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06 June 2021, Volume 36 Issue 6 Previous Issue    Next Issue

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Expert suggestions on the influence of major emergencies on preventive vaccination in children and the management strategies Disease Prevention and Vaccination Group of Society of Child Health of China Preventive Medicine Association 2021, 36(6): 401-407.  DOI: 10.19538/j.ek2021060601 Abstract ( )

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Understanding and applying pulmonary function testing correctly in children LIU Chuan-he*，ZHENG Jin-ping 2021, 36(6): 408-411.  DOI: 10.19538/j.ek2021060602 Abstract ( )   With the wide application of lung function testing technology in children，to use this technology correctly in clinical practice to provide better clinical service has become a matter faced by pediatric professionals. In recent years，relevant societies and institutions have done a lot of work in training. However，due to the differences in lung function testing technology between children and adults，there are still many misunderstandings and disputes in the use of children’s lung function testing，especially in the selection of testing item，quality control of technical operation and interpretation of reports. The level of lung function testing and interpretation of reports should be further improved.

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Characteristics of lung function changes in children with bronchial asthma LIU Chuan-he，LI Shuo，SHAO Ming-jun 2021, 36(6): 412-416.  DOI: 10.19538/j.ek2021060603 Abstract ( )   The changes of lung function in children with bronchial asthma are characteristic，especially in the two aspects of airway hyperresponsiveness and obstructive lung dysfunction. The lung dysfunction is reversible，variable and diverse，which varies over the process of the disease. Lung function test plays an irreplaceable role in the diagnosis and management of asthma，but it does not correlate strongly with asthma symptoms in children. The changes of lung function caused by other respiratory diseases should be recognized for differential diagnosis. Only by correctly interpreting the results of lung function test and close combination with clinical expression can asthma in children be precisely diagnosed and managed.

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Characteristics of pulmonary function changes in children with interstitial lung diseases XU Yong-sheng 2021, 36(6): 416-420.  DOI: 10.19538/j.ek2021060604 Abstract ( )   Interstitial lung diseases（ILD） are functionally characterized by a restrictive ventilatory defect due to a reduced distensibility of the lung parenchyma. ILD patients also show a reduced exercise tolerance，and the main factors limiting exercise capacity are ventilatory and gas exchange abnormalities. The change of gas exchange often precedes the change of respiratory mechanics，which can improve the sensitivity of diagnosis of ILD. Resting pulmonary function and exercise-induced hypoxemia can aid to define the prognosis of ILD，and vital capacity and diffusing capacity are useful parameters to monitor the response of patients to therapy. To determine prognosis，identifying the trend of different parameters of lung function is a better method than baseline measurement. Respiratory mechanical changes and abnormal gas exchange are common characteristics of most ILD，and functional abnormalities in ILDs are typical, but not specific.

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Determination of small airway dysfunction and its clinical significance HUANG Yi-jie，AI Tao 2021, 36(6): 420-425.  DOI: 10.19538/j.ek2021060605 Abstract ( )   Small airway dysfunction has been confirmed to be widespread in patients with obstructive airway diseases and other small airway diseases，but because its clinical manifestations may be atypical，it is not easy to be detected. However，whether there is small airway dysfunction may affect clinical symptoms，disease control，and risk of recurrence. Effective  testing methods are needed to detect and evaluate small airway dysfunction in an early stage to improve the clinical diagnosis，the treatment and the prognosis. Due to the lack of a unified assessment method for small airway involvement，we summarized some function measurement methods that have been used in clinical practice and evoluated their application value.

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Clinical application of exercise challenge testing in children WANG Ning 2021, 36(6): 426-429.  DOI: 10.19538/j.ek2021060606 Abstract ( )   Exercise is a common trigger of bronchial asthma in children. Exercise challenge testing（ECT） is the gold standard for diagnosing exercise-induced bronchoconstriction（EIB） and serves as a diagnostic test for asthma. In children，ECT is highly specific for exercise-induced asthma，and because EIB reflects airway inflammation，it indicates uncontrolled asthma. Thus，ECT can be used to study the underlying pathophysiology of asthma and as a guide for therapy. In order to perform ECT better in clinical application and improve the level of asthma diagnosis，this paper focuses on the mechanisms，the detailed test methods（including patient preparation，procedures，assessing the response），the influence factors，safety and the current clinical application of ECT.

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Issues in clinical application of tidal breathing lung function test LIU Sha，ZHANG Ming-xiang 2021, 36(6): 429-433.  DOI: 10.19538/j.ek2021060607 Abstract ( )   Tidal breathing pulmonary function test is the most commonly used method of infant pulmonary function test. It is widely accepted by pediatricians and parents because of its non-invasiveness，simple operation and no need of children’s cooperation. Due to the strong professionalism of tidal breathing pulmonary function test and its short clinical application time，the ability of pediatric medical staff to control the operation quality and interpret the report still needs to be improved. In this paper，we will focus on several issues that need to be paid attention to in the detection process，report interpretation and analysis of drug test results.

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Clinical value of tidal breath lung function test in diagnosis and management of infants with asthma DONG Xiao-yan，ZHOU Yuan 2021, 36(6): 433-437.  DOI: 10.19538/j.ek2021060608 Abstract ( )   Tidal breathing lung function test is currently an effective measurement tool that can be used to understand lung development，disease progression，and treatment effects in infants. Most patients with bronchial asthma have the onset of the disease in infancy and young childhood. Therefore，it is particularly important to check the lung function of children early. This article describes the relationship between tidal lung function and asthma in infant  and highlights the clinical value of tidal lung function test in the diagnosis of infant asthma and its prognostic evaluation.

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Clinical application of determination of exhaled nitric oxide in children with airway diseases JIANG Wen-hui 2021, 36(6): 437-440.  DOI: 10.19538/j.ek2021060609 Abstract ( )   Nitric oxide（NO） plays an important role in many physiological and pathological links of airway and lungs. When the diseases occur in airway and lungs，the concentration of exhaled nitric oxide will change. In recent years，with the deepening of the clinical research and improvement in testing technology level，determination of exhaled nitric oxide in children has been widely used in a variety of airway diseases. The method  provides a new method  to understand the type，location and degree of airway inflammation.

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Association of a 4-locus gene prediction model of asthma with the asthma predictive index and atopy in children Subspecialty Group of Pediatric Allergy and Asthma，the Chinese Society of Allergy（preparatory） 2021, 36(6): 441-446.  DOI: 10.19538/j.ek2021060610 Abstract ( )   Objective　To examine the associations of 4-locus gene prediction model of asthma，including ADRB2 rs1042713（R16G），FcER1B rs569108（E237G），IL13 rs20541（R110Q） and IL4 rs2243250（-590C＞T），with asthma predictive index（API） and atopy. Methods　In this study，1490 preschool children with wheezing were randomly recruited from Shanghai Children’s Medical Center and other 10 domestic medical institutions from June 2019 to November 2020 using a multicenter empirical research method. The children were genotyped for the above four single nucleotide polymorphisms（SNPs） by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry，and then divided into high or low risk group based on the genotypes. The clinical history of the preschool children with wheezing was collected，and serum specific IgE was detected by ImmunoCAP assays，which was used as atopic index to analyze the association of API and atopy with the high-risk and low-risk groups of asthma. Results　Of the 1490 children，680 were at high risk for asthma and 810 were at low risk. For both stringent and loose API，the positive rate was significantly higher in high-risk patients than in low-risk patients（stringent API，OR＝5.33，P＜0.001；loose API，OR＝2.63，P＜0.001）. In addition，positive atopy accounted for 73.43% in high-risk patients，and it was 60.80% in low-risk patients；the risk of positive atopy was 1.78 times higher in patients at high risk than that at low risk for asthma（P＜0.01）. Conclusions　The results indicates that the 4-locus asthma prediction model consisting of IL13 rs20541，IL4 rs2243250，ADRB2 rs1042713，and FcER1B rs569108 is associated with the API and atopy，which may provide an important theoretical basis for predicting asthma and atopy in preschool children.

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A  study on serum glucagon level in hypoglycemia children HUANG Shu-yue， CHEN Xiao-bo， SONG Fu-ying， et al 2021, 36(6): 447-451.  DOI: 10.19538/j.ek2021060611 Abstract ( )   Objective　To analyze the glucagon secretion and reaction ability of hypoglycemia children with different etiologies. Methods　The child patients with hypoglycemia of Children’s Hospital Affiliated to Capital Institute of Pediatrics in March 2020 to March 2021 were included，and their data were analyzed，including 11 patients with congenital hyperinsulinemia，30 cases of idiopathic ketosis hypoglycemia and 30 cases as control group（the children with idiopathic short stature receiving insulin-induced hypoglycemia test）. Serum glucagon levels were measured during episodes of hypoglycemia and under normal glucose. The serum glucagon levels of hypoglycemia and normal blood glucose were compared to analyze the secretion capacity of glucagon and the response capacity of hypoglycemia in children with different causes. Results　Compared with normal blood glucose，the serum glucagon secretion of children with congenital hyperinsulinemia was significantly increased during hypoglycemia［（146.18±44.93） ng/L vs. （133.02±37.89） ng/L］ and the difference was statistically significant. Compared with normal glucose children with idiopathic ketosis hypoglycemia，serum glucagon level was not significantly increased［（133.47±54.29） ng/L vs. （129.23±44.60） ng/L］，and the difference was not statistically significant. Compareing the control group when hypoglycemia was induced with that when the blood glucose was normal，the serum glucagon was lower when hypoglycemia was induced，and the difference was statistically significant. There was no significant difference in glucagon level between children with congenital hyperinsulinemia and idiopathic ketosis hypoglycemia during hypoglycemia or under normal glucose. Conclusion　The ability to secrete glucagon and respond to hypoglycemia is not impaired in children with congenital hyperinsulinemia. In children with idiopathic ketogenic hypoglycemia，glucagon secretion is normal，but glucagon response capacity is insufficient in hypoglycemia. Exogenous insulin can inhibit glucagon secretion.

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Analysis of clinical characteristics of Chlamydia trachomatis pneumonia at early infancy HUANG Miao-feng，ZHENG Yue-jie 2021, 36(6): 452-458.  DOI: 10.19538/j.ek2021060612 Abstract ( )   Objective　To understand the pathogenic distribution and clinical characteristics of Chlamydia trachomatis（CT） in children with community-acquired pneumonia（CAP） at early infancy，so as to provide evidence for clinical empirical anti-infection treatment. Methods　The clinical data of 146 children with Chlamydia trachomatis pneumonia（CTP） aged 28 days to 119 days admitted to Shenzhen Children’s Hospital from January 2017 to March 2018 were retrospectively and statistically analyzed. Results　In this study，146 patients were positive for CT DNA，and the detection rate was 15.1%（146/968）. The common clinical manifestations of the children with CTP were cough（146/146，100%），expectoration（118/146，80.8%），lung moist rale（86/146，58.9%），and flushing after cough（60/146，41.1%）. Some patients had  rhinobyon（57/146，39.0%），vomiting after cough（39/146，26.7%） and polypnea（28/146，19.2%）. The average length of hospital stay was（5.27±3.75） days，and the proportion of seriously ill children was low（9/146，6.2%）. All the children got better and were discharged after treatment. In terms of CAP etiology，CT was higher than Haemophilus influenzae（125/968，12.9%） and respiratory syncytial virus（RSV）（121/968，12.5%）. Mixed CT infection was more common（85/146，58.2%），and the proportion of wheezing and three-depression signs of mixed infection was higher than that of pure CT infection（single infection），but the hospital stay of the children was not prolonged. 137 infants（93.8%） received antibiotics treatment after admission. The average treatment time was （4.85±4.04） d，more than 1 week was about 22 patients（18.0%），including one for 37 days. 109 infants（79.6%） received erythromycin or azithromycin of the 137 cases. Conclusion　CT is the most common pathogen in CAP at early infancy，and mixed infection may aggravate the disease. Treatment with azithromycin or erythromycin is effective and has a good prognosis. For infants with CAP at early infancy，macrolides are the first choice for anti-infection treatment.

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Distribution of central sleep apnea in children with obstructive sleep apnea hypopnea syndrome CUI Fei-fei，CHEN Chao，LIU Jing，et al 2021, 36(6): 459-462.  DOI: 10.19538/j.ek2021060613 Abstract ( )   Objective　To study the distribution of central sleep apnea（CSA） in children with obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods　From January 2017 to March 2018，the children who had completed the whole night respiratory sleep monitoring in the Respiratory and Sleep Monitoring Center of our hospital were enrolled. The children were divided into OSAHS and non-OSAHS groups by the PSG. The OSAHS group was divided into mild，medium and severe OSAHS groups. The differences in central apnea index（CAI） among the groups were compared，and the correlation of CAI with AHI，OAI and age were analyzed. Results　Totally 194 children were enrolled in the study，including 117 males（60.3%），and 77 females（39.7%），with an average age of （5.7±3.0） years old. The M（Q1，Q3） of AHI was 6.5（3.9，12），and CAI’s M（Q1，Q3） was 1.0（0.4，2.0）. （1）The CAI and AHI of all the children in the study were positively correlated（the correlation coefficient was r＝0.329，P＜0.05），and CAI was positively correlated with OAI（r＝0.243，P＜0.05）；CAI was negatively correlated with the age of the children（r＝-0.289，P＜0.05）. （2）There were 123 children in OSAHS group and 71 in non-OSAHS group. The CAI of the children in OSAHS group was higher than that of non-OSAHS group（P＜0.05）. With the increase of AHI，CAI increased（P trend＜0.001）. There were significant differences in CAI in different age groups in OSAHS group，and CAI decreased with the increase of age. （3）There was a positive correlation between CAI and AHI（r＝0.307，P＜0.01），and between CAI and OAI（r＝0.378，P＜0.01），while CAI was negatively correlated with age（r＝-0.362，P＜0.01）. Conclusion　The CAI of OSAHS group is higher than that of non-OSAHS group. The CAI and OAI coexist in OSAHS group，and there is a positive correlation between them. The disease severity and the age of the patients in OSAHS group are the influencing factors of CAI in OSAHS children.

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Research progress in the diagnosis and treatment of methylmalonic academia and its prognosis HAN Xiao，HAN Bing-juan，ZHU Wei-wei 2021, 36(6): 463-468.  DOI: 10.19538/j.ek2021060614 Abstract ( )

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Research progress in general situation of coronavirus infection ZHANG Li-na，CAO Ling 2021, 36(6): 469-473.  DOI: 10.19538/j.ek2021060615 Abstract ( )

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One case of Allgrove syndrome visiting hospital for dysphagia: clinical and genetic analysis HU Man，YAO Hui 2021, 36(6): 474-477.  DOI: 10.19538/j.ek2021060616 Abstract ( )

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One case report of Meier-Gorlin syndrome caused by CDC45 mutation WANG Yi，GONG Chun-xiu 2021, 36(6): 478-480.  DOI: 10.19538/j.ek2021060617 Abstract ( )