Hypereosinophilia Secondary to Varicella in a Hyperimmunoglobulinemia E Syndrome

A seven-year-old boy with hyperimmunoglobulinemia E (HIE) syndrome showed hypereosinophilia up to 49,000 per cubic millimeter (cumm) in his convalescence from a severe and protracted attack of varicella. Hypereosinophilia persisted for 40 days. Eosinophils seen in the bone marrow as well as in the peripheral blood were morphologically normal and a majority of them in the marrow were maturated. Since eosinophilia after varicella is not common, it is suggested that the pathogenesis of eosinophilia observed in this case may be associated with impaired immunity of HIE syndrome. Further studies on a large number of cases are necessary to confirm this.     

IgE and IgG Antibodies to Staphylococcus aureus Solubilized Cell Wall Proteins and Teichoic Acid in Patients with the Hyper-IgE Syndrome

The anti-staphylococcal IgE and IgG antibody levels of patients with hyper-IgE syndrome (HIE) were measured by microtiter solid phase radioimmunoassay (MSPRIA) and enzyme-linked immunosorbent assay (ELISA) using solubilized cell wall proteins (SCWP) and teichoic acid extracted from Staphylococcus aureus. Using MSPRIA, specific IgE antibodies to SCWP were detected at significant levels in all 5 patients with HIE, but not in 23 patients with atopic allergy or Wiskott-Aldrich syndrome with or without staphylococcal infections. IgG antibodies to SCWP and teichoic acid were lower in the patients with HIE than those in non-allergic infectious controls. These findings suggest an abnormal immunologic response to Staphylococcus aureus in patients with HIE.     

血清胰岛素样生长因子Ⅰ及生长激素与新生儿缺氧缺血性脑病的关系

目的：研究新生儿缺氧缺血性脑病（HIE）血清胰岛素样生长因子Ⅰ（IGF-Ⅰ）和生长激素（GH）水平, 探讨血清IGF-Ⅰ,GH与HIE严重程度之间的关系。方法：测定实验组53例HIE新生儿（其中轻度30例、中度15例、重度8例）生后72 h内、26～28 d血清IGF-Ⅰ和GH水平,以30例正常新生儿作对照;HIE组新生儿分别在急性期和恢复期做新生儿神经行为测定（NBNA）,分析血清IGF-Ⅰ和GH与HIE严重程度及与NBNA之间的关系。结果：轻、中、重度 HIE新生儿血清 IGF-Ⅰ 水平在生后72 h内分别为59.65±29.61 ng/mL、33.56±17.32 ng/mL、23.58±13.57 ng/mL,生后26～28 d分别为89.26±48.65 ng/mL、71.46±38.35 ng/mL、54.39±26.39 ng/mL。对照组在72 h及26~28 d时,IGF 1水平为71.23±35.42 ng/mL、96.54±52.38 ng/mL,与实验组比较均P<0.01。病情越重血清IGF-Ⅰ水平越低（P＜0.05)。血清GH水平与HIE的严重程度无相关性。HIE组血清IGF-Ⅰ水平在急性期和恢复期均与NBNA高度相关（r=0.295, P＜0.05; r=0.263,P＜0.05）,而GH无论在急性期和恢复期均与NBNA分值没有相关性。结论：测定新生儿HIE血清IGF-Ⅰ水平可判断HIE的严重程度,血清IGF-Ⅰ水平可能影响HIE新生儿的预后。［中国当代儿科杂志,2007,9（1）：22-24］     

新生儿缺氧缺血性脑病血浆D-二聚体的动态观察

目的　探讨D -二聚体在新生儿缺氧缺血性脑病 (HIE)中的变化和临床意义。方法　采用胶乳凝集法测定 40例HIE患儿和 2 0例健康对照新生儿急性期和恢复期血中D -二聚体水平 ,同时观察了全身炎症反应综合征 (SIRS)的发生率。结果　HIE急性期患儿的D -二聚体水平明显高于恢复期 (3 .5 0± 0 .2 0 )mg/L对 (0 .42± 0 .0 4)mg/L ;(8.2 0± 0 .35 )mg/L对 (3 .0 0± 0 .2 0 )mg/L (P <0 .0 1) ,也明显高于正常对照 (P <0 .0 1)。中、重度明显高于轻度和对照 (0 .2 6± 0 .0 3)mg/L (P <0 .0 1) ,轻度与对照无明显差异 (P >0 .0 5 )。D -二聚体水平与SIRS的发生率呈正相关 (r =0 .987)。结论　D -二聚体在HIE的病理过程中起重要的作用 ,可作为快速诊断、判断预后、治疗效果的参考指标     

Neonatal encephalopathy: Etiologies other than hypoxic-ischemic encephalopathy

Neonatal encephalopathy (NE) describes the clinical syndrome of a newborn with abnormal brain function that may result from a variety of etiologies. HIE should be distinguished from neonatal encephalopathy due to other causes using data gathered from the history, physical and neurological exam, and further investigations. Identifying the underlying cause of encephalopathy has important treatment implications. This review outlines conditions that cause NE and may be mistaken for HIE, along with their distinguishing clinical features, pathophysiology, investigations, and treatments. NE due to brain malformations, vascular causes, neuromuscular causes, genetic conditions, neurogenetic disorders and inborn errors of metabolism, central nervous system (CNS) and systemic infections, and toxic/metabolic disturbances are discussed.     

孕酮对新生鼠缺氧缺血性脑病脑水肿的保护作用

目的探讨孕酮对缺氧缺血性脑病(HIE)新生鼠脑水肿的影响。方法52只7日龄新生Wistar大鼠,随机分为:假手术对照组(A组)、HIE组(B组)、药物预防组(C、D、E组)。动物先行左侧颈总动脉结扎术,再吸入8%氧气和92%氮气混合气体2.5 h,建立HIE动物模型。C、D、E 3组分别于建立模型前30 min给予不同剂量孕酮溶液。24 h观察各组新生鼠海马水肿情况的变化。结果C、D、E 3组海马Na 含量明显低于B组,且D组K 含量明显高于B组(P<0.05),而A、E组K 含量与B组比较均无明显差异(P>0.05)。结论孕酮对新生鼠HIE引起的脑水肿有明显的预防和保护作用。     

缺氧缺血性脑病新生儿自然杀伤细胞与T细胞亚群的变化及其相关因素

目的了解缺氧缺血性脑病(HIE)新生儿自然杀伤(NK)细胞及T细胞亚群的变化,观察其与各种因素的相关性。方法应用流式细胞仪测定50例HIE和20例正常新生儿血NK细胞、CD3 、CD4 、CD8 细胞及CD4 /CD8 比值。结果HIE患儿NK细胞和T细胞亚群的表达均明显低于正常新生儿(P均<0.05);中、重度HIE患儿NK细胞和CD3 、CD4 细胞及CD4 /CD8 比值明显均低于轻度HIE(P均<0.05),而不同分度HIE的CD8 细胞则无统计学差异(P均>0.05);NK细胞、CD3 、CD4 及CD4 /CD8 与HIE病情分度均呈负相关(P均<0.05)。NK细胞表达与胎龄呈正相关;CD3 细胞与羊水污染呈负相关(P<0.05);CD4 细胞与羊水污染呈负相关,与出生体质量和Apgar评分呈正相关(P<0.05);CD4 /CD8 比值与分娩方式存在线性相关(P<0.05)。结论缺氧缺血可导致HIE患儿NK细胞活性抑制及T淋巴细胞亚群紊乱,某些因素对细胞免疫功能有一定影响。     

Birth asphyxia: incidence, clinical course and outcome in a Swedish population

A total of 42 203 live infants were born in Goteborg in 1985-1991, and 292 term infants had Apgar scores < 7 at 5 min. Infants with congenital malformations, infections and opioid-induced respiratory depression were excluded and thus 227 infants were included in the birth asphyxia group, which formed the basis of this retrospective study. Clinical signs of mild, moderate or severe hypoxic-ischemic encephalopathy (HIE) were present in 65 infants, and in another 10 infants, sedated and on controlled ventilation, HIE was assumed but grading was not possible. The incidences of Apgar scores < 7 at 5 min, birth asphyxia and birth asphyxia with HIE were 6.9, 5.4 and 1.8 per 1000 live born infants: 95% of infants resuscitated with bag and mask ventilation only, did well, compared with 1 of 11 in whom resuscitation included adrenaline. Seizures occurred in 27 of 227 infants, beginning in 18 infants within 12 h of birth. Small-for-gestational-age (SGA) infants were overrepresented in the birth asphyxia group but not in the birth asphyxia-HIE group. All infants with severe HIE died or developed neurological damage. Half of the infants with moderate, and all of the infants with mild, HIE were reported to be normal at 18 months of age. A total of 0.3 per 1000 live born infants died and 0.2 per 1000 developed a neurological disability related to birth asphyxia. The disabilities were dyskinetic (4), tetraplegic (2), spastic diplegic (2), cerebral palsy and mild neuromotor dysfunction (1). The relatively low incidences of birth asphyxia and HIE were probably due to effective antenatal care. Asphyxia neonatorum, cerebral palsy, hypoxic-ischemic encephalopathy, incidence, outcome, population, resuscitation, seizures, term infant
E Thornberg, Department of Pediatric Anesthesia and Intensive Care, Östra Hospital, S-416 85 Göteborg, Sweden     

新生儿缺氧缺血性脑病血浆与脑脊液降钙素基因相关肽的研究

目的　 探讨降钙素基因相关肽 (CGRP)在新生儿缺氧缺血性脑病 (HIE)中的变化及其意义。 方法 　应用放射免疫分析法测定 3 1例新生儿HIE患儿和 12例正常新生儿血浆CGRP水平及 2 4例HIE患儿脑脊液CGRP水平。 结果 　HIE患儿急性期血浆CGRP水平显著高于对照组 (P <0 0 5 ) ,且随HIE程度加重而增高。中、重度HIE急性期与恢复期比较均具有显著性差异 (P均 <0 0 1)。CT异常组血浆和脑脊液CGRP水平均高于CT正常组。血浆与脑脊液CGRP之间呈正相关关系。 结论 　CGRP参与了HIE的病理过程 ,在HIE病程中对脑损伤可能具有一定保护作用。     

Lack of evidence for a causal relationship between hypoxic-ischemic encephalopathy and subdural hemorrhage in fetal life, infancy, and early childhood.

It has been asserted that hypoxic-ischemic encephalopathy (HIE) with cerebral swelling in the absence of marked trauma may be responsible for subural hemorrhage in the young. As this may have considerable implications in determining both the mechanism of death and the degree of force required to cause injury in certain cases of inflicted head injury in infancy, clarification is required. A retrospective study of 82 fetuses, infants, and toddlers with proven HIE and no trauma was undertaken from forensic institutes in Australia, the United Kingdom, Germany, Denmark, and the United States. The age range was 35 weeks gestation to 3 years, with a male to female ratio of 2:1. All cases had histologically confirmed HIE. Causes of the hypoxic episodes were temporarily resuscitated sudden infant death syndrome with delayed death (N = 30), drowning (N = 12), accidental asphyxia (N = 10), intrauterine/delivery asphyxia (N = 8), congenital disease (N = 6), aspiration of food/gastric contents (N = 4), inflicted asphyxia (N = 3), epilepsy (N = 1), dehydration (N = 1), drug toxicity (N = 1), complications of prematurity (N = 1), and complications of anesthesia (N = 1). The initiating event was not determined in 4 instances. In no case was there macroscopic evidence of subdural hemorrhage. In this study no support could be given to the hypothesis that HIE in the young in the absence of trauma causes subdural hemorrhage.     

新生儿缺氧缺血性脑病患儿血清IL-18水平变化的临床意义

目的研究新生儿缺氧缺血性脑病(HIE)患儿血清中IL-18水平变化，为临床提供一种新的监测指标。方法足月HIE患儿30名，轻度HIE15名，中重度HIE15名，15名非HIE为对照组。采用ELISA法测血清IL-18浓度。结果生后第3、第7天，对照组IL-18低于患病组。轻度HIE组低于中重度HIE。结论IL-18参与HIE病理过程；动态测定IL-18可判断HIE病情轻重及病程预后。     

缺氧缺血性脑病新生儿内皮素、降钙素基因相关肽、心钠素及血清钠、钙的变化

目的探讨HIE患儿血浆内皮素(ET)、降钙素基因相关肽(CGRP)及心钠素(ANP)的变化及其临床意义。方法应用放射免疫分析法和离子交换法测定46例HIE和26例正常新生儿的血浆ET、CGRP、ANP和血清钠、钙水平。结果HIE组急性期血浆ET、CGRP和ANP水平明显高于对照组及恢复期组(P均<0.001));病情越重,ET、CGRP和ANP水平越高,恢复期血浆ET、CGRP和ANP水平渐下降,中重度组下降的幅度更为缓慢。HIE中重度组血钠水平明显低于对照组(P<0.05);不同程度HIE组血钙水平均明显低于对照组,差异显著(P<0.01)。HIE组治疗前后血浆ET与CGRP、ANP水平呈直线正相关,急性期血浆ET与血钙、血浆ANP与血钠之间无明显相关性(P均>0.05)。结论血浆ET、CGRP和ANP共同参与HIE发病机制及病理过程,其动态变化有助于病情判断、疗效评价及预后评估。     

The hypoxic ischaemic encephalopathy score in predicting neurodevelopmental outcomes among infants with birth asphyxia at the Muhimbili National Hospital, Dar-es-Salaam, Tanzania

Hypoxic Ischemic Encephalopathy (HIE) score may be used to predictneurodevelopment outcome in infants with birth asphyxia. A totalof 140 infants who had a 5 min Apgar score of <7 at birthhad detailed motor and neurodevelopment assessment. Outcomemeasures were grouped as normal or abnormal with morbidity (convulsions,abnormal muscle tone and delayed development) or death. Thepositive predictive value (PPV) for mortality was 42.3% formoderate HIE and 93.8% for severe HIE. For severe HIE the PPVwas 100%. Thirteen infants had delayed development, the scorehad PPV of 63.6% for moderate HIE and 100% for severe HIE. Thebest correlation with outcome was the peak score of 15 or higherhad a PPV of 100%. Specificity was found to be 100% and sensitivityof 14%. The HIE scoring system is a useful predictor of neurodevelopmentoutcome at 6 months of age in a resource poor setting.     

新生儿缺氧缺血性脑病血浆及脑脊液血小板活化因子的变化

目的　观察新生儿缺氧缺血性脑病 (HIE)血浆及脑脊液 (CSF)血小板活化因子 (PAF)的变化 ,探讨PAF在HIE发病中的作用。方法　于急性期和恢复期分别采集患儿血浆和CSF ,采用生物活性法检测血浆及CSF中PAF水平 ,并分析其与脑损伤和 1minApgar评分的关系。 结果　 1.HIE患儿急性期CSF中PAF水平明显高于对照组患儿 (P <0 .0 1) ,且与病情轻重呈明显正相关 (r =0 .6 5　P <0 .0 1) ;急性期中度与重度HIE患儿血浆PAF水平显著高于对照组 (P <0 .0 1) ,且与病情轻重呈明显正相关 (r =0 .5 9　P <0 .0 1) ,而轻度患儿与对照组无明显差异 (P >0 .0 5 ) ;恢复期与对照组比较无显著差异。 2 .血浆PAF水平与CSF中PAF水平呈正相关 ,血浆及CSF中PAF水平与脑损伤程度及 1minApgar评分呈明显正相关。 结论　PAF可能参与新生儿HIE的发病机制 ,CSF中PAF水平可作为判断HIE病情轻重和预后的重要指标     

缺氧缺血性脑病新生儿血浆内皮素和降钙素基因相关肽水平动态观察

目的探讨内皮素（ＥＴ）和降钙素基因相关肽（ＣＧＲＰ）在新生儿缺氧缺血性脑病（ＨＩＥ）中的变化及临床意义。方法采用放射免疫法对３６例ＨＩＥ患儿和１８例健康足月新生儿血浆ＥＴ和ＣＧＲＰ水平进行了同期动态测定。结果ＨＩＥ患儿急性期血浆ＥＴ和ＣＧＲＰ水平较恢复期明显增高（Ｐ＜０．０１）,并明显高于同期对照组水平（Ｐ＜０．０１）,恢复期与正常对照组无显著性差异。急性期不同程度ＨＩＥ及对照组之间ＥＴ,ＣＧＲＰ水平比较表明,重度组明显高于对照组、轻度组及中度组,中度组高于对照组和轻度组,轻度组与对照组无显著性差异。急性期患儿血浆ＥＴ和ＣＧＲＰ呈直线正相关（ｒ＝０．３８,Ｐ＜０．０５）。结论ＥＴ和ＣＧＲＰ参与了新生儿缺氧缺血性脑病的病理生理过程。ＥＴ的增高可能是促发ＨＩＥ脑损伤的一个重要因素,而ＣＧＲＰ增高在ＨＩＥ病程中对脑损伤可能具有一定保护作用。     

尿8-异前列腺素F_(2α)测定在新生儿缺氧缺血性脑病病情评估中的价值(英文)

目的：测定新生儿尿8-异前列腺素F2α(8-iso-PGF2α)水平，分析其在缺氧缺血性脑病（HIE）患儿病情评估中的价值。方法：分别于生后1 d、3 d和7d收集正常（n = 126）和HIE（n = 151）新生儿尿液，应用ELISA法检测其8-iso-PGF-2α含量。结果：①正常新生儿生后1、3和7d的尿8-iso-PGF2α水平分别为29.9±7.9、27.7±9.8和27.5±10.5 ng/mmol·Cr，差异无统计学意义；②病程第1 d，轻、中和重度HIE患儿尿8-iso-PGF2α水平分别为65.3±13.2、154.6±31.6和241.7±41.0 ng/mmol·Cr，差异具有显著性意义，且均高于正常新生儿水平(P＜0.001)；③病程第3 d，中度和重度HIE患儿8-iso-PGF2α水平（34.2±10.3ng/mmol·Cr 、50.8±12.8 ng/mmol·Cr）仍高于正常新生儿(P＜0.001），而轻度HIE患儿尿8-iso-PGF2α水平下降至正常新生儿水平；④病程第7 d，轻、中和重度HIE及正常新生儿之间的8-iso-PGF-2α水平无明显差异；⑤以8-iso-PGF2α水平45.5、89.9 和217.5 ng/mmol·Cr作为区分正常与轻度HIE、轻度与中度HIE、中度与重度的界限，其敏感性和特异性分别为95.2%和99.2%，100%和95.2%，65.8%和 100%。结论：生后7d内正常新生儿尿8-iso-PGF2α水平相对稳定；HIE患儿尿中8-iso-PGF2α峰值于病程第1 d出现，其升高程度与病情严重程度相关，是一项评估患儿病情可靠而简便的生化指标。［中国当代儿科杂志，2005, 7(2):103-106］     

新生儿缺氧缺血性脑病血清及脑脊液中促红细胞生成素的变化(英文)

目的：探讨缺氧缺血性脑病(HIE)患儿血清和脑脊液(CSF)中促红细胞生成素（Epo）的变化,观察Epo与脑损伤的关系。方法：对26例HIE患儿（轻度8例,中度10例,重度8例）和8例正常对照组进行研究,在生后0~24 h、48~72h 及7~10 d抽取静脉血,HIE组在生后48~72 h腰穿取CSF,放射免疫法测定血清和CSF Epo含量,HIE组生后7~10d做头部MRI检查。结果：对照组血清Epo随日龄增加呈下降趋势,有统计学差异(P 0.05)。头部MRI为重度改变的HIE患儿CSF中Epo水平均较头部MRI为轻、中度改变的HIE患儿显著升高(F = 8.56, P < 0.01)。结论：HIE患儿血清Epo显著升高,持续不降是病情危重的标志。CSF中Epo显著升高提示HIE患儿脑损伤严重,预后不良。重度HIE患儿可能存在着血脑屏障的破坏,Epo可能透过血脑屏障。［中国当代儿科杂志,2005, 7(2): 107-111］     

新生儿缺氧缺血性脑病时胃肠激素的变化

为了探讨新生儿缺氧缺血性脑病（ＨＩＥ）时血液中生长抑素（ＳＳ）、胃泌素（ＧＡＳ）、胃动素（ＭＴＣ）对消化系统的影响，用放射地４９例ＨＩＥ患儿急性期及恢复期测定血清ＳＳ、ＧＡＳ、及血浆ＭＴＬ，并与２４例正常足月新生儿脐血作对照，结果显示，ＨＩＥ急性期ＳＳ、ＧＡＳ浓度明显高于正常对照组，胃纱与对照组相比有所降低，且血清ＳＳ、ＧＡＳ水平与ＨＩＥ轻重程度正相比提示新生儿ＨＩＥ时ＳＳ及胃肠激素水平的民消化系     

缺氧缺血性脑病新生儿血浆生长激素和催乳素水平变化及其临床意义

目的：探讨血浆生长激素(GH)和催乳素(PRL)在新生儿缺氧缺血性脑病(HIE)发病过程中的水平变化以及二者之间作用的相互关系。方法：采用放射免疫分析法测定54例HIE急性期、恢复期和20例对照组患儿血浆GH,PRL水平。结果：急性期中、重度HIE患儿与轻度和对照组比较,血浆GH水平明显降低,而PRL水平明显增高(P<0.01);恢复期HIE各组与对照组血浆GH,PRL水平比较差异无显著性(P>0.05);中、重度HIE患儿急性期与恢复期比较,血浆GH水平明显降低,而PRL水平明显升高(P<0.01);急性期血浆GH与PRL水平呈高度负相关(r=-0.8759,P<0.01)。结论：GH,PRL参与了新生儿HIE的发生和发展过程,急性期血浆GH,PRL水平与HIE病情程度密切相关。     

新生儿缺氧缺血性脑病脑脊液环磷酸腺苷变化及其临床意义

目的 探讨新生儿缺血缺氧性脑病(HIE)脑脊液(CSF)环磷酸腺苷(cAMP)变化及其临床意义。方法 采用法国:Immunotech公司提供的125I-cAMP放免药盒对86例HIE患儿进行脑脊液cAMP。结果 中、重度HIE组CSI-cAMP值较非HIE组明显降低,有显著差异(P<0.05);重度HIE患儿CSI-cAMP值较轻、中度患儿降低,差异具有显著性(P<0.05);恢复期较急性期CSF-cAMP值都有所升高,但无显著差异。结论 HIE时CSF-cAMP降低,病情愈重,降低愈明显。CSF-cAMP测定可作为HIE患儿判断病情的辅助指标。