.518 and-2.002,-2.335,-2.316,all P ＜ 0.05).And the cough,wheezing remission time and pulmonary rales disappearance time,days of hospitalization in the two observation groups were also shorter,there were statistically significant differences [(6.63 ± 1.41) d and (6.56 ± 1.37) d vs.(7.35 ± 1.25) d,(5.19 ± 1.03) d and (5.25 ± 1.05)d vs.(5.87 ± 1.09)d,(5.75 ±1.34)d and (5.72 ± 1.51)d vs.(6.68 ± 1.60)d,(7.25 ± 1.37)d and (7.16±1.48)d vs.(8.10±l.47)d,Z=-2.498,-2.469,-2.359,-2.213 and-2.982,-2.405,-2.373,-2.222,P ＜0.05,or P ＜0.01)].There were no significant differences in the Lowell score,the length of time of cough,wheeze,lung rales disappears and the length of hospital stay between the observation group A and observation groupB[(5.81 ± 1.53) points vs.(5.85 ± 1.37) points,(4.75 ± 1.34) points vs.(4.72 ±1.30) points,(3.19± 1.15) points vs.(3.22 ± 1.16) points,(6.63 ± 1.41) d vs.(6.56 ± 1.37) d,(5.19 ±1.03)d vs.(5.25 ± 1.05)d,(5.75 ± 1.34) d vs.(5.72 ± 1.51) d,(7.25 ± 1.37) d vs.(7.16 ± 1.48) d,Z =-0.164,-0.021,-0.140,-0.295,-0.167,-0.374,-0.233,all P ＞ 0.05].Children in three groups had no serious adverse events (all P ＞ 0.05).Conclusion Nebulized hypertonic saline in the treatment of bronchiolitis can relieve symptoms and signs,shorten the hospitalization time,and has less adverse reaction,it is worthy of clinical use.