苏州大学附属儿童医院支气管哮喘及过敏性鼻炎患儿皮肤点刺试验结果分析

目的　应用皮肤点刺试验了解支气管哮喘及过敏性鼻炎患儿的主要过敏原, 为其预防、 诊断、 治疗提供依据。方法　选取于2015年8月至2017年7月在苏州大学附属儿童医院门诊诊断为支气管哮喘及过敏性鼻炎的2252例患儿进行皮肤点刺试验检测过敏原,并对其性别、 疾病种类数据采用SPSS 21.0软件进行分析。结果　2252例患儿进行皮肤点刺试验, 1390例阳性, 阳性率61.7%。男女比例1.75∶1, 男性阳性率（925/1433, 64.5%）高于女性阳性率（465/819, 56.8%）, 差异有统计学意义（P＜0.05）。支气管哮喘患儿阳性率为65.3%（607/929）, 过敏性鼻炎患儿阳性率为58.8%（664/1129）, 支气管哮喘合并过敏性鼻炎患儿阳性率61.3%（119/194）。支气管哮喘阳性率高于过敏性鼻炎, 差异有统计学意义（P＜0.05）。过敏原以粉尘螨（60.3%）、 屋尘螨（43.4%）最常见, 其次是草花粉、 猫毛。结论　苏州大学附属儿童医院的支气管哮喘、 过敏性鼻炎患儿最常见过敏原为螨类; 皮肤点刺试验可为过敏性疾病的诊断提供依据。     

3085例儿童过敏性疾病吸入性过敏原皮肤点刺试验及临床意义

目的：探讨西安及其周边地区儿童过敏性疾病吸入性过敏原状况及分布,为该地区儿童过敏性疾病的防治提供理论依据。方法：采用丹麦ALK-ABELL公司提供的13种标准化变应原皮肤点刺液,对2006年7月至2011年7月因各种过敏性疾病等原因就诊的来自西安及其周边地区的3085例儿童进行吸入性过敏原皮肤点刺试验（skin prick test, SPT）。结果：3085例患儿中,吸入性SPT阳性1368例,阳性率为44-34%。过敏原阳性率较高的前5位依次为屋尘螨804例（26.06%）、粉尘螨793例（25.71%）、热带螨440例（14.26%）、艾蒿282例（9.14%）、猫毛204例（6.61%）。<4岁组、4岁～组、7～15岁组SPT阳性率依次为28.66%、41.85%、58.61%,组间比较差异有统计学意义（P<0.01）,表现为随年龄增长SPT阳性率增加。男性SPT阳性率较女性高（47.78% vs 38.50%,P<0.05）。在各种不同的过敏性疾病中,以过敏性鼻炎患儿的SPT阳性率最高,达72.41%,其次依次为支气管哮喘（62-25%）、变态反应性皮肤病（45-83%）、过敏性紫癜（36.28%）。结论：西安及其周边地区儿童过敏性疾病吸入性过敏原以屋尘螨、粉尘螨、热带螨、艾蒿、猫毛等为主;SPT阳性率随年龄增长而增加;男性儿童SPT阳性率较女性高;在常见过敏性疾病中,以过敏性鼻炎患儿SPT阳性率最高。     

IgE介导的食物过敏诊断程序及临床评价

目的 对IgE介导的食物过敏的诊断流程进行临床评价。探讨高效的食物过敏诊断程序。方法 0～6岁患儿88例，以支气管哮喘、过敏性鼻炎、特应性皮炎以及消化道症状为主要临床表现，进行食物过敏原皮肤点刺试验（skin prick test，SPT），皮肤试验阳性者检测血清特异性IgE（sIgE）、sIgE阳性者进一步进行双盲安慰剂食物激发试验（double-blind placebo-control food challenge，DBPCFC）证实诊断。sIsE阴性者通过DBPCFC建立或排除诊断。结果 88例患儿中SPT（＋）者25例。其中SPT（＋）sIgE（＋）者16例，SPT（＋）sIsE（-）者9例；前者经DBPCFC进一步证实为食物过敏的有14例；后者通过DBPCFC建立诊断的3例。排除诊断的6例，根据SPT（＋）sIgE（＋）或SPT（＋）sIsE（-）诊断食物过敏的阳性预计值为87．5％．阴性预计值为77．8％。结论 皮肤点刺试验结合sIgE检测有较高的食物过敏确诊率，当前两者不一致时，需要通过DBPCFC建立诊断。     

哮喘儿童体外过敏原抗体280例调查研究

目的了解东莞市哮喘儿童过敏原分布情况。方法（1）问卷调查；（2）用UniCAP100全自动检测仪、荧光免疫检测法、体外检测哮喘组及肺炎组（对照组）患儿血清过敏原抗体。吸人性过敏原筛查包括：螨及屋尘螨、粉尘螨等。食人性过敏原筛查（FX5E）：主要为牛奶、鸡蛋、虾、螃蟹、鱼等。结果吸人性过敏原筛查：肺炎组受检296例患儿中，阳性为75例（25．33％）；哮喘组受检280例患儿中，阳性为230例（82．14％）。食人性过敏原筛查：肺炎组受检296例患儿中，阳性为45例（15．20％）；哮喘组受检280例中，阳性为142例（50．71％）。哮喘组与肺炎组间吸人性过敏原、食人性过敏原差异均有统计学意义（P〈0．05）。哮喘组对尘螨呈高敏感趋势，而且阳性率随年龄增长而增长，呈正相关关系。哮喘组对食人性过敏原较为敏感者，主要是对海鲜类过敏，其次为常见蔬果过敏。结论本组受检哮喘儿童吸人性过敏原中，主要过敏原为尘螨。而且阳性率及过敏反应程度随年龄的增长而增长，呈正相关关系。部分哮喘儿童对海鲜类食物过敏，其次是对常见蔬果类过敏。     

温州地区儿童血清特异性过敏原检测的临床意义

目的了解温州地区不同年龄组儿童哮喘及过敏性疾病的过敏原状况,以指导临床防治。方法采用体外过敏原检测系统(法玛西亚CAP系统)对我院呼吸科门诊及住院患儿468例进行过敏原特异性IgE(sIgE)抗体检测,将所有受检儿童分为婴幼儿、学龄前、学龄期3组,对过敏原状况进行分析比较。结果哮喘发病主要集中于学龄前和婴幼儿期,过敏性鼻炎主要发生于学龄儿童;各种过敏性疾病中过敏性鼻炎sIgE阳性检出率最高,其次是哮喘和过敏性咳嗽;婴幼儿以食物过敏为主,较大年龄儿童以吸入性过敏为主,学龄前儿童两者均可发生;温州地区吸入性过敏原以尘螨为主,食入性以虾为主;在螨sIgE阳性者中哮喘比率最高,其次是过敏性鼻炎和过敏性咳嗽。结论螨及虾是温州地区儿童最常见过敏原。哮喘应在婴幼儿及学龄前期及早进行针对性防治,体外血清过敏原特异性抗体检测CAP系统是婴幼儿及学龄前儿童过敏原检测的方法之一。     

儿童过敏性鼻炎的流行病学

过敏性鼻炎（allergic rhinitis，AR）是儿童常见的慢性疾病之一。经全球流行病学调查，不同年龄段、不同地区之间的儿童AR患病率都有差异，AR患病率整体呈现缓慢增加的趋势。但不同地区过敏原种类分布不一，在欧美及我国新疆地区，以植物类为主要过敏原；我国其他地区则以螨类为主要过敏原。     

复旦大学附属儿科医院2413例过敏性鼻炎患儿过敏原筛查结果分析

目的　了解过敏性鼻炎（allergic rhinitis,AR）患儿的过敏原,为儿童AR的预防和治疗提供依据。方法　采用免疫印迹法对2013年1月至2018年7月就诊于复旦大学附属儿科医院耳鼻咽喉头颈外科的2413例AR患儿进行过敏原检测并进行分析。结果　吸入性过敏原前4位分别为户尘螨（49.52%）、混合霉菌（23.62%）、狗毛（17.99%）、屋尘（15.54%）。食入性过敏原前4位分别为牛奶（46.54%）、鸡蛋（22.92%）、腰果（19.10%）、螃蟹（9.45%）。部分AR患儿（46.33%）同时存在吸入性及食入性过敏。男女患儿过敏原阳性率比较差异有统计学意义（P＜0.05）。随着年龄增长,儿童的吸入性过敏原阳性率逐渐增加,食入性过敏原阳性率逐渐降低。结论　儿童吸入性过敏原以尘螨及混合霉菌为主,食入性过敏原以牛奶及鸡蛋为主,过敏原检测有助于了解患儿的过敏状态。     

儿童不同过敏性疾病的过敏原构成分析

目的 研究不同过敏性疾病患儿的常见过敏原,为儿童过敏性疾病的临床诊断、治疗和预防提供依据。方法 采用皮肤点刺试验对1 179 例患各种过敏性疾病的患儿进行过敏原检测,根据临床诊断分为6 组:特应性皮炎组(n=140)、过敏性胃肠炎组(n=37)、过敏性结膜炎组(n=77)、过敏性鼻炎组(n=301)、哮喘组(n=285)、混合过敏性疾病组(n=329)。结果 1 179 例患儿过敏原阳性总检出率为82.0%,阳性率最高的吸入过敏原是粉尘螨(68.1%)和屋尘螨(53.5%),阳性率最高的食物过敏原是牛奶(5.0%)和鸡蛋(4.8%)。特应性皮炎组和过敏性胃肠炎组中≤3岁患病的人数分别占84.3% 和83.8%,过敏性结膜炎组、过敏性鼻炎组、哮喘组和混合过敏性疾病组均以4 岁以上儿童占多数。特应性皮炎组以食物过敏原阳性为主,最常见的过敏原是鸡蛋和粉尘螨;过敏性胃肠炎组以食物过敏原阳性为主,最常见的过敏原是鸡蛋和牛奶;过敏性结膜炎组、过敏性鼻炎组、哮喘组和混合过敏性疾病组均以吸入性过敏原阳性为主,最常见的过敏原均是粉尘螨和屋尘螨。结论 不同过敏性疾病患儿的年龄分布和过敏原种类不同:特应性皮炎和过敏性胃肠炎多见于婴幼儿,以食物过敏原为主;过敏性结膜炎、鼻炎、哮喘和混合过敏症多见于年长儿,以吸入性过敏原为主。     

哮喘儿童螨抗原皮肤点刺试验与血清特异性IgE测定

对哮喘儿童进行螨抗原皮肤点刺试验（SPT）和血清特异性IgE（SIgE）测定，用粉尘螨提取液进行SPT，SIgE测定，采用UniCAP变应原检测系统。结果SPT的阳性率为83．33％，SIgE的阳性率为88．89％，两者的符合率为防86．67％。认为螨是引起哮喘的重要过敏原,SPT和SIgE测定是变应原诊断的两种重要手段，两者的相关性好，临床应用中应相互补充。     

长期特异性免疫治疗对螨过敏儿童血清IgG4的影响

目的探讨长期特异性免疫治疗对螨过敏儿童血清IgG4的影响。方法对60例过敏性哮喘和(或)过敏性鼻炎的患儿,予屋尘螨特异性过敏原免疫治疗,在治疗前、治疗16周、治疗1年和治疗3年时分别进行血清IgG4检测。结果随着治疗的进行,螨特异性IgG4显著增高(F=83.91,P<0.001),各时间段差异均有统计学意义(P均<0.01),并且以治疗剂量递增过程患儿血中螨特异性IgG4含量增长最快,在三年治疗结束时血清IgG4值达到最高。结论螨特异性过敏原免疫治疗对患儿体内免疫状态有明显的调节作用,有利于改善螨过敏患儿的症状和体征。     

Breastfeeding perceptions in communities in Mangochi district in Malawi

Aim: To investigate mothers’ perceptions of breastfeeding and influences from their social network. Methods: A cross‐sectional survey was carried out in Mangochi district, Malawi where questionnaire data from 157 rural and 192 semi‐urban mother–infant pairs were obtained. Results: The proportion of mothers who thought that exclusive breastfeeding should last for 6 months and those who reported to have actually exclusively breastfed were 40.1% and 7.5% respectively. Of those who reported practising exclusive breastfeeding for 6 months, 77.5% stated that exclusive breastfeeding should last for 6 months. This opinion was independently associated with giving birth in a Baby‐Friendly facility, OR = 5.22; 95% CI (1.92–14.16). Among the mothers who thought that exclusive breastfeeding should last for less than 6 months, 43.9% reported having been influenced in their opinion by health workers. Infant crying was the most common (62.4%) reason for stopping exclusive breastfeeding. Conclusion: The findings illustrate the positive impact health workers can have, as well as the need to raise awareness of the benefits of exclusive breastfeeding among both health workers and mothers. Furthermore, continued counselling of mothers on how to deal with stressful infant behaviour such as crying may assist to prolong exclusive breastfeeding.     

胶原成分在儿童系膜增生性肾小球肾炎中的变化

目的观察系膜增生性肾小球肾炎（ＭｓＰＧＮ）系膜区胶原成分的变化。方法应用链菌素亲生物素过氧化酶连接法观察了３０例轻度ＭｓＰＧＮ肾穿刺活组织标本和正常的肾小球系膜区Ⅳ型胶原及其α链（α１、α３、α５链）、Ⅵ型胶原及Ⅰ型胶原的变化。结果（１）正常肾脏组织中，Ⅳ型胶原及其α１（Ⅳ）链分布于系膜区和基底膜，α３（Ⅳ）、α５（Ⅳ）链分布于基底膜，Ⅵ型胶原分布于系膜区、肾小球基底膜和间质，Ⅰ型胶原仅分布于肾间质。（２）在轻度ＭｓＰＧＮ时，系膜区内Ⅳ型胶原及其α１链、Ⅵ型胶原含量较正常对照明显增多（Ｐ＜０．０１）；当系膜区系膜细胞超过４个时，Ⅰ型胶原开始在肾小球内出现，且在硬化肾小球内Ⅰ型胶原均呈阳性；α３（Ⅳ）、α５（Ⅳ）链与正常对照比较无明显变化，硬化肾小球α３（Ⅳ）、α５（Ⅳ）染色呈阳性。结论系膜区胶原成分增多可先于系膜细胞增生，并随系膜细胞增生而增多，间质胶原成分Ⅰ型胶原，不但出现于硬化肾小球内，而且出现于系膜细胞增生较重时     

Cardiomyopathy in children in Ahmedabad

A clinical study and follow up of 20 children with cardiomyopathies upto age of 16 years are presented. The DCM was most common variety followed by RCM and HCM in pediatric age group. SHMD presenting with cardiomyopathy were common in infancy and early childhood. Cardiomyopathies presented most frequently between 2–5 years and 10–16 years age group with DCM having almost equal distribution. Clinical presentation of various types is described, despite of vigorous decongestive and vasodilator treatment in advanced cases, course was rapidly downhill and prognosis is poor in general.     

Achalasia in siblings in infancy

Achalasia is rare in children, more so familial. We report two siblings with familial achalasia who presented in their infancy with vomiting and failure to thrive. Achalasia can be misdiagnosed as upper gastrointestinal obstruction as happened in one of our siblings. Esophageal contrast roentgenography is diagnostic. Both the children were treated successfully by transabdominal esophagomyotomy with fundoplication.     

哮喘大鼠气道重塑中尾加压素-的表达变化

目的：研究哮喘大鼠气道重塑血清和支气管肺泡灌洗液（BALF）中尾加压素 Ⅱ（U-II）含量的变化及其作用。方法：32只雄性Sprague-Dawley大鼠随机分为正常对照组、哮喘2周组、哮喘4周组和哮喘8周组,每组8只。以卵清白蛋白(OVA)致敏与激发建立哮喘大鼠气道重塑模型,图像分析技术测量大鼠支气管壁总面积和平滑肌面积,计算单位基底膜周径(Pbm)的支气管壁厚度(Wat)和平滑肌厚度(Wam),ELISA法测定血清和BALF中U-II的含量。结果：哮喘各组Wat及Wam均明显高于正常对照组（P<0.01）;哮喘组血清和BALF中U-II含量均显著高于正常对照组（P<0.01）,其中哮喘8周组血清和BALF中U-II含量显著高于哮喘4周组和哮喘2周组（P<0.01）,哮喘4周组也显著高于哮喘2周组（P<0.01）。各组大鼠BALF中的U-II含量与Wat及Wam呈正相关,BALF与血清中U-II含量亦呈正相关。结论：哮喘大鼠气道重塑血清和BALF中U-II含量增加;且U-II含量的变化与气道重塑相关。［中国当代儿科杂志,2010,12（4）：287-289］     

北京地区2007年儿童A群轮状病毒腹泻的流行病学研究

目的 研究北京地区急性腹泻儿童中A群轮状病毒(RV)感染的流行病学特点.方法 收集2007年4月至12月我院肠道门诊就诊的2039例急性腹泻患儿的粪便标本,采用标记金的A群RV单克隆抗体,以免疫层析双抗体夹心法定性检测A群RV抗原.结果 2039份粪便标本中,621份检测到A群RV,总检出率为30.5%(621/2039),其中男430例(69.2%),女191例(30.8%).RV感染者中,以6个月～2岁年龄段的患儿为最多,共571例(91.9%).检出率以10～12月份最高,均在30%以上,其中高峰出现在11月份,达43.4%.北京地区18个区县的统计数据显示,距市区较近的区县RV抗原检出率较低,边远区县较高.少部分患儿合并肠道细菌感染.结论 A群RV为北京地区2岁以下儿童急性腹泻病的主病原,6个月～2岁婴幼儿是A群RV的易感人群,10～12月份为北京地区的流行高峰.在流行季节对肠道细菌感染患儿常规进行A群RV抗原检测有助于避免漏诊和进行更合理的治疗.     

转流术治疗小儿精索静脉曲张

目的 采用转流术治疗小儿精索静脉曲张，重新建立精索静脉通道，使静脉回流受阻立即得到改善，消除因睾丸淤血而造成的损害，以利睾丸的正常发育。方法 对28例30侧(左侧26例，双侧2例)精索静脉曲张与腹壁下静脉进行吻合，通过腹壁下静脉，髂静脉转流，手术在放大镜下应用显微外科技术进行，其中28侧用精索静脉主干，2侧结扎一条属支，用另一条静脉进行吻合。结果 通畅率为100％。术后扩张迂曲静脉团消失，阴囊下坠感消失。术后随访24例，时间为3个月-10年。除1例二次手术证实为一条静脉属支漏扎而复发外，另23例全部治愈。结论 精索静脉曲张转流术效果明显优于结扎术，可减少因睾丸淤血对其造成的进一步损害，且术后复发率低。     

Poisoning in children in Japan

The Japan Poison Information Centre (JPIC) received 31510 inquiries about poisoning in children under 6 years old being exposed to poison in the fiscal year 1995. The most frequently implicated products were tobacco (20%) and the peak age for ingestion of household products was 1 year and younger (83.3%). Especially, the inquiries related to children less than 1 year old were 35.7% of the cases. In contrast, the American Association of Poison Control Centers (AAPCC) data showed that the most common poisonings were due to pharmaceutical products and the inquiries related to children less than 1 year old were only 12.1%. The objective of this report was to find out the poison exposure in children in Japan and to compare the data with that of AAPCC.     

Rotavirus infection in children in Japan

Currently, a high morbidity of rotavirus diarrhea has been seen in children in developed and developing countries. Improvement of the vaccines is necessary in order to reduce the burden of diarrhea caused by rotavirus. A survey of rotavirus infection from diarrheal stool specimens in children of seven regions in Japan was conducted from 1984 to 1999. The present study discusses the survey results and reviews the national and international data of more than 23 papers and congress proceedings about rotavirus infection in Japan. We analyze the prevalence of rotavirus infection in acute diarrheal in- and outpatients, the distribution of rotavirus G-serotypes and surveillance data for seasonality and age groups in Japan. The data indicated that rotavirus is the most important cause of diarrhea in Japan among young children, with the prevalence ranging from approximately 9.7 to 88%. The most common rotavirus strains belonged to serotype G1, specifically since 1993. Serotypes G2, G3 and G4 had also been documented to be predominantly based in the area and year before 1992. However, untypeable rotavirus strains had been found each year, with a prevalence up to 56.7% which suggests that rare serotypes (except G1-4) or new serotypes might exist. Unexpectedly, in Tokyo and Sapporo from 1998 to 1999, G9 was found to be the first most prevailing serotype with a high prevalence of 52.9 and 71.4%, respectively. Despite these data from different geographic areas, the year under investigation was relatively clear in respect to seasonality, with a peak of rotavirus activity in late winter (February) through early spring (March). Age distribution had also characterized that the infection was predominant among children aged 1-2 years of age, although it was also common in children of 2-3 years. In addition, mixed infection with bacteria was documented.