集束化保护策略在重症手足口病诊疗中的应用效果分析

目的探讨集束化保护策略在重症手足口病患儿诊疗管理中的应用效果。方法选取广西7家三级医院和3家二级医院400例重症手足口病患儿为研究对象,按就诊顺序随机分为实验组和对照组,每组200例。两组患儿均按照卫生部制定的手足口病诊疗指南进行规范处理。实验组患儿在此基础上,通过对神经系统、呼吸及循环系统,体温、生化等进行综合评估,及时准确甄别出神经系统受累及心肺功能衰竭的危险因素,制定集束化保护策略进行诊疗管理。比较两组患儿的临床症状改善情况、生命征、生化指标、并发症发生率和死亡情况。结果实验组患儿的总病程、发热持续时间、神经系统受累持续时间、口腔疱疹愈合时间、手足皮疹愈合时间、口腔疼痛改善时间均显著短于对照组(P0.05)。干预72 h后,观察组患儿体温、心率、呼吸频率、DBP、WBC计数、血糖均显著低于对照组(P0.05)。实验组患儿的重症脑炎、肺水肿、循环衰竭发生率以及住院期间病死率均显著低于对照组(P0.05)。结论集束化保护策略的建立和实施可有效缩短重症手足口病患儿的病程,快速改善患儿的临床症状,显著改善患儿的预后,值得在临床上推广应用。     

重症手足口病患儿检测心肌酶 超敏C反应蛋白及白细胞计数的临床意义

目的：探讨手足口病患儿血清中心肌酶、超敏C反应蛋白（hs-CRP）及全血白细胞（WBC）计数的变化及临床意义。方法选取2012-06～2013-04在该院儿科收治的重症手足口病患儿38例,选取普通手足口病患儿138例,并与30例健康对照组进行以上三个项目的检测比较分析。结果重症手足口病患儿血清天门冬氨酸氨基转移酶（ AST ）活性、肌酸激酶（ CK ）活性、肌酸激酶同工酶（ CK-MB ）活性、乳酸脱氢酶（ LDH）活性、α-羟丁酸脱氢酶（α-HBDH）活性、hs-CRP浓度、WBC计数及中性粒细胞百分比均显著高于健康对照组及普通患儿组（ P＜0.05）,普通患儿组CK活性、CK-MB活性、hs-CRP浓度、WBC计数较对照组升高,差异有统计学意义（ P＜0.05）。结论联合检测心肌酶、hs-CRP及WBC计数对临床早期诊断手足口病患儿病情有较高的诊断价值。     

儿童重症手足口病动态心电图分析

目的 探讨动态心电图在重症手足口病诊疗过程中的应用价值,及其用于早期识别重症手足口病患儿,实施有效的临床干预的价值.方法 选取150例手足口病患儿,其中轻症手足口病100例,重症手足口病50例,对患者的24小时动态心电图结果进行回顾分析,比较两组患儿的心律失常情况和心率变异性的情况.结果 儿童重症手足口病24小时动态心...     

重症手足口病患儿T淋巴细胞亚群、NK细胞及细胞因子水平变化

目的 分析重症手足口病患儿外周血T淋巴细胞亚群、NK细胞及细胞因子水平变化及临床指导意义.方法 分析2018年1月—2020年4月在我院诊治的97例手足口病患儿资料,按病情分为重症组(25例),轻症组(72例);纳入同期50例健康体检儿童为对照组.检测T淋巴细胞亚群(CD3+T细胞、CD4+T细胞、CD8+T细胞)、NK细胞及细胞因子(TNF-α、IL-23、IL-22、IL-17)水平.对比上述指标在对照组、轻症组、重症组之间,重症组不同感染类型(Cox A16型、EV 71型、其他型)组间,重症组急性期组与恢复期组间及重症组预后不良组和预后良好组间的差异.分析4项细胞因子预测患儿预后的效能.结果 CD3+T细胞、CD4+T细胞、NK细胞水平从高到低均依次为对照组、轻症组、重症组,CD8+T细胞水平从低到高依次为对照组、轻症组、重症组;血清TNF-α、IL-23、IL-22、IL-17水平从低到高均依次为对照组、轻症组、重症组.组间上述指标比较差异均具有统计学意义(P均<0.05).重症组不同感染类型组间T淋巴细胞亚群、NK细胞和细胞因子水平比较,差异均无统计学意义(P均>0.05).与恢复期组相比,急性期组CD3+T细胞、CD4+T细胞、NK细胞水平更低,CD8+T细胞、TNF-α、IL-23、IL-22、IL-17水平更高,差异均具有统计学意义(P均<0.05).与预后良好组相比,预后不良组CD3+T细胞、CD4+T细胞、NK细胞水平更低,CD8+T细胞、TNF-α、IL-23、IL-22、IL-17水平更高,差异均具有统计学意义(P均<0.05).4项细胞因子联合预测不良预后敏感度为83.33％,准确度为71.43％.结论 检测外周血T淋巴细胞亚群、NK细胞和细胞因子水平有助于手足口病病情判断,可对重症手足口病患儿进行预后预测.     

手足口病患儿血清免疫球蛋白表达水平与疾病进展相关性分析

目的探讨轻症和重症手足口病(hand,foot and mouth disease,HFMD)患儿血清免疫球蛋白变化与疾病进展的相关性。方法选择本院2013年6月住院的轻症和重症HFMD患儿369例,其中轻症组259例,重症组(含危重型)110例;以同期30名体检正常的健康儿童为对照组。采用免疫比浊法检测各组血清免疫球蛋白(IgA、IgG、IgM)和补体C3、C4表达水平。比较各组及重症组肠道病毒71型(enterovirus 71,EV71)感染和非EV71感染患儿、柯萨奇病毒A16(coxsackievirus A16,CoxA16)感染和EV71感染患儿的血清免疫球蛋白表达水平。结果与对照组相比,重症组IgG、IgA和IgM水平显著升高,轻症组IgM水平显著升高;与轻症组相比,重症组IgG和IgA水平显著升高;重症组EV71感染患儿IgM水平显著高于非EV71感染患儿,其IgG和IgM水平显著高于CoxA16感染患儿;各组间补体C3、C4水平比较差异均无统计学意义。结论 HFMD患儿血清免疫球蛋白表达水平存在变化,随着病情进展,血清免疫球蛋白表达水平变化更加显著。重症患儿血清免疫球蛋白表达水平显著高于轻症患儿,重症患儿中EV71感染者较CoxA16感染者血清免疫球蛋白表达水平变化更加显著。     

重症手足口病早期诊断与治疗及其预后

目的 探讨早期发现手足口病重症病例.并进行积极干预对预后的意义.方法 回顾性分析220例手足口病住院患儿中9例重症患儿的起病、进展,血液及脑脊液,心、脑电图监测指标,治疗措施及预后.统计学处理采用Pearson x2检验和t检验.结果 9例重症患儿均有神经系统受累表现.但临床表现有所不同:脑膜刺激征和(或)病理征阳性9例.伴嗜睡7例,肢体抖动乏力6例,排尿障碍3例,感觉过敏3例,自主神经功能失调2例,共济失调1例,左下肢轻瘫1例,早期肺水肿1例.在尚未出现心肺功能衰竭前进行积极救治,给予丙种球蛋白、甲泼尼龙琥珀酸钠、甘露醇以及限制液体摄人量等.结果 无一例患儿病死,1例脑脊髓炎患儿左下肢跛行,至6周恢复,1例脑干脑炎患儿随访至8周.脑电图仍持续异常但无临床症状.结论 肠道病毒71引起的重症于足口病可并发脑炎、脑膜炎、肺水肿等,在尚未发展至种经源性肺水肿时积极治疗,可降低病死率,改善预后.     

重症手足口病细胞免疫功能变化的系统评价

目的探讨系统评价方法对小儿重症手足口病细胞免疫功能变化的可行性。方法计算机检索CNKI、万方数据库、中国生物医学文献、维普、Cochrane图书馆、Medline、Pub Med、web of science、Ovid等电子资料库,对手足口病患儿的细胞免疫功能进行比较。结果共纳入42篇文献。(1)重症手足口病组CD4~+细胞、CD8~+细胞均低于普通手足口病组(P0.05),重症手足口病组与普通手足口病组患儿CD4~+细胞、CD8~+细胞均较正常对照组降低(P0.05);(2)重症手足口病组B淋巴细胞较普通手足口病组增高(P0.05),重症手足口病组与普通手足口病组患儿B淋巴细胞均较正常对照组增高(P0.05);(3)手足口病组的自然杀伤(NK)细胞与正常对照组比较差异均无统计学意义(P0.05)。结论手足口病患儿的T淋巴细胞功能处于抑制状态与手足口病的病情轻重相关联。     

手足口病患儿65例临床分析

手足口病（HFMD）多发生于婴幼儿及学龄前儿童,致死原因主要为重症脑干脑炎及神经源性肺水肿。2010年3—8月,我们共收治65例HFMD患儿,现对其临床资料进行分析。     

手足口病患儿血清IL-6、IL-10的变化及意义

目的探讨血清IL-6、IL-10变化判断手足口病患儿病情的临床价值。方法将手足口病患儿528例随机分为轻症组482例、重症组46例,对照组40例为健康查体儿童。入院第1、3、5天抽空腹静脉血,采用ELISA方法检测血清IL-6、IL-10,观察检测指标的变化,并作对比分析。结果轻症组患儿入院第1、3、5天血IL-6高于对照组、重症组（P均〈0.01）,IL-10低于重症组（P〈0.01）。重症组患儿入院第1天血清IL-10高于对照组（P〈0.01）,第3、5天血清IL-6下降,且低于对照组（P〈0.05）。结论随着病情加重,手足口病患儿IL-6降低,IL-10升高,其可作为病情判断的良好指标。     

2011年上海地区轻、重症手足口病患者肠道病毒71型分离株VP1、VP4区的基因特征分析

目的 了解2011年上海地区手足口病重症和轻症患儿中肠道病毒71型(EV71)分离株VP1、VP4区的基因特征.方法 对来自2011年重症与轻症手足口病患儿的各5株EV71分离株进行VP1、VP4全序列的RT-PCR扩增测序,并与美国国立生物技术信息中心公布的EV71 A、B、C基因型代表株进行核苷酸、氨基酸比对分析和系统进化分析.结果 轻、重症患儿的EV71分离株之间VP1基因的核苷酸同源性为96.0％～98.1％;VP4基因的核苷酸同源性为93.7％～99.5％.轻、重症患儿的EV71分离株与C基因型代表株比较接近,VP1区核苷酸同源性分别为86.9％～98.2％、87.4％o～98.5％,VP4区核苷酸同源性分别为85.5％～100.0％、84.5％～99.5％,其中与2008年安徽省阜阳市的EV71流行株(C4亚型)VP1区核苷酸同源性分别可达97.0％～98.2％、97.9％～98.5％,VP4区核苷酸同源性分别可达96.1％～100.0％、97.1％～99.5％.3例重症患儿分离株在VP1和VP4的天冬酰胺(N)282丝氨酸(S)、苏氨酸(T)7丙氨酸(A)同时发生变异.结论 2011年上海地区10例轻、重症手足口病患儿中分离的EV71流行株均属C基因型的C4亚型;3例重症患儿分离株在VP1和VP4的N282S、T7A同时发生变异.     

33例重症手足口病临床分析

目的 总结重症手足口病的临床特点和治疗措施.方法 应用回顾性分析的方法 对我院2010年所收治的重症手足口病患者的相关资料进行分析.结果 重症手足口病多发生于3岁以下儿童,农村患儿多见.临床表现除皮疹外,多有发热、头痛、呕吐、肢体抖动、易惊等症状.外周血WBC总数轻度升高,血糖略高.脑脊液压力增高,多呈病毒性脑膜炎改变...     

Characterizing inflammatory markers in highly aggressive soft tissue sarcomas

The prognosis for soft tissue sarcomas (STSs) is poor, especially for highly aggressive STSs, and the details of prognostic factors are unknown. This study aimed to investigate the prognostic factors for STSs in hematologic inflammatory markers. We included 22 patients with STSs treated at our institution. The STSs were histologically classified as follows: undifferentiated pleomorphic sarcoma, 7 cases; myxofibrosarcoma, 6 cases; and malignant peripheral nerve sheath tumor, 2 cases. The average patient age was 72.06 years. The numbers of patients who underwent each procedure were as follows: wide resection, 7; wide resection and flap, 2; marginal resection, 2; wide resection and radiation, 1; additional wide resection with flap, 1; wide resection and skin graft, 1; and radiotherapy only, 1. The median follow-up period was 26 months (3–92 months). The outcomes were as follows: continuous disease free, 6 cases; no evidence of disease, 6 cases; alive with disease, 1 case; and died of disease, 2 cases. Pretreatment blood examinations for C-reactive protein (CRP) and albumin levels; neutrophil, lymphocyte, and white blood cell (WBC) counts; and neutrophil/lymphocyte (N/L) ratio were investigated and correlated with tumor size, tissue grade, and maximum standardized uptake value (SUVmax). CRP level and neutrophil and WBC counts were positively correlated with tissue grade and SUVmax. N/L ratio was positively correlated with tumor size and SUVmax. CRP level, WBC and neutrophil counts, and N/L ratio may be poor prognostic factors for highly aggressive STSs.     

神经元特异性烯醇化酶对手足口病重症病例诊断的临床意义

目的探讨手足口病(hand foot and mouth disease,HFMD)患儿的血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)水平对重症病例诊断的临床意义。方法收集2011年4月—2012年11月在本院儿内科治疗的320例HFMD患儿的临床资料,按临床表现分为轻症组(235例)和重症组(85例);按血清EV71抗体检测结果分为阳性组(89例)和阴性组(231例)。同时以在本院保健科体检的75名健康儿童为对照组,应用电化学发光法测定血清NSE水平。比较分析HFMD组和对照组、EV71抗体阳性组和阴性组、轻症组和重症组、HFMD并发颅内感染发病期和恢复期的NSE水平。结果血清NSE水平比较,HFMD组高于对照组;EV71抗体阳性组明显高于阴性组;重症组明显高于轻症组;重症颅内感染患儿发病期高于恢复期(P均0.05)。结论 HFMD患儿血清NSE水平升高,尤以EV71抗体阳性组最为明显。NSE水平越高,病情相对越重。NSE水平不仅是反应HFMD病程的可靠指标,也是判断病情加重趋势的有效指标。     

腺病毒性脑炎患儿23例的临床分析

目的:探讨腺病毒性脑炎患儿的临床特点,为临床诊治腺病毒性脑炎提供参考。方法:收集2012年1月至2020年12月因怀疑中枢神经系统感染而入住汕头大学医学院第二附属医院患儿的1 185份脑脊液标本,针对22种常见呼吸道病原体和脑炎常见病原体进行聚合酶链反应检测,收集腺病毒核酸检测阳性病例的临床表现、实验室检查和影像学结果...     

Eosinophil counts and plasma fibrinogen in patients with vasospastic angina pectoris

Epidemiologic studies have suggested a relation between white blood cell (WBC) counts and the incidence of coronary heart disease. However, the relation between vasospastic angina pectoris (VAP) and WBC counts remains to be elucidated. To clarify the relation between differential and WBC counts in VAP, we compared the hematologic values, blood chemical values, plasma fibrinogen levels, C-reactive protein levels, and coronary risk factors in patients with spontaneous attacks of VAP (n = 39) with those in patients with stable effort angina pectoris (EAP, n = 35) and in control subjects (n = 19). Patients with VAP were further divided into mild VAP (n = 22) and severe VAP groups (n = 17). There were no differences in the coronary risk factors, body temperature, total WBC counts, and C-reactive protein levels among the control, EAP, mild VAP, and severe VAP groups, except that the high-density lipoprotein cholesterol in the EAP group was significantly lower than that in the control group (p <0.01). In contrast, the eosinophil counts were significantly higher in the severe VAP group than in the other 3 groups (p <0.01). Plasma fibrinogen levels were also significantly higher in the severe VAP group than in the other 3 groups (p <0.05). The follow-up study for differential and WBC counts in patients with VAP (n = 23) demonstrated that, after medical therapy, the eosinophil counts were significantly decreased to the some level as those in the control group (p <0.0001). Thus, the eosinophil counts and plasma fibrinogen levels could predict the severity of VAP. Furthermore, a follow-up study in patients with VAP suggests that coronary vasospasm could result in an increase in eosinophil counts.     

Doppler velocimetry alterations related to platelet changes in third trimester pregnancies

The aim of this study was to evaluate the correlations between the haematological parameter mean platelet volume and Doppler velocimetry parameters in order to improve clinical management in third trimester complicated pregnancies (pre-eclampsia, PE, and IUGR) affected by altered uterine resistances. Fifty-one patients were included in the abnormal uterine arteries Doppler velocimetry group (25 pregnancies were complicated by PE, 26 pregnancies were complicated by IUGR). Ninety-nine normotensive pregnant women taking no drugs for at least 2 weeks prior to testing and with no difference in gestational age at evaluation, with normal Doppler velocimetry profiles at routine screen, were used as controls. From all pregnant women, 20 mL of whole blood were obtained into citrate tubes after Doppler velocimetry evaluation and analysed for red blood cell counts (RBC), mean corpuscular volume (MCV), haemoglobin (HGB), haematocrit level (HCT), white blood cells count (WBC), platelet counts (PLT), mean platelets volume (MPV) and other biochemical parameters. From all blood parameters studied, MPV was significantly higher in women with altered uterine artery Doppler velocimetry compared with those with normal Doppler profiles (9.4 +/- 1.0 vs. 8.05 +/- 1.2 fL, P<0.001). In the group with altered uterine artery Doppler velocimetry, pregnancies complicated by PE showed a MPV value higher than pregnancies affected by IUGR (9.5 +/- 1.6 vs. 8.9 +/- 1.1, P<0.001). Finally, mean uterine arteries RI values were significantly related to MPV (fL) in both PE and IUGR groups (P<0.01, r=0.37 and P<0.01, r=0.38, respectively). Our study shows that a periodical monitoring of haematological parameters such as MPV can be associated to Doppler velocimetry in order to improve the management of pregnancies with uterine arteries Doppler velocimetry alterations.     

743例手足口病临床分析

目的了解郴州市于足口病的流行特征和临床特点,为手足口病的临床诊断、治疗及预防提供依据。方法对2008年5—8月收住院的743例临床诊断为手足口病患者资料进行回顾性分析。结果本组病例中,以1～3岁患儿居多,占59．76％,男女比例为2．27：1;发病高峰为5、6月份;均有皮疹,以手和足最常见,其次为口腔、双膝和臀部;发热是常见症状,占71．33％,以中度发热最常见;重症病例血WBC、C反应蛋白、宅腹血糖升高;近半数患儿出现血IgG或IgA下降;约1/3患儿出现心肌酶谱改变。结论该病的高发年龄为1～3岁,发病情况与儿童抵抗力低及不良卫生习惯有关,病情以轻型为主,有部分重症病例出现不同程度的并发症．但这些病例临床经过良好,预后好,现行的治疗方案有效。     

冠心病患者血浆Chemerin水平的变化及其影响因素

目的:探讨冠心病患者血浆脂肪细胞因子Chemerin的变化及其影响因素。方法:选择对照组21例,冠心病组57例。空腹抽血,测定血浆脂肪细胞因子Chemerin水平及空腹血糖、血脂、肌酐、高敏C反应蛋白等生化指标。结果:冠心病组血浆Chemerin明显高于对照组[(225.25±23.74)pg/L∶(205.13±11.02)pg/L,P<0.05]。Chemerin与冠状动脉病变支数呈正相关,r=0.368,P<0.05;与入院时心率、白细胞总数、中性粒细胞、高敏C反应蛋白、纤维蛋白原、空腹血糖、肌酐呈显著正相关,r值分别为0.595、0.596、0.609、0.442、0.485、0.546、0.669,P<0.05;与入院时收缩压水平呈负相关,r=-0.419,P<0.05。结论:冠心病患者血浆脂肪细胞因子Chemerin显著升高,且与冠状动脉病变支数、心率、血压、白细胞、中性粒细胞、高敏C反应蛋白、纤维蛋白原、空腹血糖和肌酐水平等密切相关。