热性惊厥患儿血清肿瘤坏死因子-α及白细胞介素-2的变化

目的　探讨热性惊厥 (FC)患儿血清肿瘤坏死因子 - α(TNF α)及白细胞介素 - 2 (IL- 2 )的临床意义。方法　将FC患儿49例分为单纯性FC(SFC) 39例和复杂性FC(CFC) 1 0例 ,并设健康对照组 50例。采用酶联免疫吸附法进行血清TNF α及IL- 2水平测定。结果　FC组血清TNF- α及IL- 2水平均高于对照组 (t=3 .70 7　P <0 .0 0 1 ;t=2 .52 0　P <0 .0 5)。CFC组血清TNF -α及IL -2高于SFC组 ,但无统计学差异。结论　免疫功能异常可能是引起FC患儿惊厥的原因之一 ,而且FC患儿血TNF- α、IL- 2水平越高 ,惊厥复发的可能性就越大。     

Immune Function of T-lymphocyte and Erythocyte in Children with Febrile Convulsion

Ｔｈｅｎｅｒｖｏｕｓｓｙｓｔｅｍｉｓｃｌｏｓｅｌｙｒｅｌａｔｅｄｔｏｔｈｅｉｍ ｍｕｎｅｓｙｓｔｅｍ .ＡｌｔｈｏｕｇｈｔｈｅｓｅｒｕｍＩｇＡｌｅｖｅｌｉｎｃｈｉｌ ｄｒｅｎｗｉｔｈｆｅｂｒｉｌｅｃｏｎｖｕｌｓｉｏｎ (ＦＣ)ｉｓｏｆｔｅｎｒｅｄｕｃｅｄ ,ａｌｔ     

高热惊厥202例

目的研究高热惊厥(FC)患儿的临床特征及预后,以减少癫和智力低下的发生。方法回顾分析202例FC患儿的临床资料,包括发病年龄特征、与发热的关系、惊厥类型、基础疾病、治疗、惊厥发作次数及复发、家族史。结果202例中首次发作年龄6个月~5岁占90.1%,其中1~3岁占61.9%;79.2%首次发作体温≥38.5℃;多为阵挛性惊厥,96.5%惊厥持续<15 min。其基础疾病以急性上呼吸道感染为主,大多预后良好,仅有少数转为癫。结论FC多发生于6个月~5岁患儿,预后多良好,其防治在于控制惊厥,积极降温,必要时预防性使用抗惊厥药物。     

Brain Natriuretic Peptide Levels in Pediatric Cancer Patients with Febrile Neutropenia

Brain natriuretic peptide (BNP) is considered as a prognostic marker in patients with sepsis, but no data are available on BNP in pediatric cancer patients with febrile neutropenia (FN). Twenty-five pediatric cancer patients with FN were included in this study. Serum BNP level was measured. The mean BNP level was 330.8 ± 765.3 pg/mL (5.9–3806 pg/mL). BNP levels of 12 patients were found over the normal level. High BNP levels were related to some conditions of the patients, and these were statistically significant (P < .05). These conditions were required erythrocyte suspension, had pneumonia, time stayed in hospital, and neutropenia time. When regression test was done, required erythrocyte suspension for anemia and had pneumonia were found to be statistically significant. In conclusion, this is one of the first studies on BNP levels in pediatric cancer patients with FN. However, further studies with large sample sizes are needed to confirm the results and provide new data about this issue.     

癫癎和热性惊厥患儿脑脊液生长抑素的变化

目的探讨癫癎(EP)和热性惊厥(FC)患儿脑脊液(CSF)生长抑素(SS)含量及其与EP和FC发病机制关系.方法采用放射免疫法(RIA)测定EP和FC患儿CSF中SS含量.结果 EP组CSF中SS水平(139.59±45.95)ng/L明显高于FC组(89.71±37.51)ng/L和对照组(77.31±37.10)ng/L(P均＜0.05);FC组CSF中SS水平(89.71±37.51)ng/L与对照组比较无显著性差异(P＞0.05);严重组EP和FC患儿CSF中SS水平与普通组比较均无显著性差异(P均＞0.05).结论SS参与EP发作,可能有致EP发作作用,而与FC的惊厥发作无关.     

癫痫和热性惊厥患儿脑脊液生长抑素的变化

目的探讨癞痫(EP)和热性惊厥(FC)患儿脑脊液(CSF)生长抑素(SS)含量及其与EP和FC发病机制关系。方法采用放射免疫法(RIA)测定EP和FC患儿CSF中SS含量。结果EP组CSF中SS水平(139.59±45.95)ng/L明显高于FC组(89.71±37.51)ng/L和对照组(77.31±37.10)ng/L(P均<0 05);FC组CSF中sS水平(89 71±37 51)ng/L与对照组比较无显著性差异(P>0.05);严重组EP和FC患儿CSF中SS水平与普通组比较均无显著性差异(P均>0.05)。结论SS参与EP发作,可能有致EP发作作用,而与FC的惊厥发作无关。     

Mean Platelet Volume as a Negative Marker of Inflammation in Children with Rotavirus Gastroenteritis

Objective: Mean platelet volume (MPV) is a determinant of inflammation. The aim of the present study was to investigate the MPV levels in children with rotavirus gastroenteritis and to evaluate the possible relationship between MPV and severity of gastroenteritis. Methods: Children diagnosed with acute rotavirus gastroenteritis and healthy controls were enrolled in this study. Patients were classified into three disease severity groups based on their Vesikari score (<7 mild, 7-10 moderate and >11 severe). Rotavirus was determined in fresh stool samples using ELISA test. Leukocyte and platelet counts, MPV and C-reactive protein (CRP) levels were assessed for all children. Findings: A total of 151 patients with rotavirus gastroenteritis (mean age 2.41± 0.14 years) and 80 healthy controls (mean age 2.63±0.22 years, P=0.129) were enrolled. MPV levels of children with rotavirus gastroenteritis were significantly lower than those of healthy peers (7.48±0.04 vs 7.79±0.07 fl, P=0.000). MPV levels were not significantly different among three gastroenteritis groups. Gastroenteritis score was positively correlated with leukocyte (r=0.670, P<0.01) and platelet count (r=0.159, P<0.05) and CRP level (r=0.256, P<0.01) in patients group. MPV was inversely correlated with platelet count. There was no significant correlation between MPV and gastroenteritis score. Conclusion: MPV levels were significantly lower in children with rotavirus gastroenteritis compared to controls. MPV can be used as a negative acute phase reactant in children with rotavirus gastroenteritis.Key Words: Child, Gastroenteritis, Inflammation, Mean Platelet Volume, Rotavirus     

Aortic Intima-Media Thickness and Mean Platelet Volume in Children With Type 1 Diabetes Mellitus

Background:

Diabetes mellitus type 1 is the most common endocrine metabolic disorder occurring in childhood and adolescence due to the autoimmune destruction of pancreatic beta cells as a result of various environmental factors interacting with an underlying genetic predisposition. Diabetes is a risk factor for early onset atherosclerosis, and the high mortality rate seen in these patients is partially related to cardiovascular diseases.

Objectives:

This study was conducted to compare mean platelet volume as a marker of early atherosclerosis with aortic intima-media thickness in children with type 1 diabetes and to identify its correlation with known cardiovascular risk factors.

Patients and Methods:

The study included 27 patients between age range of 6 and 17 years that were diagnosed with type 1 diabetes and 30 healthy children of the same age range who did not have any chronic disease. In both groups, we used the color Doppler ultrasound to measure children’s aortic intima-media thickness and identify their mean platelet volumes.

Results:

There was no significant difference between the groups regarding gender distribution, age, High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL) cholesterol levels (P > 0.05). Also no significant difference could be documented between the patient and control groups regarding the aortic intima-media thickness and mean platelet volume (P > 0.05). However, there was a significant correlation between aortic intima-media thickness and mean platelet volume (r = 0.351; P < 0.05).

Conclusions:

In the present study, there was no evidence of early atherosclerosis in children with type 1 diabetes. However, mean platelet volume having a significant correlation with aortic intima-media thickness may be useful as an early marker of atherosclerosis.     

热性惊厥的治疗和预后

热性惊厥（FS）是小儿最常见的惊厥之一，绝大多数预后良好。多数学者认为，发热时间歇性应用地西泮能降低FS复发率，但不能改善患儿的远期预后；对复杂型FS或频繁FS使用间歇短程预防性治疗无效者，可长期日服抗癫痫药物预防发作；FS患儿若仅有脑电图（EEG）异常放电（临床没有FS复发或发生癫痫的危险因素），不能作为间歇或长期口服抗癫痫药的指征；FS与某些癫痫综合征存在遗传学联系，早期不易与婴儿严重肌阵挛癫痫鉴别，需长期随访。     

Serum Interleukin-6 Levels in Children with Febrile Seizures

Objectives

To compare levels of Interleukin-6 (IL-6) in children with febrile seizures and febrile controls.

Methods

Study conducted in a tertiary-care hospital in Northern India from November 2013 to April 2015, enrolling 160 children (80 each with febrile seizures and febrile controls), aged 6–60 months. Serum IL-6 estimated by ELISA method. Iron study done as per standard technique. All the cases of febrile seizure were followed up at 1 week, 3 months and 6 months for recurrence of seizures.

Results

The mean serum IL-6 levels in children with febrile seizures was 62.0 (63.9) pg/mL and febrile controls was 86.9 (70.6) pg/mL (P=0.025).

Conclusion

Serum IL-6 levels were significantly lower in children with febrile seizures as compared to febrile controls.

     

Association of Serum Soluble Triggering Receptor Expressed on Myeloid Cells Levels in Malignant Febrile Neutropenic Patients with Bacteremia and Fungemia

Objective

Infections are the major cause of morbidity and mortality in febrile neutropenic patients with malignancy. Rapid diagnostic tests are needed for prompt diagnosis and early treatment which is crucial for optimal management. We assessed the utility of soluble triggering receptor expressed on myeloid cells (sTREM-1) in the diagnosis of bacteremia and fungemia in febrile neutropenic patients.

Methods

Sixty-five febrile neutropenic children with malignancy hospitalized in Mofid Children''s Hospital during a period of one year from January 2007 were recruited for this cross sectional study (mean age 66.2± 37 months; 35 females and 30 males). Thirty patients (46.2%) had acute lymphoblastic leukemia, 2 (3.1%) acute myeloid leukemia, one (1.5%) lymphoma and 32 (49.2%) were under treatment for solid tumors. Simultaneous blood samples were collected for measurement of serum sTREM-1 levels and for blood cultures which were grown in BACTEC media. Gold standard for the presence of infection was a positive BACTEC culture as a more sensitive method compared to current blood culture techniques.

Findings

Blood cultures with BACTEC system were positive in 13(20%) patients (12 bacterial and one fungal culture). The mean serum sTREM-1 level in BACTEC positive patients was 948.2±592.9 pg/ml but in BACTEC negative cases it was 76.3±118.8 pg/ml (P<0.001). The optimal cut-off point of sTREM-1 for detecting patients with positive result of BACTEC was 525 pg/ml with sensitivity and specificity of 84.6% and 100%, respectively.

Conclusion

Our study revealed a significant association between serum sTREM-1 level and bacteremia and fungemia in febrile neutropenic patients suffering malignancy with acceptable sensitivity and specificity.     

惊厥患儿血β-内啡肽和神经元特异性烯醇化酶变化的意义

目的探讨惊厥患儿血β-内啡肽（β—EP）和神经元特异性烯醇化酶（NSE）水平变化的意义。方法选择惊厥患儿（惊厥组）62例，根据病因不同，分为病毒性脑炎（VE，16例）、癫痫（EP，22例）、热性惊厥（FC，24例）3组。依据病情分为严重组29例，普通组33例。健康对照组20例。采用放射免疫法测定各组血浆β—EP水平，采用酶联免疫法测定其血清NSE水平。结果1.惊厥各组惊厥发作24h内血浆β-EP和血清NSE水平均显著高于健康对照组（Pa〈0．01）。但3组不同病因之间比较无显著性差异（Pa〉0．05）。2．普通与严重组惊厥发作24h内血液β-EP和NSE水平均显著高于健康对照组（Pa〈0．01）。严重组β-EP和NSE水平显著高于普通组（Pa〈0．01）。惊厥发作次数越多，持续时间越长，惊厥程度越重，β-EP和NSE水平越高。3．惊厥患儿急性期血β—EP与NSE呈显著正相关（r=0．86P〈0．01）。结论惊厥发作后血液β—EP和NSE水平与脑损伤严重程度密切相关，可作为早期判断惊厥性脑损伤的客观指标之一。     

GABRG2 Gene Polymorphisms in Egyptian Children with Simple Febrile Seizures

Mutations in the gamma-aminobutyric acid type A receptor (GABRG2) gene have been associated with generalized epilepsy, childhood absence?epilepsy and febrile?seizures. In the present study the authors investigated the association of polymorphism of the GABRG2 with simple febrile seizures (FS) in Egyptian children. Polymorphism at GABRG2 (SNP211037, Asn196Asn), on chromosome 5q33 were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 100 Egyptian children with simple FS, and 120 healthy controls. The frequency of CC genotype of GABRG2 gene was significantly higher in children with simple FS compared to healthy children (p?≤?0.0001). The C allele of GABRG2 was associated with increased risk for developing simple FS (OR: 2.15. 95% CI, 1.4-3.2. p?≤?0.0001). The present findings suggested that the GABRG2 (SNP211037)-C allele could be a suitable genetic marker for prediction of susceptibility to simple FS in Egyptian children.     

高热惊厥患儿血钾、钠、氯、钙、糖变化的意义

目的探讨高热惊厥(FC)患儿血钾、钠、氯、钙、糖的变化及其临床意义。方法采用自动生化测定仪测定41例FC患儿(FC组)、30例发热患儿(发热组)和30例正常儿(正常组)的血钾、钠、氯、钙、糖水平,并进行比较分析。结果FC组血钾、钙水平与发热组之间无明显差异,但均明显低于正常儿(F=5.965,3.048 P<0.01,0.05);FC组血钠明显低于发热组和正常组;血糖则明显高于后两组(F=22.329,22.203 P均<0.001);发热组与正常组血钠、糖均无明显差异;血氯在3组间均无明显差异(F=0.867 P>0.05)。结论小儿FC存在低钾、低钠、低钙和高血糖。在常规治疗时应注意纠正电解质紊乱和高血糖等,以减少FC的复发、减轻脑组织和其他重要脏器的损害。     

高热惊厥发育期大鼠脑组织血红素氧合酶-1 mRNA表达及锌原卟啉对其影响

目的探讨锌原卟啉（ZnPP）对高热惊厥（FC）发育期大鼠血红素氧合酶（HO）-1mRNA表达的影响及作用机制。方法65只21日龄Wistar大鼠,随机分为对照组、高热未惊厥组、FC组及ZnPP治疗组。采用热水浴（每次5min,隔日1次,共10次）诱导FC大鼠动物模型;ZnPP治疗组于制备FC模型前腹腔注射ZnPP45μmol/kg。取大鼠脑组织制作冷冻切片,用组织原位杂交技术观察大鼠海马CA1、CA3区和齿状回DG区HO-1mRNA表达。结果FC组大鼠海马CA1、CA3区及齿状回HO-1mRNA表达显著增强,与ZnPP治疗组、高热未惊厥组及对照组比较均有显著性差异（Pa〈0.01）。ZnPP治疗组HO-1mRNA表达显著高于高热未惊厥组及对照组（Pa〈0.01）。结论FC能引起HO-1mRNA过度表达;ZnPP能通过下调HO-1mRNA表达对FC脑损伤起保护作用。     

平均红细胞体积降低儿童的珠蛋白生成障碍贫血基因携带率

目的了解平均红细胞体积（MCV）降低儿童的珠蛋白生成障碍贫血（地贫）基因携带率。方法因上呼吸道感染和腹泻等常见儿科疾病或常规体检进行血细胞分析,检出MCV〈79fL儿童105例,进行国内常见3种缺失型α地贫基因、5种非缺失型α地贫基因和17种β地贫基因分析。结果检出携带地贫基因儿童92例,其中静止型α地贫21例,轻型α地贫46例,中间型α地贫2例,β地贫杂合子18例,β地贫杂合子复合α地贫5例。结论MCV降低的儿童地贫基因携带率极高。     

轻度胃肠炎伴婴幼儿良性惊厥在婴幼儿急性腹泻伴惊厥疾病谱中的地位及意义

目的探讨轻度胃肠炎伴婴幼儿良性惊厥(BICE)在婴幼儿急性腹泻伴惊厥疾病谱中的地位及意义。方法对2009-2011年收治的急性腹泻并有惊厥症状患儿的住院资料进行回顾性分析。结果 184例急性腹泻伴惊厥的病例中,轻度胃肠炎伴婴幼儿良性惊厥58例、热性惊厥49例、癫癎43例、病毒性脑炎19例、低钠性脑病6例、高钠性脑病5例、中毒性脑病2例、低钙惊厥2例。BICE患儿年龄为(17.47±7.90)个月,全身症状轻,脱水轻或无,惊厥多呈全面性强直或强直阵挛发作,发作持续时间短,多发生在病程前2 d;轮状病毒阳性率为65.52%;血常规、生化、脑脊液、CT/MRI、脑电图等无明显异常。BICE患儿入院后予补液治疗,在首次惊厥后给予肌注苯巴比妥,住院过程惊厥再发者立即静脉注射地西泮,均住院2～5 d治愈出院。结论 BICE为婴幼儿急性腹泻伴惊厥中的常见疾病,临床应以对症治疗为主,应避免不必要的检查和过度药物治疗。