小儿轮状病毒肠炎肠道外脏器损伤及免疫状态研究

目的 研究轮状病毒肠炎并发肠道外损伤的发生情况及影响因素,监测轮状病毒肠炎患儿免疫球蛋白和淋巴细胞亚群变化,了解轮状病毒肠炎患儿发病时免疫状态.方法 研究对象为2007年1月至2008年12月在我院住院确诊的轮状病毒肠炎患儿(观察组)64例,对照组为同期在发育儿科体检正常者18例.记录患儿临床表现的同时,采用ELISA方法检测粪便轮状病毒特异性抗原,流式细胞术进行淋巴细胞亚群分析,透色比浊法测定血清IgG、IgA、IgM,生化法检测肝功能和心肌酶谱.结果轮状病毒感染可导致肝脏、心肌、呼吸及神经系统等多脏器损害.观察组患儿丙氨酸氨基转移酶(ALT)、天冬氨酸转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-mB)活性均明显高于对照组(P<0.05);<1岁组患儿肝功能损伤发生率显著高于>1岁组(P<0.05);重型腹泻组患儿CK[(324.5±995.5)U/dl]、CK-mB[(93.8±61.5)U/dl]活性明显高于轻型者[CK(252.8±130.4)U/dl,CK-mB(59.6+32.6)U/dl],差异有显著性(P<0.05).观察组免疫球蛋白IgG[(4.46±1.56)g/L]明显低于对照组[(5.80±1.67)g/L],差异有显著性(P<0.05);淋巴细胞亚群中观察组CD4+[(29.0±4.18)%]较对照组[(38.6±3.97)%]降低,CDl9+检测结果[(38.8±3.94)%]较对照组[(23.1±7.70)%]升高,差异均有显著性(P<0.05);观察组患儿CD4+/CD8+比例倒置.结论 轮状病毒肠炎患儿可出现肠道外感染表现,以呼吸系统、肝脏、心肌及中枢神经系统受累居多;轮状病毒感染可导致体液及细胞免疫功能低下.肝功能、心肌酶谱、免疫球蛋白及淋巴细胞亚群测定对监测患儿病情变化及指导治疗有重要的临床意义.     

小儿轮状病毒肠炎肠道外脏器损伤及免疫状态研究

Objective To evaluate the parenteral complications and their risk factors and to study the immune status by detecting immunoglobulin and lymphocyte subsets in children with rotavirus enteritis. Methods Sixty-four children with rotavirus enteritis who were treated in Shengjing Hospital of China Medical University between January 2007 and December 2008(observation group) and 18 healthy chiIdren for health screening at pediatric health care center (normal control group) were reeruimd.Clinical manifestations were collected,stool specimens were detected for rotavirus using ELISA,lymphocyte subsets were detected using flow cytometer,and immunoglobulin.liver enzyme and myocardial enzyme were detected.Results Rotavirus enteritis may be complicated by parenteral complications(liver,myocardium,respiratory and nervous system).The activity of ALT,AST,LDH,CK and CK-mB were higher in observation group than that in normal control group(P<0.05).In observation group,liver injury rate in children younger than 12 months was higher than that in children older than 12 months,and the activity of CK and CK-mB were highcr in severe diarrhea cases[CK(324.5±995.5)U／dl,CK-mB(93.8 4±61.5)U／dl]than that in mild diarrhea cases [CK(252.8±130.4)U／dl,CK.mB(59.6±32.6)U／dl](P<0.05).The level of IgG was lower in observation group[(4.46±1.56)g／L]than that in control group[(5.80±1.67)g／L](P<0.05).Lymphocytes subsets study revealed that the activity of CD4+ in observation group[(29.0±4.18)％]was lower than that in control group[(38.6±3.97)％](P<0.05),the activity of CDl9+ [(38.8±3.94)％]was higher than that in control group[(23.1±7.70)％](P<0.05)and the CD4+／CD8+ ratio was reverse in observafion group.Conclusion Rotavirus enteritis may be complicated by parenteral injuries which get liver,myocardium,respiratory and nervous system involved.Children with rotavirus enteritis Call lead to low immune function.Determination of liver enzyme,myocardial enzyme,immunoglobulin and lymphocyte subsets has important clinical significance to monitoring the change of condition and guiding treatment.     

小儿轮状病毒肠炎肠道外脏器损伤及免疫状态研究

Objective To evaluate the parenteral complications and their risk factors and to study the immune status by detecting immunoglobulin and lymphocyte subsets in children with rotavirus enteritis. Methods Sixty-four children with rotavirus enteritis who were treated in Shengjing Hospital of China Medical University between January 2007 and December 2008(observation group) and 18 healthy chiIdren for health screening at pediatric health care center (normal control group) were reeruimd.Clinical manifestations were collected,stool specimens were detected for rotavirus using ELISA,lymphocyte subsets were detected using flow cytometer,and immunoglobulin.liver enzyme and myocardial enzyme were detected.Results Rotavirus enteritis may be complicated by parenteral complications(liver,myocardium,respiratory and nervous system).The activity of ALT,AST,LDH,CK and CK-mB were higher in observation group than that in normal control group(P<0.05).In observation group,liver injury rate in children younger than 12 months was higher than that in children older than 12 months,and the activity of CK and CK-mB were highcr in severe diarrhea cases[CK(324.5±995.5)U／dl,CK-mB(93.8 4±61.5)U／dl]than that in mild diarrhea cases [CK(252.8±130.4)U／dl,CK.mB(59.6±32.6)U／dl](P<0.05).The level of IgG was lower in observation group[(4.46±1.56)g／L]than that in control group[(5.80±1.67)g／L](P<0.05).Lymphocytes subsets study revealed that the activity of CD4+ in observation group[(29.0±4.18)％]was lower than that in control group[(38.6±3.97)％](P<0.05),the activity of CDl9+ [(38.8±3.94)％]was higher than that in control group[(23.1±7.70)％](P<0.05)and the CD4+／CD8+ ratio was reverse in observafion group.Conclusion Rotavirus enteritis may be complicated by parenteral injuries which get liver,myocardium,respiratory and nervous system involved.Children with rotavirus enteritis Call lead to low immune function.Determination of liver enzyme,myocardial enzyme,immunoglobulin and lymphocyte subsets has important clinical significance to monitoring the change of condition and guiding treatment.     

手足口病患儿的免疫功能

目的 研究手足口病(HFMD)患儿免疫功能状况,探讨其在HFMD发病机制中的作用.方法 选取重型HFMD患儿30例作为观察组,另选取同期在本院保健科体检的健康儿童30例作为健康对照组.采集二组儿童清晨空腹静脉血标本4 mL,采用免疫酶法检测二组外周血T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+水平,采用散色比浊法测定二组血清IgG、IgA、IgM水平.结果1.观察组CD4+、CD4+/CD8+分别为(40.63±3.63)％、(1.51±0.25)％,IgA为(0.78±0.39)g·L-1,明显低于健康对照组,差异均有统计学意义(Pa＜0.01).2.观察组CD8+为(27.20±2.57)％,IgM为(1.53±0.44)g·L-1,明显高于健康对照组,差异均有统计学意义(Pa＜0.01).3.观察组CD3+为(67.90±2.62)％,IgG为(9.28±2.16) g·L-1,与健康对照组比较差异均无统计学意义(Pa＞0.05).结论 机体的免疫功能受抑制参与了HFMD的发病.     

婴幼儿轮状病毒性肠炎168例的肠外表现分析

目的分析婴幼儿轮状病毒性肠炎的肠外表现及可能机制，为进一步认识该疾病提供帮助。方法回顾性分析我院收治的168例确诊为轮状病毒性肠炎的病例资料。结果轮状病毒肠炎合并有肠外表现的发病率依次为心肌损害、呼吸系统、肾脏损害、肝脏损害等，住院过程给予对症治疗后均预后良好。结论轮状病毒感染不仅有胃肠道症状，还可以有其他系统的损害，虽说轮状病毒性肠炎是一种自限性疾病，但也有可能引起多系统损害，甚至衰竭，临床上不容忽视。     

轮状病毒肠炎的肠道外表现

目的 分析轮状病毒（RV）肠炎的肠道外表现。方法 对155例RV肠炎患儿的临床资料进行回顾性分析。结果 RV肠炎的同时，出现呼吸系统表现，88例并鼻塞，流涕，咳嗽，气促，26例肺部闻及罗音，肺炎6例，支气管炎34例。神经系统表现抽搐6例，前囟隆起1例。5例伴皮疹。丙氨酸转氨酶增高26例，天冬氨酸转氨酶增高89例。心肌酶谱中乳酸脱氢酶增高23例，羟丁酸脱氢酶增高13例，肌酸激酶增高104例。X线胸片检查肺纹理增粗34例，双肺斑片影6例；心电图检查：窦性心动过速38例，T波改变7例，右室高电压3例，左室高电压，室早伴室性融合波，完全性右束支传导阻滞，不完全性右束支传导阻滞各1例；脑电图1/7例异常，头颅CT检查1例示左颞叶低密度灶，1例示左侧豆状核点状钙化，脑沟略增宽等。结论 RV可发生肠道外感染，以呼吸系统和中枢神经系统受累居多，病毒血症可能是RV多系统播散的途径。     

婴幼儿轮状病毒性肠炎并心肌损害的检测

轮状病毒是婴幼儿秋季腹泻的主要病原体，其发病率和严重程度居秋冬季腹泻的首位。轮状病毒不仅可以引起肠道内感染，也能引起心肌损害，为此，笔者于2003年10月～2004年5月对我院收治的108例轮状病毒性肠炎患儿检测其心肌酶及其同工酶，并与同期53例其他病因引起的腹泻患儿进行对比分析，现报告如下。     

婴幼儿轮状病毒性肠炎140例发病特点分析

目的 了解2002—2003年肠道门诊轮状病毒性肠炎的发病特点。方法 对2002年1月～2003年12月在肠道门诊就诊的急性腹泻患儿粪便标本进行常规检查、大便潜血检查、轮状病毒检测和细菌培养,并对1岁以下的患儿进行喂养情况的调查。结果 轮状病毒性肠炎2002年感染率为21．74％,2003年感染率为27．11％,2a总感染率为24．91％,2岁以内婴幼儿发病率高,10～12月份为发病高峰,同时合并条件致病菌生长率为23．88％;1岁以内婴儿腹泻程度母乳喂养组与人工喂养组之间比较差异有统计学意义。结论 轮状病毒仍是秋冬季婴幼儿急性腹泻的主要病原之一,母乳喂养婴儿轮状病毒肠炎腹泻的程度相对较轻;轮状病毒腹泻时存在菌群紊乱,应以调节肠道菌群和对症处理为主要治疗手段,避免滥用抗生素。     

乐清地区小儿轮状病毒肠炎的临床分析

目的探讨乐清地区轮状病毒感染及其肠道外损害情况。方法对2011年10月至2013年1月在本院住院治疗的287例急性轮状病毒肠炎患儿通过粪便检测进行前瞻性研究。结果轮状病毒感染以秋冬季节多发,287例患儿中,发生肠道外损害共223例（77．7％）,心肌损害175例（60．80％）,呼吸道损害78例（27．18％）,肝功能损害51例（17．77％）,惊厥21例（7．31％）。代谢性酸中毒48例,合并心肌损害39例（81．25％）,非代谢性酸中毒239例,合并心肌损害136例（56．90％）。轮状病毒感染发生缺铁性贫血123例,其中发生惊厥15例（12．19％）,无贫血者发生惊厥6例（3．65％）,惊厥发生率两者差异有统计学意义（P〈0．01）。缺铁性贫血患儿惊厥的构成比（12．19％）与非缺铁性贫血患儿（3．65％）比较差异有统计学意义（P〈0．01）。结论轮状病毒腹泻可导致肠道外功能损害,应引起临床重视。     

轮状病毒肠炎124例患儿肠道分泌型免疫球蛋白水平变化

目的 探讨轮状病毒(RV)性肠炎患儿肠道分泌型免疫球蛋白(SIgA)的分泌情况。方法 通过放射免疫分析法检测2002年7月~2003年7月124例RV肠炎患儿粪便中SIgA含量。采用SPSS 8.0统计软件比较观察组与对照组均值。结果 各病程日粪便标本SIgA含量均较对照组增高,肠炎d1、2、3、5 SIgA含量与对照组无显著性差异(P>0.05)。d4、6、7 SIgA含量较对照组显著性增高(P<0.01)。结论 RV肠炎患儿肠道排出SIgA增加,肠道局部免疫水平在d4达保护水平,d5出现顿挫,随后d6、7持续升高。     

轮状病毒肠道外感染的研究进展

近年来,不断有轮状病毒肠炎患儿在病程中出现各种肠道外脏器损伤的报道,主要见于肺、心、肝胆、肾以及神经系统的损伤,并且在部分受累器官中已找到明确的证据,提示轮状病毒可能存在新的发病机制和感染途径,但目前仍未完全清楚.     

轮状病毒肠道外感染发病机制的研究进展

轮状病毒是一种双链RNA病毒,其基因序列已经基本查明.它是引起婴幼儿严重腹泻最常见的病原体,不仅可以引起胃肠道疾病,还可导致全身各个脏器的病变,发病机制和多个因素有关.肠道外发病可能是免疫功能异常(或正常)的情况下,轮状病毒穿透胃肠道屏障通过血液播散,感染肠道外多个器官所致.     

Predictors for extraintestinal infection in Salmonella enteritis in Thailand

To identify the risks and predictors for extraintestinal Salmonella infection (ETI) in infants and children with nontyphoidal Salmonella enteritis, we performed a retrospective review of 326 infants and children with diarrhea and rectal swab cultures positive for nontyphoidal Salmonella enteritis seen at Ramathibodi Hospital between 1981 and 1983. Nineteen patients had bacteremia. The overall rate of bacteremia was 5.8% which was 24.3% of those having blood cultures taken. Salmonella typhimurium was the most common cause of ETI and the most invasive among the common serotypes causing enteritis. The clinical characteristics of the patients with high probabilities of having ETI were: younger than 6 months of age; high body temperature; and immunocompromising conditions. The observed frequency of ETI in these patients was 21.9 to 26.3% compared with 0 to 0.7% in patients without those risk factors.