背景　慢性咳嗽是儿科常见的就诊原因，不同地区儿童慢性咳嗽病因存在差异。兰州地处西北内陆，气候干燥，沙尘天气较多，秋季花粉浓度较高，但目前缺乏本地区儿童慢性咳嗽的病因研究。目的　探讨兰州地区2014—2023年儿童慢性咳嗽病因构成及其主要病因变化。方法　回顾性分析2014—2023年于甘肃省妇幼保健院（甘肃省中心医院）门诊及住院治疗的944例慢性咳嗽患儿的临床资料，并探讨儿童慢性咳嗽病因构成及其与性别、年龄、季节、年份的关系。结果　2014—2023年儿童慢性咳嗽的病因分布为：咳嗽变异性哮喘314例（33.26%），上气道咳嗽综合征259例（27.44%），感染后咳嗽221例（23.41%），迁延性细菌性支气管炎34例（3.60%），胃食管反流性咳嗽9例（0.95%），其他病因咳嗽107例（11.34%）。107例其他病因咳嗽的患儿中多病因儿童80例（占总病例数8.47%），多病因儿童中上气道咳嗽综合征合并感染后咳嗽占30.00%（24/80）。不同性别儿童慢性咳嗽病因分布比较，差异无统计学意义（χ2=0.894，P=0.971）。不同年龄、季节儿童慢性咳嗽病因分布比较，差异有统计学意义（χ2=361.544，P<0.001；χ2=31.793，P=0.007）。趋势χ2检验结果显示，随着年份的增长，咳嗽变异性哮喘逐渐减少（χ2=43.252，P<0.001），上气道咳嗽综合征逐渐上升（χ2=30.431，P<0.001）。结论　咳嗽变异性哮喘、上气道咳嗽综合征、感染后咳嗽是2014—2023年兰州地区儿童慢性咳嗽的主要病因。在多病因中，上气道咳嗽综合征合并感染后咳嗽是其首位原因。年龄与季节会影响本地区儿童慢性咳嗽构成。随着年份变化，咳嗽变异性哮喘逐渐减少，上气道咳嗽综合征呈明显上升趋势。

BackgroundChildhood obesity is a global public health issue, and the status of clinical practice guidelines (CPGs) as instruction manuals for the management of childhood obesity remains unclear. This study aims to identify and apprise the methodological and reporting quality of CPGs focused on childhood obesity and provide an overview of key recommendations.MethodsDatabases and websites reporting guidelines were searched from January, 2018 to September, 2023. The methodological quality was graded using the AGREE II, and RIGHT was used to assess the reporting completeness.ResultsAmong the six included CPGs, two were rated as high quality and considered "Recommended" and three were reported no less than 80%. CPGs included 184 recommendations cover diagnosis, assessment and management of complications, interventions and prevention. The diagnostic criteria for children with obesity over 2 years of age are based on normative BMI percentiles, depending on sex and age. CPGs recommended the delivery of multi-component behavior-changed interventions included controlling diet and increasing physical activity. Pharmacological interventions and bariatric surgery are considered as complementary therapies.ConclusionCPGs for childhood obesity should emphasize the impact of psychological factors and consider the provision of interventions from multiple settings, and could consider the role of complementary alternative therapies.ImpactSix guidelines have been published in the past 5 years focusing children obesity.Recommendations covered diagnosis, multiple intervention and prevention.Guidelines should focus on the role of complementary alternative therapies.Guidelines should emphasize the impact of psychological factors.Guidelines should consider the provision of interventions from multiple settings.

The objective was this study to investigate the effect of spleen aminopeptide combined with xinxibao on erythrocyte immunity and Toll-like receptors (TLRs) signaling pathways in adjuvant treatment of children with recurrent respiratory tract infections (RRTI). A total of 138 children with RRTI admitted to our hospital from May 2017 to May 2019 were selected as the study subjects and randomly divided into 3 groups with 46 cases in each group. The 3 groups were given conventional treatment. On this basis, control group A was given spleen aminopeptide adjuvant treatment, the control group B was given xinxibao adjuvant treatment, while the observation group was given xinxibao combined with spleen aminopeptide adjuvant treatment. Statistical comparison was made on the clinical efficacy, clinical symptom improvement time and trace element calcium (Ca), zinc (Zn) content, peripheral blood T lymphocyte subsets (CD4+, CD8+), erythrocyte immunity indicators [Cooperative Tumor Erythrocyte Rosette (ATER), Erythrocyte Immune Adherence Enhancing Factor (FEER), Erythrocyte Immune Adherence Inhibiting Factor (FEIR)], Toll -like Receptor 2 (TLR2), Toll-like Receptor 4 (TLR4) level related to the TLRs signaling pathway before treatment, 2 weeks and 4 weeks after treatment. The observation group had higher total effective rate of clinical treatment than the control groups A and B, faster disappearance of high fever, cough, and pulmonary rales than the control groups A and B, showing statistically significant difference (P<0.05); after 2, 4 weeks of treatment, the observation group had higher contents of trace elements Ca and Zn than the control groups A and B, lower TLR2 and TLR4 levels than the control groups A and B, showing statistically significant difference (P<0.05); after 2, 4 weeks of treatment, the observation group had higher ATER, FEER, CD4+, CD4+/CD8+ levels, lower FEIR and CD8+ than the control groups A and B, showing statistically significant difference (P<0.05). It is concluded that the combination of spleen aminopeptide and xinxibao in adjuvant treatment of RRTI can alleviate children's symptoms, enhance peripheral T lymphocyte subsets, erythrocyte immunity, supplement trace element content, regulate TLRs signaling pathway, and further improve the therapeutic effect.

Importance Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infection in children younger than 5 years; effective prevention strategies are urgently needed. Objective To compare the efficacy and safety of monoclonal antibodies for the prevention of RSV infection in infants and children. Data Sources In this systematic review and network meta-analysis, PubMed, Embase, CENTRAL, and ClinicalTrials.gov were searched from database inception to March 2022. Study Selection Randomized clinical trials that enrolled infants at high risk of RSV infection to receive a monoclonal antibody or placebo were included. Keywords and extensive vocabulary related to monoclonal antibodies, RSV, and randomized clinical trials were searched. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was used. Teams of 2 reviewers independently performed literature screening, data extraction, and risk of bias assessment. The Grading of Recommendations, Assessments, Developments, and Evaluation approach was used to rate the certainty of evidence. A random-effects model network meta-analysis was conducted using a consistency model under the frequentist framework. Main Outcomes and Measures The main outcomes were all-cause mortality, RSV-related hospitalization, RSV-related infection, drug-related adverse events, intensive care unit admission, supplemental oxygen use, and mechanical ventilation use. Results Fifteen randomized clinical trials involving 18 395 participants were eligible; 14 were synthesized, with 18 042 total participants (median age at study entry, 3.99 months [IQR, 3.25-6.58 months]; median proportion of males, 52.37% [IQR, 50.49%-53.85%]). Compared with placebo, with moderate- to high-certainty evidence, nirsevimab, palivizumab, and motavizumab were associated with significantly reduced RSV-related infections per 1000 participants (nirsevimab: −123 [95% CI, −138 to −100]; palivizumab: −108 [95% CI, −127 to −82]; motavizumab: −136 [95% CI, −146 to −125]) and RSV-related hospitalizations per 1000 participants (nirsevimab: −54 [95% CI, −64 to −38; palivizumab: −39 [95% CI, −48 to −28]; motavizumab: −48 [95% CI, −58 to −33]). With moderate-certainty evidence, both motavizumab and palivizumab were associated with significant reductions in intensive care unit admissions per 1000 participants (−8 [95% CI, −9 to −4] and −5 [95% CI, −7 to 0], respectively) and supplemental oxygen use per 1000 participants (−59 [95% CI, −63 to −54] and −55 [95% CI, −61 to −41], respectively), and nirsevimab was associated with significantly reduced supplemental oxygen use per 1000 participants (−59 [95% CI, −65 to −40]). No significant differences were found in all-cause mortality and drug-related adverse events. Suptavumab did not show any significant benefits for the outcomes of interest. Conclusions and Relevance In this study, motavizumab, nirsevimab, and palivizumab were associated with substantial benefits in the prevention of RSV infection, without a significant increase in adverse events compared with placebo. However, more research is needed to confirm the present conclusions, especially for safety and cost-effectiveness.

背景支气管哮喘（BA）和阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是困扰儿童健康的两大慢性疾病，合并OSAHS可能使BA病情加重、难以控制，BA又可通过多种机制导致OSAHS的发生或进展，两者关系日益受到关注。目的 探讨儿童BA合并OSAHS的临床特征及影响因素。方法 选取2021年9月至2022年8月在甘肃省妇幼保健院儿童哮喘中心就诊的BA患儿109例为研究对象，根据是否合并OSAHS，分为BA合并OSAHS组（n=49）和单纯BA组（n=60），收集患儿的一般临床资料、肺功能检查、血清炎性细胞因子、25-（OH）D及CRP检测结果，分析BA合并OSAHS患儿的临床特征，并采用多因素Logistic回归分析探讨BA合并OSAHS患儿的影响因素。结果多因素Logistic回归分析结果显示肥胖[OR=4.803,95%CI（1.011,2.822）]、颈围增大[OR=1.318,95%CI（1.003,1.732）]、合并胃食管反流病（GERD）[OR=7.756,95%CI（1.398,43.045）]是BA合并OSAHS患儿的独立危险因素（P＜0.05）;25-（OH）D水平升高[OR=0.830,95%CI（0.757,0.910）]是BA合并OSAHS患儿的保护因素（P＜0.05）。结论 BA合并OSAHS患儿的肺功能指标低于单纯BA患儿，肥胖、颈围、合并GERD、25-（OH）D水平是BA合并OSAHS患儿的影响因素。

Importance:Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infection in children younger than 5 years; effective prevention strategies are urgently needed. Objective:To compare the efficacy and safety of monoclonal antibodies for the prevention of RSV infection in infants and children. Data Sources:In this systematic review and network meta-analysis, PubMed, Embase, CENTRAL, and ClinicalTrials.gov were searched from database inception to March 2022. Study Selection:Randomized clinical trials that enrolled infants at high risk of RSV infection to receive a monoclonal antibody or placebo were included. Keywords and extensive vocabulary related to monoclonal antibodies, RSV, and randomized clinical trials were searched. Data Extraction and Synthesis:The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was used. Teams of 2 reviewers independently performed literature screening, data extraction, and risk of bias assessment. The Grading of Recommendations, Assessments, Developments, and Evaluation approach was used to rate the certainty of evidence. A random-effects model network meta-analysis was conducted using a consistency model under the frequentist framework. Main Outcomes and Measures:The main outcomes were all-cause mortality, RSV-related hospitalization, RSV-related infection, drug-related adverse events, intensive care unit admission, supplemental oxygen use, and mechanical ventilation use. Results:Fifteen randomized clinical trials involving 18 395 participants were eligible; 14 were synthesized, with 18 042 total participants (median age at study entry, 3.99 months [IQR, 3.25-6.58 months]; median proportion of males, 52.37% [IQR, 50.49%-53.85%]). Compared with placebo, with moderate- to high-certainty evidence, nirsevimab, palivizumab, and motavizumab were associated with significantly reduced RSV-related infections per 1000 participants (nirsevimab: -123 [95% CI, -138 to -100]; palivizumab: -108 [95% CI, -127 to -82]; motavizumab: -136 [95% CI, -146 to -125]) and RSV-related hospitalizations per 1000 participants (nirsevimab: -54 [95% CI, -64 to -38; palivizumab: -39 [95% CI, -48 to -28]; motavizumab: -48 [95% CI, -58 to -33]). With moderate-certainty evidence, both motavizumab and palivizumab were associated with significant reductions in intensive care unit admissions per 1000 participants (-8 [95% CI, -9 to -4] and -5 [95% CI, -7 to 0], respectively) and supplemental oxygen use per 1000 participants (-59 [95% CI, -63 to -54] and -55 [95% CI, -61 to -41], respectively), and nirsevimab was associated with significantly reduced supplemental oxygen use per 1000 participants (-59 [95% CI, -65 to -40]). No significant differences were found in all-cause mortality and drug-related adverse events. Suptavumab did not show any significant benefits for the outcomes of interest. Conclusions and Relevance:In this study, motavizumab, nirsevimab, and palivizumab were associated with substantial benefits in the prevention of RSV infection, without a significant increase in adverse events compared with placebo. However, more research is needed to confirm the present conclusions, especially for safety and cost-effectiveness.

儿童哮喘患病率逐年上升,除遗传因素外,室外环境因素也扮演着重要角色.儿童人群肺部尚未完全发育,日益复杂多变的室外空气污染物可通过各种特定机制增加患儿哮喘症状、门急诊次数,引发免疫学紊乱,降低治疗的敏感度.因此,本文对室外空气污染对儿童哮喘的影响及其机制的研究进展进行综述,并对儿童哮喘管理措施进行了总结.

Antibiotic exposure in early life significantly increases the risk of childhood asthma, which is closely related to the dysbiosis and decreased diversity of intestinal and airway microbial flora caused by antibiotics. During birth and early life, the normal microbiota in the body plays an important role in the regulation of immune homeostasis and tolerance in children. Early antibiotic exposure can severely damage the gut and lung microbiota, resulting in dysbiosis and reduced microbial diversity, causing respiratory hyperresponsiveness, leading to high incidence of asthma in children. In recent years, the irrational use of antibiotics has become prominent. This article reviews the effect of early life antibiotics on the development of asthma in children, hoping that pediatricians will apply antibiotics more carefully and rationally to avoid the risk of developing asthma in children due to early exposure.

Background Paediatric pleural tuberculosis (TB) is a paucibacillary disease, which increases the difficulty of examination. We aimed to assess the performance of pleural fluid adenosine deaminase (ADA) in the detection of paediatric pleural TB.Methods PubMed, Web of Science Core Collection, Embase and Cochrane Library databases were searched up to 20 December 2021. We used the bivariate and hierarchical summary receiver operating characteristic models to compute pooled estimates for the overall diagnostic accuracy parameters of ADA for diagnosing paediatric pleural TB.Results Eight studies, including 290 pleural fluid samples, met the inclusion criteria. The pooled sensitivity of ADA was 0.85 (95% CI: 0.78–0.90, I2: 55.63% < 75%) for detecting patients with paediatric pleural TB. A total of 262 pleural fluid samples from four studies were included to differentiate patients with paediatric pleural TB from controls. At a unified cut-off value of 40 U/L, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the summary receiver operating characteristic curve of ADA were 0.89, 0.58, 2.09, 0.20, 10.48 and 0.89, respectively.Conclusions At a cut-off value of 40 U/L, the overall performance of ADA was good for detecting paediatric pleural TB, with relatively high sensitivity and low specificity. Key messageAccurate identification of paediatric pleural TB will help eliminate TB in children. At a cut-off value of 40 U/L, the overall performance of ADA was good for detecting paediatric pleural TB, with relatively high sensitivity and low specificity.

目的 分析兰州地区支气管哮喘儿童常见吸入过敏原种类,探讨国产过敏原皮肤点刺试验(skin prick test,SPT)试剂的安全性.方法 对本院儿童哮喘中心438例支气管哮喘患儿进行过敏原SPT,用变应原溶媒作阴性对照,0.01％磷酸组胺作阳性对照,进而对过敏原检出状况进行分析,观察评价国产SPT试剂的安全性.结果 438例支气管哮喘患儿过敏原SPT总阳性率为69.86％(306/438),兰州地区常见吸入性过敏原前4位分别是大籽蒿花粉(42.2％)、柳树花粉(41.1％)、向日葵花粉(38.4％)、藜属花粉(37.0％).30种过敏原在不同性别间差异无统计学意义(P>0.05).花粉、尘螨、动物皮屑及昆虫在不同年龄段间差异有统计学意义(P<0.05),而霉菌无统计学意义(P>0.05).所有进行SPT的患儿无不良事件(aside effect,AE)发生.结论 花粉是兰州地区儿童哮喘最常见的吸入性过敏原.随着年龄增长,花粉、尘螨、动物皮屑及昆虫过敏越来越多.国产SPT试剂安全性高,有助于儿童支气管哮喘的诊断及治疗.

目的:探讨多排螺旋CT(MDCT)低剂量扫描高分辨率重建在新型冠状病毒肺炎(COVID-19)筛查中的应用价值.方法:选取2020年2月1日～3月1日间就诊的66例疑似COVID-19肺炎患者作为研究对象,将66例患者随机平均分为2组,分别实施胸部常规剂量CT扫描(n=33,120 kV,300 mAs)和胸部低剂量CT扫描(n=33,100 kV,70 mAs),其中常规剂量组采用512×512矩阵,低剂量组采用1 024×1024矩阵.同时对胸部低剂量组用4种不同权重的迭代算法进行处理(30％、50％、70％、90％),对比两种检查模式的辐射剂量和图像质量.结果:低剂量组的有效辐射剂量为(1.81±0.14)mSV,与常规剂量组(6.83±0.68)mSV相比降低73.5％(P＜0.05);采用1 024大矩阵、90％权重迭代算法的低剂量组图像的CNR、SNR均略低于采用512常规矩阵、90％权重迭代算法的常规剂量组,但差异无统计学意义(SNR:5.11±0.75 vs 5.38±0.41,CNR:5.37±0.33 vs 5.44±0.51,P＞0.05);低剂量组患者的肺窗、纵膈窗图像质量主观评分低于常规剂量组,但差异无统计学意义(肺窗:3.30±0.72vs3.39±0.78;纵膈窗:3.15±0.90 vs 3.36±0.82,P＞0.05).结论:使用MDCT进行胸部低剂量扫描,同时采用高分辨率重建技术及90％权重迭代算法可用于COVID-19肺炎筛查,可在保证图像质量的前提下显著降低患者所受辐射剂量.

Human asthma is caused by interactions between a range of genetic and environmental factors. However, the specific pathogenesis of asthma remains controversial. This study explored the contribution of DNA methylation to asthma using computer learning methods. Relevant datasets and information related to patients with asthma were collected from the Gene Expression Omnibus (GEO) database. A multivariate linear regression model was established. Differentially expressed genes and DNA methylation sites were identified. The results showed that the expression of 169 genes was significantly different between the two groups. Through differential analysis of methylation and differential analysis of gene expression, 44 differentially expressed genes that may be affected by DNA methylation modification were identified. The results of the multiple linear regression model showed that DNA methylation could explain 9.81% of the variation in gene expression. Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses showed that the differentially expressed genes, HLA-DMB, IL4, HLA-DPB1, and CD40LG, were related to the occurrence of asthma, and HLA-DMB expression was significantly reduced in allergic asthma. There was a positive correlation between cg04933135 and HLA-DMB expression, and cg04933135 was a differential site for DNA methylation. Using blood samples from asthma patients, we confirmed that HLA-DMB expression is down-regulated, which may be affected by abnormal DNA methylation. DNA methylation plays an important role in the development of asthma, and HLA-DMB which modified by abnormal DNA methylation can be regarded as a new biomarker of asthma.

特异性免疫是现阶段唯一以病因为依据对花粉症进行治疗的方案,多通过皮下注射方式开展.随着医学的不断进步,人们对花粉症的研究也不断深化,临床实验的技术在不断的提高,对花粉症的特异性免疫治疗又有了新的突破.本文章将针对花粉症特异性免疫的治疗方法,如皮下注射、口服、舌下含服和淋巴注射等治疗方式的新进展进行综述,并详细评价各种方法的安全性.

目的 研究维生素AD联合细菌溶解产物胶囊对支气管哮喘患儿的疗效及免疫功能的影响.方法 选择2019年10月～2021年1月收治的200例支气管哮喘患儿,随机分为两组.对照组服用维生素AD滴剂;观察组在维生素AD滴剂的基础上,联用细菌溶解产物胶囊.检测两组患儿的血清免疫球蛋白、白细胞介素-4(IL-4)、γ干扰素(IFN-γ)和IL-5水平.结果 观察组的有效率明显高于对照组(P<0.05);治疗后,两组的血清IgM、IgA和IgG水平明显升高(P<0.05),且观察组的血清IgM、IgA和IgG水平明显高于对照组(P<0.05);治疗后,两组的血清IFN-γ水平明显升高(P<0.05),血清IL-4以及IL-5水平明显降低(P<0.05),且观察组血清IL-4、IFN-γ和IL-5水平明显优于对照组(P<0.05).结论 维生素AD联合细菌溶解产物胶囊能明显改善支气管哮喘患儿的免疫功能,增强疗效.

Background : Asthma can increase the risk of anxiety and abnormal behavior among children but the correlation between anxiety and behavioral abnormalities in children with asthma was unclear. Methods: The Self-Rating Anxiety Scale and the Rutter Children’s Behavior Questionnaire were used to conduct surveys with 337 children aged 6 to 14 years who were diagnosed in the asthma clinic of Gansu Provincial Maternity and Child Care Hospital in Lanzhou, China from January to December 2019. SPSS 22.0 software was used to perform multivariate logistic regression and factor analysis on the items of the anxiety scale to extract different anxiety manifestations. Results : The abnormal behavior rate was 37.1% among the 337 investigated children with asthma. A total of 3 factors were extracted by factor analysis on the 20 items of the anxiety scale, namely mental, sensory, and hand-and-foot manifestations. The 3 factors were divided into 3 groups using tertiles (Q1~Q3). After controlling for sex, age, wheezing history, marital status of parents, caregiver awareness, and caregiver’s home care situation, compared with Q1, the multivariate logistic regression model showed that Q3 had a statistically significant relationship with abnormal behavior, regardless of mental or hand-and-foot manifestation. No connection between Q2 and behavior abnormalities was found. For sensory manifestations, neither Q3 nor Q2 was significantly related to abnormal behavior. Conclusions : Abnormal behavior was related to only severe anxiety among children with asthma. Therefore, psychological intervention should be carried out as early as possible in the treatment of children with asthma to prevent and correct abnormal behavior.

目的 系统评价和分析中性粒细胞CD11b(nCD11b)对新生儿败血症的诊断潜能.方法 对8个医学数据库进行系统检索,包括PubMed、Cochrane library、Embase、Web of science、CNKI、CBM、万方和维普,时间截止到2018年12月,纳入中英文发表的nCD11b对新生儿败血症的诊断试验研究,2名研究人员进行数据提取和质量评价后,采用stata软件进行统计分析.结果 共纳入11个研究合计975例患者.合并敏感度为0.80(95％CI:0.71 ～0.87)、特异度为0.91 (95％CI:0.69～0.98)、阳性似然比为8.80(95％ CI:2.06～37.64)、阴性似然比为0.22(95％CI:0.13 ～0.36)、诊断比值比为39.95(95％ CI:6.04 ～ 264.06)和ROC曲线下面积依次为0.88(95％ CI:0.85 ～0.91).Deek's漏斗图显示发表偏倚可能性较小(P=0.08).结论 目前的证据表明nCD11b对新生儿败血症具有较高的诊断价值和潜力.

目的:分析克拉霉素三联疗法对小儿Hp(幽门螺旋杆菌)阳性消化性溃疡(PU)疾病的治疗效果及不良反应.方法:以本院在2017年4月至2018年7月纳入治疗的96例小儿Hp阳性PU患者为研究对象.分成A组和B组,均是48例.A组给予克拉霉素三联疗法治疗,B组给予阿莫西林三联疗法治疗.对比治疗效果和不良反应情况.结果:A组的治疗总有效率为95.83％,B组为91.67％,对比无显著差异(P>0.05).A组的Hp清除率为95.83％,B组为83.33％,对比有显著差异(P<0.05).A组的不良反应发生率为6.25％,B组为20.83％,对比差异明显(P<0.05).结论:为小儿Hp阳性PU患者行克拉霉素三联疗法治疗可提高Hp清除率,减少不良反应,具有较佳的治疗效果.