Research Progress of Combined Detection of WBC, CRP and SAA in Early Diagnosis of Respiratory Tract Infection in Children

Objective: To investigate the application of WBC, CRP and SAA combined detection in the early diagnosis of respiratory tract infection in children. Methods: Collect the literature reports on the early diagnosis of respiratory tract infection in children by the combined detection of WBC, CRP and SAA in recent years, and follow up the relevant literature reports from the selection of “new three routine” laboratory items for rapid diagnosis in pediatric outpatient department and the application of the combined detection of WBC, CRP and SAA in the early diagnosis of respiratory tract infection in children. Results: Many literature studies found that the combined detection of WBC, CRP and SAA has important clinical significance in the early diagnosis of respiratory tract infection in children. Conclusion: Through reviewing the relevant literature, we can understand the application of WBC, CRP and SAA combined detection in the early diagnosis of respiratory tract infection in children. To provide more accurate and reliable laboratory data for the early diagnosis and treatment of respiratory tract infection in children in the future.

Human bocavirus infection in children hospitalized with lower respiratory tract infections:Does viral load affect disease course?

Objective:To examine the effects of human bocavirus type 1(HBoV1)on the course of lower respiratory tract infections in cases of monoinfection and coinfection,and the effects of HBoV1 viral load on the disease in children under six years old hospitalized with a diagnosis of HBoV1-associated lower respiratory tract infections.Methods:Children under six years of age,who were hospitalized with the diagnosis of lower respiratory tract infection due to HBoV1 between 1 January 2021 and 1 January 2022 were included in the study.Laboratory confirmation of the respiratory pathogens was performed using polymerase chain reaction(PCR).Results:Fifty-four(16.4%)children with HBoV1 among 329 children whose PCR was positive with bacterial/viral agent in nasopharyngeal swab samples were included in the study.There were 28(51.9%)males and 26(48.1%)females with a median age 23.4 months[interquartile range(IQR):13.2,30.0 months](min-max:1 month-68 months).HBoV1 was detected as a monoinfecton in 26(48.1%)children,and as a coinfection with other respiratory agents in 28 children(51.9%).In multiple regression analysis,coinfection(P=0.032)was associated with the length of hospitalization(P<0.001;R^(2)=0.166).There was a negative correlation(r=−0.281,P=0.040)between cough and cycle threshold.Fever was found to be positively correlated with C-reactive protein(r=0.568,P<0.001)and procalcitonin(r=0.472;P=0.001).Conclusions:Although we found a higher HBoV1 viral load in children with more cough symptoms in our study,it had no effect on the severity of the disease,such as length of hospital stay and need for intensive care.Coinfection was found to affect the length of hospitalization.

Effect of secretory IgA combined with conventional anti-infectious drugs on inflammatory response and immune response in children with upper respiratory tract infection

Objective: To investigate the effect of secretory IgA combined with conventional anti-infectious drugs on inflammatory response and immune response in children with upper respiratory tract infection. Methods: A total of 130 children with upper respiratory tract infection who were treated in the hospital between February 2016 and February 2017 were divided into control group and secretory IgA group by random number table method, each group with 65 cases. Control group received routine anti-infectious drug treatment, and secretory IgA group received the secretory IgA combined with conventional anti-infectious drug treatment, which lasted for 1 week. The differences in serum levels of routine inflammatory factors, fat inflammatory factors and immunoglobulin were compared between the two groups before and after treatment. Results: There was no statistically significant difference in serum levels of normal inflammatory factors, fat inflammatory factors and immunoglobulin between the two groups before treatment. After 1 week of treatment, serum conventional inflammatory factors CRP, IL-1 and IL-8 levels of secretory IgA group were lower than those of control group;serum fat inflammatory factors SAA and Chemerin levels were lower than those of control group whereas Leptin level was higher than that of control group;serum immunoglobulin IgA, IgG and IgM contents were higher than those of control group. Conclusion: The secretory IgA combined with conventional anti-infectious drugs can effectively inhibit the systemic inflammatory response and enhance the humoral immune response in children with upper respiratory tract infection.

A Study on Isolation and Antibiotic Sensitivity Testing of Pseudomonas aeruginosa Isolated from Patients with Respiratory Tract Infection with Special Reference to Phenotypic and Genotypic Characterization of Extended Spectrum Beta Lactamases (ESBL)

Backgrounds: Pseudomonas aeruginosa is a classic opportunistic pathogen with innate resistance to many antibiotics and disinfectants. The lung is a main target for colonization and infection by the bacteria either in the context of a chronic, progressively deteriorating infectious and inflammatory pulmonary disease such as cystic fibrosis (CF) or in a more acute setting such as severe pneumonia in immunocompromised patients [1]. Aim and Objectives: To study the prevalence, virulence and the resistance pattern, phenotypic and genotypic characterization of P. aeruginosa from sputum samples. Materials and Methods: The present study was carried out with a total of 500 clinical sputum samples, which were received from patients, admitted to the various departments of Rajah Muthiah Medical College & Hospital, Annamalai University, Chidambaram. Result: Of the 500 samples subjected for isolation and identification of P. aeruginosa, 116 (23.20%) were positive. The isolated strains were tested for antibiotic sensitivity patterns. 93.10% of P. aeruginosa showed a maximum sensitivity to Ofloxacin, Norfloxacin and 86.20% of strains were highly resistant to Cefotaxime. The same isolates were also tested for phenotypic characterization of Extended Spectrum of Beta Lactamases by double disc synergy method against Cefotaxime and Clavulanic acid, according to the criteria of Hi-Media [2]. Of the resistant strains of P. aeruginosa isolated from sputum, 59% were positive for ESBL. The genotype characterization of ESBL P. aeruginosa showed 40% of CTX-M and 46.66% SHV gene. Conclusion: The present study strongly recommends for further checking of the antibiotic resistant strains of P. aeruginosa for phenotypic characterization of ESBL for effective treatment.

Prescription practice of antihistamines for acute upper respiratory tract infections in pediatric patients in a local emergency department in Hong Kong

BACKGROUND: Currently there is very limited data in the literature assessing the prevalence of antihistamine prescription, and there is no local prevalence data about the prescription of antihistamine agents among primary practitioner and emergency physicians. The objectives are 1) to report the prevalence of antihistamine prescription for children less than 6 years old with acute upper respiratory infection and 2) to explore the associated factors for the prescription practice.METHODS: This is a cross-sectional study. All consecutive cases of paediatric patients aged 6 or below who presented to the emergency department during a study period of one week from April 1 to July 4, 2009 with diagnosis of acute upper respiratory infection were included. Totally 162 patients were included.RESULTS: Among the 162 cases, 141(87%) patients were prescribed one antihistamine of any group. Sixty(37%) patients were prescribed two or more antihistamines. In multivariate logistic regression model, age was found to be signi? cantly(P<0.001) associated with multiple antihistamine prescription(OR=1.042, 95%CI=1.02 to 1.06). Years of graduation of attending physician for more than 5 years was also a strong predictor of multiple antihistamine prescription(OR=4.654, 95%CI=2.20 to 9.84, P<0.001).CONCLUSION: In the local emergency department, patients' age and the years of graduation from medical school of the attending physician were predictors of multiple antihistamine prescription for acute upper respiratory infections for children aged less than 6.

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.

Burden of RSV among inpatients with lower respiratory tract infection under 5 years of age: A 10-year retrospective study in Southwest China from 2009 to 2019

Objectives:Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infection(LRTI).However,few comprehensive descriptions of the disease burden,medical resource utilization(MRU),and costs of RSV are available for China.This study aimed to provide the basis for the development of RSV prevention strategies by analyzing the burden of RSV among inpatients with lower respiratory tract infection under 5 years of age.Methods:We conducted a retrospective hospital-based study from June 2009 to May 2019 in Chongqing.Inpatients with LRTI were tested for eight viruses.We analyzed the RSV disease burden,MRU,and direct hospitalization costs by using non-parametric Mann‒Whitney U test,Chi-squared test or Fisher’s exact test and logistic regression.Results:A total of 6991 children under 5 years of age with LRTI were included in this study.The overall RSVpositive rate was 34.5%(2410/6991).Prior to admission,81.9%(1973/2410)of these RSV-positive cases were otherwise healthy.Compared with children aged 24–59 months,the odds ratio(OR)and 95%confidence interval(CI)for RSV infection were 2.509(2.139–2.945),1.882(1.549–2.222),and 1.479(1.240–1.765)for those aged 1–5 months,6–11 months,and 12–23 months,respectively.The proportions of patients treated with invasive ventilation and continuous positive airway pressure(CPAP)were significantly higher among RSV-positive cases(1.1%[27/2410]and 3.9%[93/2410])than RSV-negative cases(0.9%[43/4581]and 2.7%[124/4581])(P=0.023).Compared with RSV-negative cases,RSV-positive cases had significantly longer hospital length of stay(6[5,8]days vs.6[5,8]days,P<0.001)and higher hospitalization costs(963.0[757.9,1298.5]USD vs.935.6[719.7,1296.3]USD,P=0.022).Conclusions:Most RSV infections occurred during early childhood and among individuals in the otherwise healthy group.Younger age was associated with a higher RSV-positive rate.Effective prevention measures are needed in the earliest stages to reduce the RSV burden.

Burden of respiratory syncytial virus infection in young children

Respiratory syncytial virus(RSV) is the most frequent and important cause of lower respiratory tract infection in infants and children. It is a seasonal virus, with peak rates of infection occurring annually in the cold season in temperate climates, and in the rainy season, as temperatures fall, in tropical climates. High risk groups for severe RSV disease include infants below six mo of age, premature infants with or without chronic lung disease, infants with hemodynamically significant congenital heart disease, infants with immunodeficiency or cystic fibrosis, and infants with neuromuscular diseases. Mortality rates associated with RSV infection are generally low in previous healthy infants(below 1%), but increase significantly in children with underlying chronic conditions and comorbidities. Following early RSV lower respiratory tract infection, some patients experience recurrent episodes of wheezing mimicking early childhood asthma with persistence of lung function abnormalities until adolescence. There is currently no RSV vaccine available, but promising candidate vaccines are in development. Palivizumab, a monoclonal RSV antibody that is the only tool for immunoprophylaxis in high-riskinfants, lowers the burden of RSV infection in certain carefully selected patient groups.

Clinical Diagnosis and Treatment Characteristics of Acute Respiratory Infections in Children and New Developments in Laboratory Testing

Acute respiratory tract infection (ARTI) in children is the most common infectious disease in childhood, and its pathogens include viruses, bacteria and fungi, mycoplasma, chlamydia and rickettsia. In recent years, with the continuous development of pathogen detection methods, the diagnosis and treatment of acute respiratory infections has received more and more clinical attention. The clinical diagnosis and treatment characteristics of acute respiratory infections in children and the research of clinical laboratory detection methods have also been continuously developed. The author collected references to review the clinical features and new developments in laboratory testing of acute respiratory tract infection in children.

Association between early viral lower respiratory tract infections and subsequent asthma development

BACKGROUND The association between hospitalization for human respiratory syncytial virus(HRSV)bronchiolitis in early childhood and subsequent asthma is well established.The long-term prognosis for non-bronchiolitis lower respiratory tract infections(LRTI)caused by viruses different from HRSV and rhinovirus,on the other hand,has received less interest.AIM To investigate the relationship between infant LRTI and later asthma and examine the influence of confounding factors.METHODS The PubMed and Global Index Medicus bibliographic databases were used to search for articles published up to October 2021 for this systematic review.We included cohort studies comparing the incidence of asthma between patients with and without LRTI at≤2 years regardless of the virus responsible.The meta-analysis was performed using the random effects model.Sources of heterogeneity were assessed by stratified analyses.RESULTS This review included 15 articles(18 unique studies)that met the inclusion criteria.LRTIs at≤2 years were associated with an increased risk of subsequent asthma up to 20 years[odds ratio(OR)=5.0,95%CI:3.3-7.5],with doctor-diagnosed asthma(OR=5.3,95%CI:3.3-8.6),current asthma(OR=5.4,95%CI:2.7-10.6),and current medication for asthma(OR=1.2,95%CI:0.7-3.9).Our overall estimates were not affected by publication bias(P=0.671),but there was significant heterogeneity[I 2=58.8%(30.6-75.5)].Compared to studies with hospitalized controls without LRTI,those with ambulatory controls had a significantly higher strength of association between LRTIs and subsequent asthma.The strength of the association between LRTIs and later asthma varied significantly by country and age at the time of the interview.The sensitivity analyses including only studies with similar proportions of confounding factors(gender,age at LRTI development,age at interview,gestational age,birth weight,weight,height,smoking exposure,crowding,family history of atopy,and family history of asthma)between cases and controls did not alter the overall estimates.CONCLUSION Regardless of the causative virus and confounding factors,viral LRTIs in children<2 years are associated with an increased risk of developing a subsequent asthma.Parents and pediatricians should be informed of this risk.

Middle East respiratory syndrome coronavirus disease is rare in children: An update from Saudi Arabia

AIM To summarize the reported Middle East respiratory syndrome-coronavirus(MERS-Co V) cases, the associated clinical presentations and the outcomes. METHODS We searched the Saudi Ministry of Health website, the World Health Organization website, and the Flutracker website. We also searched MEDLINE and Pub Med for the keywords: Middle East respiratory syndromecoronavirus, MERS-Co V in combination with pediatric, children, childhood, infancy and pregnancy from the initial discovery of the virus in 2012 to 2016. The retrieved articles were also read to further find other articles. Relevant data were placed into an excel sheet and analyzed accordingly. Descriptive analytic statistics were used in the final analysis as deemed necessary.RESULTS From June 2012 to April 19, 2016, there were a total of 31 pediatric MERS-Co V cases. Of these cases 13(42%) were asymptomatic and the male to female ratio was 1.7:1. The mean age of patients was 9.8 ± 5.4 years. Twenty-five(80.6%) of the cases were reported from the Kingdom of Saudi Arabia. The most common source of infection was household contact(10 of 15 with reported source) and 5 patients acquired infection within a health care facility. Using real time reverse transcriptase polymerase chain reaction of pediatric patients revealed that 9 out of 552(1.6%) was positive in the Kingdom of Saudi Arabia. CONCLUSION Utilizing serology for MERS-CoV infection in Jordan andSaudi Arabia did not reveal any positive patients. Thus, the number of the pediatric MERS-CoV is low; the exact reason for the low prevalence of the disease in children is not known.

呼出气一氧化氮、肺泡一氧化氮和嗜酸性粒细胞对3~6岁儿童呼吸系统疾病的鉴别诊断价值

目的探讨呼出气一氧化氮(FeNO)、肺泡一氧化氮(CaNO)和嗜酸性粒细胞(EOS)在甘肃省兰州市3~6岁儿童呼吸系统疾病鉴别诊断中的应用价值。方法选取确诊哮喘或过敏性鼻炎或下呼吸道感染的360例3~6岁儿童作为研究对象,采用斯皮尔曼秩相关系数评估FeNO、CaNO、EOS的相关性,通过随机森林模型、受试者工作特征(ROC)曲线、多因素逻辑回归分析评估FeNO、CaNO和EOS对3种疾病的鉴别诊断价值。结果哮喘患儿的FeNO、CaNO中位数高于其他疾病患儿,过敏性鼻炎患儿的EOS中位数最低,下呼吸道感染患儿的FeNO、CaNO中位数最低。相关性分析结果显示,FeNO与CaNO呈正相关(r=0.59,P<0.05),FeNO与EOS呈负相关(r=-0.61,P<0.05),CaNO与EOS呈负相关(r=-0.63,P<0.05)。随机森林模型显示,FeNO在疾病分类中的重要性最高。ROC曲线分析结果显示,3种疾病中,FeNO、CaNO、EOS对下呼吸道感染的诊断效能均最高(曲线下面积分别为0.86、0.91、1.00)。多因素逻辑回归模型诊断哮喘的曲线下面积为0.96,灵敏度为0.902,特异度为0.881。结论FeNO、CaNO和EOS在鉴别诊断兰州地区3~6岁儿童哮喘、过敏性鼻炎、下呼吸道感染方面展现出较好的潜力,且基于三者构建的多因素逻辑回归模型可有效提升对哮喘的诊断准确性。

sCD14-ST联合IL-6对细菌性呼吸道感染患儿的诊断价值

目的探讨可溶性白细胞分化抗原14亚型(sCD14-ST)联合白细胞介素-6(IL-6)对细菌性呼吸道感染患儿的诊断价值。方法选取2021年4月至2022年4月该院收治的55例细菌性呼吸道感染患儿作为观察组,另选取同期在该院健康体检的55例儿童作为对照组。检测并比较两组sCD14-ST、IL-6水平,采用Pearson相关分析细菌性呼吸道感染患儿sCD14-ST水平与IL-6水平的相关性,采用多因素Logistic回归分析儿童发生细菌性呼吸道感染的危险因素,绘制受试者工作特征曲线分析血清sCD14-ST、IL-6对儿童发生细菌性呼吸道感染的诊断价值。结果观察组血清sCD14-ST、IL-6水平均高于对照组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,细菌性呼吸道感染患儿血清sCD14-ST水平与IL-6水平呈正相关(r=0.422,P=0.001)。多因素Logistic回归分析结果显示,sCD14-ST>443.82 pg/mL、IL-6>13.75 pg/mL是儿童发生细菌性呼吸道感染的独立危险因素(P<0.05)。2项指标联合诊断儿童发生细菌性呼吸道感染的曲线下面积为0.887(95%CI:0.741~0.975),灵敏度为90.91%,特异度为80.00%。结论sCD14-ST>443.82 pg/mL、IL-6>13.75 pg/mL是儿童发生细菌性呼吸道感染的独立危险因素,2项指标联合检测能提高对儿童发生细菌性呼吸道感染的诊断价值。

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。

小儿清炎合剂(716合剂)治疗呼吸道合胞病毒所致呼吸道感染疗效观察及血清学研究

目的探究小儿清炎合剂(716合剂)治疗呼吸道合胞病毒所致呼吸道感染疗效观察及血清学研究。方法将2023年1月至2023年9月江西省儿童医院收治的呼吸道合胞病毒所致呼吸道感染的80例患儿作为研究对象,根据随机对照表法将其分为观察组40例,对照组40例。对照组采用雾化吸入联合静脉输液进行治疗,观察组在对照组的基础上口服小儿清炎合剂(716合剂)。比较两组的临床疗效,治疗前后炎性因子[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、肿瘤坏死因子-α(TNF-α)],免疫功能水平(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)),恢复情况和不良反应。结果观察组治疗有效率为95.00%,高于对照组的80.00%(P<0.05)。治疗后,两组IL-6、IL-10、CRP、SAA、TNF-α水平均下降且观察组低于对照组(P<0.05);观察组CD4^(+)、CD4^(+)/CD8^(+)水平均高于对照组,而观察组CD8^(+)水平低于对照组(P<0.05)。观察组退热、止咳、平喘以及住院时间均小于对照组(P<0.05)。两组在治疗过程中均未出现任何不良反应。结论小儿清炎合剂(716合剂)能够缓解呼吸道合胞病毒感染患儿的炎性症状,增强患儿免疫功能,促进患儿恢复,安全性良好。

儿童急性呼吸道感染者PA、PSP、CD64、sCD14-ST的变化及其诊断价值

目的 探讨儿童急性呼吸道感染者血前白蛋白(PA)、血清胰石蛋白(PSP)、免疫球蛋白G Fc段受体I(CD64)、可溶性白细胞分化抗原14亚型(sCD14-ST)的变化及其临床诊断价值。方法 回顾性选取2019年9月至2023年3月眉山市四所医院收治的498例儿童急性呼吸道感染患儿作为研究组,根据咽拭子细菌培养结果将其分为细菌感染组232例和非细菌感染组266例;另选取同期体检的健康儿童506例作为对照组。检测所有儿童的血清PA、PSP、外周血sCD14-ST水平、CD64指数。比较三组儿童的临床资料,同时比较研究组和对照组以及细菌感染组和非细菌感染组患儿的血清PA、PSP、外周血sCD14-ST水平、CD64指数;采用受试者工作特征曲线(ROC)分析血清PA、PSP、外周血sCD14-ST水平、CD64指数单独及联合检测对儿童急性呼吸道感染的诊断价值。结果 研究组患儿的血清PA水平明显低于对照组,而血清PSP、外周血sCD14-ST水平、CD64指数则明显高于对照组,差异均有统计学意义(P<0.05);细菌感染组患儿的血清PA水平明显低于非细菌感染组,而血清PSP、外周血sCD14-ST水平、CD64指数则明显高于非细菌感染组,差异均有统计学意义(P<0.05);绘制ROC获得血清PA、PSP、外周血sCD14-ST水平、CD64指数单独及联合检测诊断儿童急性呼吸道感染患儿的AUC分别为0.885、0.780、0.818、0.848、0.934。其中,联合诊断的AUC高于各项单独检测(P<0.05),且联合检测的敏感度和特异度为89.20%,81.40%,诊断价值均较高。结论 儿童急性呼吸道感染者血清PA水平呈低表达,血清PSP、外周血sCD14-ST水平、CD64指数呈高表达;且细菌感染较非细菌感染的儿童急性呼吸道感染患儿血清PA水平降低,而血清PSP、外周血sCD14-ST水平和CD64指数则升高;联合检测血清PA、PSP、外周血sCD14-ST水平、CD64指数有助于诊断儿童急性呼吸道感染。

TLR4基因多态性与小儿反复呼吸道感染的关系

目的探究Toll样受体4(TLR4)基因多态性与小儿反复呼吸道感染(RRTI)的关系。方法选择107例RRTI病儿作为观察组,另选103例体检健康儿童作为对照组(近1年未出现RRTI),采用限制性片段长度多态性聚合酶链反应(PCR-RFLP)技术分析两组TLR4基因rs2737190位点多态性,比较不同病情严重程度病儿TLR4基因多态性的差异,并分析不同TLR4基因多态性病儿临床特征的差异。结果观察组TLR4基因rs2737190位点AG基因型、G等位基因频率均明显高于对照组,AA基因型频率明显低于对照组(χ^(2)=4.129~8.564,P<0.05);中重度RRTI病儿GG基因型、G等位基因频率明显高于轻度病儿,AA基因型频率显著低于轻度病儿(χ^(2)=9.233~13.357,P<0.05);AA基因型病儿年发作次数、合并呼吸困难比例,以及C反应蛋白、白细胞介素-6、γ-干扰素和丙二醛等指标均显著低于AG和GG基因型病儿,超氧化物歧化酶则显著高于AG和GG基因型病儿(χ^(2)=7.573,F=4.668~24.317,P<0.05)。结论TLR4基因rs2737190位点AG基因型、G等位基因频率会增加小儿RRTI易感性,并促进其炎症反应升高和病情进展。

百蕊颗粒治疗儿童急性上呼吸道感染疗效及安全性系统评价

目的系统评价百蕊颗粒治疗儿童急性上呼吸道感染(AURTI)的疗效及安全性。方法通过计算机系统检索中国知网、万方数据与维普网数据库自建库至2022年9月有关百蕊颗粒治疗儿童AURTI的随机对照研究,并按照Cochrane质量评价标准对纳入研究的方法学质量进行评估,运用RevMan 5.4软件进行Meta分析。结果纳入文献10篇,涉及患儿1257例。Meta分析显示百蕊颗粒组总有效率高于对照组(OR=4.26,95%CI:2.94~6.16,P<0.00001)。依据疾病类型、治疗疗程进行亚组分析,结果显示,疱疹性咽峡炎患者与非疱疹性咽峡炎患者百蕊颗粒组总有效率均高于对照组(OR=5.34,95%CI:3.23~8.84,P<0.00001;OR=3.12,95%CI:1.80~5.42,P<0.0001);疗程3~5 d与6~7 d百蕊颗粒组总有效率均高于对照组(OR=5.24,95%CI:3.20~8.59,P<0.00001;OR=3.14,95%CI:1.79~5.52,P<0.0001)。百蕊颗粒组退热时间、咽喉部症状消退时间短于对照组(MD=-1.23,95%CI:-1.78~-0.68,P<0.0001;MD=-1.38,95%CI:-1.65~-1.11,P<0.00001)。百蕊颗粒组与对照组不良反应总发生率比较差异无统计学意义(OR=2.09,95%CI:0.69~6.33,P=0.19)。结论百蕊颗粒治疗儿童AURTI疗效较好,且不会增加不良反应。

Alterations of intestinal flora and the effects of probiotics in children with recurrent respiratory tract infection

Background Recurrent respiratory tract infection (RRTI) is a disease occurred frequently in preschool children.Methods A total of 120 RRTI children were randomly divided into active group,remission group,intervention group and control group,meanwhile 30 healthy children were selected as the healthy group.Children in the intervention group were given oral Bifidobaeterium tetravaccine tablets (Live) for 2 months,while the control group received routine treatment.Stool sample were detected to analyze the bacterial strains.The occurrence of respiratory tract infection (RTI) was compared between different groups during 1 year follow-up.Results Compared with the healthy group,the number of Bifidobacteria and Lactobacilli in the active group,remission group,intervention group and control group was significantly decreased (P < 0.05).The number of Bifidobacteria and Lactobacilli in the intervention group was significantly higher compared to other RRTI groups (P < 0.05).During the follow-up period,the average annual frequency of different acute RTI and use of antibiotics were significantly reduced (P < 0.05),the average duration of cough,fever and use of antibiotics at each episode were also significantly shortened (P < 0.05) in the intervention group compared to the control group.Conclusions Children with RRTI are susceptible to intestinal flora imbalance.Oral probiotics can effectively improve the RRTI intestinal microecological balance in children and reduce the frequency of RTI.