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Objective:To explore the value of changes of plasma amino acids in the diagnosis of neonatal intrahepatic cholestasis caused by Citrin deficiency (NICCD).Methods:A total of 144 infants diagnosed with cholestasis and undergoing blood tandem mass spectrometry in Jiangxi Children′s Hospital From January 2016 to December 2018 were studied.They were divided into 3 groups: NICCD group(11 cases), biliary atresia group (BA group, 40 cases), and Cholestatic Cytomegalovirus hepatitis group (CMV group, 93 cases). The plasma amino acids and biochemical results of the 3 groups were compared, and the data of the 3 groups were statistically analyzed by Kruskal- Wallis test.The items with statistical discrepancy were examined by Mann- Whitney test between groups. Results:Compared with BA group and CMV group, the levels of arginine(Arg), methionine(Met), tyrosine(Tyr), citrulline (Cit), glutamic oxaloacetic transaminase and glutamic-pyruvic transaminase ratio(AST/ALT) in NICCD group increased significantly, while the level of alanine(Ala) decreased.The above discrepancy were statistically significant(all P<0.05). The Arg, Met, Tyr, Cit, AST/ALT, and Ala levels of NICCD group were 68.518(19.714, 108.470) μmol/L, 111.724(42.156, 214.585) μmol/L, 104.394(75.642, 146.086) μmol/L, 165.664(119.874, 291.327) μmol/L, 3.17(1.97, 3.98), and 140.297(112.052, 184.015) μmol/L, respectively.The Arg, Met, Tyr, Cit, AST/ALT, and Ala levels of BA group were 29.470(10.739, 48.124) μmol/L, 32.938(24.918, 44.013) μmol/L, 78.244(66.814, 94.479) μmol/L, 23.698(19.450, 27.714) μmol/L, 1.54(1.23, 1.95), and 244.246(214.554, 295.729) μmol/L, respectively.The Arg, Met, Tyr, Cit, AST/ALT, and Ala levels of CMV group were 16.507(8.220, 28.566) μmol/L, 30.997(23.739, 37.183) μmol/L, 76.120(64.004, 86.290) μmol/L, 21.272(17.040, 24.111) μmol/L, 1.19(0.96, 1.48), and 228.468(191.131, 260.056) μmol/L, respectively.In the receiver operating characteristic (ROC) curve, the area under the ROC curve of Ala, Arg, Met, Tyr, Cit and AST/ALT in diagnosing NICCD were 0.886, 0.770, 0.906, 0.745, 0.999, and 0.887, respectively. Conclusions:The changes of plasma amino acids provides a basis for early diagnosis of NICCD.Elevated Arg, Met, Tyr, Cit and decreased Ala have high diagnostic value of NICCD.Combined with the degree of biochemical changes, plasma amino acids can help with clinical diagnosis of the disease and reduce the misdiagnosis rate.
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Objective By studying clinical features, treatment and prognosis of eosinophilic gastroenteritis of infants resulted from milk protein allergy an, to improve the diagnosis and treatment level of eosinophilic gastroenteritis. Methods 24 cases of infants which diagnosed eosinophilic gastroenteritis were chosen from June of 2010 to January of 2014 in children’s Hospital of XX province and By retrospective analysis clinical manifestations, endoscopic features, histopathology, treatment and prognosis of the 24 cases. Results The 24 cases who were vomiting, paroxysmal crying, abdominal distension (100.00%), which accompanied by haematemesis 23 cases (95.83%), 1case (4.17%) hematochezia, 17cases (70.83%) eczema, 21 cases (87.50%) mild to moderate anemia, 1 cases (4.17%) severe anemia, 19 cases (79.17%) the increasing of peripheral blood eosinophil cells, 8 cases (33.33%)the increasing of IgE of the serum and 4 cases (16.67%) the test of antibody of the Helicobacter pylori in Serum was positive; 3 cases (12.50%) were milk protein allergy by the detecting of food allergen-speciifc IgE antibodies, the endoscopic characteristics were hyperemia, edema, erosion, ulcer of gastric and duodenal mucosa. Among them, 24 cases (100.00%) were gastritis, 5 cases (20.83%) duodenitis and 1 cases (4.17%) duodenal ulcer. The histopathology of the 24 cases revealed that there were gastric or duodenal eosinophils infiltration (> 20/HPF) and were all associated with mast cell infiltration; By antisecretory, protection of the gastrointestinal mucosa and the obviating of milk protein had a satisfactory treatment effect, 24 cases of children with oral general formula milk test conifrmed that the milk protein allergy, The 3 cases of the patients were reviewed by 8~12 weeks after gastroscope, and the mucosa of the duodenum was smooth, Eosinophils were/HPF<8, mast cells were/HPF<5. Conclusion There are no speciifc clinical and endoscopic manifestations in eosinophilic gastroenteritis of infants resulted from milk protein allergy, gastrointestinal mucosa eosinophil inifltration and simultaneously are accompanied by abnormal mast cell inifltration;Mucosal type without the use of corticosteroids, through milk protein avoidance treatment can achieve satisfactory results, But definite diagnosis must rely on biopsy and eosinophils, combined with avoidance stimulation test of milk protein can further confirmed, But the excitation test should be at least 10 days of observation of children, and carefully recorded symptoms, so as not to delay the missed diagnosis of CMPA.
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Objective To construct a scoring system of combination of procalcitonin and C-reactive protein for diagnosis of invasive bacterial diarrhea in children. Methods The clinical data of hospitalized children with acute diarrhea were retrospectively analyzed. All of the children were divided into two groups, invasive bacterial diarrhea group and nonbacterial diarrhea group. The scoring system of combination of two markers for diagnosis of invasive bacterial diarrhea in children was constructed by means of two categories logistic regression analysis using procalcitonin and C- reactive protein as parameters. In addition,receiver operating characteristic curve(ROC)was used to evaluate the diagnostic accuracy.Results One hundred ten cases of invasive bacterial diarrhea and 108 cases of nonbacterial diarrhea were included. The levels of serum procalcitonin and C-reactive protein in invasive bacterial diarrhea group were significantly higher than those in nonbacterial diarrhea group, and there were statistical difference(P all<0.05).The area under the ROC curve(AUC)of invasive bacterial diarrhea was 0.894 when the established scoring system was used, which was higher than the AUCs when either serum procalcitonin or in C- reactive protein was used (P<0.05). The best diagnostic boundary value for combination of serum procalcitonin and C- reactive protein scoring was 0.52 with a sensitivity at 80.9% and specificity at 88.9%. Conclusions The scoring system of combination of procalcitonin and C- reactive protein has good accuracy in diagnosis of invasive bacterial diarrhea in children, and can assist the early diagnosis of the disease.
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Objective To construct a scoring system of combination of procalcitonin and C-reactive protein for diagnosis of invasive bacterial diarrhea in children. Methods The clinical data of hospitalized children with acute diarrhea were retrospectively analyzed. All of the children were divided into two groups, invasive bacterial diarrhea group and nonbacterial diarrhea group. The scoring system of combination of two markers for diagnosis of invasive bacterial diarrhea in children was constructed by means of two categories logistic regression analysis using procalcitonin and C- reactive protein as parameters. In addition,receiver operating characteristic curve(ROC)was used to evaluate the diagnostic accuracy.Results One hundred ten cases of invasive bacterial diarrhea and 108 cases of nonbacterial diarrhea were included. The levels of serum procalcitonin and C-reactive protein in invasive bacterial diarrhea group were significantly higher than those in nonbacterial diarrhea group, and there were statistical difference(P all<0.05).The area under the ROC curve(AUC)of invasive bacterial diarrhea was 0.894 when the established scoring system was used, which was higher than the AUCs when either serum procalcitonin or in C- reactive protein was used (P<0.05). The best diagnostic boundary value for combination of serum procalcitonin and C- reactive protein scoring was 0.52 with a sensitivity at 80.9% and specificity at 88.9%. Conclusions The scoring system of combination of procalcitonin and C- reactive protein has good accuracy in diagnosis of invasive bacterial diarrhea in children, and can assist the early diagnosis of the disease.
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Fecal microbiota transplantation(FMT),as a special organ transplantation,can be used to reconstruct the intestinal flora.It has been concerned by clinical practice,but it has not become a routine treatment method.With the gradual deepening of the study of FMT,the refractory difficile fusiform bacillus infection,inflammatory bowel disease,irritable bowel syndrome,chronic fatigue comprehensive syndrome and some metabolic disorders related to intestinal diseases were obtained using.In recent years,there are some reports about the application of FMT in children's diseases.Combining with the relevant literature at home and abroad,this paper reviews the indications and the taboo of the application of FMT in children,the aim is to provide a reference for FMT to be better applied in pediatric clinical.
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Objective To evaluate the accuracy of 99mTcO4- gastrointestinal imaging in the diagnosis of Meckel’s diverticulum in children. Methods The clinical data of 99mTcO4-imaging, surgery and pathological results of 95 children with gastrointestinal bleeding were retrospectively analyzed. Results Forty-four cases of 95 patients had positive ifnding of 99mTcO4-ectopic gastric mucous membrane imaging, and positive rate was 46.3%. In the positve cases 52.3%cases (23/44) were diagnosed of intestinal heterotopic gastric mucosa, 47.7%cases (21/44) were suspected of intestinal heterotopic gastric mucosa. The sex ratio (males to females) was 7.8:1. Thirty-seven positive cases underwent operation;among them, 35 cases were found to have Meckel’s diverticulum and 1 case had duplication of the digestive tract;Diverticulum lesion was not found in 1 case. The samples of 35 cases diagnosed surgically of Meckel’s diverticulum were examined by pathologic histology. All 35 cases were conifrmed as Meckel’s diverticulum and ectopic gastric mucosa epithelium, including 2 cases with ulcer formation, 1 case with small patches of pancreatic tissue, 1 case with ileocecal junction of suppurative enteritis and 1 case with chronic appendicitis. Conclusions 99mTcO4-radionuclide imaging technique is of high value for the non-invasive diagnosis of children’s Meckel’s diverticulum.