目的 比较肺炎支原体肺炎(MPP)、非MPP患儿和健康儿童的免疫球蛋白、补体水平,以探讨儿童MPP体液免疫指标的变化规律。方法 分别检测52例MPP、55例非MPP患儿和33例健康儿童的血清免疫球蛋白(IgG、IgA、IgM)、补体(C3、C4),并比较儿童MPP急性期和恢复早期体液免疫指标。结果 MPP组急性期血清IgM、C3、C4水平高于非MPP组急性期和健康儿童(P<0.05)。儿童MPP恢复早期IgM水平高于急性期,C4水平低于急性期(P<0.05)。结论 与非MPP和健康儿童比较,MPP患儿存在明显体液免疫功能紊乱,从急性期到恢复早期,血清IgM逐渐升高,补体C4先升高后降低,自身免疫反应可能参与了儿童MPP的发病过程。
Objective To investigate the changes of serum immunoglobulins and complement in children with mycoplasma pneumoniae pneumonia (MPP). Methods 52 children with MPP, 55 children with non-MPP and 33 healthy children were enrolled. The levels of serum immunoglobulins (IgG, IgA and IgM) and complements (C3, C4) were detected. Results Compared with the non-MPP group and healthy control, the levels of IgM, C3 and C4 in MPP group during their acute phase were significantly higher (P<0.05). And among the MPP group the levels of IgM were hisher and C4 were lower than that in the acute phase. Conclusion Immune function disturbance exists in children with MPP. From acute to recovery stage, the level of IgM increased while C4 increased firstly and then decreased. Immune injury may be involved in the pathophysiology of childhood MPP.
目的 利用可视化软件CiteSpace分析近20年儿童注意缺陷多动障碍（ADHD）及其共患病的相关文献,得出该领域的研究现状和发展趋势,为儿童注意缺陷多动障碍及其共患病的研究和诊疗提供参考。方法 检索2004—2024年发表在中国知网、维普、万方数据库关于儿童注意缺陷多动障碍及其共患病的相关文献,运用CiteSpace软件对纳入文献进行可视化分析,对来源、机构、发文量、作者、关键词绘制科学知识图谱。结果 共纳入383个机构、500个作者、235种期刊、577篇有效文献。自2012年发文量总体上呈波动上升趋势;在发文来源中,《中国儿童保健杂志》以47篇居首;研究机构以北京大学精神卫生研究所为代表;王玉凤作者发文21篇为最多;ADHD患儿的主要共患病为抽动障碍、癫痫、对立违抗障碍、学习障碍;主要治疗药物为托莫西汀;主要影响患儿的执行功能。ADHD患儿共患病研究分为3个阶段,第一阶段为2004—2009年,研究对象主要为品行障碍、对立违抗障碍、学习障碍、焦虑障碍,主要研究内容为患儿的脑损伤与基因;第二阶段为2009—2017年,重视研究患儿的心理问题,如焦虑、抑郁,也重视患儿的生活及家庭环境;第三阶段为2017—2024年,重点研究托莫西汀、阿立哌唑等药物,并重视ADHD共患癫痫的研究。结论 目前对ADHD共患病的研究仍较为局限,主要集中研究共患抽动障碍、对立违抗障碍、癫痫,未来应重视研究其他共患病,进一步探索更好的诊治方法。
Objective To analyze the literature on attention deficit hyperactivity disorder（ADHD）and its comorbidities in children in the past 20 years by using the visualization software CiteSpace, and to obtain the research status and development trend of this field, so as to provide reference for the research, diagnosis and treatment of ADHD and its comorbidities in children. Methods The relevant literature on ADHD and its comorbidities in children published in CNKI, VIP and Wanfang data bases from 2004 to 2024 was searched, and the included literature was visually analyzed by CiteSpace 6. 2R6 software, and the scientific knowledge graph was drawn by the source, institution, number of publications, authors and keywords. Results A total of 383 institutions, 500 authors, 235 journals, and 577 valid articles were included. Since 2012, the number of published documents has fluctuated and increased. Among the sources of publication, the Chinese Journal of Child Health ranked first with 47 articles. The research institutions were represented by the Institute of Mental Health of Peking University. Wang Yufeng was the most prolific author with 21 articles. The main comorbidities of ADHD children were tic disorder, epilepsy, oppositional defiant disorder and learning disorder. The main treatment drug was tomoxetine. It mainly affects the executive function of the children. The study on comorbidity in children with ADHD was divided into three stages. The first stage was from 2004 to 2009. The research objects mainly included conduct disorder, oppositional defiant disorder, learning disorder and anxiety disorder, and the main research content was brain injury and genes in children. The second stage, from 2009 to 2017, focused on the psychological problems of children, such as anxiety and depression, and also paid attention to the life and family environment of children. The third stage was 2017-2024, focusing on tomoxetine, aripiprazole and other drugs, and paying attention to the study of ADHD co-induced epilepsy. Conclusions The current research on ADHD and its comorbidities is still limited, and its pathogenesis should be explored in the future, so as to quickly and accurately identify comorbidities and further study better treatments.
儿童孤立性直肠溃疡综合征（SRUS）是一种较为罕见的慢性直肠疾病,儿童发病率低且缺乏明确统计学数据。该病主要表现为便血、排黏液便和排便不尽感,临床诊断较为困难,常易误诊为其他疾病。其发病机制尚不明确,可能与排便习惯异常、直肠黏膜异常、血管异常以及遗传易感性等多种因素有关,其中 CHEK2 基因的 p.H371Y 突变可能在发病机制中起关键作用。诊断需综合病史、体格检查以及排粪造影、超声内镜、肠镜检查与组织病理活检等多种辅助检查手段。治疗上目前尚无统一指南,主要包括改善饮食和排便习惯、生物反馈治疗、药物治疗、内镜下治疗和外科手术治疗等,但总体治疗难度较大且复发率较高。本文对儿童 SRUS 的流行病学、发病机制、临床表现、诊断和治疗等方面的研究进展进行综述,旨在提高临床医师对该病的诊疗水平,为未来进一步的研究提供参考依据。
Solitary rectal ulcer syndrome（SRUS）in children is a chronic and benign disease of the rectum characterized by ulcers. The clinical incidence of SRUS in children is not high, but it is prone to misdiagnose and miss diagnosis,which can delay the optimal treatment opportunity. This article reviews the research progress on the epidemiology,pathogenesis, clinical manifestations, diagnosis and treatment of SRUS in children, aiming to improve the diagnostic and therapeutic level of clinicians.
目的 探讨支气管镜灌洗用于儿童重症肺部感染合并肺实变的治疗效果及对CT特征、肺功能的影响。方法 选取2022年5月—2024年5月铜仁市人民医院收治的100例重症肺部感染合并肺实变患儿开展前瞻性研究，应用随机数表法分为对照组和观察组，每组各50例。对照组患儿采取常规治疗，观察组则采取常规治疗加支气管镜灌洗治疗。对比其临床疗效，治疗前后炎症因子、CT特征及肺功能变化。结果 观察组治疗总有效率高于对照组（P＜0.05）；治疗后观察组患儿白细胞计数（10.36±2.52）×109 /L、白细胞介素-6（20.57±5.05）ng/L、C反应蛋白（13.12±2.64）mg/L、降钙素原（101.62±12.16）pg/L均低于对照组白细胞计数（13.25±3.32）×109 /L、白细胞介素-6（31.69±4.11）ng/L、C反应蛋白（16.16±4.44）mg/L、降钙素原（113.46±18.11）pg/L（P＜0.05）；治疗后两组患儿胸腔积液、支气管壁增厚、空气支气管征、肺部实变、磨玻璃影等相关CT影像特征占比下降，且观察组低于对照组（P＜0.05）；治疗后两组患儿呼气流量峰值水平均升高，观察组（90.67±18.45）L/s高于对照组（81.27±17.69）L/s，用力肺活量水平均更高，观察组（3.33±0.68）L高于对照组（2.68±0.25）L（P＜0.05）。结论 针对儿童重症肺部感染合并肺实变，在常规治疗基础上增加支气管镜灌洗可提升临床疗效，减轻机体炎症反应，改善胸部CT各种表现及肺功能。
Objective To explore the therapeutic effects of bronchoalveolar lavage in children with severe pulmonary infection complicated by lung consolidation and its impact on CT features and pulmonary function．Methods A prospective study was conducted on 100 children with severe pulmonary infection complicated with pulmonary consolidation in a hospital from May 2022 to May 2024．They were randomly divided into observation group and control group using a random number table method，50 cases in each group．The control group of children received routine treatment，and the observation group received conventional treatment plus bronchoalvelar lavage．Clinical efficacy，inflammatory factors，CT features，and alterations in pulmonary function before and after therapy were compared．Results The total effective rate of the observation group was higher than that of the control group（P＜0.05）．After treatment，the white blood cell count（10.36±2.52）×109 /L，interleukin-6（20.57±5.05）ng/L，C-reactive protein（13.12±2.64）mg/L，and procalcitonin（101.62±12.16）pg/L in the observation group were all lower than those in the control group（13.25±3.32）×109 /L，interleukin-6（31.69±4.11）ng/L，C-reactive protein（16.16±4.44）mg/L，and procalcitonin（113.46±18.11）pg/L（P＜0.05）．After treatment，the proportion of CT imaging features such as pleural effusion，bronchial wall thickening，air bronchogram sign，lung consolidation，ground glass opacities，decreased in both groups of children，and the observation group was lower than the control group（P＜0.05）．After treatment，the peak levels of expiratory flow in both groups of children increased，with the observation group（90.67±18.45）L/s higher than the control group（81.27±17.69）L/s．The forced vital capacity levels were also higher，with the observation group（3.33±0.68）L higher than the control group（2.68±0.25）L（P＜0.05）．Conclusions Adding bronchoalvelar lavage to routine treatment for children with severe pulmonary infection complicated with pulmonary consolidation can improve their clinical efficacy，alleviate inflammatory reactions，and improve various chest CT manifestations and lung function．
目的 回顾分析高原地区儿童阑尾炎术后早期炎性肠梗阻的临床特征，总结治疗经验。方法 回顾分析青海省妇女儿童医院2019—2023年收治的49例儿童阑尾炎术后早期炎性肠梗阻病例资料。结果 纳入研究的49例患儿，阑尾炎发病时间3～8 d，平均（5.38±1.25）d，术后出现肠梗阻时间3~11 d，平均时间（4.81±1.70）d，其中48例经过保守治疗后梗阻解除，恢复排气、排便，肠功能恢复时间4~13 d，平均（5.93±2.49）d，1例经积极保守治疗后病情进展，最终经手术治愈。49例患儿均顺利治愈出院，住院时间10～26 d，平均（15.69±3.79）d。术后随访1～2年，患儿饮食、排便均无异常。结论 高原地区儿童阑尾炎术后早期粘连性肠梗阻预防是关键，采取保守治疗同样可获得较高的治愈率，若保守治疗无效或病情进展应及时积极采取手术治疗。
Objective To review the clinical characteristics of early postoperative inflammatory small bowel obstruction（EPISBO） in children with appendicitis in plateau area and summarize the treatment experience．Methods The data of 49 cases of appendicitis EPISBO in children admitted to Qinghai Women and Children’s Hospital from 2019 to 2023 were retrospectively analyzed．Results The onset time of appendicitis was 3-8 days，with an average of（5.38±1.25）days，and the time of intestinal obstruction was 3-11 days after surgery，with an average of（4.81±1.70）days．After conservative treatment，48 cases were relieved of obstruction，resumed exhaust and defecation，and intestinal function recovered in 4-13 day，average（5.93±2.49）d，1 case had progression after conservative treatment，and was cured by surgery．All the 49 children were successfully cured and discharged．The length of hospital stay was 10-26 days，with an average of（15.69±3.79）days．Postoperative follow-up of 1 to 2 years showed normal eating and bowel movements．Conclusions The prevention of EPISBO in children with appendicitis in plateau area is the key．Conservative treatment can also achieve a higher cure rate．If conservative treatment is ineffective or the disease progresses，timely surgical treatment should be provided．
目的 探讨运动干预联合治疗性聆听对孤独症谱系障碍儿童社会交往功能的影响。方法 选取黄河三门峡医院2020年1月—2023年10月收治的100例孤独症患儿，应用随机数字表法分为两组，各50例。对照组患儿实施常规护理，观察组在对照组基础上增加运动干预联合治疗性聆听。分别在干预前及干预6个月后采用孤独症治疗评价量表（ATEC）、儿童感觉统合发展评定量表、格塞尔发育量表（GDS）及中国韦氏儿童智力量表（WISC-R）评价两组患儿社会交往能力、感觉统合发展水平、神经发育水平及智力水平变化。结果 干预后两组患儿的ATEC各部分评分，包括健康/生理/行为、感知/认知能力、社交能力、语言表达/沟通能力及ATEC总分均降低，观察组低于对照组（P＜0.05）；干预后两组患儿学习能力发展、本体感觉、触觉防御、前庭功能及儿童感觉统合发展评定量表总分均升高，观察组高于对照组（P＜0.05）；干预后两组患儿动作能、应物能、言语能、应人能相关神经发育情况评分均升高，观察组高于对照组（P＜0.05）；干预后两组患儿言语智商、操作智商、总智商相关WISC-R评分均升高，观察组高于对照组（P＜0.05）。结论 运动干预联合治疗性聆听对孤独症谱系障碍儿童应用效果显著，可提升其社会交往能力，促进感觉统合发展，进而促进其神经发育及智力水平提升。
Objective To explore the effect of exercise intervention combined with therapeutic listening on social communication function in children with autism spectrum disorder．Methods A total of 100 autistic children who were admitted to our hospital from January 2020 to October 2023 were selected and divided into two groups by random number table method，with 50 children each．The control group received routine care，while the observation group received exercise intervention combined with therapeutic listening in addition to routine care．The Autism Treatment Evaluation Scale （ATEC），Children’s Sensory Integration Development Scale，Gesell Development Scale，and Wechsler Intelligence Scale for Children-Revised by China （WISC-R）were used before and 6 months after the intervention to evaluate the social communication ability，sensory integration development level，neural development level，and intellectual level changes of the two groups of children．Results After intervention，the score of every dimension in ATEC including the health/physiology/behavior，perception/cognitive ability，social ability，language expression/communication ability，and total ATEC score of the two groups of children decreased，and the observation group was lower than the control group （P＜0.05）．After intervention，the total scores of the learning ability development insufficient，proprioceptive dysfunction，excessive tactile defense，vestibular dysfunction，and children’s sensory integration development assessment scale in both groups of children increased，with the observation group being higher than the control group （P＜0.05）．After intervention，the neurological development scores related to motor，adapt，language，and social ability in both groups of children increased，and the observation group was higher than the control group （P＜0.05）．After intervention，the WISC-R scores related to verbal intelligence，operational intelligence，and total intelligence in both groups of children increased，and the observation group was higher than the control group （P＜0.05）．Conclusions The combination of exercise intervention and therapeutic listening has asignificant effect on children with autism spectrum disorder，which can enhance their social communication ability，promote sensory integration development，and ultimately promote their neural development and intellectual level improvement．
患有发育障碍类疾病的儿童数量庞大，给社会造成了严重的影响。这类疾病难以预防和治愈，同时缺乏特效药物，因此治疗主要依赖于行为和教育干预，药物治疗只是辅助手段。然而，目前临床相关治疗均有一定的不足，如存在不良反应、治疗周期相对较长、专业性要求相对较高等缺点。与之相比，音乐疗法具有操作简便、不良反应少等优势，因此可应用于儿科多种慢性疾病的治疗。文章旨在通过研究现代音乐治疗，探讨结合古代五音疗法、现代知识以及中医理论，为儿童临床治疗提供一定的方法指导。
The number of children suffering from developmental disorders is substantial，causing significant impact on society．These diseases are difficult to prevent and cure，with a lack of specific medications，thus treatment primarily relies on behavioral and educational interventions，with medication being only an auxiliary measure．However，current clinical treatments have certain drawbacks，such as potential toxic side effects，relatively long treatment periods，and high demands for specialization．In contrast，music therapy offers significant advantages such as easy operation and minimal side effects，making it suitable for the treatment of various chronic pediatric disease．This paper aims to explore the integration of ancient pentatonic therapy，modern knowledge，and traditional Chinese medicine theory through the study of modern music therapy，providing guidance for clinical treatment of children．
目的 探讨眼底豹纹斑密度（FTD）及视盘旁萎缩弧（PPA）与眼轴长（AL）的相关性，为眼底定量化在儿童近视防控的应用提供科学依据。方法 本研究随机抽取广州市荔湾区两所小学三年级学生作为研究对象，在校园视力筛查的过程中同时采集AL、CR和眼底彩照。使用AI软件对眼底彩照进行量化分析，量化指标包括不同区域和范围的FTD及PPA面积大小，根据眼轴长度分为三组：A组（AL＜23 mm）；B组（23 mm≤AL＜24 mm）；C组（24 mm≤AL）。结果 共有398例右眼被纳入统计分析，年龄范围8~11岁，中位数是9岁，男性人数占55.1％。三组组间AL、AL/CR和SE比较均有统计学差异（P＜0.05）。A组与B组相比，FTD在后极部整体范围、黄斑中心3 mm区域、黄斑中心3 mm区域上方区域具有统计学差异（P＜0.05），C组与B组相比，PPA面积及FTD在后极部整体范围、视盘为中心4.5 mm范围、黄斑为中心直径3 mm和6 mm范围均具有统计学差异（P＜0.05），Spearman相关性分析表明，AL与PPA（r=0.443）和FTD（r=0.322）呈正相关（P＜0.001）。亚组相关性分析表明，A组仅黄斑为中心直径3 mm上方范围FTD与AL呈正相关（P=0.028），B组PPA、黄斑中心直径3 mm及其上方范围FTD与AL呈正相关（P＜0.05），C组仅PPA与AL呈正相关（P=0.005）。结论 眼底定量对于儿童近视防控具有潜在价值，PPA和FTD与AL呈正相关性，不同区域和范围FTD与AL相关性具有一定差异性，黄斑中心直径3 mm范围及其上方范围与眼轴相关性最强。FTD在短眼轴阶段就可以作为生物标记物预测近视严重程度，而PPA主要在长眼轴阶段体现生物标记物的作用。
Objective To investigate the correlation between fundus tessellated density（FTD）and peripapillary atrophy（PPA）with axial length（AL）, providing a scientific basis for the application of fundus quantification in the prevention and control of myopia in children. Methods This study randomly selected third-grade students from two primary schools in Liwan District, Guangzhou City, as research subjects. Axial length（AL）, corneal radius（CR）, and fundus color photographs were collected simultaneously during the school vision screening process. AI software was utilized to perform quantitative analysis on the fundus color photographs, with quantification indicators including the area size of PPA and FTD in different regions and ranges. Subjects were divided into three groups based on axial length：Group A（AL＜23 mm）; Group B（23 mm≤AL＜24 mm）; Group C（AL≥24 mm）. Results A total of 398 right eyes were included in the statistical analysis, with an age range of 8 to 11, a median age of 9, and 55.1% were male. There were significant statistical differences in AL, AL/CR, and spherical equivalent（SE）among the three groups（P＜0.05）. Compared with Group B, Group A showed significant statistical differences in FTD in the overall posterior pole, the 3 mm diameter area centered on the fovea, and the superior area of the 3 mm foveal center（P＜0.05）. Compared with Group B, Group C showed significant differences in PPA area and FTD in the overall posterior pole, the 4.5 mm diameter area centered on the optic disc, and the 3 mm and 6 mm diameter areas centered on the fovea（P＜0.05）. Spearman correlation analysis indicated that AL was significantly positively correlated with PPA（r=0.443）and FTD（r=0.322）（P＜0.001）. Subgroup correlation analysis showed that in Group A, only the FTD in the superior area of the 3 mm diameter centered on the fovea was significantly positively correlated with AL（P=0.028）. In Group B, PPA and FTD in the 3 mm diameter and superior area centered on the fovea were significantly positively correlated with AL（P＜0.05）. In Group C, only PPA was significantly positively correlated with AL（P=0.005）. Conclusions Fundus quantification holds potential value for the prevention and control of myopia in children. PPA and FTD show significant positive correlations with AL, with varying degrees of correlation in different regions and ranges of FTD with AL. The 3 mm diameter area centered on the fovea and its superior area have the strongest correlation with the eye axis. FTD can serve as a biomarker to predict the severity of myopia in the early stages of eye axis elongation, while PPA primarily manifests as a biomarker in the later stages of elongation.
