Background The incidence of mucocutaneous lymph node syndrome（MCLS）,also known as Kawasaki disease（KD）,has been increasing year by year. Coronary artery lesions（CAL） induced by KD has become the main cause of acquired heart disease in children. Many clinical studies show that mycoplasma pneumoniae（MP） is associated with CAL in KD,but the strength of association between them differs across original research on different individuals. Objective To systematically evaluate the correlation between MP infection and CAL in KD,providing evidence for early and timely delivery of effective clinical treatment to improve the quality of life and to prevent adverse outcomes in children with KD. Methods Observational studies on KD[KD patients with MP infection（MP-IgM positive）（exposed group） compared with those with simple KD（control group）,with CAL as the outcome measure] were retrieved from databases of CNKI,Wanfang Data,VIP,SinoMed,PubMed,Embase,Cochrane Library and Web of Science from inception to April 3,2022. Two researchers independently performed literature screening and data exaction. The Newcastle-Ottawa Scale（NOS） was used to evaluate the quality of included studies. Stata 15.0 and RevMan 5.4 were used for data analysis. Results A total of 31 studies involving 6131 subjects were included. The average quality score of the studies rated using the NOS was 7,indicating a high overall quality.Meta-analysis showed that the risk of CAL in the exposed group was higher than that in the control group[RR=1.65,95%CI（1.40,1.94）,P＜0.000 01]. Subgroup analysis based on baseline data revealed that,the risk of CAL in exposed group was higher in studies on exposed and control groups with matched baseline data[RR=1.92,95%CI（1.71,2.16）,P＜0.000 01],but was similar in studies on two groups with unmatched baseline data[RR=0.98,95%CI（0.91,1.06）,P=0.65].Furthermore,the risk of CAL was found to be higher in the exposed group in subgroup analysis based on MP infection diagnosed serologically with IgM＞1 ∶160,or by quantitative PCR,or undescribed method（P＜0.05）. And in subgroup analysis based on age,C-creactive protein/procalcitonin ratio,or undescribed method,the risk of CAL was still higher in the exposed group（P＜0.05）. Egger’s and Begg’s tests showed that all the studies had publication bias（P＜0.05）. However,the comparison of the pooled effect size using the random effects model[RR=1.32,95%CI（1.13,1.54）,P＜0.000 01] showed that the results before and after trimming and filling were not reversed,indicating that the results of this study were relatively stable. Conclusion MP infection increased the risk of CAL in children with KD. Early detection of MP and timely delivery of effective intervention are very important.

Objective To analyze the relationship between the level of blood inflammatory markers and attention deficit hyperactivity disorder(ADHD)in children,and to provide evidence for early intervention and prevention of ADHD.Methods Relevant literatures published in PubMed,Embase,Web of Science,Cochrane Library,CNKI,Wanfang Data Knowledge Service Platform,VIP Chinese Journal Service Platform,and China Biomedical Literature Database were retrieved as of May 20,2022.Two investigators independently screened the literature and extracted information,and carried out quality evaluation.RevMan 5.3 and Stata 16.0software were used for Meta-analysis and publication bias testing.Results A total of 15 literatures were included,with a total sample size of 2199 cases.Me-ta-analysis results showed that:the serum interleukin-6(IL-6)level in ADHD group was significantly higher than that in healthy control group(SMD =0.98,95%CI:0.10-1.86,P =0.03);subgroup analysis found that the serum IL-6 level in the ADHD group in African countries was higher than that in the healthy control group(P<0.001);for studies with a total sample size of 60 cases,100-120 cases in the case and control groups,the serum IL-6 level in the ADHD group was higher than that in the healthy control group(P<0.001).There was no significant difference in serum IL-1β level between ADHD group and healthy control group(SMD =0.70,95%CI:-0.46-1.86,P =0.24).There was no significant difference in serum TNF-α level between ADHD group and healthy con-trol group(SMD =-0.26,95%CI:-1.29-0.77,P =0.62).The blood neutrophil-to-lymphocyte ratio(NLR)of ADHD group was significantly higher than that of healthy control group(SMD =0.63,95%CI:0.25-1.01,P =0.001),subgroup analysis found that the NLR value of ADHD group was higher than that of healthy control group in studies with a sample size of less than 100 cases(SMD =0.71,95%CI:0.47-0.96,P<0.001).Conclusion Serum IL-6 levels and NLR values were higher in children with ADHD than in healthy children,suggesting that blood inflammatory markers may play a key role in the etiological mechanism of ADHD and that anti-in-flammatory measures may have positive significance for the treatment and prevention of ADHD.

目的 观察清咽利膈汤或解毒利咽方联合抗生素治疗急性扁桃体炎肺胃热盛证患儿的临床疗效.方法 纳入2020年11月—2021年11月在上海中医药大学附属龙华医院治疗的急性扁桃体炎肺胃热盛证患儿90例,采用双盲、随机对照方法将患儿分为对照组、治疗1组、治疗2组,每组30例.3组均给予抗生素治疗(首选阿莫西林,青霉素过敏者改用阿奇霉素),在此基础上对照组给予中药安慰剂颗粒口服,治疗1组给予清咽利膈汤颗粒口服,治疗2组给予解毒利咽方颗粒口服,3组疗程均为5 d.观察3组退热时间及治疗前后中医症状积分、外周血白细胞计数、中性粒细胞百分比、C反应蛋白水平和临床疗效、中医证候疗效.结果 治疗2组退热时间明显快于治疗1组和对照组(P均<0.05),治疗1组明显快于对照组(P<0.05).3组主症和次症积分均随治疗时间延长逐渐降低(对照组大便干积分无明显变化),且治疗1组和治疗2组治疗1,3,5 d后各项积分均明显低于对照组(P均<0.05);治疗2组治疗3 d后咽痛、咽黏膜充血、扁桃体肿大积分和治疗5 d后扁桃体肿大积分均明显低于同期治疗1组(P均<0.05),治疗1组治疗3 d后分泌物渗出积分和治疗5 d后咳嗽、大便干积分均明显低于同期治疗2组(P均<0.05).治疗5 d后,3组外周血白细胞计数、中性粒细胞百分比、C反应蛋白水平比较差异均无统计学意义(P均>0.05);对照组、治疗1组、治疗2组的临床总有效率分别为73.3％(22/30)、93.3％(28/30)和96.7％(29/30),中医证候总有效率分别为73.3％(22/30)、96.7％(29/30)和96.7％(29/30),治疗1组和治疗2组均明显高于对照组(P均<0.05),治疗1组和治疗2组比较差异均无统计学意义(P均>0.05).结论 清咽利膈汤与解毒利咽方治疗儿童急性扁桃体炎肺胃热盛证可有效改善患儿临床症状,疗效显著优于单纯使用抗生素.

To summarize the animal and cell models of attention deficit hyperactivity disorder（ADHD） and describe its pathological mechanism to provide a theoretical foundation for experimental pharmacological research. Research on ADHD was gathered from CNKI, Wanfang, PubMed, and other databases. The principles, characteristics, and research progress of ADHD animal models were comprehensively outlined, and their merits and shortcomings were highlighted. The research status of ADHD cell models was evaluated and the pathological mechanism of ADHD was explained. There are two types of animal models for ADHD: genetic models（hybrid mouse and transgenic animal models） and non-genetic models（chemically and environmentally induced models）. The focus on face validity, construct validity, and prediction validity differs among models in addition to their application span. Neuronal and non-neuronal cell lines are the most often used cell lines for ADHD research, but they are understudied. The etiology of ADHD mostly involves neurotransmitter dysregulation, neuroinflammation, and decreased neuronal energy. SHR is the optimum animal model to simulate ADHD symptoms and has a strong predictive validity for neurostimulator medications. SH-SY5Y cells display the dopaminergic phenotype of ADHD and are a useful tool to determine cell viability and drug safety. Neurotransmitter dysregulation, particularly dopamine insufficiency, appears to be the primary pathophysiology of ADHD in accordance with in vitro and in vivo investigations.

肾小球新月体病变是紫癜性肾炎(HSPN)重要的病理表现之一,随着HSPN发病率的升高,减少或延缓肾损伤的发生已成为防治HSPN的共识."久病入络"理念来自叶天士《临证指南医案》,强调了病久入络,由气至血的传变规律,阐明了络脉损伤、络脉瘀阻等病理变化.HSPN属于"络病"范畴,病变部位在于肾络(肾小球毛细血管),肾络纤细迂曲,盘根错杂,血行缓慢而易瘀滞.伏邪触动、正气不足、脏腑本虚可致体内精微物质代谢失常、脏腑结构功能改变,为瘀血的产生创造了条件,成为了肾小球新月体病变的基础.病程的长短、病情的轻重均可致瘀,病程长、病情重者则瘀更甚,病情发展也越快,治疗上需把握"络通则瘀去"的原则,肾络畅行,血不瘀滞,则可延缓疾病进展.

紫癜性肾炎(HSPN)是过敏性紫癜所引起的肾小球疾病之一,是儿童时期最常见的继发性肾小球疾病,临床常表现为血尿或(和)蛋白尿,肾脏病理常表现为以免疫球蛋白A(IgA)为主的免疫复合物沉积.针对儿童HSPN,丁樱教授融合三焦及脏腑辨证理论,并结合六经中的表里归属、气血津液变化,从"肺(皮)-脾(肉)-肾(髓)三焦"立论,充分发挥中医辨证论治的特色,认为上焦当治肺(皮),清源洁流;中焦当治脾(肉),清热化湿;下焦当治肾(髓),补益为主,谨守病机,合理配伍,随症加减,在临床施治中取得显著疗效.

儿童紫癜性肾炎病因病机复杂,反复发作且缠绵难愈,临床治疗较为棘手.基于伏毒学说,结合中医整体观念及辨证论治,可从外感伏毒及内伤伏毒两个方面论治本病:针对外感伏毒之风毒、热毒、湿毒,分别治以疏风解毒、清透祛邪,清热解毒、凉血消斑,除湿解毒、通络止痛;针对内伤伏毒之胎毒、瘀毒、虚毒,分别治以调理体质、未病先防,化瘀生新、活血解毒,益气养阴、泄浊祛毒.附验案1则以佐证.

为探讨紫癜性肾炎(Henoch-Sch?nlein purpura nephritis,HSPN)患儿系膜区C3沉积与肾脏病理及免疫指标的相关性,纳入2015年1月至2017年12月河南中医药大学第一附属医院儿科肾脏病区行肾活检的HSPN患儿249例.采用微量免疫比浊法测定患儿血清IgA、IgM、IgG、C3、C4水平;采用流式细胞术测定CD3+、CD4+、CD8+T细胞水平;采用免疫荧光法对肾组织中IgA、IgM、IgG、C3和纤维蛋白(fibrin,Fib)沉积进行评价.结果显示,根据C3沉积强度,将患儿分为A组135例(-～±,54.2％)、B组83例(+,33.3％)、C组31例(++,12.4％).在249例患儿中,肾脏病理I级1例(0.4％)、Ⅱa级41 例(16.5％)、Ⅱb级18例(7.2％)、Ⅲa级100例(40.2％)、Ⅲb级79例(31.70％)、Ⅳ级9例(3.6％)、V级1例(0.4％).C3沉积强度与肾脏病理分级呈正相关(r=0.127,P=0.045).血清补体C3水平与肾小球系膜区C3沉积程度呈负相关(r=-0.210,P=0.001).IgA、IgM、C4、IgG水平的组间比较,差异无统计学意义(P＞0.05);CD4+/CD8+T与C3沉积程度组间比较(A组与B组、A组与C组),差异有统计学意义(P＜0.05),且大部分患儿伴有CD4+/CD8+T下降.血清CD3+、CD4+、CD8+T细胞水平组间比较,差异无统计学意义(P＞0.05).这提示HSPN患儿肾脏损伤程度与肾小球系膜区C3沉积有关,C3沉积程度越高,肾脏损伤越严重,相应的血清补体C3水平也越低,反映出机体的免疫功能低下.

系统性红斑狼疮(Systemic lupus erythematosus,SLE)是一种临床表现有多个系统损害症状的慢性、系统性自身免疫性疾病,目前SLE治疗以激素、免疫抑制剂为主,但由于SLE病情顽固,病程长,容易反复,长期使用会产生明显的毒副作用.中医治疗SLE的精髓在于辨证论治,调整人的整体状态,平衡阴阳,温补五脏,配合应用中药序贯疗法,对SLE的治疗常有明显的减毒增效之功.

目的 运用数据挖掘方法分析丁樱教授治疗紫癜性肾炎的用药、配伍规律及其治疗思想.方法 搜集其在2017年5月-2019年5月间门诊治疗紫癜性肾炎的医案处方作为研究对象,运用软件Excel 2013进行药物频数统计,SPSS Modeler 14.1的Apriori建模进行关联规则分析及SPSS Statistics 23.0进行系统聚类分析.结果 在纳入标准的152首方剂中,涉及中药161味,累积次数1614次,频数排列前五的药物依次为地黄、当归、连翘、牡丹皮、芡实等,用药类别以清热凉血、清热解毒以及补血药为主.经关联规则分析得到常用药对关联规则17条,3味药关联规则28条,4味药关联规则6条.经系统聚类分析归为6类.结论 丁樱教授治疗紫癜性肾炎主要以清热凉血,活血化瘀为法,结合病程及临床症状,辅以益气温肾养血治疗,故基于数据挖掘对丁樱教授用药规律探索,有助于指导中医治疗紫癜性肾炎的临床实践.

目的:探讨雷公藤颗粒治疗儿童反复性过敏性紫癜皮疹疗效的最佳剂量及不良反应的影响.方法:回顾性分析2019年4月至2020年10月河南中医药大学第一附属医院儿科医院肾脏病区及门诊反复性过敏性紫癜患儿共175例.根据治疗方案不同,分为雷公藤颗粒组119例,中医组27例,西医组29例.雷公藤颗粒组根据使用剂量的不同,又分为低剂量组(0.3 g·kg-1)30例,中剂量组(0.5 g·kg-1)54例,高剂量组(0.7 g·kg-1)35例.比较患儿用药后紫癜的消退时间及复发次数,并对其不良反应进行统计,初步探索雷公藤颗粒治疗儿童反复性过敏性紫癜的最佳用药剂量,并对其安全性进行总结.结果:雷公藤颗粒3个剂量组皮疹有效率均高于中医组、西医组,以中剂量组疗效更为显著(有效率为90.7％),差异具有统计学意义(P＜0.05).雷公藤颗粒中、高剂量组在皮疹消退时间、皮疹新出次数方面均低于中医组、西医组,中剂量组皮疹消退时间为(3.50±1.40)d,皮疹新出次数为(0.98±1.18)次,效果最为明显,差异具有统计学意义(P＜0.05);低剂量组与中医组在皮疹消退时间、皮疹新出次数方面比较,差异无统计学意义(P＞0.05).各组患儿不良反应发生率分别为6.7％、5.6％、8.5％、3.7％,6.9％,差异无统计学意义(P＞0.05).结论:雷公藤颗粒能促进反复性过敏性紫癜患儿的皮疹消退,减少皮疹新出,以0.5 g·kg-1为最佳有效剂量,且无明显不良反应.

目的 探讨不同剂量雷公藤颗粒联合紫癜Ⅰ号方治疗儿童反复发作性过敏性紫癜(recurrent Henoch-Sch?nlein purpura,RHSP)的疗效及近期安全性.方法 筛选2020年4～12月河南中医药大学第一附属医院儿科肾脏病区RHSP患儿144例,随机分为试验1组、试验2组、中医对照组和西医对照组.试验1组给予0.025 g/(kg·d)雷公藤颗粒[雷公藤饮片0.5g/(kg·d)]+紫癜Ⅰ号方,试验2组给予0.035g/(kg·d)雷公藤颗粒[雷公藤饮片0.7g/(kg·d)]+紫癜Ⅰ号方,中医对照组给予紫癜Ⅰ号方,西医对照组给予氯雷他定+维生素C+泼尼松片.治疗4周,随访8周,比较4组疗效及不良反应.结果试验1组、试验2组皮疹疗效、临床疗效均优于中医对照组和西医对照组,差异有统计学意义(P＜0.05).治疗后试验2组中医症状总积分、皮疹(主症)积分、次症积分均优于试验1组、中医对照组、西医对照组,差异有统计学意义(P＜0.05).4组患儿不良反应发生率、皮疹复发率、肾脏损伤发生率差异均无统计学意义(P＞0.05).结论0.025、0.035g/(kg·d)剂量雷公藤颗粒联合紫癜Ⅰ号方可促进RHSP患儿皮疹消退,以0.035 g/(kg·d)雷公藤颗粒总有效率更高,短期临床应用未发现明显不良反应.

免疫性血小板减少症(ITP)即特发性血小板减少性紫癜,是儿童时期较为常见的免疫性出血性血小板减少性疾病,临床以皮肤黏膜瘀斑瘀点、鼻衄、牙衄等为主要表现.本病的病因及发病机制尚不完全明确,感染、免疫、遗传等因素均与本病的发生有关.丁樱教授认为血瘀是本病的关键所在,正所谓"瘀血不去,新血不生",并依据本病的发病机制及特点将本病划分为邪实和正虚两个阶段,治疗则以疏风清热凉血、益气养阴活血为法.由于本病易迁延发展为慢性病程,病机特点以虚以瘀为主,故又提出"养血活血"等重要理论.

目的:探讨C3a及C5a在紫癜性肾炎诊断中的应用价值.方法:选择2018年5月至2018年12月河南中医药大学第一附属医院儿科肾脏病区45例HSPN患儿、15例HSP患儿及同期体检15例健康儿童为研究对象.留取健康儿童、HSP及HSPN患儿急性期及恢复期的外周血,采用ELISA检测血清中C3a及C5a的水平,并采集HSPN患儿24 h尿蛋白定量、肌酐及肾脏病理分级的临床数据.结果:HSPN患儿急性期血清中C3a及C5a水平高于健康儿童及HSP患儿(P＜0.05),且恢复期出现下降(P＜0.001);HSPN患儿急性期血清中C3a与24h尿蛋白相关,但与肌酐不相关,血清中C5a与尿蛋白及肌酐均不相关,肾穿患儿血清中C3a及C5a与肾脏病理分级呈正相关;血清中C3a在HSPN诊断中的敏感性为0.822,特异性为0.722,截点为7 621.94 ng/ml,C5a在诊断HSPN的敏感性为0.756,特异性为0.611,截点为73 423 pg/ml,C3a联合C5a在诊断HSPN的敏感性为0.822,特异性为0.867.结论:C3a及C5a可能参与HSP发病,且与肾脏损伤及病情活动相关.

本文旨在介绍丁樱教授从邪去正安论治儿童难治性肾病综合征的治疗经验.丁樱教授认为本虚标实为儿童难治性肾病综合征的主要病机,其中邪气结聚是难治性肾病综合征区别于一般肾病综合征的主要因素.故治疗上以张子和"邪去则正安"理论为指导,在扶助正气的基础上重视邪气的祛除,以期达到"治病不留邪,邪去则正安"的治疗效果,临床疗效颇丰.

过敏性紫癜(HSP),又称IgA血管炎或亨-舒综合征,是儿童时期较为常见的自身免疫性过敏性疾病之一,临床常表现为非血小板减少性皮肤紫癜、腹痛、关节痛等,部分患儿可表现为血尿或(和)蛋白尿等肾脏损害.由于该病具有病程较长、病情反复、易发展为肾脏损伤的特点,因此除常规治疗外,积极的康复护理也显得至关重要.了解疾病特点,注意康复护理,才能更有效地促进皮疹消退,并在一定程度上减少该病复发率.

河南中医药大学儿科研究所所长丁樱教授虽年近古稀,但精气神丝毫不亚于当下的年轻人,仍深耕门诊工作,对待患儿和蔼亲切,用药简、便、廉、效;定期组织教学查房,一丝不苟、精益求精.对于小儿养生,丁樱有自己独到的见解,强调从"大环境"进行整体调摄,包括儿童形体发育、体质类型、心理教育及社会环境等.

本文旨在介绍丁樱教授治疗儿童肾性血尿的经验.丁樱教授将本病病机归纳为“热、瘀、虚”三个方面,病位主要在肾与膀胱,阳热聚于下焦,扰动血络,血液外溢是本病发生的关键,阴虚内热是本病最常见的临床证型,血瘀是贯穿疾病全程的病理状态.同时,基于“络病”理论,认为肾络瘀阻是肾性血尿迁延难愈的根本原因.治疗上,从滋阴清热、活血通络为治则人手,自拟“清热止血方”与“五藤通络饮”,随证加减,疗效颇丰.

儿童肾病综合征属于祖国医学"水肿""尿浊"等范畴,目前普遍认为多由素体本虚,外邪引动而发病,预后差异较大.通过研究刘完素"玄府气液"理论及叶天士"久病入络"理论,并结合儿童肾病综合征的疾病特点,试进一步探析儿童儿童肾病综合征的微观病机演变规律,以完善对儿童肾病病机及病机演变的认识.认为其病程中存在玄府开阖失常的微观病理变化,部分肾病难治、反复的原因在于久病邪毒伤及肾脏络脉致肾络虚损、脉道瘀阻.应以调节玄府开阖和通利络脉虚滞为治疗大法,治疗过程中注重辛味药物的使用,为儿童肾病的治疗提供更多思路.

住院医师规范化培训实施后,临床专业学位研究生也参加了规范化培训,脱离了以往根据学生的特质、导师的需求来定专硕、科硕的模式.虽然这种制度在一定程度上为医学生提高临床能力提供了条件,但在这种制度下,专业研究生不仅要参加规范化培训,还要搞科学研究,跟师坐诊,任务繁多,难于精细求精,且住院医师规范化培训与研究生培养两者之间存在一定的重复性,造成医疗卫生资源的浪费.本文通过剖析住院医师规范化培训和临床专业学位研究生培养两种教育模式的异同点及利弊,为提高临床实践能力的继续教育发展提供合理化建议.