肺炎支原体是一种附着于纤毛上皮细胞并在呼吸道黏膜中破坏它们的微生物,可引发各种严重程度的疾病,从轻度上呼吸道感染到严重的非典型肺炎[1].在肺炎支原体感染的免疫应答过程中,遗传多态性的作用不容忽视,特定基因可能影响肺炎支原体的易感性[2-3].遗传多态性与肺炎支原体感染之间的关系越来越受到公众的关注.CRP是机体在急性感染时由炎症刺激所产生的一种能够加强机体吞噬作用的蛋白,CRP蛋白水平与感染引起炎症反应强度有关[4-5].rs1205位点是位于CRP基因3'非翻译区(UTR)的一个单核苷酸多态性(SNP)位点,该位点突变与CRP的表达水平有关[6-8].本研究通过病例对照研究的方式分析CRP基因rs1205位点SNP与儿童支原体肺炎感染风险及其严重程度的相关性,现报道如下.

目的 评估母孕期及婴儿期服用抑酸药与发生儿童哮喘的关系.方法 全面检索PubMed、Medline、Embase、Cochrane、EBSCO、Web of Science、CNKI及万方数据库,检索时限截止2019年5月,筛选文献、提取资料、评价文献质量后,使用stata 11.0软件进行Meta分析.结果 共纳入9项研究,Newcastle-Ottawa量表评分均在6分以上,文献质量均较高.合并后结果显示,母孕期及婴儿期服用抑酸药物可明显增加儿童哮喘发生风险.口服所有抑酸药物、质子泵抑酸剂(PPI)及H2受体拮抗剂(H2RAs)人群中儿童哮喘发生率分别为10.9％、10.7％、12.2％,合并OR分别为1.35、1.51、1.56.结论 母孕期及婴儿期服用抑酸药物可明显增加哮喘发生的风险.

目的 调查新冠疫情期间儿童常见呼吸道病毒感染的分布情况和流行趋势.方法 选取2020年1月17日至2020年3月18日在杭州市儿童医院就诊的呼吸道感染患儿3964例,收集鼻咽拭子标本,采用快速呼吸道病毒抗原检测(胶体金法)方法对甲型流感病毒(IVA)、乙型流感病毒(IVB)、腺病毒(ADV)、呼吸道合胞病毒(RSV)进行检测,并按性别、年龄、重大公共突发卫生事件响应前后等条件进行统计分析.结果 共检出各类病原体1030例,阳性率25.98％,其中IVB阳性率最高,为9.56％,其次是IVA(7.26％),RSV(5.12％),AVD(4.04％).男女患儿之间的IVA、IVB、ADV、RSV阳性率和总阳性率比较,差异均无统计学意义(χ2分别=0.04、0.29、1.18、1.51、0.29,P均>0.05).不同年龄之间的各病毒阳性率和总阳性率比较,差异均有统计学意义(χ2分别=13.11、98.05、14.19、101.88、46.22,P均<0.05),其中<1岁的患儿以RSV为主(6.38％),≥6岁的患儿以IVB为主(15.52％).重大公共卫生事件响应后患儿呼吸道病毒RSV、IVA、IVB阳性率和总阳性率均明显低于响应前患儿,ADV阳性率高于响应前患儿,差异均有统计学意义(χ2分别=31.39、122.47、139.95、264.01、5.48,P均<0.05).结论 儿童常见呼吸道病毒感染存在明显的年龄差异性,浙江省启动重大公共卫生事件响应,采取隔离、保护措施后病毒感染情况明显下降.

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.

Objective To investigate effect of dopamine and dobutamine in auxiliary treatment of children with severe pneumonia and its influence on cytokines. Method 106 cases of children with severe pneumonia from June 2013 to May 2014 were randomly divided into research group and control group, with 53 cases in each group, patients in control group were given conventional treatment; on the basis of conventional treatment, patients in research group were given small dose dopamine and dobutamine( pump injection) , 2~5μg/( kg·min) ,4~6 hours/d, 1 time/d, 5 days as one course of treatment. After 10 days of treatment, curative effect of all children was evaluated, then re-covery time of breathing, heart rate, disappear time of fever, cyanopathy, lung rale were recorded. Before and after treatment, interleukin 6 (IL-6), interleukin 8 (IL-8), C-reactive protein (CRP), tumor necrosis factor alpha ( TNF-α) level of all children were detected and compared between two groups. Result The total effective rate of re-search group was significantly higher than the control group, the difference was statistically significant (P<0. 05). The breathing, heart rate recovery time and fever, cyanopathy, lung rale disappear time were significantly shorter than the control group, the differences were statistically significant (P<0. 05). Before treatment, The IL-6, IL-8, CRP, TNF-αlevel between two groups was not significantly different;after treatment,IL-6, IL-8 CRP, TNF-αlevel were significantly lower (P<0. 05), and IL-6, IL-8, CRP, TNF-α level of research group were significantly lower than the control group, the differences were statistically significant (P<0. 05). Conclusion Dopamine, dobutamine as adjuvant treatment of pediatric children with severe pneumonia can effectively improve symptoms, reduce the in-flammatory cytokine levels, and has a positive effect on improving the treatment effect, shortening the course of the disease, is worthy of popularization and application.

肺炎支原体是导致儿童社区获得性肺炎的重要病原体之一，也是引起喘息发作的重要病原。近年来的研究表明，肺炎支原体感染不仅局限于学龄儿童，婴幼儿的患病率也呈现上升趋势[1]。本次研究通过对肺炎支原体感染婴幼儿的外周血IgE水平的检测，分析其临床意义。现报道如下。