目的 探讨槐杞黄颗粒联合吸入糖皮质激素(inhaled corticosteroids,ICS)对轻度持续哮喘患儿的临床疗效及其机制.方法 选取2020年3月 ～2021年2月在徐州医科大学附属医院门诊就诊的轻度持续哮喘患儿90例,将其按随机数字表法分为两组,即A组(ICS+槐杞黄)45例和B组(ICS)45例,监测治疗前及治疗3个月后血清白细胞介素(IL)-25、IL-33、IL-5、IL-13水平及肺功能情况,随访6个月记录喘息发作情况,分析比较各项监测指标变化.结果 90例患儿中失访8例,实际收集有效病例82例,其中A组38例,B组44例.治疗后,A、B组IL-25、IL-33、IL-5、IL-13水平较治疗前降低(P<0.05);A组IL-25、IL-33、IL-5、IL-13降低较B组显著(P<0.05);治疗后,A、B组的第1秒用力呼气容积占预计值百分比(FEV1％pred)、呼气峰流速占预计值百分比(PEF％pred)、最大呼气中期流量占预计值百分比(MMEF75/25％pred)较治疗前升高(P<0.05),A组FEV1％pred、PEF％pred、MMEF75/25％pred升高较B组显著(P<0.05);A组治疗后3、6个月的喘息次数较治疗前减少(P<0.05).结论 槐杞黄颗粒联合ICS治疗哮喘的疗效显著,可能是通过降低IL-25、IL-33、IL-5、IL-13及抑制Ⅱ型固有淋巴细胞活化实现的.

Objective:To explore the expression of the nucleotide-binding oligomerization domain-like receptor containing pyrin domain protein 6 (NLR family,pyrin domain containing 6,NLRP6) in the gastric tissue and gastric juice of children with chronic non-atrophic gastritis (CNG), and to analyze the influence of Helicobacter pylori (Hp) infection on the expression of NLRP6.Methods:A case-control study was conducted to select 120 CNG patients in pediatrics of Department of Pediatrics, The Affiliated Hospital of Xuzhou Medical University from October 2020 to July 2021. According to pathological diagnosis, endoscopic gastric mucosal damage and Hp infection, they were divided into 4 groups: mild CNG group Hp negative, Moderate to severe CNG group Hp negative, Mild CNG group Hp positive, Moderate to severe CNG group Hp positive. The enzyme-linked immunosorbent assay (ELISA) was used to detect the expression level of NLRP6 in the four groups of gastric tissue and gastric juice, and Western blot was used to detect the expression of NLRP6 in the gastric tissue of the 4 groups, and the significance of expression in CNG of children is analyzed. Independent sample t-test was used to compare the mean between the two groups. One way ANOVA was used to compare the mean of multiple groups of samples, and LSD t-test was used for pairwise comparison. Comparison between count data groups χ 2 inspection. Results:The positive rate of Hp in the moderate to severe chronic non-atrophic gastritis group was 62.96% (34/54) higher than that in the mild chronic non-atrophic gastritis group 37.04% (20/54), and the difference was statistically significant (χ 2=18.32, P<0.001). Under the same Hp conditions, the expression of NLRP6 in the mild chronic non-atrophic gastritis group (Hp negative mild CNG: gastric tissue (653.73±37.71) ng/L, gastric juice (471.75±38.47) ng/L; Hp positive mild CNG: Gastric tissue (616.69±43.33) ng/L, gastric juice (445.29±36.39) ng/L was higher than the moderate to severe chronic non-atrophic gastritis group (Hp negative moderate to severe CNG: gastric tissue (623.82±52.99) ng/L, gastric juice (446.48±47.49) ng/L; Hp positive Moderate to severe CNG: gastric tissue (580.43±62.75) ng/L, gastric juice (406.88±51.85) ng/L, the difference is statistically significant (under Hp negative, mild compared with moderate to severe CNG: gastric tissue P=0.035; gastric juice P=0.046; Under Hp positive, mild compared with moderate to severe CNG: gastric tissue P=0.010;gastric juice P=0.002); in the same degree of gastric mucosal injury, NLRP6 expression in Hp-negative group (Hp-negative mild CNG: gastric tissue (653.73±37.71) ng/L, gastric juice (471.75±38.47) ng/L; Hp negative moderate to severe CNG: gastric tissue (623.82±52.99) ng/L, gastric juice (446.48±47.49) ng/L higher than the positive group (Hp positive mild CNG: gastric tissue (616.69±43.33) ng/L, gastric juice (445.29±36.39) ng/L; Hp positive moderate to severe CNG: gastric tissue (580.43±62.75) ng/L, gastric juice (406.88±51.85) ng/L, the difference is statistically significant (under mild CNG, Hp negative is compared with positive: Gastric tissue P=0.005; gastric juice P=0.023; under moderate to severe CNG, negative versus positive: gastric tissue P=0.004; gastric juice P=0.003). Conclusion:Under the same Hp conditions, the more severe the gastric mucosal damage, the lower the NLRP6; under the same degree of mucosal damage, the expression level of NLRP6 in the Hp-negative group was significantly higher than that of the Hp-positive group. It is suggested that NLRP6 plays a role in inhibiting inflammation in chronic gastritis, maintaining the integrity of epithelial cells, and Hp can inhibit the expression of NLRP6.

目的 评价神经丝蛋白H磷酸化亚型(pNF-H)、基质金属蛋白酶-9(MMP-9)联合振幅整合脑电图(aEEG)对早产儿脑损伤的早期预测价值.方法 选择2018年9月至2019年12月收入徐州医科大学附属医院新生儿重症监护室的具有高风险脑损伤的早产儿为研究对象,根据头颅影像学结果,将56例早产儿分为脑损伤组26例和无脑损伤组30例.两组早产儿均于生后6 h进行aEEG检查,并采用酶联免疫吸附法(ELISA法)检测早产儿生后1 d、3 d、7 d血浆中pNF-H、MMP-9水平.以生后第3天血浆pNF-H、MMP-9水平、aEEG结果及三者联合得到的总体预测概率变量为自变量,疾病诊断结果为因变量,绘制ROC曲线,计算灵敏度、特异度及曲线下面积(AUC).结果 脑损伤组早产儿生后1 d、3 d、7 d血浆pNF-H和MMP-9水平较无脑损伤组显著升高,差异均有统计学意义,且脑损伤组血浆pNF-H、MMP-9水平在生后3 d时检测浓度最高.脑损伤组与无脑损伤组中aEEG异常的比例差异有统计学意义.三者联合诊断的曲线下面积(AUC)显著大于单独检测pNF-H、MMP-9水平及aEEG,诊断的灵敏度达到96.2％,特异度达到90.0％.结论 pNF-H、MMP-9联合aEEG诊断对早产儿脑损伤具有早期预测价值.

目的 研究氨基末端B型尿钠肽前体(N.Terminal pro B.Type natriuretic peptide,NT-proBNP)在动脉导管未闭(patent ductus arteriosus,PDA)诊断及治疗中的意义,探寻预测血流动力学显著动脉导管未闭(haemodynamically significant PDA,hsP-DA)的NT-proBNP阈值.方法 选取2019年1月至2020年7月蚌埠医学院第三附属医院收治的115例早产儿作为研究对象.依据出生后3 d心脏彩超检查分为无PDA组(nPDA组)(n=46)、血流动力学显著异常动脉导管未闭组(hsPDA组)(n=38)、无症状性PDA组(asymptomatic PDA,asPDA组)(n=31).hsPDA组予口服对乙酰氨基酚治疗,复查心脏彩超分为PDA关闭组及未关闭组.监测并比较nPDA、asPDA、hsPDA各组生后3 d NT-proBNP值、关闭组与未关闭组治疗前与治疗后的NT-proBNP值;使用受试者工作特征(receiver operating characteristic,ROC)曲线下面积预测诊断hsPDA的最佳切点.结果 nPDA、asPDA、hsP-DA三组生后3 d NT-proBNP分别为1859.50(1508.00,2373.50)ng/L、3213.00(2987.00,3906.00)ng/L、9830.00(6251.00,12961.50)ng/L,asPDA组高于nPDA组,hsPDA明显高于asPDA组(均P<0.05).hsPDA早产儿关闭组与未关闭组治疗前NT-proBNP分别为7521.00(3813.00,9635.00)ng/L、12093.00(10086.00,15651.00)ng/L,未关闭组明显高于关闭组(P<0.05);两组治疗后分别为2039.00(1423.00,4089.00)ng/L、7365.00(5609.00,8697.00)ng/L,关闭组明显低于未关闭组(P<0.05).生后3d,预测hsPDA的NT-proBNP值为9875.50时,诊断hsPDA的灵敏度为0.842,特异度为0.895.结论 NT-proBNP有助于临床诊断PDA、预测干预时机,并为hsPDA疗效评估提供帮助.

目的 分析支原体肺炎(M PP)患儿行多次支气管镜下灌洗治疗的影响因素并构建预测模型.方法 回顾性分析2018年6月至2020年6月入住徐州医科大学附属医院儿科的203例行支气管镜下灌洗治疗的M PP患儿的临床资料,根据支气管镜下灌洗次数分为单次灌洗组(150例)及多次灌洗组(53例).比较2组患儿在一般情况、临床症状、实验室检查、合并症等方面的差异,分析M PP多次灌洗的危险因素,并构建预测模型.结果 单因素分析发现:2组患儿性别、年龄、合并其他感染、炎症累及肺叶数、发病季节、白细胞计数、肌酸激酶同工酶水平的差异无统计学意义(P>0.05);在合并胸腔积液、合并肺外并发症、入院前发热和咳嗽持续时间、入院前最高体温、入院后第1～3天体温平均值(Tmean)、入院前使用大环内酯类抗生素≥5 d、纤维蛋白原降解产物、D-二聚体、C反应蛋白、谷丙转氨酶(ALT)、血清白蛋白(ALB)、血清前白蛋白、乳酸脱氢酶指标上的差异具有统计学意义(P<0.05).进一步行多因素Logistic回归分析发现,Tmean升高,D-二聚体、ALT升高,ALB降低是影响支气管灌洗次数的危险因素,预测的准确率为90.6％.根据多因素回归分析结果进行联合预测因子的ROC曲线运算,联合预测因子的曲线下面积为0.885,34.885为临界点,敏感度为0.837,特异度为0.851.结论 支气管镜下灌洗是治疗M PP的有效手段,早期识别可能需多次灌洗治疗的危险因素,对于合理医患沟通、改善预后有着积极的意义.

目的 探讨徐州市5～14岁儿童肥胖发生的危险因素及早期干预方法.方法 从徐州市随机抽取3个城区的学龄前儿童进行体格测量,以WHO标准体重2个标准差为标准分为肥胖组和正常组,对问卷调查方式对5～14岁儿童肥胖的危险因素进行分析,并提出早期干预措施.结果 此组肥胖儿童检出率53.00％,单因素分析母乳喂养、4、6个月添加辅食、进食快、喜欢甜点饮料和油炸食品、睡眠时间<8h/d、不喜欢运动、每日看电视时间≥2h/d、父亲、母亲肥胖、母亲文化程度、父母对肥胖认知与5～14岁儿童肥胖有关(P<0.05),logistic回归分析,人工喂养、进食快、喜食油炸、喜食甜点饮料、母亲文化程度、父亲肥胖、母亲肥胖是导致儿童肥胖的高危因素.结论 徐州市5～14岁儿童肥胖发生率较高,早期喂养方式、儿童偏食油炸甜点类食物、父母亲肥胖、母亲文化程度是导致儿童肥胖的主要危险因素.社区应做好儿童肥胖的健康宣教工作.

目的探讨振幅整合脑电图（aEEG）联合晚期氧化蛋白产物（AOPP）、可溶性凝集素样氧化型低密度脂蛋白受体1（sLOX-1）在早产儿脑损伤早期诊断中的价值。方法选择2018年9月至2019年9月有脑损伤高风险因素的住院早产儿63例,根据磁共振成像结果分成脑损伤组（27例）及非脑损伤组（30例）。于早产儿出生后6小时内行aEEG监测;在早产儿出生后6小时、3天、7天时采集血浆,以酶联免疫吸附法（ELISA）检测AOPP、sLOX-1;行logistic回归分析,创建受试者工作特征曲线（ROC）,计算aEEG、AOPP、 sLOX-1单独及联合检测对诊断早产儿脑损伤的灵敏度、特异度及曲线下面积（AUC）。结果两组间胎龄、出生体质量、性别差异均无统计学意义（P＞0.05）。脑损伤组aEEG异常率（88.9%）高于非脑损伤组（26.7%）,aEEG图形的连续性（Cy）、睡眠觉醒周期（Co）、宽带（B）评分及总评分（T）低于非脑损伤组,差异均有统计学意义（P＜0.05）。脑损伤组生后6小时、3天、7天时血浆sLOX-1及AOPP水平高于非脑损伤组,差异均有统计学意义（P＜0.001）。血浆sLOX-1及AOPP联合aEEG诊断早产儿脑损伤的灵敏度、特异度及AUC高于单项检测,分别为0.93、0.90和0.96。结论 aEEG联合AOPP、sLOX-1可明显提高早产儿脑损伤早期诊断效能,对其早期诊断具有较好的临床应用价值。

Objective To analyze the expression of plasma inflammatory factors in the children with sepsis.Methods Plasma levels of inflammatory factors were detected in the children with sepsis (group A, 64 cases) and those without (group B, 30 cases).The children of group A were subdivided into groups of A1 (age≤28 days), A2 (aged 29 days to 1 year) and A3 (age＞1 year) and plasma levels of inflammatory factors were compared among groups of A1, A2 and A3.Results Compared with group B, plasma levels of IL-6, IL-10, WBC, percentage of neutrophils and high sensitive C-reactive protein were higher in group A (P＜0.01).Plasma level of TNF-α was higher in groups of A2 and A3 than that in group A1 (P＜0.01).Of 64 septic children, 5 cases were dead and their plasma levels of IL-6, IL-1β and TNF-α were higher than those in survival children (P＜0.05).Conclusion Plasma levels of inflammatory factors are increased in the children with sepsis, which may be related to the severity of the disease and prognosis.

目的 探讨脂氧素A4对LPS致肥胖大鼠炎性因子释放的影响.方法 将大鼠分为普通饲料(ND)及高脂饲料(HFD)喂养组,再将2组大鼠分成对照组、LPS(脂多糖)组及LXA4(脂氧素A4)干预组.12 h后处死大鼠,心脏取血留取血清,ELISA检测血清TNFα 及IL-6水平.Western blot检测肝组织NF-κB及MAPK下游信号通路的活化.结果 HFD组较ND组大鼠IL-6和TNFα 的释放量明显增加(P<0.05);LPS可致ND及HFD组IL-6及TNFα 的释放明显增加(P<0.05),而使用LXA4干预后可以明显降低IL-6及TNFα 的释放(P<0.05).HFD较ND组大鼠的NF-κB及MAPK信号通路明显活化;LXA4的干预可降低LPS致ND及HFD组NF-κB及MAPK信号通路的活化.结论 LXA4干预能够有效降低LPS致肥胖大鼠炎性因子的释放,并可抑制NF-κB及MAPK下游信号通路的活化,对肥胖及炎性反应有双重保护作用.

目的:探讨呼吸道合胞病毒(respiratory syncytial virus,RSV)感染鼠肺组织后,G蛋白偶联受体激酶2(G protein coupled receptor kinase 2,GRK2)的变化规律及其与哮喘的关系.方法:Balb/c雌性小鼠100只,随机分为5组,每组20只.正常对照组,于第1、14天予生理盐水0.2 ml腹腔注射,第21～25天用37℃生理盐水20 ml雾化吸入30 min;RSV感染组,于第19、20、21天,以RSV按浓度1×106PFU、100 μl/次鼻腔滴入;哮喘组,第1、14天予以鸡卵白蛋白(ovalbumin,OVA) 100 μg、AL(OH)32mg腹腔注射,第21天开始激发,以2％OVA生理盐水20 ml雾化吸入30 min,持续激发5d;双重感染组,模型制备同哮喘组,第19、20、21天,以RSV按浓度1×106 PFU、100 μl/次鼻腔滴入;地塞米松干预组,RSV感染同RSV组,第21～25天予腹腔注入地塞米松0.2 mg/(kg·d).末次激发后24 h,10％水合氯醛腹腔注射麻醉(0.3 ml/kg),处死小鼠,取左肺上叶和右肺中叶,4％甲醛固定,分别用于免疫荧光检测GRK2的表达和组织病理改变检测;取右肺下叶用于Western blot检测各组GRK2的表达;无菌条件下取左肺下叶,用于肺组织病毒分离及免疫荧光鉴定.结果:RSV组GRK2表达较正常组显著增加,与哮喘组相比差异有统计学意义;双重感染组GRK2表达较RSV组显著增加;地塞米松干预组GRK2表达较RSV组显著减少.结论:RSV感染小鼠肺组织后GRK2表达增加,合并哮喘时表达显著增加,地塞米松干预对GRK2的表达有一定的抑制作用.

目的 观察比较巨细胞病毒(CMV)肝炎婴儿停哺乳与继续母乳喂养后临床及实验室指标的异同,为临床巨细胞病毒肝炎婴儿确定合理的治疗方案并提供有力的理论依据.方法 87例非淤胆型巨细胞病毒肝炎婴儿为研究对象,发病年龄均<6个月.根据母乳CMV-IgM阳性,随机分成2组:哺母乳组54例,停母乳组33例;2组均给予更昔洛韦诱导缓解、巩固维持、保肝退黄、调节免疫等治疗.治疗前及治疗3个月、6个月、1年分别应用免疫荧光法检测血清CMVpp65抗原;荧光定量聚合酶链反应(FQ-PCR)法检测尿CMV DNA;放射免疫法检测血清CMV-IgM;赖氏比色法、匀相测定法、溴甲酚绿法、改良J-G法等检测肝功能.结果 治疗前及治疗后3个月、6个月,2组巨细胞病毒肝炎婴儿肝功能、HCMVpp65抗原阳性率和CMV-IgM阳性率及尿CMVDNA阳性率相比差异无统计学意义(P>0.05);与治疗前相比,治疗后3个月2组婴儿肝功能、HCMVpp65抗原阳性率及CMV-IgM阳性率差异均有统计学意义(P<0.05),尿CMVDNA阳性率与治疗前相比差异无显著性(P>0.05);治疗6个月后与治疗前及治疗3个月相比各指标差异均有统计学意义(P<0.05);随访1年时检测2组患儿肝功能差异无统计学意义(P>0.05).结论 非淤胆型巨细胞病毒肝炎婴儿,无需停哺母乳.

<正>支气管肺炎和心力衰竭是左向右分流先天性心脏病常见并发症,缺氧、二氧化碳潴留、毒素血症和各种炎症因子均可导致血小板数量和功能状态的改变[1],但国内有关先天性心脏病并肺炎、心力衰竭血小板参数变化的研究还很少,我们对45例先天性心

目的 研究哮喘小鼠外周血CD4+CD25+Treg细胞数量改变与血清Th1/Th2相关细胞因子IFN-γ和IL-4水平的关系,探讨其在支气管哮喘发病中的作用.方法 健康雌性BALB/c小鼠20只,随机分为2组(每组10只):①模型组于第0、7、14天予OVA/Al(OH)3腹腔注射,第21～26天每天以OVA雾化吸入激发.②对照组则以生理盐水(NS)在致敏阶段替代OVA 腹腔注射、激发阶段替代OVA雾化.第27天处死动物.观察小鼠肺组织病理改变,流式细胞仪检测CD4+CD25+Treg细胞的变化,ELISA方法检测血清中IL-4、IFN-γ的含量变化.结果 模型组外周血CD4+CD25+Treg细胞的数值、占CD4+T细胞比例和血清IFN-γ水平较对照组降低(P<0.01);血清IL-4水平较对照组明显升高(P<0.01).结论 哮喘小鼠表现明显的Th1/Th2平衡失调、Th2细胞功能亢进,其机制与CD4+CD25+Treg细胞的抑制作用降低有关.

Objective To evaluate the efficacy and safety of Shengmai injection for hypoxic-ischemic encephalopathy(HIE).Methods We searched MEDLINE(1966 to February 2007),EMBASE(1980 to February 2007),CBM(1978 to 2006),CNKI(1979 to February 2007),VIP(1989 to February 2007),and handsearched five Journals on Pediatrics.We evaluated features of quality of included studies,including randomization,blinding,allocation concealment and loss of follow-up.Meta-analyses were performed using The Cochrane Collaboration's RevMan 4.2.8.Results Seven randomized controlled trials were included.The cure rate on day 5 in the Shengmai injection group was higher than in the control group(RR 1.55,95%CI 1.25 to 1.93),but this rate was similar on day 10(RR 0.74,95%CI 0.43 to 1.29).No significant difference in cure rate was noted between the Shengmai injection group and naloxone group(RR 0.88,95%CI 0.53 to 1.46).No significant differences were observed in mortality(RR0.44,95%CI 0.16 to 1.19) and mutilation rate(RR 0.58,95%CI 0.21 to 1.56) between the Shengmai injection group and the control group.For those babies suffering from HIE combined with myocardial damage,Shengmai injection could speed up the recovery of ECG(WMD=-2.02,95%CI-2.76 to-1.28) and myocardial enzymogram(CK-MB:WMD=-4.78,95%CI-6.77 to-2.79;CK-BB:WMD=-2.68,95%CI-4.58 to-0.78).Significant differences in NBNA score were noted between the Shengmai injection group and the control group on day 5(WMD=4.05,95%CI 2.47 to 5.63) and day 10(WMD=3.50,95%CI 2.26 to 4.74).No fatal side effects were reported.Conclusions Shengmai injection has certain therapeutic values in treating HIE.Shengmai injection can speed up the recovery ECG,CK-BM and CK-BB of HIE patients,especially in those who have myocardial damage.Shengmai injection can also improve the NBNA score.However,because of the low statistical powerand high risks for selection bias,performance bias and measurement bias in the included trials,these conclusions need to be interpreted cautiously.