Distribution and Drug Resistance Analysis of 2287 Strains of Pathogenic Bacteria in Children’s Blood Culture

Background: Bloodstream infection is a serious infectious disease. In recent years, the drug resistance of pathogenic bacteria to commonly used anti-infective drugs has been widely concerned, which also makes the treatment of bloodstream infection face severe challenges. Objective: To explore the distribution characteristics of blood culture-positive pathogens and the resistance to antibacterial drugs, so as to provide clinicians with accurate laboratory evidence, so as to guide clinicians to rationally apply antibiotics, improve clinical treatment effects, and reduce the emergence of drug-resistant strains. Methods: From January 2019 to June 2022, 2287 positive blood culture specimens of patients in Guangzhou Women and Children’s Medical Center were retrospectively analyzed, and the proportion of different pathogenic bacteria, the distribution of pathogenic bacteria in different departments, and the multi-drug resistance of different pathogenic bacteria were counted. Results: Among the 2287 blood culture positive samples, 1560 strains (68.20%) of gram-positive bacteria and 727 strains (31.80%) of gram-negative bacteria were strained. The top three departments in the distribution of pathogenic bacteria were pediatric intensive care unit (600 strains), pediatric internal medicine (514 strains), and pediatric emergency comprehensive ward (400 strains). The pathogens with high detection rates were: Staphylococcus epidermidis (24.09%), Staphylococcus humans (23.74%), Escherichia coli (13.21%) and Klebsiella pneumoniae (8.71%). The pathogens with high multi-drug resistance rates were: Streptococcus pneumoniae (93%), Staphylococcus epidermidis (83.76%), Enterobacter cloacae (75.61%) and Staphylococcus humans (62.43%). Conclusion: In our hospital, gram-positive bacteria were the main pathogenic bacteria in the blood culture of children patients. The children’s intensive care unit was the department with the largest distribution of pathogenic bacteria, and the multiple drug resistance rate of Streptococcus pneumoniae was the highest.

Trends in Bacterial Blood Culture Isolates and Resistance in Children in Two Microbiologic Eras from a Tertiary Health Facility in North East Nigeria

Introduction: Antimicrobial Resistance surveillance is predicated on blood culture as a priority clinical specimen in especially resource limited settings. Establishing trends in blood stream infections and resistance patterns can inform institutional and national policy on antimicrobial stewardship, surveillance, infection prevention and control. Methodology: Blood Culture isolates in children (0 - 18 years) by conventional method from 2008-2012 and Bactec Automated culture system from 2015-2020 were retrieved. Information analyzed included age, sex, month, and year and culture growth/identity of microorganisms and their sensitivity/resistance patterns. Clinical and Laboratory Standards Institute (CLSI) guideline for antibiotic susceptibility testing was used. Results: 20,540 children were admitted: 8964 (44.6%) and 11,630 (55.4%) in the Manual and Bactec blood culture era respectively. Blood cultures were done in 5271 in the manual culture era and 1077 in the Bactec culture era;of these cultures, 514 (9.7%) and 461 (42.8%) were positive for isolates in the respective era (p = 0.01). There were no statistically significant differences in trend between positive and negative blood cultures in males and females. Newborns, followed by children 1 - 5 years had more blood culture performed on them than other age categories. In general, there is no significant relationship in blood culture outcomes between the age categories and sex of the patients. The isolation of Staph aureus, Citrobacter and Alkaligenes increased two-fold with Bactec automated system. Resistance to the quinolones and the penicillin was high. Resistance trend to Genticin, an aminoglycoside was less than 40%. Resistance to Ceftazidime was high. Conclusion: Antimicrobial resistance surveillance is critical to reduce AMR related morbidity and mortality.

Correlations of PCBs, DIOXIN, and PBDE with TSH in Children's Blood in Areas of Computer E-waste Recycling

Objective To study correlations of polychlorinated biphenyls （PCBs）, DIOXIN, and polybrominated diphenyl ethers （PBDE） with thyroid stimulating hormone（TSH） in children, and assess the impact on children＇s health. Methods Three hundred and sixty nine children aged from 6 to 8, including 195 from Luqiao, the computer E‐waste recycling area, and 174 from Longyou, the control area, were selected for this investigation to elucidate the correlation of PCBs, DIOXIN, and PBDE with TSH in children’s blood samples. The children had a physical examination and their blood levels of PCBs, DIOXIN, PBDE, and TSH were detected after sample collection. Results In the E‐waste recycling area, the contents of PCBs, PBDE, DIOXIN, and TSH in the blood samples of children were 484.00±84.86 ng·g ‐1 lipid weight, 664.28±262.38 ng·g ‐1 lipid weight, 26.00±19.58 ng·g ‐1 lipid weight and 1.88±0.42 μIU/mL （serum） respectively, while in the control area, the PCBs, PBDE, DIOXIN, and TSH contents were 255.38±95 ng·g ‐1 lipid weight, 375.81±262.43 ng·g ‐1 lipid weight, 39.64±31.86 ng·g ‐1 lipid weight, and 3.31±1.04 μIU/mL respectively. Conclusion The health status of children in the control area are better than that in the contaminated area. Among children who are exposed to persistent organic pollutants, the pollutant content increases significantly in their serum, and the distribution of TSH levels in their bodies are also affected.

The Association of Overweight and Obesity with Blood Pressure among Chinese Children and Adolescents

Objective To examine the association between obesity and high blood pressure （BP） in Chinese children and adolescents. Methods Body mass index （BMI） and blood pressure measurements of 197 191 children aged 7-17 years were obtained from a Chinese national survey in 2010. Obesity and high BP were defined according to the reference values for Chinese children. Adjusted odds ratios （ORs） and 95% confidence intervals （CIs） of different BMI categories for high BP, as well as the population attributable risk percent （PAR%）, were also calculated. Results The prevalence of high BP was 16.1% for boys and 12.9% for girls in 2010. Overweight and obese children had a significantly higher prevalence of high BP than non-overweight children in both boys and girls in each age group. ORs （95% CI） for high BP were 4.1 （3.9, 4.4） in obese boys and 4.0 （3.7, 4.3） in obese girls. The overall PAR% for high BP due to overweight and obesity was 14.4%. Conclusion Overweight and obese children have a significantly higher risk of high BP than non-overweight children. Eliminating overweight and obesity could reduce 14.4% of high BP cases.

Bacterial Blood Isolates in Children: Conventional vs. Bactec Automated Blood Culture System in a Tertiary Health Centre in Gombe, North East Nigeria

Background/Aim: Blood culture is critical in the diagnosis and treatment of blood stream infections (BSIs) especially in children. BSIs are among the most common cause of morbidity/mortality and blood culture has remained the gold standard for diagnosis. We sought to compare Blood Culture Isolates (BCI) from conventional and Bactec automated blood culture system (ABCS) among paediatric patients at the Federal Teaching Hospital Gombe (FTHG) Nigeria. Methods: BCI in children (0 - 18 years) by conventional method from 2008-2012 and Bactec Automated culture system from 2015-2020 were retrieved from the clinical microbiology laboratory register. Information analyzed included, age, sex, month, and year and blood culture isolates. Results: There were 5276 (56.9% males, 43.1% females) and 1169 (54% males, 46% females) Blood Culture Isolates by CM and ABCS respectively. Overall positive culture isolates were 9.7% (515/5276) in CM and 45.9% (536/1169) in ABCS (p = 0.01). Positivity rate in newborn was 13.3% (282/2114) by CM and 40.9% (219/263) by ABCS p = 0.01;under-5 was 10.5% (448/4253) vs. 37% (359/873) (p = 0.01);Gram positive 32.6% (172) vs. 65% (759) (p = 0.01;Gram negative 55% (2910) vs. 34% (397) (p = 0.01). Staph aureus 22% (114/515) by CM vs. 61.9% (332/536)) by ABCS (p = 0.01);Klebsiella 24.9% (128/515) by CM vs. 7.5% (40/536) p = 0.01) in ABCS, E. coli 8.9% (46/515) vs. 2.1% (11/536) p = 0.01;Proteus vs. 1.1% (6/515) by ABCS, Pseudomonas 3.3% (17/515) vs. 5.6% (30/536) p = 0.05, Alkaligenes 1% (5/515) vs. 8.2% (44/536) p = 0.01 and Citrobacter 1% (5/515) vs. 8.4% (45/536) p = 0.01. Conclusion: Blood culture yield was five times higher with Bactec compared with Conventional method.

A Systematic Assessment of Blood Lead Level in Children and Associated Risk Factors in China

In this study, we searched multiple databases for all relevant original articles (1996-2013). To investigate blood lead levels (BLL) and possible risk factors for lead exposure among children in China A total of 388 articles met our inclusion criteria. The overall geometric mean (GM) BLL was 71 μg/L, and the prevalence of elevated BLL (EBLL, defined as BLL ≥100 μg/L) was 18.48% among children. The prevalence of EBLL remained significantly higher among boys. In children less than 6 years of age, there were significantly increasing trends in both BLL and prevalence of EBLL in an age-dependent manner. The ban on leaded gasoline significantly reduced the BLL as well as EBLL prevalence; however, children whose parents had lower educational levels or were exposed to lead in the workplace had a higher EBLL prevalence. Despite its decline over time, the average BLL among children in China remains higher than the average level most recently reported in the United States. Childhood lead poisoning remains a public health problem in China.

Prevalence and Correlates of Elevated Blood Pressure in Chinese Children Aged 6-13 Years: a Nationwide School-Based Survey

Objective To estimate the prevalence of elevated blood pressure（EBP） in Chinese children and identify individual and family factors associated with EBP. Methods A nationwide cross-sectional study was conducted in 2010 using stratified cluster sampling. Participants＇ blood pressure was measured, and their parents completed a questionnaire on personal and family characteristics. Prevalence and correlates of EBP were assessed. Results Among a total of 24,333 participants, 20.2% of boys and 16.3% of girls had EBP. The prevalence of EBP increased with the ascending trend of waist circumference, Waist-to-height ratio, and body mass index. The adjusted prevalence ratios（aP Rs） for obese boys and girls were 2.50 and 2.97, respectively. Fewer urban boys（16.2%） had EBP than rural boys（21.7%）. Boys with a family history of hypertension were 12% more likely to have EBP. Children whose mothers received a college education tended to have lower likelihood of EBP; with an aP R was 0.85 among boys and 0.78 among girls. Conclusion EBP is common among obese students and those who have a family history of hypertension. A negative association between mothers＇ education levels and EBP risk in children was found.

A SIX-YEAR RETROSPECTIVE STUDY ON THE RELATIONSHIP OF SODIUM-LITHIUM COUNTERTRANSPORT WITH BLOOD PRESSURE AND SODIUM SENSITIVITY IN CHILDREN

Red-cell membrane sodium-lithium countertransport (Na+-Li+CT) and sodium sensitivity (SS) were measured in 300 children in Hanzhong.By comparison and retrospective study, the results showed:①In children with higher blood pressure(HBP) and positive rainily history (FH+),Na+-Li+ CT rate was signiricantly higher than that in controls (P<0. 01).②6-year retrospective review of blood pressure evolution, the blood pressure increased degree (ASBP) in children with higher Na+-Li+ CT rate was much greater than that in those with lower one (P<0.05), and at the same time,the percentiles of systolic blood pressure (PSBP) for children with higher countertransport mostly kept rising or kept higher levels during this period.③In children with SS, Na+-Li+ CT rate was increased than that in SR group (P<0. 01),and was correlated to the concentration of intra-erythrocytic Na+ (P= 0.004).These suggest that, as intermediate phenotype of essential hypertension, red-cell membrane sodium-lithium countertransport defect could participate in the regulation of blood pressure and pathogensis or hypertension development in children.

Blood Pressure Profile of Apparently Healthy Primary School Children in Delta State, Nigeria: Impact of Social Factors and Anthropometric Variables

Background: Systemic hypertension in children is one of the rising public health problems because of its attendant significant morbidity and mortality. Despite the rising prevalence of this problem, it is often under-reported as most of the attention has been focused on hypertension in adults with not much concerted effort made in tackling this problem in children. Aim: This study is aimed at determining the prevalence of hypertension and possible risk factors for its development and their relationship to hypertension among healthy primary school children in Asaba, Delta State. Subjects and Methods: This was a cross-sectional descriptive study involving 400 primary school students in Asaba. Variables such as weight, height, Body Mass Index (BMI), and blood pressure were measured using standard methods and the children categorized for hypertension and obesity using the Fourth Task Force Report and WHO BMI chart respectively. Result: The overall prevalence of hypertension was 3.5% and pre-hypertension 12.5%. The prevalence of hypertension increased from 2.4% in childhood to 12.5% in mid adolescents. Of the 14 subjects with hypertension, 12.5% were obese while 14.3% were overweight. The mean systolic and diastolic blood pressure of subjects in public schools was higher than their counterparts in private schools. Prevalence of hypertension in children was independent of the socioeconomic status and the type of school attended by the children unlike obesity and presence of proteinuria which appeared to be influenced by these variables. Conclusion: Hypertension was observed to be common in the study subjects. It appeared to be more among obese children and those in their mid adolescent period.

Testing the value of simple arterial blood pressure measurements in a Greek children’s hospital

Arterial hypertension begins in childhood and may continue, without intervention, throughout adulthood with severe health sequelae.The base of timely diagnosis is the systematic blood pressure (BP) measurement. Background: The study aims at revealing the level of parental and community awareness and testing the value of a simple measurement in uncovering children who need further assessment when performing an in-hospital BP screening. Methods: BP was measured in 600 children (0 - 17 yr, mean age 5.1 ± 4.3 yr) at a Children’s hospital. Parents were asked to fill in a specially structured questionnaire. Results: In 47.2% of the subjects (40.1% of them were Greeks and 60.6% foreigners), BP had never been checked before (p arterial BP had never been checked before. Surprisingly, a health certificate was issued for school purposes for 81.2% of the schoolchildren of this study, and 75.3% of the enrolled children were allowed to participate in sports clubs without first checking BP. Moreover, parents demonstrated a low level of alertness with respect to paediatric hypertension. Conclusions: Simple arterial BP measurements can ensure early detection and thus early referral to specialists.

Transitioning to Automated Microbiologic Era: Blood Culture Isolates in Children and Adults in Federal Teaching Hospital in Gombe, North East Nigeria 2016-2020

Introduction: Automated blood culture systems for incubation and growth monitoring have become the standard in high-income countries (HICs), but are still relatively expensive and not universally available for implementation in most low- and middle-income countries (LMIC). We aimed to report blood culture isolates using Automated technique in children and adults admitted into the Federal Teaching Hospital Gombe from 2016 to 2020. Materials and Methods: Blood Culture Isolates in children (0 - 18 years) and adults (>19 yrs) by Bactec 9050 Automated culture system from 2016-2020 were retrieved from the medical and laboratory register. Information analyzed included, age, sex, month, and year and culture growth and reported antibiotic sensitivity. A Bactec Blood culture tests is $20 in this facility. In Nigeria, the minimum monthly wage is $70 (Official currency exchange rate is N423/US Dollar). Results: Of the 1713 blood cultures performed, children 0 - 18 years were 1322 (77.2%) and adult (19 years above) (22.8%). Overall positivity was 733 (42.2%) with males 385 (52.5%). Of the 1322 Blood cultures (BC) in children 615 (46.5%) were positive for isolates and adults 118 (30.2)%. Blood culture positivity decreased with increasing age with newborns 251 (34.5%) and adults > 65 years 18 (2.5%). Staphylococcus aureus constituted 61.3% of all isolates and was the leading isolates in all age groups;Alkaligenes (9.1%);Citrobacter 8.1%, Klebsiella 6.7%;Pseudomonas 6.1%;E. coli 2.7%;Enterococcus 2%;Proteus 1%. Of the Antimicrobial resistance priority isolates E. coli susceptibility ranged from 71% to Gentamycin and 100% to Cefixime;Klebsiella from 25% sensitivity to Amikacin to 78% each to chloramphenicol and ciprofloxacin;Salmonella was 100% sensitive to chloramphenicol, ciprofloxacin and cefuroxime. Klebsiella was 100% sensitive to Cefoxitin;Proteus sensitivity ranged from 35% to ampicillin and 100% to ciprofloxacin and cefuroxime. Staph aureus sensitivity was 35% to cefoxitin, 70% to amoxicillin/clavulanate and 70% to cefuroxime. Conclusion: Blood culture yield by Automated method was high. Staph aureus was the predominant pathogen and bacterial yield reduced with increasing age. Antibiotic sensitivity was variably reduced against gram negative bacteria.

Analysis of Factors Influencing the Effect of Red Blood Cell Suspension Infusion in Children

Objective: The related factors of no improvement of hypoxia and ineffective infusion were analyzed to provide new ideas, clinical observation and evaluation pathway for RBC transfusion in clinical children. Methods: Retrospective analysis from January 2020 to December 2020, Guangzhou women and children’s medical center hospital in the emergency observation room of 249 children under 1 month to 18 years of blood cell suspension infusion, analyze the clinical effect of red blood cell infusion and children gender, age, fever after transfusion, disease type, delay transfusion. The possible influencing factors were analyzed by logistic regression. Results: Invalid transfusion was associated with the type of transfusion product (P = 0.032), logistic regression analysis showed that patients infused with washed RBC suspension were 3.231 times more likely to not achieve the expected effect than those infused with RBC suspension (P = 0.025). Failure transfusion was associated with the type of transfusion products. In ineffective transfusion was closely related to post-transfusion fever (P P P = 0.031). Logistic regression analysis showed that fever after transfusion was a risk factor for no improvement of hypoxia (OR = 5.809, P = 0.001), and the improvement of hypoxia in adolescent children was 10.744 times higher than that of infants (0 - 3 years old). Late transfusion hypoxia improvement was 4.212 times more likely to achieve no effect than timely transfusion. If ineffective infusion of red blood cells is considered and hypoxia after transfusion is not improved, univariate suggests a close correlation with fever after transfusion (P = 0.002), logistic regression analysis showed that fever after transfusion was an independent risk factor (OR = 7.258, P = 0.002). Conclusion: There was no correlation between the ineffective transfusion of red blood cells and the type of disease affected in the child. Infusion of red cell suspension has an advantage over the wash red cell infusion. Ineffective RBC transfusion and no improvement in hypoxia after transfusion were closely related to post-transfusion fever, with no difference between children in all age groups. Red blood cell infusion in pediatric clinical treatment activities should pay attention to adolescent children, especially female children to give more attention, and give timely red blood cell infusion as much as possible.

儿童血液净化股静脉置管并发症风险预测模型的构建与验证

目的首次构建儿童血液净化股静脉置管并发症的风险预测模型,并验证预测效果。方法选取2020年1月—2022年6月四川大学华西第二医院小儿肾脏科使用股静脉置管行血液净化治疗的患儿428例,行单因素和多因素Logistic回归分析股静脉置管并发症发生的危险因素,建立风险预测模型并使用列线图展示模型。采用ROC曲线、校准曲线评价模型的区分度和校准度,以2022年7月—10月50例患儿资料进行模型的外部验证。结果病因肾衰竭(OR=5.041,95%CI:1.170~21.726,P=0.030)、合并低白蛋白血症(OR=2.963,95%CI:1.090~8.057,P=0.033)、躁动(OR=2.871,95%CI:1.159~7.109,P=0.023)、双下肢水肿(OR=2.359,95%CI:1.052~5.288,P=0.037)、高血压(OR=2.473,95%CI:0.010~6.057,P=0.048)、腹腔积液(OR=5.673,95%CI:2.242~14.357,P<0.001)以及输注血/血制品(OR=2.693,95%CI:1.0697~6.612,P=0.031)是儿童血液净化股静脉置管并发症的独立危险因素。预测模型ROC曲线下面积(AUC)为0.794(95%CI:0.738~0.851,P<0.001),灵敏度为0.733,特异度为0.725,最大约登指数为0.458,预测模型拟合优势比χ^(2)=3.395,P=0.907。依据验证组所建模型预测概率绘制ROC曲线,AUC为0.810(P<0.001,95%CI:0.689~0.931),灵敏度为0.739,特异度为0.778。结论本研究构建的预测模型能较好地预测儿童血液净化股静脉置管并发症的发生风险,可为医护人员早期识别高危患儿,采取有效措施预防并发症的发生提供参考。

经鼻加温湿化高流量氧疗对重症肺炎患儿血气指标、MMP-9及TNF-α的影响

目的 探讨经鼻加温湿化高流量氧疗(HFNC)治疗小儿重症肺炎的疗效及对血气指标、基质金属蛋白酶9(MMP-9)、肿瘤坏死因子α(TNF-α)的影响。方法 选取2018年5月—2020年8月河北省人民医院收治的123例重症肺炎患儿作为研究对象,按照随机抽样法分为观察组(HFNC治疗,n=62)与对照组(面罩吸氧治疗,n=61)。对比两组临床症状、动脉血二氧化碳分压(PaCO_(2))、血氧分压(PaO_(2))、TNF-α、MMP-9、血氧饱和度/吸入氧浓度与呼吸频率的比值(ROX指数)。结果 观察组的退热时间、体征消失时间、咳嗽咳痰消失时间、住院时间分别为(5.21±1.02)d、(10.02±1.32)d、(7.41±0.96)d、(9.02±2.69)d,均短于对照组(t=5.688、10.332、10.253、2.180,P<0.05)。观察组治疗后2、6、12、24 h的ROX指数分别为(6.31±1.62)、(9.85±1.96)、(11.65±2.39)、(13.46±3.25),均高于对照组(t=2.467、3.380、4.251、4.902,P<0.05);治疗后,观察组的PaCO_(2)(35.69±5.21)mmHg低于对照组,而PaO_(2)(87.52±18.69)mmHg高于对照组(t=2.379、4.647,P<0.05);治疗后,观察组的MMP-9、TNF-α分别为(6.32±1.05)pg/mL、(10.40±1.30)pg/mL,低于对照组(t=13.425、13.060,P<0.05)。结论 HFNC用于重症肺炎患儿中具有显著效果,有利于改善患儿血气指标,降低MMP-9、TNF-α水平。

小儿颈部淋巴管瘤的超声诊断及血流特征分析

目的 分析超声诊断小儿颈部淋巴管瘤的声像图特点及血流特征。方法 选择2016年6月至2019年6月收治的超声疑似颈部淋巴管瘤患儿50例,以手术病理诊断作为金标准,计算超声诊断符合率,分析巨囊型淋巴管瘤、微囊型淋巴管瘤、混合型淋巴管瘤的超声特征及阻力指数、静脉流速、收缩期峰值流速。结果 50例患儿手术病理中,巨囊型淋巴管瘤35例(70.0%),微囊型淋巴管瘤8例(16.0%),混合型淋巴管瘤3例(6.0%),淋巴血管畸形4例(8.0%)。超声诊断符合率为92.0%。巨囊型淋巴管瘤的阻力指数、静脉流速、收缩期峰值流速最高,其次是微囊型淋巴管瘤,最低的是混合型淋巴管瘤,三者间差异均有统计学意义(P<0.05)。结论 超声在小儿颈部淋巴管瘤的诊断中准确性高,为临床医师制定治疗方案提供科学依据。

超声参数联合外周血指标诊断儿童淋巴瘤的价值分析

目的探讨超声参数联合外周血指标对儿童淋巴瘤的诊断价值。方法对2018年6月至2020年10月该院收治的疑为淋巴瘤的浅表淋巴结肿大123例患儿进行超声检查,其中85例患儿经病理诊断为淋巴瘤(淋巴瘤组),38例患儿诊断为良性病变(良性组),同期选取30例健康儿童作为健康组。评价长短径比(L/S)、淋巴门、血流类型等超声参数对儿童非霍奇金淋巴瘤的诊断价值。通过逆转录-聚合酶链反应分析3种免疫相关基因——CC趋化因子受体5(CCR5)、程序性细胞死亡蛋白1(PD-1)、叉头盒P3(FOXP3)在淋巴瘤儿童外周血中的表达,分析超声参数联合3种外周血指标对儿童淋巴瘤的联合诊断价值。结果L/S、淋巴门、血流类型联合诊断淋巴瘤的受试者工作特征曲线下面积、灵敏度和特异度分别为0.846、89.41%、68.42%。淋巴瘤组患儿外周血CCR5、PD-1、FOXP3 mRNA相对表达量均明显高于健康组和良性组,差异均有统计学意义(P<0.05)。超声参数联合外周血CCR5、PD-1、FOXP3诊断淋巴瘤的受试者工作特征曲线下面积、灵敏度和特异度分别为0.976、97.65%、92.11%。结论超声参数(L/S、淋巴门和血流类型)联合外周血CCR5、PD-1、FOXP3对淋巴瘤具有较高的诊断价值。

地中海贫血与缺铁性贫血患儿血常规红细胞参数检验价值分析

目的探讨地中海贫血与缺铁性贫血患儿血常规红细胞参数检验价值。方法在2022年1月—2023年3月本院治疗的患者中分别选取地中海贫血患儿作为A组(42例)和缺铁性贫血患儿作为B组(42例),并将42例健康体检儿童作为C组,对比三组血常规红细胞参数、铁元素相关指标。结果以C组红细胞参数为基准,A组Hb、RBC、MCHC均高于B组,MCH、RDW、MCV低于B组,数据对比差异有统计学意义(P<0.05);铁元素指标中,A组Fe、SF高于B组,数据对比差异有统计学意义(P<0.05)。结论血常规红细胞参数在区分地中海贫血与缺铁性贫血方面具有较高的准确性,可为临床诊断与治疗提供重要参考依据。

TLR9 mRNA在巨细胞病毒感染儿童外周血中的表达

目的 探讨HCMV感染患儿外周血中TLR9 mRNA的表达。方法 选择2019年1月-2019年12月江西省儿童医院收治HCMV感染88例为研究对象,其中未给予更昔洛韦治疗23例为治疗前组,给予更昔洛韦治疗27例为治疗后组;同期未感染HCMV健康儿童38例为正常组。采用RT-PCR检测TLR9 mRNA表达,以2^(-△△Ct)方法对mRNA表达进行相对定量,对比分析各组指标的变化。结果 HCMV感染组和正常组外周血中TLR9 mRNA表达量平均值分别为1.986±0.306和3.001±0.543,2组间差异无统计学意义(t=1.724,P=0.088)。HCMV感染治疗前组和治疗后组外周血中TLR9 mRNA表达量平均值分别为1.778±0.312和2.163±0.504,2组间差异无统计学意义(t=0.624,P=0.536)。结论 TLR9 mRNA在HCMV感染儿童外周血中的表达降低,但其表达水平与不同治疗时期无相关性。

反复输血地中海贫血儿童血清免疫球蛋白水平变化及其与迟发性溶血性输血反应的相关性研究

目的 探讨反复输血地中海贫血儿童血清免疫球蛋白水平变化及其与迟发性溶血性输血反应(delayed hemolytic transfusion reactions, DHTR)的相关性。方法 收集2022年6月-2023年4月期间到本院接受输血治疗的地中海贫血儿童(观察组)及健康体检儿童(对照组)血清标本,运用流式细胞仪CBA多因子定量检测技术,检测血清免疫球蛋白(IgG亚类、IgM、IgA、IgE、IgD)水平,比较2组儿童血清免疫球蛋白差异;按照不同输血次数分为4组:≤10次、11~30次、31~50次、>50次,各组采用单因素方差分析比较不同输血次数与血清免疫球蛋白水平之间的差异;将DHTR的地中海贫血儿童分为溶血组,未发生DHTR的地中海贫血儿童分为非溶血组,比较2组儿童血清免疫球蛋白(IgG亚类、IgM、IgA、IgE、IgD)之间的变化,探讨反复输血的地中海贫血儿童血清免疫球蛋白与DHTR的相关性。结果 血清免疫球蛋白IgG1、IgG3、IgG4、IgA观察组明显高于对照组,分别增加了(2.07±2.12)、(0.67±2.03)、(0.30±0.37)、(6.04±11.40)mg/mL,IgD观察组明显低于对照组,降低了(0.03±0.01)mg/mL,P<0.05;IgG2、IgM、IgE 2组之间,P>0.05。输血次数与血清免疫球蛋白之间的相关性:随着输血次数增加,IgG1、IgG4均明显增高,4组IgG1依次增加(0.30±0.62)、(0.41±0.51)、(3.60±3.48)mg/mL,IgG4依次增加(0.12±0.13)、(0.22±0.07)、(0.21±0.38)mg/mL,IgG2、IgM、IgD明显降低,4组IgG2、IgM、IgD依次降低(0.91±1.50)、(0.14±0.10)、(0.05±0.05)mg/mL,与输血次数之间有显著差异性,P<0.05;IgG3、IgA、IgE与输血次数之间无显著差异性,P>0.05。IgG1、IgG3、IgG4溶血组明显高于非溶血组,分别增加了:IgG1(4.44±3.41),IgG3(0.73±1.26),IgG4(0.52±0.40)mg/mL,IgD溶血组明显低于非溶血组,降低了(0.00±0.06)mg/mL,P<0.05;IgG2、IgM、IgA、IgE溶血组与非溶血组之间,P>0.05。结论 反复输血的地中海贫血儿童血清免疫球蛋白水平异常;反复输血的地中海贫血儿童不同输血次数与血清免疫球蛋白之间存在相关差异性;反复输血的地中海贫血儿童发生DHTR的相关血清免疫球蛋白为IgG1、IgG3、IgG4。

他克莫司治疗儿童肾病综合征的最佳血药浓度范围探究

目的探究他克莫司(TAC)治疗儿童肾病综合征(NS)的最佳血药浓度范围。方法回顾性选取2021年1月至2023年12月河北省儿童医院肾脏免疫科收治的NS患儿为研究对象。根据治疗是否有效分为有效组和无效组,采用受试者工作特征(ROC)曲线确定治疗有效的TAC阈值。根据NS患儿TAC浓度分为低浓度组(<3 ng/mL)、中浓度组(3~5 ng/mL)和目标浓度组(5~10 ng/mL),分析TAC浓度与临床疗效和不良反应的关系。结果研究共纳入患儿160例。NS患儿完全缓解(CR)、部分缓解(PR)和无效(NR)例数分别为91例、37例和32例,治疗有效128例(80%)。ROC曲线分析结果显示,TAC平均谷浓度预测疗效的ROC曲线下面积(95%CI)、敏感性、特异性和阈值分别为0.779(0.704,0.853)、62.5%、84.45%和3.33 ng/mL。临床疗效方面,与目标浓度组比较,低浓度组CR和PR较低,而NR较高(P<0.05);而中浓度组CR较低,PR较高(P<0.05),NR差异无统计学意义(P>0.05)。NS不同激素反应型方面,与目标浓度组或中浓度组比较,低浓度组CR较低(P<0.05);而中浓度组与目标浓度组CR和PR差异无统计学意义(P>0.05)。NS不同病理类型方面,与目标浓度组或中浓度组比较,低浓度组CR较低(P<0.05);而中浓度组与目标浓度组CR和PR差异无统计学意义(P>0.05)。不良反应方面,目标浓度组肢体震颤和血糖异常发生率显著高于其余两组(P<0.05)。此外,3组严重感染和高血压差异无统计学意义(P>0.05)。结论TAC治疗儿童NS时,推荐TAC浓度范围为3~5 ng/mL。