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.     

轮状病毒肠道外感染与血清甘露聚糖结合蛋白水平的关系研究

Objective To explore the relationship between extraintestinal rotavirus infections and serum MBP levels. Methods Serum MBP levels were measured by double-antibody sandwich enzyme-linked immunosorbent assays (ELISA) in children including extraintestinal rotavirus infections (n = 76) and common rotavirus enteritis ( n = 63 ) during the acute and convalescence phases. A group of healthy children ( n =50) were recruited as control. Results MBP levels were significantly lower in patients with extraintestinal rotavirus infections( 176.35 ± 113.12 ) μg/L in acute phases than those in patients with common rotavirus enteritis (392. 27 ± 128.96) μg/L and healthy control group(676. 25 ± 248. 63) μg/L, and the difference was significant (P ＜0. 001 ). The serum MBP levels in convalescence phases in the group of extraintestinal rotavirus infections( 358.63 ± 106. 54 ) μg/L was lower than those in the group of common rotavirus enteritis (558. 49 ± 173. 24 ) μg/L and the healthy controls, and their difference was significant ( P ＜ 0. 001 ). The MBP levels in the acute phases among pneumonia group, hepatic lesion group, cardiac damage group and central nervous system damage group caused by rotavirus infection were ( 198.24 ± 126.47) μg/L, ( 169.34 ±124. 38) μg/L,( 184. 62 ± 123.64) μg/L, ( 180. 74 ± 126. 86) μg/L, respectively. The difference among those groups was not significant ( P ＞ 0. 05 ). Conclusion Patients with extraintestinal rotavirus infections showed significantly lower MBP levels during acute and convalescence phases than patients with common rotavirus enteritis. But MBP levels showed no significant differences among those groups of patients with different extraintestinal organ damage caused by rotavirus infection. Lower MBP levels may be associated with the increased susceptibility to extraintestinal rotavirus infections.     

川崎病患儿血清脑利钠肽的水平改变及其与肌钙蛋白Ⅰ的对比分析

Objective To determine the serum levels of brain natriuretie peptide(BNP)and cardiac troponin I(cTnⅠ)in children with Kawasaki disease(KD),and to assess their value in the early diagnosis of KD.Methods Serum levels of BNP and cTnI were measured in 21 KD children(KD group)and 20 healthy children as control group by enzyme-linked immunoabsorbent assay.The internal diameter of coronary artery was measured by two-dimensional eehocardiography.Results Mean serum level of BNP[(517.26±213.40)μg/L]was significantly higher than that in the control group[(37.55±7.56)μg/L](P ＜ 0.01),and cTnI level[(0.31±0.17)μg/L]was significantly higher than that of the control group[(0.13±0.04)μg/L](P ＜0.01).Among KD patients,the percentage of patients with increased BNP(100%)was significantly higher than that of increased cTnⅠ(47.7%),there was significant difference(P ＜ 0.01).Serum levels of BNP and cTnⅠ in the coronary artery lesion(CAL)group were significantly higher than those in the group without coronary artery lesion(NCAL)[(719.33±221.17)μg/L vs(416.23±120.45)μg/L,(0.44±0.22)μg/L vs(0.24±0.11)μg/L,t = 3.03,2.52,P ＜ 0.05].There were no significant difference in serum BNP and cTnⅠ concentrations between the typical and incomplete KD group[(536.15±243.80)μg/L vs(515.71±208.16)μg/L,(0.33±0.21)μg/L vs(0.31±0.16)μg/L,t = 1.06,1.21,P＞0.05].Conclusion Serum levels of BNP and cTnⅠ increase significantly in the KD patients,and BNP has higher sensitivity and specificity than cTnⅠ.Serum BNP level is useful for diagnosis of KD,especially for the incomplete KD.     

Effect of lactadherin on IL-2、IL-4 and INF-γ secreted by intestinal tract of newborn rats with rotavirus infection

Objective To explore the influence of laetadherin on gut contents level of IL-2,IL-4 and IFN-γ in newborn rats with rotavirus infection.Methods Forty-five ten-day-old SD rats were randomly divided into three groups: control group(group N), rotavirus infection group(group V), rotavirus infection and lactadherin group(group VL) .All the rats were fed with formula,group V and group VL were fed with rotavirus(1 x 106) on the first day,then group VL were fed 25 mg/d lactedberin when they started diarrhea, until recovery. Gut contents samples were taken before feeding(T1), with most serious diarrhea(T2),after recovery(T3),the level of IL-2,IL-4 and IFN-γ in the gut contents were detected by ELISA. Results At time of T1 gut contents level of IL-2,IL-4 and IFN-γ were no statistically significant differences.Gut contents level of IL-2 and INF-γ were higher in group N[(348.84± 45.44) pg/ml, (33.95 ± 5.76) pg/ml] than those in group V[(97.97 ± 7.22) pg/ml, (25.00 ± 8.32)pg/ml] and group VL[(70.00 ± 8.27)pg/ml, (20.53 ± 2.10) pg/ml] at time of T2(P < 0.05). At time of T3 gut contents level of IL-2 and INF-γ, were higher in group VL than those in group V[(369.83 ± 36.83)pg/ml, (42.59 ± 7.54) pg/ml vs. (293.59 ± 45.64) pg/ml, (31.35 ± 3.63)pg/ml, P < 0.05], but the differences between group VL and group N were not statistically significant. Conclusions Lactadherin could boost gut contents levd of IL-2 and INF-γ in rats with rotavirus inretctiom, it plays a certain positive role on anti-rotavirus infection.     

乳凝集素对轮状病毒感染新生大鼠肠道分泌IL-2、IL-4及INF-γ的影响

Objective To explore the influence of laetadherin on gut contents level of IL-2,IL-4 and IFN-γ in newborn rats with rotavirus infection.Methods Forty-five ten-day-old SD rats were randomly divided into three groups: control group(group N), rotavirus infection group(group V), rotavirus infection and lactadherin group(group VL) .All the rats were fed with formula,group V and group VL were fed with rotavirus(1 x 106) on the first day,then group VL were fed 25 mg/d lactedberin when they started diarrhea, until recovery. Gut contents samples were taken before feeding(T1), with most serious diarrhea(T2),after recovery(T3),the level of IL-2,IL-4 and IFN-γ in the gut contents were detected by ELISA. Results At time of T1 gut contents level of IL-2,IL-4 and IFN-γ were no statistically significant differences.Gut contents level of IL-2 and INF-γ were higher in group N[(348.84± 45.44) pg/ml, (33.95 ± 5.76) pg/ml] than those in group V[(97.97 ± 7.22) pg/ml, (25.00 ± 8.32)pg/ml] and group VL[(70.00 ± 8.27)pg/ml, (20.53 ± 2.10) pg/ml] at time of T2(P < 0.05). At time of T3 gut contents level of IL-2 and INF-γ, were higher in group VL than those in group V[(369.83 ± 36.83)pg/ml, (42.59 ± 7.54) pg/ml vs. (293.59 ± 45.64) pg/ml, (31.35 ± 3.63)pg/ml, P < 0.05], but the differences between group VL and group N were not statistically significant. Conclusions Lactadherin could boost gut contents levd of IL-2 and INF-γ in rats with rotavirus inretctiom, it plays a certain positive role on anti-rotavirus infection.     

痉挛型脑性瘫痪患儿下肢H反射量化痉挛的初步研究

Objective To study the changes of H reflex and its dependability to estimate spasticity of lower limbs in spastic cerebral palsy children. Methods Twenty healthy children as control group and 20 spastic cerebral palsy children with spastic lower limbs in various degree as cerebral palsy group. They were all accepted H reflex examination of electromyogrophy in both lower limhs and CSS evaluation. We analyzed the relationship between the changes of H reflex latency and CSS scores. Results In cerebral palsy group,the average H reflex latency was (19.38 ±3.15)ms. Tbe average H reflex amplitude was (3.90 ± 3.15)μV and the average H/M was 34.86 ± 17.80. In control group,the average H reflex latency was (21.15 ± 2.05)ms,the average H reflex amplitude was (2.5 ± 1.46) μV, the average H/M was 13.68 ± 7.14. The latency of H reflex in cerebral palsy group was shorter than that in control group. H reflex amplitude and H/M in cerebral palsy group was higher than that in control group. Both H reflex amplitude and H/M to CSS score of cerebral palsy group were positive with correlation of r1 = 0.554(P1 = 0.011) and r21 = 0.893 (P2 < 0.001),H/M was more related with CSS score than H reflex amplitude.Its linear regression formula was y= -29.314+ 8.384x.Conclusion H reflex of legs in spastic cerebral palsy children was more active than that in contol group. H/M was a good marker to evaluate excitability of spinal neurons.     

痉挛型脑性瘫痪患儿下肢H反射量化痉挛的初步研究

Objective To study the changes of H reflex and its dependability to estimate spasticity of lower limbs in spastic cerebral palsy children. Methods Twenty healthy children as control group and 20 spastic cerebral palsy children with spastic lower limbs in various degree as cerebral palsy group. They were all accepted H reflex examination of electromyogrophy in both lower limhs and CSS evaluation. We analyzed the relationship between the changes of H reflex latency and CSS scores. Results In cerebral palsy group,the average H reflex latency was (19.38 ±3.15)ms. Tbe average H reflex amplitude was (3.90 ± 3.15)μV and the average H/M was 34.86 ± 17.80. In control group,the average H reflex latency was (21.15 ± 2.05)ms,the average H reflex amplitude was (2.5 ± 1.46) μV, the average H/M was 13.68 ± 7.14. The latency of H reflex in cerebral palsy group was shorter than that in control group. H reflex amplitude and H/M in cerebral palsy group was higher than that in control group. Both H reflex amplitude and H/M to CSS score of cerebral palsy group were positive with correlation of r1 = 0.554(P1 = 0.011) and r21 = 0.893 (P2 < 0.001),H/M was more related with CSS score than H reflex amplitude.Its linear regression formula was y= -29.314+ 8.384x.Conclusion H reflex of legs in spastic cerebral palsy children was more active than that in contol group. H/M was a good marker to evaluate excitability of spinal neurons.     

体位引流辅助气管吸引对胎粪吸入综合征的防治效果

Objective To evaluate the effect of postural drainage assisting trachea suction on meconium aspiration syndrome. Methods Total 61 cases of asphyxia neonates with MAS who were born in our hospital from Jan,2007 to Dec,2008, were divided into control group (24 cases) and observing group( 37 cases). The neonates in control group had endotracheal suction directly after intubation. But the infant in observing group was treated with endotracheal suction after postural drainage. The amount of suction from endotracheal tube,the complication of MAS and the outcome of these newborns were evaluated. Results The total amount of meconium drainage from endotrachea in observing group was statistics significantly more than that in control group [( 2. 16 ± 1.82) ml vs ( 1.23 ± 0. 97 ) ml, P ＜ 0. 05 )]; The intubating times in observing group were statistical significantly less than that in control group[( 1.19 ± 0. 46) vs ( 1.79 ± 0. 83 ) times, P ＜0. 01 ). The incidence of complication in observing group was 8. 11% ,which was significantly lower than that in control group(29. 17% ,P ＜0. 05). There were shorter needing oxygen time [(21.30 ± 22. 38) h vs (52. 91 ±39. 20) h,P ＜0. 01]and shorter hospitalization days [(9. 24 ±3.94) d vs ( 14. 39 ±6. 49) d,P ＜0.01 )]in observing group than those in control group respectively. The mortality in control group was 4. 17%, and no death occurred in observing group. Apgar scores of the first minute was similar in both groups ( P ＞ 0. 05 ). But there was significant difference(70. 16% vs 58. 34% ,respectively;P ＜0. 05) in the fifth minute Apgar scoring of 8 ～ 10 scores between the observing group and the control group. Conclusion Postural drainage assisting endotracheal suction may remove meconium in trachea effectively, decrease the complications of MAS and shorten the oxygen days and hospitalization time.     

Expression of Toll-like receptors 3 (TLR3) on peripheral blood mononuclear cells and serum IFN-γ,TNF-α levels in children with acute rotavirus diarrhea

Objective To explore the relationship between TLR3 mRNA expression on peripheral blood mononuclear cells(PBMCs)and acute rotavirus(RV)diarrhea.Methods Sixty-one children with acute RV diarrhea served as study subject,the expression of TLR3 mRNA on PBMCs was detected by real-time fluorescence quantitative RT-PCR.the concentrations of IFN-γand TNF-α in serum were measured by the method of Enzyrme-linked immunosorbent assay(EUSA).Results The expression of TLR3 on PBMCs and the serum levels of IFN-γ and TNF-α in the serious diarrhea group were 0. 820±0.051,(33.67±12.88)Pg/ml, (62.21±14.65)pg/ml,respectively,while it were 0.717±0.040,(24.01±10.06)pg/ml,(50.99± 12.18)pg/ml in the slight diarrhea group,and 0.525±0.029,(12.52±5.19)pg/ml,(28.65±7.44)pg/ml in the control group.Compared with the control group.the expression of TLR3 on PBMCs and the serum levels of IFN-γ,TNF-α in the serious and slight diarrhea group were significantly higher(P<0.01).There were significant differences between the serious and slight diarrhea group(P<0.01).There were positive relationship between the expression of TLR3 on PBMCs and tHe serum IFN-γ,TNF-α levels(r=0.431,P< 0.05,r=0.372,P<0.05).Conclusion The expression of TLR3 on PBMCs in children with acute rotavirus dialThea iS up-regulated,TLR3 and its mediated immune response are associated with the development of acute rotavirus diarrhea.     

Expression of Toll-like receptors 3 (TLR3) on peripheral blood mononuclear cells and serum IFN-γ,TNF-α levels in children with acute rotavirus diarrhea

Objective To explore the relationship between TLR3 mRNA expression on peripheral blood mononuclear cells(PBMCs)and acute rotavirus(RV)diarrhea.Methods Sixty-one children with acute RV diarrhea served as study subject,the expression of TLR3 mRNA on PBMCs was detected by real-time fluorescence quantitative RT-PCR.the concentrations of IFN-γand TNF-α in serum were measured by the method of Enzyrme-linked immunosorbent assay(EUSA).Results The expression of TLR3 on PBMCs and the serum levels of IFN-γ and TNF-α in the serious diarrhea group were 0. 820±0.051,(33.67±12.88)Pg/ml, (62.21±14.65)pg/ml,respectively,while it were 0.717±0.040,(24.01±10.06)pg/ml,(50.99± 12.18)pg/ml in the slight diarrhea group,and 0.525±0.029,(12.52±5.19)pg/ml,(28.65±7.44)pg/ml in the control group.Compared with the control group.the expression of TLR3 on PBMCs and the serum levels of IFN-γ,TNF-α in the serious and slight diarrhea group were significantly higher(P<0.01).There were significant differences between the serious and slight diarrhea group(P<0.01).There were positive relationship between the expression of TLR3 on PBMCs and tHe serum IFN-γ,TNF-α levels(r=0.431,P< 0.05,r=0.372,P<0.05).Conclusion The expression of TLR3 on PBMCs in children with acute rotavirus dialThea iS up-regulated,TLR3 and its mediated immune response are associated with the development of acute rotavirus diarrhea.