目的 分析胎龄≤32 周早产儿血小板减少症的特点,并探讨其与支气管肺发育不良(broncho-pulmonary dysplal-sia,BPD)的相关性.方法 选取 2018 年 9 月～2022 年 2 月徐州医科大学附属医院新生儿重症监护室收治的胎龄≤32 周的早产儿作为研究对象,回顾性收集并分析研究对象生后 4 周内的临床资料,根据生后 4 周内最低血小板计数(platelet count,PLT)进行分组,采用单因素及二元 Logistic回归分析方法,分析各组间临床资料的差异及血小板减少症与 BPD的关系,并比较 BPD 组早产儿与非BPD组早产儿在不同胎龄时血小板减少症构成比及生后4 周内PLT水平.结果 共纳入197 例早产儿,发生血小板减少症 134 例,发生率为 68.0%,轻度、中度及重度血小板减少症分别占 52.2%(70/134)、36.6%(49/134)、11.2%(15/134),生后第1 周 PLT达最低值(180×109/L).单因素分析结果显示,PLT 水平与出生体重、胎膜早破、孕母子痫、坏死性小肠结肠炎(necro-tizing enterocolitis,NEC)、败血症、BPD、红细胞增多症、红细胞输注量、有创呼吸机使用天数等临床因素相关,不同程度血小板减少症患儿 BPD发生率及严重程度差异有统计学意义(P＜0.05).应用 Logistic 逐步回归方法(前进法)筛选自变量,以是否发生BPD作为因变量,构建 Logistic回归模型,结果显示,中重度血小板减少症是 BPD 发生的危险因素(OR = 2.983,95%CI:1.027～8.662,P =0.044).结论 早产儿血小板减少症发生率高,PLT在生后第 1 周最低,中度、重度血小板减少症可能与 BPD 发生相关,在临床实践中应加以关注.

Objective:To study the early predictive values of serum thrombospondin-1(TSP-1)and transforming growth factor-β1(TGF-β1) for bronchopulmonary dysplasia(BPD)in preterm infants.Methods:From September 2020 to April 2022, preterm infants with gestational age<32 weeks and ≥28 weeks as well as birth weight<1 500 g admitted to neonatal intensive care unit within 2 hours after birth were enrolled in the study.The dynamic changes of serum TSP-1 and TGF-β1 levels in preterm infants were observed on 1st, 7th, 14th, and 28th day after birth.Preterm infants were divided into BPD group and non-BPD group according to the diagnostic criteria of BPD.Receiver operating characteristic(ROC) curve and area under curve(AUC)was used to analyze the predictive value of serum TSP-1 and TGF-β1 for preterm infants with BPD.Results:According to the diagnostic criteria of BPD, 38 cases were in the BPD group and 52 cases in the non-BPD group.There was no significant difference in gestational age, birth weight and gender between the two groups( P>0.05). The levels of TSP-1 and TGF-β1 in the serum of BPD group were gradually increased, which were significantly higher than those of non-BPD group on the 1st, 7th, 14th, and 28th day( P<0.001). ROC results showed that AUC of TSP-1, TGF-β1 and their combination for predicting BPD were 0.889(95% CI 0.819~0.959), 0.826(95% CI 0.743~0.910), and 0.923(95% CI 0.870~0.976), respectively.The sensitivity were 86.80%, 86.70%, 89.50%, and the specificity were 86.50%, 73.10%, 80.80%, respectively.Cutoff values of TSP-1 and TGF-β1 for predicting BPD were 44.50 μg/L and 6.13 μg/L, respectively. Conclusion:Combined detection of serum TSP-1 and TGF-β1 on the first day after birth has an early predictive value for BPD in preterm infants.

目的 探讨槐杞黄颗粒联合吸入糖皮质激素(inhaled corticosteroids,ICS)对轻度持续哮喘患儿的临床疗效及其机制.方法 选取2020年3月 ～2021年2月在徐州医科大学附属医院门诊就诊的轻度持续哮喘患儿90例,将其按随机数字表法分为两组,即A组(ICS+槐杞黄)45例和B组(ICS)45例,监测治疗前及治疗3个月后血清白细胞介素(IL)-25、IL-33、IL-5、IL-13水平及肺功能情况,随访6个月记录喘息发作情况,分析比较各项监测指标变化.结果 90例患儿中失访8例,实际收集有效病例82例,其中A组38例,B组44例.治疗后,A、B组IL-25、IL-33、IL-5、IL-13水平较治疗前降低(P<0.05);A组IL-25、IL-33、IL-5、IL-13降低较B组显著(P<0.05);治疗后,A、B组的第1秒用力呼气容积占预计值百分比(FEV1％pred)、呼气峰流速占预计值百分比(PEF％pred)、最大呼气中期流量占预计值百分比(MMEF75/25％pred)较治疗前升高(P<0.05),A组FEV1％pred、PEF％pred、MMEF75/25％pred升高较B组显著(P<0.05);A组治疗后3、6个月的喘息次数较治疗前减少(P<0.05).结论 槐杞黄颗粒联合ICS治疗哮喘的疗效显著,可能是通过降低IL-25、IL-33、IL-5、IL-13及抑制Ⅱ型固有淋巴细胞活化实现的.

目的 观察脑损伤早产儿血清25-羟维生素D[25-(OH)D]水平的变化情况,探讨其与炎症反应的关系.方法 选择生后24 h内入住NICU的53例早产儿,其中发生脑损伤24例(观察组),未发生脑损伤29例(对照组).采集两组生后第1、7、14天桡动脉血,采用ELISA法检测血清25-(OH)D及IL-17、IL-10水平,分析血清25-(OH)D与IL-17、IL-10的相关性.结果 两组血清25-(OH)D水平在生后第1、7天较低,第14天逐渐升高,观察组各时间点25-(OH)D水平均低于对照组(P均<0.05).观察组第7天IL-17水平高于第1、14天(P均<0.05),第14天与第1天差异无统计学意义(P>0.05),观察组各时间点IL-17水平均高于对照组(P均<0.05).观察组第14天IL-10水平高于第1、7天(P均<0.05),对照组IL-10水平第7天低于第1天、第14天低于第7天(P均<0.05).观察组血清25-(OH)D水平在生后第1、7、14天与IL-17水平均呈负相关(P均<0.05),在第1、7天与IL-10水平呈正相关(P均<0.05).结论 脑损伤早产儿生后各时间点血清25-(OH)D水平均较低,其水平变化与IL-17、IL-10水平相关;补充维生素D或可抑制脑损伤后的炎症反应.

目的:探讨槐杞黄颗粒联合吸入糖皮质激素对支气管哮喘患儿肺功能、细胞免疫因子及趋化因子3(CCL3)、趋化因子5(CCL5)水平的影响.方法:按照随机数字表法,将我院收治的轻度持续性支气管哮喘患儿(n=90),分为对照组(吸入糖皮质激素,45例)和研究组(槐杞黄颗粒联合吸入糖皮质激素,45例),两组均治疗3个月.对比两组患儿治疗前、治疗后1、3、6个月的常规肺功能、细胞免疫因子及CCL3、CCL5水平.观察两组临床疗效、指标和不良反应.结果:研究组的临床总有效率71.11％(32/45)高于对照组91％(41/45),差异有统计学意义(P＜0.05).治疗后1个月(T2)、治疗后3个月(T3)、治疗后6个月(T4)时间点,两组第1秒用力呼气量占预测值百分比(FEV1％)、呼气峰流速占预测值百分比(PEF％)、最大呼气中期流速占预计值的百分比(MMEF75/25)升高,总呼吸阻抗(Z5)、肺弹性阻力(X5)及共振频率(Fres)下降,且研究组的改变程度大于对照组(P＜0.05).T2、T3、T4时间点,两组免疫球蛋白(IgE)、白细胞介素-4(IL-4)、白细胞介素-5(IL-5)、白细胞介素-13(IL-13)、白细胞介素-17(IL-17)下降,且研究组的改变程度大于对照组(P＜0.05).T2、T3、T4时间点,两组CCL3、CCL5下降,且研究组的改变程度大于对照组(P＜0.05).两组不良反应发生率组间对比无差异(P＞0.05).研究组C-ACT评分高于对照组,呼吸道感染次数、哮喘发作次数少于对照组(P＜0.05).两组因哮喘住院次数组间对比未见统计学差异(P＞0.05).结论:槐杞黄颗粒联合吸入糖皮质激素治疗支气管哮喘,可促进患儿肺功能恢复,改善细胞免疫因子及CCL3、CCL5水平.

目的:通过检测前B细胞集落增强因子(pre-B cell colony-enhancing factor,PBEF)和脂联素(adiponectin,APN)在支气管肺发育不良(bronchopulmonary dysplasia,BPD)患儿血浆中的表达水平,以评估PBEF和APN在BPD中的早期诊断价值.方法:采用前瞻性队列研究方法,选择2018年3月至2019年10月在新生儿重症监护室住院的胎龄28～32周、出生体重<1500 g的86例早产儿为研究对象.采集患儿出生后第1、7、14天血标本,用ELISA方法检测血浆中PBEF和APN浓度.根据BPD的诊断标准将患儿分为BPD组与非BPD组,其中BPD组32例,非BPD组54例.结果:生后第1、7、14天,两组PBEF表达水平均逐渐升高,且BPD组(分别96.72±15.54、108.29±16.16、119.40±16.23)的表达水平均高于非BPD组(分别85.71±15.47、93.91±12.00、101.53±13.76),差异有统计学意义(P<0.05);出生后第1、7、14天,两组APN表达水平均逐渐升高,且BPD组(分别60.99±9.86、66.77±9.29、83.05±10.96)的表达水平均低于非BPD组(分别67.13±7.37、81.70±8.25、92.82±9.72),差异有统计学意义(P<0.05).ROC曲线分析显示:出生后第1、7、14天,APN曲线下面积分别为0.686、0.867、0.744;PBEF曲线下面积分别为0.687、0.751、0.774;APN联合PBEF曲线下面积分别为0.777、0.938、0.859(均P<0.05).不同时点APN、PBEF以及APN联合PBEF对BPD的预测价值均有统计学意义.结论:早产儿生后早期血浆PBEF和APN水平的变化,可为BPD的发生提供早期预测依据.

目的 分析支原体肺炎(M PP)患儿行多次支气管镜下灌洗治疗的影响因素并构建预测模型.方法 回顾性分析2018年6月至2020年6月入住徐州医科大学附属医院儿科的203例行支气管镜下灌洗治疗的M PP患儿的临床资料,根据支气管镜下灌洗次数分为单次灌洗组(150例)及多次灌洗组(53例).比较2组患儿在一般情况、临床症状、实验室检查、合并症等方面的差异,分析M PP多次灌洗的危险因素,并构建预测模型.结果 单因素分析发现:2组患儿性别、年龄、合并其他感染、炎症累及肺叶数、发病季节、白细胞计数、肌酸激酶同工酶水平的差异无统计学意义(P>0.05);在合并胸腔积液、合并肺外并发症、入院前发热和咳嗽持续时间、入院前最高体温、入院后第1～3天体温平均值(Tmean)、入院前使用大环内酯类抗生素≥5 d、纤维蛋白原降解产物、D-二聚体、C反应蛋白、谷丙转氨酶(ALT)、血清白蛋白(ALB)、血清前白蛋白、乳酸脱氢酶指标上的差异具有统计学意义(P<0.05).进一步行多因素Logistic回归分析发现,Tmean升高,D-二聚体、ALT升高,ALB降低是影响支气管灌洗次数的危险因素,预测的准确率为90.6％.根据多因素回归分析结果进行联合预测因子的ROC曲线运算,联合预测因子的曲线下面积为0.885,34.885为临界点,敏感度为0.837,特异度为0.851.结论 支气管镜下灌洗是治疗M PP的有效手段,早期识别可能需多次灌洗治疗的危险因素,对于合理医患沟通、改善预后有着积极的意义.

目的 研究喜炎平注射液联合头孢曲松钠对支气管肺炎患儿VPTEF/VE、VT、RR及炎性因子的影响.方法 选取在徐州医科大学附属医院2018年6月至2019年6月就诊的支气管肺炎患儿104例,依据随机数字表法进行分组,将对照组和观察组各分为52例.对照组患儿单用头孢曲松钠治疗,观察组患儿采用喜炎平注射液联合头孢曲松钠治疗,治疗周期均为7d.比较两组患儿治疗后临床疗效;比较两组患儿治疗前后肺功能及血清IL-1β、IL-6、IL-8、TNF-α水平的变化.结果 治疗后观察组患儿临床总有效率高于对照组患儿;治疗后两组患儿VPTEF/VE、VT较治疗前比均升高,且观察组高于对照组;治疗后两组患儿RR值及血清IL-1β、IL-6、IL-8、TNF-α水平较治疗前比均降低,且观察组低于对照组(均P＜0.05).结论 喜炎平注射液联合头孢曲松钠可有效抑制炎性反应,缓解支气管肺炎患儿临床症状,改善肺功能,安全性较高.

OBJECTIVE:To study the association of the dynamic changes of peripheral blood human cartilage glycoprotein-39 (YKL-40) and high-mobility group box 1 (HMGB1) with bronchopulmonary dysplasia (BPD) in preterm infants. METHODS:Preterm infants, with a gestational age of 28-32 weeks and a birth weight of <1 500 g, who were admitted to the neonatal intensive care unit from July 2017 to August 2019 were prospectively selected and divided into a BPD group with 35 infants and a non-BPD group with 51 infants. ELISA was used to measure the serum concentrations of YKL-40 and HMGB1 in preterm infants on days 3, 7, and 14 after birth. RESULTS:The BPD group had a significantly lower serum YKL-40 concentration and a significantly higher serum HMGB1 concentration than the non-BPD group on days 3, 7, and 14 (P<0.001). The serum concentrations of YKL-40 and HMGB1 on days 7 and 14 were significantly higher than those on day 3 in both groups (P<0.017). In the BPD group, HMGB1 concentration on day 14 was significantly higher than that on day 7 (P<0.017), while there was no significant change in YKL-40 concentration from day 7 to day 14 (P>0.017). In the non-BPD group, YKL-40 concentration on day 14 was significantly higher than that on day 7 (P<0.017), while there was no significant change in HMGB1 concentration from day 7 to day 14 (P>0.017). CONCLUSIONS:There are significant differences in the levels of YKL-40 and HMGB1 in peripheral blood between the preterm infants with BPD and those without BPD on days 3, 7, and 14 after birth, suggesting that YKL-40 and HMGB1 might be associated with the development of BPD.

目的 探讨早产儿外周血胱抑素C(cystatin C,Cys C)水平变化及其临床意义.方法 选取2018年1月—2018年6月于徐州医科大学附属医院新生儿科住院治疗的早产儿89例,男47例,女42例,平均胎龄(32.78±2.26)周,平均体重(1.94±0.48)kg,采用颗粒增强透射免疫比浊法检测其生后第3天外周血Cys C水平,采用SPSS 18.0软件进行统计学处理,比较不同胎龄、性别、出生体重、生产方式、Apgar评分及母亲有无合并妊娠期高血压、胎膜早破时Cys C水平差异,分析Cys C和胎龄、出生体重、Apgar评分、肌酐(creatinine,Cr)、尿素氮(blood urea nitrogen,BUN)、血清总胆红素(total bilirubin,TBIL)水平的相关性.结果 早期早产儿Cys C水平明显高于中、晚期早产儿,差异有统计学意义(P<0.05),中、晚期早产儿比较差异无统计学意义(P>0.05);极低出生体重早产儿CysC水平高于低出生体重及正常出生体重早产儿,差异有统计学意义(P<0.05),而低出生体重早产儿与正常出生体重早产儿比较差异无统计学意义(P>0.05);3、5分钟Apgar评分<8分的早产儿Cys C水平明显高于>8分早产儿,差异有统计学意义(P<0.05);母亲合并胎膜早破的早产儿Cys C水平高于无胎膜早破早产儿,差异有统计学意义(P<0.05);不同性别、生产方式、TBIL水平及母亲有无合并妊娠期高血压早产儿Cys C差异无统计学意义(P>0.05).相关分析显示:Cys C水平与Cr、BUN呈明显正相关(P<0.05),与胎龄、出生体重、Apgar评分呈负相关(P<0.05),但相关关系不密切(r<0.5),与TBIL水平无相关性(P>0.05).结论胎龄、出生体重、5分钟Apgar评分、母亲合并胎膜早破均为早产儿Cys C水平的影响因素,胎龄越小、出生体重及5分钟Apgar评分越低早产儿Cys C水平越高,且呈负相关,此类早产儿应高度警惕肾脏损害存在,而性别、生产方式、TBIL水平及母亲合并妊娠高血压对Cys C水平无明显影响.

目的:探讨巨细胞病毒性肝损伤患儿外周血CD4+CD25+调节性T细胞(CD4+CD25+regulatory T cells,Treg)、辅助性T细胞17(Th17)、IL-17及IL-35水平及其临床意义.方法:选取20例巨细胞病毒感染肝损伤患儿为肝损伤组,18例巨细胞病毒感染无肝损伤患儿为非肝损组,同期20例体检健康婴儿为对照组;采用荧光免疫PCR(FQ-PCR)法检测尿HCMV-DNA载量,流式细胞术检测外周血Th17、Treg细胞比例,ELISA法检测血浆IL-17、IL-35浓度,同时测定血清丙氨酸转移酶(ALT)含量,分析细胞比例与细胞因子之间的关联.结果:① 与对照组比较,肝损伤组婴儿外周血Th17细胞比例、IL-17浓度明显升高,且两者呈显著正相关(P均<0.05);② 肝损伤组Treg比例及IL-35浓度显著低于非肝损组和正常对照组,且Treg与IL-35间呈显著正相关(P<0.05);肝损伤组Th17/Treg比值明显高于非肝损组和对照组(P均<0.05).③肝损伤组外周血ALT显著高于非肝损组和对照组(P均<0.05),非肝损组和对照组间ALT无明显差异(P>0.05).结论:IL-17、IL-35与巨细胞病毒感染引起的肝损伤密切相关,Th17/Treg的平衡在维持巨细胞病毒感染患儿机体免疫内环境稳定中起着重要作用.

目的 探究分析巨细胞病毒(CMV)感染患儿发生肝功能损伤的临床特点和危险因素.方法 回顾性分析2015年1月-2017年12月在该院初次确诊为巨细胞病毒感染婴儿的临床资料,分析其临床特点和危险因素.结果 肝功能损伤组患儿与非肝功能损伤组患儿比较,外周血中性粒细胞/淋巴细胞比率(NLR)及CD16+ CD56+ NK细胞比例差异有统计学意义(P＜0.05),而白细胞总数、淋巴细胞计数、中性粒细胞计数、患儿年龄、性别、CMV病毒载量以及炎症指标[C-反应蛋白(CRP)、α-酸性糖蛋白]差异无统计学意义(P＞0.05).结论 NLR及NK细胞比例降低与CMV感染患儿发生肝功能损伤密切相关,同时NLR较传统炎症指标对CMV感染患儿肝功能损伤具有更好的诊断和预测价值.

目的 探讨白细胞介素-33(IL-33)、可溶性致癌抑制因子2(sST2)在婴儿巨细胞病毒(HCMV)肝炎中的表达及意义.方法 选取HCMV感染婴儿40例,其中肝炎组20例,其他疾病组20例;另选择同期健康婴儿20例作为对照组.采用ELISA法检测三组婴儿血浆IL-33、sST2、IFN-γ、IL-4浓度,采用流式细胞术检测外周血Th1、Th2细胞比例.结果 HCMV阳性肝炎组和HCMV阳性其他疾病组患儿的血浆IL-33、sST2、IFN-γ、IL-4浓度及Th1、Th2细胞比例均高于对照组,肝炎组高于其他疾病组.肝炎组和其他疾病组患儿IFN-γ/IL-4及Th1/Th2均低于对照组,肝炎组低于其他疾病组,差异均有统计学意义(P<0.05).HCMV肝炎组血浆IL-33浓度与sST2、IL-4浓度及Th2细胞比例呈显著正相关(P<0.05),与IFN-γ/IL-4、Th1/Th2呈显著负相关(P<0.05).结论 HCMV肝炎婴儿存在Th1/Th2失衡,IL-33可能参与HCMV感染所致Th2优势应答和Th1/Th2失衡.

目的 探讨妊娠期宫内感染对胎龄＜37周早产儿免疫指标的影响及相关机制,为临床诊治提供参考依据.方法 收集2016年10月-2018年4月在徐州医科大学附属医院娩出的早产儿189例为研究对象,其中宫内感染组86例,未感染组103例.比较出生后24 h、7d的外周血T淋巴细胞亚群(CD3+、CD4+、CD8+)、免疫球蛋白(IgG、IgM、IgA)、白细胞介素(IL-6、IL-8、IL-1β)及肿瘤坏死因子(TNF-α)水平.收集脐带血,分离脐带血单个核细胞(UBMC),RT-PCR检测细胞中Tlr2、Tlr4、Socsl、Socs3 mRNA表达水平;使用细菌脂多糖LPS刺激未感染组UBMC,检测不同刺激时间(lh、3h、6h、12 h)的Tlr2、Tlr4、Socs1、Socs3 mRNA表达水平.结果 出生后24h、7d感染组早产儿血清CD3+、CD4+、CD8+水平明显高于未感染组,IgG、IgM、IgG水平明显低于未感染组,IL-6、IL-8、IL-1β、TNF-α水平明显高于未感染组(均P＜0.05).感染组早产儿UBMC中Tlr2、Tlr4、Socs1、Socs3 mRNA表达水平明显高于未感染组(均P＜0.05).LPS刺激各时间点Tlr2、Tlr4、Socs1、Socs3 mRNA表达水平均明显高于空白对照组(均P＜0.05);其中Tlr2 mRNA表达在LPS刺激3h时达到峰值,Tlr4 mR-NA表达在LPS刺激1h时达到峰值,Socs1和Socs3 mRNA表达在LPS刺激3h时达到峰值.结论 宫内感染可引发早产儿体内免疫指标异常改变,其机制可能通过Toll样受体和Socs信号通路调节体内免疫反应.

OBJECTIVE To investigate the percentages of peripheral blood γδ T cells and regulatory T cells (Treg) and the expression of associated cytokines, interleukin 17 (IL-17) and transforming growth factor-β1 (TGF-β1), in infants with human cytomegalovirus (HCMV) infection. METHODS Twenty-two infants with HCMV infection (HCMV group) and 22 healthy infants who underwent physical examination (control group) were enrolled in this study. The percentages of peripheral blood γδ T cells and Treg cells were determined by flow cytometry. The levels of IL-17 and TGF-β1 in plasma were measured using ELISA. RESULTS Compared with the control group, the HCMV group had significantly higher percentage of γδ T cells and IL-17 level (P<0.01) and significantly lower percentage of Treg cells and TGF-β1 level (P<0.01). In the HCMV group, the percentage of γδ T cells was negatively correlated with the percentage of Treg cells and TGF-β1 level (P<0.05), but positively correlated with IL-17 level (P<0.05); the percentage of Treg cells was positively correlated with TGF-β1 level (P<0.05), but negatively correlated with IL-17 level (P<0.05); there was no correlation between IL-17 level and TGF-β1 level (P>0.05). CONCLUSIONS There is an imbalance between γδ T cells and Treg cells in the peripheral blood of infants with HCMV infection, and γδ T cells may be involved in the secretion of IL-17.

OBJECTIVE:To compare the efficacy between synchronized intermittent mandatory ventilation (SIMV) and pressure support ventilation with volume guarantee (PSV+VG) in the weaning phase of preterm infants with respiratory distress syndrome (RDS). METHODS:Forty preterm infants with RDS who were admitted to the neonatal intensive care unit between March 2016 and May 2017 were enrolled as subjects. All infants were born at less than 32 weeks' gestation and received mechanical ventilation. These patients were randomly and equally divided into SIMV group and PSV+VG group in the weaning phase. Ventilator parameters, arterial blood gas, weaning duration (from onset of weaning to extubation), duration of nasal continuous positive airway pressure (NCPAP) after extubation, extubation failure rate, the incidence rates of pneumothorax, patent ductus arteriosus (PDA) and bronchopulmonary dysplasia (BPD), and the mortality rate were compared between the two groups. RESULTS:The PSV+VG group had significantly decreased mean airway pressure, weaning duration, duration of NCPAP after extubation, and extubation failure rate compared with the SIMV group (P<0.05). There were no significant differences in arterial blood gas, mortality, or incidence rates of pneumothorax, PDA and BPD between the two groups (P>0.05). CONCLUSIONS:For preterm infants with RDS, the PSV+VG mode may be a relatively safe and effective mode in the weaning phase. However, multi-center clinical trials with large sample sizes are needed to confirm the conclusion.

Objective To analyze high risk factors for poor prognosis in the refractory neonatal respiratory distress syndrome(NRDS).Methods A retrospective analysis was conducted at NICU in the Affiliated Hospital of Xuzhou Medical university.The newborns with NRDS,chest radiograph for grades 3 and 4,who required mechanical ventilation and pulmonary surfactant(PS)therapy were recruited from January 2014 to December 2015.According to treatment rusults,they were divided into death group(21 cases)and survival group(25 cases).Data regarding antenatal corticosteroid administration,maternal high risk factors,the basic situation of neonatal in the perinatal period,surfactant applications,the blood routine,albumin,lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),blood coagulation function with the first 24 hours after birth were collected and analyzed.Results The frequency of using PS in the death group and the survival group was(2±0.9)times and(1.5±0.6)times,the difference between the two groups was statistically significant(t=2.131,P=0.039).Dangerous placenta previa in death group was 19％(4/21),in the survival group was 0％(0/25),the two groups had statistical differences(x2=5.215,P=0.022).CK in death group was(541.5±399.1)U/L,in the survival group was(345.4±173.3)U/L,the difference between of the two groups was statistically significant(t=2.224,P=0.031).Prothrombin time(PT)in the death group was(23.2±6.3)s,in the survival group was(18.5±3.6)s,there was a significant difference between the two groups(t=3.008,P=0.039).Maternal risk factors of premature rupture of the survival group(38.9％)was higher than that of death group(5.0％),the two groups was statistically significant(x2=4.29,P=0.038).The application of prenatal hormone NRDS newborns were more likely to survive,there was statistical difference between two groups(x2=5.197,P=0.023).Multivariate Logistic analysis showed that PT was an independent risk factor for poor prognosis of NRDS.Conclusion PT is an independent risk factor for poor prognosis of neonatal respiratory distress syndrome.

Objective To investigate the effects of sodium aescinate(SA) on the expressions of absent in melanoma 2(AIM2),Caspase-1 and matrix metallopeptidase 9(MMP-9) in the brain tissues of the mice with cytomegalovirus infection.Methods Fifty-four newborn Balb/c mice were intraperitoneally injected murine cytomegalovirus(MCMV) suspension(TCID50 104.44U/ml,20μl) to establish the mouse models of disseminated MCMV infection,which were randomly and equally divided into three groups of A(model control),B(intraperitoneally injected SA 5mg·kg-1·d-1) and D(intraperitoneally injected ganciclovir 60mg·kg-1·d-1).Another 18 mice were selected as the blank controls(group C).Groups of A and C were intraperitoneally injected an equal volume of normal saline.On the 7th,14th and 21st day after administration,the MCMV-DNA expression in brain tissues was determined by PCR and the protein expressions of AIM2,Caspase-1 and MMP-9 in brain tissues were detected by Western blot.Results The MCMV-DNA expression in brain tissues was seen in groups of A, B and D.At each time point, the MCMV-DNA expression in group B was higher than that in group D(P<0.05), but lower than that in group A(P<0.05).The protein expressions of AIM2,Caspase-1 and MMP-9 in brain tissues were higher in groups of A,B and D than those in group C(P<0.05).At each time point,the protein expressions of AIM2,Caspase-1 and MMP-9 in group D were higher than those in group B,but lower than those in group A(P<0.05).The expressions of AIM2,Caspase-1 and MMP-9 in groups of B and D were lower on the 21st day than those on the 7th day,while group A showed an opposite trend in the expressions of above proteins(P<0.05).Conclusion AIM2,Caspase-1 and MMP-9 are involved in the inflammatory process of MCMV-related brain damage.SA can reduce MCMV-related brain damage by inhibiting neuronal pyroptosis.

目的 总结本院NICU住院超过30d早产儿的临床特点,分析导致住院时间长的原因.方法 选择2011年1月-2014年12月本院NICU住院超过30 d的104例早产儿为研究对象,采用回顾性分析方法,对性别、胎龄、出生体质量、孕母导致早产的高危因素、Apgar评分、住院期间合并症、转归、住院费用等进行总结和分析.结果 在这104例早产儿中,男62例,女42例,平均胎龄(31.0±2.1)周,平均出生体质量(1 506±341)g,其母妊高症、重度子痫前期、胎膜早破是导致早产主要原因(64例,67.8％),5min Apgar评分＜7分的占71.7％,合并症中常见的以新生儿呼吸窘迫综合征(NRDS)最多见,共89例(85.6％),84例(80.8％)患儿有呼吸机使用史,其中有创机械通气60例(57.7％),平均呼吸机使用时间(14.3±9.9)d,使用肺表面活性剂的87例(83.7％),其次是新生儿肺炎和呼吸机相关性肺炎(61.5％)、呼吸暂停(48.1％)、新生儿败血症(40.4％)、慢性肺病(32.7％).好转出院90例(86.5％),放弃11例,死亡3例,出院时宫外发育迟缓80例(76.9％),有33例出院前行头颅MRI或CT、脑干诱发电位检查,均有不同程度异常.平均住院时间(40.7±10.8)d,人均住院费用(50 299±18 314.2)元.结论 胎龄、出生体质量、合并症多且重是导致早产儿住院时间长的主要原因,而合并症中仍以呼吸系统疾病和感染为主,积极预防早产和治疗各种早产儿并发症是缩短早产儿住院时间的重要举措.

Objective To investigate the effects of different phototherapy durations on neonatal hyperbilirubinemia and adverse reactions .Methods A total of 120 newborn infants with moderate to high non -hemolytic hyperbilirubinemia were enrolled in the study .They were randomly divided into three groups according to the duration of phototherapy given :8 hours, 12 hours and 24 hours (n=40 for each).The level of total serum bilirubin (TSB) was measured before photothera-py, after the first phototherapy and three days after treatment .The amount of transcutaneous bilirubin ( TCB) was deter-mined 2 hours after each phototherapy , and phototherapy was continued until TCB <205μmol/L.Meanwhile, the duration that neonatal jaundice appeared in each group and adverse reactions were recorded .Results After the first phototherapy and three days after treatment , no significant difference was found as to the rate and duration that neonatal jaundice ap-peared among these groups (P>0.05).However, these groups were remarkably different in adverse reactions which were increased along phototherapy extended ( P<0.05) .Conclusion Single phototherapy for 8 hours can produce the same ef-ficacy after 12 hours and 24 hours of treatment , with less adverse reactions .