目的 分析CT+MRI在原发性肝癌诊断与介入治疗预后评估中的临床意义。方法 选定本院2019年1月—2021年1月住院治疗的150例原发性肝癌患者,入院后均接受介入治疗,分别予以CT、MRI检查,将手术病理检查结果作为本次研究的金标准,比较CT、MRI、CT+MRI诊断效能,Kappa检验CT、MRI、CT+MRI与金标准的一致性,比较CT、MRI、CT+MRI介入术后病灶检出率。结果 CT+MRI诊断准确率(98.67%)、特异度(75.00%)、灵敏度(99.32%)均高于CT(86.00%、25.00%、87.67%)、MRI(90.67%、91.78%、50.00%),P＜0.05(差异均有统计学意义),CT+MRI与金标准的一致性较好(Kappa值为0.779),CT、MRI与金标准的一致性一般(Kappa值为0.527、0.596)。CT+MRI介入术后病灶总检出率(12.00%)高于CT(2.00%)、MRI(4.00%),P＜0.05(差异有统计学意义)。结论 CT+MRI可提高原发性肝癌患者介入术后病灶检出率,弥补了单一CT、MRI检查的不足。

Objective To evaluate the clinical significance of CT + MRI scans in diagnosis of primary liver cancer and prognosis evaluation after interventional therapy. Methods A total of 150 cases of patients with primary liver cancer admitted to our hospital from January 2019 to January 2021 were selected. They all received interventional treatment, and were examined by CT and MRI. The results of pathological examination were taken as the gold standard in this study to compare the diagnostic efficacy of CT, MRI and CT+MRI.Kappa value was used to compare the consistency of CT, MRI, CT+MRI scans with gold standard, and compared the detection rate of lesions after CT, MRI and CT+MRI interventional surgery. Results The diagnostic accuracy (98.67%), specificity (75.00%) and sensitivity (99.32%) of CT + MRI scans were higher than those of CT (86.00%, 25.00%, 87.67%) and MRI scans (90.67%, 91.78%, 50.00%),P<0.05 (which differences were statistically significant). The consistency of CT + MRI scans with gold standard was good (kappa value was 0.779), but the consistency of CT/MRI scans with gold standard were not satisfying (kappa value were 0.527, 0.596). The total detection rate of lesions after CT + MRI interventional surgery (12.00%) was higher than that of CT (2.00%) and MRI (4.00%, which P<0.05). Conclusion CT + MRI scans can improve the detection rate of lesions in patients with primary liver cancer after interventional therapy, and make up for the deficiency of only CT or MRI scans.

目的 研究磁共振成像(magnetic resonace imaging, MRI)检查颈椎病患者椎间盘及颈髓病变的检出率。方法 选取2017年3月—2019年3月我院颈椎病患者216例,均行MRI检查、CT检查。比较MRI检查、CT检查颈椎病的检出率、颈椎病影像征象的检出率及神经根型、脊髓型颈椎病的检出率。结果 MRI检查颈椎病患者椎间盘膨出及突出、椎间盘变性、椎间盘纤维环病变、颈髓缺血性损伤、后纵韧带病变、颈椎病椎间隙狭窄、钩突增生、椎体后缘骨赘、小关节突增生、骨性椎管狭窄、颈椎曲度异常检出率均高于CT检查(P＜0.05);MRI检查、CT检查颈椎病患者椎间孔狭窄、椎管狭窄检出率比较,差异无统计学意义(P＞0.05);MRI检查椎间盘钙化、椎小关节骨质增生、椎间盘积气检出率低于CT检查,椎间盘突出、黄韧带增厚、脊髓变性、硬膜囊受压、神经根受压检出率高于CT检查(P＜0.05);MRI检查神经根型颈椎病检出率94.44%、脊髓型颈椎病检出率88.89%高于CT检查检出率75.00%、25.25%(P＜0.05)。结论 MRI检查颈椎病患者能提高椎间盘及颈髓病变的检出率,对多种颈椎病变征象显著,有助于颈椎病分型的鉴别诊断,从而为临床治疗方案的制定提供科学依据。

Objective To study the detection rate of cervical disc and spinal cord lesions in patients with cervical spondylosis by magnetic resonance imaging (MRI). Methods A total of 216 patients with cervical spondylosis in our hospital from March 2017 to March 2019 were selected, all of them underwent MRI and computed tomography (CT) examination. The detection rate of cervical spondylosis, imaging signs of cervical spondylosis, and cervical spondylosis of nerve root type and spinal cord type by MRI and CT were compared. Results The detection rates of cervical spondylosis patients with disc herniation and protrusion, disc degeneration, disc annulus fibrosus disease, cervical spinal cord ischemic injury, posterior longitudinal ligament disease, cervical intervertebral space stenosis, uncinate process hyperplasia, vertebral posterior margin osteophyte, facet hyperplasia, bony spinal stenosis, abnormal cervical curvature by MRI examination were higher than that by CT examination (P<0.05). There were no significant differences in the detection rates of foramen stenosis and spinal canal stenosis between MRI and CT examination (P>0.05); the detection rates of intervertebral disc calcification, vertebral facet joint hyperosteogeny and intervertebral disc pneumatosis by MRI examination were lower than that by CT examination; the detections rates of intervertebral disc herniation, ligamentum flavum thickening, spinal degeneration, dural sac compression and nerve root compression by MRI examination were higher than that by CT examination (P<0.05); the detection rates of cervical spondylotic radiculopathy and cervical spondylotic myelopathy by MRI examination were 94.44% and 88.89%, which were higher than 75.00% and 25.25% of the detection rates by CT examination (P<0.05). Conclusion MRI examination of patients with cervical spondylosis can improve the detection rates of intervertebral disc and cervical spinal cord lesions, and has significant signs for a variety of cervical lesions, which is helpful for the differential diagnosis of cervical spondylosis classification, so as to provide scientific basis for the formulation of clinical treatment plan.

目的 探索两种常用免疫学指标—结核菌素试验(purified protein derivative skin test, PPD皮试)与结核分枝杆菌γ-干扰素释放试验(tuberculosis-interferon gamma release assay,TB-IGRA)对结核病的辅助诊断价值。方法 收集2017年1月—2021年1月于我中心门诊部就诊的疑似结核病患者资料,共171例,所有病例均行PPD皮试和外周血TB-IGRA。将病例分为结核病组(TB组)和非结核病组(非TB组)。TB组共98例,非TB组共73例。比较两组病例PPD皮试、TB-IGRA对结核病诊断的准确度、敏感度、特异度。结果 TB-IGRA对结核病诊断的准确度、敏感度和特异度分别为94.2%、93.9%和90.4%,PPD皮试对结核病诊断的准确度、敏感度和特异度分别为77.2%、84.7%和76.7%。TB-IGRA的准确度和特异度与PPD皮试比较差异有统计学意义(分别为χ²=20.034,P<0.05和χ²=5.176,P<0.05);TB-IGRA的敏感度高于PPD皮试,但两者比较差异无统计学意义(χ²=0.948,P>0.05)。2组间TB-IGRA结果、PPD皮试结果比较差异均具有统计学意义(分别为χ²=132.77,P<0.01和χ²=47.963 5,P<0.01)。结论 TB-IGRA和PPD皮试均具有良好的结核病辅助诊断价值;TB-IGRA的引进大大提高了诊断试验的准确度和特异度,但仍需要进一步探索其诊断标准以更好地为临床使用。

Objective To explore the auxiliary diagnosis value of two commonly used immunological indicators for tuberculosis, purified protein derivative skin test (PPD test) and tuberculosis-interferon gamma release assay (TB-IGRA). Methods A total of 171 cases of suspected tuberculosis patients who were treated in the outpatient department of our center from January 2017 to January 2021 were collected. All cases underwent PPD test and peripheral blood TB-IGRA. The cases were divided into tuberculosis groups (TB group) and non-tuberculosis group (non-TB group). There were 98 cases in the TB group and 73 cases in the non-TB group. The accuracy, sensitivity, and specificity of PPD test and TB-IGRA for tuberculosis diagnosis were compared between the two groups. Results The accuracy, sensitivity, and specificity of TB-IGRA for tuberculosis diagnosis were 94.2%, 93.9% and 90.4% respectively, which of PPD test for tuberculosis diagnosis were 77.2%, 84.7% and 76.7% respectively. The accuracy and specificity of TB-IGRA were statistically different from those of PPD test (χ²=20.034,P<0.05 and χ²=5.176,P<0.05, respectively). The sensitivity of TB-IGRA was higher than that of PPD test, but the difference was not statistically significant (χ²=0.948,P>0.05). The differences of TB-IGRA and PPD test results between the two groups were statistically significant (χ²=132.77,P<0.01 and χ²=47.9635,P<0.01). Conclusion Both TB-IGRA and PPD test had good auxiliary diagnostic value for tuberculosis; the introduction of TB-IGRA had greatly improved the accuracy and specificity of the diagnostic test, but it is still necessary to further explore its diagnostic criteria to better serve the clinical use.

目的 探讨富血小板血浆(platelet-rich plasma, PRP)联合髓芯减压治疗早期膝关节自发性骨坏死(spontaneous osteonecrosis of the knee, SONK)的临床疗效。方法 回顾性分析我院2015年6月—2020年6月收治Koshino分期为Ⅰ、Ⅱ期的SONK患者,按治疗方法不同分为单纯髓芯减压组(对照组 21例)和PRP注射+髓芯减压组(PRP组 22例),比较2组患者治疗前、后1月、3月、6月、12月的VAS评分、WOMAC评分,评估术前和随访时膝关节功能,并观察记录有无并发症。结果 43例患者术后随访12～62个月,2组患者治疗后均无切口感染、关节感染、深静脉血栓等并发症。2组患者术前VAS评分、WOMAC评分比较无统计学意义(P>0.05);VAS评分、WOMAC评分在术后1、3、6 、12月较术前比较差异均有统计学意义(P<0.05);与对照组相比,PRP组术后3、6、12月的VAS评分降低(P＜0.05),PRP组在术后6、12月的WOMAC评分改善(P＜0.05)。PRP组、对照组的总体有效率分别为90.48%(19/21)、77.27%(17/22),差异有统计学意义(P＜0.05)。在完成治疗12个月后至今的随访中,对照组共有6例患者、PRP组仅2例患者行单髁置换。结论 富血小板血浆联合髓芯减压治疗早期SONK,安全有效,临床疗效优于单纯髓芯减压术。

Objective To investigate the clinical effect of platelet-rich plasma(PRP) combined with core decompression in the treatment of early spontaneous osteonecrosis of the knee(SONK). Methods A retrospective analysis of SONK patients with Koshino stage I and Ⅱ admitted to our hospital from June 2015 to June 2020 was carried out. According to the different treatment methods, patients were divided into core decompression group (control group, 21 patients), and knee joint cavity PRP injection combined with core decompression group (PRP group, 22 patients). The VAS scores and WOMAC scores before treatment, 1, 3, 6 and 12 months after surgery were compared between the two groups to assess the knee joint function, and observed whether there were complications. Results Forty-three patients were followed up for 12 to 62 months after the operation. After treatment, the two groups had no complications such as wound infection, joint infection, or deep vein thrombosis. The preoperative VAS score and WOMAC score of the two groups were not significantly different (P>0.05);compared with those before the operation, VAS score and WOMAC score were significantly different at 1, 3, 6, and 12 months after the operation (P<0.05); compared with the control group, the VAS score of the PRP group was significantly reduced at 3, 6, and 12 months after surgery (P<0.05), and the WOMAC score of the PRP group was significantly improved at 6 and 12 months after surgery (P<0.05). The overall effective rates of the PRP group and the control group were 90.48% (19/21) and 77.27% (17/22) respectively, and the difference between the two groups was statistically significant (P<0.05). In the follow-up 12 months after the completion of the treatment, 6 patients in the control group and 2 patients in the PRP group underwent unicondylar replacement. Conclusion The combination of platelet-rich plasma and core decompression in the treatment of early SONK was safe and effective, and the clinical effect was better than that of core decompression only.

目的 探讨剖宫产围术期患者采用布托啡诺治疗寒战的最佳剂量。方法 选取2019年10月—2020年11月期间于本院分娩的150例剖宫产妇女作为研究对象,按照随机数字表法分为A组、B组、C组,各组50例。A组给予0.01 mg/kg布托啡诺静脉注射,B组给予0.02 mg/kg,C组给予0.03 mg/kg。比较3组临床疗效、血流动力学、镇静(Ramesay)评分、不良反应、新生儿Apgar评分。结果 3组治疗有效率、 血流动力学、T₁、T₂时间段Ramesay评分及1 min、5 min、10 min 新生儿Apgar评分比较,差异无统计学意义(P＞0.05);C组不良反应发生率高于B组与A组(P＜0.05);T₃时间段Ramesay评分C组＜B组＜A组(P＜0.05)。结论 0.02 mg/kg剂量布托啡诺治疗剖宫产围术期寒战效果最为理想,产妇围术期血流动力学稳定,不良反应较轻,且对新生儿无明显影响。

Objective To investigate the optimal dose of butorphanol in the treatment of shivering in patients underwent cesarean section. Methods A total of 150 women with cesarean section in our hospital from October 2019 to November 2020 were selected as the research objects, and were divided into group A, group B and group C according to random number table method, with 50 cases in each group. Group A was given 0.01 mg/kg butorphanol intravenously, group B was given 0.02 mg/kg, and group C was given 0.03 mg/kg. Clinical efficacy, hemodynamics, sedation (Ramesay) scores, adverse drug reactions (ADR) and neonatal Apgar scores were compared among the three groups. Results There were no significant differences in effective rate, hemodynamics, Ramesay scores at T₁ and T₂ time periods and Apgar scores of neonates at 1 min, 5 min and 10 min among the three groups (P>0.05). The incidence of ADR in group C was higher than that in group B and A (P<0.05). Ramesay score at time of T₃ of group C was lower than group B and group A (P<0.05). Conclusion The 0.02 mg/kg dose of butorphanol in the treatment of perioperative shivering in cesarean section was the most ideal dose, perioperative hemodynamics of puerpera was stable, adverse reactions were mild, and there was no obvious influence on neonates.

目的 分析厄贝沙坦+美托洛尔治疗慢性充血性心力衰竭(congestive heart failure,CHF)的临床效果及对患者心功能影响。方法 选取本院2018年12月—2020年12月住院治疗的200例慢性CHF患者,根据不同的治疗方法分组,参照组100例患者采用厄贝沙坦治疗,治疗组100例患者采用厄贝沙坦+美托洛尔治疗,比较2组临床疗效、心功能指标、血清炎性因子、血清N端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、同型半胱氨酸(homocysteine,Hcy)水平、不良反应发生率。结果 治疗组临床总有效率(97.00%)高于参照组(87.00%),治疗组治疗后左室射血分数(left ventricular ejection fraction,LVEF)高于参照组,治疗组治疗后左室舒张末期内径(left ventricular end diastolic diameter,LVEDd)、左室收缩末期内径(left ventricular end systolic diameter,LVESd)、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(hypersensitivity C-reactive protein,hs-CRP)、白细胞介素-6(interleukin-6,IL-6)、NT-proBNP、Hcy水平均低于参照组,差异均具有统计学意义(P＜0.05)。治疗组不良反应发生率(4.00%)与参照组(5.00%)比较,P>0.05。结论 厄贝沙坦+美托洛尔可有效改善慢性CHF患者心功能,减轻炎症反应,抑制NT-proBNP、Hcy释放,且不良反应较少。

Objective To analyze the clinical effect of irbesartan combined with metoprolol in the treatment of chronic congestive heart failure (CHF) and its influence on cardiac function. Methods A total of 200 patients with chronic CHF in our hospital from December 2018 to December 2020 were selected and divided into two groups according to different treatment methods. One handred patients in the control group were treated with irbesartan, and 100 patients in the treatment group were treated with irbesartan + metoprolol. The clinical efficacy, cardiac function indexes, serum inflammatory factors, serum NT-proBNP, Hcy levels and adverse reactions of the two groups were compared. Results The total effective rate of the treatment group (97.00%) was higher than that of the control group (87.00%), LVEF of the treatment group was higher than that of the control group, LVEDd, LVESd, serum TNF-α, hs-CRP, IL-6, NT-proBNP, Hcy levels of the treatment group were lower than those of the control group, the differences were statistically significant (P<0.05). The incidence of adverse reactions in the treatment group (4.00%) was higher than that in the control group (5.00%),P>0.05. Conclusion Irbesartan + metoprolol could effectively improve cardiac function, reduce inflammatory reaction, inhibit the release of NT-proBNP and Hcy in patients with chronic CHF, with less adverse reactions.

目的 分析银川地区单采献血者流失原因,制定回召策略。方法 对银川地区末次献血时间在2019年1月1日—2020年12月31日的1 498名单采献血者逐个致电回访,使用SPSS 26.0软件进行统计学分析,不同组间变量比较用χ²检验,P<0.05为差异有统计学意义。结果 成功召回355人(23.7%),和未召回组比较,性别无统计学差异(P>0.05),各年龄段、民族、职业、文化程度、血型之间均有统计学差异(P<0.05)。18～24岁、汉族、国家企事业单位、研究生及以上学历人群回召率最高;随着年龄增长、文化程度降低,回召成功率下降。未召回原因中工作繁忙占比最大,其次为在外地、身体原因、亲友献血者、失联、学生毕业、对献血误解、停车不便。结论 不断优化、细化单采献血服务,让工作更加人性化,加大献血正面形象的宣传,不断创新,从而保留固定献血者。

Objective To analyze the causes of apheresis blood donors loss in Yinchuan area, and to work out the call-back strategy. Methods A total of 1 498 blood donors whose last blood donation time was between January 1, 2019 and December 31, 2020 in Yinchuan area were called one by one. SPSS 26.0 software was used for statistical analysis. Variables between different groups were compared usingχ² test, and P<0.05 was considered statistically significant. Results Three hundred and fifty-five people (23.7%) were successfully called back. Compared with the failed call-back group, there was no significant difference in gender (P>0.05), but there were significant differences in age, nationality, occupation, education level and blood type (P<0.05). People aged 18-24, with Han Nationality, working in national enterprises or institutions, or with graduate degree or above had the highest call-back rate; with the increase of age and the decrease of education level, the success rate of call-back decreased. Among the reasons for call-back failure, no free time accounted for the largest proportion, followed by being in other places, physical reasons, donors of relatives and friends, losing contact, graduated from school, misunderstanding of blood donation, and inconvenient parking. Conclusion We will continue to optimize and refine the apheresis blood donation service, make the work more humanized, expand the publicity of the positive image of blood donation, and innovate constantly, so as to retain the blood donors.

目的 比较冷冻前和复苏后脐带血样本的造血功能,探讨冷冻袋附属小管是否可用于脐带血质量控制及移植供体发放前复核。方法 选取2009年3月—2021年2月在广州脐血库冻存的53份脐带血为研究对象,常规复温后,从冷冻袋和附属小管抽取样本,分为冷冻前、小管复苏和大袋复苏组。评价各组的总有核细胞(total nucleated cells,TNCs)数、细胞活率、CD34阳性细胞数量、粒-巨噬细胞集落(colony-forming units-granulocyte/macrophages, CFU-GMs)数量、祖细胞集落(colony-forming units, CFUs)数量等质量参数。结果 小管复苏后TNCs数量、细胞活率、CFU-GMs数量及CFUs数量较冷冻前均显著减少,差异有统计学意义(P＜0.05),而二者的CD34阳性细胞数量差异无统计学意义(P＞ 0.05);大袋复苏后TNCs数量、细胞活率及CFUs数量较冷冻前各相应值比较,差异有统计学意义(P＜0.05),而二者的CD34阳性细胞数量及CFU-GMs数量差异无统计学意义(P＞ 0.05);小管复苏后的TNCs数量、细胞活率、CD34阳性细胞活率、CFU-GMs数量及CFUs数量较大袋复苏后的相应值均减少,差异有统计学意义(P＜0.05),而二者的CD34阳性细胞数量差异无统计学意义(P＞ 0.05)。小管复苏与大袋复苏后的各项参数存在高度相关性。结论 附属小管在一定程度上可作为脐血库质量控制和产品发放前复核的取材。

Objective To compare the hematopoietic function of cord blood before and after cryopreservation, and to explore whether sampling from the attached segment can be used for quality control of cord blood units and confirmatory testing before transplantation. Methods A total of 53 cryopreserved cord blood units from March 2009 to February 2021 in Guangzhou Cord Blood Bank were enrolled in this study. After routine thawing, samples were taken from main bag and its attached segment. They were divided into pre-freezing, post-thawing segment and post-thawing main bag groups. Total nucleated cells (TNCs), cell viability, CD34 positive cells, colony-forming units-granulocyte/macrophages(CFU-GMs)and colony-forming units (CFUs) were examined. Results The number of TNCs [(1.12±0.38)×10⁹], cell viability [(79.11±7.71)%], the number of CFU-GMs [(5.55±4.58)×10⁵] and the number of CFUs [(15.11±9.68)×10⁵] were significantly decreased in samples from post-thawing attached segments compared with those pre-freezing(P＜0.05), but there was no significant difference in the number of CD34 positive cells between two groups (P＞0.05). The number of TNCs [(1.25±0.40)×10⁹], cell viability [(84.75±5.89)%] and CFUs [(18.61±6.42)×10⁵] in samples from post-thawing main bags were significantly different from those pre-freezing (P＜0.05), but there were no significant differences in the number of CD34 positive cells and CFU-GMs between them (P＞0.05). The number of TNCs, cell viability, CD34 positive cell viability, the numbers of CFU-GMs and CFUs were significantly decreased in post-thawing segments compared with those in main bags after thawing (P＜0.05), but there was no significant difference in the number of CD34 positive cells between the two groups (P＞0.05). Spearman correlation analysis showed that the parameters of samples from main bag and its attached segment were highly correlated after thawing. Conclusion Cord blood from attached segment could be quality control sample for cord blood bank and confirmatory testing before product release in some degree.

目的 本研究对广州地区5家教学医院的鲍曼不动杆菌进行分子流行病学分析。方法 5家教学医院共采集138株鲍曼不动杆菌,利用多位点序列分型(multilocus sequence typing,MLST)及eBURST算法评价菌株之间的遗传关系。结果 MLST将138株鲍曼不动杆菌分为8个已有序列类型(STs),分别为ST195、ST208、ST457、ST136、ST254、ST548、ST445和ST53,还发现17个新STs。其中ST195的数量最多,占所有分离株的35.5%(49/138),其次为ST208,占所有分离株的21.0%(29/138)。eBURST算法分析显示以ST195为预测祖先型的克隆复合体(clonal complex, CC) 195在医院环境中广泛传播。结论 鲍曼不动杆菌CC195是广州地区的流行克隆,各家医疗机构应根据其自身实际制定感染防控策略。

Objective We analyzed the molecular epidemiology of A.baumannii isolated from 5 teaching hospitals in Guangzhou to identify the epidemic clone in this area. Methods A total of 138 strains of A.baumannii were collected from 5 teaching hospitals, and the genetic relationship was evaluated by multilocus sequence typing (MLST) and eBURST algorithm. Results MLST divided 138 strains of A.baumannii into 8 existing sequence types (STs), namely ST195, ST208, ST457, ST136, ST254, ST548, ST445 and ST53, and 17 new STs. Among them, ST195 had the largest number, accounting for 35.5% (49/138) of all isolates, followed by ST208, accounting for 21.0% (29/138) of all isolates. eBURST algorithm showed that the clonal complex (CC) 195, the predicted founder ST195, was widely spread in the hospital environment. Conclusion A.baumannii CC195 was an epidemic clone in Guangzhou area. Medical institution should develop infection prevention and control strategies according to its own actual conditions.

目的 探讨广州地区儿童2019新型冠状病毒(2019 novel coronavirus, 2019-nCoV)感染筛查/疑似病例的流行病学特点、发病特点、可能的原因及防控建议。方法 回顾性分析2020年1月20日—2020年2月29日广州市唯一一家儿童2019-nCoV感染隔离定点医疗单位隔离病房收治住院的符合儿童2019-nCoV感染筛查/疑似病例129例,对其流行病学、发病特点、临床特征、实验室检查及转归、随访等进行总结分析。 结果 男 79例,女 50例,最小1个月,最大13岁,中位数2岁,51例(39.5%)有武汉疫区旅游或居住史,20例(15.5%)有与来自疫区有呼吸道症状人员接触史,17例(13.1%)周边或社区有确诊病例,3例(2.3%)有确诊病人接触史(其中2例为家庭确诊病例密切接触史),38例(29.5%)为临床符合或聚集性发病;临床症状:发热121例(93.8%),咳嗽92例(71.3%),流涕50例(38.8%),32例伴有腹泻、呕吐/腹痛(24.8%),102例(79.0%)白细胞降低或正常,C反应蛋白(C-reactive protein,CRP)＜20 mg/L有103例(79.8%),57例(44.2%)胸片或CT示肺部斑片状影或实变;病原学检查:2019-nCoV实时荧光定量反转录PCR检测结果:所有患儿及陪同家属都有行咽拭子检查,只有21例患儿(16.3%)有行肛拭子检查,仅有1例(0.78%)家庭确诊病例密切接触者肛拭子阳性,但连续多次咽拭子结果阴性,余患者肛拭子和咽拭子及陪同家属咽拭子结果均阴性。其他病原学检查结果61例(47.3%),包括14例RSV阳性,9例流感病毒A,8例人偏肺病毒,6例肠道病毒,6例流感病毒B,6例肺炎支原体,4例副流感病毒1型,1例副流感病毒3型,2例人博卡病毒,3例腺病毒,1例肺炎克雷伯菌,1例人型葡萄球菌,其中1例合并副流感病毒1型及人博卡病毒。跟踪唯一1例确诊患者咽拭子多次检查均阴性,肛拭子持续19天后才转阴,一直无任何症状。其余患者好转出院后第3天、7天及14天进行随访,无异常发现。结论 儿童2019-nCoV感染筛查/疑似病例临床多表现为呼吸道或消化道症状,确诊主要依靠核酸检测,新冠病毒感染确诊率极低,而其将近50%病例能找到除新冠病毒外的其它相关病原体;高危患者为密切接触者,但存在漏诊的可能,肛拭子阳性率或高于咽拭子。

Objective To explore the epidemiological characteristics, onset characteristics, pathogenic mechanism of 2019-nCoV infection in children, and its control and prevention in Guangzhou. Methods From January 20, 2020 to February 29, 2020, a retrospective analysis was carried out on 129 suspected cases of 2019-nCoV infection admitted to the isolation ward of the only medical unit designated for children in Guangzhou. The epidemiology, disease characteristics, clinical characteristics, laboratory examination, outcome and follow-up were summarized and analyzed. Results There were 79 males and 50 females, with a minimum age of 1 month and a maximum age of 13 years. Anong them, 51 cases (39.5%) had a history of tourism or residence in the epidemic area of Wuhan, 20 cases (15.5%) had a history of contact with people with respiratory symptoms from the epidemic area, 17 cases (13.1%) with a confirmed case in the surrounding area or community, 3 cases (2.3%) had a history of contact with a confirmed patient (2 of them were family clustering cases), 38 cases (29.5%) were clinically suspected cases. Clinical symptoms: 121 cases with fever (93.8%), 92 cases with coughing (71.3%), 50 cases with runny nose (38.8%), 32 cases with diarrhea, vomiting or abdominal pain (24.8%). In 102 cases (79.0%), white blood cells were decreased or normal, 103 cases (79.8%) with CRP＜20 mg/L, and 57 cases (44.2%) showed focal infection on chest X-ray or CT scan. Etiological examination: only one case (0.78%) of the family confirmed cases had positive anal swab result, but the throat swab results were negative all the time. The anal swab and throat swab results of other patients and the throat swab results of their accompanying family members were negative. Other pathogens were detected in 61 cases (47.3%), including 14 RSV positive cases, 9 influenza A positive cases, 8 human metapneumovirus positive cases, 6 enterovirus positive cases, 6 influenza B positive cases, 6 Mycoplasma pneumoniae positive cases, 4 parainfluenza virus type 1 positive cases, 1 parainfluenza virus type 3 positive cases, 2 human bocavirus positive cases, 3 adenovirus positive cases, 1 Klebsiella pneumoniae positive cases, 1 Human Staphylococcus positive case, and 1 case with parainfluenza virus type 1 and human bocavirus. The only confirmed patient was followed up while multiple pharyngeal swab results were negative, and the positive anal swab results lasted for 19 days before turning negative and remained asymptomatic. Other patients were followed up on the 3rd, 7th and 14th day after discharge, and no abnormal findings were found. Conclusion Screening/suspected cases of 2019-nCoV infection in children were mostly clinically manifested as respiratory or gastrointestinal symptoms. The diagnosis rate of nucleic acids was extremely low, and there was a possibility of missed diagnosis. Nearly 50% of cases could find other relevant pathogens excluding the 2019-nCoV. The positive rate of anal swab results was higher than that of pharyngeal swab.