ABSTRACT
Objective To provide laboratory diagnosis for clinical monitoring of VPA hepatotoxicity,this study explored the levels of amino acid in children with epilepsy on valproate monotherapy.Methods The disease subjects were selected from 178 children with epilepsy treated by VPA only in Beijing Children's Hospital from June 2015 to February 2017,and the control subjects were selected from 178 healthy children with age-and sex-matched.The baseline clinical data and liver and renal function results were collected.The concentrations of VPA in children were monitored by fluorescence polarization immunoassay,the levels of amino acids in the blood dry spot were detected by liquid chromatography tandem mass spectrometry.The levels of amino acids between the disease group before and after VPA therapy and the control group were com pared.Results Compared with controls,there was no significant difference in the level of urea and creatinine between patients before and after VPA treatment (F=0.187～ 0.970,P＞0.05).Compared with the control group and the patients before VPA treatment,the levels of ALT,AST and γ-GT of the patients after VPA treatment increased obviously (F=3.547 ～ 16.181,P＜0.05).Compared with the control group and before VPA treatment,the levels of Cys,Gln,Glu,Gly,Leu and Lys (F=3.489～ 71.896,P＜0.05) in the blood of children with epilepsy after VPA treatment were significantly different.The levels of Cys,Gln,Glu,Gly,VPA and Lys in the blood of the children with epilepsy treated by VPA were significantly higher than those in the control group and before VPA treatment,but the level of Leu was lower than that of the control group and before treatment with VPA.Conclusion The increases of ALT,AST and γ-GT indicated that VPA or its metabolites induced liver injury of patients.In the early stage of VPA hepatotoxicity,the levels of amino acid in children had changed obviously,so detection of amino acid may be a sensitive index to reflect the hepatotoxicity of VPA.Regular examination of amino acid in children after VPA treatment may be helpful for the clinical monitoring of hepatotoxicity caused by VPA.
ABSTRACT
Objective To analyze and discuss the correlations of blood plasma thromboelastography (TEG) values and antithrombin Ⅲ (ATⅢ) level in children's Kawasaki disease (KD).Methods Selected 60 children's KD cases as well as 42 control cases as the KD group,28 children's KD cases with coronary arterial lesions (CAL) as well as 30 children's KD cases without coronary arterial lesions (NCAL) as the CAL group.All cases were archived from January 2015 to February 2017 in Beijing Children's Hospital.The blood plasma TEG parameters were detected by thromboelastography,including blood coagulation time (R),blood clotting time (K),rate of blood clotting (α angle),the maximum intensity of blood clotting (MA),coagulation comprehensive index (CI) and plasma AT Ⅲ level(detected by blood aggregation tester).Results The K (11.1±0.36 min),AT Ⅲ (90.5％ ±[19.05％) and R (5.4± 1.72 min) values were less than those in the control group (2.29±0.66 min,110.4％±10.8％ and 6.85±2.32 min,t=-6.483,-4.267,-3.205,all P＜0.05).CI (2.11±0.70),α angle (75.23°±6.97°) and MA (67.08±6.27 mm) values in the KD group were higher than those in the control group (1.90±0.40,69.65°±5.28° and 59.12±3.52 mm,t=2.339,3.235,4.265,all P＜0.05).InCALgroup,AT Ⅲ (75.5％±9.70％),R (4.40±1.27 min) and K (1.03±0.30 min) values were less than those in the NCAL group (95.6％±12.8％,5.73±1.26 min,1.21± 0.16 min,t=-5.382,-2.731,-2.483,all P＜0.05).MA (70.54± 5.17 mm),CI (2.76±0.38),and α angle (78.79°±2.56°) values in CAL group werehigher than NCAL group (64.37±4.20 mm,2.10±0.49 and 74.43°± 3.03°,t=3.286,4.369,4.759,all P＜0.05).In CAL group,it showed that AT Ⅲ level was positive correlated with R and K values (r=0.495,0.793,P＜0.05) but negative correlated with α angle,MA and CI values (r=-0.422,-0.244 and-0.236,P＜0.05).Conclusion Blood plasma TEG values and AT Ⅲ level has some correlations in children's KD according to our analysis.Combine the two test would be necessary and meaningful in the diagnosis and treatment of children's KD in the future.