先天性甲状腺功能减低症45例影响因素分析

目的 了解先天性甲状腺功能减低症(CH)发病情况及其影响因素,为CH的防治提供依据。方法 选取2015年1月—2019年12月本地区进行新生儿疾病筛查的新生儿进行问卷调查,分析本地区CH发病率及分布情况。应用单因素及多因素Logistic回归分析影响CH发病的相关因素。结果 2015—2019年进行新生儿疾病筛查人数总共为127 524例,确诊为CH患儿45例,5年CH总体发病率为35.29/10⁵。冬春季CH发病率高于夏秋季,但差异无统计学意义(χ²=0.884,P=0.347);早产儿CH发病率最高,发病率为251.68/10⁵(18/7 152),早产儿CH发病率高于足月儿20.93/10⁵(25/119 467),差异有统计学意义(χ²=105.839,P<0.001)。多因素Logistic回归分析显示,低出生体重(OR=3.172,95%CI:2.185～8.116,P=0.012)、早产(OR=2.662,95%CI:1.904～7.115,P=0.008)、合并妊娠期糖尿病(OR=1.973,95%CI:1.362～4.950,P=0.037)、合并妊娠期高血压疾病(OR=1.892,95%CI:1.207～4.216,P=0.024)、孕期用药史(OR=2.350,95%CI:1.802～6.713,P=0.016)、孕期射线接触史(OR=2.712,95%CI:1.938～7.346,P=0.028)及孕期碘摄入量不足(OR=4.120,95%CI:2.713～9.150,P<0.001)是CH发病的危险因素(P<0.05)。结论 本地区CH发病率较高,影响CH发病的危险因素较多,应根据这些因素制定预防措施,以减少CH发病。     

彭涛教授治疗慢性萎缩性胃炎的经验拾萃

慢性萎缩性胃炎（Chronic Atrophic Gastritis,CAG）是一种常见病,世界卫生组织将其列为胃癌前状态。发展中国家的CAG发病率高于发达国家,中老年发病率高于中青年。但由于社会生活节奏加快,该病有年轻化趋势。概因部分年轻人生活不规律、饮食无节制导致。大多数患者有上腹部灼痛、胀痛、胀满、便秘或腹泻等症状。山西省中西医结合医院彭涛教授从事多年脾胃病治疗,他认为寒热错杂证是临床上最为常见的CAG证型,可以自拟乌梅和胃汤治疗,临床上取得了显著疗效,应注重中西医结合治疗慢性萎缩性胃炎,推动中医学术理论的发展,增强文化自信,促进中医现代化进程。文章结合案例介绍彭涛教授用乌梅和胃汤治疗慢性萎缩性胃炎经验,为临床提供参考。     

4日龄新生儿感染奥密克戎变异株BA.5.1.3病例报道1例

目的 了解新生儿新型冠状病毒奥密克戎（Omicron）变异株BA.5.1.3感染后的临床表现、体征、治疗及恢复情况,为后续新生儿感染新型冠状病毒诊疗提供一定的参考资料。方法 选取三亚市1名4日龄社区感染新型冠状病毒变异株BA.5.1.3的新生儿为对象,收集患儿患病以来的临床表现、流行病学史、辅助检查结果及治疗经过进行回顾性分析。结果 患儿母亲分娩前1 h被确定为新型冠状病毒密切接触者,分娩后24 h内核酸检测结果阳性,产后母乳及羊水、胎盘、脐带均未行新冠病毒核酸检测。患儿出生后24 h内核酸检测结果阴性,转移至酒店隔离。转移前一直母婴同室并食用母乳且其母亲未佩戴口罩,出生第2天、第3天未行核酸检测,第4天核酸检测结果阳性,第5天核酸检测结果阴性,第6天核酸检测结果阳性,立即转至三亚市中心医院住院治疗。患儿无咳嗽,无发热,皮肤出现黄染,腹胀,吃奶一般,反应好。入院时实验室检查结果血常规、电解质均正常,心肌酶及肝肾功能均正常,胆红素（449.3 μmol/L）明显升高,新冠病毒核酸检测结果阳性,胸部影像学结果正常。治疗措施主要是隔离、按需喂养、蓝光照射,密切监测生命体征,未使用抗病毒药物。治疗6 d后黄疸消退,腹胀缓解,治疗过程顺利无并发症。结论 新生儿是Omicron变异株BA.5.1.3的易感人群,该病例垂直传播依据不足,感染后临床症状较轻,未见有累及心肝肾脑等器官损伤,临床分型为轻型,对症治疗14 d后出院。     

海南省三亚市新型冠状病毒感染孕妇所分娩核酸阴性新生儿临床特征

Objective To explore the clinical characteristics of nucleic acid negative newborns delivered by pregnant women infected with SARS-CoV-2 (Omicron variant BA. 5.1.3) in Sanya area, and to provide evidence for understanding its clinical characteristics. Methods A retrospective analysis was performed on 14 neonates with negative nucleic acid delivered by pregnant women who tested positive for SARS-CoV-2 (Omicron variant BA.5.1.3) in Sanya Central Hospital (the Third People's Hospital of Hainan Province) from June 2022 to September 2022 (observation group, n=14). The corresponding nucleic acid-negative newborns delivered by pregnant women detected negative with SARS-CoV-2 (Omicronon variant strain BA.5.1.3) were set as the control group (n=56), and the general data and clinical characteristics of neonates in the two groups were compared. Results There was no significant difference between the observation group and the control group in pregnancy diabetes, pregnancy induced hypertension, gestational pre-eclampsia, fetal intrauterine distress, premature rupture of membranes (P>0.05); there was no significant difference between the observation group and the control group in terms of sex, gestational age, birth weight, age, mode of delivery, birth Apgar score, heart screening, pulmonary disease, glucose 6-phosphate dehydrogenase (G6PD) deficiency, thalassemia, breast milk jaundice, hemolytic jaundice (P>0.05). The bilirubin level, blue light irradiation cases and the duration of blue light irradiation of the newborns in the observation group at 7 days after birth were higher than those in the control group (P<0.05); the ratio of blood oxygen saturation ≥ 90% in the observation group was lower than that in the control group (21.43% vs 89.29%, P<0.05), and the ratio of blood oxygen saturation occasionally<90% was higher than that in the control group (57.14% vs 10.71%, P<0.05). The ratio of blood oxygen saturation<90% had no significant difference compared with that in the control group (7.14% vs 0, P>0.05), and the ratio of blood oxygen saturation reduced to the required oxygen uptake was higher than that in the control group (14.29% vs 0, P<0.05). Conclusions The jaundice manifestation of the nucleic acid-negative newborns delivered by pregnant women infected with SARS-CoV-2 (Omicronon variant strain BA.5.1.3) in Sanya area is relatively obvious, with blood oxygen saturation easily lower than 90% and even requiring oxygen inhalation in severe cases. © 2023 China Tropical Medicine. All rights reserved.