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训练免疫及其对儿童健康的影响

中华实用儿科临床杂志 2024年第2期39卷 81-84页

训练免疫是近10余年新出现的免疫学术语, 指固有免疫系统对再次刺激所产生的记忆免疫。训练免疫能够非特异性增强机体的免疫防御功能, 也参与过敏性炎症和自身免疫性疾病的发生。目前, 越来越多的研究开始关注训练免疫在疾病预防、治疗... 详细信息

训练免疫是近10余年新出现的免疫学术语, 指固有免疫系统对再次刺激所产生的记忆免疫。训练免疫能够非特异性增强机体的免疫防御功能, 也参与过敏性炎症和自身免疫性疾病的发生。目前, 越来越多的研究开始关注训练免疫在疾病预防、治疗和发生发展等方面的作用。现就训练免疫的定义、机制、诱导剂及其对儿童健康的影响进行阐述, 以提高儿科医师对训练免疫的认识。

关键词：儿童训练免疫非特异记忆免疫

Type I interferon:From innate response to treatment for COVID-19

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Pediatric Investigation 2020年第4期4卷 275-280页

作者： Fuyu Lin kunling shen Beijing Engineering Research Center of Long-acting IFN BeijingChina Department of Respiratory Medicine Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina Correspondence

Effective prophylactic and therapeutic interventions are urgentlyneeded to address the coronavirus disease 2019(COVID-19)pandemic.Various antiviral drugs have recently been tested.Type I interferon(IFN)is a regulatory protein involved in the innate immune response,with broad-spectrum antiviral activities and the ability to directly block viral replication and support the immune response to eliminate virus infection.Insufficient virus-induced type I IFN production is characteristic of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection,because SARS-CoV-2 suppresses the IFN response by interacting with essential IFN signaling pathways.Exogenous type I IFN is recommended for treating COVID-19.Unexpectedly however,angiotensin converting enzyme-2(ACE2)receptor,which acts as a SARS-CoV-2 receptor,was shown to be stimulated by IFN,raising doubts about the suitability of IFN use.However,further studies have excluded concerns regarding IFN administration.Type I IFNs,including IFN-α1b,have been used clinically as antiviral drugs for many years and have shown strong antiviral activity against SARS-CoV-2in vitro.Preliminary clinical studies of type I IFNs,especially when delivered via aerosol inhalation,have demonstrated efficacy for the treatment and prevention of COVID-19.Randomized controlled trials of IFN for COVID-19 treatment are ongoing.

关键词： Interferon COVID-19 SARS-CoV-2 ACE2 Treatment

Monogenic diseases in respiratory medicine:Clinical perspectives

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Pediatric Investigation 2017年第1期1卷 27-31页

作者： Yao Yao kunling shen National Clinical Research Center for Respiratory Diseases Department of Respiratory MedicineBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina

With the increasing awareness of genetics in respiratory medicine and improvements in molecular diagnostic techniques,many complicated and rare diseases in respiratory medicine can be diagnosed.Most respiratory diseases have no specific phenotype.However,the clinical spectrum of monogenic diseases in respiratory medicine varies,from pulmonary disease to other inherited disorders that involve the lung.The genes that mediate some of these diseases have been identified.Certain monogenic diseases remain poorly characterized clinically.Because of the specificity of the phenotype of respiratory disease,a future challenge will be to correlate the phenotype and genotype and understand its phenotypic variability.With the development of precision medicine,research on monogenic disorders has been intensive and vigorous.In this article,we provide a brief clinical introduction to monogenic diseases in pediatrics.

关键词： monogenic diseases pediatrics respiratory medicine

2020 Global Pediatric Pulmonology Alliance(GPPA)Forum on COVID-19

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Pediatric Investigation 2020年第4期4卷 225-229页

作者： kunling shen Spencer Li Yu Guan Yonghong Yang China National Clinical Research Center of Respiratory Diseases Department of Respiratory MedicineBeijing ChildrenhospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina Global Pediatric Pulmonology Alliance Department of Respiratory Medicine Shenzhen Children’s HospitalShenzhenGuangdongChina

As the coronavirus disease 2019(COVID-19)pandemic struck the entire world,our health systems,global economy,and humanity have been put to a test that was never seen before.By September 1,2020 when this article was submitted,COVID-19 has infected over 25 million people worldwide,and resulted in a total mortality of more than 856555(https://covid19.***.int).The actions taken by global medical professionals,health agencies and organizations,governments,etc.,can directly impact the health,safety,and wellbeing of our lives,including lives of our most vulnerable population,children.

关键词： mortality Alliance struc

Causes and manifestations of chylothorax in children in China:Experience from a children's medical center, 2007–2017

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Pediatric Investigation 2018年第1期2卷 8-14页

作者： Yan Guo Jiehua Chen Baoping Xu Yuejie Zheng kunling shen National Clinical Research Center for Respiratory Diseases Department of Respiratory Medicine Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China Department of Respiratory Medicine Shenzhen Children's Hospital Shenzhen China

Importance: Chylothorax is the most common cause of pleural effusion in neonates and relatively rare in children. It can cause significant respiratory morbidity. Many clinical entities may contribute to chylothorax. Objective: To investigate the causes and manifestations of chylothorax in infants and children in China. Methods: Case records of 107 cases with chylothorax seen in Beijing Children's Hospital from 2007 to 2017 were retrieved and analyzed; follow-up was carried out by telephone. Results: Of 107 cases, 58.9％ (63/107) were primary chylothorax (PC) and 41.1％(44/107) were secondary chylothorax (SC). Also, 36.4％ (39/107) were neonatal chylothorax (NC) and 35.5％ (38/107) were postoperative chylothorax. In PC with a verified lymphatic anomaly, there was one case of diffuse pulmonary lymphangiomatosis (DPL) and six cases of generalized lymphatic anomaly (GLA), which accounted for 6.5％ (7/107) of cases. In most patients, chylothorax was alleviated by conservative treatment based on total parenteral nutrition (TPN);13.1％ (14/107) of cases needed further surgery. In NC, the median duration of TPN was 9 days, but 10 of 20 cases who improved had recurrence upon re-introduction of a fat-free diet, which was alleviated by further TPN. The duration of hospitalization was (23 ± 14) days for congenital chylothorax. Upon long-term follow-up, except for GLA and DPL, most patients were doing well without recurrence. Interpretation: NC and postoperative chylothorax are the common subtypes. TPN is effective for most patients. Despite a prolonged and fluctuating clinical course, most patients had a good long-term prognosis.

关键词： Chylothorax Etiology Neonate Postoperative Lymphatic anomaly

Severe acute respiratory syndrome coronavirus 2-induced multisystem inflammatory syndrome in children

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Pediatric Investigation 2020年第4期4卷 257-262页

作者： Zhiguan Feng Yanmin Bao Yonghong Yang Yuejie Zheng kunling shen Department of Respiratory Medicine Shenzhen Children’s HospitalShenzhenGuangdongChina Beijing Children’s Hospital Capital Medical UniversityNational Center for Children’s HealthBeijingChina

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)-induced multisystem inflammatory syndrome in children(MIS-C)is a life-threatening illness that has been reported in the United States and Europe.It affects multiple organ systems and often requires patient admission to an intensive care unit.Although some features of MIS-C overlap with Kawasaki disease,MIS-C is more common among older children and adolescents,more often affects cardiovascular and gastrointestinal systems,and more frequently presents with elevated inflammatory markers.Rapid and complete clinical recovery is possible in nearly all patients following immunomodulation therapy.Thus far,MIS-C pathophysiology and long-term prognosis are not sufficiently clear;further studies are needed.

关键词： Multisystem inflammatory syndrome in children Kawasaki-like disease COVID-19 SARS-CoV-2

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气象因素对儿童和青少年哮喘的影响

国际儿科学杂志 2024年第4期51卷 270-276页

作者：孔琰申昆玲国家儿童医学中心、国家呼吸系统疾病临床医学研究中心、首都医科大学附属北京儿童医院呼吸科 100045 深圳市儿童医院呼吸科 518038

目的分析气象因素对不同特征哮喘儿童和青少年的影响。方法该研究为回顾性研究,以2021年6月至2022年6月期间使用电子版中国儿童哮喘行动计划(China Children's Asthma Action Plan,CCAAP)的2600例哮喘儿童和青少年为研究对象,收集患儿... 详细信息

目的分析气象因素对不同特征哮喘儿童和青少年的影响。方法该研究为回顾性研究,以2021年6月至2022年6月期间使用电子版中国儿童哮喘行动计划(China Children's Asthma Action Plan,CCAAP)的2600例哮喘儿童和青少年为研究对象,收集患儿的基本信息、症状及同期环境监测数据。分析空气质量指数(air quality index,AQI)、温度、湿度对哮喘患儿的影响。结果2021年6月至2022年6月哮喘患儿共记录日常症状49107次,其中“黄区”及“红区”症状共3274次。多因素Logistic回归分析显示与AQI等级为优相比等级为良(OR=1.270,95%CI:1.162~1.389,P<0.05)、污染(OR=1.640,95%CI:1.436~1.873,P<0.05)时出现哮喘症状的风险增加;与日温为21~30℃相比日温为11~20℃(OR=1.545,95%CI:1.400~1.706,P<0.05)、1~10℃(OR=1.583,95%CI:1.415~1.770,P<0.05)及大于30℃(OR=1.393,95%CI:1.122~1.730,P<0.05)时出现哮喘症状的风险增加;与空气湿度为41%~60%相比湿度为0~20%(OR=1.767,95%CI:1.381~2.259,P<0.05)、21%~40%(OR=1.456,95%CI:1.273~1.665,P<0.05)时出现哮喘症状的风险增加。出现哮喘症状的风险随着哮喘儿童和青少年的年龄增长而降低(OR=0.916,95%CI:0.903~0.930,P<0.05),随使用电子版CCAAP依从性升高而降低(OR=0.930,95%CI:0.927~0.933,P<0.05)。哮喘儿童和青少年自我报告的单一诱发因素中最常见的为呼吸道感染占56.03%,气候变化占23.99%,空气污染占5.08%。组间比较显示青春期、居住在华北地区、肥胖的哮喘患儿更容易受空气污染影响,居住在华东、华南及华中地区的哮喘患儿更容易受气候变化影响。结论空气质量差、低温、高温、空气湿度低、患儿年龄较小及使用电子版CCAAP依从性降低为出现哮喘症状的危险因素。

关键词：哮喘气象因素儿童和青少年

Noninvasive ventilation in a young infant with congenital central hypoventilation and 7-year follow-up

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Pediatric Investigation 2019年第4期3卷 261-264页

作者： Zhifei Xu Yunxiao Wu Bei Li Li Zheng Jingyuan Liu kunling shen Department of Respiratory Medicine Beijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina Beijing Key Laboratory of Pediatric Otolaryngology Head and Neck SurgeryBeijing Pediatric Research InstituteBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina Department of Otolaryngology Head and Neck SurgeryBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina Department of Pediatric Critical Care Medicine Beijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina

Introduction:Congenital central hypoventilation syndrome(CCHS)is a rare disorder characterized by alveolar hypoventilation and autonomic system dysregulation secondary to mutations of the PHOX2B gene.Treatment consists of assisted ventilation using positive-pressure ventilators via tracheostomy,bi-level positive airway pressure(BPAP)via a noninvasive interface,negative-pressure ventilators,or diaphragm pacing.The long-term use of BPAP in younger children at home has been less frequently reported.Case presentation:We present a case of a 2-month-old infant with CCHS who was successfully managed by BPAP without the need for tracheostomy and followed up for 7 years.Conclusion:CCHS is a rare disease that manifests as nocturnal desaturation and carbon dioxide retention in early life.Noninvasive ventilation can be successfully used in young infants via an appropriate mask.

关键词： Congenital central hypoventilation syndrome PHOX2B gene Noninvasive ventilation

Safety and efficacy of Yupingfeng granules in children with recurrent respiratory tract infection:A randomized clinical trial

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Pediatric Investigation 2022年第2期6卷 75-84页

作者： Baoping Xu Xinmin Li Siyuan Hu Yixiao Bao Fengmei Chen Zhimin Chen Yonggang Du Enmei Liu Yufeng Liu Qinghui Mou Baoling Su Bo Wang Jianwen Xu Guiping Xu Qiaozhi Yang Liwei Gao Xiaohui Liu Lei Li Rong Ma kunling shen China National Clinical Research Center of Respiratory Diseases Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine TianjinChina Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine ShanghaiChina Guangdong Women and Children Hospital and Health Institute GuangzhouGuangdongChina Children’s Hospital of Zhejiang University School of Medicine ZhejiangChina Changzhi People’s Hospital ChangzhiShanxiChina Children’s Hospital of Chongqing Medical University ChongqingChina The Fourth Affiliated Hospital of Liaoning University of Traditional Chinese Medicine ShenyangLiaoningChina Qilu Children’s Hospital of Shandong University JinanShandongChina Heji Hospital Affiliated to Changzhi Medical College ChangzhiShanxiChina The Third Affiliated Hospital of Xinxiang Medical College XinxiangHenanChina Huizhou Traditional Chinese Medicine Hospital GuangdongChina Liaocheng People’s Hospital ShandongChina Beijing Children’s Hospital Capital Medical UniversityNational Center for Children’s HealthBeijingChina Drug Research and Evaluation Technology Center Chinese Assocaiation of Traditional Chinese MedicineBeijingChina

Importance:Recurrent respiratory tract infection(RRTI)is common in children.Inappropriate RRTI treatment will lead to asthma and other diseases,thereby seriously affecting the growth and physical health of children.Immune function modulation can prevent and alleviate childhood RRTI.Yupingfeng(YPF),a patented traditional Chinese medicine(TCM),has immunomodulatory effects and is widely used in China to treat children with RRTI.Objective:To evaluate the safety and efficacy of YPF monotherapy in treating children with RRTI.Methods:This multicenter,randomized,double-blind,double-simulation,noninferiority clinical trial was conducted from January 2015 to August 2017,with an 8-week treatment period and 52-week follow-up after the drug withdrawal.Children aged 2–6 years with RRTI meeting the inclusion and exclusion criteria were enrolled in 13 hospitals in China and divided randomly into three groups(2:2:1 ratio)to receive YPF,pidotimod,or placebo.The primary outcome was the proportion of RRTI returning to normal standard level during the follow-up.The secondary outcomes were reduction in the number of RRTI recurrences,effect on clinical symptoms(in accord with TCM practice),effect per symptom,and safety.The trial was registered at the Chinese Clinical Trials Registry(***)under the unique identifier ChiCTR-IPR-15006847.Results:Three hundred and fifty-one children were enrolled and randomly assigned to 3 groups;124,125,and 61 children in the YPF,pidotimod,and placebo groups,respectively,had completed the trial.During the follow-up,the proportion of RRTI returning to normal standard level was 73.13%,67.15%,and 38.81%with YPF,pidotimod,and placebo,respectively(P<0.0001).The proportion of cases who returned to normal standard level in the YPF group was 34.32%higher than that in the placebo group.The safety profile did not significantly differ among the groups.Interpretation:YPF granules were noninferior to the active control drug pidotimod oral solution for the treatment of RRTI in children,and were superior to placebo,with

关键词： Pidotimod Recurrent childhood respiratory tract infection Traditional Chinese medicine Yupingfeng