目的 探讨肺炎支原体核糖核酸恒温扩增技术(MP RNA-SAT)对儿童社区获得性肺炎(CAP)诊治的价值。方法 选择310例CAP的临床资料进行回顾性分析,其中肺炎支原体肺炎(MPP)和非肺炎支原体肺炎各155例,比较这两组的MP RNA-SAT和MP-IgM的检测结果。结果 以临床诊断为标准,RNA-SAT的特异度(97.4%)及阳性预测值(92.2%)高于IgM(分别为72.3%、74.4%),而敏感度(30.3%)及阴性预测值(58.3%)则低于IgM(分别为80.6%、78.9%),差异有统计学意义(P＜0.05);年龄＞3岁、检测前不使用大环内酯类药物以及选择肺泡灌洗液作为检测标本均能提高RNA-SAT的检出率(P＜0.05)。结论 RNA-SAT能特异度识别出MP的活动性感染,联合使用RNA-SAT和IgM检测,能更加快速、准确地诊断MP感染,对儿童肺炎的诊治具有较高的价值。尽量在使用大环内酯类药物治疗前进行RNA-SAT检测,必要时可选择肺泡灌洗液作为检测标本以提高检出率。

Objective To investigate the value of Mycoplasma pneumoniae RNA simultaneous amplification and testing(MP RNA-SAT)in the diagnosis and treatment of community acquired pneumonia(CAP) in children. Methods The clinical data of 310 children with CAP were selected for retrospective analysis,including 155 Mycoplasma pneumonia pneumonia(MPP)and 155 non-MPP,and the results of MP RNA-SAT and MP-IgM in both groups were compared. Results With the results of clinical diagnosis as reference, the specificity (97.4%)or positive predictive value (92.2%)by RNA-SAT was higher than that by IgM (72.3% and 74.4%, respectively), while the sensitivity (30.3%)or negative predictive value (58.3%)was lower than that by IgM (80.6% and 78.9%, respectively).The difference was statistically significant (P<0.05). Age>3 years, no macrolide treatment before testing, or choosing bronchoalveolar lavage fluid as testing samples, that can improve the detection rate of RNA-SAT(P<0.05). Conclusion RNA-SAT may specifically identify active infection of MP, and the combined use of RNA-SAT and IgM test may more quickly and accurately diagnose infection of MP.It has high value for the diagnosis and treatment of community acquired pneumonia in children. RNA-SAT should be performed before the application of macrolide treatment as early as possible. If necessary, bronchoalveolar lavage fluid could be chosen as testing samples to improve the detection rate of RNA-SAT.

目的 探讨雷火灸对于小儿下元虚寒型遗尿症的临床疗效。方法 采用回顾性分析,将60例遗尿症患儿随机分为治疗组和对照组各30例,对照组给予基础治疗(包括调整作息饮食、膀胱功能锻炼、反射训练等),治疗组则在基础治疗外给予雷火灸温灸小腹部及温阳补肾的相应穴位,两组均连续治疗3周。比较两组治疗前后每周遗尿天数、每天遗尿次数、每天的睡眠深度及中医症候积分变化,观察两组临床疗效及6个月后的复发率。结果 治疗组使用雷火灸治疗小儿遗尿症的总有效率96.67%高于对照组的总有效率76.67%,治疗组中医症候积分减少优于对照组,治疗后6个月治疗组的复发率为10.34%,少于对照组,差异均有统计学意义(P<0.05)。结论 雷火灸能有效减少下元虚寒型遗尿症患儿的遗尿次数,疗效显著,值得临床推广应用。

Objective To investigate the clinical efficacy of treating kidney deficiency-cold syndrome enuresis children with thunder-fire moxibustion. Methods 60 cases were randomly divided into a control group of 30 cases and a treatment group of 30 cases. Patients in the control group were treated with basic treatment (including adjusting diet, bladder function exercise, reflex training and so on); while patients in the treatment group were treated with thunder-fire moxibustion,three weeks for treatment. The research was aimed at assessing the clinical effect of the two groups,observing the number of enuresis days per week, the number of enuresis times per day,the sleep depth per day and the change of TCM symptom score, and recording the recurrence rate after 6 months of treatment. Results The clinical efficacy of treatment group was better than that of the control group,and the efficiency was 96.67%,which was higher than that of the control group 76.67%,and the TCM symptom score of the treatment group decreased than that of the control group, both of the differences were statistically significant (P< 0.05). The recurrence rates at 6 months after treatment was 10.34% respectively,which were lower than those in the control group(P＜0.05). Conclusion The therapy has good effect,it can reduce the number of enuresis times and has low recurrence.

目的 本研究观察应用鼻喷激素联合白三烯受体拮抗剂在腺样体肥大患儿中治疗的效果。方法 选择2016年2月—2018年3月期间在广州市某区妇幼保健院耳鼻咽喉科确诊腺样体肥大的患儿,在患儿及家长知情同意的基础上,按照随机数字表法将87例耳鼻咽喉科诊断为腺样体肥大的儿童分为研究组和对照组。前者给予鼻喷激素联合白三烯受体拮抗剂进行治疗,后者独立使用白三烯受体拮抗剂进行治疗,比较两组患儿的临床治疗效果和不适症状的改善程度。结果 研究组腺样体肥大患儿临床症状得分小于对照组,优于对照组的治疗效果,差异有统计学意义(P＜0.05);且对比对照组,研究组患儿经鼻呼吸困难、入睡时打鼾、鼻部阻塞感等不适症状明显减轻。结论 鼻喷激素联合白三烯受体拮抗剂治疗儿童腺样体肥大,临床症状改善较为明显,具有经济性,家属及患儿接受度较高,相比手术创伤小,在基层医院推广有一定的价值。

目的 分析小儿葫芦散应用于儿童喘息性支气管炎中的治疗效果。方法 在我院2015年8月—2018年12月诊治的喘息性支气管炎患儿中选取68例,并严格按照系统随机分配原则分为对照组和观察组,各34例。其中对照组采用常规治疗,观察组采用小儿葫芦散治疗,观察对比两组患儿治疗效果和临床症状消失时间。结果 对照组总有效率为76.47%,观察组总有效率为94.12%,对照组总有效率低于观察组,且对照组临床症状消失时间均长于观察组,差异有统计学意义(P<0.05)。结论 小儿葫芦散应用于喘息性支气管炎患儿中具有显著疗效,进一步改善肺功能情况,促进患儿康复,值得推广。

目的 总结预防接种认知干预对儿童预防接种效果的影响。方法 对2018年5—9月在东莞企石镇接种百白破疫苗的儿童家属按接种时间顺序分为对照组254名、实验组248名,对照组家属按常规方法进行预防接种,实验组在常规接种基础上,结合不按时接种、延迟接种等问题对幼儿家属开展多种多样的百白破疫苗预防知识、不良反应观察处理、接种注意事项等知识宣教和培训干预,总结两组儿童在按时接种、延迟接种、疫苗接种知识、不良反应表现与处理、接种注意事项知识的掌握、服务满意度等情况。结果 实验组幼儿按时接种率比对照组高,延迟接种率比对照组低,结果有差异(P＜0.05);家属对疫苗接种知识、不良反应表现和处理、接种注意事项等知识的掌握比对照组高,结果有差异(P＜0.05)。结论 实施家属预防接种认知干预管理能提高家属掌握预防接种知识和不良反应护理知识;提高儿童疫苗接种率和及时接种率,提高预防接种服务管理效果。

Objective To summarize the effect of cognitive intervention on children's vaccination. Methods The family members of children vaccinated with DPT vaccine in Qishi Town of Dongguan City from May to September 2018 were divided into control group 254 and experimental group 248 according to the sequence of vaccination time. The family members of control group were vaccinated by routine methods. On the basis of routine vaccination, the experimental group carried out a variety of preventive knowledge and adverse reactions observation of DPT vaccine to the family members of children in combination with the problems of untimely vaccination and delayed vaccination. The knowledge propaganda and training intervention of treatment and vaccination precautions were summarized. The situation of two groups of children in timely vaccination, delayed vaccination, vaccination knowledge, adverse reaction performance and treatment, knowledge of vaccination precautions and service satisfaction were summarized. Results The vaccination rate of children in the experimental group was higher than that in the control group, and the delayed vaccination rate was lower than that in the control group. The results showed statistical difference (P＜0.05). The knowledge of vaccination, adverse reactions, treatment and matters needing attention of family members were higher than that in the control group, and the results showed statistical difference (P＜0.05). Conclusion Implementing cognitive intervention management of family vaccination may improve family members'knowledge of vaccination and nursing of adverse reactions, improve children's vaccination rates and timely vaccination rates, and improve the management effect of vaccination service.

目的 分析儿童危重症乙型流感患者的临床特点,提高临床医师对此危重症的认识水平。方法 对2017年12月—2018年2月广州市妇女儿童医疗中心收治的7例儿童危重症乙型流感患者的临床资料进行回顾性分析。结果 危重患儿好发年龄以幼儿及学龄前期为主。5例表现为呼吸衰竭,1例表现为心源性休克,1例表现为急性坏死性脑病。起病初(3 d内)均未见白细胞减少,白细胞数最高28.1×10⁹/L。白细胞分类以中性粒细胞为主。痰培养出流感嗜血杆菌、肺炎链球菌各1例。3例存在塑型性支气管炎改变。经积极治疗,体温恢复正常最短2 d,最长7 d,平均(4.20±1.79) d。住院时间最短12 d,最长23 d,平均(16.71±3.90)d。结论 乙型流感危重患儿临床表现多样,可累及多个系统器官;呼吸道合并症最多见,可出现塑型性支气管炎改变;及早识别及积极治疗,预后良好。

Objective To analyze the clinical characteristics of the children with severe influenza B and to provide reference for identifying severe cases. Methods Clinical data of 7 children with severe influenza B were retrospectively analyzed. Results The age ranged from 11 months to 7 years old, with an average was (4.13±2.06) years old. Five cases were characterized by respiratory failure, one by cardiogenic shock and one by acute necrotizing encephalopathy. No leukopenia was observed at the beginning of the disease(in 3 days), and the number of white blood cells was as high as 28.1×10⁹/L, White blood cell classification is dominated by neutrophils. haemophilus influenzae and streptococcus pneumoniae were produced by sputum culture in 1 case for each. Three patients had plastic bronchitis changes. After active treatment, the body temperature returned to normal with minimum 2 days, longest 7 days and average (4.20+1.79)days. The length of stay was the shortest 12 days, the longest 23 days, and the average (16.71+3.90) days. Conclusion The clinical manifestations of severe influenza B are diverse and may involve multiple system organs. Respiratory complications were the most common, with plastic bronchitis changes. Early recognition and active treatment had a good prognosis.

目的 探讨布地奈德联合特布他林对中度哮喘患儿血清变态反应及Th相关指标的影响。方法 选择本院2016年3月—2017年4月收治的中度哮喘患儿100例,将其随机分为2组,各50例。对照组采用布地奈德雾化吸入治疗,观察组采用布地奈德联合特布他林雾化吸入治疗,比较两组临床疗效、血清变态反应与Th相关指标、药物不良反应。结果 1周后,观察组治疗总有效率较对照组高,MCP-1、IgE、IL-10及IL-6水平均较对照组低,差异具有统计学意义(P＜0.05);观察组药物不良反应率与对照组相比,差异无统计学意义(P＞0.05)。结论 布地奈德联合特布他林可提高中度哮喘患儿临床疗效,减轻血清变态反应,改善Th相关指标,且用药安全性较高。

目的 探讨广东汉族儿童ACE2基因A9570G多态性与儿童激素敏感型肾病综合征(SSNS)复发的关系。方法 选取广东汉族SSNS患儿92例,按发病后1年复发情况分为频复发组31例、非频复发组61例,健康体检者60例为对照组,采用聚合酶链反应-DNA直接测序技术观察患儿与对照组ACE2基因A9570G基因型分布和等位基因频率。结果 在女性,SSNS组G等位基因频率及GG基因型分布均低于对照组(39％ vs 65％,P<0.05;27％ vs 50％,P<0.05);在男性,SSNS组G等位基因/GG基因型分布亦低于对照组(35％ vs 60％,P<0.05 )。亚组分析发现,在女性,频复发组G 等位基因频率及GG 基因型分布均高于非频复发组(58％ vs 29％,P<0.05;42％ vs 19％,P<0.05);在男性,频复发G基因型/G等位基因频率高于非频复发(58％ vs 24％,P<0.05)。结论 ACE2基因A9570G多态性与儿童SSNS复发相关,携带G等位基因的患儿容易表现为频复发。

Objective To investigate the association between the A9570G polymorphism of ACE2 gene and the relapse of steroid-sensitive nephrotic syndrome (SSNS) in Han childhood of Guangdong.Methods Ninety-two children with SSNS were selected from Guangdong Han nationality. According to the relapse frequency during the first year of the disease, 31 cases with more than 3 relapses were as frequency relapse group, 61 cases with less than 3 relapses were as non-frequent relapse group, and 60 healthy children were as control group. The gene distribution and allele frequency of ACE2 gene A9570G were observed by polymerase chain reaction-DNA direct sequencing technology.Results In female,the distribution of G allele frequency and GG genotype in SSNS group were significantly lower than that in the control group(39％ vs 65％, P<0.05; 27％ vs 50％, P<0.05). In male, the distribution of G allele/GG genotype in SSNS group was also significantly lower than that in the control group(35% vs 60%, P<0.05). Subgroup analysis found that the distribution of G allele frequency and GG genotype in female of the frequency relapse group were significantly higher than that of the non-frequency relapse group(58% vs 29%, P<0.05; 42% vs 19%, P<0.05), and the distribution of G allele/GG genotype in male of the frequency relapse group was significantly higher than that of the non-frequency relapse group (58% vs 24%, P<0.05).Conclusion The A9570G polymorphism of ACE2 gene was associated with the recurrence of children's SSNS, and the children with G allele were susceptible to recurrence.

目的 研究参附注射液在小儿川崎病治疗中的应用价值。方法 将2015年1月—2016年12月期间在我院接受治疗的川崎病患儿120例作为研究对象,并按照随机数表法将其随机分为两组,对照组和观察组,每组60例。对照组采取丙种球蛋白注射、口服阿司匹林、激素等常规治疗措施,观察组在对照组的基础上实施参附注射液治疗。对比2组患儿的退热时间、住院时间、C反应蛋白变化情况、红细胞沉降率,观察2组治疗期间的不良反应发生情况。结果 治疗后,观察组患儿的C-反应蛋白水平、红细胞沉降率与白细胞水平均小于对照组,血小板与血红蛋白水平高于对照组,退烧时间与治疗时间均小于对照组,差异有统计学意义(P＜0.05);2组的不良反应发生率相比较,差异无统计学意义(P＞0.05)。结论 参附注射液可以有效降低川崎病患儿机体内的C-反应蛋白水平、红细胞沉降率,改善血常规指标,加快康复进程,且具有一定的安全性。

目的 探讨揭阳地区急性下呼吸道感染住院患儿病毒病原学特点。方法 对2 125例急性下呼吸道感染患儿应用直接免疫荧光法(DIF)进行A型流感病毒(甲型流感病毒IFA)、B型流感病毒(乙型流感病毒IFB)、呼吸道合胞病毒(RSV)、腺病毒(AdV)、副流感病毒1(PIVⅠ)、2(PIVⅡ)和3型(PIVⅢ)进行病毒学检测。结果 2 125例患儿鼻咽部分泌物标本中有538例检测出至少1种病毒,总阳性率25.3％,其中RSV 阳性率(19.7%)明显高于其他病毒,具有统计学意义。春、夏、冬季的RSV阳性率大致相当,明显高于秋季。婴儿期组RSV阳性率(27.2%)最高,幼儿期组(18.7%)次之,均显著高于学龄前期、学龄期,后2组阳性率无统计学差异,青春期组未检出RSV。结论 病毒是急性下呼吸道感染的重要病原体,而其中又以RSV为著,RSV感染具有显著的季节性和年龄特征性。

Objective To investigate the viral etiology feature in hospitalized children with acute lower respiratory infection in Jieyang area. Methods A total of 2 125 children with acute lower respiratory tract infection were screened by direct immune fluorescence assay (DIF) for influenza virus A (IFA), influenza virus B (IFB), respiratory syncytial virus (RSV), adenovirus (AdV), parainfluenza virus I (PIV Ⅰ), PIV Ⅱ and PIV Ⅲ. Results In 2 125 cases of nasopharyngeal secretory specimens, 538 cases were detected at least one kinds of viruses. The total positive rate was 25.3%, of which the positive rate of RSV (19.7%) was higher than that of other viruses. The positive rate of RSV was similar in spring, summer and winter, much higher than that in autumn.The positive rate of RSV in infancy group (27.2%) was the highest,then the second was the toddler's age(18.7%), both of which were higher than that in preschool age group and school age group. There was no significant difference in the positive rate between preschool age group and school age group. In addition, RSV was not detected in the adolescence group. Conclusion Virus is an important pathogen of acute lower respiratory tract infection. The most common virus is RSV, infection of which has seasonal and age characteristics.