2014年 · 第52卷第08期

In the 1970s and 1980s, the infectious disease departments of various children's hospitals and the hepatitis wards of adult infectious diseases hospitals mainly treated acute viral hepatitis B (hepatitis B) and viral hepatitis A, and they were overcrowded, so it was difficult to find a bed in the hepatitis wards. Because viral hepatitis A is self-limiting, and people without underlying diseases will not become chronic. Although 70% ~80% of acute hepatitis B in adults can recover by self-limitation, more than 20% of them still carry the virus after converting to hepatitis B, that is, hepatitis B virus (HBV) carrier or chronic hepatitis after hepatitis. Acute hepatitis B can develop into subacute severe hepatitis or onset is acute fulminant hepatitis B. Although rescued, it eventually dies from liver failure or hepatic encephalopathy (hepatic coma). Not to mention liver fibrosis, cirrhosis and hepatocellular carcinoma caused by chronic infection of HBV, a large number of cases make us specialists engaged in infectious diseases busy all day rescuing severe hepatitis B. In the late 1990s, especially since the 21st century, the Department of Children's Infectious Diseases has been closed in major children's hospitals one after another, and has been converted into various specialized wards, such as hematology, respiratory department, nephrology, neurology and cardiovascular department. Even if there is a gastroenterology department, it mainly sees gastrointestinal diseases. Only a few children's hospitals in China still retain infectious diseases departments, but there is no hepatitis ward with digestive tract isolation. Of course, adult infectious disease hospitals or general hospitals still retain hepatitis wards, because adult patients with chronic hepatitis B who can't be relieved repeatedly and become severe can only live in hepatitis isolation wards. The digestive tract isolation ward of the Department of Children's Infectious Diseases treats epidemic diarrhea with dehydration or other intestinal infectious diseases, such as typhoid fever and bacillary dysentery, while the reserved hepatitis ward treats infantile liver diseases, mostly genetic metabolic liver diseases with jaundice and liver damage and infantile cytomegalovirus hepatitis. The size of infectious disease areas and the number of reserved beds are also decreasing. The existence of infectious diseases in children is mainly to deal with new and sudden infectious diseases, such as hand, foot and mouth disease, novel influenza A (H1N1) and avian influenza virus (H7N9) infection in recent years.

A consensus has been reached on the antiviral treatment of adults with chronic hepatitis B (CHB) and chronic hepatitis C (CHC) in China, but the clinical evidence of antiviral treatment of children with CHB and CHC is still scarce and controversial. The current status and progress of antiviral treatment in children with CHB and CHC are reviewed.

functional gastrointestinal disorders (FGIDs) are common diseases of children's digestive system, which seriously affect children's quality of life and learning. Among the published studies on FGIDs in children, the most common subjects are functional constipation (FC), irritable bowel syndrome (IBS), functional abdominal pain (FAP), functional dyspepsia (FD), cyclic vomiting syndrome (CVS), and abdominal migraine; Among them, FC has the most related clinical trials, which may be related to the high prevalence of FC in FGIDs, involvement in all age groups, and greater influence on children's quality of life. Rigorous randomized controlled trial (RCT) has promoted the development of pediatric FGIDs treatment and is also an important basis for the consensus of pediatric FGIDs treatment. There are relatively few RCTs related to the treatment of FGIDs in children in China. The present situation of RCT research on common FGIDs in children is introduced, and evaluation and suggestions are put forward.

Drug-induced liver injury (DILI) is one of the common adverse drug reactions (ADR). In mild cases, serum transaminases and bilirubin are only increased, and in severe cases, acute liver failure can occur, even leading to death. Children use more drugs, but on the one hand, most of the drugs currently used for children have only been clinically trialed in adults, and there is a lack of sufficient safety-related data for children's applications; On the other hand, children's developing liver is immature in its metabolism and transformation of drugs, so there are many differences in the treatment of DILI in children compared with adults. This paper introduces the problems related to children's DILI that are of common clinical concern.

Hodgkin lymphoma (HL) in children is a lymphoma derived from B lymphocytes, and its incidence in mainland China is significantly lower than that of non-Hodgkin lymphoma, but there is no national epidemiological survey data. According to the data of the Shanghai Center for Disease Control and Prevention from 2002 to 2005, the annual incidence of HL among children under 15 years of age registered in Shanghai is 0.6/1 million^[1], similar to the results reported in Hong Kong, China^[2], but significantly lower than the incidence rate of 5.5/1 million in North America^[3]。 According to the National Surveillance, Epidemiology, and End Results (SEER) statistics (2002 – 2008), the 5-year survival rate of children with HL has reached 96% ± 0.4%^[4]。 China lacks systematic large-sample clinical reports on the diagnosis and treatment of this disease, and there is a big gap with developed medical countries and regions. The purpose of this diagnosis and treatment recommendation is to introduce the generally accepted experience and conclusions in the clinical practice of HL in children and adolescents, and to help pediatric hematology oncologists establish reasonable clinical ideas and standardize medical behaviors, so as to improve the long-term survival rate of children.

A 14-year-old child was seen for maintenance hemodialysis for 2 years and craniofacial deformation for 5 months. Two years ago, the patient was diagnosed with "chronic nephritis, chronic renal failure, chronic kidney disease stage 5" in Hunan Children's Hospital due to fatigue and poor eating. After the internal fistula operation, maintenance hemodialysis treatment was started in November of the same year. Dialysis machine model Baxter 550, dialyzer SAXON 0.8~1.2 m², using JMS pediatric dialysis line; Blood flow rate 120-180 ml/min, dialysate potassium concentration 2.0 mmol/L, bicarbonate concentration 34 mmol/L; The dose of heparin was 50 U/kg for the first time, and then continuously injected at a rate of 2~4 mg/h until 30 min before the end of hemodialysis. Dialysis was performed twice a week for 2.5 to 3.5 h each time. Five months ago, the child developed gradually aggravating craniofacial deformation, accompanied by shortening of the joints of the trunk and limbs, bone pain and discomfort; Two months ago, his oral cavity was seriously deformed, and his lips could not be closed, which affected eating and speaking; One month ago, progressive aggravation of bone pain caused difficulty in walking. Since the onset of the disease, the patient has poor eating, skin itching and discomfort, normal urine and stool, and no change in weight.

steroid resistant nephrotic syndrome (SRNS) has a poor prognosis. If there is no partial or complete remission after treatment, there is about a 50% risk of progression to end-stage renal disease (ESRD) within 5 years.^[1]。 Genetic studies have confirmed that some SRNS are caused by single gene mutations in structural proteins encoding the glomerular filtration barrier, namely nephrotic syndrome (NS). In clinical practice, children with familial SENS who are resistant to both hormones and immunosuppressants or children with sporadic idiopathic nephrotic syndrome who are resistant to hormones and have renal insufficiency need to consider their etiological genetic factors and need genetic diagnosis. Hereditary NS phenotype and its corresponding pathogenic genes and diagnostic strategies of hereditary NS genes are briefly introduced.