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??Abstracts??Objective Different diagnostic methods of biliary atresia ??BA?? and infantile intrahepatic cholestasis disease were investigated in order to find a simple?? fast??practical??economic and non invasive differential diagnostic method. Methods A total of 584 cases of infantile cholestasis were collected from May 2006 to June 2012 for persistent jaundice??pale yellow or white shit who lived in Department of Pediatric Digestion and Infection?? Tongji Hospital?? Tongji Medical College?? Huazhong University of Science & Technology??HUST??. Seven methods including clinical diagnosis??blood biochemical tests?? liver and gallbladder ultrasonography?? dynamic continuous duodenal liquid bile check?? nuclide hepatic imaging?? magnetic resonance imaging and histology were applied for differential diagnosis and the results were analyzed. Results The correctness of clinical diagnosis method was 74.5%?? sensitivity 81.6%??specificity 69.9%?? liver size: 49.0%??89.0%?? and76.9%?? stool color:83.2%??96.1% and96.7%??blood total bilirubin:63.0%??93.1%and91.2% ?? serumγ-GT:79.7%?? 71.1%and78.7% ?? dynamic duodenal liquid color check:93.3%??91.7% and92.7%?? bile acid of duodenal liquid:97.8%??100.0% and 100.0%??B graphy :89.7%??91.7%and94.3%??porta fibre block check:72.1%??29.4%and 68.7%??nuclide hepatic imaging :60.5%??100.0% and 100.0%??MRCP:88.3%??96.5%and94.4%??liver pathology :97.4%??98.2% and 94.9%. Conclusion Differential diagnosis in 1 week can help differentiate biliary atresia from infantile intrahepatic cholestasis. B-ultrasonography and dynamic duodenal fluid test are simple?? fast practical??economic and noninvasive as differential diagnostic methods.     

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目的评价免疫调节T细胞和细胞因子在再生障碍性贫血(再障)细胞免疫功能紊乱中的作用。方法2004-02—2005-06中山大学第二附属医院采用流式细胞术检测27例特发性再障患儿骨髓及外周血淋巴细胞亚群和CD 4CD2 5T细胞水平,ELISA检测骨髓转化生长因子(TGFβ-1)和F lt-3L水平,并与正常儿童对照。结果与对照组比较,初诊再障患儿外周血和骨髓CD 8T细胞均显著增高(P<0.05),重型再障(SAA)组伴外周血CD3-CD 56NK细胞及骨髓B细胞显著下降(P<0.05)。初诊SAA组骨髓CD 4CD 25T细胞[(7.5±3.4)%]显著高于对照组[(4.3±0.9)%,P<0.05],初诊SAA组及轻型再障(MAA)组骨髓CD 4CD2 5/CD 4比值分别为(28.9±11.1)%和(28.2±9.4)%,均显著高于对照组[(17.4±0.9)%,P均<0.05],骨髓TGFβ-1分别为(2.2±1.7)μg/L和(2.0±0.6)μg/L,均较对照组[(4.4±0.9)μg/L]显著降低(分别为P<0.01、P<0.05),而F lt-3L水平分别为(1031.1±321.8)ng/L和(694.7±424.7)ng/L,均较对照组[(63.0±37.5)ng/L]显著增高(P均<0.01)。缓解期SAA儿童除外周血CD8 T细胞仍较对照组显著增高外,其余上述指标均接近正常水平。相关分析显示,骨髓CD4 CD 25T细胞与CD 3CD 4T细胞呈显著正相关(r分别为0.495、0.540,P<0.01);F lt-3L与骨髓CD 3、CD 4、CD 8T细胞及CD 4CD 25T细胞均呈显著正相关(r分别为0.732、0.542、0.688、0.405,P分别<0.01、0.01、0.01、0.05),而TGFβ-1与骨髓CD 8T细胞和F lt-3L水平呈显著负相关(r分别为-0.431、-0.482,P分别<0.05、<0.01)。结论儿童再障发病与CD 4CD 25T细胞数量缺乏无关,骨髓TGFβ-1水平显著降低和F lt-3L水平显著增高可能在再障儿童T淋巴细胞数量增多和功能紊乱中起重要作用。     

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??Objective To detect the serum levels of soluble triggering receptor expressed on myeloid cells-1??sTREM-1??so as to investigate the significance of sTREM-1 in small infants with infectious diseases. Methods All subjects were infants aged 7 d ~3 m hospitalized from January 1??2011 to December 31??2011.Ninety-four patients were enrolled .According to the results of the pathogens the patients were divided into three groups?? 32 with bacterial infection?? 30 with viral infection and 32 controls without infection. Blood samples were collected from the enrolled patients hospitalized in 12 hours .At convalescence and recovery time the blood samples were collected from the bacterial infection patients. Serum sTREM-1 was measured by ELISA??enzyme-linked immunosorbent assay??. The data were analyzed by Paired T test and Single factor analysis of variance. Results The levels of serum sTREM-1 in acute phase in patients of three groups were as follows?? the mean level was ??240.20 ± 120.25??pg/mL in bacterial infection group?? viral infection group ??81.26 ± 13.83??pg/mL?? no-infection group ??69.42 ± 23.69??pg/mL. The bacterial infection group had higher sTREM-1 level than viral infection group and no-infection group. The difference was of statistical significance. The viral infection group had higher sTREM-1 level than no-infection group. The difference was of no statistical significance. The levels of serum sTREM-1 in acute phase?? convalescent phase?? recovery phase were as follows?? sTREM-1 level in acute phase??240.2 ± 120.25 pg/mL??was higher than convalescent and recovery phase??118.92 ± 59.74?? 73.59 ± 35.49 pg/mL??.The difference was of statistical significance. The level of serum sTREM-1 in recovery phase in bacterial infection group was ??73.59 ± 35.49 pg/ml????the level in no-infection group??69.42 ± 23.69 pg/mL??.The difference was of no statistical significance. The level of serum sTREM-1??Gram-positive bacterial infection??202.54 ± 107.14 pg/mL??and Gram-negative bacterial infection??210.36 ± 120.93 pg/mL????the difference was of no statistical significance. Serum level of sTREM - 1 to distinguish between bacterial infection and virus infection or are infected area under ROC curve for 0.983 ??95% CI 0.96 1.00???? higher than other markers CRP 0.947 ??95% CI0.883??1.01???? WBC 0.747 ??95% CI0.631??0.864???? PCT 0.950 ??95% CI0.907??0.994?? .Conclusion The sTREM-1 has high expression level in serum in infantile bacterial infection. The sTREM-1 is higher in bacterial infection group than that in viral infection group and no-infection group. The sTREM-1 declines with the recovery of the bacterial infection. There is significant difference according to the infection severity. This suggests it may be an index to bacterial infection diagnosis and evaluation of the severity of infection.     

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目的观察全身炎症反应综合征(SIRS)患儿血内毒素、脂多糖结合蛋白(LBP)、脂多糖受体(sCD14)及肿瘤坏死因子-α(TNF-α)水平的变化,探讨内毒素、LBP/CD14系统及TNF-α在SIRS发病中的作用以及与病情严重程度的关系。方法2000-09—2004-09对河北省人民医院儿科就诊的62例SIRS患儿分别采用鲎试剂动态比浊定量测定法、酶联免疫试验进行血内毒素、LBP、sCD14及TNF-α的定量测定,并对部分患儿进行动态观察。结果SIRS组内毒素、LBP、sCD14的水平均明显高于健康对照组,多器官功能障碍综合征(MODS)组明显高于非MODS组,且LBP、sCD14的质量浓度均随内毒素水平升高而升高,两者呈显著正相关。动态研究发现,恶化后内毒素、LBP、sCD14及TNF-α水平明显高于恶化前,且TNF-α分别与LBP和sCD14呈显著正相关。将患儿血sCD14均值在不同范围进行分组比较发现,随sCD14水平的升高,SIRS患儿合并MODS的例数增多,病死率亦随之上升。结论全身炎症反应时内毒素血症可能是刺激机体合成和释放LBP、CD14的重要因素之一,而LBP、CD14又可增敏内毒素效应,进一步刺激机体产生大量炎症因子,介导组织损伤。而且,sCD14水平与MODS的发生、发展密切相关,动态监测其变化对SIRS患儿的病情转归有一定的预警意义。     

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??Abstracts??Children’s allergic diseases have become onekind ofcommonchronic diseases??which are seriously harmful to children’s physical and mental health. Digestive tractallergy isone aspect of theallergic diseases?? involving??infant colic??oralallergysyndrome??allergicproctocolitis??food protein inducedenterocolitissyndrome??glutenallergydisease??eosinophilic esophagitis??eosinophilic gastroenteritis??allergicpurpura??abdominal??,etc..This article focuses on diagnosis andcoping strategies??in order to help toimprove the level of diagnosis and treatmentin clinics.     

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正随着围生医学的发展和新生儿重症监护救治水平的提高,超低出生体重儿(extremely low birth weight infant,ELBWI)的成活率明显提高,但存活的患儿疾病发生率未降低[1],存活者脑瘫和神经发育损害的发生率仍然较高[2-3]。     

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??Abstract??Objective The time-effect relationship in treating postural orthostatic tachycardia syndrome ??POTS?? of children with alpha receptor agonist midodrine hydrochloride was analyzed to explore the optimum course of treatment for POTS children. Methods A total of 104 cases of the POTS children were studied from 2005 to 2011 in Peking University First Hospital. A chi-square test was used to evaluate the relationship between effect and time of medication?? and the time-effect curve was constructed. Results According to the 104 cases?? the time accumulative total efficacy for 1 month?? 2 months?? 3 months?? 4 months?? 5 months and 6 months were 19.23%?? 48.08%?? 69.23%?? 73.08%?? 74.04% and 75.96%?? respectively. The time accumulative total efficacy for 3 months was higher than that for 1 month or 2 months ??P??0.05???? but there was no difference in the efficacy among 4 months?? 5 months and 6 months treatment and with 3 months treatment. Conclusion It has the best treatment efficacy when the course of treatment for POTS children with midodrine hydrochloride is 3 months?? and prolonging the duration of treatment does not significantly improve the therapeutic effect.