槐杞黄颗粒辅助治疗PNS患儿血清IL-21及IFN-γ的变化

目的:观察原发性肾病综合征(PNS)患儿采用槐杞黄颗粒辅助治疗前后血清白细胞介素-21(IL-21)及干扰素-γ(IFN-γ)的动态变化。方法:2010年6月31日～2011年12月31日收治于中国医科大学附属盛京医院小儿肾脏风湿科的PNS患儿50例,随机分为两组:泼尼松联合槐杞黄颗粒治疗组24例(A组),单纯泼尼松治疗组26例(B组)。观察治疗前和治疗1个月、3个月后外周血中IL-21及IFN-γ的变化。选取健康体检儿童15名为健康对照组(C组)。采用酶联免疫吸附法测定血清中IL-21及IFN-γ的浓度。结果:(1)A、B组IL-21均显著高于C组(P<0.05),治疗1个月后两组IL-21均显著下降,组间差异无统计学意义,至3个月后A组显著降低,并低于B组(P<0.05),仍未达C组水平。(2)A、B组IFN-γ均低于C组(P<0.05),治疗1个月后两组IFN-γ显著升高,组间差异无统计学意义,至3个月后A组显著升高,并高于B组(P<0.05),接近C组水平。结论:PNS患儿治疗前IL-21的升高和IFN-γ的降低可能参与PNS的发病,槐杞黄辅助治疗可以下调肾病患儿IL-21的表达,上调IFN-γ的表达,纠正Th1/Th2失衡,从而发挥免疫调节作用。     

血液净化治疗大剂量甲氨蝶呤中毒致急性肾功能衰竭的疗效

目的探讨血液净化在大剂量甲氨蝶呤(HD-MTX)中毒致急性肾功能衰竭中的疗效。方法 2002年12月至2011年7月我院收治的急性淋巴细胞白血病(ALL)患儿行髓外防治过程中,3例患儿发生HD-MTX中毒致急性肾功能衰竭,给予血液净化治疗。结果 3例患儿应用血液净化治疗后,MTX血药浓度迅速下降至无毒水平,肾功能恢复正常。结论血液净化可以迅速降低MTX血药浓度,恢复肾功能。     

阿达木单抗治疗幼年特发性关节炎的疗效分析

探讨阿达木单抗治疗幼年特发性关节炎(JIA)的有效性和安全性。选取2019年1月至2021年1月中国医科大学附属盛京医院小儿风湿免疫科收治的诊断明确(JIA,除外全身型),常规治疗无效,且既往应用其他生物制剂疗效不佳或存在预后不良因素或并发症(重要关节受累或出现骨破坏、伴有眼虹膜睫状体炎等)的7例患儿。患儿均给予阿达木单抗治疗(24 mg/m~2,1次/2周,皮下注射),同时口服甲氨蝶呤和(或)来氟米特。比较患儿治疗前、治疗12周后C反应蛋白(CRP)、红细胞沉降率水平;患儿治疗后4、12、24周采用28处关节疾病活动度评分(DAS28)和幼年关节炎活动性系统评分(JADAS)评估病情,同时监测不良反应发生情况。结果显示,与治疗前比较,治疗12周后患儿CRP、红细胞沉降率均显著降低(P <0.05),其中6例(85.71%) DAS28评分提示达到临床缓解,关节疼痛和肿胀症状明显缓解,治疗24周后5例患儿JADAS评分提示达到临床缓解。骨破坏患儿骨破坏明显好转,关节腔积液消失,滑膜增生面积减少,血流消失。虹膜睫状体炎患儿眼部体征好转。治疗过程中患儿均耐受良好,没有严重不良反应发生...     

纳络酮治疗中、重度新生儿缺氧缺血性脑病的临床研究

目的:观察伍用纳络酮治疗中、重度新生儿HIE的疗效及治疗前后患儿血浆及脑脊液中β-内啡肽（β-EP）的变化。方法:将40例HIE患儿随机分为两组:纳络酮治疗组23例,对照组17例,两组除进行相同的常规治疗外,治疗组给纳络酮0.1mg/kg·d,以0.03～0.05mg/kg·h速度静滴,连续3天,观察患儿临床症状体征的变化并进行NBNA评分,治疗前后分别留取患儿血浆和脑脊液测定β-EP,并与20名正常儿对照。结果:治疗组患儿临床症状明显改善,NBNA评分明显提高,与对照组相比差异显著;两组患儿治疗前血浆和脑脊液中β-EP明显高于正常新生儿,治疗后较治疗前显著下降,但治疗组与对照组治疗前后血浆和脑脊液β-EP含量均无统计学差异。结论:伍用纳络酮治疗中重度HIE临床疗效显著。     

内毒素血症新生大鼠肾组织核因子κB和转化生长因子β1表达及超微结构的动态变化

目的 探讨新生大鼠内毒素血症时肾脏损伤与修复的可能机制.方法 将80只健康7日龄Wistar大鼠随机分为2组,每组40只,对照组腹腔内注射0.9%氯化钠溶液0.1 ml;内毒素组(LPS组)腹腔注射等容积LPS 5 mg/kg.每组大鼠分别于腹腔注射后1、4、8和12 h处死.采用免疫组织化学方法检测肾组织中核因子(NF)-κB及转化生长因子(TGF)-β1表达的动态变化,用透射电镜观察.肾组织超微结构变化.结果 NF-κB在对照组基本无表达,LPS组主要在肾小管上皮细胞表达,于实验后1 h即有升高,8 h达高峰,12 h略有下降.TGF-β1在对照组肾小管中少量表达,LPS组1、4及8 hTCF-β1表达较对照组差异无显著性,而12 h显著升高.电镜下观察到,LPS组于实验后4 h可见肾小球上皮细胞足突融合减少,肾小管上皮细胞线粒体空泡形成,刷状缘无明显改变;12 h肾小球上皮细胞足突明显融合,系膜细胞线粒体嵴断裂,肾小管上皮细胞线粒体扩张.结论 NF-κB参与了新生大鼠内毒素血症时肾损害的病理过程,而TGF-β1可能促进肾组织修复,同时可能抑制NF-κB产生.     

血清和尿中NGAL、KIM-1水平在儿童泌尿系统疾病致急性肾损伤诊断中的作用

目的 评价血清和尿中中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子1(KIM-1)在儿童泌尿系统疾病致急性肾损伤(AKI)诊断中的作用.方法 收集我院小儿肾内科收入院的泌尿系统疾病患儿共102例,均检测血清和尿中的NGAL、KIM-1水平,以AKI pRIFLE为分组标准,评价血清和尿中NGAL、KIM-1在儿童急性肾损伤早期诊断中的敏感性和特异性,并进行ROC曲线分析.对符合AKI诊断的患儿,分别检测诊断AKI后第1天、第4天、第7天的血清和尿中的NGAL、KIM-1水平,并与当天相应的血肌酐(Scr)进行相关分析.结果 入选102例患儿中,43例符合AKI pRIFLE诊断标准,18例患儿为AKI-R期,10例患儿为AKI-I期,15例患儿为AKI-F期.AKI组患儿的血清和尿中NGAL、KIM-1水平在Scr没有升高之前已经升高,与非AKI组及正常对照组比较,这2个指标的组间差异有统计学意义(P＜0.05).血清NGAL的ROC曲线下面积(AUC)为0.89(95％ CI 0.65～0.91),尿中NGAL的AUC为0.84(95％ CI 0.62～0.90),均好于血清和尿中的KIM-1水平.血清和尿中的NGAL水平与Scr相关(r分别为0.79、0.62,P＜0.01);血清和尿中KIM-1水平与Scr相关(r分别为0.52、0.55,P＜0.05).结论在儿童泌尿系统疾病致AKI时,血清和尿中的NGAL、KIM-1在Scr没有升高之前已经升高,是诊断儿童AKI的早期生物标志物.在发生AKI后,这两个指标与Scr有相关性.     

The expression of NF-κB and TGF-β1 in the injured kidneys of neonate rats with endotoxemia

Objective To investigate the mechanism of the kidney injure in the newborn rats with endotoxemia.Methods Eighty Wistar rats aged 7 days were randomly divided into 2 groups:control group (intraperitoneal injection of saline of 0.1 ml;n = 40),lipopolysaccharide(LPS) group(intraperitoneal injection of LPS of 5 mg/kg;n =40).The rats in either group were killed at 1 h,4 h,8 h and 12 hours after intraperitoneal injection,respectively.The expressions of NF-κB and TGF-β1 in the kidney were detected by using the immunohistochemical assay.Renal ultrastructural changes was observed with a CM100 Philips electron microscope.Results The NF-κB in control group had no expression.NF-κB in LPS group mainly expressed in the renal tubular epithelial cell,increased at 1 h after test and peaked at 8 h,and slightly descended at 12 h.The expression of TGF-β1 in control group was slight,and had not show significant difference from control group at 1 h,4 h and 8 h,but significantly higher than that in control group at 12 h.In LPS group,newborn rat renal glomerular basement membrane was complete,part epithelial cell foot processes were fused and renal tubules epithelial cell mild mitochondria vacuolization was found at 4 h.Renal glomeruli epithelial cell foot processes obvious confluenced,quantities of mesangial cells mitochondria vacuole,and renal tubules epithelial cell mitochondria expanded to bubbles at 12 h.Conclusion The NF-κB involves in the pathogenesis of kidney damage induced by endotoxemia,but TGF-β1 may help to repair the damaged kidney,and may repress the production of NF-κB.     

Boulardii酵母菌治疗小儿抗生素相关性肠炎的疗效观察

目的　 探讨抗生素对腹泻患儿肠道菌群的影响及Boulardii酵母菌治疗小儿抗生素相关性肠炎的疗效。 方法 　分析 99例腹泻患儿的临床资料 ,检测肠道菌群。其中用抗生素治疗 6 8例 ,未用抗生素治疗 31例。 99例患儿分为两组治疗 :治疗组用Boulardii酵母菌 +思密达 ;对照组用思密达。Boulardii酵母菌 2 5 0mg/d ,思密达 <1岁 1包 /d ;～ 2岁 1 5包 /d ;>2岁 2包 /d ,分三次口服。 结果 　曾用抗生素治疗的腹泻患儿发生肠道菌群失调的严重程度明显高于未用抗生素组 (μ =3 77,P <0 0 5 ) ;在儿科门诊中以氨苄青霉素、头孢类及大环内酯类抗生素引起小儿腹泻居多 ;Boulardii酵母菌可明显提高小儿腹泻治愈率 (χ2 =5 0 6 7,P <0 0 5 )。 结论 　合理应用抗生素能够防止和降低婴幼儿腹泻率 ;Boulardii酵母菌可缩短腹泻病程 ,提高腹泻治愈率。     

The expression of NF-κB and TGF-β1 in the injured kidneys of neonate rats with endotoxemia

Objective To investigate the mechanism of the kidney injure in the newborn rats with endotoxemia.Methods Eighty Wistar rats aged 7 days were randomly divided into 2 groups:control group (intraperitoneal injection of saline of 0.1 ml;n = 40),lipopolysaccharide(LPS) group(intraperitoneal injection of LPS of 5 mg/kg;n =40).The rats in either group were killed at 1 h,4 h,8 h and 12 hours after intraperitoneal injection,respectively.The expressions of NF-κB and TGF-β1 in the kidney were detected by using the immunohistochemical assay.Renal ultrastructural changes was observed with a CM100 Philips electron microscope.Results The NF-κB in control group had no expression.NF-κB in LPS group mainly expressed in the renal tubular epithelial cell,increased at 1 h after test and peaked at 8 h,and slightly descended at 12 h.The expression of TGF-β1 in control group was slight,and had not show significant difference from control group at 1 h,4 h and 8 h,but significantly higher than that in control group at 12 h.In LPS group,newborn rat renal glomerular basement membrane was complete,part epithelial cell foot processes were fused and renal tubules epithelial cell mild mitochondria vacuolization was found at 4 h.Renal glomeruli epithelial cell foot processes obvious confluenced,quantities of mesangial cells mitochondria vacuole,and renal tubules epithelial cell mitochondria expanded to bubbles at 12 h.Conclusion The NF-κB involves in the pathogenesis of kidney damage induced by endotoxemia,but TGF-β1 may help to repair the damaged kidney,and may repress the production of NF-κB.