病毒性乙型肝炎致Kwashiorkor症

目的探讨Kwashiorkor症(蛋白营养缺乏症)的致病原因。方法回顾性分析经手诊治的1例Kwashiorkor症的临床资料。 结果该例为1名11岁女孩,以眼睑浮肿久治不愈就诊。反复查尿常规、肾功能、心功能正常,但HBsAg(+)、HBeAg(+)、HBcAb(+),肝功能酶轻度异常,各种蛋白包括清蛋白、糖蛋白、各种球蛋白,甚至尿素氮等皆低于正常。经抗病毒、补充维生素治疗,e抗原转阴,各种蛋白恢复正常,眼睑浮肿消失。结论Kwashiorkor症主要由蛋白质严重缺乏所致,但乙肝病毒感染是否引起肝细胞合成蛋白质障碍从而出现蛋白质营养缺乏的临床表现有待进一步研究。

Acute effects of rotavirus and malnutrition on intestinal barrier function in neonatal piglets

AIM: To investigate the effect of protein-energy malnutrition on intestinal barrier function during rotavirus enteritis in a piglet model.METHODS: Newborn piglets were allotted at day 4 of age to the following treatments:(1) full-strength formula(FSF)/noninfected;(2) FSF/rotavirus infected;(3) half-strength formula(HSF)/noninfected;or(4) HSF/rotavirus infected.After one day of adjustment to the feeding rates,pigs were infected with rotavirus and acute effects on growth and diarrhea were monitored for 3 d and jejunal samples were collected for Ussingchamber analyses.RESULTS: Piglets that were malnourished or infected had lower body weights on days 2 and 3 post-infection(P < 0.05).Three days post-infection,marked diarrhea and weight loss were accompanied by sharp reductions in villus height(59%) and lactase activity(91%) and increased crypt depth(21%) in infected compared with non-infected pigs(P < 0.05).Malnutrition also increased crypt depth(21%) compared to full-fed piglets.Villus:crypt ratio was reduced(67%) with viral infection.There was a trend for reduction in transepithelial electrical resistance with rotavirus infection and malnutrition(P = 0.1).3H-mannitol flux was significantly increased(50%;P < 0.001) in rotavirus-infected piglets compared to non-infected piglets,but there was no effect of nutritional status.Furthermore,rotavirus infection reduced localization of the tight junction protein,occludin,in the cell membrane and increased localization in the cytosol.CONCLUSION: Overall,malnutrition had no additive effects to rotavirus infection on intestinal barrier function at day 3 post-infection in a neonatal piglet model.

Severe Acute Malnutrition among Hospitalized Children, Aden, Yemen

Objective: Severe acute malnutrition (SAM) is one of the most common causes of morbidity and mortality among children under 5 years of age worldwide. The aim of this study was to find out the prevalence of SAM among hospitalized children at Al-Wahda teaching hospital in Aden, Yemen. Methods: This descriptive cross-sectional hospital based study was conducted on 622 hospitalized children (336 males and 286 females) below 6 years of age during 2012-2013. SAM was defined as a very low weight for height (below-3 Z scores of the median WHO growth standards). Results: SAM was diagnosed in 622 children with prevalence rate of 5.2% from total 11,941 admissions during 24 months period. A higher proportion of patients were marasmus 586 (94.2%) and only 36 (5.8%) were kwashiorkor. Marasmus was common in <1 year of age in 347 (59.2%) while kwashiorkor between 1 - 5 years in 22 (61.1%) patients. Males (54%) predominated females (46%) with a male to female ratio of 1.18:1 in SAM but with no significant difference in sex. The highest comorbidities with SAM were gastroenteritis 442 (71.1%) and 103 pneumonia (16.6%) with a total cure of 492 (79.1%) patients. Conclusion: This high prevalence of SAM among males who were <5 years of age with high risk of gastroenteritis and pneumonia added weight to the urgent need to improve the nutritional status of children.

蛋白质营养不良1例

患者男,71岁,手足皮疹伴发热1个月,泛发半个月。查体见躯干、四肢红斑、脱屑、破溃、结痂。皮损组织病理示:表皮中上层可见单个及灶性坏死的角质形成细胞,棘细胞间裂隙形成,基底细胞空泡变性,真皮浅层血管周围较多淋巴细胞浸润。结合临床与组织病理诊断为蛋白质营养不良。

膳食亚油酸,免疫抑制和疾病

对所掌握发表的文献证据进行回顾,表明以玉米为主粮的国家里与疾病有关的观点发生了根本的变化。在这些国家中,膳食亚油酸代谢产物引起免疫状况的变化极大地决定了疾病的模式。高亚油酸摄入、同时缺乏其它多不饱和脂肪酸和核黄素的膳食会导致组织中高前列腺素 E2的产生,这反过来又会造成对 Th1细胞的增殖及其细胞因子生成的抑制以及对细胞免疫介质的抑制。结核、麻疹、肝细胞瘤、HIV 的二次感染和 Kwashiorkor 病等都会因为细胞免疫的降低而易感。由于在非洲撒哈拉周边地区玉米是主粮,在这些地区与膳食相关的 Th1亚型抑制是上述疾病高发的主要因素。