目的 探究阿昔洛韦联合奥卡西平对单纯性疱疹病毒性脑炎伴癫痫患儿的临床疗效及安全性.方法 将我院2014年7月至2018年9月收治的经临床确诊为单纯性疱疹病毒性脑炎伴癫痫的98例患儿随机分为对照组和观察组,每组49例.对照组给予阿昔洛韦联合左乙拉西坦口服液进行治疗,观察组给予阿昔洛韦联合奥卡西平口服混悬液进行治疗.对比分析两组患儿的临床有效率、血清NSE及炎性因子IL-1β、IL-6和TNF-α的表达、患儿的生活质量改善效果以及后遗症复发率.结果 观察组患儿总有效率高于对照组(91.84％vs.65.31％,P＜0.05).观察组患儿治疗后血清NSE及炎性因子IL-1β、IL-6和TNF-α的表达较对照组患儿明显降低,差异有统计学意义(P＜0.05).观察组患儿的日常生活质量评分高于对照组(P＜0.05).此外,观察组患儿出现高热、颅内高压、意识障碍、抽搐和锥体外系反应等后遗症复发率低于对照组(6.12％ vs.30.61％,P＜0.05).结论 阿昔洛韦联合奥卡西平治疗单纯性疱疹病毒性脑炎伴癫痫患儿具有良好的临床疗效,可显著提升患儿的日常生活质量,降低患儿的后遗症复发率.

目的 探讨髓鞘少突胶质细胞糖蛋白(myelin oligodendrocyte glycoprotein,MOG)抗体介导的儿童特发性炎性脱髓鞘病的临床特征,影像学特点、治疗及预后,以期提高对该病的认识.方法 选择2011年5月至2019年3月在湖南省儿童医院神经内科确诊的9例MOG抗体介导的儿童特发性炎性脱髓鞘病患儿的临床特征、影像学检查、治疗情况及随访情况进行回顾性分析.结果 纳入的9例研究对象中,女6例,男3例,男女比例1:2,其中6例临床诊断为ADEM,1例临床诊断为MS,2例临床诊断为ON.5例患者脑脊液白细胞数升高,脑脊液蛋白均正常.MOG抗体经CBA法检测,抗体滴度波动于1:10～1:1000.7例患者有头部MRI异常,脑部受累患者中,多表现为多脑叶受累,以额顶叶受累最为常见,丘脑、基底节、脑干、小脑及胼胝体亦常受累.4例患者有脊髓MRI异常,胸髓、颈髓受累,无腰髓受累.2例患儿视神经MRI有异常.9例患者经静脉激素联合丙种球蛋白冲击治疗,8例临床症状完全恢复,但1例患儿出现多次临床复发.结论 MOG抗体介导的儿童特发性炎性脱髓鞘病在儿童期以急性播散性脑脊髓炎最常见,临床表现多样,多有脑病症状及视觉症状,脊髓症状亦多见,影像学主要表现为多部位受累,急性期静脉激素联合丙种球蛋白冲击治疗有效,临床预后大多良好,但亦可见多次临床复发病例.

目的 探讨自身免疫性脑炎(AE)患儿癫痫发作特点及抗癫痫药物的治疗效果.方法 收集2014年1月-2018年12月在本院神经内科住院的有癫痫发作且诊断为自身免疫性脑炎患儿62例,其中男34例,女28例,就诊年龄为6个月～13岁6个月,平均年龄7岁8个月.总结分析患儿癫痫发作特点、头部MRI、视频脑电图、血及脑脊液抗神经元抗体检测、使用的免疫疗法及抗癫痫药物类型、治疗结果等.结果 所有患儿中有34例(54.84％)患儿以癫痫发作为首发症状;13例患儿为全面性强直阵挛发作,27例为局灶性发作,18例为局灶性进展为双侧强直-阵挛,2例为局灶起源自主神经发作,1例为失神发作,1例为痉挛发作.62例患儿中局灶性起源发作共47例(75.81)％.有24例(38.71％)患儿有癫痫发作持续状态,16例(25.81％)有频繁的簇状发作.所有患儿明确诊断后均给予了免疫治疗(免疫球蛋白联合激素),23例单用免疫治疗后癫痫发作控制.39例患儿联合了口服抗癫痫药物治疗,其中21例用了1种抗癫痫药物,13例用了2种抗癫痫药物,5例用了3种抗癫痫药物.首选抗癫痫药物主要为奥卡西平.结论 癫痫发作是AE最突出的症状,多表现为部分性发作并快速进展为癫痫持续状态(SE)或严重的簇状发作.对于有癫痫发作的AE患者,主要依靠免疫治疗,并建议依据癫痫发作的类型,合理选用抗癫痫药物联合治疗.

目的:研究左乙拉西坦添加治疗对小儿癫痫患者认知功能及阵挛发作频率的作用.方法:随机选取2014年1月～2016年1月于湖南省儿童医院就诊的小儿癫痫患者88例,按照入院治疗的顺序分为观察组(44例)与对照组(44例).对照组患儿给予常规的抗癫痫治疗,观察组患儿则在此基础上添加左乙拉西坦治疗,对比两组患儿的治疗效果以及治疗后的认知功能状况.结果:观察组患儿的治疗总有效率、控制率均显著高于对照组患儿(P＜0.05);两组治疗后日常生活能力评定(Barthel)指数评分明显高于治疗前,且观察组Barthel的70.45(±7.89)指数评分明显高于对照组的54.53(±9.21),差异均有统计学意义(P＜0.05).观察组患儿治疗后的认知功能显著高于对照组患儿(P＜0.05).结论:采用左乙拉西坦添加治疗能够明显减少小儿癫痫患者的阵挛发作频率,并且能够明显提高小儿患者的认知功能,具有临床推广价值.

目的 探讨自身免疫性脑炎(AE)患儿的临床鉴别诊断以及治疗.方法 选择湖南省儿童医院儿科2011年至2016年4月收治的50例AE患儿作为研究对象,采用回顾性分析法对其临床鉴别诊断及治疗进行分析.结果 50例患者中抗电压-门控钾通道(VGKC)脑炎10例,抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎8例,边缘叶脑炎32例;3组在临床特征、核磁共振(MR)检查、脑脊液检测、免疫肿瘤治疗效果指标检测等方面均存在差异性,可以用这些指标进行AE的临床鉴别诊断.分析入选患儿的治疗和预后结果显示,其中预后良好13例,复发8例,继发癫痫16例,有认知障碍9例,有精神障碍4例.结论 AE的分类较广,其发病原因较广,需要辅助临床特征、MR检查、脑脊液检测、免疫肿瘤治疗效果指标检测等方法对其进行临床鉴别诊断,进而实施针对性的治疗,以提高AE的治疗效果.

目的 观察分析左乙拉西坦治疗小儿癫痫的临床疗效和安全性.方法 选取我院2014年1月至2016年1月收治的癫痫患儿200例,随机分为观察组和对照组各100例.对照组给予丙戊酸钠治疗,观察组给予左乙拉西坦治疗.观察两组患儿的治疗效果及不良反应发生情况.结果 观察组患儿的临床治疗总有效率为95.0％,显著高于对照组的77.0％,差异具有统计学意义(P＜0.05);两组不良反应发生率比较差异无统计学意义(P＞0.05).结论 采用左乙拉西坦治疗小儿癫痫,有利于缓解患儿的临床症状,提高治疗总有效率,不良反应发生率低,安全可靠.

目的 研究高压氧结合药物综合治疗小儿病毒性脑炎的临床疗效及实验室指标的变化情况.方法 选择2011年3月至2016年3月在湖南省儿童医院就诊的病毒性脑炎患儿153例作为研究对象,随机分为观察组77例和对照组76例.对照组患儿给予抗病毒、退热、镇静、止吐、营养支持等药物综合对症治疗;观察组患儿在对照组治疗的基础上结合高压氧治疗,每日1次,连续治疗7 d为1个疗程.连续进行3个疗程后,对两组患儿的临床疗效及实验室指标的比较,如患儿血管内皮生长因子、可溶性血管细胞黏附因子1、β-内啡肽以及髓鞘碱性蛋白的检测结果比较等.结果 观察组的临床总有效率为94.81%(73/77),显著高于对照组82.89%(63/76),差异有统计学意义(P<0.05).观察组患儿经治疗后其血管内皮生长因子、可溶性血管细胞黏附因子1、β-内啡肽和髓鞘碱性蛋白的检测值与观察组治疗前、对照组治疗后先比显著降低,差异有统计学意义(P<0.05).结论 高压氧结合药物综合治疗小儿病毒性脑炎较单纯药物对症治疗具有更好的临床治疗效果,更利于患儿病情的恢复,该治疗方案值得在临床上推广和应用.

目的 探讨自身免疫性脑炎相关癫痫对于儿童认知功能所带来的影响效果.方法 选取我院2012年1月至2016年1月收治的50例自身免疫性脑炎相关癫痫患儿作为研究组,另选同期50例健康体检儿童作为对照组,在两组受试者家属均已经了解研究方案内容后对其认知功能进行测定和比较.结果 研究组IQ评分(78.22±8.38)分、MQ评分(69.45±6.85)分、DQ评分(0.38±0.05)分,而同期对照组分别为(124.20±8.40)分、(90.12±6.98)分、(0.08±0.02)分,组间比较差异具有统计学意义(P＜0.05).结论 自身免疫性脑炎相关癫痫可给患儿认知功能带来严重损害,必须予以足够重视并采取积极的治疗措施,为儿童认知功能提供保障.

目的：探讨病毒性脑炎患儿脑脊液和血清S-100B蛋白含量变化与其在脑损伤中的评估价值。方法将50例病毒性脑炎患儿分为轻型组（35例）与重型组（15例）。采用酶联免疫吸附试验双抗体夹心法检测50例病毒性脑炎患儿和46例对照组患儿脑脊液和血清中的S-100B蛋白含量，并进行动态观察。结果（1）脑炎组患儿血清S-100B蛋白含量高于对照组，重型组的脑脊液和血清S-100B蛋白含量高于轻型组。（2）病毒性脑炎患儿脑脊液和血清中S-100B蛋白的变化随着的病情的好转而逐渐降低。结论 S-100B蛋白可作为病毒性脑炎患儿脑损伤的标志物，有助于病情严重程度的判定的疗效的观察。

Retinopathy of prematurity (ROP) is a kind of abnormal neovascularization and fibrous tissue proliferation retinopathy in premature and low birth weight infants.It is regarded as one of the important diseases causing visual impairment in children,which can lead to permanent visual loss.A large number of domestic and foreign study found that ROP affected retinal development and function,mainly affected the tight-sensitive cells,and clinical study found that the retinal dysfunction even early controlled,usually following the ametropia,especially myopia.Recent studies have found that oxygen induced retinopathy (OIR) retinal dysfunction may be related to the release of dopamine (DA) and the changes in the activity of DA.Studies found that ROP early myopia and the high incidence of myopia in children with ROP were close ly related to the effect of ROP on the secretion and release of dopamine in the retina.Therefore,discussing the role of DA in ROP myopia will provide a new way of thinking for the prevention and treatment of myopia in children with ROP.

目的 评价小儿结核性脑膜炎(TBM)的临床、实验室和影像学特征,为诊断和判定TBM预后提供科学依据.方法 收集55例诊断为TBM患儿的年龄、性别、结核病史、入院前症状持续时间(＞5 d)、临床症状、临床分期、实验室检测数据、胸部X线片、头颅CT或MRI改变及预后等临床资料进行回顾性分析.结果 55例患儿年龄1.5～12.0岁,平均年龄(5.32±2.98)岁,＜6岁38例(69.09％).临床特点:有结核病史33例(60.00％);TBM临床表现分期为Ⅱ或Ⅲ期46例(83.64％),入院前症状持续时间(DSBA)＞5 d 47例(85.45％).除死亡8例(14.54％)外,余均给予至少6个月的抗结核治疗.评价疗效:正常8例(14.54％)、轻微后遗症23例(41.82％)和严重后遗症l6例(29.09％).单因素分析:结核病史、精神症状、抽搐、年龄、局部神经功能障碍、临床表现分期为Ⅱ和Ⅲ期、头颅CT和MRI改变是预后不良的相关影响因素.多因素Logistic回归分析表明:临床表现分期为Ⅲ期,头颅CT和MRI有改变的患儿预后较差.结论 TBM患儿临床症状特异性差,确诊时已合并脑损伤,尤其是临床分期晚、颅内有病变的患儿预后较差,早期诊断和治疗可显著改善预后.

Objective To studied the protein and mRNA level of the disrupted-in-schizophrenia 1 ( DISC1 ) in the hippocampus of epileptic mice induced by pilocarpine and its effect on epilepsy .Methods Two hundreds and six male C57BL/6 mice were randomly diveded into experimental group (n=198) and control group (n=48),the mice in experimental group were given small dosage of pilocarpine to set up the epileptic mice model .Expression of DISC1 and minichromosome maintenance protein 2 ( MCM2 ) in the hippocampus of two groups were analysed via immunohistochemistry and real-time PCR at different time points (3,7,14,28 d) after status epilepticus.Results Compared with the control group ,the quantity of MCM2 posotive cells and MCM2 mRNA in experimental group were significant increased at each time point (P<0.05-0.01), which appeared a decreasing tendency in control group (all P<0.05).Compared with the control group, the expression level of DISC1 and DISC1 mRNA at dentate gyrus and CA3 area in experimental group were significantly lower from 7 d(P<0.05-0.01).A significant correlation existed between the expression level of DISC 1 and MCM2 according to Pearson correlation analysis ( P<0.01 ) .Conclusion DISC1 may participate in the pathogenesis of epilepsy by mediating the proliferation of new neurons .

目的：探讨不同的手术方式对先天性下睑内翻倒睫的疗效。方法选择3～12岁的儿童453例（894只眼）。其中单侧12例，双侧441例；原发性438例，15例为缝线法术后复发患儿。根据症状及体征采用不同术式，全部患儿均在全麻下手术。结果358例内眦部轻至中度内翻倒睫患儿选择采用下睑穹窿皮肤缝线术，治愈211例，好转132例，未愈15例，有效率95．81％；53例重度下睑内翻倒睫、下睑皮肤堆积明显者，选择部分皮肤＋眼轮匝肌切除术，治愈48例，好转5例，有效率100％；42例下睑内翻倒睫合并内眦赘皮患儿选择采用内眦赘皮矫正＋部分皮肤＋眼轮匝肌切除术，治愈38例，好转4例，有效率100％。结论应根据病情选择不同术式矫正下睑倒睫，下睑穹窿皮肤缝线术是轻度至中度先天性下睑内翻倒睫的首选术式，但术后有一定的复发率。重度下睑内翻倒睫或伴有内眦赘皮的患儿，应直接选择部分皮肤＋眼轮匝肌切除术或联合内眦赘皮矫正术。

Objective To report our experience of retinopathy of prematurity (ROP) in Hunan Children’s Hospital (HNCH), central south of China over a 8-year period. Methods A retrospective review was made for all premature infants with a diagnosis of ROP at HNCH between 2006 and 2013. The annually ROP and severe ROP incidence, blindness rate, complications of cryotherapy and laser surgery were collected and risk factors of ROP were analyzed. Results 2512 infants were diagnosed ROP. Surgery was done in 536 infants. There was no difference of the incidence of ROP between male and female, >0.05. The incidence of ROP in BA<32w infants higher than BA≥32w, <0.05,BW<1500g infants higher than BW≥1500g, <0.01,multiple birth infants high-er than single birth infants, <0.05. ROP incidence and blindness ROP rate decreasing annually. Laser with low risk and better than cryotherapy but need more repeated surgery. Conclusions Low BW, low BA and multiple births are high risk factors for ROP. Timely screening and surgery intervention decrease the blindness rate of ROP. Laser surgery with good outcome and lower risk than cryotherapy.

Abstract?AlM: To evaluate the visual impairment in cerebral palsy children with series objective indicators, and conclude their clinical features of visual function.? METHODS: Objective tests including following pursuing test, optokinetic nystagmus(OKN) drum test, refractive error examination, fundus examination, ocular deviation examination, pattern visual evoked potential ( P-VEP ) tests and brain magnetic resonance imaging ( MRl) were carried out in 43 cerebral palsy children ( 86 eyes ) with ocular visual dysfunction; The visual impairment data of the cerebral palsy children were collected, and the clinical features and possible mechanism were analyzed.?RESULTS: 1. Of the 43 cerebral palsy children ( 86 eyes) with the visual impairment presented diversified, 25 ( 50 eyes, 58. 1%) of refractive error, 24 ( 48 eyes, 55. 8%) of strabismus, 12 ( 24 eyes, 27. 9%) with nystagmus, 19 ( 38 eyes, 44. 2 %) of optical nerve atrophy or hyperplasia, 35 ( 70 eyes, 81. 4%) of VEP abnormality. Among children with spastic cerebral palsy, the incidence of visual impairment was statistically significant difference compared with other groups (P<0. 01). 2. There were 16 cases (32 eyes,37. 2%) with esotropia, 6 cases ( 12 eyes, 14. 0%) with exotropia and 2 cases ( 4 eyes, 4. 7%) with vertical deviation. Strabismus was most common in spastic cerebral palsy children, totally 13 (26 eyes, 30. 2%) with esotropia, and exotropia was common in hypotonia and other types cerebral palsy children; 3. 23 ( 46 eyes, 53. 5%) with hyperopia, 8 ( 16 eyes, 18. 6%) with myopia, 16 ( 32 eyes, 37. 2%) with astigmutism and 14 cases (28 eyes, 32. 6%) with anisometropia;4. Cerebral palsy children were usually with decreased VEP amplitude and prolong latency, and poor wave formation, mostly in spastic cerebral palsy children; 5. Visual abnormality was most common in occipital cortex damage and periventricular leukomalacia ( PVL ) . The incidence in PVL and occipital cortex had no statistically significant difference ( P > 0. 05 ), no nystagmus in patients with severe occipital cortex damage.?CONCLUSlON: Cerebral palsy children were usually with visual impairment, and presented with special clinical features; Comprehensive objective visual tests are accurate and reliable for evaluation of the visual function in cerebral palsy children.

Retinopathy of prematurity(ROP)is an important cause of infant blindness and visual impairment in the world, of which main clinical characteristics are peripheral retinal vascular abnormalities, including large non-perfusion area and abnormal neovascularization. Numerous researches have demonstrated that ROP affects the differentiation and maturity of retinal photoreceptor cells, with more significantly effect on rods than cones, and later mostly caused ametropia, strabismus, amblyopia and a series of abnormal visual functions, the specific mechanism remains unclear. After treatments, even the retinal vascular proliferation lesions disappear itself, but the abnormal development of photoreceptor cells and the resulting visual dysfunction will persist. Currently the best evaluation mean of clinical assessment about retinal function is mainly visual electrophysiology, especially flash electroretinogram(f-ERG), which can reflect the whole retinal functional status before ganglion cells, has a unique significance for the evaluation of retinal photoreceptor cells function. In this review, we aims at the development of neural retina(mainly photoreceptor cells)and its related mechanisms, also the visual function changes appeared in the late period about ROP and its mechanisms, guiding us to pursuit better methods for treatment.

Objective To retrospectively analyze "exudative change"of ocular fundus examined by RetCam II .[Methods] The overall fundus photography with RetCam II after mydriasis under superficial anesthesia were per-formed in 12186 infants for screening out fundus "exudative change".Cases were counted for obtaining the per-centage .[Results] Fundus "exudative change"of 489 patients(4 .01% ) were found .The punctiform effusion was the most common .In eye diseases ,there were 202 retinopathy of prematurity (ROP)(41 .31% ) ,12 familial exuda-tive vitreoretinopathy (2 .45% ) ,8 Coats disease(1 .64% ) and 2 Norrie disease(0 .40% ) .In original diseases ,there were 176 cytomegalovirus infection(36 .00% ) ,10 neonatal asphyxia(2 .04% ) ,8 anemia(1 .64% ) ,8 septicemia (1 .64% ) and 63 other diseases(12 .88% ) .[Conclusion]"Exudative change" not only occurs in eye diseases ,but also occurs in children with systemic diseases .Because infants do not cooperate the examination ,RetCam II is the best choice in order to avoid the missing of peripheral retinopathy .

Objective To evaluate the retinal function by full-field flash electroretinogram (F-EGR) in children with history of pre-threshold or threshold ROP. Methods 24 children (48 eyes) with history of pre-threshold or threshold ROP and 10 children (20 eyes) with a history of premature birth but without ROP were examined by F-ERG. The latency and amplitude of a-wave and b-wave of various responses were analyzed. Results There was significant difference between ROP and control group in rod response, P<0.05, the latency was longer and the amplitude was low-er in ROP group. But there was no difference between ROP and control group in cone response, P>0.05. Conclusions The retinal function of ROP children are abnormal, which mainly in rod response. F-ERG is useful to evaluate retinal function in ROP children.

目的 分析儿童细菌性角膜炎病原菌构成,比较0.5％左氧氟沙星与0.3％氧氟沙星治疗儿童细菌性角膜炎的临床疗效及治愈时间的差异,以期为临床用药提供参考.方法 选取2010年2月-2012年5月诊断为细菌性角膜炎的患儿160例,随机分成两组,每组各80例,前60例为主要研究对象,后20例为备选研究对象,分别给予0.5％左氧氟沙星(试验组)和0.3％氧氟沙星(对照组)滴眼液进行治疗并做细菌培养,观察两组的疗效、治疗时间和不良反应.结果儿童细菌性眼内炎以革兰阳性菌感染为主占79.6％,其中以表皮葡萄球菌居首位,两组分别占51.7％、56.7％,其次为金黄色葡萄球菌,两组分别占25.0％、26.7％;左氧氟沙星和氧氟沙星治疗儿童细菌性眼内炎的疗效差异无统计学意义;治疗7d内的治愈率氧氟沙星为43.3％、左氧氟沙星为63.3％,左氧氟沙星显著高于氧氟沙星治疗组(P=0.03);两组不良反应率分别为8.3％和10.0％,主要为眼部刺痛,差异无统计学意义.结论 0.5％左氧氟沙星滴眼液可以有效治疗儿童细菌性角膜炎,并且可以缩短治疗时间.

AIM: To analyze the prognosis and influencing factors of retinopathy of prematurity (ROP). METHODS: The prognosis of 145 ROP cases treated in our hospital from September 2011 to September 2012 was recorded (110 males, 35 females). Gestational weeks, birth weight, time of oxygen, oxygen [continuous positive airway pressure (CPAP) or mechanical ventilation], pulmonary surfactant, septicemia were statistically analyzed between surgical group and non-surgical group. RESULTS: A total of 145 cases of retinopathy of premature were all in stage 1 to 3, no cases in 4 to 5 stage. Thirty-six cases (24.8%) had undergone the laser and/orcryocoagulation. ROP regressed completely or were stable before prethreshold lesions without surgery in 109 cases (75.2%). Using the Chi-square test, multivariate logistic regression analysis, it showed that gestational age, time of oxygen, CPAP or mechanical ventilation and septicemia were associated with ROP outcome, with the statistically significant difference. Gestational age, oxygen, septicemia were progression factors of ROP, which was significant difference between groups. CONCLUSION: Most of ROP degenerated or were stable without surgery.Gestational age, mechanical ventilation or CPAP, oxygen for a long time, septicemia could aggravate ROP and increase the probability of surgery.