ABSTRACT
Objective To study the application value of neutrophil elastase (NE), fibrinogen (Fib) combined with tumor necrosis factor-α (TNF-α) in the prognosis prediction of severe pneumonia in children. Methods Eighty-two children with severe pneumonia who were admitted into the Yuhang District Maternal and Child Health Hospital of Hangzhou in Zhejiang Province from July 2016 to September 2018 were treated as a severe group, and the children with severe pneumonia were subdivided into a survival group (70 cases) and a death group (12 cases) according to the prognosis; another 90 children with common pneumonia who were treated in our hospital at the same time were selected as a general group; and 85 normal children who received physical examinations at the same time as a healthy control group. The levels of serum NE, Fib and TNF-α in the three groups were measured by enzyme-linked immunosorbent assay (ELISA), and the pneumonia severity index (PSI) was calculated in the severe group and the general group; Spearman correlation analysis was used to analyze the correlation between NE, Fib, TNF-α and PSI;the NE, Fib and TNF-α levels were evaluated to predict the prognosis of children with severe pulmonary disease;the receive operating characteristic (ROC) curve was drawn to evaluate the prognostic value of NE, Fib, TNF-α in children with severe pulmonary disease. Results The expression levels of serum NE, Fib and TNF-α in the severe group were higher than those in the general group and the healthy control group [NE (μg/L): 127.5±12.3 vs. 75.1±6.6, 24.3±5.9, Fib (g/L): 6.9±1.2 vs. 5.1±0.7, 2.8±0.8, TNF-α (μg/L): 98.3±6.9 vs. 63.1±6.8, 30.2±2.1, all P <0.05]. Serum levels of NE, Fib and TNF-α in the death group were higher than those in the survival group [NE (μg/L):141.2±14.9 vs. 80.3±7.4, Fib (g/L): 7.6±1.5 vs. 5.7±1.0, TNF-α (μg/L): 105.4±7.8 vs. 68.2±4.6, all P < 0.05]. It was shown by ROC curve analysis that NE, Fib, TNF-α have some value in predicting the prognosis of children with severe pneumonia, the area under the ROC curve (AUC) were 0.889, 0.809, 0.803, 0.961, 95% confidence internal (95%CI) were 0.817-0.968、0.706-0.909、0.702-0.891、0.908-1.000, the sensitivity were 71.2%, 62.7%, 64.9%, 92.3%, the specificity were 73.5%, 68.3%, 74.5%, 90.9%, all P = 0.000. The PSI of severe pneumonia group was significantly higher than that of the general group (97.4±12.1 vs. 76.4±9.6), the PSI of the death group was obviously higher than that of the survival group (100.8±13.1 vs. 87.3±10.5), and the differences were statistically significant (both P < 0.01). Spearman correlation analyses showed that serum NE, Fib, TNF-α and PSI were significantly positively correlated in children with severe pneumonia respectively (r = 0.767, 0.734, 0.673, all P < 0.05), and there were positive correlations between NE and Fib (r = 0.655,P = 0.000), NE and TNF-α (r = 0.530,P = 0.000), Fib and TNF-α (r = 0.522,P = 0.000). Conclusion The combined detections of NE, Fib, and TNF-α levels can help clinicians determine the changes in the condition of children with severe pneumonia and evaluate their prognoses, combined detection has high sensitivity and specificity.
ABSTRACT
Objective Detection of S-100B protein in different degree meconium pollution level in serum of children with value.MethodsIn 2012 June to 2013 December in our department were simple meconium stained amniotic fluid in term newborns in 73 cases, and set up for the observation group, and according to the amniotic fluid pollution degree is divided into 47 cases of amniotic fluid of Ⅰ-Ⅱdegree pollution group and 26 cases in grade Ⅲmeconium group during the same period, selected 20 cases without amniotic fluid contamination in term healthy newborns for the control group, the groups were compared in S-100B protein content difference.ResultsⅢmeconium stained amniotic fluid were within 6h serum S-100B was significantly higher than that in control group(P0.05).Ⅲ meconium stained amniotic fluid in children with 72h also increased.ConclusionThird degree meconium stained amniotic fluid but normal Apgar score of newborns may still exist in clinical brain injury, so pay close attention to.
ABSTRACT
Objective To investigate the significance of early diagnosis and intervention in cases with severe hand-foot-mouth disease. Methods Nine severe cases were chosen from 220 hospitalized children with hand-foot-mouth disease for retrospective analysis, including onset, disease progression, the blood and cerebrospinal fluid tests, electroencephalogram data, patients' treatment responses and prognosis. Pearson X2 test and t test were utilized for statistical analysis. Results All cases showed nervous systems involved symptom, including meningeal irritation sign and (or) other pathological signs of nervous system (9 cases), drowsy (7 cases), trembling (6 cases), voiding dysfunction (3 cases), hypersensitivity(3 cases), autonomic nervous system disorders (2 cases), ataxia (1 case), left leg mild paralysis (1 case) and early stage of pulmonary edema (1 case). Early intervention, such as high dose gamma globulin, methylprednisolone, mannitol treatment restriction of fluid input, started before the development of heart and lung failure. No case died but one patient with encephalomyelitis showed hobbling left leg, which didn't recover until 6 weeks later. One case with brainstem encephalitis still showed abnormal electroencephalogram after 8 weeks follow-up but without clinical symptom. Conclusions Enterovirus 71 can cause severe hand-foot-mouth disease complicated by encephalitis, meningitis and pulmonary edema. Early active intervention before the development of neurogenic pulmonary edema can improve the prognosis and reduce the mortality.