Objective To explore the impacts of plasma 8-hydroxydeoxyguanosine(8-OHDG)and plasma malondialdehyde(MDA)on coronary arteries lesions(CAL)and vascular endothelial dysfunction in children with Kawasaki disease(KD).Methods The plasma 8-OHDG and plasma MDA were measured in KD children group at acute stage(n=60,12 cases had coronary artery lesions,48 coronary were normal),paracmastic and recovery stage(both 40 cases)by ELISA method.Measurement of vasodilator response(FMD%)mediated by brachial artery flow in paracmastic and recovery stage KD children group.Another 15 febrile children(the febrile group)and 15 healthy children(the control group)were selected.Results The plasma 8-OHDG and plasma MDA concentrations in acute and paracmastic and recovery stage of KD children group were all higher than those of normal control group(P<0.05).Plasma 8-OHDG and plasma MDA concentrations in acute stage were significandy higher than those of KD children group in paracmastic and recovery stage and the fever patients group(P<0.05).The CALs patients had higer plasma 8-OHDG and plasma MDA concentrations than the NCALs patients(P<0.05).Using plasma 8-OHDG concentration≥1.241 ng/mL,MDA concentration≥0.456nmol/mL as cut-off values for diagnosing CALs respectively,the areas under the ROC curves were 0.899 and 0.748,the sensitivity were 83.3%and 100%,the specificity were 91.7%and 39.6%,respectively.FMD of the brachial artery was significantly lower in both of KD children in paracmastic and recovery stage than that in the control group(P<0.05).KD children in paracmastic stage had lower FMD of the brachial artery than that in recovery stage group.The FMD of the brachial artery with KD children in paracmastic and recovery stage were negatively correlated with the plasma level of 8-OHDG and plasma MDA(r=-0.495,-0.357,P<0.05).Conclusion Oxidative stress maybe involve from the acute stage to the recovery stage with KD children.8-OHDG appears to be better in the diagnosis of coronary artery lesions than MDA.There are vascular endothelial dysfunction during the paracmastic and recovery stage with KD children.Increasing plasma 8-OHDG and MDA concentrations may impair the vascular endothelial function.

目的 研究维生素D及甲泼尼龙琥珀酸钠联用对过敏性紫癜(henoch-schonlein purpura,HSP)患儿的预后效果及对细胞免疫功能的影响.方法 选择2020年2月至2022年2月杭州市儿童医院收治的150例HSP患儿,采用随机数字表法分为观察组与对照组,每组各75例,对照组予静脉滴注甲泼尼龙琥珀酸钠治疗,观察组在对照组的基础上联合维生素D治疗,比较两组的临床疗效,症状消失时间及住院时间、细胞免疫功能、不良反应等.结果 观察组患儿治疗后的总有效率明显高于对照组(P＜0.05).观察组患儿治疗后的皮疹、腹痛、关节肿痛消失时间及住院天数分别短于对照组(P＜0.05).治疗后观察组CD3+、CD4+及自然杀伤细胞水平分别高于对照组(P＜0.05).两组不良反应比较,差异无统计学意义(P＞0.05).结论 维生素D及甲泼尼龙琥珀酸钠联合应用治疗HSP患儿预后效果显著,有利于提高患儿的细胞免疫功能,安全性良好.

Introduction: Childhood asthma is one of the most common pediatric diseases, and its incidence is increasing. Annexin A3 (ANXA3) is a member of the Annexin family, a well-known polygenic family of membrane binding proteins. Bioinformation analysis showed that ANXA3 was highly expressed in asthmatic patients, suggesting the effects of ANXA3 on asthma, whereas the mechanism is still unclear. Methods: A inflammatory response model of bronchial epithelial BEAS-2B cells induced by LPS was constructed. Immunoblot and quantitative PCR assays were performed to detect the expression levels of ANXA3 in control or LPS-induced BEAS-2B cells. MTT, flow cytometry (FCM), and Immunoblot assays were respectively conducted to detect the effects of ANXA3 on survival and apoptosis of LPS-induced BEAS-2B cells. qPCR and ELISA assays were performed to detect the expression of TNF-α, IL-6, and IL-8. Additionally, Immunoblot assays were performed to detect the effects of ANXA3 on HIF1α and NLRP3 inflammasome in BEAS-2B cells. Results: We found ANXA3 was overexpressed in LPS-induced BEAS-2B cells. ANXA3 ablation promoted the survival of LPS-induced BEAS-2B cells and suppressed the inflammatory response of LPS-induced BEAS-2B cells. Importantly, we noticed ANXA3 inhibited HIF1α-induced NLRP3 inflammasome activity, and increasing the expression of HIF-α rescued the effects of ANXA3 depletion on asthma. Conclusion: ANXA3 enhanced LPS-triggered inflammation of human bronchial epithelial cells by regulating hypoxia-inducible factor-1α (HIF1α)-mediated NLRP3 inflammasome activation, and thought ANXA3 as a promising molecular target for acute asthma treatment.

目的 探讨川崎病(KD)患儿并发冠状动脉损伤(CAL)的特点及其危险因素.方法 选取2016年1月至2020年2月我院儿科收治的KD住院患儿296例为调查对象,按照超声心动图检查结果是否发生CAL将其分为CAL组(97例)和NCAL组(199例).计算KD患儿并发CAL的发生率;KD患儿并发CAL的危险因素筛选采用单因素χ2检验和多因素逐步Logistic回归法,筛选因素包括性别、年龄、持续发热时间、临床诊断、诊治时间、IVIG开始使用时间、IVIG抵抗、WBC、hs-CRP、ESR、PLT、ALB、cTnI、D-二聚体、血钠、心电图检查、激素治疗.结果 我院KD患儿并发CAL的发生率为32.77％(97/296);单因素分析结果显示,两组年龄、持续发热时间、诊治时间、IVIG开始使用时间、IVIG抵抗、WBC、hs-CRP、ESR、PLT、ALB、cTnI、D-二聚体、血钠、心电图检查因素比较,差异有统计学意义(P<0.05);多因素分析结果显示,持续发热时间(OR=2.195)、诊治时间(OR=3.297)、IVIG抵抗(OR=4.367)、hs-CRP(OR=2.989)、ESR(OR=3.550)、cTnI(OR=5.328)、D-二聚体(OR=3.892)是KD患儿并发CAL的危险因素.结论 KD住院患儿具有较高的CAL发生率,且影响其发生的危险因素较多,应针对这些高危因素进行早筛查、早诊断、早治疗,降低CAL的发生率,改善KD患儿预后.

目的 分析糖皮质激素联合静脉注射丙种球蛋白(IVIG)治疗IVIG无反应型川崎病的临床效果.方法 选取2016年6月至2020年6月于我院住院治疗确诊为IVIG无反应型KD患儿68例作为研究对象,依据再次治疗是否联合使用糖皮质激素分为A组(IVIG)和B组(糖皮质激素联合IVIG),其中A组42例、B组26例.分析两组患儿总热程、热退时间、冠状动脉损害情况及再次治疗前、治疗后1周实验室指标白细胞(WBC)、血小板(PLT)、超敏C反应蛋白(hsCRP)、血沉、IL-6的变化.结果 B组患儿的总热程、热退时间均短于A组,差异有统计学意义(P<0.05).B组患儿出现冠状动脉扩张、冠状动脉瘤发生率略高于A组,但差异无统计学意义(P>0.05).B组治疗后WBC高于A组,B组WBC治疗前后差值低于A组;B组治疗前hsCRP及治疗前后hsCRP差值均高于A组;B组治疗后IL-6低于A组,B组IL-6治疗前后差值高于A组,差异均有统计学意义(P<0.05).结论 两种方案治疗IVIG无反应型川崎病均有效;两组冠状动脉损害发生率,差异无统计学意义,糖皮质激素联合IVIG没有增加冠状动脉病变的发生风险;不同治疗方案对两组患儿治疗前后WBC、hsCRP、IL-6水平存在影响,与单用IVIG治疗相比,糖皮质激素联合IVIG在KD急性期能更好的控制IVIG无反应型KD患儿的炎症指标并能缩短发热时间.

目的 探讨腺病毒感染儿童体液免疫的特点.方法 收集2019年1月-2020年4月于杭州市儿童医院住院确诊为人腺病毒(HADV)感染的患儿191例,另选取50例健康儿童为对照组.其中HADV感染患儿按临床表现、影像学检查分为肺炎组、支气管炎组及上呼吸道感染组,分析HADV各组与对照组间体液免疫水平的差异.结果 HADV各组与对照组IgG、C3、C4水平比较,差异有统计学意义(P＜0.05).两两比较显示,肺炎组、支气管炎组IgG水平均低于对照组(P＜0.05),但肺炎组与支气管炎组比较,上呼吸道感染组与其他3组比较,IgG水平差异均无统计学意义(P＞0.05).肺炎组、支气管炎组、上呼吸道感染组C3、C4水平均高于对照组(P＜0.05),但HADV各组C3、C4水平比较,差异无统计学意义(P＞0.05).HADV各组与对照组IgA、IgM水平比较,差异均无统计学意义(P＞0.05).随着HADV感染后呼吸道疾病程度加重,IgA、IgG水平呈现出逐渐下降而IgM水平逐渐上升的趋势,但各组间水平差异并无统计学意义(P＞0.05).结论 HADV感染后患儿体液免疫功能发生紊乱,出现部分免疫球蛋白水平下降而补体水平升高的异常免疫应答,监测HADV感染患儿体液免疫水平可有助于病情监控,为免疫调节干预提供支持.

目的分析手足口病(HFMD)并发急性弛缓性瘫痪(AFP)患儿的临床特点。方法观察8例HFMD并发AFP患儿的临床特点,在起病1～3周内进行神经电生理、MRI检查,并进行早期药物治疗及康复锻炼,随访3～12个月。结果 8例手足口病并发AFP病例中,3例四肢瘫痪,2例单侧上肢瘫痪,2例双下肢瘫痪,1例单侧下肢瘫痪。7例神经电生理结果提示脊髓前角细胞病变,4例MRI显示颈2～7或胸12～腰1脊髓前角区长T1长T2信号。其中有1例四肢瘫痪MRI示延髓长T1长T2信号,胸3～7中央管扩张。单侧下肢瘫痪者功能恢复较快,上肢及四肢瘫痪患儿恢复相对缓慢。1例四肢瘫患儿随访至6个月时出现后遗症,随访至12个月时其患肢功能障碍仍存在。8例手足口病合并AFP中,EV71阳性5例。其中1例双下肢瘫痪患儿粪便EV71排毒时间长达70 d。结论手足口病并发AFP患儿其神经电生理、MRI显示病变越重,相应患肢功能障碍越明显,恢复时间亦相对漫长,预后较差。神经电生理、MRI检查对于早期诊断、评估病情及预后有重要的参考价值。EV71感染后粪便排毒周期长,需强化综合预防控制措施。

<正>手足口病(hand-foot-and-mouth disease,HFMD)是儿童尤其是婴幼儿常见传染病之一,主要由肠道病毒尤其以EV71及CoxA16感染最为常见。HFMD患儿的临床经过及转归差别较大,与患儿机体免疫状况可能存在一定关系。本研究对我院2012年4月—10月收治的112例EV71阳性、53例CoxA16