目的:观察健脾助长方加减联合常规干预及rhGH治疗青春期特发性矮身材(ISS)儿童的疗效、安全性以及对生长发育调节因子胰岛素样生长因子(IGF-1)及胰岛素样生长因子结合蛋白-3(IGFBP-3)的影响.方法:选择13～15岁ISS儿童110例作为研究对象,采用随机数表法分为观察组55例和对照组55例,对照组患儿进行常规生活方式干预联合rhGH药物治疗,观察组患儿在对照组的基础上联合使用健脾助长方加减进行治疗,治疗12个月,比较治疗前后两组患儿身高标准差(Ht-SD)、生长速度(GV)、预测成年身高(PAHt),ELISA检测血清IGF-1、IGFBP-3水平,并观察治疗期间不良反应.结果:经过12个月治疗,观察组及对照组患儿Ht-SD、GV、PAHt、IGF-1、IGFBP-3水平均显著改善(P<0.05),且观察组改善效果显著于对照组,差异有统计学意义(P<0.05).观察组及对照组均未出现严重不良反应.结论:健脾助长方加减联合常规生活方式干预及rhGH治疗可有效促进患儿生长发育,提高预测成年身高,且安全性好.

目的 探讨失巢环境下肿瘤源性外泌体调控结肠癌细胞增殖和凋亡的相关机制.方法 采用低黏附细胞培养板将结肠癌细胞系SW480培养建立结肠癌抗失巢凋亡细胞株.采用超速离心法收集抗失巢凋亡细胞和常规结肠癌细胞的外泌体,利用透射电镜观察外泌体的形态,采用Western blot法检测外泌体标志物CD63和CD81的表达.采用CCK-8试剂盒、Edu试剂盒和AV-PI试剂盒检测在两种细胞源性外泌体的刺激下结肠癌细胞的增殖和凋亡能力.采用RT-PCR和Western blot法检测细胞外信号调节激酶5(ERK5)、凋亡相关因子B淋巴细胞瘤-2基因(Bcl-2)、B淋巴细胞瘤-2基因相关启动子(Bad)和半胱氨酸蛋白酶-3(Caspase-3)的mRNA和蛋白的表达水平.结果 透射电镜观察结果显示,外泌体为直径50～150 nm的双层膜囊泡状结构.Western blot结果显示,外泌体的分子标志物CD81和CD63表达阳性.失巢环境下提取的外泌体与结肠癌细胞共培养的过程中,可见结肠癌细胞可以摄取并内化PKH67标记的外泌体.抗失巢凋亡结肠癌细胞的细胞凝集能力要明显高于常规结肠癌细胞,差异有统计学意义(P<0.05).CCK-8和Edu染色结果显示,抗失巢凋亡结肠癌细胞外泌体与结肠癌细胞共培养后细胞的增殖能力要明显高于常规结肠癌细胞组(P<0.05).RT-PCR和Western blot等结果显示,抗失巢凋亡结肠癌细胞组的ERK5、Caspase-3和Bad的表达水平均明显低于常规结肠癌组(均P<0.05),而Bcl-2高于常规结肠癌组(P<0.05).AV-PI试剂盒检测结果显示,抗失巢凋亡结肠癌细胞外泌体组细胞凋亡率明显低于常规结肠癌外泌体组(P<0.05).结论 抗失巢凋亡结肠癌细胞外泌体可以通过ERK5信号通路促进细胞的增殖,抑制细胞的凋亡.

目的 观察益肺健脾方对缓解期哮喘儿童血清IgG、IgA、IgE水平的影响.方法 选取缓解期哮喘儿童96例,采用随机数表法分为对照组和实验组,每组48例.对照组采用布地奈德粉吸入剂治疗,实验组在对照组基础上加用益肺健脾方进行治疗,比较两组患儿在治疗前后的血清IgG、IgA、IgE水平.结果 两组治疗前血清IgG、IgA、IgE水平差异均无统计学意义(均P＞0.05);治疗后,对照组血清IgG、IgA水平均低于实验组,对照组血清IgE水平明显高于实验组,差异均有统计学意义(均P＜0.05).结论 益肺健脾方提高了缓解期哮喘儿童的血清IgG、IgA水平,并降低了IgE水平,值得临床推广借鉴.

近年来，我国儿童性早熟发病率显著升高，已成为目前最常见的小儿内分泌疾病之一［1］。为了解本地区性早熟发病情况，2012年9月至12月对本区3~10岁儿童进行流行病学调查及影响因素分析，为实施早期干预提供科学依据。报道如下。

Infantile allergic purpura is a typical immune disease with systemic generalized vasculitis as main pathological changes, which could injury skin, gastrointestinal tract, kidneys, joints, and even more such as heart and brain. Western therapy based on symptomatic and hormonal treatment for the disease shows limited applicability and remarkable side effect. This study designed to observe efficacy of traditional Chinese herbal medicine combined with western therapy on infantile allergic purpura through perspective of immunology, in which76 cases of infantile allergic purpura patients were randomly divided into control group of 38 cases which were treated with conventional western therapy and observation group of 38 cases which were given oral Chinese herbal medicine on the basis of conventional ways. Fasting venous blood of each patient was extracted and detected for the indexes of immunoglobulin, complement, and cells secrete factors. We found that there was no significant difference(P 0.05) between groups in serum immunoglobulin, complement, and cells secrete factor levels before the treatment. After treatment, indexes of IgA, IgE, C3, TNF-α, IL-4, IL-6, IL-10 and IL17 level were significantly reduced(P 0.05), and all of them in observation group were significantly lower than that of control group(P 0.05);but IL-12 level was significantly increased(P 0.05) while observation group got the higher level(P 0.05); there was no significant difference in indexes of IgG, IgM, C4 and IFN-γ between groups. Our research indicated that the therapy combined with traditional Chinese and western medicine could balance humoral and cellular immunity function through adjust inflammatory factors of pediatric allergic purpura patients, which contributes to inflammatory remission and excision.

目的 探讨阿莫西林、克拉霉素、奥美拉唑联合中药加味乌贝散治疗幽门螺杆菌(Hp)引起小儿消化性溃疡的临床疗效.方法 采用单盲随机法将确诊的186例患儿随机分为对照组和治疗组,各93例.对照组采用西药三联疗法(阿莫西林+克拉霉素+奥关拉唑),治疗组在对照组治疗基础上加用加味乌贝散,连续用药7d为1个疗程,4个疗程后统计临床疗效、Hp根除率、溃疡愈合时间和质量、临床症状积分,并对治疗6月和1年后不良反应率和复发率进行随访.结果 治疗组治愈率和总有效率分别为58.06％和93.55％,显著高于对照组(P＜0.05);治疗4周后嗳气、腹痛、腹胀和反酸临床症状积分显著低于对照组(P＜0.05);治疗组溃疡愈合时间和Hp根治时间分别为(4.45±1.76)周和(8.91±2.11)d,显著低于对照组(P＜0.05);溃疡愈合率和Hp根治率分别为94.62％和93.54％,显著高于对照组(P＜0.05).治疗组总不良反应发生率为9.68％,显著低于对照组的16.13％(P＜0.05),1年随访复发率为10.75％,显著低于对照组的17.20％(P＜0.05).结论 三联疗法联合加味乌贝散可有效缓解Hp阳性的儿童消化性溃疡;缓解患儿临床症状,根除Hp感染,缩短愈合溃疡时间,提高愈合质量,不良反应少,复发率低.

目的：观察锌剂联合喜炎平注射液治疗婴幼儿轮状病毒肠炎效果。方法140例轮状病毒肠炎患儿，按入院时间分为对照组69例与观察组71例。两组均给予补液、蒙脱石散、益生菌等常规治疗，观察组加用硫酸锌口服液及喜炎平注射液，对照组加用利巴韦林（病毒唑）注射液，治疗3d 进行疗效判定。结果观察组脱水纠正、粪便恢复正常时间均短于对照组，疗效显著好于对照组，差异均有统计学意义。结论在进行常规治疗的基础上，辅以锌剂及喜炎平注射液疗效明显好于加用病毒唑，且能明显减少粪便次数、缩短腹泻病程。

<正>近年来,由于营养、环境、文化等方面的因素,儿童发育提前的问题较为突出,尤其是女童。这其中既有真性性早熟患儿,也有部份属于正常发育,但发育进程过快,骨龄偏大,乳房发育明显而身高未达标的。目前,来医院儿科生长发育

目的 了解宁波市镇海区2~7岁儿童哮喘的患病率、影响因素及防治现状.方法 采用2000年全国0~ 14岁儿童哮喘流行病学调查方案,对宁波市镇海区招宝山街道、庄市街道、骆驼街道7026名2~7岁儿童进行随机抽样 调查.对调查确诊的791例哮喘儿童按哮喘调查表设计的21项进行现场调查、分析、统计.结果 ①我区2.7岁儿童 哮喘患病率为12.7%;⑦哮喘的诱发因素以呼吸道感染最多见,其次是天气变化、劳累、运动等.③有家族哮喘病史者 占17.1%.有过敏性咳嗽史占64.6%,过敏性鼻炎史占54.4%,婴儿湿疹占53.2%,毛细支气管炎占41.8%.④患儿 哮喘发作时有96.2%的患儿采用了雾化吸人治疗.西药口服与西药静脉滴注所占构成比高于中药口服与穴位贴敷.⑤在 预防性用药中不规则激素吸人占49.4%,西药口服占42.4%,长期吸人激素所占构成比只有2.4%.结论 本地区为儿 童哮喘高发区,但哮喘防治工作,同全球哮喘防治创议方案的要求相差甚远.

OBJECTIVE:Leukemia is the most common malignancy in children. Combined chemotherapy is currently the primary treatment modality. During the past decade, very high cure rates of childhood acute lymphoblastic leukemia (ALL) have been reported both at home and abroad. However, the cure rates of children with acute myeloid leukemia (AML) remain low due to the multiple-drug resistance (MDR). P-glycoprotein (P-gp) is one of the most important mechanisms of MDR for leukemia cells. However, the function of the protein, the clinical application of its reversal agents and the efficacy of the combination of the reversal agents remain to be elucidated. The present study aimed to evaluate the P-gp pump function on leukemia cell membrane and the effects of the combined administration of the reversal agents cyclosporin A (CSA) and verapamil (VER) through the observation of Calcein-AM (C-AM) metabolism in the cell line K562 and its multi-drug resistant subline K562/VCR.METHODS:The mean fluorescence intensity (MFI) of C-AM inside the cytoplasm was analyzed with flow cytometry (FCM). The events of K562 and K562/VCR cells treated and untreated with CSA, VER and CSA + VER were acquired at time points 0, 30, 60, 90 and 120 minutes, respectively, and the data obtained were analyzed with CellQuest software.RESULTS:The C-AM in the K562 and K562/VCR varied more apparently in the fist 24 hours. In addition, the MFI of the C-AM in K562 was significantly higher than that in K562/VCR cells indicating that the P-gp pump molecules were functioning. The MFIs of the CSA, VER and CSA + VER groups co-cultured with K562/VCR cells were 4014 +/- 219, 3879 +/- 116 and 4158 +/- 302, respectively after 120 min of incubation, significantly higher as compared to that of control group (3251 +/- 107, P < 0.05). On the other hand, significant inhibition of the efflux from the K562/VCR cell line was also noticed after the same time period of incubation with the MFIs of 2237 +/- 155, 1932 +/- 233 and 2231 +/- 147, respectively in the three groups, which was significantly higher than that of control group (1622 +/- 191, P < 0.05). CSA, VER and CSA + VER could increase the uptake and inhibit the efflux of C-AM by K562/VCR cells, while no evident influence on those functions inside the parental cell line K562 cells was noticed.CONCLUSIONS:CSA, VER and CSA + VER could increase the uptake and reduce the efflux of C-AM by K562/VCR cells while no significant difference between the CSA + VER and CSA or VER was noticed. P-gp pump function and the effects of its reversal agents on leukemic cells can be rapidly and easily evaluated by using the C-AM and FCM.

目的 通过分析小儿阑尾炎临床误诊的主要原因,以期降低小儿阑尾炎误诊率.方法 对被误诊的23例小儿阑尾炎原因进行回顾性分析.结果 本组病例中误诊率为19.83%,误诊病例的种类较多.结论 小儿阑尾炎误诊原因复杂,主要误诊的原因为对不典型病例认识不足、病史采集不详细、盲目相信辅助检查、小儿查体不合作和片面强调典型体征.

目的 探讨联合应用甘草锌冲剂和肯特令治疗婴幼儿腹泻病的疗效.方法 146例婴幼儿腹泻病随机分为观察组(联合应用肯特令和甘草锌冲剂)83例及对照组(单用肯特令)63例进行治疗.结果 对比观察组与对照组粪便性状、次数及全身症状恢复情况,差异有显著性意义(P＜0.05).结论 联合应用甘草锌冲剂和肯特令治疗婴幼儿腹泻病的疗效突出.

晚发性维生素K缺乏症是指出生后2周～6个月婴儿因维生素K缺乏,体内维生素K依赖因子的凝血活力下降而引起的自限性出血性疾病,颅内出血常为本病首发症状.本病起病突然,病情来势凶猛,以其高颅内出血率、高病死率和致残率而引起儿科界的关注[1].但目前对初生新生儿已常规给予维生素K1肌注,发生率已相对减少,作者对收治的2例晚发性维生素K缺乏致颅内出血患儿的诊治情况报道如下.

毛细支气管炎(毛支)是婴幼儿时期最常见的急性下呼吸道疾病,大多由呼吸道合胞病毒感染引起,其次为副流感病毒、流感病毒、腺病毒和鼻病毒等,少数由肺炎支原体和细菌感染引起.此病仅见于2岁以下婴幼儿,以1～6个月的婴儿发病率最高,临床常表现为发作性喘憋,解除呼吸道阻塞、改善通气、控制喘憋是提高毛支疗效的关键[1].2003年4月-2005年5月,笔者采用普米克令舒与博利康尼雾化吸入治疗毛支患儿67例,疗效较好,现报道如下.

支气管肺炎是婴幼儿期常见的下呼吸道炎症性疾病,也是婴幼儿时期主要死亡原因.氨溴索是目前临床主要使用的祛痰药物[1],给药途径主要通过静脉、口服和雾化吸入治疗;作者旨在通过观察三种给药途径之间临床疗效的差别,以选择在婴幼儿期支气管肺炎时较为合适的给药途径,现报告如下.

目前在儿科临床中,胃肠道外营养(TpN)已得到较为广泛的应用.对于因病长期或一段时间内不能接受经口进食或喂养的患儿通过静脉提供各种营养素,有利于保证极低体重儿及其他患有严重疾病的患儿在应激状态下的各种能量平衡和满足正常生长发育所需.近年我们在临床中通过使用TPN治疗极低体重儿及其他患有严重疾病的患儿取得一定疗效,现报道如下.

病毒性肺炎是儿科最为常见的病种之一.近年来国内外对其诊疗和预防进行了大量的研究,但至今尚无特效治疗.笔者自2005年1月～2005年7月对120例病毒性肺炎患儿使用喜炎平注射液治疗,并与使用利巴韦林治疗的90例对照观察,取得较好疗效,现总结如下.

白血病细胞对化疗药物产生多药耐药性是联合化疗失败的最重要原因之一.虽然大量研究表明白血病耐药的机制很多,包括细胞膜药物泵分子的诱导、细胞浆内药物代谢酶活性或代谢途径的改变、白血病细胞凋亡机制的改变等,但P-糖蛋白(P-glycoprotein,P-gp)在白血病细胞膜上的表达仍是目前研究发现最主要的耐药机制.

Multi-drug resistance (MDR) remains the major obstacles for the successful treatment of patients with unfavorable hematopoietic malignancies. The mechanism of MDR is very sophisticated and not well understood. One of the major mechanisms for MDR is the pump function of the MDR1 gene product P-glycoprotein (P-gp). However a practical assay to accurately determine the pump function of P-gp is still lacking. In this study, an assay based on a fluorescent dye (Calcein acetoxymethyl esteror, Calcein-AM) and multi-parameter flow cytometry capable of accurately determining the pump function was established. By using the assay, the effectiveness of two reversal agents, Verapamil (VER) and cyclosporin A (CsA) could be evaluated.

由于新生儿的自身生理因素和疾病的影响,其血糖的稳定性与成人相比明显较差.而0sier[1]等研究发现与血糖值正常的住院新生儿相比,无论低血糖或者高血糖均可明显增加住院新生儿的病死率.因此,对部分住院新生儿进行反复血糖监测并维持正常血糖值对其疾病的康复起着重要的作用.而反复进行静脉采血对新生儿损伤较大,甚至可造成部分新生儿失血性贫血[2],故目前对需要连续检测血糖的新生儿基本采用末梢血进行血糖测定.