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??Abstract??Objective??To observe the change of NT-proBNP in incomplete Kawasaki disease and study the value in the diagnosis of incomplete Kawasaki disease. Methods??From Mar. 2007 to Feb. 2009 in department of paediatrics??Provincial Clinical Medical College of Fujian Medical University??we detected the acute- and restoration-stage plasma NT-proBNP level in 36 children with typical Kawasaki disease??TKD?? and 20 with incomplete Kawasaki disease ??IKD??respectively and 30 children with respiratory tract infection and 30 healthy children?? and made a mutual comparison. Meanwhile ultrasound cardiogram examination was made in Kawasaki disease. Results??There was no statistical significance in the difference of plasma NT-proBNP between TKD group and IKD group. Acute-stage plasma NT-preBNP in TKD group and in IKD group was clearly higher than that in restoration stage and control group??respiratory tract infection group and healthy children group??. Coronary lesion in IKD group was significantly higher than that in TKD. Conclusion??The plasma NT-proBNP can be used as a reference index in early diagnosis of IKD.     

Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment

Clinical, laboratory, and echocardiographic data were retrospectively analyzed in 112 patients with acute Kawasaki disease who received high-dose (2 g/kg) intravenous gamma-globulin (IVIG) treatment within 2 days and were compared for those who were responsive and non-responsive to initial IVIG treatment. Coronary arteries adjusted for body surface area (BSA) were evaluated quantitatively by comparison with the mean dimensions for 85 normal control subjects. The incidence of coronary abnormalities was higher in IVIG-non-responsive patients as compared to IVIG-responsive patients (71% versus 5%, p<0.0001). Univariate analysis of pre-IVIG data showed that the neutrophil count and serum levels of C-reactive protein (CRP), total bilirubin (TB), aspartate aminotransferase (AST), alanine aminotransferase, and lactate dehydrogenase (LDH) were significantly higher in IVIG-non-responsive versus responsive patients. Multivariate analysis selected CRP (p=0.009), TB (p<0.001), and AST (p=0.002) as independent predictors of non-responsiveness to initial IVIG treatment. By defining predictive values, patients with at least two of three predictors (CRP≥7.0 mg, TB≥0.9 mg, or AST≥200 IU/L) are considered to be non-responsive to IVIG for acute Kawasaki disease. Alternatively, more intense initial therapy may be a promising therapeutic strategy for patients who are predicted to be IVIG-non-responsive.     

Prediction of non-responsiveness to intravenous high-dose gamma-globulin therapy in patients with Kawasaki disease at onset

Children with Kawasaki disease (n = 82), treated with intravenous immune globulin (IVIG) at a high dose, were classified as IVIG-responsive (defervescence within 5 days of starting IVIG, n = 69) or IVIG-non-responsive (consistent fever over a 6-day period since starting IVIG, n = 13). One patient in the IVIG-responsive group had a coronary artery abnormality during the acute phase (1. 4%) versus 5 in the IVIG-non-responsive group (38.5%). Age, duration of fever before the initiation of IVIG therapy, and laboratory data obtained on admission were tested by the Mann-Whitney U test. Serum levels of C-reactive protein, total bilirubin, lactate dehydrogenase, and gamma-glutamyltranspeptidase were significantly higher (P =.002, P <.001, P <.034, and P <.038, respectively), and the hemoglobin value was significantly lower (P =.025) in patients in the non-responsive group. A multivariate analysis showed that serum levels of C-reactive protein (P =.006), lactate dehydrogenase (P =. 035), and total bilirubin (P =.046) on admission were independent correlates of the success of IVIG therapy. By defining the predictive values, patients with a C-reactive protein level >10 mg/dL, LDH level >590 IU/L, and/or hemoglobin value <10 g/dL are considered non-responsive to IVIG. Additional therapy at an early stage of the disease should be considered for patients who are predicted to be IVIG-non-responsive.     

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目的了解单次小剂量(0.4g/kg)静脉输注免疫球蛋白(IVIG)提升初发免疫性血小板减少性紫癜(ITP)患儿血小板至安全范围(≥30×109/L)的作用。方法研究对象为北京大学第一医院儿科2008-04-01—2011-04-01收治初发ITP患儿62例,其中2008-04-01—2009-10-01收治的30例为激素组,初始接受常规剂量醋酸泼尼松治疗;2009-10-02—2011-04-01就诊的32例为IVIG组,初始接受0.4g/(kg·d)IVIG治疗1～5d,每天复查血常规,血小板升至安全范围则规范停用。比较两组治疗第1、3、5天时血小板升至安全范围比例及长期随访结果。结果治疗前,激素组和IVIG组血小板中位值分别是10×109/L和6×109/L。治疗1d后两组血小板升至安全范围的比例分别是3.33%和43.75%,差异有统计学意义(P<0.01)。随访7～42个月后激素组和IVIG组分别有3.45%和3.23%血小板未升至正常(≥100×109/L)。所有患儿均无颅内出血发生及死亡。结论单次小剂量IVIG可使近半数初治ITP患儿血小板升至≥30×109/L相对安全范围,明显高于常规剂量醋酸泼尼松疗效。     

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??Objective To observe the change of different forms of osteocalcin in children with Kawasaki disease??KD?? and explore the relationship of osteocalcin with Kawasaki Disease. Methods A total of 34 hospitalized children with Kawasaki disease between March 2015 and December 2015 were selected??and all of them came from Children’s Hospital of Shanxi Province. According to the course??each child was divided into acute stage and subacute stage. At the same time??20 healthy children were chosen as the control. The levels of plasma N-MID osteocalcin and undercarboxylated osteocalcin were measured. Erythrocyte sedimentation rate??ESR?? and C-reactive protein??CRP?? were analyzed and the changes of osteocalcin??ESR and CRP were compared. Results The levels of plasma undercarboxylated osteocalcin in KD patients were significantly lower than control???14.2±0.3?? ng/mL for acute stage????14.4±0.3?? μg/L for subacute stage????16.3±0.4?? μg/L for control??P??0.01????. The levels of plasma N-MID osteocalcin in KD patients did not differ from control???27.3±0.5?? μg/L for acute stage????27.5±0.5?? μg/L for subacute stage????28.3±0.8?? μg/L for control??all P??0.05????. The levels of CRP in acute stage were significantly higher than in subacute stage???79.1±10.3??mg/L for acute stage vs.??2.7±0.5?? mg/L for subacute stage??P??0.001????. The levels of ESR in acute stage were higher than in subacute stage???58.5±4.1?? mm/h for acute stage vs. ??49.1±4.7?? mm/h for subacute stage??P??0.05????. In acute stage?? the correlation analysis showed that the levels of plasma undercarboxylated osteocalcin were negatively correlated with CRP and ESR??P??0.05??. Conclusion Plasma undercarboxylated osteocalcin might participate in the pathogenesis and development of KD. The measurement of plasma undercarboxylated osteocalcin could be valuable in the diagnosis of KD in children.     

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目的探讨儿童川崎病(KD)的临床、治疗和预后特点。方法对2000—2005年广东省中山市博爱医院儿科收治的100例KD患儿进行随访,对其临床特征、治疗方案以及预后进行回顾分析。结果 (1)临床特点:发病年龄(2.01±1.35)岁,随访年龄(8.2±1.7)岁;男女之比为1.7∶1。典型KD88例,其中再发病例2例;不完全KD12例。心血管系统并发症25例,包括冠状动脉改变22例,心包积液2例,心肌炎1例,其中一过性冠脉扩张18例,冠脉瘤形成4例;非心血管系统并发症包括肝损害34例,胆囊积液3例,麻痹性肠梗阻1例,无菌性脑膜炎3例,面神经麻痹5例,肺炎53例,尿道炎12例,关节炎6例。(2)治疗和疗效:89例病程10d内给予丙种球蛋白(IVIG)2g/kg,12例无效,需追加第2次IVIG,其中2例加用肾上腺皮质激素。11例亚急性期确诊者给予IVIG1～2g/kg,其中3例并发冠脉瘤(P<0.05)。无冠脉损害者病程6～8周停药,18例有冠脉扩张者跟踪至半年至1年后停药,3例中小型冠脉瘤者在病程1～3年停药,1例巨大冠脉瘤者服用阿司匹林至今已7年。(3)随访和预后:56例追踪随访至病程≥5年,最长10年。随访...     

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??Abstract??Objective??This study was aimed at evaluating present randomized controlled trials ??RCT?? regarding the drug therapy for intravenous immunoglobulin ??IVIG?? resistant Kawasaki disease ??KD??. Methods??According to inclusion and exclusion criteria?? articles were selected from medical electronic databases. RCT were then assessed based on the Juni assessment?? and meta-analysis was completed by the Review Manager 4.2 software. Indications to evaluate effects were the change of body temperature and change of coronary artery situation detected by ultrasound-cardiogram. The results were stated as relative risk ??RR?? or odd ratio ??OR???? with a 95% confidence interval ??CI?? and a P < 0.05 significant level. Results??In total?? three RCT were selected. Funel plot analysis showed possible publication bias. Meta-analysis of the three RCT?? including all 59 patients in the 2nd intravenous immunoglobulin treatment group and 66 patients in the glucocorticosteroid treatment control group?? indicated that after their first doses of IVIG treatment?? the temperatures of IVIG resistant KD patients who received 2nd IVIG treatment could be more effectively improved than those who received glucocorticosteroid treatment ??RR = 1.29??95% CI??1.10??1.52??P = 0.002???? but there were no differences on the incidence of coronary artery aneurysm between two groups ??OR = 0.91??95% CI??0.33??2.49??P = 0.85??. Conclusion??The Meta-analysis of currently published RCT demonstrates that the 2nd IVIG can more effectively improve the temperature than glucocorticosteroid in IVIG resistant KD patients?? but there were no differences on the incidence of coronary artery aneurysm between two groups.     

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??Objective To analyze the correlation of heart rate variability??HRV?? parameters with troponin??cTn?? and N-terminal pro-B-type natriuretic peptide??NT-proBNP?? in children with Kawasaki disease??KD??. Methods According to presence or absence of coronary artery lesion??CAL????the enrolled 118 children with KD as KD group were divided into CAL group??n??43?? and non-CAL??NCAL?? group??n??75??. Meanwhile??32 children without cardiovascular disease in convalescent period and 106 healthy children at the same term were respectively selected as non-KD group and control group. Long-term HRV parameters were detected in each group??and levels of cTn?? and NT-proBNP were detected in KD group and non-KD group. Results HRV parameters in KD group were all higher during recovery phase than those during acute phase??except for LF/HF value lower than that during acute phase ??P??0.05 or P??0.01??. HRV parameters in KD group were all lower than those in control group??except for LF/HF value higher than that in control group ??P??0.05 or P??0.01??. Each index in time domain of HRV and high frequency ??HF????low frequency ??LF?? and very low frequency ??VLF?? in CAL group were all lower than those in control group and non-KD group ??P??0.05 or P??0.01????and SDANN??SDNN and PNN50 were also lower than those in NCAL group ??P??0.01??. Besides??the LF/HF value in CAL group was higher than that in control group??non-KD group and NCAL group ??P??0.05 or P??0.01??. The levels of cTn?? and NT-proBNP in CAL group and NCAL group were significantly higher than those in non-KD group??in which the level of cTn?? in CAL group was also higher than that in NCAL group ??P??0.01??. The level of cTn?? was negatively correlated with SDNN and HF in children with KD??while positively correlated with LF/HF value ??P??0.01??. The level of NT-proBNP had a significantly negative correlation with SDANN??SDNN and HF ??P??0.01??. Conclusion The heart autonomic nervous function is damaged in children with KD. HRV parameters have a certain clinical value for assessment of CAL in children with KD.     

大剂量静脉注射丙种球蛋白无反应性川崎病的临床分析

目的 探讨对大剂量静脉注射丙种球蛋白(IVIG)无反应性川崎病的发生率及临床特点,以及再治疗方案的选择.方法 回顾性总结2000年1月至2006年12月入院的KD患儿的临床资料,根据对首次大剂量IVIG有无反应分成IVIG敏感组和无反应组,比较两组的临床特点.结果 诊断为川崎病并接受IVIG治疗患儿222例,其中IVIG敏感者185例,无反应者37例,发生率16.67%(37/222).无反应组接受IVIG治疗时间早,发热时间长,住院时间长,白细胞总数、中性粒细胞比值、CRP明显高于敏感组,而血浆白蛋白明显低于敏感组.IVIG无反应组合并冠状动脉病变14例(37.84%),明显高于IVIG敏感组(15.68%).IVIG无反应组合并噬血细胞综合征2例,多发性冠状动脉瘤及心肌梗死者1例,多脏器功能衰竭死亡1例.对IVIG无反应者的冉治疗,给予IVIG追加疗法,甲基泼尼松龙冲击治疗,泼尼松口服治疗.结论 IVIG无反应性川崎病较IVIG敏感性川崎病更易发生冠状动脉病变和严重并发症;接受IVIG治疗时间、发热时间、中性粒细胞比值、CRP、血浆白蛋白是IVIG无反应的危险因素.对IVIG无反应性川崎病可以用IVIG追加治疗,无效者选用糖皮质激素.     

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??Objective To detect the serum levels of soluble triggering receptor expressed on myeloid cells-1??sTREM-1??so as to investigate the significance of sTREM-1 in small infants with infectious diseases. Methods All subjects were infants aged 7 d ~3 m hospitalized from January 1??2011 to December 31??2011.Ninety-four patients were enrolled .According to the results of the pathogens the patients were divided into three groups?? 32 with bacterial infection?? 30 with viral infection and 32 controls without infection. Blood samples were collected from the enrolled patients hospitalized in 12 hours .At convalescence and recovery time the blood samples were collected from the bacterial infection patients. Serum sTREM-1 was measured by ELISA??enzyme-linked immunosorbent assay??. The data were analyzed by Paired T test and Single factor analysis of variance. Results The levels of serum sTREM-1 in acute phase in patients of three groups were as follows?? the mean level was ??240.20 ± 120.25??pg/mL in bacterial infection group?? viral infection group ??81.26 ± 13.83??pg/mL?? no-infection group ??69.42 ± 23.69??pg/mL. The bacterial infection group had higher sTREM-1 level than viral infection group and no-infection group. The difference was of statistical significance. The viral infection group had higher sTREM-1 level than no-infection group. The difference was of no statistical significance. The levels of serum sTREM-1 in acute phase?? convalescent phase?? recovery phase were as follows?? sTREM-1 level in acute phase??240.2 ± 120.25 pg/mL??was higher than convalescent and recovery phase??118.92 ± 59.74?? 73.59 ± 35.49 pg/mL??.The difference was of statistical significance. The level of serum sTREM-1 in recovery phase in bacterial infection group was ??73.59 ± 35.49 pg/ml????the level in no-infection group??69.42 ± 23.69 pg/mL??.The difference was of no statistical significance. The level of serum sTREM-1??Gram-positive bacterial infection??202.54 ± 107.14 pg/mL??and Gram-negative bacterial infection??210.36 ± 120.93 pg/mL????the difference was of no statistical significance. Serum level of sTREM - 1 to distinguish between bacterial infection and virus infection or are infected area under ROC curve for 0.983 ??95% CI 0.96 1.00???? higher than other markers CRP 0.947 ??95% CI0.883??1.01???? WBC 0.747 ??95% CI0.631??0.864???? PCT 0.950 ??95% CI0.907??0.994?? .Conclusion The sTREM-1 has high expression level in serum in infantile bacterial infection. The sTREM-1 is higher in bacterial infection group than that in viral infection group and no-infection group. The sTREM-1 declines with the recovery of the bacterial infection. There is significant difference according to the infection severity. This suggests it may be an index to bacterial infection diagnosis and evaluation of the severity of infection.