Three pediatric massage schools in treating recurrent respiratory tract Infection

This paper describes the similarities and differences between three-character scripture school from Shandong, Shanghai pediatric massage and Hunan Liu Kaiyun pediatric massage in the treatment of Recurrent respiratory tract in order to standardize operation, collect references and provide the basis for local infantile massage school.

The Expression of Exogenous ADA Gene in T－lymphocytes of Children with Recurrent Respiratory Tract infectious Diseases

The adenosine deaminase(ADA) activities in blood lymphocytes of 41normal children and 17 with recurrent respiratory tract infections were examined,and the T-lymphocytes of two children whose ADA activities were obviously lower than those of others were cultared in vilro. Then the exogenous human ADA gene was transfected into these cells by means of lipofectin mediated gene transfer. The results showed that the ADA activities in cultured T-lymphocytes were raised and the immunological were also improved.

Clinical Observation on 46 Cases of Infantile Repeated Respiratory Tract Infection Treated by Mild-Moxibustion over Acupoints on Back

Repeated respiratory tract infection is a frequently-occurring disease during childhood. At present, western medicine doctors generally adopt anti-infectives and immunomodulators to treat the disease, while traditional Chinese medicine doctors mainly administer decoction of Chinese herbs. The authors treated 46 cases of repeated respiratory tract infection from March 1990 to April 1996 by applying mild-moxibustion over points on the back with satisfactory therapeutic results. A report follows.Clinical Data All the 86 cases were outpatients in our hospital with duration of common cold for over 10 days and characterized by relapse of respiratory tract infection. There were over 7-time relapse of respiratory tract infection on each case within a year. Eighty-six cases were randomly divided into treatment group (46 cases) and control group (40 cases). Of the 46 cases in the treatment group, 22 were boys and 24 girls. 17 cases (36.9%) were 6 months to 4 years old, 18 (39.1%) 4 to 6 years, and 11 (23.9%) 6 to 12 years. Among the 40 cases in the control group, 19 cases were boys and 21 girls.

Association between gastrointestinal heat retention syndrome and respiratory tract infections in children:A prospective cohort study

Objective:To explore the relationship between gastrointestinal heat retention syndrome and the incidence of pneumonia and recurrent respiratory tract infections(RRTIs)in children.Methods:A prospective cohort study was conducted in the pediatric outpatient department of Beijing Dongfang Hospital.Children without respiratory tract infections(RTIs)were consecutively recruited according to the selection criteria.A semi-structured questionnaire was used to record traditional Chinese medicine(TCM)symptoms and demographic and physiological characteristics.Gastrointestinal heat retention syndrome was considered to be a predisposing factor and was diagnosed according to a scale with reliability and validity.The participants were followed up for 12 months.Participants and their parents or guardians were contacted via clinical interviews and telephone every 6 months.Episodes of pneumonia and RTIs were recorded in detail.Results:A total of 420 children were included.Of participants,370(88.10%)were followed up for 12 months.The mean number of RTI episodes per participant was 5.37(95%CI:5.14 to 5.60).In total,186 participants in the gastrointestinal heat retention syndrome group and 184 participants in the nongastrointestinal heat retention syndrome group completed the 12-month follow-up period.The baseline of both groups was comparable.The incidence of RRTIs in children with gastrointestinal heat retention syndrome was 1.27(95%CI:1.01 to 1.59)times that in children without gastrointestinal heat retention syndrome.Logistic regression analysis revealed that abnormally increased appetite with frequent hunger,foul breath,dry stools,and dark red or purple fingerprints were positively correlated with the incidence of pneumonia.Irascibility and feverish feelings in the palms and soles were positively correlated with the occurrence of RRTI.Conclusions:Gastrointestinal heat retention syndrome is a risk factor for RRTIs in children.Studies with larger sample sizes and longer follow-up time are warranted to confirm the degree of causal risk associated with RTIs.

肠道菌群失调与RRTI患儿T淋巴细胞亚群、免疫球蛋白水平的关系

目的探讨肠道菌群失调与反复呼吸道感染(RRTI)患儿T淋巴细胞亚群、免疫球蛋白水平的关系。方法选取2020年5月至2023年5月在郑州大学第一附属医院治疗的130例RRTI患儿作为观察组,选取同期60例健康体检儿童作为对照组,取两组儿童粪便标本检测肠道菌群分布,根据检测结果进一步将观察组患儿分为菌群失调组和非菌群失调组,同时取空腹静脉血检测T淋巴细胞亚群和免疫球蛋白(Ig)水平。比较各组儿童肠道菌群失调情况、T淋巴细胞亚群和Ig水平,采用Pearson相关系数分析肠道菌群失调与RRTI患儿免疫功能之间的相关性。结果与健康对照组儿童相比,观察组患儿的双歧杆菌、乳酸杆菌总数及双歧杆菌/大肠杆菌总数比值(B/E)均明显减少,而大肠杆菌、肠球菌总数均明显增加,观察组患儿CD3^(+)、CD4^(+)百分率和CD4^(+)/CD8^(+)均降低,而CD8^(+)百分率升高,其IgA和IgG也均低于健康对照组,差异均有统计学意义(P<0.05);菌群失调组患儿CD3^(+)、CD4^(+)百分率和CD4^(+)/CD8^(+)分别为(58.31±10.65)%、(28.19±8.02)%和1.16±0.22,低于非菌群失调组的(62.13±9.80)%、(34.12±7.93)%和1.32±0.37,CD8^(+)百分率为(35.97±9.49)%,高于非菌群失调组的(29.14±9.11)%,IgA和IgG分别为(0.33±0.10)g/L和(7.52±2.12)g/L,低于非菌群失调组的(0.50±0.16)g/L和(8.29±2.07)g/L,差异均有统计学意义(P<0.05);Pearson法分析结果显示,RRTI患儿粪便标本中双歧杆菌、乳酸杆菌计数及B/E与CD3^(+)、CD4^(+)T淋巴细胞比例、CD4^(+)/CD8^(+)比值、IgA和IgG均呈正相关(P<0.05),与CD8^(+)呈负相关(P<0.05);而大肠杆菌和肠球菌计数与T淋巴细胞亚群及IgA、IgG均呈负相关(P<0.05)。结论RRTI患儿肠道菌群失调明显,这可能是影响其发病和病情加重的主要因素之一,同时患儿存在的肠道菌群紊乱与其外周血T淋巴细胞和免疫球蛋白水平异常有关,可能是造成患儿免疫功能降低的原因之一,因此对RRTI的防治还应重视肠道菌群紊乱的监测和肠道微生态环境的改善。

Safety and efficacy of Yupingfeng granules in children with recurrent respiratory tract infection:A randomized clinical trial

Importance:Recurrent respiratory tract infection(RRTI)is common in children.Inappropriate RRTI treatment will lead to asthma and other diseases,thereby seriously affecting the growth and physical health of children.Immune function modulation can prevent and alleviate childhood RRTI.Yupingfeng(YPF),a patented traditional Chinese medicine(TCM),has immunomodulatory effects and is widely used in China to treat children with RRTI.Objective:To evaluate the safety and efficacy of YPF monotherapy in treating children with RRTI.Methods:This multicenter,randomized,double-blind,double-simulation,noninferiority clinical trial was conducted from January 2015 to August 2017,with an 8-week treatment period and 52-week follow-up after the drug withdrawal.Children aged 2–6 years with RRTI meeting the inclusion and exclusion criteria were enrolled in 13 hospitals in China and divided randomly into three groups(2:2:1 ratio)to receive YPF,pidotimod,or placebo.The primary outcome was the proportion of RRTI returning to normal standard level during the follow-up.The secondary outcomes were reduction in the number of RRTI recurrences,effect on clinical symptoms(in accord with TCM practice),effect per symptom,and safety.The trial was registered at the Chinese Clinical Trials Registry(www.chictr.org.cn)under the unique identifier ChiCTR-IPR-15006847.Results:Three hundred and fifty-one children were enrolled and randomly assigned to 3 groups;124,125,and 61 children in the YPF,pidotimod,and placebo groups,respectively,had completed the trial.During the follow-up,the proportion of RRTI returning to normal standard level was 73.13%,67.15%,and 38.81%with YPF,pidotimod,and placebo,respectively(P<0.0001).The proportion of cases who returned to normal standard level in the YPF group was 34.32%higher than that in the placebo group.The safety profile did not significantly differ among the groups.Interpretation:YPF granules were noninferior to the active control drug pidotimod oral solution for the treatment of RRTI in children,and were superior to placebo,with a high safety profile.

From infections to autoimmunity:Diagnostic challenges in common variable immunodeficiency

Common variable immunodeficiency(CVID)is the most common clinically significant primary antibody deficiency diagnosed in adults.The early symptoms are not specific.They include common infections,mainly of the respiratory tract,caused by typical microorganisms,so cases can be missed in primary care.In the majority of patients increased susceptibility to infections coexists with signs or symptoms of autoimmunity,inflammation or polyclonal lymphoproliferation,which can divert diagnosis from immune deficiency.The overall incidence of malignancy is increased in CVID and certain cancers are significantly more common.Lymphomas and gastric carcinoma are the most frequently reported malignancies in CVID,so a high index of suspicion is recommended.Diagnostic delay in CVID is seen worldwide.The main goal of this paper is to increase the awareness about CVID among health care professionals.We aim to present features which can be helpful in CVID diagnosis in order to shorten the“latency”of proper management of CVID patients.We review clinical symptoms,complications and laboratory abnormalities of CVID.Immunoglobulin replacement therapy is regarded as the cornerstone of pharmacological intervention.New modes of Ig application,mainly subcutaneously and via the hyaluronidase-facilitated subcutaneous route,help to adjust therapy to patients’needs and preferences.Still there remain unmet needs.It remains to be seen whether CVID complications can be avoided by earlier diagnosis,treatment and thorough monitoring in the context of increased risk of malignancy.Development of patient tailored protocols depending on the clinical phenotype and risk factors might be more appropriate.The most important consideration is to diagnose suspected cases and stratify patients in a precise and timely way.Work is needed to define features predictive of unfavorable prognosis.

宣肺运脾方辅助西药治疗儿童哮喘并发反复呼吸道感染临床研究

目的:探究宣肺运脾方辅助西药治疗哮喘并反复呼吸道感染儿童的临床价值。方法:将110例哮喘并发反复呼吸道感染患儿按抽签法分为西医组55例,使用西药治疗;中西医结合组55例,使用宣肺运脾方加西药治疗。比较两组疗效指标、炎症因子、免疫功能及药物不良反应发生情况。结果:两组疗效指标、炎症因子、免疫功能比较差异均有统计学意义(P<0.05),中西医结合组治疗总有效率更高,呼吸道感染及哮喘发作次数、发热及咳嗽持续时间均更少(P<0.05),干扰素γ(IFN-γ)、辅助性T细胞CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)更高(P<0.05),白细胞介素13(IL-13)、基质金属蛋白酶9(MMP-9)、CD8^(+)更低(P<0.05);两组药物不良反应发生情况差异无统计学意义(P>0.05)。结论:西药联合宣肺运脾方治疗哮喘并反复呼吸道感染儿童可提高疗效,抑制炎症反应,改善免疫功能。

反复呼吸道感染患儿外周血单个核细胞中TLR2、TLR4表达情况与Th1/Th2免疫应答的关系

目的探讨反复呼吸道感染(RRTI)患儿外周血单个核细胞(PBMC)Toll样受体2(TLR2)、Toll样受体4(TLR4)表达情况与辅助性T细胞1(Th1)/辅助性T细胞2(Th2)免疫应答的关系。方法将2020年12月至2022年12月该院收治的65例确诊为RRTI的患儿纳入研究作为RRTI组。另选取同期于该院体检的健康儿童45例作为对照组。采用实时荧光定量PCR(qPCR)检测PBMC中TLR2和TLR4的信使核糖核酸(mRNA)相对表达水平。采用流式细胞仪检测PBMC中TLR2和TLR4蛋白表达率。采用酶联免疫吸附法(ELISA)检测血浆中Th1细胞因子干扰素-γ(IFN-γ)、Th2细胞因子白细胞介素-4(IL-4)水平及二者比值(IFN-γ/IL-4)。采用Pearson相关分析TLR2、TLR4蛋白表达率与血浆IFN-γ、IL-4水平的相关性。结果RRTI组血浆Th2细胞因子IL-4水平高于对照组,血浆Th1细胞因子IFN-γ水平低于对照组,IFN-γ/IL-4低于对照组,差异均有统计学意义(P<0.05)。RRTI组PBMC中TLR2和TLR4 mRNA相对表达水平及蛋白表达率均高于对照组,差异均有统计学意义(P<0.05)。Pearson相关分析显示,RRTI患儿PBMC中TLR2和TLR4蛋白表达率与血浆IFN-γ水平及IFN-γ/IL-4均呈负相关(P<0.05),与血浆IL-4水平均呈正相关(P<0.05)。结论RRTI患儿PBMC中TLR2、TLR4的表达及血浆Th1/Th2细胞因子均可能参与疾病的发生、发展的过程。过度活化的TLR2和TLR4可能会使Th1功能减弱、Th2功能增强。

陈华教授从“阴虚瘀热”论治小儿反复呼吸道感染经验总结

[目的]总结陈华教授从“阴虚瘀热”论治小儿反复呼吸道感染的经验。[方法]通过随师临证,总结整理病案资料,阐释陈师治疗小儿反复呼吸道感染的临床经验及方药特色,并通过临床验案加以佐证。[结果]陈师认为,小儿反复呼吸道感染病因为风、痰、瘀、虚,病机为肺脾两虚,痰瘀阻络,迁延不愈,瘀热互结,创新性地提出从“阴虚瘀热”辨治小儿反复呼吸道感染,总结出重视风邪,祛风解表;三因制宜,滋阴清瘀;详辨虚实,巧用和法;顾护中焦,健运脾胃的诊治经验。验案为反复呼吸道感染患儿,辨为阴虚感冒,兼痰瘀阻滞证,陈师分期论治,滋阴清瘀治法贯穿疾病治疗的中后期,迁延期养阴退热、化痰祛瘀,恢复期养阴退热、健脾益气,疗效显著。[结论]陈师继承浙派中医儿科特色,从“阴虚瘀热”辨治小儿反复呼吸道感染,疗效显著,对指导临床有较高实用价值。

保儿宁口服液联合耳穴贴压治疗小儿反复呼吸道感染肺脾气虚证的临床研究

目的 研究保儿宁口服液联合耳穴贴压治疗小儿反复呼吸道感染肺脾气虚证的临床效果。方法 选择2022年2月至2023年2月江苏省江阴市中医院收治的106例反复呼吸道感染患儿为研究对象,按照随机数字表法将其分为对照组与研究组,各53例。对照组接受保儿宁口服液治疗,研究组在对照组的基础上联合耳穴贴压治疗。两组均治疗8个疗程(6 d为1个疗程)。比较两组临床疗效;比较两组治疗前后中医证候评分、炎症因子、血清学指标、免疫功能;比较两组不良反应发生率。结果 研究组临床疗效优于对照组(P<0.05)。治疗后,两组中医症候评分、肿瘤坏死因子-α、人类β-防御素2低于治疗前,且研究组低于对照组(P<0.05);白细胞介素-2、分泌型免疫球蛋白A、CD3^(+)、免疫球蛋白G高于治疗前,且研究组高于对照组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 保儿宁口服液联合耳穴贴压治疗小儿反复呼吸道感染肺脾气虚证效果确切,可改善患儿临床症状、免疫功能,减轻炎症反应,调节血清sIgA、人类β-防御素2表达,且安全可靠。

重组人干扰素α1b雾化吸入联合布地奈德对反复上呼吸道感染患儿的治疗效果

目的分析重组人干扰素α1b雾化吸入联合布地奈德对反复上呼吸道感染(RURTI)患儿的治疗效果。方法选取2022年6月至2023年6月我院收治的90例RURTI患儿,随机分为联合组(n=45)和单一组(n=45),单一组予以匹多莫德治疗,联合组予以重组人干扰素α1b雾化吸入联合布地奈德治疗。对比两组的临床疗效、症状消失时间及不良反应。结果联合组总有效率为93.33%,高于单一组的75.56%(P<0.05)。联合组发热、咽喉肿痛、咳嗽、肺啰音消失时间短于单一组(P<0.05)。两组的不良反应发生率比较无统计学差异(P>0.05)。结论重组人干扰素α1b雾化吸入联合布地奈德治疗RURTI患儿可提高临床疗效,缩短发热、咽喉肿痛、咳嗽、肺啰音消失时间,安全性良好。

PI3Kδ过度活化综合征7例报道

目的总结7例PI3Kδ过度活化综合征(activated phosphoinositide 3-kinase delta synd rome,APDS)患儿的临床资料,提高对该病的认识。方法回顾性分析2019年1月—2023年8月湖南省人民医院收治的7例APDS患儿的临床资料。结果7例患儿(男4例,女3例)中位发病年龄为30个月,中位诊断年龄为101个月。临床表现:反复呼吸道感染、肝脾大及多部位淋巴结肿大7例,脓毒血症5例,中耳炎及多发性龋齿3例,腹泻及关节痛2例,淋巴瘤、系统性红斑狼疮各1例。4例患儿行纤维支气管镜检查,管腔内均可见大量散在的结节样突起。最常见的呼吸道病原为肺炎链球菌(4例)。6例患儿为p.E1021K位点错义突变,1例为p.434-475del位点剪切突变。结论p.E1021K是APDS患儿最常见的突变位点。对于具有反复呼吸道感染、肝脾大、多部位淋巴结肿大、中耳炎、龋齿等表现1项或多项,且纤维支气管镜下见散在结节样突起的患儿,需警惕APDS。

胆碱脂酶、触珠蛋白在反复呼吸道感染儿童血清中的表达水平及其对预后的评估价值

目的探讨胆碱脂酶(CHE)、触珠蛋白(HPT)在反复呼吸道感染(RRTI)儿童血清中的表达水平及其对预后的评估价值。方法选取112例RRTI患儿纳入RRTI组,随机选取同期健康体检儿童95例纳入对照组。根据疾病的严重程度,将RRTI组患儿分为轻度组38例、中度组40例和重度组34例。检测血清CHE、HPT、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)水平以及CD3^(+)、CD3^(+)CD4^(+)水平。分析RRTI患儿的CHE与HPT的相关性。分析血清CHE、HPT的表达水平对RRTI患儿预后的预测价值。结果RRTI组患儿的CHE表达水平低于对照组,HPT水平高于对照组,差异有统计学意义(P<0.05)。重度组RRTI患儿的CHE水平低于中度组和轻度组,中度组低于轻度组;重度组RRTI患儿的HPT水平高于中度组和轻度组,中度组高于轻度组,差异有统计学意义(P<0.05)。RRTI患儿的CHE表达水平与HPT表达水平呈负相关(r=-0.637,P<0.001)。RRTI组的IL-1、IgA、IgM水平和CD3^(+)、CD3^(+)CD4^(+)低于对照组,IL-6水平高于对照组,差异有统计学意义(P<0.05)。RRTI患儿CHE表达水平与IL-1、IgA、IgM、CD3^(+)、CD3^(+)CD4^(+)呈正相关,与IL-6呈负相关;HPT表达水平与IL-1、IgA、IgM、CD3^(+)、CD3^(+)CD4^(+)呈负相关,与IL-6呈正相关(P<0.05)。预后良好RRTI患儿的血清CHE表达水平高于预后不良RRTI患儿,HPT水平低于预后不良RRTI患儿,差异有统计学意义(P<0.05)。CHE、HPT联合预测RRTI患儿预后的曲线下面积(AUC)大于其单独预测的AUC,差异有统计学意义(P<0.05)。结论在RRTI患儿血清中,CHE呈低表达,HPT呈高表达。CHE、HPT联合评估RRTI患儿预后的价值较高。

从“内虚外损”理论辨治儿童反复呼吸道感染

总结尚莉丽教授基于“内虚外损”理论辨治儿童反复呼吸道感染(RRTIs)的经验,认为儿童处于生长发育期,脏腑娇嫩、正气不足,谓之“内虚”;外邪反复侵袭,寒热兼夹,损伤气、血、精、神,谓之“外损”;“内虚外损”导致患儿反复感邪,身心受累,影响生长发育。“内虚外损”理论突出内、外因素对儿童RRTIs的影响,反映了病机演变规律,从而有利于指导临床分期治疗,急性感染期风热证治以辛凉清散,风寒证治以辛温开闭,虚实夹杂证活用攻、补、和、托诸法,辨证论治,随症加减;感染间歇期以扶助正气为目的,兼顾上、中、下三焦,采取益肺、健脾、补肾等治则,为儿童RRTIs的治疗提供有益的思路和方法。

基于“肺-脾-大肠”轴的培土生金法干预RRTI肺脾气虚证患儿唾液sIgA黏膜免疫研究

目的:通过对缓解期RRTI肺脾气虚证患儿唾液免疫球蛋白检测,探讨培土生金法对"肺-脾-大肠"免疫机制的调节作用。方法:采用随机对照的前瞻性设计方法,将140例肺脾气虚证患儿分成4组,分别在药物干预前后测定sIgA的变化。结果:唾液sIgA通过药物干预治疗后,治疗组数值较疗前均有明显升高(P>0.05),空白对照组治疗前后比较差异无统计学意义(P>0.05),3组治疗组唾液sIgA在治疗后组间比较差异无统计学意义(P>0.05)。结论:培土生金法可提高缓解期RRTI肺脾气虚证患儿唾液sIgA含量,改善缓解期RRTI患儿唾液sIgA的作用。

RRTI患儿25羟基维生素D_3及免疫球蛋白的变化分析

目的:探讨反复呼吸道感染(RRTI)患儿25羟基维生素D_3[25(OH)D_3/25 HVD_3]及免疫球蛋白的变化情况。方法:100例RRTI患儿随机分成A组和B组,各50例,另选50名健康体检儿童为C组,A组、B组采取常规治疗措施,B组再给予维生素D治疗。将三组不同阶段的25 HVD_3及免疫球蛋白进行比较。结果:三组各阶段的IgM水平对比无统计学意义,治疗前,A组和B组25 HVD_3、IgA、IgG水平均低于C组,P<0.05;治疗后3个月,B组的25 HVD_3、IgA、IgG水平均高于A组,低于C组(P<0.05)。结论:RRTI患儿存在25 HVD_3、IgA、IgG水平偏低的情况,维生素D治疗RRTI效果较为理想。

儿童RRTIs T细胞亚群和NK细胞的变化分析

目的了解3~6岁儿童反复呼吸道感染(RRTIs)T细胞亚群及自然杀伤细胞(NK)的变化,指导临床预防用药,避免过度以及不当治疗。方法严格按照入选标准和剔除标准收集3~6岁儿童160例,其中:病例组73例,对照组87例。采用病例对照研究。用流式细胞仪对病例组和对照组分别进行T细胞亚群、NK细胞的检测,并对有关数据进行统计分析。结果对T细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)进行两独立样本的Wilcoxon秩和检验,结果表明:CD3^+(z=-1.588,P=0.112)、CD4^+(z=-0.541,P=0.588)、CD8^+(z=-0.733,P=0.463)、CD4^+/CD8^+(z=-0.315,P=0.753)病例组和对照组比较差异均无统计学意义(均P>0.05)。对NK细胞(CD3^+CD16^+CD56^+)进行t'检验(t'=2.779,P=0.006<0.05;95%CI:0.674~4.003),病例组和对照组比较差异有统计学意义。结论对RRTIs儿童检测T细胞亚群与NK细胞具有显著的临床指导意义,可避免过度使用免疫调节剂引起的用药不当。

阿莫西林-克拉维酸钾序贯治疗反复下呼吸道感染患儿的疗效

目的观察阿莫西林-克拉维酸钾序贯治疗反复下呼吸道感染(recurrent lower respiratory tract infection,RLRTI)患儿的疗效及对潮气肺功能,血清白细胞介素-6(interleukin-6,IL-6)、白细胞介素-8(interleukin-8,IL-8)、白细胞介素-10(interleukin-10,IL-10)水平的影响。方法纳入近92例RLRTI患儿作为研究对象,用随机数字表法分为观察组和对照组,各46例,应用阿莫西林-克拉维酸钾治疗。对照组静脉滴注7~10 d,观察组序贯治疗(静脉滴注3~5 d,口服混悬剂4~5 d)。比较2组临床疗效、主要症状(发热、咳嗽、喘息和肺啰音)消失时间、白细胞计数(white blood cell count,WBC)恢复时间、住院时间;治疗前后潮气肺功能指标(潮气量、呼吸频率、吸气时间、呼气时间、吸呼比、达峰时间比和达峰容积比)、血清炎症因子(IL-6、IL-8和IL-10)水平,及治疗期间不良反应。结果观察组的治疗总有效率高于对照组(P<0.05);观察组发热、咳嗽、喘息、肺啰音消失时间,WBC恢复时间及住院时间均短于对照组(P<0.05);2组呼吸频率均较治疗前下降(P<0.05),吸气时间、呼气时间、达峰时间比、达峰容积比均较治疗前升高(P<0.05),且观察组达峰时间比、达峰容积比均高于对照组(P<0.05);2组血清IL-6、IL-8水平均较治疗前降低(P<0.05),且观察组低于对照组(P<0.05);IL-10水平均较治疗前升高(P<0.05),且观察组高于对照组(P<0.05);2组治疗期间不良反应发生率比较差异无统计学意义(P>0.05)。结论阿莫西林-克拉维酸钾序贯治疗小儿RLRTI可促进症状恢复,改善潮气肺功能,提高疗效,机制可能与其调节IL-6、IL-8、IL-10等炎症细胞因子的表达水平有关。

儿童反复上呼吸道感染血清PTX3、SOCS3水平及其诊断价值

目的探究儿童反复上呼吸道感染(rURTIs)血清正五聚蛋白3(PTX3)、细胞因子信号转导抑制因子-3(SOCS3)水平及其诊断价值。方法选取2020年8月至2023年8月在黄骅市人民医院就诊的rURTIs患儿132例作为研究组,依据临床肺部感染评分分为轻度组75例、中度组43例、重度组14例。选取同时期在黄骅市人民医院进行健康体检的健康儿童130例作为对照组。采用酶联免疫吸附试验测定血清PTX3、SOCS3、白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)的水平,Pearson相关分析rURTIs患儿中血清PTX3与SOCS3水平的相关性及二者与IL-6、TNF-α和CRP水平的相关性,多因素Logistic回归分析影响rURTIs发生的因素,受试者工作特征(ROC)曲线分析血清PTX3、SOCS3水平诊断rURTIs发生的临床价值。结果与对照组比较,研究组血清PTX3、SOCS3、IL-6、TNF-α、CRP水平升高(P<0.05)。随着rURTIs病情越严重,血清PTX3、SOCS3水平越高(P<0.05)。rURTIs患儿血清中PTX3水平与SOCS3呈正相关(r=0.642,P<0.05),且rURTIs患儿血清中PTX3和SOCS3水平均与IL-6、TNF-α、CRP呈正相关(P<0.05)。血清PTX3、SOCS3、IL-6、TNF-α、CRP是影响rURTIs发生的危险因素(P<0.05)。血清PTX3、SOCS3水平分别及二者联合诊断rURTIs发生的曲线下面积为0.833、0.833、0.914,二者联合诊断明显高于各指标单独诊断(Z二者联合-PTX3=2.607,Z_(二者联合-SOCS3)=2.679,P<0.05)。结论rURTIs患儿血清PTX3、SOCS3水平明显升高,二者水平呈正相关,二者联合可用于rURTIs的早期诊断。