Acute cholestatic hepatitis caused by amoxicillin/ clavulanate

Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used,especially for the treatment of respiratory and cutaneous infections.In general,it is a well-tolerated oral antibiotic.However,amoxicillin/clavulanate can cause adverse effects,mainly cutaneous,gastrointestinal,hepatic and hematologic,in some cases.Presented here is a case report of a 63-yearold male patient who developed cholestatic hepatitis after recent use of amoxicillin/clavulanate.After 6 wk of prolonged use of the drug,he began to show signs of cholestatic icterus and developed severe hyperbilirubinemia(total bilirubin>300 mg/L).Diagnostic investigation was conducted by ultrasonography of the upper abdomen,serum tests for infection history,laboratory screening of autoimmune diseases,nuclear magnetic resonance(NMR)of the abdomen with bile duct-NMR and transcutaneous liver biopsy guided by ultrasound.The duration of disease was approximately 4 mo,with complete resolution of symptoms and laboratory changes at the end of that time period.Specific treatment was not instituted,only a combination of anti-emetic(metoclopramide)and cholestyramine for pruritus.     

新生儿ABO溶血病相关性研究

目的 研究母婴血型、孕期血型抗体效价、胎儿性别、胎儿血型、羊水性质、脐血胆红素、脐血溶血三项实验与新生儿ABO溶血病的相关性.方法 分析我院568例ABO血型不合孕妇及其分娩的新生儿病例,根据母婴血型、是否发病来分组分析.结果 母婴血型不同组脐血血清胆红素浓度、新生儿ABO溶血病(ABO-HDN)的发生率及新生儿高胆红素血症发生率均显著高于母婴血型相同组;当孕期血型抗体效价≥1/128时,新生儿患ABO-HDN的几率明显增加;A型血的胎儿更易患新生儿溶血病,胎儿性别及羊水性质与新生儿溶血病的发生无明显相关性.结论 孕期血型抗体效价、胎儿血型、脐血胆红素和脐血溶血三项均与新生儿ABO溶血病有密切相关,根据检测结果可提前预防疾病的发生.     

广西三江县侗族新生儿UGT1A1基因变异分析北大核心CSCD

目的探讨广西柳州三江县侗族新生儿UGT1A1基因变异特点及其与侗族新生儿高胆红素血症发生的关系。方法前瞻性选取2021年1月至2022年1月于三江县人民医院新生儿科诊断不明原因高胆红素血症的新生儿84例为研究对象;另选取同期健康新生儿60例纳入健康对照组。提取两组新生儿外周血基因组DNA,对UGT1A1启动子区TATA盒和外显子1进行PCR扩增并进行基因测序。结果病例组检测出33例G71R错义突变,突变率为39%,A等位基因频率(21%)显著高于健康对照组(10%)(P<0.05)。携带G71R错义突变基因型的侗族新生儿发生高胆红素血症的风险是携带野生型的健康新生儿的2.588倍(P<0.05)。Hardy-Weinberg遗传平衡检验结果提示两组新生儿UGT1A1 G71R位点基因型符合遗传平衡(P>0.05)。结论UGT1A1 G71R突变是三江县侗族新生儿高频基因变异类型,且G71R错义突变与侗族新生儿发生高胆红素血症相关。     

换血疗法对新生儿高胆红素血症患儿心肌酶水平的影响研究

目的探讨换血疗法对新生儿高胆红素血症患儿心肌酶水平的影响。方法选取50例新生儿高胆红素血症患儿作为研究对象,所有患儿均接受换血疗法治疗。比较患儿治疗前后血胆红素水平及心肌酶水平。结果治疗后,患儿总胆红素(220.41±20.46)μmol/L、间接胆红素(206.45±16.45)μmol/L、直接胆红素(14.86±3.45)μmol/L均低于治疗前的(488.86±30.40)、(465.12±24.53)、(23.64±6.43)μmol/L,差异有统计学意义(P<0.05)。治疗后,患儿天门冬氨酸氨基转移酶(AST)为(22.53±4.12)U/L、乳酸脱氢酶(LDH)为(112.43±12.74)U/L、肌酸激酶(CK)为(42.85±10.44)U/L、肌酸激酶同工酶(CK-MB)为(14.56±4.85)U/L均低于治疗前的(63.53±8.12)、(243.56±20.41)、(211.55±25.46)、(42.58±8.46)U/L,差异有统计学意义(P<0.05)。结论换血疗法可以有效降低新生儿高胆红素血症患儿的血胆红素水平及心肌酶水平,起到保护心肌细胞的作用。     

Ethical Issues and Management of Fetal Hemolytic Anemia Caused by Anti-Rh17 in a Multipara with Rare −D– Phenotype

BackgroundThe development of allo-anti-Rh17 (anti-Hr0) in a −D– phenotype whose red blood cells (RBCs) lack CcEe antigens is most likely triggered by transfusion, transplantation, or pregnancy. Gene conversion is the predominating factor in generating RHD-CE-D and RHCE-D-CE hybrids like −D–.MethodsWe report here immunohematological and obstetrical data from 2 of the 5 pregnancies of a 24-year-old woman presenting with the −D– phenotype with anti-Rh17. Blood group typing, antibody screening, antibody differentiation, direct antiglobulin test (DAT), and antibody titers were performed by routine gel technology and tube testing. Additionally, molecular genetic analysis was performed. Fetal surveillance was done by sonographic evaluation of the fetal middle cerebral artery peak systolic velocity (MCA-PSV).ResultsBlood group typing showed O, C-c-D+E-e- and the DAT was negative. DNA sequencing revealed homozygosity for an RHCE-D(3–9)-CE null allele. Anti-Rh17 titers in the fourth pregnancy remained between 1:8 and 1:128, and no signs for a fetal anemia were observed. However, in the fifth pregnancy, the antibody titers increased up to 1:4,096. Signs of moderate fetal anemia were detected and cesarean section was performed at 34 + 6 weeks of gestation. The newborn presented with hemolytic anemia (cord blood hemoglobin [Hb] = 8.5 mg/dL). She received 2 compatible (small) packed RBC concentrates, phototherapy, and intravenous immunoglobulins.ConclusionOur case shows that the risk for hemolytic complications increases with the number of pregnancies of sensitized women. Only people who also lack CcEe antigens are compatible as donors. The role of such rare donors as lifesavers, their freedom, and voluntariness conflict with the urgent need for compatible blood.     

经皮胆红素动态监测在新生儿黄疸干预治疗中的作用

目的 探讨经皮胆红素动态监测在新生儿黄疸干预治疗中的作用.方法对962例新生儿在出生后1～7 d,每天对其进行经皮胆红素动态监测.对检测结果为阳性的患儿84例采血检测血胆红素水平,比较两种方法的阳性率,同时对高胆红素血症患儿给予枯草杆菌二联活菌颗粒治疗,观察治疗后的胆血素水平变化.结果 1～7 d新生儿经皮胆红素水平分别为（81.9±8.2）μmol/L、（181.7±32.3）μmol/L、（222.9±22.4）μmol/L、（230.6±20.5）μmol/L、（235.1±22.4）μmol/L、（233.7±21.1）μmol/L、（228.9±19.6）μmol/L,平均为（234.2±22.7）μmol/L.对84例经皮胆红素检测结果为阳性的患者儿进行血液胆红素检测,胆红素水平分别为（233.7±30.2）μmol/L、（215.5±28.7）μmol/L,两者呈直线性相关（r=2.55,P＜0.05）.干预治疗后血胆红素水平为（163.4±21.7）μmol/L,明显低于治疗前的胆红素水平（232.4±28.5）μmol/L（t=5.23,P＜0.05）.结论 经皮胆红素动态监测新生儿黄疸水平具有采样方便、操作简单的优点,对于早期发现和干预治疗新生儿黄疸意义重大.     

早期喂养降低新生儿高胆红素血症发生率的临床研究

目的：探讨早期喂养与新生儿高胆红素血症发生率的关系。方法120例足月健康新生儿随机分为观察组和对照组各60例,观察组采取混合喂养的方式达到早期足量喂养,对照组单纯母乳喂养,比较两组新生儿胎粪排出时间、大便转黄时间、高胆红素血症发生率以及胆红素水平,并观察产妇首次泌乳时间。结果观察组在胎粪排出时间、大便转黄时间上均较对照组短,高胆红素血症发生率低于对照组,差异均有统计学意义（均P＜0．05）;产妇泌乳时间差异无统计学意义（P＞0．05）。结论早期喂养尽早达到足量喂养能降低新生儿高胆红素血症发生率和严重程度,并不影响产妇泌乳。     

外周动静脉同步换血治疗新生儿溶血病的临床效果

目的探讨外周动静脉同步换血治疗新生儿溶血病的临床效果。方法本院2009年3月-2013年3月收治新生儿溶血病患儿共74例,其中30例符合换血治疗的标准,实施外周动静脉同步换血治疗,观察换血治疗前、后的血清总胆红素、非结合胆红素、结合胆红素及血生化指标水平改变情况。结果换血治疗后患儿血清总胆红素、非结合胆红素及结合胆红素水平均显效低于治疗前,差异有统计学意义（P〈0．05）。换血前后患儿血钾、血钠、血钙水平均无明显改变（P〉0．05）。结论外周动静脉同步换血治疗新生儿溶血病疗效显著,能够显著改善患儿临床症状,值得借鉴。     

NICU中新生儿重度高胆红素血症的换血治疗

目的探讨NICU中新生儿重度高胆红素血症换血治疗的应用及效果。方法选取2013年1月—2014年3月该院新生儿监护病房收治的重度高胆红素血症新生儿57例,采用外周动静脉同步换血方式进行治疗,换血中密切监测患者生命体征、血糖等指标变化,并在结束治疗后进行血常规、血生化等检查比较。结果所有患儿经换血治疗后血清总胆红素和间接胆红素等均显著下降,6例患儿出现贫血,22例患儿出现血小板减少,49例患儿出现高血糖症,无血钙、血钠及血钾异常改变。结论在新生儿重度高胆红素血症临床治疗过程中,采用外周动静脉同步换血治疗可有效降低血清胆红素,同时对患儿不良反应少,值得在临床上进行推广和应用。