1983年 · 第21卷第03期

Infants born of mothers infected by HBV, either as patients of type B hepatitis or as HBsAg carriers, can be infected during pregnant or delivery period. The rate of such kind of transmission was 20—70%. The main route of infection is in the birth canal during delivery through mucus membrane, skin or by oral. Infection sometimes occurs through placenta, breast milk feeding or intimate contact after birth. The higher the HBsAg titer of the mothers, especially those also with positive HBeAg, the more chance to infect their infants. The preven tion of Mother-infant transmission of HBV includes protecting the pregnant mother from HBV infection, strict sterilization system before and during delivery. It has been proved that specific hyperimmune HBIG and/or HBV vaccine (or HBIG first, then followed by HBV vaccine) given as early as possible, and repeated regularly within a definite period can protect the infants from HBV infection.

18 children, asymptomatic HBV car riers, were followed up for over one year, The clinical data, immunology and patho logic changes were evaluated. Serial clinical follow-up (at least over one year) and repeated liver-function tests are necessary to diagnose the asymptomatic carriers. There may be different histologic but non-specific changes in the liver tissues of the 14 asymptomatic carriers. Therefore, differen tiation of healthy and asymptomatic carriers depends more on liver biopsy. Anti-HBc was detectable in all 18 carriers and in part, HBcAg particles can be found in some hepatocellular nucleus under electromicroscopy. Therefore anti-HBc can be used as a serologic mark in asymptomatic HBV carriers. In the present study positive rate of anti-HBc, anti-HBs and anti-HBe are 73.0%, 20.5% and 13.5%, and the percentage of increasing IgG and IgM, 70.8% and 40.3%. This result suggests that the asymptomatic carriers have con siderable humoral immunoreaction. We agree with the idea that asymptomatic HBV carriers have abnormal cellular immunoreaction.

Laparoscopy and liver biopsy under direct vision were performed in 33 children with a clinical diagnosis of chronic viral hepatitis. Examination of the biopsy speci mens revealed that chronic active hepatitis (CAH) and post-hepatitis cirrhosis (PHC) were not rare in our cases, and that a considerable proportion of the cases with CAH and PHC was clinically misdiagnosed. Therefore, liver biopsy is necessary for correct diagnosis and typing of chronic hepatitis in children. Our results also indicated that liver biopsy through laparo scope is a valuable means for the final diagnosis of chronic hepatitis in children, and it is safer and more reliable than the percutaneous method.

In order to find out the relation between clinical prognosis and seroconver sion of HBVM (Hepatitis B virus markers), 233 acute hepatitis with HBVM were followed up. As a result, the rate of HBVM turning negative after two years was 52.8%, and it was higher significant in the icteric (59.5%) than the anicteric (38.7%). The rates of HBsAg and AntiHBc turning negative were 61.8% and 55.9% respectively after the same duration. Whenever HBsAg and Anti-HBc appeared with HBeAg together, the rates of HBsAg and Anti-HBc negative seroconversion would become the lowest (5.3% and zero respec tively). During the course of two years, 21 (9.0%) recurred and chronic hepatitis ensued. The recurrent rate was highest (61.1%) in cases with all three markers of HBsAg, Anti-HBc and HBeAg. It showed that HBeAg may indicate a poor prognosis.

This paper reports the analysis of types and clinical characteristics of 95 cases of childhood viral hepatitis patients. We used the method of SPRIA to indentify HBcAg, anti-HAVIgM, and the method of ELISA to indentify anti-HBcIgM. Prelimi nary results are as follows. The 95 cases were divided into 4 groups i. e. group of type A, B, AB mixed, and unidentified hepatitis, which accounted for 61.1%, 21.1%, 13.7% and 4.2% respectively. The patients were mostly school children 7—14years old. The total infection ratio of type A, among 95 patients was 74.7%. About 25% of 60 cases of type A showed anti-HBc positive reaction and with the titre 1:10—10⁶ (IAHA), so that anti-HBc was not reliable in the dignosis of viral hepatitis type B. Cases of type A hepatitis always had fever at onset. Most of the type B cases were discovered during physical examination. Recovering time of the liver function for both types in acute cases were about the same. Among hepatitis B cases there was a high proportion of chronic cases. Hepatitis of mixed AB type occurred in a certain proportion (13.7%), their clinical characteristics were similar to hepatitis A. The pathogenicity and mecha nism of the mixed type of hepatitis need further study.

Serum C₈, FDP, Immune Complex, IgG, IgM were studied in 53 children suffering from meningitis, of which, part of the patients were of septic shocked and part of usual type. In the shocked children the serum C₃ level was reduced significant ly while the FDP increased obviously, negative lineal correlation (r= -0.50, P<0.05) was evident. The other immunological studies mentioned were within the normal range except in a few of them for unknown reasons. Activation of complement system exhibited only in a few patients of usual type, but in 80.6% of the shock patients. The changes of C₃ level in our study might be due to the activation of the C₃ alterna tive route or properdin pathway. The greater activation of fibrinolytic system in shocked children than that of the patients of usual type, at least partly is correlated to the activation of the complement system. Analysis of C₃ and FDP of the convalescent cases and that of the 3 fatal cases indicates that the changes of serum C₃ and FDP level could be of some help in estimating the prognosis of the patients.

From August 1981 to September 1982130 cases of bacillary dysentery with posi tive stool cultures of Bacillus Shigella in children were treated. Among them, 80were treated with pipemidic acid + TMP and 50 with berberine+ TMP as controls. Pipemidic acid 30—40mg/kg/day, TMP 5—8mg/kg/day divided into 2 doses were given for 5一7 days. All 80 cases were cured with better result than the controls. Of the 80 cases only one showed elevated SGPT and 2 abnormal urinary findings. The adverse reactions disappeared 7 and 2days respectively after the treatment was discontinued.

This paper reports 35 cases of neuro logic complications following inoculation of Semple's sheep brain rabies vaccine. Out of 35 patients 26 were boys and 9 girls. Thirty of them aged 7—14 years. The onset of the disease was acute or subacute after the 7 th—18 th inoculation. According to the clinical features, they were divided into 5 types: encephalitis, encephalomeningitis, meningitis, myelitis, and peripheral neuritis or cranial nerve involvement. All patients were treated with corticosteroid. 33 patients recovered. Two patients died of complicating infection and/or cerebral edema and one autopsy was done. The patho logical changes of the brain included demyelination lesions around small veins, diffuse proliferation of glial cells and infil tration of lymphocytes and plasma cells. The author suggests that concentrated hamster kidney ultrafiltrate vaccine should be used instead of brain tissue vaccine.

Using self made culture medium for mycoplasma, mycoplasma pneumoniae were isolated from the throat swabs of 5 cases of pneumonia and one case of hemolytic anemia, moreover, 13 strains of M. Orale type 1, 4 strains of M. Salivarium and one strain of M. Orale type Ⅲ were also isolated. In addition, the technique of metabolic inhibition test was established for clinical serological diagnosis. Of 100cases of pneumonia in children, 24 showed four-fold increase of antibody titer in their convalescent sera The clinical manifestations of 24 cases of serologically diagnosed myco plasma pneumonia were analysed. The re markable features noted in these cases were higher incidence in the 7—14 year age group, minimal abnormal physical signs of the chest, big patches of cloudiness near the hilum on X-ray examination and longer duration of illness. Some cases presented clinical pictures of bronchiolitis and lobar pneumonia. Pleural effusion was not un common.

This paper reports clinical features of 80 cases of botulism in children in Shihezi. All cases belonged to the food poisoning type, with a history of eating fermented beans. Most of the cases occurred in spring when vegetables were lacking. The incubation period was 6.4 days in average. The poisoned food samples obtained from 34 cases were identified, of which CI. botulinum type A in 29, type B in 1 and unable to be typed in 4 cases. On the basis of clinical symptoms and signs criteria for evaluation were established. Accordingly the cases were graded into mild (42 cases), moderate (21 cases) and severe (17 cases). Some features in children, which were different from that of the adult patients, such as fever, leucocytosis and convulsion were discussed. By comparing the patients treated five days before the onset of disease with those five days or more, it showed that early use botulism antitoxin with large initial dosage could be an important factor for shortening the clinical course and raising the cure rate.

9 cases of von Willebrand's disease are reported to have various levels of factor VIII related activities. The assay for factor VIII coagulent (VIII: C) showed low levels but not less than 9% in 4 cases while those in the other 5 patients fell within the normal range (103±26%) or even elevated. The activities of factor VIII related antigen (VIII R: Ag) were ≤21% (3 cases) and between 29一57% (5 cases) respectively. One case with a high level of VIII R: Ag (116%) revealed a variant type demonstrated by its altered electrophoretic mobility on crossed immunoelectrophoretic assay. Estimations of factor VIII related Willebrand factor (VIII R: WF) were found decreased in 7 cases (≤3% in 3, between 26—60% in 4) and within the normal level (85±10%) in 2 cases.

Other data for hemostatic disorders included the followings: reduced platelet count (occasionally in I case), prolonged bleeding time (in 7/8), prolonged clotting time (in 1/5), prolonged KPTT (in 5/9), deficient platelet factor 3 availability (in 1/7) and diminished platelet adhesion to glass beads (in 1/6). Aspirin tolerance test performed in 4 cases on 11 occasions gave positive results in 7. 2 cases with deficient platelet aggregation to ADP (one with deficient platelet factor 3 availability) were suspected to have concurrent func tional disorders of platelets.

The present cases reported according to their clinical and laboratory findings can be subdivided into 3 categories: the classical form (3 cases), their variants (5cases), and carrier (1 case).