目的 通过年龄、性别等多方面研究各亚型注意缺陷多动障碍（ADHD）儿童的智力结构分布特征的临床研究，为ADHD的个体化干预提供科学依据。方法 实验组纳入ADHD儿童754例，其中注意缺陷型（ADHD-I）280例（37.13%）、多动-冲动型（ADHD-HI）212例（28.12%）、混合型（ADHD-C）262例（34.75%），按年龄分为三组：低龄组（6~8岁）、中龄组（9~11岁）及高龄组（12~14岁）；对照组为正常儿童412例，为同期选择的性别、年龄相匹配的儿童。选择采用韦氏智力评估等方法分别对两组儿童进行评估等，对评估结果进行比较和综合分析。结果 ADHD儿童的智力评估结果低于对照组（P＜0.01），且在言语智商方面表现更为明显，在各分测验中以A因子（言语理解）和C因子（记忆/注意集中）为主，而B因子（知觉组织能力）方面则无差异。ADHD-HI型及ADHD-C型的总智商及操作智商均高于ADHD-I型，ADHD-C型言语智商和A因子均高于ADHD-I型（P＜0.01），ADHD-HI型的智力水平最高，而ADHD-I型与ADHD-C型的智力水平差异无统计学意义（P＞0.05）。各年龄段ADHD儿童的智力发育均受到不同程度的影响，尤其是中龄组儿童及高龄组女童所受影响更明显；低、中龄组儿童的智力发育水平均高于高龄组儿童，提示ADHD儿童的智力损害随年龄增长而加重；同一年龄段ADHD女童的智力损害较男童更为严重。结论 本地区6~14岁ADHD儿童的智力水平较低，以言语智商低下更为明显，ADHD-HI型在3个亚型中智力损害最小，ADHD儿童的智力损害随年龄增长而加重，同一年龄段ADHD女童的智力损害较男童更为严重。

   Objective To investigate the distribution characteristics of intellectual structure in children with different subtypes of attention deficit hyperactivity disorder（ADHD）by age and gender，providing scientific basis for individualized treatment and intervention of ADHD．Methods The experimental group consisted of 754 children with ADHD，including 280 cases（37.13%）of inattentive type（ADHD-I），212 cases（28.12%）of hyperactivity impulsive type（ADHD-HI），and 262 cases（34.75%）of combined type（ADHD-C）．They were divided into three groups by age：young group（6-8 years old），middle group（9-11 years old），and older group（12-14 years old）．The control group consisted of 412 normal children with matched sex and age recruited during the same period and had similar sex ratio．The specific methods of Wechsler Intelligence Scale were mainly applied to evaluate normal children and children with ADHD，and the evaluation results were subjected to multidimensional analysis and comparison．Results The intelligence assessment results of ADHD children were significantly lower than those of the control group（P＜0.01），with a more pronounced performance in verbal intelligence．In various sub tests，factors A（verbal comprehension）and C（memory and attention concentration）were the main factors，while there was no difference in factor B（perceptual organization ability）．The ADHD-HI and ADHD-C types had higher total intelligence and operational intelligence than the ADHD-I type，and the ADHD-C type had higher verbal intelligence and factor A than the ADHD-I type（P＜0.01）．The intelligence level of the ADHD-HI type is the highest，while there is no statistically significant difference in intelligence level between the ADHD-I type and the ADHD-C type．The intellectual development of children in different age groups was affected to varying degrees，especially in the middle and older groups of girls．This study found that the intellectual development of children in the young and middle group was higher than that of children in the older group，indicating that the intellectual development of ADHD children will be increasingly damaged with age．At the same time，it was also found that ADHD girls in the same age group had more severe intellectual development impairment than boys．Conclusions The intelligence level of children with ADHD aged 6-14 in this region is relatively low，with verbal intelligence quotient being more pronounced．ADHD-HI has the smallest intellectual impairment among the three subtypes，and the intellectual development of ADHD children becomes more severe with age．ADHD girls in the same age group have more severe intellectual development impairment than boys．

目的 探讨益生菌辅助治疗儿童过敏性哮喘的临床疗效，分析其对Th1/Th2免疫失衡、炎症反应、免疫功能及复发风险的影响。方法 选取2022年1月至2023年12月本院收治的80例过敏性哮喘患儿，按随机数字表法分为对照组和观察组，各40例。对照组接受常规抗哮喘治疗（布地奈德雾化吸入+孟鲁司特钠），观察组结合益生菌进行辅助治疗。比较两组肺功能[第1秒用力呼气容积占预计值百分比（FEV1%）、最大呼气峰流速占预计值百分比（PEF%）]、Th1/Th2细胞因子[干扰素-γ（IFN-γ）、白细胞介素-4（IL-4）、白细胞介素-13（IL-13）]以及治疗总有效率、治疗后6个月内复发率。结果 治疗后，观察组FEV1%、PEF%分别为（87.35±5.21）%、（85.62±4.93）%，高于对照组的（78.44±5.67）%、（76.18±5.20）%（P<0.05）。观察组IFN-γ为（32.58±4.12）pg/mL，高于对照组的（24.36±3.89）pg/mL（P<0.05）；IL-4、IL-13分别为（18.27±3.06）pg/mL、（22.14±3.51）pg/mL，低于对照组的（25.63±3.74）pg/mL、（31.05±4.02）pg/mL（P<0.05）。观察组治疗总有效率为92.50%（37/40），高于对照组的75.00%（30/40）（P<0.05）。随访6个月，观察组哮喘复发率为10.00%（4/40），低于对照组的27.50%（11/40）（P<0.05）。结论 益生菌辅助治疗儿童过敏性哮喘可显著改善肺功能及临床症状，调节Th1/Th2免疫失衡，提高临床疗效，并降低复发风险，值得临床推广。

【摘要】目的：探讨安全-行为双维度管理模式在儿童全麻舒适化口腔治疗中的应用效果。方法：选取2025年4月至2025年12月在本院接受全麻舒适化口腔治疗的80例患儿作为研究对象，根据围术期不同管理方式分为观察组和对照组，每组40例。对照组实施常规围术期管理，观察组实施安全-行为双维度管理模式。对比两组患儿牙科恐惧程度、治疗依从性、苏醒期躁动发生率及家属满意度。结果：术前检查、麻醉诱导、出院时观察组CFSS-DS评分均比对照组低（P＜0.05），FCS评分均比对照组高（P＜0.05）。与对照组苏醒期躁动发生率20.00%对比，观察组5.00%显著降低（P＜0.05）。与对照组家属满意度75.00%对比，观察组95.00%显著升高（P＜0.05）。结论：在儿童全麻舒适化口腔治疗中应用安全-行为双维度管理模式干预，可有效减轻患儿牙科恐惧程度，提高治疗依从性，减少苏醒期躁动发生，提升家属满意度，值得临床推广应用。

【摘要】目的：探究淀粉样蛋白A（serum amyloid?A，SAA）、超敏C反应蛋白（high sensitivity C-reactive protein，hsCRP）、白细胞计数（white blood cell count，WBC）、SAA/hsCRP比值对儿童感染性疾病早期鉴别的临床价值。方法：选取2025年1月--2025年6月我院就诊的感染性疾病患儿296例进行研究，其中细菌感染组86例、病毒感染组180例，另选取同期30例健康体检儿童作为对照组。检测三组SAA、hsCRP、WBC水平，计算SAA/hsCRP比值情况，通过受试者工作特征（receiver operating characteristic curve，ROC）分析各指标单独及联合检测对细菌感染和病毒感染的诊断效能。结果：与对照组比较，细菌感染组和病毒感染组SAA、hsCRP、WBC、SAA/hsCRP比值更高（P<0.05）；与病毒感染组比较，细菌感染组SAA、hsCRP、WBC更高，SAA/hsCRP比值更低（P<0.05）。相关性分析显示，SAA 与 hsCRP、WBC 及 SAA/hsCRP 比值均呈正相关（r=0.417、0.473、0.324，均 P＜0.001）；hsCRP 与 WBC 呈正相关（r=0.408，P＜0.001），与 SAA/hsCRP 比值呈负相关（r=-0.402，P＜0.001）；SAA/hsCRP 比值与 WBC 呈负相关（r=-0.523，P＜0.001）。ROC 曲线分析结果显示，SAA、hsCRP、WBC 及 SAA/hsCRP 比值均可用于儿童细菌感染与病毒感染的鉴别诊断，其 AUC 分别为 0.810、0.879、0.893 和 0.893，联合检测的 AUC 为 0.997，灵敏度为98.80%，特异度为93.89%，诊断效能优于单项指标。结论：SAA、hsCRP、WBC、SAA/hsCRP比值在儿童细菌感染性疾病及病毒感染性疾病鉴别诊断中有一定价值，临床可联合检测上述指标水平以鉴别具体感染类型，为患儿诊断及预后评估提供依据。

目的 分析2016—2024年宜春市5岁以下儿童死亡水平、死因构成、县区分布特征及变化趋势，为制定儿童健康干预策略提供依据。方法 回顾性收集2016—2024年宜春市5岁以下儿童死亡监测资料，统计各年度新生儿、婴儿及5岁以下儿童死亡率，分析死因构成比、顺位变化及县区分布特征，采用线性趋势χ2检验分析死亡率年度变化趋势。结果 2016—2024年宜春市各年龄段儿童死亡率均呈下降趋势（均P＜0.05），新生儿、婴儿、5岁以下儿童9年平均死亡率分别为1.35‰、2.62‰、5.02‰，较2016年分别下降26.79%、43.55%、43.06%。死因顺位整体呈现小幅变迁，肺炎占比逐步下降，溺水、意外窒息等意外伤害相关死因顺位持续前移。各县区死亡率存在差异，高死亡率县区集中在袁州区、奉新县，低死亡率县区以铜鼓县为主。结论 2016—2024年宜春市5岁以下儿童死亡率呈下降趋势，但意外伤害已成为主要死因，县区差异客观存在。应重点加强意外伤害预防工作，针对高死亡率县区实施差异化干预。

      目的 分析儿童大环内酯类耐药重症肺炎支原体肺炎（SMPP）的危险因素,构建列线图预测模型。 方法 回顾性收集2023年1月—2024年9月在广州医科大学附属番禺中心医院儿科住院治疗的1 121例大环内酯类耐药肺炎支原体肺炎患儿入院初期的临床资料。按7∶3比例将患儿资料随机分为训练集（784例）和验证集（337例）。采用R4.4.1软件使用10重交叉验证最小绝对收缩与选择算法（LASSO）回归分析进行单因素变量筛选,采用Logistics回归分析建立预测模型, 绘制可视化列线图。使用受试者操作特征曲线（ROC）, 校准曲线、Hosmer-Lemeshow（HL）检验及临床决策曲线（DCA）分别评估模型的区分度、校准度和临床使用价值。 结果 在训练集中, LASSO回归结合Logistics回归分析结果显示,院前发热时间>5.5 d、谷丙转氨酶>14.5 U/L、乳酸脱氢酶>287.5 U/L、C反应蛋白>18.65 mg/L、肺实变、合并病毒感染是大环内酯类耐药SMPP发生的危险因素（P<0.05）, 根据上述危险因素构建列线图预测模型。训练集和验证集ROC曲线下面积分别为0.847和0.822; 校准曲线和HL检验显示模型具有良好的校准度; DCA显示预测模型在风险阈值为0.05~0.95时预测性能最优。 结论 院前发热时间、谷丙转氨酶、乳酸脱氢酶、C反应蛋白、肺实变、合并病毒感染是大环内酯类耐药SMPP发生的影响因素, 基于以上因素构建的列线图模型具有较好的预测效能, 有利于早期识别耐药重症病例, 及早采取有效干预,改善患者预后。

      Objective To explore the risk factors and to construct a nomogram prediction model for severe macrolide-resistant Mycoplasma pneumoniae pneumonia（MPP）in children．Methods The clinical data during the initial admission period of 1 121 children with macrolide-resistant MPP who were hospitalized in the Department of Pediatrics of the Affiliated Panyu Central Hospital of Guangzhou Medical University from January 2023 to September 2024 were retrospectively collected．The children data were randomly divided into a training set（n=784）and a validation set（n=337）at a ratio of 7∶3．With R language software（version 4.4.1）, least absolute shrinkage and selection operator（LASSO）regression analysis with tenfold cross-validation was used to screen risk factors, Logistics regression analysis was used to establish prediction model, and a visualization of the risk variables was created using a nomogram．The receiver operating characteristic（ROC）curves, calibration curves, Hosmer-Lemeshow（HL）test and clinical decision curve analysis（DCA）were used to evaluate the discrimination, calibration and clinical application value of the model．Results In the training set, LASSO regression analysis combined with Logistics regression analysis showed that prehospital fever duration > 5.5 days, alanine aminotransferase level> 14.5 U/L, lactate dehydrogenase level> 287.5 U/L, C-reactive protein > 18.65 mg/L, lung consolidation, and co-infection with virus were risk factors for severe macrolide-resistant MPP（P<0.05）．A nomogram prediction model was constructed based on the above risk factors．The area under the ROC curves of the training set and the validation set were 0.847 and 0.822, respectively．The calibration curves and HL test showed that the model had good calibration． The DCA curves showed that the prediction model had the best prediction performance when the risk threshold was between 0.05-0.95．Conclusions Prehospital fever duration, alanine aminotransferase level, lactate dehydrogenase level, C-reactive protein level, lung consolidation and co-infection with virus were risk factors for prediction of severe macrolide-resistant MPP．The nomogram model based on the above factors had a good prediction efficiency, which was conducive to early identification of severe cases with macrolide-resistant, and taking early effective interventions to improve the prognosis．

        目的   观察桂枝加芍药汤个体化干预治疗儿童功能性腹痛的临床疗效。方法   选取2023年100名在广东省妇幼保健院门急诊就诊确诊为儿童功能性腹痛患儿。100名儿童随机分为两组，益生菌组50名、益生菌+中药个体化干预组50名。连续治疗1周。记录两组患儿卧立位心率、卧立位血压、Rutter 儿童行为量表和中医临床症状的改善情况。结果   益生菌+中药个体化干预组患儿治疗后卧立位心率和Rutter儿童行为量表中N行为评分比益生菌组下降，中医临床症状评分的有效率优于益生菌组。结论   桂枝加芍药汤个性化干预治疗儿童功能性腹痛疗效显著。

    Objective  To observe the clinical efficacy of individualized intervention with Guizhi plus Shaoyao Decoction in children with functional abdominal pain disorders（FAPDs）．Methods  A total  of  100  children  diagnosed with  FAPDs at the outpatient and emergency departments of Guangdong Women and Children Hospital were selected．These children were randomly divided into two groups：the probiotics group（50 cases）and the probiotics+traditional Chinese medicine individualized intervention group（50 cases）．Both groups received continuous treatment for 1 week．Parameters including  supine/upright heart rates，supine/upright blood pressure，Rutter Children’s Behavior Questionnaire，and improvements in traditional Chinese clinical symptom scores were recorded．Results  The probiotics+traditional Chinese medicine individualized intervention group exhibited significantly greater reductions in supine/upright heart rates and N-behavior scores compared to the probiotics group．The effective rate of Chinese clinical symptom scores was also significantly higher in the individualized intervention group．Conclusions  Individualized intervention of Guizhi plus Shaoyao Decoction has a remarkable efficacy in treating FAPDs in children．

      目的 探讨一种保护型的上肢约束衣在儿童洗胃中的应用。方法   自制并获得实用新型专利“一种保护型的上肢约束衣”，包括背单和两条前襟连接单，三条可调节性约束带，以及下肢延伸固定。选取2023年1月—2023年12月在我院急诊科因急性中毒施行洗胃的患儿为研究对象，依据住院时间，将2023年1月—2023年6月收治患儿为对照组（58例），将2023年7月一2023年12月收治患儿为观察组（58例）。观察组使用本研究发明的保护型上肢约束衣进行约束，对照组则采用传统的约束方法。对两组患儿的洗胃时间、协助人员数量和重复置管次数进行了记录和比较。结果   观察组协助洗胃人数、洗胃时间、重复置管次数分别为1.00（1.00，1.00）人、28.00（26.00，32.00）min、0.00（0.00，0.00）次，均低于对照组的3.00（3.00，3.00）人、32.00（29.00，35.25）min、0.00（0.00，0.00）次，差异有统计学意义（P＜0.05）。结论   儿童洗胃中应用保护型上肢约束衣，能显著减少协助洗胃人数和重复置管次数，缩短洗胃时间，提高了洗胃效率。

       Objective  To explore the application of a protective upper extremity restraint in gastric lavage in children．Methods  A new patent for“A protective upper extremity restraint garment” was designed，which includes a back sheet and two front-flap connecting sheets，three adjustable restraint bands，and an extension fixation of lower extremity．From January 2023 to December 2023，children who underwent acute gastric lavage due to accidental ingestion in the emergency department of a hospital were selected as the research subjects，according to the admission date，the control group（58 cases）was selected from January 2023 to June 2023，and the observation group（58 cases）was selected from July 2023 to December 2023．The observation group was restrained by the protective upper extremity restraint garment，while the control group was restrained by the traditional restraint method．The time of gastric lavage，the number of assistants and the times of repeated intubation were recorded and compared between the two groups．Results  The gastric lavage assistance，lavage time，and number of repeated intubations in the observation group were 1.00［1.00，1.00］person，28.00［26.00，32.00］min，and 0.00［0.00，0.00］times，lower than in the control group（3.00［3.00，3.00］person，32.00［29.00，35.25］min，0.00［0.00，0.00］times），the differences were statistically significant（P＜0.05）．Conclusions  The application of a protective upper extremity restraint suit during pediatric gastric lavage significantly reduces the number of required assistants，decreases repeated intubation attempts，shortens lavage time，and enhances procedural efficiency．

       目的   剖析中医药治疗儿童哮喘的随机对照试验（RCT）结局指标，为中医药治疗该病临床试验的核心指标集构建提供初步依据。方法   检索中国知网（CNKI）、万方（WanFang）、维普网（VIP）、中国生物医学文献数据库（SinoMed）、PubMed、Cochrane Library、EmBase、Web of Science。时间跨度为建库至2024年7月1日。此次检索全面覆盖了中医药疗法治疗儿童哮喘的临床随机对照研究，由两名研究者根据纳排标准独立完成文献筛选和资料提取，提取文献基本特征和结局指标。结果   初步检索出2 449篇文献，最终纳入165个RCT，包括205个结局指标，分为症状/体征、中医症状/证候、理化检查、生活质量评价、远期预后、安全性指标六域。结论   中医药治疗儿童哮喘尚存在中医证候诊断和疗效标准不完善、主要和次要结局指标界限不清等问题，应当构建统一规范且广为认可的核心指标集，以促进儿童哮喘核心指标集的完善。

        Objective  To analyze the outcome indicators of randomised controlled trials（RCTs）of traditional Chinese medicine（TCM）for the treatment of childhood asthma，and to provide a preliminary basis for the construction of a core set of indicators for clinical trials of TCM for the treatment of this disease．Methods  A database search was conducted on China Knowledge Network（CNKI），WanFang，VIP，SinoMed，PubMed，Cochrane Library，EmBase，and Web of Science，covering the period from the establishment of the database to 1 July 2024．The search comprehensively covered clinical randomised controlled studies of TCM therapies in the treatment of childhood asthma，and was completed independently by two investigators who screened the literature and extracted information according to the criteria，and extracted the basic characteristics of the literature and outcome indicators．Results  Initially，2 449 literatures were retrieved，and 165 RCTs were finally included，including 205 outcome indicators，which were classified into six domains：symptoms/signs，TCM symptoms/evidence，physical and chemical examination，quality of life evaluation，long-term prognosis，and safety indicators．Conclusions  Currently，there are problems such as imperfect diagnostic and efficacy criteria for TCM evidence，and unclear boundaries between primary and secondary outcome indicators in the treatment of childhood asthma with TCM．A unified，standardised and widely recognised core indicator set should be constructed to promote the improvement of the core indicator set for childhood asthma．

目的 调查儿童川崎病（KD）冠状动脉损伤发生情况,并进行危险因素分析。方法 选择2018年1月—2022年12月在泉州市妇幼保健院儿童医院诊治的KD儿童782例为研究对象,所有患儿在入院时均给予超声检查,判定冠状动脉损伤情况,调查所有患儿的一般资料,进行危险因素分析。结果 782例患儿中,超声判断为冠状动脉损伤171例,占比21.9%（冠脉损伤组）,无冠状动脉损伤611例（无冠脉损伤组）。冠脉损伤组的皮疹、肢端硬性红肿、球结膜充血、杨梅舌等临床表现占比分别为83.6%、67.8%、86.0%、81.9%,高于无冠脉损伤组的63.5%、49.7%、62.5%、65.3%（P<0.05）。冠脉损伤组与无冠脉损伤组的性别、年龄、血红蛋白、血红细胞沉降率（ESR）等比较差异无统计学意义（P>0.05）,冠脉损伤组的丙氨酸氨基转移酶、白细胞计数（WBC）、D-二聚体（D-D）、C-反应蛋白（CRP）、降钙素原（PCT）、血小板计数（PLT）、发热时间与无冠脉损伤组比较差异有统计学意义（P<0.05）。多因素Logistic逐步回归分析显示,WBC、D-D、CRP、PCT、PLT、发热时间均为川崎病患儿发生冠状动脉损伤的影响因素（P<0.05）。结论 KD儿童中,冠状动脉损伤发生率较高,可导致患儿临床特征多样化,加重患儿的病情,WBC、D-D、CRP、PCT、PLT、发热时间为导致冠状动脉损伤发生的影响因素。

Objective To investigate the incidence of coronary artery injury in children with Kawasaki disease（KD）and analyze the risk factors．Methods From January 2018 to December 2022,782 children with KD diagnosed and treated in Quanzhou Women’s and Children’s Hospital were selected as the study subjects．All the children were given ultrasound examination on admission to determine the coronary artery injury level．The general information of all the children was investigated and the risk factors were analyzed．Results Among the 782 children,171 cases（21.9%）were diagnosed as the“coronary artery injury group”．The remaining 611 patients did not exhibit any coronary artery injury and were thus categorized as the“no coronary artery injury group”．The clinical manifestations incidences of rashes,hard red swelling of extremity,bulbar conjunctival congestion and bayberry tongue in the coronary injury group were 83.6%,67.8%,86.0% and 81.9%,respectively,which were significantly higher than those in the non-coronary injury group（63.5%,49.7%,62.5% and 65.3%,P<0.05）．There were no significant differences in gender,age,hemoglobin and erythrocyte sedimentation rate between the coronary injury group and the no coronary injury group（P>0.05）．There were significant differences in alanine aminotransferase,white blood cell count（WBC）,D-dimer（D-D）,C-reactive protein（CRP）,procalcitonin（PCT）,platelet count（PLT）and fever duration between the two groups（P<0.05）．Multivariate Logistic stepwise regression analysis showed that WBC,D-D,CRP,PCT and PLT were all important factors leading to coronary artery injury（P<0.05）．Conclusions The incidence of coronary artery injury in children with KD is relatively high,which can lead to the diversification of clinical features and disease aggravation of children．WBC,D-D,CRP,PCT,PLT and fever duration are important risk factors for the occurrence of coronary artery injury．