五味子乙素对丙戊酸钠肝脏损伤的保护作用

目的观察五味子乙素(SchB)对丙戊酸钠诱导大鼠肝损伤的保护作用。方法 30只大鼠随机分成丙戊酸钠组、SchB加丙戊酸钠联合给药组及对照组各10只,分别给予丙戊酸钠、SchB+丙戊酸钠、生理盐水灌胃,2周后眼眶采集血液5mL,检测血清转氨酶水平。结果丙戊酸钠组血清中谷草转氨酶和谷丙转氨酶为(72.29±4.14)IU/L、(67.26±2.38)IU/L,对照组分别为(39.80±5.92)IU/L、(33.00±4.59)IU/L,两组比较,差异均有统计学意义(P0.05);丙戊酸钠加五味子乙素组谷草转氨酶和谷丙转氨酶分别为(32.29±3.68)IU/L、(34.25±5.69)IU/L,与对照组比较差异无统计学意义(P0.05);各组大鼠总蛋白、白蛋白等比较,差异无统计学意义(P0.05)。结论丙戊酸钠可造成大鼠肝功能异常,而SchB可缓解肝功能的损害,发挥保肝作用。     

儿童肺炎支原体肺炎100例临床特点分析

目的探讨肺炎支原体肺炎(MPP)患儿炎症反应指标的变化及临床意义。方法将100例MPP患儿根据病情轻重分为轻症MPP组68例和重症MPP组32例。所有患儿入院24h内测血常规、血沉、C反应蛋白;患儿经治疗后,感染恢复期复查上述指标。结果重症MPP组白细胞、血小板、血沉、C反应蛋白平均水平均高于轻症MPP组,差异均有统计学意义(P0.01);恢复期重症MPP组炎症指标异常高于轻症MPP组。结论不同病情MPP炎症反应指标不同,其可作为MPP免疫干预依据;重症MPP组炎症反应持续时间长。     

新生儿缺氧缺血性脑病398例临床分析

目的总结新生儿缺氧缺血性脑病(HIE)的临床特点及预后情况,为提高该病诊治水平总结经验。方法对398例新生儿缺氧缺血性脑病患儿住院资料进行分析总结。结果所有病例均有异常围产史,急性宫内窘迫、窒息、催产素助娩、脐带、胎位和羊水异常以及胎头吸引助娩等异常围产史为HIE常见原因;患儿在生后3d内行血尿素氮、谷丙转氨酶、谷草转氨酶、乳酸脱氢酶、α羟丁酸脱氢酶、肌酸激酶、肌酸激酶同功酶检测,中度、重度与轻度比较,差异均有统计学意义(P0.01);对305例系统治疗患儿随访观察至12个月,总预后不良率7.54%。结论加强和规范孕期保健、提高产科技术、规范新生儿窒息抢救是预防HIE防治重点;中、重度HIE多合并心、肝、肾等多脏器损害,强调综合治疗;头颅CT对HIE病情及预后判断有重要作用,早期诊断应侧重于临床表现;综合治疗、早期干预、科学连续、坚持全程治疗可明显改善中、重度HIE预后,减少神经系统后遗症。     

X线胸片呈大叶性肺炎改变的儿童肺炎支原体肺炎409例临床分析

探讨X线胸片呈大叶性肺炎改变的儿童肺炎支原体肺炎（MPP）的临床特点及诊疗转归。方法　2005年1月至2009年8月于吉林大学第一医院就诊的409例X线胸片呈大叶性肺炎改变、血肺炎支原体抗体（MP-IgM）阳性的MPP患儿,对其临床资料进行回顾性分析。结果　409例中学龄期以上发病223例（54.5%）,婴幼儿期发病95例（23.2%）。病程长,以发热（88.3%）为主要表现, 胸片检查中359例（87.8%）单侧病变,225例（55.1%）合并肺外并发症,325例（79.4％）的患儿外周血常规中白细胞计数高于正常,中性粒细胞比例 > 0.80 259例（63.3%）,单核细胞比例 > 0.08 317例（77.5%）,324例（83.7%）患儿超敏C反应蛋白（CRP）高于正常;体液培养共培养出阳性菌株162例,最常见的合并细菌感染种类为金黄色葡萄球菌及肺炎链球菌。合并细菌感染者单纯应用大环内酯类药物治疗效果欠佳,联合青霉素类或头孢类抗生素治疗后见效明显。 结论　临床需注意MPP胸片改变的多样性, 对于胸片呈大叶性改变、单纯应用大环内酯类抗生素治疗效果欠佳的MPP患儿,应高度警惕合并细菌感染,及时行相关病原学检查,联合用药效果较好。     

婴幼儿肺炎支原体肺炎50例临床特点分析

目的总结婴幼儿肺炎支原体肺炎（MPP）的发病特点,提高诊断与治疗水平。方法50例MPP患儿均给予大环内酯类抗生素序贯疗法,即低剂量红霉素20mg／（kg·d）匀速静脉滴注,疗程1周;1周后根据病情改为阿奇霉素10mg／（kg·d）,静脉滴注或口服1周;2周后给予阿奇霉素颗粒口服,服用3d停4d,总疗程3～4周。同时联合止咳、祛痰、解痉、平喘、雾化吸痰、丙种球蛋白、肾上腺糖皮质激素等综合性治疗。观察婴幼儿MPP的临床表现、辅助检查及治疗转归。结果50例婴幼儿MPP均以咳嗽起病,呈阵发性剧烈咳嗽、多伴发热、呼吸困难、呕吐、腹泻及肺外多系统损害。胸部X线片异常率远高于肺部体征阳性率,全部病例均临床治愈。结论婴幼儿剧烈咳嗽、呼吸困难、高热不退,应警惕MPP,确诊后选用大环内酯类抗生素序贯疗法效果好,值得推广。     

益气化瘀清热方治疗小儿难治性肾病临床观察

目的观察益气化瘀清热方治疗儿童难治性肾病综合征临床疗效。方法 2013年7月至2014年7月河南中医学院第一附属医院和郑州市儿童医院收治门诊和住院的难治性肾病综合征患儿60例,随机分为对照组和观察组各30例。对照组常规给予抗感染、抗凝、利尿等对症治疗,应用足量强的松(2 mg/kg)诱导缓解。观察组在对照组治疗基础上加用益气化瘀清热方加减,4周为1个疗程,共9个疗程。观察临床疗效及复发率;疗效指标:24 h尿蛋白定量、血浆白蛋白、血总胆固醇、活化部分凝血酶时间、凝血酶原时间、纤维蛋白原;安全性指标:不良反应的症状及体征,血常规,肝功能及肾功能检查。结果观察组临床总有效率为86.7%(26/30),优于对照组70.0%(21/30),差异有统计学意义(P0.05)。治疗后观察组复发率为36.7%(11/30),显著低于对照组70.0%(21/30),差异有统计学意义(P0.05)。观察组治疗后血白蛋白、活化部分凝血酶时间、凝血酶原时间高于治疗前,24 h蛋白定量、总胆固醇、纤维蛋白原低于治疗前,差异有统计学意义(P0.05);且观察组在改善以上指标方面优于对照组,差异有统计学意义(P0.05)。两组治疗前后血常规、谷丙转氨酶、谷草转氨酶、尿素氮和血肌酐方面比较差异无统计学意义(P0.05),并未发现严重不良反应。结论益气化瘀清热方可改善患儿24 h蛋白定量、血浆白蛋白、血脂及高凝血情况,减少儿童难治性肾病综合征的复发率,提高临床总有效率,临床观察未见不良反应。     

先天性结核病二例误诊探讨

例 1　男 ,16 d,足月剖宫产。以发热、纳差 7d、呼吸困难3d入院。体检 :体重 32 5 0 g,体温 39.8℃ ,呼吸 6 2次 / min,呻吟 ,口吐白沫 ,三凹征 ,双肺满布细湿音 ,心音低钝。肝肋下 6 .5 cm,脾肋下 4.5 cm。躯干部皮肤见散在少许充血性皮疹。入院当天摄 X线胸片 ,示双肺普遍密度增高影 ,呈毛玻璃状改变。诊断为葡萄球菌性肺炎。入院第 14天再次摄 X线胸片示广泛性分布均匀的斑点状密度增高影 ,X线提示粟粒性肺结核。肝功能示谷丙转氨酶 5 6 IU / L ,谷草转氨酶 2 10IU / L ,乳酸脱氢酶 990 IU/ L。肾功能正常 ,血培养阴性。临床诊断 …     

输精管结扎与实验性高血脂对兔血清酶及过氧化脂质的影响

用日本大耳白兔复制输精管结扎动物模型,术后12个月时随机分为输精管结扎基础饲料组(V-S)和输精管结扎胆固醇饲料组(V-Ch),以体重相近的同种雄兔作为对照基础饲料组(C-S)和对照胆固醇组(C-Ch)。结果表明,血清谷草转氨酶(GOT)、谷丙转氨酶(GPT)、乳酸脱氢酶(LDH),组间比较均无显著差异。血清磷酸肌酸激酶(CK)水平,V-Ch与C-Ch组明显地高于V-S、C—S组(P<0.01),主动脉脂质斑块面积在对应组间比较均无明显差异;相关检验表明,血清CK与抗精子抗体滴度无相关性,而与血清总胆固醇、过氧化脂质含量呈正相关(P<0.01,P<0.001)。     

中医辨证论治配合更昔洛韦治疗婴儿巨细胞病毒肺炎疗效观察

目的观察中医辨证论治配合更昔洛韦治疗婴儿巨细胞病毒肺炎的临床疗效。方法将95例婴儿巨细胞病毒肺炎患儿随机分为观察组48例和对照组47例。对照组给予止咳、平喘、化痰等对症治疗,更昔洛韦5mg/kg,加入5%葡萄糖(1∶1)稀释后静脉滴注,每日2次,连用14d;观察组在对照组基础上辨证运用五虎汤合葶苈大枣泻肺汤加减。14d后观察患儿症状、体征变化。结果观察组治疗后血清谷丙转氨酶、谷草转氨酶、碱性磷酸酶、谷氨酸转氨酶、血清总胆红素与直接胆红素较对照组下降更为显著,差异有统计学意义(P0.05);观察组治愈率为91.7%(44/48),显著高于对照组61.7%(29/47),差异有统计学意义(P0.05)。结论五虎汤合葶苈大枣泻肺汤加减配合更昔洛韦治疗婴儿巨细胞病毒肺炎治疗作用强,无肝功能异常,疗效显著,可在临床推广应用。     

血清脑钠肽水平与新生儿脓毒血症炎性因子及预后转归的关系

目的探讨新生儿脓毒血症的血清脑钠肽水平变化,并分析其与炎性因子C反应蛋白、白细胞介素10及肿瘤坏死因子α的关系。方法 2012年10月至2014年10月珠海市第二人民医院新生儿科收治住院的脓毒血症新生儿50例,采用Elias法检测脑钠肽、C反应蛋白、白细胞介素10及肿瘤坏死因子α水平,并观察患儿在治疗12、24、48h后水平变化,分析脓毒血症患儿血清脑钠肽与炎性因子C反应蛋白、白细胞介素10及肿瘤坏死因子α的关系,以脑钠肽≥150ng/L水平分两组进一步分析患儿预后情况。结果当脑钠肽≥150ng/L时患儿的APACHEⅡ评分为(21.36±2.68)分,死亡率达34.5%(10/29),均明显高于脑钠肽150ng/L患儿,差异有统计学意义(P0.05)。Spearman相关分析显示,血清脑钠肽与患儿C反应蛋白及肿瘤坏死因子α呈正相关(P0.01),而与白细胞介素10呈负相关(P0.01)。随着治疗时间的延长,在治疗48h后血清脑钠肽与炎性因子C反应蛋白及肿瘤坏死因子α水平明显降低,白细胞介素10水平升高,与治疗前及治疗12、24h比较差异有统计学意义(P0.05)。结论新生儿脓毒血症存在明显脑钠肽高水平,并与体内炎性因子水平及治疗时间均密切相关,提示患儿可能存在心功能不全并通过介导炎症反应促进疾病的发展。     

儿童重症肺炎支原体肺炎中D-二聚体水平的临床意义

目的 分析D-二聚体(D-D)水平对判断儿童肺炎支原体肺炎(MPP)病情严重程度的临床价值及对重症MPP(SMPP)早期识别的意义.方法 选取2018年8月至2020年12月于包头市第四医院儿科住院部收治的MPP患儿255例,其中包含SMPP患儿80例(SMPP组)及非SMPP患儿175例(非SMPP组).观察比较SM...     

Serum enzyme activities in premature infants with bronchopulmonary dysplasia

Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltranspeptidase (gamma-GT) and lactate dehydrogenase (LDH) activities were measured in 26 premature infants with bronchopulmonary dysplasia (BPD) (group 1), and in 24 premature controls, matched for gestational age and birth weight (group 2). Blood samples were taken serially on 3, 10, 20, 30 and 60 postpartum days. Group 1 and group 2 premature infants showed statistically higher LDH activities on the 3rd postpartum day. These differences disappeared later and LDH activities progressively decreased with time in both premature groups. Mean AST values of group 1 and group 2 premature infants were also significantly higher on the 3rd postpartum day. Subsequently, in all groups, AST showed a postpartal decrease, and a stabilization from the 10th day of life until the 2nd postnatal month. Mean ALT values were instead, comparable on the 3rd postnatal day and subsequently increased, although not significantly. Like the AST, gamma-GT of group 1 and group 2 premature infants were slightly more elevated on the 3rd postpartum day. The subsequent decrease was however transitory, and at 1 and 2 postnatal months a noticeable, significant progressive increase in mean values was found. It is concluded that serum ALT, AST, LDH and gamma-GT measurement of sick premature infants within the first 2 months of life are not significantly altered by the occurrence of BPD.     

Effect of labour and delivery on plasma hepatic enzymes in the newborn

OBJECTIVE: To study the relationship between cord blood hepatic enzymes and obstetric and neonatal outcome in a Chinese population. MATERIALS AND METHODS: The study group consisted of 288 low-risk Chinese women with singleton term pregnancies. The following enzymes were assayed in cord blood: lactate dehydrogenase (LDH), glutamyl transferase (GGT), aspartate aminotransferase (AST) and alanine transferase (ALT). These were correlated to maternal and neonatal characteristics. RESULTS: A strong correlation was noted between cord blood AST and LDH (R = 0.582, p < 0.01), which was absent amongst those infants delivered by elective cesarean section. LDH, AST and ALT were negatively correlated with cord arterial pH and base excess (BE). GGT was inversely related only to gestational age (R = -0.18, p < 0.01). Both LDH and AST were weakly correlated with the duration of the first and second stages of labour. LDH was most closely linked to arterial pH, whereas AST was related to both arterial BE and duration of the second stage. CONCLUSIONS: The reference values are comparable to those published for Caucasian populations. There are moderate elevations in LDH and AST associated with the onset of labour and changes in acid-base status.     

正常男性与不育者精浆酶活性比较

采用生化自动分析仪酶动力学检测了30例正常生育男子及160例男性不育症患者的精浆乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、天门冬氨酸转氡酶(AST)、磷酸肌酸激酶(CPK)活性。结果表明:正常生育组LDH 1905.0±762.2 IU/L,α-HBDH 3430.0±2287.9 IU/L,AST 619.2±130.6 IU/L,CPK 725.3±347.5 IU/L;男性不育症中无精子组LDH、α-HBDH、AST 活性与正常对照组相比有极显著减低(P<0.001);精子活动力差组(Ⅰ级)CPK 含量明显增高(P<0.01);不液化组AST 活力显著减低(P<0.001);前列腺炎组CPK 含量降低(0.05>P>0.01)。精浆中LDH、α-HBDH 活力与精子密度呈完全正相关(P<0.001);CPK 活性与精子成活率呈负相关(P<0.05)。     

5-烯丙基-7-二氟亚甲基白杨素对人卵巢癌裸鼠移植瘤生长的影响

目的:研究5-烯丙基-7-二氟亚甲基白杨素(ADFMChR)对人卵巢癌COC1裸鼠移植瘤生长的影响。方法:建立人卵巢癌COC1裸鼠皮下移植瘤模型,随机分为5组:生理盐水组、顺铂组(2mg/kg)、低剂量ADFMChR组(6mg/kg)、中剂量ADFMChR组(18mg/kg)和高剂量ADFMChR组(54mg/kg),每组4只。观察各组裸鼠移植瘤生长情况,裸鼠体重的变化,检测裸鼠血清谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)、肌酐(CRE)及外周血白细胞计数;PI染色流式细胞术(FCM)测定移植瘤细胞凋亡率。结果:ADFM-ChR有明显抑制移植瘤生长的作用,低剂量组、中剂量组和高剂量组的瘤重抑制率分别为42.86%,62.76%和77.55%。ADFMChR3种剂量组处理裸鼠的外周血白细胞数和血清谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)、肌酐(CRE)与生理盐水对照组的差异均无统计学意义(P>0.05)。PI流式细胞术结果显示ADFMChR诱导移植瘤细胞凋亡,呈剂量依赖性。结论:ADFMChR通过诱导细胞凋亡抑制人卵巢癌裸鼠移植瘤的生长。     

Abnormal liver function tests as predictors of adverse maternal outcomes in women with preeclampsia

ObjectivesTo evaluate whether (1) the absolute magnitude of liver function test values, (2) the percentage change in liver function test values over time, or (3) the rate of change in liver function test values over time predicts adverse maternal outcomes in women with preeclampsia.MethodsWe used data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study, a prospective multicentre cohort study assessing predictors of adverse maternal outcomes in women with preeclampsia. Women with at least one liver function test performed at the time of hospital admission were included. Liver functions were tested by serum concentrations of aspartate amino transferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH), albumin, total bilirubin, and the international normalized prothrombin time ratio. Parameters investigated were absolute levels, change within 48 hours of hospital admission, change from admission to delivery or outcome, and rate of change from admission to delivery or outcome of each liver function test. The ability of these parameters to predict adverse outcomes was assessed using logistic regression analyses and by calculating the receiver operating characteristic (ROC) area under the curve (AUC).ResultsOf the 2008 women, 1056 (53%) had at least one abnormal liver function test result. The odds of having an adverse maternal outcome were higher in women with any abnormal liver function test than in women with normal results. When test results were stratified into quartiles, women with results in the highest quartile (lowest quartile for albumin) were at higher risk of adverse outcomes than women in the lowest quartile for all parameters (highest for albumin). The absolute magnitude of AST, ALT, and LDH predicted adverse maternal outcomes (AST: ROC AUC 0.73 [95% CI 0.67 to 0.97]; ALT: ROC AUC 0.73 [95% CI 0.67 to 0.79]; LDH: ROC AUC 0.74 [95% CI 0.68 to 0.81]). Neither change of liver function test results, within 48 hours of admission or from admission to delivery or outcome, nor rate of change were predictive.ConclusionWe found abnormal liver function test results to be associated with an increased risk for adverse maternal outcomes. Levels of AST, ALT, and LDH were found to be modestly predictive of these outcomes.     

Hemolysis,elevated liver enzymes,and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital

Purpose: The aim was to assess outcomes for pregnancies in which hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome develops and the patient requires transfer for critical care. Materials and Methods: The cases of women with HELLP syndrome who delivered at our tertiary center or surrounding hospitals and were admitted to the intensive care between January 2007 and July 2012 were retrospectively analyzed. Results were compared for the surviving and non-surviving patients. Results: Among the 77 women with HELLP syndrome, maternal mortality rate was 14% and 24 (30%) of 81 fetuses and newborns died in the perinatal period. The most common maternal complications were disseminated intravascular coagulation (DIC) (n = 22; 29%), acute renal failure (n = 19; 25%), and postpartum hemorrhage (n = 16; 21%). Compared with surviving women, the non-surviving women had higher mean international normalized ratio (INR) (p < 0.0001); higher mean serum levels of aspartate aminotransferase (AST) (p < 0.0001); higher alanine aminotransferase (ALT) (p < 0.0001); higher lactate dehydrogenase (LDH) (p < 0.0001), and higher bilirubin (p = 0.040) levels; and lower platelet count (p = 0.005). Conclusion: DIC is a major risk factor for maternal outcome among patients with HELLP syndrome who require intensive care. Low platelet count; high AST, ALT, LDH, INR; and total bilirubin are associated with high mortality risk in this patient group. In addition, low platelet count; low fibrinogen level; prolonged activated thromboplastin time; high INR; and high total bilirubin, LDH, blood urea nitrogen, and creatinine are associated with high risk for complications in this patient group.     

胎儿感染乙型肝炎病毒的临床研究

目的　探讨临床诊断胎儿感染乙型肝炎病毒 (HBV)的方法 ,及其与各种临床因素的相互关系。方法　采用聚合酶链反应 (PCR)及斑点杂交法 ,检测 14 1例HBV携带者孕妇及其分娩的 14 4例新生儿静脉血HBVDNA、HBV标志物及肝功能。其中 4 0例新生儿同时留取脐带血及出生后 2 4～4 8h外周静脉血用于检测HBVDNA。 14 4例新生儿根据有无HBV感染分为胎儿感染组及对照组 ,比较两组新生儿的临床资料及其肝转氨酶水平。结果　 (1) 14 4例新生儿中有 33例发生宫内HBV感染(胎儿感染组 ) ,感染率为 2 2 9% ;无宫内HBV感染 111例 (对照组 )。 4 0例新生儿脐血与外周静脉血HBVDNA阳性率相比 ,脐血的假阳性率为 2 0 0 % ,其敏感性、阳性预测值分别为 10 0 0 %、80 0 %。追踪HBV携带者孕妇所分娩的新生儿出生 6～ 9个月后 ,HBVDNA持续阳性者 7例 (7/2 8) ,抗 HBs转阳率为 85 3% ;出生时HBsAg阳性者 5例 ,均于 1个月后转为阴性。 (2 )在HBeAg或HBVDNA阳性孕妇中 ,其胎儿感染率分别为 70 5 %、6 1 1% ,显著高于HBeAg或HBVDNA阴性者的 2 0 % (2 /10 0 )、0 0 %(P <0 0 1)。胎儿感染组与对照组孕妇 ,在年龄、孕周、分娩方式、出生体重、身长、出生 1分钟Apgar评分等比较 ,差异均无显著性 (P >0 10 )。 (3)胎儿感染组天     

Change in platelet count predicts eventual maternal outcome with syndrome of hemolysis,elevated liver enzymes and low platelet count

Objective : To profile the rates of change for platelets and lactate dehydrogenase (LDH) in patients with the syndrome of hemolysis, elevated liver enzymes and low platelet count (HELLP) to reflect and possibly predict disease severity. Methods : Serial determinations of the platelet count and serum LDH were analyzed retrospectively for 545 patients with HELLP syndrome and 94 severely pre-eclamptic patients. A repeated measures (mixed model) analysis of variance (ANOVA) was utilized to estimate the rates of change for LDH and platelets in each group. Results : Patients who developed class 1 or 2 HELLP syndrome exhibited a rapid deterioration in platelet count of 45-50 000/ &#119 l per day compared to 30 000/ &#119 l per day for class 3 and non-HELLP severe pre-eclampsia. For LDH, values increased at a rate of approximately 1400 IU/l per day, 600 IU/l per day, 300 IU/l per day and 200 IU/l per day for patients with classes 1, 2 and 3 and for non-HELLP severe pre-eclampsia, respectively. Conclusion : The rate of change of platelets and LDH appeared to correlate well with eventual syndrome severity and this can be used to enhance patient assessment beyond the value of a single test for either laboratory parameter.