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100 ЛЕТ СОВЕТСКОЙ СИСТЕМЕ ОХРАНЫ ЗДОРОВЬЯ МАТЕРИ И РЕБЕНКА: УСПЕХИ, ПРОБЛЕМЫ, УРОКИ 100年的苏联母婴保健系统:成功、挑战、教训
Pub Date : 2018-04-01 DOI: 10.15690/VSP.V17I1.1851
Александр Александрович Баранов, В. Ю. Альбицкий
The article presents the text of the authors' report at the plenary session of the XX Congress of Pediatricians of Russia (dated February 16, 2018) dedicated to the centenary of the Soviet state mother and child welfare system. The features of its formation and development were described. The most important achievements in the field of child health care were outlined. Attention is focused on the personalities of the first facilitators of pediatric healthcare in Soviet Russia. Authors summarise the findings resulting from the history of the Soviet pediatric service.
文章介绍了作者在俄罗斯第二十届儿科医生大会全体会议(2018年2月16日)上的报告全文,该会议致力于苏联国家母婴福利制度一百周年。叙述了其形成和发展的特点。概述了儿童保健领域最重要的成就。注意力集中在苏联俄罗斯儿科保健的第一批促进者的个性上。作者总结了从苏联儿科服务的历史结果。
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引用次数: 2
Клинико-фармакологические подходы к оптимизации режима дозирования антибактериальных препаратов в педиатрии 临床药理学方法优化儿科抗菌药物剂量制度
Pub Date : 2018-04-01 DOI: 10.15690/VSP.V17I1.1855
Natal’ya B. Lazareva, Evgeniya V. Chikh, V. Drozdov, E. Rebrova
The rational use of antibacterial drugs in children implies an adequate choice of the necessary medication, its dosing regimen, and the duration of treatment in order to achieve maximum efficacy and minimize toxic effects. The knowledge of pharmacokinetic and pharmacodynamic profiles of the antibacterial drug plays a crucial role for optimizing the dosing regimen. The strategy of individual choice of the dosing regimen, taking into account the principles of pharmacokinetics and pharmacodynamics, can be especially effective in patients with the expectedly changed parameters of pharmacokinetics and in infections caused by bacteria strains with low sensitivity to antibiotics. The review presents a contemporary view of pharmacokinetic and pharmacodynamic profiles of antibacterial drugs most commonly used in pediatrics and their relationship to the clinical efficacy of the administered therapy.
儿童抗菌药物的合理使用意味着充分选择必要的药物、给药方案和治疗时间,以达到最大的疗效和最大限度地减少毒性作用。了解抗菌药物的药代动力学和药效学特征对优化给药方案起着至关重要的作用。考虑到药代动力学和药效学的原则,个体选择给药方案的策略对药代动力学参数预期变化的患者和对抗生素低敏感性的细菌菌株引起的感染尤其有效。这篇综述介绍了当代儿科最常用抗菌药物的药代动力学和药效学概况及其与给药治疗的临床疗效的关系。
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引用次数: 2
ЭФФЕКТИВНОСТЬ И БЕЗОПАСНОСТЬ ФЕРМЕНТОЗАМЕСТИТЕЛЬНОЙ ТЕРАПИИ У ДЕТЕЙ С МУКОПОЛИСАХАРИДОЗАМИ I, II И VI ТИПОВ: ОДНОЦЕНТРОВОЕ КОГОРТНОЕ ИССЛЕДОВАНИЕ 多糖儿童的酶替代疗法的效率和安全性
Pub Date : 2018-04-01 DOI: 10.15690/VSP.V17I1.1858
Л. А. Осипова, Людмила Михайловна Кузенкова, Лейла Сеймуровна Намазова-баранова, Анаит Казаровна Геворкян, Т. В. Подклетнова, Николай Андреевич Маянский, Григорий Валерьевич Ревуненков, Н. Д. Вашакмадзе
Background. There are limited data on the efficacy of long-term enzyme replacement therapy (ERT) in children with mucopolysaccharidosis (MPS). Objective. Our aim was to study the efficacy and safety of long-term ERT in children with MPS type I, II, and VI. Methods. We analyzed the results of ERT with laronidase, idursulfase, and galsulfase in children with MPS type I, II, and VI admitted to the federal research center from January 2007 to November 2016. The response rate was assessed by the level of normalized urinary excretion of glycosaminoglycans (GAGs) (the ratio of GAGs concentration to urine creatinine) recalculated in percent (%) exceedance of the upper limit of normal for the corresponding age. Data on the administered therapy and its results, including adverse events, is extracted from the medical records of in-patients. Results. The results of treatment (intravenous infusions, intervals between administrations from 4 to 10 days) were studied in 33 children (5 of them were girls) with MPS type I (n = 4; laronidase at a dose of 0.58 mg/kg), II (n = 26; idursulfase at a dose of 0.5 mg/kg), and VI (n = 3; galsulfase at a dose of 1 mg/kg). A decrease in the normalized urinary excretion of GAGs from 376% (172; 791) to 54% (0; 146) exceedance of the upper limit of normal for the age (p < 0.001) was noted in the course of ERT lasting (median) 27 (14; 41) months. A decrease in the normalized GAGs excretion below the upper limit of normal for the age was established in 12/33 (36%) patients. ERT-associated adverse events were identified in 12 patients; one case required a two-fold therapy interruption. The development of nephrotic syndrome in the course of ERT in patients with severe MPS II was first described. Conclusion. Long-term ERT in children with MPS type I, II, and VI is characterized by acceptable efficacy and safety. Key words: children, mucopolysaccharidosis, enzyme replacement therapy, laronidase, idursulfase, galsulfase, glycosaminoglycans.
背景。长期酶替代疗法(ERT)治疗粘多糖病(MPS)的疗效数据有限。目标。我们的目的是研究长期ERT治疗I型、II型和VI型MPS患儿的疗效和安全性。我们分析了2007年1月至2016年11月在联邦研究中心收治的I、II、VI型MPS患儿中laronidase、idursulase和galsulase联合ERT的结果。通过尿中糖胺聚糖(GAGs)的正常排泄水平(GAGs浓度与尿肌酐的比值),以超过相应年龄正常上限的百分比(%)来评估反应率。所给治疗及其结果的数据,包括不良事件,是从住院患者的医疗记录中提取的。结果。对33例(其中5例为女孩)MPS I型患儿(n = 4;laronidase(剂量为0.58 mg/kg), II (n = 26;idursulase(剂量为0.5 mg/kg)和VI (n = 3;半乳糖酶(剂量为1mg /kg)。尿中正常排泄的GAGs从376% (172;791)到54% (0;在ERT持续的过程中(中位数)超过了正常年龄的上限(p < 0.001)。41)个月。33例患者中有12例(36%)的正常GAGs排泄低于正常年龄上限。在12例患者中发现ert相关不良事件;一个病例需要两次治疗中断。在严重MPS II患者的ERT过程中肾病综合征的发展首次被描述。结论。长期ERT治疗1、2、6型MPS患儿具有可接受的疗效和安全性。关键词:儿童,粘多糖病,酶替代疗法,laronidase, idursulase, galsulase,糖胺聚糖
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引用次数: 0
ГЕНОТИП-ФЕНОТИПИЧЕСКИЕ КОРРЕЛЯЦИИ ТЕЧЕНИЯ КИСТОЗНОГО ФИБРОЗА У РОССИЙСКИХ ДЕТЕЙ. ПЕРВОЕ ОПИСАНИЕ ОДИННАДЦАТИ НОВЫХ МУТАЦИЙ 在俄罗斯儿童中,基因型与囊性纤维化流动有关。11个新突变的第一个描述
Pub Date : 2018-04-01 DOI: 10.15690/VSP.V17I1.1856
Ю. В. Горинова, К. В. Савостьянов, А. А. Пушков, А. Г. Никитин, Е. Л. Пеньков, С. А. Красовский, Ольга Игоревна Симонова, Лейла Сеймуровна Намазова-баранова
Background. Cystic fibrosis is a hereditary disease that occurs as a result of mutations in the regulator gene of chloride ion transmembrane transport (CFTR). Finding mutations in the CFTR gene is necessary for identification of the clinical features of cystic fibrosis. Objective. Our aim was to identify genotype-phenotype correlations between mutations of the first class of pathogenicity and clinical manifestations of cystic fibrosis based on studying the prevalence and structure of CFTR gene mutations. Methods. The study included children under 18 years with cystic fibrosis admitted to hospital between 2013 and 2017. Biallelic mutations in the CFTR gene were the noninclusion criterion. The CFTR gene variants were analyzed by next-generation sequencing method. Results. In 125 patients with cystic fibrosis, 59 different variants of the CFTR gene were detected, 11 of them not previously described. The most common was the deletion c.1521_1523del found in 98 (39.2%) of the 250 analyzed CFTR gene alleles and the deletion c.1545_1546del found in 22/250 (8.8%) alleles. It has been shown that the mutation c.1545_1546del, p.Y515* was more often found in children of the Chechen nation — odds ratio (OR) 139 (95% confidence interval 15–1,257). It has been established that meconium ileus, pancreatic deficiency and cirrhosis are more common in patients with mutations of the first category of pathogenicity: OR 3.9 (95% CI 1.0–15.0), 4.4 (95% CI 1.8–11.1), and 351 (95% CI 17.5–7,046), respectively. The association of CFTR gene mutations with the development of bronchiectases and polypous pancinusitis has not been found. Conclusion . Correlations between the genotype and clinical manifestations of cystic fibrosis in Russian children with CFTR gene mutations of the first class of pathogenicity have been established.
背景。囊性纤维化是一种由氯离子跨膜转运(CFTR)调控基因突变引起的遗传性疾病。发现CFTR基因的突变对于确定囊性纤维化的临床特征是必要的。目标。我们的目的是在研究CFTR基因突变的患病率和结构的基础上,确定囊性纤维化第一类致病性突变与临床表现之间的基因型-表型相关性。方法。该研究包括2013年至2017年住院的18岁以下囊性纤维化儿童。CFTR基因双等位基因突变为未纳入标准。采用新一代测序方法分析CFTR基因变异。结果。在125例囊性纤维化患者中,检测到59种不同的CFTR基因变体,其中11种以前没有描述过。在分析的250个CFTR基因等位基因中,有98个(39.2%)缺失c.1521_1523del, 22个(8.8%)缺失c.1545_1546del。研究表明,突变c.1545_1546del, p.Y515*更常见于车臣民族的儿童——优势比(OR) 139(95%置信区间15 - 1257)。已确定胎粪肠梗阻、胰功能不足和肝硬化在第一类致病性突变的患者中更为常见:OR分别为3.9 (95% CI 1.0-15.0)、4.4 (95% CI 1.8-11.1)和351 (95% CI 17.5 - 7046)。CFTR基因突变与支气管扩张症和息肉性胰腺炎的发展之间的关系尚未发现。结论。俄罗斯CFTR基因一级致病性突变患儿囊性纤维化的基因型与临床表现之间存在相关性。
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引用次数: 2
ПЕДАГОГИКА В ПОДГОТОВКЕ ВРАЧЕЙ-ПЕДИАТРОВ НА УРОВНЕ ОРДИНАТУРЫ
Pub Date : 2018-04-01 DOI: 10.15690/VSP.V17I1.1852
Е. Н. Гринько
The training program for a modern pediatrician involves the study of Pedagogy in medical residency in specialty 31.08.19 Pediatrics. The urgency of such training for the future doctor is uncontroversial today. Currently the experience of studying this discipline has been gained in Russian medical universities. At the same time this work requires further improvement and exchange of experience with colleagues.
现代儿科医生的培训计划包括儿科专科住院医师的教育学研究。对未来医生进行这种培训的紧迫性在今天是无可争议的。目前,俄罗斯医科大学已经取得了研究这一学科的经验。同时这项工作需要进一步的完善和与同事的经验交流。
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引用次数: 0
Системная красная волчанка: клинические рекомендации. Часть 1 系统红斑狼疮:临床建议。第1部分
Pub Date : 2018-04-01 DOI: 10.15690/VSP.V17I1.1853
Екатерина Иосифовна Алексеева, Т. М. Дворяковская, Ирина Петровна Никишина, Рина Валериановна Денисова, Н. С. Подчерняева, О. А. Сухоруких, Л. С. Шубина
The article presents current data on the etiology, pathogenesis, and epidemiology of systemic lupus erythematosus (SLE). The SLE diagnosis details are considered with a description of each examination technique. Moreover, an assessment of reliability level of both evidence and recommendations for each thesis-recommendation are discussed thoroughly. The aspects of differential diagnosis and criteria for the diagnostic quality of SLE are revealed.
本文介绍了系统性红斑狼疮(SLE)的病因学、发病机制和流行病学的最新资料。SLE的诊断细节与每种检查技术的描述一起考虑。此外,对每篇论文的证据和推荐信度的评估也进行了深入的讨论。本文对SLE的鉴别诊断和诊断质量的标准进行了探讨。
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引用次数: 11
ЭКСКРЕЦИЯ ВОДОРАСТВОРИМЫХ ВИТАМИНОВ (С, В1, В2 И В6) С МОЧОЙ У ЗДОРОВЫХ ДЕТЕЙ ДОШКОЛЬНОГО И ШКОЛЬНОГО ВОЗРАСТА: ОДНОМОМЕНТНОЕ ИССЛЕДОВАНИЕ 健康学龄前儿童和学龄前儿童排尿水溶性维生素(c、v1、v2和v6):立即进行研究
Pub Date : 2018-04-01 DOI: 10.15690/VSP.V17I1.1857
Светлана Геннадьевна Макарова, О. А. Вржесинская, В. М. Коденцова, О Г Переверзева, С. Н. Леоненко, Татьяна Владимировна Турти, Д. С. Ясаков
Background . Children of preschool and school age are at risk of developing vitamin deficiency. Screening of the vitamin provision of children remains an urgent problem of pediatrics. Objective. Our aim was to determine the prevalence of low excretion of watersoluble vitamins among healthy preschool and school-age children. Methods. The study was conducted in March-April 2017. We determined the urinary excretion (fasting morning portion collected during 30–120 min after night-time urination) of metabolites of vitamins C, B 1 , B 2 , and B 6 in healthy children. Riboflavin (vitamin B 2 metabolite) was determined spectrophotometrically by titration with a riboflavin-binding apoprotein; 4-pyridoxyl acid (vitamin B 6 metabolite) and thiamine (vitamin B 1 metabolite) — by fluorescent method, ascorbic acid (vitamin C metabolite) — by visual titration with Tillman’s reagent. The excretion considered to be low (equivalent to vitamin deficiency) when thiamine excretion was < 7, 10, 11, and 12 μg/h and riboflavin < 6, 9, 10, and 13 μg/h in children aged 3–5, 6–8, 9–11, and above 12 years, respectively; 4-pyridoxylic acid — < 40, 60, and 70 μg/h in children aged 3–5, 6–8, and ≥ 9 years, ascorbic acid — < 0.2 and 0.4 mg/h in children aged 3–11 and ≥ 12 years, respectively. Results. Metabolites were excreted in 39 children (20 girls), 14 of them aged 4–6 years and 25 children aged 7–14 years. A low level of ascorbic acid excretion was found in 13 (33%) children, of thiamine — in 24 (62%), of riboflavin — in 16 (41%), of 4-pyridoxyl acid — in 26 (67%). Low excretion of at least one vitamin metabolite was detected in 30 (77%) children, of 3 or more metabolites simultaneously — in 15 (39%). Conclusion. A low level of urinary excretion of metabolites of at least one water-soluble vitamin (C, B 1 , B 2 , and B ≥ ) occurs in most preschool and schoolage children.
背景。学龄前和学龄儿童有患维生素缺乏症的风险。儿童维生素提供的筛查仍然是儿科的一个紧迫问题。目标。我们的目的是确定在健康的学龄前和学龄儿童中水溶性维生素排泄低的患病率。方法。该研究于2017年3月至4月进行。我们测定了健康儿童尿液中维生素C、b1、b2和b6代谢物的排泄量(在夜间排尿后30-120分钟内收集的空腹早晨部分)。采用核黄素结合载脂蛋白滴定法测定核黄素(维生素b2代谢物);4-吡哆酸(维生素b6代谢物)和硫胺素(维生素b1代谢物)-荧光法,抗坏血酸(维生素C代谢物)-用蒂尔曼试剂目测滴定。3-5岁、6 - 8岁、9 - 11岁和12岁以上儿童硫胺素排泄量分别< 7、10、11和12 μg/h和核黄素< 6、9、10和13 μg/h为低排泄量(相当于维生素缺乏);3-5岁、6-8岁和≥9岁儿童4-吡甲酸- < 40、60和70 μg/h, 3-11岁和≥12岁儿童抗坏血酸-分别< 0.2和0.4 mg/h。结果。39例儿童(20例女童)有代谢物排泄,其中4 ~ 6岁14例,7 ~ 14岁25例。13名(33%)儿童的抗坏血酸排泄水平低,24名(62%)儿童的硫胺素排泄水平低,16名(41%)儿童的核黄素排泄水平低,26名(67%)儿童的4-吡哆酸排泄水平低。在30名(77%)儿童中检测到至少一种维生素代谢物的低排泄,同时检测到3种或更多代谢物的15名(39%)儿童。结论。大多数学龄前和学龄儿童尿中至少有一种水溶性维生素(C、b1、b2和B≥)的代谢物排泄水平低。
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引用次数: 2
Типовые формы патологии печени у детей
Pub Date : 2018-04-01 DOI: 10.15690/VSP.V17I1.1854
Пётр Францевич Литвицкий, Лариса Дмитриевна Мальцева, Ольга Леонидовна Морозова
This lecture for the system of postgraduate medical education analyzes causes, types, key links of pathogenesis, and manifestations of the main typical forms of liver pathology — liver failure, hepatic coma, jaundice, cholemia, acholia, cholelithiasis, and their complications in children. To control the retention of the lecture material, case problems and multiple-choice tests are given.
本课程面向研究生医学教育体系,分析了儿童肝衰竭、肝性昏迷、黄疸、胆血症、胆盲症、胆石症等主要典型肝脏病理的病因、类型、病机关键环节、表现及其并发症。为了控制对讲课材料的记忆,课程中会有案例题和多项选择题。
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引用次数: 0
Случай течения первичного туберкулезного комплекса у ребенка при позднем выявлении // The Case of a Primary Tuberculosis Complex in a Child With Late Detection
Pub Date : 2018-01-24 DOI: 10.15690/vsp.v16i6.1827
V. B. Yukhimenko, Irina Petrakova Yu., A. M. Bagirov, F. M. Gubkina, S. Y. Berezovsky
We present a case of late detection and course of the primary tuberculosis complex in a child who was previously in an unknown contact with a tuberculosis patient at the first year of life. The  disease onset simulating pneumonia took place at the age of 1 year  8 months. Hereafter, the child did not have any clinical signs of the  disease. At the age of 5 years, the child was examined in connection  with the hyperergic reaction to tuberculin: the results of computed  tomography revealed calcinated foci in the lung tissue and  calcifications in the intrathoracic lymph nodes; bronchoscopy  revealed infiltrative bronchial tuberculosis. Surgery was performed:  video-assisted thoracoscopy, resection of C9,10 part of the left lung  with precision removal of the focus in its C6 segment, extirpation of  bifurcation, and left bronchopulmonary lymph nodes. The results of  the histological examination indicated the chronic course of the  tuberculosis process with formation of bronchiectasis and presence  of bronchonodular fistulas. After surgery and the main course of  antituberculous therapy, a clinical cure with small residual changes was achieved. Представлен случай позднего выявления и течения первичного туберкулезного комплекса у ребенка, находившегося в ранее неизвестном контакте с больным туберкулезом на 1-м году  жизни. Дебют заболевания под маской пневмонии имел место в возрасте 1 года 8 мес. В  дальнейшем у ребенка не отмечалось никаких клинических признаков заболевания. В  пятилетнем возрасте ребенок обследован в связи с гиперергической реакцией на  туберкулин: по результатам компьютерной томографии выявлены кальцинированные  фокусы в ткани легкого и кальцинаты во внутригрудных лимфатических узлах; при  бронхоскопии — инфильтративный туберкулез бронхов. Проведено оперативное вмешательство: видеоассистированная торакоскопия, резекция части С9,10 левого легкого с прецизионным удалением очага в его С6 сегменте, экстирпацией бифуркационных и левых  бронхопульмональных лимфатических узлов. Результаты гистологического исследования  свидетельствовали о хроническом течении туберкулезного процесса с формированием  бронхоэктазов, наличием бронхонодулярных свищей. После операции и основного курса  противотуберкулезной терапии достигнуто клиническое излечение с малыми остаточными  изменениями.
我们提出了一个病例的晚期发现和过程的原发性肺结核复杂的儿童谁是以前在一个未知的接触结核病患者在生命的第一年。模拟肺炎发病时间为1岁8个月。此后,孩子没有任何临床症状的疾病。5岁时,该儿童接受了与结核菌素过敏反应有关的检查:计算机断层扫描结果显示肺组织中有煅烧灶,胸内淋巴结有钙化;支气管镜检查显示浸润性支气管结核。手术:电视胸腔镜下,切除C9,10部分左肺,精确切除C6节段病灶,切除分叉,切除左支气管肺淋巴结。组织学检查结果显示结核病程为慢性,伴有支气管扩张和支气管结节瘘管的形成。经过手术和主要的抗结核治疗,临床治愈,残余变化很小。Представленслучайпозднеговыявленияитеченияпервичноготуберкулезногокомплексауребенка,находившегосявранеенеизвестномконтактесбольнымтуберкулезомн1 -магодужизни。Дебютзаболеванияподмаскойпневмонииимелместоввозраст1егода8мес。Вдальнейшемуребенканеотмечалосьникакихклиническихпризнаковзаболевания。Впятилетнемвозрастеребенокобследованвсвязисгиперергическойреакциейнатуберкулин:порезультатамкомпьютернойтомографиивыявленыкальцинированныефокусывтканилегкогоикальцинатывовнутригрудныхлимфатическихузлах;прибронхоскопии——инфильтративныйтуберкулезбронхов。Проведенооперативноевмешательство:видеоассистированнаяторакоскопия,резекциячастиС9,10левоголегкогоспрецизионнымудалениемочагавегоС6сегменте,экстирпациейбифуркационныхилевыхбронхопульмональныхлимфатическихузлов。Результатыгистологическогоисследованиясвидетельствовалиохроническомтечениитуберкулезногопроцессасформированиембронхоэктазов,наличиембронхонодулярныхсвищей。Послеоперациииосновногокурсапротивотуберкулезнойтерапиидостигнутоклиническоеизлечениесмалымиостаточнымиизменениями。
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引用次数: 0
Двенадцать мифов о пищевой аллергии у детей // Twelve Myths About Food Allergies in Children
Pub Date : 2018-01-23 DOI: 10.15690/vsp.v16i6.1826
Гюзель Ильясовна Макарова, S. G. Makarova
Food allergy is often the first manifestation of allergy in a child, and this problem is most relevant at an early age. With an allergic reaction to food, a seemingly not very significant pathology,  a so-called «atopic march» may begin with the development of  severe forms of allergic diseases in a child. At the same time, a favourable course of food allergy is possible with the disappearance of disorder signs with age. The disease prognosis depends on many factors, both genetic and environmental, but early diagnosis and adequate treatment of children with food allergies in most cases allow to  improve the prognosis of tolerance formation or, at least, to achieve  a mild course of food allergy manifestations. It is pediatricians who  first deal with early manifestations of food allergies, and adherence  to clinical guidelines for managing patients avoids the most common  mistakes. This article is addressed to practicing doctors. It considers  the most common mistakes of pediatricians in the management of  children with food allergies and discusses the surviving «myths»  about this pathology. Пищевая аллергия часто является дебютным признаком аллергии у ребенка, и эта проблема наиболее актуальна в раннем возрасте. С аллергической реакции на пищу — казалось бы,  не очень значимой патологии — может начаться так называемый «атопический марш» с  развитием у ребенка тяжелых форм аллергических заболеваний. Вместе с тем возможно и  благоприятное течение пищевой аллергии с исчезновением признаков нарушения с  возрастом. Прогноз заболевания зависит от многих факторов, как генетических, так и  средовых, однако ранняя диагностика и адекватное лечение детей с пищевой аллергией в  большинстве случаев позволяют улучшить прогноз формирования толерантности или, как  минимум, добиться легкого течения проявлений пищевой аллергии. С ранними  проявлениями пищевой аллергии в первую очередь сталкиваются педиатры, и четкое  следование клиническим рекомендациям по ведению пациентов позволяет избежать  большинства типичных ошибок. Данная статья адресована практическим врачам: в ней  рассматриваются наиболее частые ошибки педиатров в ведении детей с пищевой аллергией  и обсуждаются прижившиеся «мифы» об этой патологии.
食物过敏通常是儿童过敏的第一个表现,这个问题在早期是最相关的。由于对食物的过敏反应,一种看似不太重要的病理,所谓的“特应性行军”可能开始于儿童严重形式的过敏性疾病的发展。与此同时,随着年龄的增长,疾病症状的消失,食物过敏的有利过程是可能的。疾病的预后取决于许多因素,包括遗传因素和环境因素,但在大多数情况下,对食物过敏儿童的早期诊断和适当治疗可以改善耐受性形成的预后,或者至少可以实现食物过敏表现的轻度病程。儿科医生首先处理食物过敏的早期表现,坚持临床指导方针来管理患者可以避免最常见的错误。这篇文章是写给执业医生的。它考虑了儿科医生在处理儿童食物过敏时最常见的错误,并讨论了关于这种病理的现存“神话”。Пищеваяаллергиячастоявляетсядебютнымпризнакомаллергииуребенка,иэтапроблеманаиболееактуальнавраннемвозрасте。Саллергическойреакциинапищу-казалосьбы,неоченьзначимойпатологими——ожетначатьсятакназываемый«атопическиймарш»сразвитиемуребенкатяжелыхформаллергическихзаболеваний。Вместестемвозможноиблагоприятноетечениепищевойаллергиисисчезновениемпризнаковнарушениясвозрастом。Прогноззаболеваниязависитотмногихфакторов,какгенетических,такисредовых,однакоранняядиагностикаиадекватноелечениедетейспищевойаллергиейвбольшинствеслучаевпозволяютулучшитьпрогнозформированиятолерантностиили,какминимум,добитьсялегкоготеченияпроявленийпищевойаллергии。Сраннимипроявлениямипищевойаллергиивпервуюочередьсталкиваютсяпедиатры,ичеткоеследованиеклиническимрекомендациямповедениюпациентовпозволяетизбежатьбольшинстватипичныхошибок。Даннаястатьяадресованапрактическимврачам:внейрассматриваютсянаиболеечастыеошибкипедиатроввведениидетейспищевойаллергиейиобсуждаютсяприжившиеся«мифы»обэтойпатологии。
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引用次数: 1
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Current Paediatrics
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