缺氧缺血性脑病新生儿血清尿酸和C-反应蛋白水平的变化

目的研究缺氧缺血性脑病（HIE）患儿血清尿酸（UA）和C-反应蛋白（CRP）水平的变化与临床意义。方法利用全自动生化分析仪检测56例HIE患儿（轻度24例,中重度32例）急性期及恢复期血清UA和CRP水平,并与18例正常足月新生儿作对照。结果HIE患儿急性期血清UA和CRP水平均高于对照组（P〈0．01）,恢复期与对照组比较UA间差异有统计学意义（P〈0．05）,而CRP差异无统计学意义（P〉0．05）;血清UA和CRP水平与病情的严重程度密切相关,中重度组高于轻度组（P〈0．05）。结论血清UA和CRP的动态变化有协同性,且与HIE的病程相平行,能敏感地反映出HIE的病情轻重程度,血清UA和CRP水平可作判断病情及指导治疗的重要指标．     

60例婴幼儿反复呼吸道感染病因学分析

目的研究婴幼儿反复呼吸道感染发病机制中相关因素。方法选取60例反复呼吸道感染的患儿作为实验组治疗前后对应为急性期，缓解期，同时选取50例健康体检儿童作为对照组，检测免疫球蛋白、急性时相反应蛋白，血清微量元素等三大类项目。结果（1）IgG急性期与缓解期对比t=3．53，与对照组t=5．12，IgA急性期水平均显著低于对照组水平t=3．20，缓解期与对照组t=2．67。P均〈0．05；（2）急性期铁锌钙含量低于对照组t〉4．0均P〈0．01（3）急性期c3，CRP水平明显高于对照组。结论IgA水平低下，铁锌钙含量减低与反复呼吸道感染发作相关；急性时相蛋白异常与病情有密切关系。     

手足口病患儿血清细胞因子水平变化及意义

目的探讨手足口病患儿血清细胞因子的变化及临床意义。方法采用ELISA法测定42例手足口病患儿急性期（重症23例、轻症19例）、恢复期血清IL-1B、IL-6、IL-12及TNF．d水平,并与同期35例健康儿童作比较。结果手足口病患儿发病急性期IL-1β、IL-6、IL-12以及TNF-α均明显高于对照组,P均〈0．01;而在恢复期,上述细胞因子与对照组比较P〉0．05。急性期各细胞因子水平均明显高于恢复期及对照组,重症患儿各细胞因子水平均明显低于轻症患儿,P均〈0．01;恢复期各细胞因子水平与对照组比较无统计学差异。结论手足口病患儿感染病毒后细胞免疫功能受到影响,急性期各细胞因子水平升高有助于机体早期启动特异性和非特异性免疫,加速疾病自限恢复。     

肺炎支原体肺炎患儿血清白介素18、TNF-α、TGF-β1的临床意义

目的 探讨肺炎支原体肺炎（MP）患儿血清白介素18、肿瘤坏死因子（TNF-α）、转化生长因子（TGF-β1）水平及其临床意义.方法 采集2011年5月～2012年12月入住我院的60例肺炎支原体患儿与40例健康儿的血清,采用酶联免疫吸附法测定其血清IL-18、TNF-α及TGF-β1,比较MP急性期及恢复期与对照组、MP重症患者与轻症患者急性期、MP重症患者与轻症患者恢复期上述指标的水平.结果 MP恢复期及急性期与对照组血清IL-18、TNF-α及TGF-β1水平相比,差异均具有统计学意义（P＜0.05）,且MP急性期与恢复期相比,差异具有统计学意义（P＜0.05）;MP重症患者与轻症患者急性期血清各指标差异具有统计学意义（P＜0.05）;MP重症患者与轻症患者恢复期血清各指标差异具有统计学意义（P＜0.05）.结论 健康儿与MP患儿血清IL-18、TNF-α、TGF-β1具有明显差异,且在不同发病期、病情轻重方面也具有明显差异,对于MP的临床诊断具有重要意义.     

血清氨基末端脑利钠肽前体水平与小儿毛细支气管炎心肌损伤的相关性分析

目的探讨血清氨基末端脑利钠肽前体(NT-pro BNP)水平与小儿毛细支气管炎心肌损伤的相关性及其对早期诊断的价值。方法随机选取2013年3月至2015年3月在我院接受治疗的毛细支气管炎患儿40例为观察组,选取同一时期在我院进行体检的正常儿童40例作为对照组,检测比较两组儿童血清NT-pro BNP水平、C反应蛋白(CRP)含量;对NT-pro BNP与CRP水平的关系进行相关性分析。结果观察组患儿恢复期(治疗后第10天)的NT-pro BNP水平明显低于急性期(治疗后第2天),差异具有统计学意义(P0.05);恢复期NT-pro BNP阳性率(30.0%)显著低于急性期(55.0%),差异有统计学意义(P0.05);观察组患儿恢复期的NT-pro BNP水平显著高于对照组正常儿童,差异有统计学意义(P0.05)。观察组患儿急性期的血清NT-pro BNP水平与CRP水平呈正相关,患儿血清NT-pro BNP水平随着CRP的升高而升高(r=0.922,P=0.001)。结论 NT-pro BNP水平与毛细支气管炎患儿受到的感染程度和病情轻重有关,检测血NTpro BNP水平,可对患儿心肌损伤进行早期诊断、治疗和判断预后。     

CRP和NT-proBNP对小儿川崎病的临床意义

目的探讨血浆C反应蛋白(CRP)和N末端B型利钠肽原(NT-pro BNP)在小儿川崎病中的变化及其临床意义。方法收集徐州市儿童医院就诊的川崎病患儿45例,将其分为冠脉病变组与无冠脉病变组,选择同期来医院接受治疗的呼吸道感染患儿30例作为对照组,分别对川崎病急性期与对照组、川崎病急性期与恢复期、冠脉病变组与无冠脉病变组患儿血浆NT-pro BNP及CRP水平进行比较,并对急性期川崎病患儿血浆NT-pro BNP与左室射血分数及肌钙蛋白I(c Tn I)间关系进行分析。结果急性期川崎病组患儿血浆NT-pro BNP及CRP水平均高于对照组患儿;恢复期血浆NT-pro BNP及CRP水平均较急性期下降;冠脉病变组急性期血浆CRP值高于无冠脉病变组,差异均有统计学意义(P0.001)。急性期川崎病患儿血浆NT-pro BNP与肌钙蛋白值呈正相关性(r=0.657,P=0.021)。结论 NT-pro BNP及CRP可作为早期诊断川崎病以及有无冠脉损伤生化指标和疾病治疗效果的评价指标。     

肾综合征出血热患者血清CRP、C3、C4与BUN、SCr水平的相关性分析

目的探讨肾综合征出血热（HFRS）患者血清C反应蛋白（CRP）、补体3（C3）、补体4（C4）与血尿素氮（BUN）、肌酐（SCr）水平的相关性及血清CRP、C3、C4水平变化的临床意义。方法采用国赛NSⅡ型特定蛋白分析仪,免疫散射比浊法和CL-7200全自动生化分析仪分别检测118例HFRS患者及85例正常献血员血清CRP、C3、C4和BUN、SCr水平。结果HFRS患者血清CRP与BUN、SCr水平呈明显正相关,C3与BUN、SCr水平呈明显负相关;HFRS患者轻、重症组血清CRP、C3水平均明显增高,低于对照组（P〈0．01）,重症组血清C4明显低于对照组（P〈0．01）;HFRS患者早期、极期血清CRP、C3水平明显增高,低于对照组（P〈0．01）,以极期最明显,此期同时伴有C4水平降低,与对照组比较差异有显著性（P〈0．05）。结论HFRS患者存在血清CRP、C3、C4异常变化,CRP与BUN、SCr水平呈明显正相关,而C3与BUN、SCr呈明显负相关,联合检测血清CRP、C3、C4与BUN、SCr水平对判断HFRS患者的病情程度和预后具有一定的临床价值。     

血清白蛋白变化对真菌性社区获得性肺炎的临床价值

目的探讨血清白蛋白（ALB）变化对真菌性社区获得性肺炎（CAP）的临床价值。方法分析49例真菌性CAP患者急性期和恢复期ALB及生化指标的变化。结果真菌性CAP患者急性期ALB水平较正常对照组降低,恢复期显著升高（P〈0.05）,其他生化指标治疗前后未见差异。结论真菌性CAP容易导致急性期ALB水平降低,随着感染逐步控制ALB水平可有所升高。     

心肌酶在肺炎支原体肺炎急性期感染患儿中的水平变化及相关因素分析

目的探讨心肌酶在肺炎支原体(MP)肺炎急性期感染患儿中的水平变化,并结合临床相关指标和症状体征,评估其对肺炎支原体感染的临床应用价值。方法收集肺炎支原体肺炎(MPP)急性期患儿136例(急性期),同期MPP恢复期患儿100例(恢复期),另选同期体检健康儿童100例(对照组)。应用全自动生化分析仪检测血液中天冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)水平。结果急性期患儿LDH、CK、CK-MB、AST、PCT、CRP、MPV、PDW、PCt、中性粒细胞百分比、外周血WBC计数、ESR均高于恢复期患儿和对照组,PLT水平低于恢复期和对照组(P0.05)。急性期患儿CK-MB水平与患儿发热情况、发热持续时间、肺外损害(除心肌损害)、MP抗体滴度均有关(P0.05)。急性期患儿CK-MB水平与CRP、PCT、外周血WBC计数、MPV、PDW、PCT呈正相关(P0.05),与患儿年龄、PLT水平呈负相关(P0.05)。结论肺炎支原体感染急性期检测患儿CK-MB水平不仅能够及时反映患儿心肌损伤情况,并且能够反映MP感染情况、炎症情况和疾病严重程度,对MPP的及时诊治有较好指导价值。     

RMPP患儿血清IL-2、IL-6、IL-10和TGF-β1检测及分析

目的探讨IL-2、IL-6、IL-10和转化生长因子（TGF）-β1在儿童难治性肺炎支原体肺炎（RMPP）发病中的作用,为临床提供依据。方法选择25例RMPP患儿（RMPP组）,分别于急性期和恢复期采用ELISA法测定血清IL-2、IL-6、IL-10和TGF-β1,并与25例肺炎支原体肺炎（MPP）患儿（MPP组）和15例健康儿童（对照组）对照。结果 RMPP组急性期及恢复期血清IL-2、IL-10水平均显著低于MPP组和对照组,IL-6、TGF-β1水平均显著高于MPP组和对照组（P均〈0.05）;RMPP组和MPP组组内上述各项指标在急性期及恢复期均有显著差异（P均〈0.05）,恢复期MPP组IL-2、IL-6与对照组无显著差异。结论 IL-2、IL-6、IL-10和TGF-β1可能参与了RMPP的发病机制,检测其血清水平可为临床判断MPP病情及预后提供依据。     

Elevated serum levels of interleukin-10 in children with acute rubella infection.

Interleukin-10 (IL-10) is known to be an anti-inflammatory cytokine which inhibits cell growth and cytokine production of both Th1 and Th2 cells. Using a human IL-10 ELISA kit we investigated whether serum IL-10 levels increased during the acute and convalescent stages in 45 children with rubella infections. Serum levels of IL-10 were markedly elevated in rubella patients during the acute stage, compared with those at the convalescent stage and those in healthy age-matched children (mean +/- SEM): 18.5 +/- 3.4 vs. 6.0 +/- 0.6 vs. 7.9 +/- 1.3 pg/ml. IL-10 levels determined 5 d after the onset of the disease had returned to the normal range. In patients with rubella, there were significant negative correlations between serum IL-10 levels and both rubella virus-specific IgM and IgG antibodies. These findings suggest that IL-10 may play a role in the pathogenesis of acute rubella infections.     

Evaluation of ELISA kits for detection of Mycoplasma pneumoniae--specific IgG, IgA, IgM antibodies on the diagnosis of Mycoplasma pneumoniae infection in children

A retrospective study was conducted to evaluate the utility of Mycoplasma pneumoniae IgG (quantitative), IgA (quantitative), IgM (qualitative) ELISA kits (Medac Diagnostika, Germany) for the diagnosis of M. pneumoniae pneumonia in children under 16 years of age. This study included a total of 159 serum samples from 113 patients with acute respiratory diseases such as bronchitis, pneumonia, which were classified into three groups according to the results of a particle agglutination (PA) test as a reference method, that is, Group I (Mycoplasma-definite cases): Group I-a (paired 52 samples from 26 cases); a four-fold or greater rise of antibody from an acute phase PA titer of < or = 1:80, Group I-b (paired 12 samples from 6 cases); a four-fold or greater rise of antibody from an acute phase PA titer of > or = 1:160, Group I-c (48 samples from 38 cases); a single high PA titer of > or = 1:640 either or both in acute or convalescent serum, Group II (Mycoplasma-probable cases, 18 samples from 17 cases): a PA titer of 1:160 or 320 was observed either or both in acute or convalescent serum, but the above serological criteria for Group I were not fulfilled, Group III (non-cases, 29 samples from 26 cases): a PA titer of any sample was < or = 1:80. The ELISA tests were performed according to the supplier's recommendations, and the results were classified according to the interpretation provided by the supplier: Early stage of infection (category 1,2), Acute- (3,4,5), Current- (6), Past- (7), and No-infection (8). The day of onset of fever (defined as a body temperature of > or = 37.5 degrees Celsius) was denoted as day 0. As a result from Group I, the category initially observed following the onset of fever was category 8 (triple negative), and the predominance of category 8 was replaced by category 1 (IgM solely positive) after day 4, followed by a shift of predominance to category 4 (IgM and IgG double positive) or 5 (triple positive) after day 10 or later. Specifically, category 1 was rather exclusively observed before day 21 following the onset of fever. These results suggest that category 1, when observed, is a useful marker of acute infection by Mycoplasma pneumoniae in children because it appears early in the acute phase and no longer observed beyond the convalescent phase. On the other hand, significance of detecting IgA antibody, which must be important for adults, was not remarkable in our study. Five samples in group II and 3 samples in group III fell into category 1. Whether or not such cases, in the absence of significant PA titers, can be taken actually as mycoplasmal infection remains to be clear. This study validated the utility of this ELISA methodology in terms of the acute phase diagnosis using a single point serum sample for Mycoplasma pneumoniae infection specifically in children.     

炎性细胞因子在儿童肺炎支原体肺炎中的表达及其在免疫学发病机制中的作用

目的:观察肺炎支原体肺炎(MPP)患儿炎性细胞因子水平,并探讨其在免疫学发病机制中的作用。方法:采用前瞻性研究方法,选择2016年1月至2019年3月在成都医学院第一附属医院确诊的MPP患儿81例作为研究对象,根据急性期病情严重程度分为重症组(37例)和轻症组(44例)。于急性期(发病3~5 d)、恢复期(发病8~15 d)抽取MPP患儿空腹静脉血。选取同期健康体检儿童30名作为对照组,抽取空腹静脉血。检测白细胞介素2(IL-2)、IL-8、IL-10、免疫球蛋白A(IgA)、IgG、IgM水平,进行分组比较。结果:MPP患儿急性期、恢复期和对照组血清IL-2、IL-8、IL-10水平差异均有统计学意义( F值分别为19.242、17.872、4.173, P值均<0.05)。MPP患儿急性期、恢复期IL-2、IL-10水平明显低于对照组,IL-8水平明显高于对照组;MPP患儿急性期IL-2、IL-10水平明显低于恢复期,IL-8水平明显高于恢复期,差异均有统计学意义( P值均<0.05)。MPP患儿急性期、恢复期和对照组血清IgA、IgG、IgM水平差异均有统计学意义( F值分别为10.472、13.870、9.702, P值均<0.05)。MPP患儿急性期、恢复期IgA、IgG、IgM水平明显高于对照组,MPP患儿急性期IgA、IgG、IgM水平明显高于恢复期,差异均有统计学意义( P值均<0.05)。重症组患儿IL-2、IL-10水平明显低于轻症组,IL-8水平明显高于轻症组,差异均有统计学意义( P值均<0.05)。重症组患儿IgA、IgG、IgM水平明显高于轻症组( P值均<0.05)。激素治疗组、非激素治疗组患儿恢复期IgA、IgG、IgM水平差异无统计学意义。 结论:炎性细胞因子水平与MPP的病情相关,说明儿童在发生肺炎支原体感染的同时存在包括炎性细胞因子在内的免疫功能紊乱。     

Serum levels of healthy adult humans and changes of IgG subclass levels between infected and convalescent phase in respiratory infections

We measured serum levels of IgG subclasses in 100 healthy adult humans and 64 patients with respiratory infections by utilizing the enzyme linked immunosorbent assay (ELISA). The patients were composed of 18 patients with acute bacterial pneumonia and bacterial infection of 9 patients with pulmonary emphysema, 27 patients with chronic bronchitis and 10 patients with bronchiectasis. In healthy adults, serum levels of IgG1 subclass decreased in proportion of age increase. Serum levels of IgG2 rose after 30 years of age. Serum levels of IgG3 and IgG4 showed no remarkable changes by age. In patients with respiratory infectious disease, serum levels of IgG1, IgG2 and IgG4 decreased significantly but IgG3 increased significantly. We also measured serum levels of IgG subclasses in 10 patients with acute bacterial pneumonia and bacterial infection of 5 patients with pulmonary emphysema, 12 patients with chronic bronchitis and 4 patients with bronchiectasis at both infected and convalescent phases. The serum levels of IgG2 in patients with pneumonia and pulmonary emphysema at convalescent phase were significantly lower than those in the patients of infected phase. Other subclasses showed no significant change. We summarized that IgG2 was consumed at the infected phase by protecting against bacterial infections. IgG2 probably has an important role of protecting against bacterial respiratory infections among all IgG subclasses.     

Total and Specific IgE Responses in the Acute and Recovery Phases of Respiratory Infections in Children

Total IgE and specific IgE antibodies to common allergens were determined by the enzyme-linked im-munosorbent assay in children with Mycoplasma pneumoniae or respiratory syncytial virus (RSV) infections. The decrease of total IgE from the acute to convalescent phase was observed in 105 of 134 (78.4%) children with M. pneumoniae infection and in 40 of 49 (81.6%) of those with RSV infection. Similarly, many patients showed a decrease of the responses of specific IgE in the convalescent phase of the infections. The results indicated that these infections might alter the production of total IgE and IgE specific to common allergens unrelated to the infectious agents.     

Cilia in children with recurrent upper respiratory tract infections: ultrastructural observations.

We investigated the ultrastructure of nasal cilia in 27 children suffering from recurrent infections of the upper respiratory tract, during and after the onset of an acute respiratory infection, and after a convalescent period of 12 weeks. Our results demonstrated that in seven subjects after resolution of infection, the morphology of a large proportion of the cilia (32%) was not back to normal. These findings suggest a long-term residual effect of infection, or the inability to reestablish normal ciliary structure during the convalescent period in some subjects with recurrent upper respiratory tract infection.     

Evaluation of ImmnoCard mycoplasma for diagnosis of Mycoplasma pneumoniae infection]

We compared the differences of two tests, for the diagnosis of Mycoplasma pneumoniae infection a rapid detection kit for Mycoplasma pneumoniae-specific IgM antibody, ImmunoCard (IC) Mycoplasma test (Meridian Bioscience-USA), and a particle agglutination (PA) test in a retrospective study among 57 patients. They were all suspected to be suffering from atypical bacterial respiratory infection and were checked by the IC test at the Fukuroi Municipal Hospital from January 2004 to January 2006. In this study, the concordance of IC and PA results showed a great difference in children and adults. All children, whose IC test was positive, showed positive PA results. It was particularly difficult to obtain convalescent serum samples in children and IC was useful for children because it was judged by acute phase serum. On the other hand, some in 20% (7/35) of adults, results of the IC test were not concordant with that of the PA test, therefore, diagnosis in adults should be made based on 4-fold rises in titers between paired sera for serological diagnosis of Mycoplasma pneumoniae infection.     

慢性阻塞性肺病并发急性呼吸衰竭的危险因素分析

目的探讨慢性阻塞性肺疾病(COPD)并发急性呼吸衰竭的相关危险因素及预后因素,为临床防治策略的制定提供参考依据。方法选取我院呼吸内科收治的COPD患者148例,根据是否有并发急性呼吸衰竭分为急性呼衰组52例和非急性呼衰组96例。根据急性呼衰组患者的转归情况,将其分为好转组36例以及死亡组16例。分析慢性阻塞性肺疾病并发急性呼吸衰竭的危险因素,并研究急性呼吸衰竭预后的相关因素。结果每年发生慢性阻塞性肺病急性发作次数多、尿酸水平低、白蛋白水平低、消瘦、发生医院感染、未使用吸入用糖皮质激素、酸碱失衡是COPD致急性呼吸衰竭的危险因素;而酸碱值低、血二氧化碳分压升高、血清钠降低、血清氯低、医院感染、并发肺性脑病、并发心功能衰竭是COPD并发急性呼吸衰竭患者预后的危险因素。结论慢性阻塞性肺疾病并发急性呼吸衰竭与COPD发作的次数、机体营养状况、电解质酸碱失衡、医院感染的发生、吸入用糖皮质激素的使用等多个危险因素有关。     

Cellular and humoral inhibition of Plasmodium falciparum growth in vitro and recovery from acute malaria

Both mononuclear cell cytotoxicity and serum inhibition of Plasmodium falciparum growth in vitro were found to vary according to the stage of infection in Gambian children with clinical malaria. Cytotoxicity was displayed by mononuclear cells and serum from children with acute malaria but this form of parasite killing was more effective in children with low grade P. falciparum infections of at least 10 days duration. Parasite inhibitory antibody was not evident in sera from acutely infected children but was found in sera from children recovering from malaria and reached a peak in convalescent children when P. falciparum growth was inhibited by at least 50%. The humoral response in convalescent children was strain related, being more effective against the most recent infecting parasite strain than against other 'wild' P. falciparum isolates. In contrast, mononuclear cell cytotoxicity was not strain related; when effective, multiplication of all parasite isolates tested was retarded to the same degree. The discussion considers the role of mononuclear cell cytotoxicity in the development of protective immunity and suggests that it may be a 'front line' defense mechanism during each malaria attack.     

Viral respiratory tract infections among patients with acute undifferentiated fever in Vietnam

To investigate the proportion of viral respiratory tract infections among acute undifferentiated fevers (AUFs) at primary health facilities in southern Vietnam during 2001-2005, patients with AUF not caused by malaria were enrolled at twelve primary health facilities and a clinic for malaria control program. Serum was collected on first presentation (t0) and after 3 weeks (t3) for serology. After exclusion of acute dengue infection, acute and convalescent serum samples from 606 patients were using enzyme-linked immunoassays to detect IgA, as well as IgM and IgG antibodies against common respiratory viruses. Paired sera showed the following infections: human parainfluenza virus (HPIV, 4.7%), influenza B virus (FLUBV, 2.2%), influenza A virus (FLUAV, 1.9%) and human respiratory syncytial virus (HRSV, 0.6%). There was no association between type of infection and age, sex or seasonality; some inter-annual differences were observed for influenza. Antibody prevalence, indicative of previous infections, was relatively low: HPV, 56.8%, FLUBV, 12.1%; FLUAV, 5.9% and HRSV, 6.8%.