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06 June 2012, Volume 27 Issue 06 Previous Issue    Next Issue

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Nephrotic syndrome complicated with thromboembolism in children -retrospective analysis of 23 cases . 2012, 27(06): 428-431.  Abstract ( )   Objective    To discuss the clinical manifestations and therapeutic methods of nephrotic syndrome(NS) complicated with thromboembolism(TE) in children. Methods    The clinical data of NS complicated with TE between 2006 and 2010 were retrospectively analysed. Gender， the onset age of TE， site， clinical manifestations， blood/urine indices， the course of NS， the use of steroids and curative effects were investigated. Results    Totally 23 cases of NS complicated with TE were found in our study. The ratio of boys to girls was 4.75∶1 and the average age was （8.17 ± 4.12） years old. There was 1 case with arterial thrombosis，14 cases with venous thrombosis and 9 cases with embolism. In these 23 cases，urinary protein quantity for 24 hours was （132.65 ± 46.79） mg/(m2·h) and serum albumin was （12.73 ± 4.06）g/L. The elevation of fibrinogen and D-dimer were seen in 18 and 22 children respectively. Symptoms，coagulative function and imaging performances were improved in 22 children， 1 child gave up treatment for economic difficulties. There was no thrombolysis-related adverse event. Conclusion    The diagnosis of TE should be considered when nephrotic syndrome is complicated with massive proteinuria， hypoalbuminemia， hypercholesteraemia， using of steroids and diuretics. Fibrinogen and D-dimer increase are predictive for the diagnosis of TE.

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Clinicopathological characteristics of the primary IgA nephropathy with crescentic formation in children. 2012, 27(06): 432-435.  Abstract ( )   Objective    To understand the clinical and pathological characteristics of the primary IgA nephropathy（IgAN） with crescentic formation in children. Methods    Clinicopathological data of 78 children with primary IgAN were analyzed. These patients were divided into two groups according to with or without crescents，and their results were compared. Results    There were 57 male and 21 female patients，with a mean age of （9.32 ± 3.16） years old；33 of them were in Group C （with crescents） and 45 were in Group NC （without crescents）. Compared with Group NC，there were significant differences in the course of disease ［（2.15 ± 4.06）m vs （9.87±19.09）m，P＜0.05］，macrohematuria （30/33 vs 25/45，P＜0.01），the levels of 24hrs proteinuria［（93.08 ± 82.75）mg/（kg·d） vs （44.92 ± 68.44）mg/（kg·d），P＜0.05］，the case number of severe proteinuria（19/31 vs 10/42 ，P＜0.01） and occurence of renal impairment （8/33 vs 2/45，P＜0.01） in Group C. In renal pathology，significantly more cases in Group C had moderate-severe mesangial proliferation，endocapillary proliferation and tuft adhesion than in Group NC（P＜0.01）. Immunofluorescence of both Group C and Group NC showed no significant difference. Conclusion    The clinical manifestation and renal lesions of IgAN with crescentic formation in childhood are worse than those without，thus we should improve the understanding of this type of IgAN so as to make early diagnosis，treatment and improve the prognosis of this disease.

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The therapeutic effect of HLH-2004 protocol for hemophagocytic lymphohistiocytosis in children. 2012, 27(06): 436-439.  Abstract ( )   Objective    Explore the therapeutic effect of HLH-2004 protocol announced by Histiocyte Society in children with hemophagocytic lymphohistiocytosis (HLH) and the related factors affecting curative effect. Methods Cases of children of our hospital in January 2005 - December 2009 based on diagnostic criteria of HLH-2004 were retrospectively analyzed.According to criterion of therapeutic effect of HLH-2004，observe their clinical symptoms and reaction to the treatment，and analyze related factors which possibly affect the curative effect of HLH in children . Results    Totally 28 cases of HLH patients received HLH-2004 therapy，and follow-up time ranged from 2 weeks to 22 months；17 patients (60.7%) achieved complete remission or cure， patients lost to follow-up in 9 cases (32.1%)，among which 3 cases have been clinically effective or improved discharge lost，while 6 cases lost to follow-up has not been ease； 2 cases (7.2%) died. Conclusion    Early positive treatment of the primary disease and the use of HLH-2004 immune chemotherapy in children with HLH effectively control the disease， improving the cure rate and survival rate in children.

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Analysis of prevalence and antibiotic resistance of Acinetobacter baumannii in children with acute respiratory tract infection in Suzhou 2009-2010. 2012, 27(06): 440-442.  Abstract ( )   Objective    To analye the prevalence,clinical characteristics and antibiotic resistance of Acinetobacter baumannii (AB) in children with acute respiratory tract infection in Suzhou. Methods    Data of sputum culture of 3529 hospitalized child patients with acute respiratory tract infection from January 2009 to December 2010 were collected.The incidence of positive AB and the rate of resistance to different antibiotics were calculated. Results    Of the total 3529 cases,44 ABs were detected.The infection rate had no relation with sex or age but was related to season，which was more frequent in summer and autumn.The resistance to ampicillin，furantoin and cephazolin was completely with the adscendent resistance rates to ceftazidime，cefotaxime and cefpirome；isolates resistance to cefoperazone sodium，tobramycine，levofloxacin，ampicillin sulbactam，amikacin and imipenem was not found. Conclusion    The infection of AB in children with acute respiratory tract infection is closely related to season，but has no relation with sex or age in Suzhou.It is completely resistant to ampicillin，furantoin and cephazolin；the resistance rates to the third and fourth generation of cephalosporin step up.

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Clinical data analysis of 11 cases of medullary sponge kidney in children. 2012, 27(06): 443-445.  Abstract ( )   ：Objective    To achieve early diagnosis and treatment as well as to improve prognosis through literature review and clinical features of medullary sponge kidney in children. Methods    Eleven children with medullary sponge kidney admitted to the Affiliated Children’s Hospital from Jan 2005 to Dec 2010 were retrospectively analyzed. Results Among the 11 cases， there were 3 male and 8 female， agied from 48 days to 17 years (6 were within 1 year old and 5 were above 3 years old). None of these cases were clinically specific， and all were image-diagnosed to be bilateral medullary sponge kidney. The clinical demonstrations included： recurrent urinary tract infection (5 cases)， distal renal tubular acidosis (7 cases)， kidney stones (1 case)， hypertension (2 cases)， malnutrition and growth retardation (6 cases)， renal failure (2 cases)， and adrenal cortical hyperfunction (1case). Conclusion    Medullary sponge kidney in early childhood is not clinical specific but with diverse clinical manifestations. The early diagnosis could be based on laboratory examinations； abdominal ultrasound and CT can be used as first choice. In the occasion of complications， a reasonable treatment can improve the prognosis.

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The immune state and regulatory function of Haiqihuang particle in the patients with primary nephrotic syndrome. 2012, 27(06): 446-448.  Abstract ( )   Objective    Observe the effect of Huaiqihuang particles on the lymphocyte populations，immunoglobins and the times of infection of patients with primary nephrotic syndrome（PNS）. Methods    Totally 101 patients first diagnosed with PNS were randomly divided into group A （62 cases） and group B （39 cases）.Group A was treated with prednisone and Huaiqihuang particles，while Group B was treated with prednisone only. Detect the level of lymphocyte populations，immunoglobins，albumin，urine protein before the treatment，3 months and 6 months after treatment. Record the times of infection and relapse of the patient and the side-effect of Haiqihuang particle. A total of 22 healthy children were selected as control group. Results    （1） Before the treatment， the percentage of CD8+ in group A and B was higher than that of the control group（P＜0.05）. However， the percentage of CD4+， NK cell， CD4+/CD8+ and the serum level of IgA and IgG in group A and B were lower than that of the control group（P＜0.05）. （2） After 3 months of treatment， there was no difference in the percentage of CD8+ between group A （n = 39） and group B （n = 30）， but in both groups it was significant ly higher than that of the control group（P＜0.01）. The percentage of CD4+and CD4+/CD8+ in group B was significantly lower than that of group A and control group（P＜0.05）； after 3 months treatment， the percentage of NK cell in group A and B was significantly increased， and in group A was it higher than group B（P＜0.05）. The level of IgG was increased， but there was no difference between the two groups. （3） After 6 months of treatment， there was no difference in every index between group A （n = 23） and group B （n = 9）， but every index in both groups was lower than that of the control group （P < 0.01）. （4） Only one case appeared severe diarrhea. There were 6 cases of upper respiratory tract infection，only 2 cases of pneumonia，and 4 cases of relapse in group A. While， there were 10 cases of upper respiratory tract infection，only 3 cases of pneumonia，2 cases of urinary tract infection，and 6 cases of relapse in group B. Conclusion    The immunity of  patients  with  PNS is abnormal. Huaiqihuang particles can  improve the levels of NK cell and T lymphocyte，hence reduce the times of infection and relapse. Huaiqihuang particles has little side effects.

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Clinical effect observation of 59 cases of childhood hypersensitivity disease treated with montelukast and their life evaluation. 聂亚玲1a，许鹏飞2，史 杰1b 2012, 27(06): 449-451.  Abstract ( )   Obejective    To observe the effect of LTRA montelukast in treating childhood hypersensitivity disease and to get data related to their life. Methods    Thirty-one children with hypersensitivity disease under conventional therapy took additional montelukast （5 mg/d， h.s.）. After a course of six months， the effect was comprehensively assessed according of  skin prick test result， clinical improvement， weight changes， mental activity changes and school record changes. Results    After the treatment， the five assessments of 31 children had improved to different extent. And the clinical efficacy reached 100%. The improvement rates of behavior disorder and school record had significant difference between pre-and post-treatment（P＜0.05）.Conclusion      Montelukast is effective to treat childhood hypersensitivity disease and the clinical comprehensive assessment can better reflectthe clinical efficacy.

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Analysis of efficacy evaluation indicators of malnourished children.    2012, 27(06): 452-455.  Abstract ( )   Objective    To study the significance of serum albumin （ALB），retinol-binding protein （RBP），prealbumin （PA），fibronectin （FN），transferrin （TRF），leptin （LP） and amino acids in malnourished children，to detect sensitive indicators of the effectiveness of enteral nutrition. Methods    30 outpatients from health care clinic from January to Februry 2010 and 30 malnourished inpatients from February 2009 to Februry 2010 were chosen in Department of Gastroenterology，Women and Children’s Medical center. Routine blood test and serum ALB，TRF，PA，RBP，FN，LP，TC，amino acid were determined respectively before continued nasogastric feeding and 10 days later. Results    Serum RBP、PA、FN、TRF、LP were significantly higher than before （P < 0.01 or P < 0.05），no change was observed in height，weight，BMI，TSF，MAC，MAMC，TC，Hb，RBC，MCHC，TLC，ALB （P > 0.05）. There were significant positive correlations between BMI and ALB，RBP，PA，FN，TRF；ALB and RBP，PA，FN，TRF；PA and BMI，ALB，RBP，FN，TRF，LP；LP and BMI，ALB，RBP，PA. Glutamine，histidine，isoleucine，alanine，valine，arginine，leucine，lysine，EAA，EAA/NEAA，BCAA were significantly higher than before （P < 0.01 or P < 0.05），tyrosine，phenylalanine and total aromatic amino acids decreased significantly （P < 0.01 or P < 0.05）.  Conclusion    RBP，PA，FN，TRF，LP and amino acids were sensitive indicators to assess the effectiveness of enteral nutrition.

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The Characteristics of Streptococcus pyogenes from Chinese children with impetigo between 2003 and 2008. 2012, 27(06): 456-459.  Abstract ( )   Objective    To investigate the characteristics of Streptococcus pyogenes (Group A Streptococcus, GAS) isolated from Chinese children with impetigo.Methods    The sensitivity of 52 GAS to nine antibiotics (penicillin,cephadine, ofloxacin, chloramphenicol, tetracycline, erythromycin, clarithromycin, clindamycin and azithromycin) was measured as minimal inhibitory concentration (MICs). The macrolide-resistance genes and M protein gene (emm gene) were detected by polymerase chain reaction (PCR).Results    Among 52 GAS strains isolated from 1735 patients with impetigo, 100% (52/52) were resistant to tetracycline and the macrolide antibiotics erythromycin, clarithromycin, clindamycin and azithromycin;  No isolates were detected with both ermB and ermA, and no isolates were detected with the mefA gene. The most common strains were emm 12.0 (28/52, 53.85% ), and emm 1.0 (19/52, 36.54%). Rare strains were emm 4.0 (1/52, 1.92%), emm 8.0(1/52, 1.92%), emm 22.0 (1/52, 1.92%), emm 101 (1/521.92%), and emm 114 (1/52, 1.92%).Conclusion    The most prevalent types were emm1.0 and emm12.0. GAS strains had a high percentage of resistance to macrolide antibiotics and tetracycline. Most expressed the ermB gene and were sensitive to penicillin,cephadine and ofloxacin.