咳嗽是呼吸系统疾病最常见的症状,也是机体重要的反射性防御动作.当呼吸道粘膜发生炎症或受到异物、刺激性气体等刺激时,气道内分泌物增加,咳嗽可将分泌物排出体外,达到保护作用. 秋冬季昼夜温差加大,气候干燥多变,小儿对环境变化适应能力弱,容易引发咽喉和鼻腔的不适,患感染性疾病和过敏性疾病几率也增加,咳嗽增多,家长要注意鉴别诊断,必要时尽早带孩子到医院就诊.

目的 观察古拉定联合易善复治疗传染性单核细胞增多症肝功损害的临床效果.方法 选择2014年1月～ 2016年2月期间在我院接受治疗的116例传染性单核细胞增多症肝功损害患者作为本次研究的对象,随机分为观察组和对照组(n=58).对照组患者给予还原性谷胱甘肽(古拉定)治疗,观察组患者给予多烯磷脂酰胆碱(易善复)联合还原性谷胱甘肽进行治疗.观察两组患者的肝功能指标,症状消失时间和住院时间,记录两组患者的不良反应发生率及治疗的有效率.结果 观察组患者的住院时间和症状消失时间均明显低于对照组;治疗后,观察组患者的各项肝功能指标也明显优于对照组;观察组患者治疗的有效率(96.55％)明显高于对照组患者(68.97％),两组比较差异均具有统计学意义(P＜0.05).此外两组患者的不良反应发生率比较,无明显差异(P＞ 0.05).结论 古拉定联合易善复对改善传染性单核细胞增多症肝功能安全有效,临床上值得推广.

Objective To evaluate the clinical effect of acyclovir in the treatment of infectious mononucleosis. Method According to the inclusion / exclusion criteria 83 cases were selected as the research object and randomly divided into two groups;the control group was given routine symptomatic treatment plus ribavirin therapy,the study group was given conventional treatment and acyclovir treatment the temperature returned to normal,lymphadenopathy disappeared,angina symptoms,atypical lymphocytes ﹤ 10% and in hospital time and treatment period and adverse reaction in two groups were compared. Results The study group with the temperature returned to normal,lymphadenopathy disap-peared,angina symptoms,atypical lymphocytes ﹤ 10% and hospitalization time values were(4. 1 ± 1. 3)d(,6. 7 ± 2. 8)d(,6. 8 ± 2. 0) d(,8. 4 ± 4. 5)d(,9. 2 ± 2. 6)d,mean significantly shorter than the control group,there was significant difference( P﹤0. 05);treatment in the two groups were no obvious adverse reactions,completed the treatment according to schedule. Conclusion The clinical effect of acyclov-ir in the treatment of infectious mononucleosis syndrome is better,can effectively alleviate children,fever,swollen lymph nodes,go far angina symptoms,promote early recovery of children,to avoid serious complications. It is worthy of clinical application.

Objective To investigate the therapy effect of mycoplasma pneumonia by early and effective immune reaction suppression. Methods By retrospectively analyze, 2959 hospitalized patients from the Second Affiliated Hospital of Guangzhou Medical University from 2005.1 to 2014.12, a total of 112 cases were diagnosed as severe mycoplasma antiinflammatory, including 78 cases in the early use of macrolide of treatmenting mycoplasma infection, also the early use of hormones to suppress the immune response compared with the control group without early usage of hormones. In order to evaluate the effectiveness of early effective immunosuppression therapy in the treatment of severe mycoplasma pneumonia the he curative effect, the course of disease, complications were compared. Results In the 78 cases of early stage of immunosuppression therapy, after 7 days therapy, 52 cases had valid effect accounted for 66.7 %. 18 cases relieved accounted for 23.1 % and 8 cases had no effect 10.3%. Without early immune control group of 44 cases, after 7 days treatment, valid 12 cases accounted for 27.3 %, 13 cases relieved 29.5 % and 19 cases had no effecty 43.2 %. The difference was statistically significant by chi square test(P 0.05). The early treatment of immunosuppressive agents, the mean disease duration was(12.5 ± 4.4)days, the control group was(19.8 ± 7.5)days, the difference was statistically significant(P 0.05). Conclusion Early effective suppression of the immune response in the treatment of severe mycoplasma pneumonia can shorten the hospitalization time and rapidly control the disease and reduce complications.

Objective To analyze the risk factors of children Henoch- Schonlein purpura(HSP) and provide theoretical basis for targeted therapy. Methods All the patients were hospitalized from pediatrics de-partment of the Second Affiliated Hospital of Guangzhou Medical University from 2004 to 2013. All of 306 pa-tients diagnosed as HSP were retrospectively analyzed to compare the clinical characteristics and the pathogen test results of mycoplasma pneumoniae,helicobacter pylori,and streptococcus. The allergen test results of mites and food are also compared and analyzed. Results The main type of children HSP is skin type accounted for about 89. 2 % . The mycoplasma pneumoniae infection positive rate was 34. 9 % ,helicobacter pylori 2. 6 % , streptococcus 4. 9% . The mite allergy allergen test positive rate was 34. 8% ,food allergies 24. 7% . Conclu-sion The infection is still the first pathogenic factors of Henoch Schonlein purpura. Pneumonia mycoplasma infection is one of the main pathogenic microorganisms,while mite is one of the main allergy factors. To in-crease curative effect of HSP,shorten course and reduce the recurrence,specific diagnosis and corresponding treatment should be given according to the diagnosis of pathogenic bacteria and allergen.

Objective To observe the clinical effect of pidotimod in the treatment of infant wheezing and its influence on infant’s immune function.Methods A total of 98 wheezing infants were taken as the observation subjects, and they were randomly divided into two groups. 48 cases among them received conventional treatment as control group, and the other 50 cases were given pidotimod combined with conventional treatment as observation group. Clinical effects and immunological indicators were compared and analyzed in the two groups.Results There were 33 cases with excellent effect, 15 effective cases, and 2 ineffective cases in the observation group, with the total effective rate as 96.00%. The control group contained 17 cases with excellent effect, 18 effective cases, and 13 ineffective cases, with the total effective rate as 72.92%. The total effective rate was obviously higher in the observation group than in the control group, and the difference had statistical significance (P<0.05). After treatment, the observation group had remarkably higher CD3+CD4+, CD3+CD4+/CD3+CD8+ indicators and lower IgE index than the control group, and the differences all had statistical significance (P<0.05).Conclusion Pidotimod provides precise effect in the treatment of infant wheezing with good protection of infant’s immune system. It brings new measure into clinical treatment.

Objective To investigate atypical lymphocyte and lymphocyte subsets in children with infectious mononucleosis(IM)and its relationship with the clinical symptoms by retrospective method.Methods Two hundred and six children were diagnosed as infectious mononucleosis.Atypical types,lymphocyte subsets,and clinical symp-toms and their relationship were evaluated and analyzed.Results In the IM children CD +3 increased,CD +3 CD +4 decreased,CD +3 CD +8 increased and NK cells decreased.The control group was (64.23 ±6.26 )%,(32.96 ± 8.68)%,(20.25 ±7.45)%,(14.68 ±5.4)%,the IMgroup was (84.13 ±14.64)%,(18.45 ±5.14)%,(54.46 ± 16.82)%,(4.65 ±1.50)%,the difference was statistically significant(P <0.001).92.9% patients had more 10%atypical lymphocytes.The children with more than 20% atypical lymphocytes had higher CD +3 CD +v8 and NK cells decreased,(58.78 ±16.67)%,(3.28 ±1.57)%.The difference with the atypical cells more than 10% less than 20% and the group less than 10% has statistically sighnificant which were (54.53 ±15.12)%,(4.55 ±1.64)%, (50.25 ±14.23)%,(5.13 ±1.84)% (P <0.001).The serious type of IM children had higher ratio of increased CD +3 CD +8 and decreased NK cells and had statistically significant compared with the light group,which were (57.78 ± 15.45)%,(3.18 ±1.61)%,(51.09 ±12.26)%,(4.68 ±1.82)%,(20.25 ±7.45)%,(14.68 ±5.46)%(P <0.001).Conclusion The infectious mononucleosis can cause abnormal immune functions.The ratio of atypical lym-phocytes,CD +3 ,CD +3 CD +4 ,CD +3 CD +8 and NK cells numbers can be viewed as a monitoring index of the disease.

Objective To analyze and investigate the clinical significance of specific immunoglobulin E (IgE) level detection in anaphylactoid purpura children. Methods A total of 86 children with anaphylactoid purpura were taken 3 ml fasting venous blood after administration. Their specific IgE levels were detected by enzyme-linked immune capture method by allergens in vitro test system from Parmacia Company in Sweden. Positive was determined as specific IgE ≥0.35 kUA/L. Positive rates of increased levels of specific IgE by various allergens were counted.Results There were 40 children with higher serum specific IgE level as 46.51% than standard value. The total positive rate was 55.00% of dermatophagoides pteronyssinus, dermatophagoides farina, tropical mite, and house dust. Milk and egg had high positive rate, and gadus, soybean, wheat, and cockroach had few positive rate, while there was no positive rate in fur of cat and dog.Conclusion Most children with anaphylactoid purpura have increased levels of specific IgE, and its level provides certain guide significance for diagnosis allergen of anaphylactoid purpura. Therefore, it is key for prevention anaphylactoid purpura to avoid contact of children from those mentioned allergens.

目的探讨预防小儿热性惊厥的有效措施。方法随机抽取2008年1～9月在我院急诊就诊的发热患儿200例,分成对照组和治疗组。对照组予以口服或肌注退热药,注射预防抽搐的药物及输液治疗。治疗组除以上治疗措施外,给予搓暖四肢。结果对照组出现惊厥14例(14.0%),治疗组出现惊厥2例(2.0%),两组惊厥发生率有显著性差异(χ2=9.783,P<0.05)。结论临床护理中除应及时使用退热药外,同时搓暖患儿四肢,更能有效防止惊厥的发生。

Objective It is to approach the method of constructing a RNA interfering retrovirus vector for making silence the expression of p38MAPK gene.Methods Search for the sequence of human p38MAPK cDNA,design and synthesize with software two short hairpin-shape oligonucleotide sequence that can form a complementary double-strain and transcript target human p38MARK gene,after annealing,connecting to the linear vector of pSIREN,harvesting a recombinant plasmid pSIREN-p38MAPK,identification through enzyme digestion and sequencing was made.Results Specific restriction enzyme map was obtained from double enzyme digestion,verified correctness of the recombination of synthesized nucleate fragment;sequencing showed identity between the recombinant nucleate fragment and the designed sequence.Conclusion The recombinant plasmid pSIREN-p38MAPK that can make silence the human p38MAPK gene is successfully constructed.

目的 探讨早产儿缺氧缺血性脑病的高压氧(HBO)治疗效果及其视网膜病变(retinopathy of prematurity,ROP)的预防措施.方法 采用婴儿高压氧舱,对早产儿、低体重儿矫正胎龄至满40周,体重在2.5 kg以上后行HBO治疗,严格掌握适应证和禁忌证,早产儿HBO治疗的压力、浓度、时间要与足月儿进行区分,实行HBO治疗前、治疗期间、治疗后均需作眼底追踪检查.结果 38例早产儿、低体重儿经过HBO治疗,4～9 个月复查头颅CT或MRI,治愈32例,占82.1%;有效6例,占15.4%.眼底检查无一例发生早产儿视网膜病变.结论 在严格掌握适应证、治疗方案,定期进行眼底检查的情况下,HBO治疗是有效安全的。

目的探讨重症支原体肺炎的有效诊治方法。方法重症支原体肺炎35例随机对照分组:采用单纯治疗方案即单用大环内酯类抗生素(阿奇霉素)治疗16例,采用联合治疗方案即用阿奇霉素联合激素和丙种球蛋白等治疗19例.评价不同治疗方案疗效差别。结果重症支原体肺炎的单纯治疗方案有效率为43.8%,联合治疗方案有效率为78.9%,差异有统计学意义(四格表X 2 检验,X 2 =4.609,P=0.03)。结论重症支原体肺炎须用大环内酯类抗生素联合激素和丙种球蛋白治疗方能取得良好的疗效。

Objective To detect the mutation of α1-antichymotrypsin exonⅢPro229→Ala gene in healthy children and children with asthma from Guangdong. Methods The mutation of α1-antichymotrypsin exonⅢ Pro229→Ala was analyzed by PCR-RFLP in 100 healthy children and 52 children with asthma. Results No α1-antichymotrpsin gene exonⅢ Pro229→Ala mutation was found in all samples. Conclusion It showed that the mutation of α1-antichymotrypsin gene exonⅢ Pro229→Ala was not found in children from Guangdong.

Objectives On the basis of Fluticasone inhalation, to investigate the effect of inhalationFluticasone combining with Montelukast in therapy and prevention of Asthma in infants and youngchildren.Methods 63 cases of moderate-to-severe asthma in infants and young children were randomlydivided into three groups: daily inhalation of Fluticasone combining with Montelukast (group A, n=24),inhalation of Fluticasone alone (group B, n=22) , those didn't adhere to the therapy served as control(group C, n=17). The study period was six months. The end point of the study was mean asthmatic symptomsscore, the length of each exacerbation episode, the number of acute exacerbation, the total amount ofsystemic corticosteroids used.Results The asthmatic symptoms score, the length of each exacerbationepisode , the number of exacerbation,and the total amount of systemic corticosteroids used of groupA were significantly lower than those of the group B and the control group,( P0.01); the asthmaticsymptoms score, the length of each exacerbation episode ,the number of exacerbation,and the totalamount of systemic corticosteroids used of group B was also significantly lower than those of thecontrol group(P0.01). Conclusions On the basis of daily inhalation of Fluticasone, combininginhalation of Fluticasone with Motelukast can significantly improve the therapeutic effect and lowerthe total amount of systematic corticosteroid used.

联合应用美林布洛芬混悬液(美林)及开塞露治疗小儿上呼吸道感染发热120例,报告如下. 1 病例与方法 1.1 病例:选择2004年9月20日-12月20日本院儿科急诊就诊,诊断为上呼吸道感染并发热,24 h内无腹泻,大便硬结或1～2 d内无大便,或体检左下腹可扪及粪块样包块者为研究对象,主要为病因不明的急性上呼吸道感染,根据病史及临床症状分析以病毒感染为主.根据患者的就诊顺序随机分组,腋温≥38.5 ℃者使用退热药.

Objective To investigate the relation between improvement in life quality,pulmonary function of asth-matic children and inhalation corticosteroid(ICS)therapy,and analyze the cause of incompliance to regular ICS.Methods Data of 83 asthmatic children with indication of ICS therapy and being able to complete the Pediatric Asthma Quality of Life Questionnaire(PAQLQ)and paralleling pulmonary function test were analyzed retrospectively,the relation between improvement of their life quality and pulmonary function and the ICS therapy were evaluated.Results During acute exacerbation,there was significant difference in FEV_1 and PAQLQ score before and after the ICS therapy in the therapy group(p0.05)and the longer the inhalation therapy the greater the improvement was;while there wasn't significant difference in FEV_1 before and after the therapy in the control group(p0.05),and the PAQLQ score was much lower in the control group.There was significant difference statistically in the FEV_1 and PAQLQ score between the two groups(p0.05).During the course without acute exacerbation,there wasn't significant difference in FEV_1 and PAQLQ score before and after the ICS therapy between the two groups(p0.05).Conclusion Improvement of life quality and pulmonary function of those compliance to regular ICS therapy is significantly greater than those of irregular inhalation therapy and severity of the exacerbation was less than those of irregular inhalation therapy group.

Objective: To evaluate the effect of the network environment education to promote pediatrics interactive teaching.Methods: 61 students were randomly divided into two groups,who received the acute glomerulonephritis and nephritic syndrome teaching.One group was given the traditional teaching and the other group was given network teaching.The questionnaires were used to evaluate and compare the difference between the two groups.T-test and non-parametric test were used to evaluate the statistic difference.Results: The average score in the network group was 62.5±5.5(n=30).The average score in the traditional group was 52.84±3.4(n=31).The statistical significant difference was found through T-test.Through non-parametric test,the statistical significant difference was also found in the two groups.Conclusion: The pediatrics teaching based on the network environment may promote interactive teaching,which is helpful to improving the students' activeness,originality and consciousness.

目的观察糖皮质激素与长效β2受体激动剂吸入及单纯糖皮质激素吸入治疗小儿哮喘的临床疗效差别.方法广州医学院第二附属医院2002年3月至2004年5月儿科急诊及门诊诊断为哮喘的患儿141例,按单双日进行随机分组,治疗组选用糖皮质激素与长效β2受体激动剂(舒利迭)吸入,对照组行单纯激素吸入(辅舒酮)治疗,对其临床疗效及肺功能指标进行比较并进行统计学分析.结果接受舒利迭治疗并成功随访的有63例,接受辅舒酮治疗并成功随访的有62例,两者临床疗效指标比较差异经非参数检验具有统计学意义.同时PEFR之间比较,差异经方差分析同样具统计学意义.结论对中到重度的哮喘患儿,糖皮质激素与长效β2受体激动剂吸入较单纯激素吸入治疗能较好地控制并改善哮喘的症状.

OBJECTIVE To investigate the effects of rhein on the progression of renal injury and cell apoptosis in glomerulosclerosis, and further explore the protective mechanism of rhein on glomerulosclerosis. METHODS Glomerulosclerosis models were made for SD rats by unilateral nephrectomy and being injected with Adriamycin into caudal vein, and randomly divided into control group, renal disease group, Rhein treatment group and Benazepril treatment group, and 6 rats in each group were killed at the 6th, 8th, 10th, 12th week respectively. The apoptosis protease-3 (caspase-3) in renal cortex was determined by immunohistochemistry stain method, and the activity of caspase-3 was measured by colorimetry, and the activity of nuclear factor-kappa B (NF-kappaB) was analyzed by gel electrophoretic mobility shift assay (EMSA), and renal tissue cell apoptosis was tested by terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) in order to observe expressions of caspase-3 and NF-kappaB and cell apoptosis of renal tissue. RESULTS Renal disease group presented with distinct proteinuria, decreasing of blood albumin content and increasing of cholesterol concentration. Glomerulosclerosis index, apoptosis index, activity of NF-kappaB and expression of caspase-3 in renal disease group were more significantly higher than those in control group (P < 0.05 or P < 0.01) as time passed. Compared with the other time points in renal disease group, there were a great number of TUNEL-positive cells observed at the 10th week, slightly higher than that at the 12th week (9.3 +/- 2.3 vs 8.4 +/- 1.2, P > 0.05), the expression of Caspase-3 was also most obvious at the 10th week, significantly higher than that at the 12th week (11.4 +/- 2.5 vs 8.2 +/- 1.7, P < 0.05), which mainly located around capillary vessel in renal cortex, tending to be consistent with apoptosis cells expression. After the 8 weeks treatment of rhein or Benazepril, the number of TUNEL-positive cells significantly decreased and maintained at a certain level, and the activity of NF-kappaB and expression of caspase-3 decreased (P < 0.05), and renal pathological changes and biochemical changes improved magnificently, moreover, the expression of caspase-3 showed positive correlation with apoptosis index (r = 0.836, P < 0.01). CONCLUSION Rhein could have significant protective effects on the progression of renal injury, and might regulate pathological changes by influencing the activities of NF-kappaB and caspase-3 in the early phase of glomerulosclerosis. Therefore, down-regulating caspase-3 expression in kidney might be one of the molecular mechanisms in the way that rhein could alleviate renal tissue cell apoptosis in glomerulosclerosis.