Hypoproteinemia in the hemolytic-uremic syndrome of childhood

A retrospective review of admission serum protein concentration in 18 children with hemolytic-uremic syndrome (HUS) showed significantly decreased serum total protein, albumin and globulin concentrations upon adminission compared with 22 matched controls (P<0.003). One child with atypical disease without diarrhea had normal serum protein concentrations. A strongly positive correlation (P=0.006) was found between the age of HUS patients with diarrhea and their lowest total protein concentrations. In 10 children who eventually required hemodialysis, there was a significantly negative correlation (r=–0.8316,P=0.01) between the admission serum albumin and the patients' highest creatinine levels, suggesting that hypoproteinemia may be a risk factor in the development of renal failure. The pathophysiological and clinical significance of hypoproteinemia in HUS needs further investigation.     

Cytomegalovirus and <Emphasis Type="Italic">Helicobacter pylori</Emphasis> co-infection in a child with Ménétrier disease

Ménétrier disease, which is characterized by gastric rugal hypertrophy and hypoproteinemia secondary to a protein-losing gastroenteropathy, is uncommon in childhood. In this report we present the first case of Ménétrier disease in a child with co-infection of cytomegalovirus (CMV) and Helicobacter pylori (H. pylori).     

Segmental dilatation of the ileum accompanying hypoproteinemia

Purpose

Segmental intestinal dilatation (SID) is a rare pathologic finding, which causes intestinal obstruction in newborn period and gastrointestinal bleeding, anemia, abdominal pain, malabsorption, and growth failure in older children. We present a case of SID causing hypoproteinemia.

Patient

A 10-year-old girl presented with recurrent abdominal distension since she was 8.5 months old. She was diagnosed to have protein-losing intestinal lymphangiectasia. Result of physical examination was normal except moderate growth retardation. Her blood workup showed depletion in total protein, albumin, and globulin levels. Gastrointestinal series revealed a dilated segment of small intestine, and Tc^99m-pertechnetate scintigraphy detected ectopic activity in abdomen. The patient was taken to operation with the presumptive diagnosis of intestinal duplication. A dilated segment of ileum was encountered, and segmental resection and anastomosis were performed.

Results

Patient was discharged on the postoperative fourth day and remains well. Histopathologic examination of the specimen revealed SID.

Discussion

Segmental intestinal dilatation is an uncommon congenital anomaly. Most of the cases were operated on in newborn period because of intestinal obstruction, and their diagnoses were made perioperatively; the others were diagnosed in older ages during the investigation of nonspecific symptoms. The index patient is the second case of SID having hypoproteinemia in the literature. Gastrointestinal series suggested the diagnosis, and segmental resection and anastomosis were the adequate treatments.     

危重患者术后血浆蛋白和免疫功能的变化及重组人生长激素的治疗作用

目的 观察外科危重患者术后血浆蛋白和免疫功能变化及重组人生长激素（rhGH）的治疗作用。方法 将45例外科危重患者术后随机分为对照组30例和rhGH组15例。两组患者术后治病和营养支持方案相同。rhGH组术后48h开始加用rhGH8U／d肌注,连续7d。观察两组患者血浆蛋白浓度、细胞免疫、体液免疫功能变化及临床结果。结果 两组患者术后血清转铁蛋白、前白蛋白、白蛋白水平;CD3、VD4、VD8、NK活性及CD4／CD8比值均用于正常。rhGH组使用rhGH后第4天血清前白蛋白浓度明显高于治疗前和对照组（P＜0．05）,使用rhGH后第8天血清转铁蛋白、前白蛋白、白蛋白浓度均显著高于对照组（P＜0．05,P＜0．01,P＜0．05）,CD4、NK活性及CD4／CD8比值均明显高于对照组（P＜0．05,P＜0．01,P＜0．05）。结论 术后营养支持加rhGH迅速改善外科危重患者的营养状况和免疫功能。     

肝癌肝切除术后持续低蛋白血症的相关因素分析

目的 探讨影响原发性肝细胞癌(HCC)肝切除术后持续低蛋白血症的因素.方法 回顾性分析2007年3月至2010年7月川北医学院附属医院收治的行肝切除术的88例HCC患者的临床资料.用Logistic同归模型对肝切除术后持续低蛋白血症发生的相关因素进行单因素和多因素分析.应用ROC曲线评估术后持续低蛋白血症发生的风险,并作风险等级划分.结果 共有17例患者术后持续低蛋白血症.单因素分析结果显示,腹腔积液、Child分级、肿瘤直径、术中出血量及输血量、术前ALP及Hb、术前WBC≥10×109/L、术前AST等于或高于正常值2倍以及肝门阻断等与术后持续低蛋白血症的发生相关( OR=2.592,5.154,6.848,2.249,3.336,5.296,0.285,15.000,3.281,1.716,P＜0.05).多因素分析结果显示肿瘤直径、术前Hb、肝门阻断是影响患者术后是否发生持续低蛋白血症的独立危险因素(Wald=9.326,6.151,4.253,P＜0.05).不同风险等级的患者术后持续低蛋白血症的发生率差异有统计学意义(x2=18.607,P＜0.05).结论 术前纠正贫血、术中尽量采用半肝阻断能减少术后持续低蛋白血症发生的风险.     

脓毒症患儿低蛋白血症与降钙素原的相关性研究

目的探讨脓毒症患儿低蛋白血症与降钙素原(procalcitonin,PCT)的相关性。方法将52例确诊为脓毒症的患儿分为严重脓毒症和非严重脓毒症组,并以同期非脓毒症患儿30例为对照组,测定血清白蛋白水平和炎症指标PCT。根据白蛋白水平将52例患儿分为轻度低蛋白血症组、重度低蛋白血症组和白蛋白正常组,比较3组PCT的变化,并对血清白蛋白的水平与PCT进行相关性分析。结果 52例脓毒症患儿白蛋白水平明显低于对照组,严重脓毒症组白蛋白水平低于非严重脓毒症组,差异均有统计学意义(P<0.05);轻、重度低蛋白血症组PCT均高于白蛋白正常组(分别P<0.05,P<0.01),而重度低蛋白组明显高于轻度低蛋白血症组(P<0.05)。重度低蛋白组多器官功能衰竭的发生率较白蛋白正常组增高(P<0.05),血清白蛋白水平与PCT呈负相关(r=-0.291,P<0.05)。结论脓毒症患儿白蛋白水平明显降低,白蛋白水平越低,病情越重,预后越差。血清白蛋白水平与反应脓毒症的炎症指标PCT呈负相关。     

谷氨酰胺和重组生长激素强化的肠外营养对低蛋白血症的影响

目的　探讨谷氨酰胺(Gln)和重组生长激素(GH)强化的肠外营养(PN)治疗低蛋白 血症的效果。方法　将62例低蛋白血症病人随机分为A组(31例)和B组(31例),A组采用常规 的肠外营养支持14天,B组采用Gln和GH强化的肠外营养支持14天,分别观察A、B组病人血清 白蛋白的变化和病情的转归。结果　PN支持14天,A组血清蛋白虽然有升高,但无差异性;1例并 发肝功能衰竭而死亡,平均住院时间22.5天。B组血清蛋白由PN前的(36.2±3.1)g/L升至 (37.5±3.5)g/L,差异具有显著性(P<0.05)。结论　常规的肠外营养支持难以纠正低蛋白血症 而采用Gln和GH强化的肠外营养支持的方法能明显提高血清白蛋白水平,而且能改善肝功能,减 少并发症和死亡率,缩短住院时间。     

A primary intestinal lymphangiectasia patient diagnosed by capsule endoscopy and confirmed at surgery： A case report

Intestinal lymphangiectasia （IL） is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography （CT） are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination.     

肿瘤并发病原菌感染患者NLR的临床意义

目的 探讨肿瘤患者外周血象中性粒细胞与淋巴细胞数比值（NLR）对肿瘤并发病原菌感染的诊断价值。方法 回顾分析中科院合肥物质研究院肿瘤医院2014年4月至2016年1月收治的43例伴病原菌感染肿瘤患者（感染组）和43例无病原菌感染患者（非感染组）资料,统计学分析两组与健康对照组患者白细胞数（WBC）、中性粒细胞数（NEUT）、淋巴细胞数（LYMPH）、NLR、血红蛋白（Hb）及血清白蛋白（ALB）指标差异及其相关性;采用logistic二分类回归分析肿瘤并发病原菌感染危险因素;ROC曲线分析NLR对肿瘤并发病原菌感染诊断价值。结果 感染组患者的NLR高于非感染组及对照组且非感染组高于对照组,差异均有统计学意义（P=0.000）;感染组WBC及NEUT数均高于非感染组及对照组（P=0.000、P=0.001）但非感染组与对照组比较,差异无统计学意义（P=0.240、P=0.666）;感染组LYMPH、ALB及Hb均低于非感染组及对照组（P=0.000、P=0.000、P=0.003）且非感染组低于对照组（P=0.000、P=0.000、P=0.000）;肿瘤组NLR与其ALB、Hb、淋巴细胞呈负相关（r=-0.530、r=-0.216、r=-0.740,P=0.000、P=0.046、P=0.000）,与中性粒细胞正相关（r=0.604,P=0.000）;logistic回归显示,NLR升高及ALB降低是肿瘤患者合并病原菌感染独立危险因素（P=0.001、P=0.023）。ROC曲线显示,NLR的曲线下面积（AUC）为0.864（P=0.000）,当NLR取值为4.19、4.62时,NLR诊断感染敏感性为88.39%,83.7%,特异性为69.77%、74.4%,诊断价值最大;NEUT的AUC为0.647（P=0.018）;WBC对感染无诊断价值（P=0.237）。结论 NLR对肿瘤患者发生病原菌感染具有较好诊断效能;NLR与ALB、Hb有相关性。     

重度子痫前期合并低蛋白血症对妊娠结局的影响

目的：探讨重度子痫前期患者并发低蛋白血症对妊娠结局的影响。方法：选择江西省妇幼保健院住院、病情危重的重度子痫前期患者63例,依据血清白蛋白结果分为低蛋白血症组（A组）34例、非低蛋白血症组（B组）29例,记录两组发病孕周、终止妊娠时间、孕妇并发症发生率、新生儿出生体重、新生儿窒息、围生儿死亡等情况。结果：A组并发症发生率为82.2%,显著高于B组（χ^2=4.275,P〈0.05）。A组胎儿并发症发生率和死亡率为64.0%、27.5%,与B组比较差异均有统计学意义（P〈0.05）。结论：重度子痫前期合并低蛋白血症往往预示不良的母婴预后,严重影响妊娠结局,适时补充白蛋白有利于改善母儿预后。