目的 研究维生素D及甲泼尼龙琥珀酸钠联用对过敏性紫癜(henoch-schonlein purpura,HSP)患儿的预后效果及对细胞免疫功能的影响.方法 选择2020年2月至2022年2月杭州市儿童医院收治的150例HSP患儿,采用随机数字表法分为观察组与对照组,每组各75例,对照组予静脉滴注甲泼尼龙琥珀酸钠治疗,观察组在对照组的基础上联合维生素D治疗,比较两组的临床疗效,症状消失时间及住院时间、细胞免疫功能、不良反应等.结果 观察组患儿治疗后的总有效率明显高于对照组(P＜0.05).观察组患儿治疗后的皮疹、腹痛、关节肿痛消失时间及住院天数分别短于对照组(P＜0.05).治疗后观察组CD3+、CD4+及自然杀伤细胞水平分别高于对照组(P＜0.05).两组不良反应比较,差异无统计学意义(P＞0.05).结论 维生素D及甲泼尼龙琥珀酸钠联合应用治疗HSP患儿预后效果显著,有利于提高患儿的细胞免疫功能,安全性良好.

目的 观察H2受体拮抗剂治疗过敏性紫癜肾炎的临床效果及其对免疫功能的影响.方法 选取99例过敏性紫癜肾炎患儿为研究对象.其中33例采用常规治疗,为对照组;33例采用常规治疗加H2受体拮抗剂法莫替丁治疗,为观察1组;另33例采用常规治疗加H2受体拮抗剂法西咪替丁治疗,为观察2组.观察并比较3组患儿的临床症状、临床疗效和免疫功能变化情况.结果 观察1组和观察2组患儿紫癜消退、腹痛消退和关节肿痛消退时间均短于对照组(均P＜0.05),而观察1组与观察2组比较差异均无统计学意义(均P＞0.05).观察1组和观察2组患儿治疗期间尿常规异常发生率均低于对照组(均P＜0.05).治疗1个月后和随访1年后,观察1组和观察2组患儿临床总有效率均高于对照组(均P＜0.05).观察1组和观察2组患儿治疗后CD4+、CD4+/CD8+水平均较治疗前升高(均P＜0.05),CD8+水平均较治疗前明显下降(均P＜0.05);而对照组患儿治疗前后CD4+、CD8+、CD4+/CD8+水平比较差异均无统计学意义(均P＞0.05).观察1组和观察2组患儿治疗后IgA、IgG水平均较治疗前明显下降(均P＜0.05),而对照组治疗后IgA、IgG水平与治疗前比较差异均无统计学意义(均P＞0.05).结论 H2受体拮抗剂能够明显缩短过敏性紫癜肾炎患儿紫癜、腹痛和关节肿痛消退时间,改善免疫功能紊乱,值得临床治疗选择.

目的 探讨川崎病(KD)合并冠状动脉病变的危险因素.方法 回顾性分析2014年1月～2016年12月本院169例KD住院患儿的临床资料;将169例KD分为A、B两组,其中A组为KD合并冠状动脉病变,B组为KD不伴冠状动脉病变;采用独立样本t检验分析两组年龄、发热天数、白细胞数、超敏C反应蛋白、血沉、血小板数、血清白蛋白、血钠、D二聚体与KD冠状动脉病变的关系;同时采用ROC曲线分析血清白蛋白、血钠、D二聚体预测冠状动脉病变的效能.结果 KD冠状动脉病变发生率为36.69％.A、B组患儿血清白蛋白、血钠、D二聚体的差异有统计学意义(P＜0.05).ROC曲线分析显示血清白蛋白、血钠、D二聚体曲线下面积分别为0.383、0.353和0.715.血清白蛋白＜35 g/L、血钠＜135 mmol/L、D二聚体＞0.92 mg/L是KD合并冠状动脉病变的危险因素.结论 KD的主要危害是冠状动脉病变;血清白蛋白＜35 g/L、血钠＜135 mmol/L、D二聚体＞0.92 mg/L是KD合并冠状动脉病变的危险因素.

呼吸系统疾病是儿童常见病之一,近年来始终处于住院儿童疾病构成的第一位[1].而肺炎又是儿童呼吸系统疾病最常见的一种[2],是我国5岁以下儿童死亡的主要原因之一[3-4].对肺炎的治疗以经验治疗为主,因而对其病原学的了解,尤其是多病原流行病学资料的掌握对正确用药、减少不合理用药极为重要.本文回顾分析2016年杭州市儿童医院住院的支气管肺炎患儿呼吸道病原体感染情况,现报道如下.

目的分析手足口病(HFMD)并发急性弛缓性瘫痪(AFP)患儿的临床特点。方法观察8例HFMD并发AFP患儿的临床特点,在起病1～3周内进行神经电生理、MRI检查,并进行早期药物治疗及康复锻炼,随访3～12个月。结果 8例手足口病并发AFP病例中,3例四肢瘫痪,2例单侧上肢瘫痪,2例双下肢瘫痪,1例单侧下肢瘫痪。7例神经电生理结果提示脊髓前角细胞病变,4例MRI显示颈2～7或胸12～腰1脊髓前角区长T1长T2信号。其中有1例四肢瘫痪MRI示延髓长T1长T2信号,胸3～7中央管扩张。单侧下肢瘫痪者功能恢复较快,上肢及四肢瘫痪患儿恢复相对缓慢。1例四肢瘫患儿随访至6个月时出现后遗症,随访至12个月时其患肢功能障碍仍存在。8例手足口病合并AFP中,EV71阳性5例。其中1例双下肢瘫痪患儿粪便EV71排毒时间长达70 d。结论手足口病并发AFP患儿其神经电生理、MRI显示病变越重,相应患肢功能障碍越明显,恢复时间亦相对漫长,预后较差。神经电生理、MRI检查对于早期诊断、评估病情及预后有重要的参考价值。EV71感染后粪便排毒周期长,需强化综合预防控制措施。

OBJECTIVE To investigate the clinical characteristics of Mycoplasma pneumonia in children.METHODS A retrospective analysis of 160 cases in our hospital from Jan 2010 to Oct 2011 for treatment of Mycoplasma pneumonia was performed.The age of onset,clinical manifestations,pulmonary foreign complications,laboratory inspection,and imaging testing were taken for statistics.RESULTS Of 160 pediatric patients investigated,the pediatric patients aged from 6 to 14 years old accounted for 59.38%,significantly higher than other age groups,the difference was statistically significant(P0.05);the incidence rates of the fever,dry cough and coarse breath sounds lungs were for 91.25%,88.75%,and 58.75%,significantly higher than others,the difference was statistically significant(P0.05);there were 39 patients complicated with digestive system infections with the incidence of 24.37%,significantly higher than other systems,the difference was statistically significant(P0.05);there were 86 patients with elevated high-sensitivity C-reactive protein with the incidence of 53.75%,significantly higher than other examinations,the difference was statistically significant(P0.05);there were 66 patients with side patchy shadows,which were more than the cases with other imaging manifestations,the difference was statistically significant(P0.05).CONCLUSION The children aged under 5 years old are the main population with Mycoplasma pneumonia,the fever and dry cough and lung breath sounds coarse are the main clinical symptoms,It often involves the digestive system,and the laboratory super-sensitivity C-reactive protein will rise for most people.The side patchy shadows is the major imaging manifestation.

AIM: To compare the therapy effect of inhalation of budesonide suspension with oral montelukast in cough variant asthma(CVA) of children..METHODS: 118 cases of CVA were divided into group A(n=40),who were used air compression pump inhalation of budesonide suspension;group B(n=40),who were taken orally montelukast;group C(n=38),who were given loratadine by oral administration.Each group of children were done observation diary every day,recorded the cough,asthma and medication from day to night,followed up once a week in the treatment of 4 weeks,followed up 1-2 times once month after symptom controlled,telephone followed up during the period.If appeared asthma,outpatient was received follow-up.During the follow-up period,three groups were recorded respectively cough symptoms in day and night after treatment with 1,2,3,4,8,12 week and done total scores. After 6 months of treatment,we assessed the control condition of asthma.Continue to follow-up 18 months,we observed the recurrence of patients within 2 years and the numbers of wheezing episode and changed into typical asthma(CA) of three groups within 2 years,and recorded the adverse reaction during the treatment. RESULTS:The valid control rates of three groups were 97.5%,95%,18.4%,respectively.Compared with group C,the efficacy had significant difference in group A,group B(χ2=16.004,P0.05).There was no significant difference between group A and group B(χ2=1.946,P0.05).Compared with before treatment,the total scores was decreased in the treatment of 1,2,3,4 week in group A,group B;In the treatment of 2,3 week,cough score of group A was decreased obviously than that in group B,the difference was statistically significant(P0.05);Three groups after treatment,the number of CVA recurrence and wheezing in group A,B was less than that in group C,and relapse rate of group A was 7.5%,wheezing ratio was 10%,while in group B were 25%,35%(χ2=8.467,P0.05). CONCLUSION: Compare with take orally montelukast,compress aerosol inhalation budesonide can anesis clinical symptoms better and faster,reduce the recurrence of CVA,effective prevent into typical asthma,and the long-term efficacy is superior to oral montelukast.

Objectives: To investigate the prevention of antibiotic-associated diarrhea by boulardii in children.Methods: In a randomized trial,216 children were enrolled,and divided into 2 groups.Boulardii was administered to 114 children who received antibiotic therapy before diarrhea(prevention);or to other 102 children after diarrhea(control).The incidence of AAD in two groups was compared.Results: The incidence of diarrhea was 19.29% in prevention group and 38.24% in the control group.The mean duration of diarrhea was(3.14±0.86) d in prevention group and(4.58±0.91) d in control group.The treatment of 2 groups were(4.09±1.11) d and(6.47±1.10) d.There were significant difference between two groups in both indicators(P0.01).Conclusion: Boulardii can be used to prevent antibiotic-associated diarrhea in children.

目的:提高儿童反复呼吸道感染免疫功能,促进呼吸道感染恢复,降低呼吸道感染复发率。方法:120例反复呼吸道感染患儿,分成治疗组60例,对照组60例,对照组单用抗生素治疗,治疗组在常规治疗基础上加用匹多莫德口服液,对两组进行疗效观察。结果:治疗组急性期发热、咳嗽、扁桃体肿大、肺部罗音持续时间较对照组缩短,呼吸道感染复发率显著降低,总有效率93%。结论:匹多莫德口服液可通过调节免疫反应治疗反复呼吸道感染,疗效良好,且安全性高,依从性好,是儿童反复呼吸道感染有效的免疫治疗药物。

现将我院2001年1月～2002年3月住院的小儿肺炎支原体肺炎(MP)伴喘息32例进行分析.

Objective:To investigate the clinical effects of the inhalation budesonide on bronchiolitis Methods: 50 cases of bronchiolitis were devided into two groups randomly Both groups were treated with synthetic therapy 25 cases in observed group were assist treated with budesonide inhalation The clinical effects were evaluated in both groups after the treatment Result: The group with inhaled budesonide is superior to the control group in relieving asthma and shortening the wheezing sound. Conclusion: Budesonide inhalation is effective, safe and convienent to treat bronchiolitis It can be one of effective way's in the treatment of bronchiolitis