2013年 · 第51卷第02期

interstitial lung disease (ILD) is a general term for a large group of heterogeneous diseases with common characteristics in clinical (oxygenation disorder) -imaging (diffuse lesion signs) -pathology (inflammation and fibrosis), but different etiologies. At present, there are more than 200 diseases with known etiological spectrum of ILD. Although ILD is a rare disease, it has been regarded as a difficult disease in respiratory specialty because of its wide and complex etiological spectrum, and its difficulty in diagnosis and treatment. Because some ILD lesions not only invade the pulmonary interstitium, but also involve the alveoli, pulmonary capillary endothelial cells and bronchioles, etc., and pulmonary parenchymal changes such as alveolitis and protein exudation in the alveolar cavity appear, which appear as alveolar-interstitial disease type in chest imaging, so ILD is also called diffuse parenchymal lung disease (DPLD); It is also called diffuse lung disease (diffuse lung disease, DLD)^[1]。

In the process of clinical diagnosis and treatment of interstitial pulmonary diseases in children, because the etiology, clinical manifestations, even imaging or pathological changes of interstitial pulmonary diseases in children and adults are quite different to a certain extent, both pediatric respiratory physicians and radiologists have experienced a difficult and tireless process of exploration and re-recognition. The diagnosis mode of clinical-radiation-pathology (C-R-P) has laid the foundation of the diagnosis process of interstitial pulmonary diseases in children. With the development of CT technology and the popularization of clinical application, high-resolution CT scan (HRCT) has played an irreplaceable and important role in the diagnosis and evaluation of interstitial lung disease in children^[1,2]。 How to correctly understand the imaging methods of HRCT and how to interpret the imaging signs for diagnosis and differential diagnosis have become the key points of our study, research and discussion.

Transdermal absorption preparation is a new type of parenteral administration, which has the advantages of convenient use, safety and good compliance. At present, many kinds of drugs have been used in the treatment of clinical diseases. tulobuterol patch is the world's first transdermally absorbable β₂Receptor agonist, has significant bronchodilating effect, is convenient to use and has good tolerance, especially suitable for the treatment of asthmatic diseases in children.

Approximately 65% of children had been infected with respiratory syncytial virus (RSV) before age 1, and almost all children had at least 1 RSV infection before age 2. RSV lower respiratory tract infection (RSV-LRTI) is the most common cause of first wheezing in infants and young children. Reactive airway disease (RAD) often occurs after acute RSV-LRTI in infants and young children, and repeated wheezing attacks occur for a long time after the acute phase, and some children develop persistent asthma.

human parechoviruses (HPeVs) are single-stranded positive-strand RNA viruses, containing many different genotypes, and are a common pathogen that can cause infections of respiratory system, digestive system and central nervous system and cause a variety of corresponding clinical symptoms and signs. human parechovirus 3 (HPEV-3) is one of the newly discovered genotypes, which was first developed by Ito et al.^[1]In 2004, it was reported that a fecal specimen from a 1-year-old child with transient paralysis in Japan had epidemiological characteristics and cytophilia that were significantly different from other HPeV genotypes. In recent years, more and more studies have shown that this virus type is closely related to the occurrence of some serious childhood diseases, such as sepsis-like clinical manifestations, infection and injury of central nervous system such as encephalitis and meningoencephalitis, sudden infant death, etc. As a newly discovered and not widely known viral pathogen that can cause serious clinical manifestations in infants and young children, the cases caused by its infection may be seriously underestimated in clinical practice at present, and sufficient attention should be paid to it in both clinical and basic research aspects. In order to improve the understanding and attention of this pathogen, the biology, epidemiology and clinical characteristics of the diseases caused by this pathogen are systematically expounded based on relevant research reports at home and abroad.

The 13th National Academic Conference on Pediatric Respiratory Diseases, organized by the Respiratory Group of Pediatrics Branch of Chinese Medical Association and the Conference Department of Chinese Medical Association, was successfully held in Nanchang, Jiangxi Province on October 25-29, 2012. 1,018 representatives from all over the country attended the meeting. This conference was co-held with the 4th Three-place Cross-Strait Pediatric Respiratory Conference. In addition to inviting experts from the United States, Greece and South Korea, the organizing committee also specially invited nine well-known experts in the field of pediatrics from Taiwan Province and Hong Kong to give special lectures. In addition to the members of the academic group, there are experts from pediatric emergency, radiology, virus and other fields.

The 5th National Children's Bronchoscopy Medical Cooperation Group Meeting of Chinese Medical Association and Children's Bronchoscopy Hands-on Study Class were held in Jinan from July 14-17, 2012. More than 300 representatives from 31 provinces, municipalities and autonomous regions across the country attended the meeting. The main contents of the meeting are now introduced as follows.

A 10-year-old female, Han nationality, was admitted to hospital due to intermittent fever, headache, vomiting for 5 days and myalgia for 1 day. The child had fever 5 days before admission, accompanied by headache, vomiting, lack of energy and drowsiness. The local clinic gave intravenous drip of "cefoperazone/sulbactam and ribavirin" for 1 day, "azithromycin and ribavirin" for 2 days, and dexamethasone 2 mg for 3 days. The fever subsided 2 days before admission, the headache and vomiting were relieved, and the symptoms of drowsiness disappeared. One day before admission, myalgia occurred, with bilateral medial thighs as the presence, and the pain was severe, so that the child could not walk, and the pain was accompanied by obvious restlessness. Routine blood test in the local hospital on the morning of admission: white blood cells 9.6×10⁹/L, neutrophil classification 0.846, erythrocytes 6.25×10¹²/L, hemoglobin 172 g/L, platelets 110×10⁹/L; Urine routine: occult blood (+ +), protein (+ +); Therefore, he was admitted to the emergency department. During the course of the disease, there was no rash, no macroscopic hematuria, no edema, oliguria, no frequent urination, urgency, painful urination, no convulsions, and normal stool. There is no history of special food and drug use, and no special records in family history.

A 4-year-old and 7-month-old child was admitted to hospital on February 6, 2012 due to repeated pale complexion for more than 3 months and melena for more than 1 month, which recurred for 5 days. The child appeared pale with bloody stools more than 3 months ago. The child had no shortness of breath, syncope, abdominal pain, hematemesis and perianal pain. At that time, no attention was paid and no treatment was given. More than 1 month ago, the child's complexion was pale and aggravated, accompanied by melena, and he went to a local hospital. Blood routine: red blood cells 2.3×10¹²/L, hemoglobin 30 g/L; Fecal routine: occult blood (+ + +), gastroscopy: antral polyps; After blood transfusion and symptomatic treatment, the child's symptoms improved. Five days before admission, the child had melena again and pale complexion, and was admitted to hospital with "gastrointestinal bleeding". One year ago, the child was diagnosed with "lymphoma" in the right neck by B-ultrasound, and was given local injection of "pingyangmycin" in the outpatient clinic. The tumor is now smaller than before. Physical examination: Height 105 cm, weight 16 kg, skin and mucosa are pale, a 4 cm ×3 cm mass can be seen subcutaneously on the right neck, soft in texture, adhering to the skin, poor mobility, and no change in epidermal color. No rash or bleeding spots were observed in other parts of the body. Cardiopulmonary abdominal examination was not special. No abnormalities were found around the anus, no mass was palpable by digital rectal examination, and there was no blood stain on the finger cuff. Blood routine: white blood cells 7.05×10⁹/L, red blood cells 1.44×10¹²/L, hemoglobin 24 g/L, platelets 308×10⁹/L, fecal occult blood: positive; Serum ferritin 3.8 μ g/L; Bone marrow routine + iron staining: hyperplastic anemia bone marrow image (intracellular iron 3%, extracellular iron negative); Urinary routine, coagulation function, liver function and renal function were normal. Gastroscopy: One breath of fleshy bulge was seen on the pylorus and the large curvature of the gastric body, with the size of 1.5 cm ×0.8 cm and 1.2 cm ×1.5 cm, respectively, and telangiectasia was seen on the surface. Colonoscopy: 20 to 30 dark red hemangiomas of different sizes and irregular shapes can be seen in the whole colon, some of which are raised or polypoid on the surface. Capsule endoscopy: More than 20 hemangiomas of different sizes were seen in the small intestine (Figure 1、Figure 2), some of which showed large polypoid protuberances with blue-purple surface, some with active bleeding, and multiple hemangiomas in the colon. Diagnosis of "blue rubber blister nevus-like syndrome" by combining gastroscopy, colonoscopy and capsule endoscopy results (blue rubber bleb nevus syndrome, BRBNS) ". After the diagnosis was confirmed, red blood cell suspension and oral iron (protein ferrous succinate oral liquid) were infused, and the hemoglobin rose to 90 g/L after re-examination, but multiple fecal occult blood tests were still positive. Endoscopic sclerosing agent injection was recommended. Parents were discharged automatically after giving up treatment, and iron was taken orally for a long time.

The child, male, 53 h, was admitted to the hospital with the main complaint of "intermittent fever with convulsions for 29 h". G₂P₂The mother was delivered by cesarean section at 38 weeks of pregnancy due to low amniotic fluid. There was no asphyxia at birth, no abnormalities in placenta and umbilical cord, and her birth weight was 2150 g. Intermittent fever began 24 hours after birth, with a body temperature of about 38.5 ℃. At the same time, the child was found to have intermittent twitches in both upper limbs, several times a day, for tens of seconds each time, and it resolved spontaneously. The fever did not go down after being treated with meropenem in the local hospital. After birth, coffee-like substances were extracted from the stomach, but no milk was given. They had defecated two stool, and there was no cough and asthma. The mother was healthy during pregnancy, and the first child died 12 days after birth due to congenital heart disease. Atrial septal defect revealed by local hospital cardiac ultrasound.

tuberous sclerosis complex (TSC), also known as Bournerille's disease, is one of the neurocutaneous syndromes with autosomal dominant inheritance and incomplete penetrance. The incidence of live births is about 1/6000 to 1/15 400. The clinical manifestations of this disease are diverse, and most of them have poor prognosis. Because the symptoms of neonatal period are atypical, it is easy to be misdiagnosed or missed. One case was admitted to our hospital, and the report is as follows.

The 2012 Sino-US (Xiaoxiang) International Summit Forum on Pediatric Medicine, sponsored by Hunan Children's Hospital and co-organized by Hunan Provincial Department of Health and Hunan Provincial Bureau of Foreign Experts, was held in Changsha from June 9 to 10, 2012. More than 20 well-known pediatricians from the United States, Australia, France, the Netherlands, Japan, Hong Kong, Macao, Taiwan and the mainland of China were invited to this conference. More than 1,000 pediatricians and nurses from 23 countries attended this forum. Professor Henri R. Ford, Vice President of Los Angeles Children's Hospital, Professor Shen Xiaoming, Vice Mayor of Shanghai/well-known pediatric expert at home and abroad, and other well-known experts at home and abroad gave special reports. This forum made special reports and exchanges around new developments, hot topics and difficult problems in pediatrics, pediatric surgery, children's health care, pediatric critical care medicine, neonatal medicine, pediatric nursing and other fields. Domestic and foreign experts gave 58 special reports on new ideas, new technologies and new progress in different fields of pediatrics at the main venue and several sub-venues respectively. After the meeting, the development of pediatric medicine was enlarged to the international perspective in the form of debates, questions and discussions, and the development gap at home and abroad was evaluated, which triggered pediatricians to think about the development of various fields of pediatrics.

The "Expert Consensus on Diagnostic Procedures for Children's Interstitial Pulmonary Diseases" (hereinafter referred to as the "Procedures") prepared by the National Children's Diffuse Parenchymal Pulmonary Diseases/Interstitial Pulmonary Diseases (chDPLD/chILD or pDPLD/pILD) Collaborative Group (hereinafter referred to as the "Collaborative Group") of the Respiratory Group of the Pediatrics Branch of the Chinese Medical Association will be published in this issue, becoming the first clinical guiding document in the field of pediatric diffuse pulmonary diseases in China. "Procedure" is the "Collaborative Group" based on nearly 4 years of research on chDPLD/chILD^[1,2,3,4,5]It is compiled by synthesizing the latest progress of relevant research at home and abroad and combining with China's national conditions. It will be applied in the clinic and will be tested in the clinic. Undoubtedly, it has certain guiding significance for improving the diagnosis level of interstitial pulmonary diseases in children in China.