Objective:To investigate whether human leukocyte antigens (HLAs) influence gut microbiota composition and contributes to delayed type 1 diabetes mellitus (T1DM) onset in children. Methods:This multicenter cross-sectional study included 106 newly diagnosed pediatric T1DM patients (age <18 years) and 69 healthy controls from nine Chinese cities. Gut microbiota was profiled via whole-metagenome shotgun sequencing, and HLA alleles were genotyped by PCR sequence-based typing. Participants were stratified by HLA-risk scores. Statistical analyses included α/β-diversity metrics, linear discriminant analysis effect size analysis (LEfSe), and Spearman correlation adjusted for confounders. Results:Principal coordinates analysis (PCoA) exposed discernible disparities in gut microbiota structures within the high-HLA-risk T1DM cohort relative to both high- and low-HLA-risk control groups (R 2 = 0.0562, p=0.003 and R 2 = 0.0343, p=0.003). HLA-C ∗ 0304 carriers exhibited delayed T1DM onset compared to noncarriers (adjusted R 2 = 0.225, p=0.017). High-HLA-risk T1DM patients showed distinct microbiota divergence from controls (R 2 = 0.0562, p=0.003), driven by reduced Lachnospiraceae and Blautia (butyrate producers) in noncarriers. Conversely, HLA-C ∗ 0304-positive T1DM patients had enriched Blautia (p=0.005) and Lachnospiraceae (p=0.039), alongside lower opportunistic pathogens (Citrobacter; p < 0.05). High-HLA-risk patients also displayed lower fasting C-peptide levels than low-risk counterparts (0.19 ± 0.14 vs. 0.26 ± 0.19 µg/mL, p=0.029). Conclusions:Our study demonstrates that specific HLA class I subtypes (e.g., C ∗ 0304) may modulate T1DM onset through selective enrichment of beneficial gut microbiota. Elucidating the mechanisms by which HLA variants regulate mucosal immunity and coordinate HLA-microbiota-immune interactions holds significant potential for developing targeted interventions against T1DM pathogenesis.

Background The increasing incidence of precocious puberty is a major health challenge for Chinese children, while related risk factors remain less well explored. Exposure to ambient fine particulate matter (PM2.5) is a leading environmental hazard in China. Although certain components of PM2.5 have been reported to be endocrine disruptors for sex hormones, population-based evidence is still lacking on the association between PM2.5 exposure and precocious puberty in China. Objective Based on a cross-sectional survey covering 30 cities in 2017 to 2019, this study was designed to explore the association between long-term exposure to PM2.5 and its 5 major components with precocious puberty in China and to check the potential modifying effects of family-related and personal factors. Methods We included 34,105 children aged 6 to 9 years. We collected the 5-year average concentrations of PM2.5 and its 5 major components (sulfate, nitrate, ammonium, organic matter, and black carbon) in the area (at a spatial resolution of 0.1° × 0.1°) where each school was located. We used mixed effect logistic regression to estimate the effect sizes of the total mass of PM2.5 and each of its components on precocious puberty, and we examined the modifying effects of family-related and personal factors using an additional interactive term. A weighted quantile sum (WQS) regression model was applied to identify the weights of each component in explaining the effect size of the total mass of PM2.5. Results We found that the odds ratio (OR) for precocious puberty per IQR increase in the concentration of total PM2.5 mass was 1.27 (95% CI 0.92-1.75) for the whole population, 2.12 (95% CI 1.27-3.55) for girls, and 0.90 (95% CI 0.62-1.30) for boys. Similarly, the effect sizes of the 5 major components were all substantial for girls but minimal for boys. Results of the WQS analysis showed that organic matter could explain the highest proportion of the effect of PM2.5, with the weight of its contribution being 0.71. Modification effects of family income and dietary habits were only observed in certain population subgroups. Conclusions Long-term exposure to total PM2.5 mass was significantly associated with precocious puberty in girls, with organic matter identified as the major effect contributor. The results add evidence on the detrimental effects of PM2.5 on children’s development and growth.

Blood microbiome signatures in patients with type 1 diabetes (T1D) remain unclear. We profile blood microbiome using 16S rRNA gene sequencing in 77 controls and 64 children with new-onset T1D, and compared it with the gut and oral microbiomes. The blood microbiome of patients with T1D is characterized by increased diversity and perturbed microbial features, with a significant increase in potentially pathogenic bacteria compared with controls. Thirty-six representative genera of blood microbiome were identified by random forest analysis, providing strong discriminatory power for T1D with an AUC of 0.82. PICRUSt analysis suggested that bacteria capable of inducing inflammation were more likely to enter the bloodstream in T1D. The overlap of the gut and oral microbiome with the blood microbiome implied potential translocation of bacteria from the gut and oral cavity to the bloodstream. Our study raised the necessity of further mechanistic investigations into the roles of blood microbiome in T1D.

Automated bone age assessment (BAA) is of growing interest because of its accuracy and time efficiency in daily practice. In this study, we validated the clinical applicability of a commercially available artificial intelligence (AI)-powered X-ray bone age analyzer equipped with a deep learning-based automated BAA system and compared its performance with that of the Tanner–Whitehouse 3 (TW-3) method. Radiographs prospectively collected from 30 centers across various regions in China, including 900 Chinese children and adolescents, were assessed independently by six doctors (three experts and three residents) and an AI analyzer for TW3 radius, ulna, and short bones (RUS) and TW3 carpal bone age. The experts’ mean estimates were accepted as the gold standard. The performance of the AI analyzer was compared with that of each resident. For the estimation of TW3-RUS, the AI analyzer had a mean absolute error (MAE) of 0.48 ± 0.42. The percentage of patients with an absolute error of < 1.0 years was 86.78

目的 研究超重和肥胖对青春期男童阴茎、睾丸发育的影响,并对其与性激素、脂代谢的相关性进行分析.方法 收集2020年8月 ～2021年9月于哈尔滨医科大学附属第一医院小儿内科门诊就诊的78例10～15岁青春期男童作为研究对象,根据体重指数(body mass index,BMI)分为正常体重组(n=21)、超重组(n=18)和肥胖组(n=39).测量3组男童身高、体重、BMI、阴茎长度、睾丸容积;检测性激素及脂代谢水平.采用Pearson相关性分析评价阴茎长度、睾丸容积与性激素及脂代谢指标之间的相关性.结果 正常体重组男童阴茎长度明显大于超重组及肥胖组,差异有统计学意义(P<0.05).3组血清睾酮水平分别呈降低趋势,肥胖组与正常体重组男童之间比较,差异有统计学意义(P<0.05).超重组及肥胖组男童的低密度脂蛋白胆固醇(low-density lipoprotein-cholesterol,LDL-C)、载脂蛋白B(apolipoprotein B,ApoB)水平均显著高于正常体重组,高密度脂蛋白胆固醇(high-density lipoprotein-cholesterol,HDL-C)则低于正常体重组,差异均有统计学意义(P均<0.05).雌二醇、睾酮、黄体生成素(luteinizing hormone,LH)与阴茎长度呈正相关(P<0.05),胆固醇、载脂蛋白A(apolipoprotein A,ApoA)与阴茎长度呈负相关;雌二醇、睾酮、LH与左右睾丸容积及平均睾丸容积呈正相关(P<0.05),胆固醇、HDL-C、ApoA与左右睾丸容积及平均睾丸容积呈负相关(P<0.05).结论 超重、肥胖青春期男童外生殖器发育相对迟缓,并且内分泌及脂代谢紊乱.应重视超重及肥胖对男童性发育的影响,并及时干预.

Context: Pubertal onset has been decreasing in many countries but there has been no data on pubertal development in Chinese children over the last decade. Objective: The primary objective of the study was to evaluate the current status of sexual maturation in Chinese children and adolescents. Secondary objectives were to examine socio-economic, lifestyle and auxological associations with pubertal onset. Design: A national, cross-sectional health survey. Setting: The community-based setting. Participants: A multistage, stratified cluster random sampling method was used to select a nationally representative sample, consisting of 231,575 children and adolescents(123,232 boys and 108,343 girls) between 2017 and 2019. Main Outcome Measure: Growth parameters and pubertal staging were assessed by physical examination. Results: Compared to 10 years previously the median age of Tanner 2 breast development and menarche were similar at 9.65 years and 12.39 years respectively. However, male puberty occurred earlier with a median age of testicular volume ≥4 ml of 10.65 years. Pubertal onset did occur earlier at the extremes with 3.3% of the girls with breast development between 6.5-6.99 years old increasing to 5.8% by 7.5-7.99 years old. Early pubertal onset was also noted in boys, with a testicular volume ≥ 4 ml noted in 1.5% between 7.5-7.99 years increasing to 3.5% between 8.5-8.99 years old. Obesity and overweight increased the risk of developing earlier puberty compared to the normal weight in both boys and girls. Conclusions: Over the past decade, pubertal development is occurring earlier in Chinese children. While the cause is multifactorial, overweight and obesity are associated with earlier puberty onset. The currently-used normative pubertal data of precocious puberty may not be applicable to diagnose precocious puberty.

雄激素与青春期女性生殖发育的生理病理密切相关,对卵巢卵泡发育具有重要影响.雄激素可以直接通过雄激素受体发挥作用,刺激原始卵泡发育启动;也可作为雌激素底物,转化为雌激素后间接发挥作用.由于性腺轴不稳定,青春期女性与多囊卵巢综合征(PCOS)临床表现具有一定重合.适量雄激素可促进卵巢发育,雄激素缺乏不利于卵巢正常发育,雄激素过多则会导致PCOS,肾上腺网状带合成的雄激素也会对卵巢发育产生影响.对雄激素与卵巢卵泡发育关系的进一步研究,有助于诊断青春期PCOS,也可为具有窦前卵泡的不孕患者提供新的治疗方向.

格雷夫斯病是一种常见的自身免疫病,发病机制未明,儿童发病率明显低于成人,各地发病情况不一,但总体呈逐年增加趋势.实验室检查以甲状腺功能改变最为常见,临床表现除高代谢症状还可出现生长加速等表现.目前,儿童格雷夫斯病的治疗首选口服甲巯咪唑,治疗方便且不良反应较少,但需关注患儿缓解情况及疗程问题.对于长期口服抗甲状腺药物治疗仍未见好转的患儿,可考虑行放射性碘治疗,将明显提高患儿的缓解率.本文就儿童格雷夫斯病的相关情况进行综述.

Background Growth chart is a valuable clinical tool to monitor the growth and nutritional status of children. A growth chart widely used in China is based on the merged data sets of national surveys in 2005. We aimed to establish an up-to-date, complete growth curve for urban Chinese children and adolescents with a full range of ages. Methods Using data collected in a large-scale, cross-sectional study (Prevalence and Risk factors for Obesity and Diabetes in Youth (PRODY), 2017–2019), we analyzed 201,098 urban children aged 3 to 18 years from 11 provinces, autonomous regions, and municipalities that are geographically representative of China. All participants underwent physical examinations. Sex-specific percentiles of height-for-age and weight-for-age were constructed by Generalized Additive Models for Location Scale and Shape (GAMLSS) model. We also compared the median values of height-for-age or weight-for-age between our growth chart and the established growth reference using Welch-Satterthwaite T-Test. Results Consistent with the established growth reference, we observed that the P 50 percentile of height-for-age reached plateaus at the age of 15 years (172 cm) and 14 years (160 cm) for boys and girls, respectively. In addition, boys aged 10 ~ 14 years and girls aged 10 ~ 12 years exhibited the most dramatic weight difference compared to those of other age groups (19.5 kg and 10.3 kg, respectively). However, our growth chart had higher median values of weight-for-age and height-for-age than the established growth reference with mean increases in weight-for-age of 1.36 kg and 1.17 kg for boys and girls, respectively, and in height-for-age of 2.9 cm and 2.6 cm for boys and girls, respectively. Conclusions Our updated growth chart can serve as a reliable reference to assess the growth and nutritional status in urban Chinese children throughout the entire childhood.

Gut dysbiosis has been linked to type 1 diabetes (T1D); however, microbial capacity in T1D remains unclear. Here, we integratively profiled gut microbial functional and metabolic alterations in children with new-onset T1D in independent cohorts and investigated the underlying mechanisms. In T1D, the microbiota was characterized by decreased butyrate production and bile acid metabolism and increased lipopolysaccharide biosynthesis at the species, gene, and metabolite levels. The combination of 18 bacterial species and fecal metabolites provided excellently discriminatory power for T1D. Gut microbiota from children with T1D induced elevated fasting glucose levels and declined insulin sensitivity in antibiotic-treated mice. In streptozotocin-induced T1D mice, butyrate and lipopolysaccharide exerted protective and destructive effects on islet structure and function, respectively. Lipopolysaccharide aggravated the pancreatic inflammatory response, while butyrate activated Insulin1 and Insulin2 gene expression. Our study revealed perturbed microbial functional and metabolic traits in T1D, providing potential avenues for microbiome-based prevention and intervention for T1D.

Purpose:To investigate the features and treatment status of children with type 1 diabetes mellitus (T1DM) in China. Methods:We recruited patients <14 years of age with T1DM from 33 medical centers in 25 major cities of China between January 2012 and March 2015. All patients completed a questionnaire that was conducted by their pediatric endocrinologists at all centers. Results:A total of 1,603 children (755 males and 848 females) with T1DM participated in this survey. Of these, 834 (52.03%) of the patients exhibited diabetic ketoacidosis (DKA) at onset, while 769 patients (47.97%) did not exhibit DKA (non-DKA) at onset. There was a higher proportion of females (55.71%) in the cohort of patients exhibiting DKA at onset than in the non-DKA cohort (49.33%). The mean age of patients exhibiting DKA at presentation was 7.12 ± 0.14 years; this was significantly younger than that in non-DKA group (7.79 ± 0.15 years; P < 0.005). The frequency of DKA in 3 years old, 3-7 years old, and 7 years old or more was 77.21%, 26.17%, and 37.62%, respectively. Upon initial diagnosis, 29.4%, 15.2% and 11.8% of patients showed positivity for glutamic acid decarboxylase antibody (GADA), Insulin autoantibodies (IAA), or islet cell antibody (ICA), respectively. During six months follow-up, 244 patients (15.21%) reported receiving insulin pump therapy, and more than 60% of patients monitored their blood glucose levels less than 35 times per week. Although the majority of patients had no problems with obtaining insulin, 4.74% of the children surveyed were not able to receive insulin due to financial reasons, a shortage of insulin preparations, or the failure of the parents or guardians to acquire the appropriate medicine. Conclusion:DKA is more common in very young children. Treatment and follow-up of T1DM in China still face very serious challenges.

目的 研究槐杞黄颗粒对阿霉素肾病大鼠肾脏氯离子通道蛋白ClC-5在肾小管表达的影响.方法 建立阿霉素肾病大鼠模型,造模成功后取24只大鼠随机分为4组,每组6只.甲强龙组给予甲强龙10 mg/(kg·d)腹腔注射;槐杞黄组给予槐杞黄颗粒2g/(kg·d)灌胃、联合组给予甲强龙10 mg/(kg·d)腹腔注射+槐杞黄颗粒2 g/(kg·d)灌胃联合治疗、盐水组给予等量生理盐水腹腔注射.此外,取6只健康普通级大鼠作为空白组给予等量生理盐水腹腔注射.治疗结束后30只大鼠留取肾脏组织,通过免疫组化观察肾脏氯离子通道蛋白ClC-5在肾小管表达的变化.结果 免疫组化显示,甲强龙组、槐杞黄组、联合组肾脏氯离子通道蛋白ClC-5在肾小管中的表达较盐水组均上调(P＜0.05),其中甲强龙组及联合组与空白组比较肾脏氯离子通道蛋白ClC-5在肾小管中的表达无明显差异(P＞0.05),而联合组较甲强龙组的表达率稍好,但无明显差异;槐杞黄组肾脏氯离子通道蛋白ClC-5在肾小管中的表达较空白组下调(P＜0.05).结论 槐杞黄颗粒对阿霉素肾病大鼠的治疗可能通过肾小管中肾脏氯离子通道蛋白ClC-5发挥一定作用.

BACKGROUND In addition to insulin resistance, impaired insulin secretion has recently been identified as a crucial factor in the pathogenesis of type 2 diabetes mellitus (T2DM). Scarce clinical data exist for pediatric T2DM. AIM To investigate the association of β-cell function and insulin resistance with pediatric T2DM in the first Chinese multicenter study. METHODS This multicenter cross-sectional study included 161 newly diagnosed T2DM children and adolescents between January 2017 and October 2019. Children with normal glycemic levels (n = 1935) were included as healthy control subjects. The homeostasis models (HOMAs) were used to assess the β-cell function (HOMA2-%B) and insulin resistance (HOMA2-IR) levels. The HOMA index was standardized by sex and age. We performed logistic regression analysis to obtain odds ratios (ORs) for T2DM risk using the standardized HOMA index, adjusted for confounding factors including sex, Tanner stage, T2DM family history, body mass index z-score, and lipid profile. RESULTS The male-female ratio of newly diagnosed T2DM patients was 1.37:1 (OR = 2.20, P = 0.011), and the mean ages of onset for boys and girls were 12.5 ± 1.9 years and 12.3 ± 1.7 years, respectively. The prevalence of related comorbidities including obesity, elevated blood pressure, and dyslipidemia was 58.2%, 53.2%, and 80.0%, respectively. The T2DM group had lower HOMA2-%B levels (P < 0.001) and higher HOMA2-IR levels (P < 0.001) than the control group. Both the decrease in HOMA2-%B z-score (OR = 8.40, 95%CI: 6.40-11.02, P < 0.001) and the increase in HOMA2-IR z-score (OR = 1.79, 95%CI: 1.60-2.02, P < 0.001) were associated with a higher risk of T2DM, and the decrease in HOMA2-%B z-score always had higher ORs than the increase in HOMA2-IR z-score after adjusting for confounding factors. CONCLUSION Besides insulin resistance, β-cell function impairment is also strongly associated with Chinese pediatric T2DM. Gender difference in susceptibility and high comorbidities warrant specific T2DM screening and prevention strategies in Chinese children.

1 患儿 患儿男性,3岁4个月,以"转氨酶异常升高三年,伴面部皮疹"为主就诊于本院儿科.患儿出生后反复出现黄疸,转氨酶升高,伴有生长发育慢.因病情反复来本院就诊.血清肝酶、胆红素和总胆固醇升高,肝胆胰彩超正常,心脏彩超显示:房间隔缺损.无遗传代谢病家族,基因检测结果:患儿JAG1片段缺失引起的杂合突变,在JAG1基因的一个拷贝中发现了新的致病性移码突变c.489delC,氨基酸(p.Ser164Asnfs*7)改变产生截短蛋白.患儿父母外周血DNA检测均无相关基因突变(图1).

Context: Aggrecan, encoded by the ACAN gene, is the main proteoglycan component in the extracellular cartilage matrix. Heterozygous mutations in ACAN have been reported to cause idiopathic short stature. However, the prevalence of ACAN pathogenic variants in Chinese short stature patients and clinical phenotypes remain to be evaluated. Objective: We sought to determine the prevalence of ACAN pathogenic variants among Chinese short stature children and characterize the phenotypic spectrum and their responses to growth hormone therapies. Patients and Methods: Over 1000 unrelated short stature patients ascertained across China were genetically evaluated by next-generation sequencing-based test. Result: We identified 10 novel likely pathogenic variants and 2 recurrent pathogenic variants in this cohort. None of ACAN mutation carriers exhibited significant dysmorphic features or skeletal abnormities. The prevalence of ACAN defect is estimated to be 1.2% in the whole cohort; it increased to 14.3% among those with advanced bone age and to 35.7% among those with both advanced bone age and family history of short stature. Nonetheless, 5 of 11 ACAN mutation carries had no advanced bone age. Two individuals received growth hormone therapy with variable levels of height SD score improvement. Conclusion: Our data suggest that ACAN mutation is 1 of the common causes of Chinese pediatric short stature. Although it has a higher detection rate among short stature patients with advanced bone age and family history, part of affected probands presented with delayed bone age in Chinese short stature population. The growth hormone treatment was moderately effective for both individuals.

目的 系统评价柯萨奇病毒感染与1型糖尿病(type 1 diabetes mellitus,T1DM)的风险关系.方法 按照PICOs原则构建检索问题,使用主题词和自由词全面检索Pubmed、EmBase、SinoMed、中国知网、万方数据库、维普网.检索时间自建库至2020年5月28日.使用Newcastle Ottawa Scale评价纳入文献质量;Revman 5.3软件包绘制森林图和漏斗图.通过随机效应模型(I2>50％)或固定效应模型(I2<50％)计算纳入文献的比值比(odd ratios,OR)和95％置信区间(95％confidence interval,95％CI).评价结果包括柯萨奇病毒感染感染及各亚型(1～6型)和1型糖尿病的风险关系,不同研究地区、不同年龄和不同柯萨奇病毒感染检测方法检测方法对柯萨奇病毒感染和T1DM风险关系的影响.结果 根据纳入和排除标准,共检索到372篇文献.剔除与研究主题不相关的文献312篇,浏览全文后排除36篇试验设计不严谨的文献.最终,对24篇文献进行系统评价和Meta分析,其中1篇文献无数据可利用.总样本量为3306例,病例组1693例,对照组1613例.分析结果显示T1DM患者感染柯萨奇病毒B组感染的风险是对照组的5倍(OR=4.49,95％CI:2.69～7.50,I2=85％)差异有统计学意义,T1DM患者感染柯萨奇病毒B组1型的风险是对照组的1.56倍(OR=1.56,95％CI:1.20～2.03,I2=0％),柯萨奇病毒B组的检测方法对结果影响较大.结论 目前证据提示柯萨奇病毒B组感染与T1DM发病有统计学相关性,柯萨奇病毒B组感染可能是T1DM发病的一个病因或促进T1DM的发生.

弥漫性毒性甲状腺肿(Graves disease,GD)和桥本甲状腺炎(Hashimoto thyroiditis,HT)都是遗传易感儿童在感染、应激、药物以及性激素等环境危险因素影响下出现的,并伴有大量淋巴细胞浸润的自身免疫性疾病.其中,GD是导致儿童甲状腺功能亢进的最常见病因,约占全部自身免疫性甲状腺疾病病例的95％.目前,已有大量研究对淋巴细胞在GD和HT患者的甲状腺激发免疫损伤的机制进行了探索.该文总结T、B细胞在GD和HT中的免疫损伤机制以及炎性因子和甲状腺相关抗体对淋巴细胞的调节作用,旨在为用淋巴细胞监测GD和HT的治疗和预后研究提供新思路.

AimsFindings from previous studies about the association of preterm birth as well as birth weight with the risk of T1DM were still inconsistent. We aimed to further clarify these associations based on Chinese children and explore the role of gender therein.MethodsA nationwide multicenter and population-based large cross-sectional study was conducted in China from 2017 to 2019. Children aged between 3 and 18 years old with complete information were included in this analysis. Multiple Poisson regression models were used for evaluating the associations of birth weight as well as preterm birth with T1DM in children.ResultsOut of 181,786 children, 82 childhood T1DM cases were identified from questionnaire survey. Children with preterm birth (<37 weeks) had higher risk of type 1 diabetes (OR: 3.17, 95%CI: 1.76-5.71). Children born with high birth weight (≥4,000g) had no statistically significant risk of T1DM (OR:1.71, 95%CI: 0.90-3.22). However, children’s gender might modify the effect of high birth weight on T1DM (girls: OR: 3.15, 95%CI: 1.33-7.47; boys: OR: 0.99, 95%CI: 0.38-2.55, p for interaction=0.065). In addition, children with low birth weight were not associated with T1DM (OR: 0.70, 95%CI: 0.24-2.08). The findings from matched data had the similar trend.ConclusionsIn China mainland, preterm birth increased the risk of childhood T1DM, but high birth weight only affected girls. Therefore, early prevention of T1DM may start with prenatal care to avoid adverse birth outcomes and more attention should be paid to children with preterm birth and girls with high birth weight after birth.

Numerous animal models and epidemiological and observational studies have demonstrated that enterovirus (EV) infection could be involved in the development of clinical type 1 diabetes mellitus (T1DM), but its aetiology is not fully understood. Therefore, we reviewed the association between EV infection and clinical T1DM. We searched PubMed and Embase from inception to April 2021 and reference lists of included studies without any language restrictions in only human studies. The correlation between EV infection and clinical T1DM was calculated as the pooled odds ratio (OR) and 95% confidence intervals (CIs), analysed using random-effects models. Subgroup and sensitivity analyses were performed to evaluate the robustness of the associations. A total of 25 articles (22 case-control studies and three nested case-control studies) met the inclusion criterion including 4854 participants (2948 cases and 1906 controls) with a high level of statistical heterogeneity (I2 = 80%, P < 0.001) mainly attributable to methods of EV detection, study type, age distribution, source of EV sample and control subjects. Meta-analysis showed a significant association between EV infection and clinical T1DM (OR 5.75, 95% CI 3.61-9.61). There is a clinically significant association between clinical T1DM and EV infection.

目的 探讨三种分子诊断技术对儿童肺结核的诊断效能,为儿童肺结核的诊断寻求简单、快速、准确的新方法.方法 搜集哈尔滨市胸科医院儿童结核科、哈尔滨市儿童医院呼吸科、哈尔滨医科大学附属第一医院儿科2016年9月至2018年6月收治的2个月至14周岁的疑似肺结核患儿共186例,最后临床诊断肺结核者119例,其中低龄儿54例(45.4％),年长儿65例(54.6％);非结核病者67例,其中低龄儿31例(42.3％),年长儿36例(53.7％).应用实时荧光定量PCR(real-time fluorescen quantitative PCR,FQ-PCR)、实时荧光核酸恒温扩增检测技术(simultaneous amplification and testing,SAT)和耐药基因芯片技术分别检测患儿胃液和痰液(年长儿)中的结核分枝杆菌,评价各方法的诊断效能.结果 以临床诊断为标准,FQ-PCR、SAT、耐药基因芯片检测胃液中MTB的敏感度分别为81.51％(97/119)、78.15％(93/119)、73.11％(87/119),特异度分别为86.57％(58/67)、98.51％(66/67)、92.54％(62/67),Kappa值分别为0.653、0.709、0.603.3种方法检测年长儿胃液中MTB的敏感度分别为80.00％(52/65)、73.85％(48/65)、67.69％(44/65),特异度分别为75.00％(27/36)、97.22％(35/36)、88.89％(32/36);检测年长儿痰液中MTB的敏感度分别为47.69％(31/65)、41.54％(27/65)、36.92％(24/65),特异度分别为88.89％(32/36)、97.22％(35/36)、91.67％(33/36),各方法检测的敏感度胃液均高于痰液,差异均有统计学意义(x2值分别为14.696、13.898、12.334,P值均为0.000),各方法检测的特异度胃液和痰液之间差异均无统计学意义(x2值分别为2.347、0.000、0.158,P值分别为0.126、1.000、0.691);胃液总的阳性检出率为87.69％(57/65),痰液总的阳性检出率为58.46％(38/65),两者差异有统计学意义(x2=14.114,P=0.000).结论 FQ-PCR、SAT、耐药基因芯片检测儿童疑似肺结核患者的胃液和痰液中结核分枝杆菌的敏感度高、特异度强,对儿童肺结核的诊断具有重要价值.