Study on the diagnostic value of transient elastography, APRI and FIB-4 for liver fibrosis in children with non-alcoholic fatty liver disease / 中华肝脏病杂志

Objective: To evaluate the diagnostic value of transient elastography, aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis index based on 4 factors (FIB-4) for liver fibrosis in children with non-alcoholic fatty liver disease (NAFLD). Methods: A retrospective study was conducted on 100 cases of nonalcoholic fatty liver disease in Hunan Children's Hospital between August 2015 to October 2020 to collect liver tissue pathological and clinical data. The receiver operating characteristic curve (ROC curve) was used to analyze the diagnostic value of liver stiffness measurement (LSM), APRI and FIB-4 in the diagnosis of different stages of liver fibrosis caused by NAFLD in children. Results: The area under the ROC curve (AUC) value of LSM, APRI and FIB-4 for diagnosing liver fibrosis (S≥1) were 0.701 [95% confidence interval (CI): 0.579 ~ 0.822, P = 0.011], 0.606 (95%CI: 0.436 ~ 0.775, P = 0.182), and 0.568 (95%CI: 0.397 ~ 0.740, P = 0.387), respectively. The best cut-off values were 6.65 kPa, 21.20, and 0.18, respectively. The AUCs value of LSM, APRI, and FIB-4 for diagnosing significant liver fibrosis (S≥ 2) were 0.660 (95% CI: 0.552 ~ 0.768, P = 0.006), 0.578 (95% CI: 0.464 ~ 0.691, P = 0.182) and 0.541 (95% CI: 0.427 ~ 0.655, P = 0.482), respectively. The best cut-off values were 7.35kpa, 24.78 and 0.22, respectively. The AUCs value of LSM, APRI and FIB-4 for the diagnosis of advanced liver fibrosis (S≥ 3) were 0.639 (95% CI: 0.446 ~ 0.832, P = 0.134), 0.613 (95% CI: 0.447 ~ 0.779, P = 0.223) and 0.587 (95% CI: 0.411 ~ 0.764, P = 0.346), respectively. The best cut-off values were 8.55kpa, 26.66 and 0.27, respectively. Conclusion: The transient elastography technique has a better diagnostic value than APRI and FIB-4 for liver fibrosis in children with NAFLD.

Effect of integrated Chinese and Western medicine therapy on severe hand, foot and mouth disease: A prospective, randomized, controlled trial / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of Chinese medicine (CM) plus Western medicine (WM) in the treatment of pediatric patients with severe hand, foot and mouth disease (HFMD) by conducting a prospective, controlled, and randomized trial.</p><p><b>METHODS</b>A total of 451 pediatric patients with severe HFMD were randomly assigned to receive WM therapy alone (224 cases, WM therapy group) or CM [Reduning Injection ( ) or Xiyanping Injection ()] plus WM therapy (227 cases, CM plus WM therapy group) for 7-10 days, according to a web-based randomization system. The primary outcome was fever clearance time, which was presented as temperature decreased half-life time. The secondary outcomes included the rate of rash/herpes disappearance within 120 h, as well as the rate for cough, runny nose, lethargy and weakness, agitation or irritability, and vomiting clearance within 120 h. The drug-related adverse events were also recorded.</p><p><b>RESULTS</b>The temperature decreased half-life time was 40.4 h in the WM therapy group, significantly longer than 27.2 h in the CM plus WM therapy group (P<0.01). Moreover, the rate for rash/herpes disappearance within 120 h was 43.6% (99/227) in the CM plus WM therapy group, significantly higher than 29.5% (66/224) in the WM therapy group (P<0.01). In addition, the rate for cough, lethargy and weakness, agitation or irritability disappearance within 120 h was 32.6% (74/227) in the CM plus WM therapy group, significantly higher than 19.2% (43/224) in the WM therapy group (P<0.01). No drug-related adverse events were observed during the course of the study.</p><p><b>CONCLUSION</b>The combined CM and WM therapy achieved a better therapeutic efficacy in treating severe HFMD than the WM therapy alone. Reduning or Xiyanping Injections may become an important complementary therapy to WM for relieving the symptoms of severe HFMD. (Registration No. NCT01145664).</p>

Clinical significance of inflammatory factors in severe EV71 hand-foot-and-mouth disease / 中国感染控制杂志

Objective To investigate the clinical significance of 5 kinds of inflammatory factors (MCP 1,IL 1β,IL-18,HMGB1,and IL-10) in severe EV71 hand-foot-and-mouth disease (HFMD).Methods Hospitalized children who were diagnosed with severe EV71 HFMD in a hospital in March August,2014 were as HFMD group,healthy children who underwent physical examination in outpatient department of the same hospital during the sameperiod were as control group,changes in expression levels of peripheral blood MCP-1,IL-1β,IL-18,HMGB1,and IL-10 of both groups were dynamically observed,clinical data of HFMD group were collected.Results There were 102 children in HFMD group,the average age was (2.18 ± 0.91) years old,80.39％ of whom were ≤3 years old;there were 77,16,and 9 cases in HFMD group at stage 2,3,and 4 respectively at admission.77,52,21,and 88 cases went through stage 2,3,4,and 5 respectively.Expression levels of 5 kinds of inflammatory factors at stage 2,3,and 4 in HFMD group were compared respectively with control group,differences were all statistically significant(all P＜0.05);expression levels of IL-10 at stage 3 and 4 in HFMD group were not significantly different (P＞0.05).In HFMD group,the expression levels of HMGB1 of stage 2,3 progression groups were both higher than recovery group(both P＜0.05).The expression levels of 5 kinds of inflammatory factors in the death group and survival group at admission were all significantly different (all P＜0.05).Conclusion The expression levels of MCP 1,HMGB1,IL-1β,IL-10,and IL-18 are closely related to the severity of HFMD,and has certain clinical significance for the prognosis of children.HMBG1 has certain predictive value in the prognosis of HFMD.

Changes in Th17 and CD4+CD25+ Treg cells and their significance among children with hand, foot and mouth disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the changes in peripheral blood Th17 and CD4(+)CD25(+) regulatory T (Treg) cells and their significance among children with hand, foot and mouth disease (HFMD).</p><p><b>METHODS</b>Eighty-nine children with HFMD, including 55 cases of common HFMD and 34 cases of severe HFMD, were included in the study; and 30 healthy children were selected as the control group. The percentages of Th17 and CD4(+)CD25(+) Treg cells in CD4(+) T cells in peripheral blood were determined by flow cytometry. The expression levels of interleukin (IL)-10, transforming growth factor-β (TGF-β), and IL-17 were measured by enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>Compared with the control group, the cases of common HFMD and severe HFMD had significantly increased levels of Th17 cells and IL-17 (P<0.05) but significantly decreased levels of CD4(+)CD25(+) Treg cells, IL-10, and TGF-β (P<0.05). The severity of the HFMD was positively correlated with the levels of Th17 cells and IL-17 in peripheral blood but negatively correlated with the levels of CD4(+)CD25(+) Treg cells, IL-10, and TGF-β.</p><p><b>CONCLUSIONS</b>Children with HFMD have increased response of Th17 cells but decreased response of CD4(+)CD25(+) Treg cells in peripheral blood. Th17/CD4(+)CD25(+) Treg cell imbalance may play an important role in the pathogenesis of HFMD.</p>

Study advances of nonalcoholic fatty liver disease in children / 中华实用儿科临床杂志

Nonalcoholic fatty liver disease(NAFLD) in obese children has increasingly become the most common cause of chronic liver disease in children and adolescents.NAFLD includes simple steatosis and nonalcoholic steatohepatitis,which will progress to cirrhosis and hepatocellular carcinoma.It is recognized as a hepatic manifestation of metabolic syndrome.With regarding to the pathogenesis of NAFLD,the "multiple-hit" hypothesis is more popular.Although clinical symptoms,laboratory data,and imaging findings are important,liver biopsy is regarded as the gold standard for the diagnosis of NAFLD.In addition,liver biopsy is essential for assessing the degree of necro-inflammatory change and fibrosis in NAFLD.Although pharmacotherapy has been studied in clinical trials,lifestyle modification by diet and exercise remains the mainstay of treatment for NAFLD.

Expression of apoptosis signal-regulating kinase 1 in dibated cardiomyoprthy and its correlation with left ventricular ejection fraction / 中华实用儿科临床杂志

Objective To observe the changes of apoptosis signal-regulating kinase 1 (ASK1) expression in left ventricular myocardium of the dilated cardiomyopathy (DCM) rats induced by adriamycin and its correlation with left ventricular ejection fraction (LVEF).Methods One hundred and twenty SPF Wistar rats were divided into 2 groups as follows:control group (n =15),model group(n =105).Adriamycin was administered in the model group by intraperitoneal injection for 3 times in a week and repeated with a two-week interval for 6 times,while 9 g/L saline were administered in the control group in the same pattern,thus DCM rats model were constructed by the end of the 8th week.Both the model group and control group rats were drawn out and their LVEF were tested by the end of the 8th week and 12th week.Apoptosis index (AI) and the ASK1 in myocardium were tested respectively by apoptotic cells situ labeling,semi-quantitative analysis and Western blot.Results The AI of the control group,the 8th weekend model group and the 12th weekend model group were 0.53 ±0.27,16.13 ± 1.72,19.54 ±2.24.The AI of the 8th and the 12th weekend model groups were obviously higher than that in the control group.Comparing the differences among the 3 groups were statistically significant (F =18.98,P ＜ 0.05).The relative ASK1 expressions in ventricular myocardium of the control group,the 8th weekend model group and the 12th weekend model group were 0.169 ± 0.010,0.649 ± 0.071,0.781 ±0.077.Comparing the differences among the 3 groups were statistically significant (F =27.72,P ＜ 0.01).The LVEF (％) results of the control group,the 8th weekend model group and the 12th weekend model group were 75.41 ± 2.02,53.25 ±3.74,39.21 ±6.13.Comparing the differences among the 3 groups were statistically significant(F =154.87,P ＜0.01).There was a negative correlation between the ASK1 expression and LVFE in model group at the end of 12weeks(r =-0.86,P ＜ 0.01).Conclusions The ASK1 expression in myocardium of the DCM group increases obviously,thus apoptosis signal-regulating probably participates in the pathological process of DCM induced by ASK1.

Pathogenesis of coxsackievirus B3-induced myocarditis: role of macrophage migration inhibitory factor / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Macrophage migration inhibitory factor (MIF) is an upstream regulator in immune and inflammatory responses. However, its role in viral myocarditis remains unknown. In this study, we investigated the role of the MIF in coxsackievirus B3 (CVB3)-induced myocarditis.</p><p><b>METHODS</b>Mice were randomized into two groups receiving either Eagle's minimal essential medium (EMEM, control group) or virus solution (infected group). Subsets of mice in the infected group were sacrificed on days 3, 7, 14 and 28 after inoculation. Expression of MIF was detected using an enzyme-linked immunosorbent assay (ELISA), reverse transcription polymerase chain reaction and immunohistochemistry. A neutralizing antibody (Ab) to MIF was injected intraperitoneally from day 0 to 7 after inoculation. Disease severity was estimated by histopathology of the heart and by the heart weight to body weight ratio, and the interleukin-1β (IL-1β) and tumor necrosis factor α (TNF-α) in the myocardium were measured by ELISA on day 14.</p><p><b>RESULTS</b>The serum MIF concentration and expression levels of myocardial MIF mRNA and protein were significantly elevated in mice on days 7 and 14 post-infection. The survival rate was markedly higher and disease severity was obviously less in mice treated with anti-MIF Ab. Furthermore, MIF blockade significantly decreased the IL-1β and TNF-α in the myocarditic heart.</p><p><b>CONCLUSION</b>These results demonstrate that MIF is an important naturally occurring inflammatory cytokine in CVB3-induced myocarditis, and anti-MIF Ab may lessen the inflammatory response.</p>

Effects of astragaloside on IGF-1 and associated protein expression in mice with acute viral myocarditis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effects of astragaloside on the expression of insulin-like growth factor-1 (IGF-1) and associated proteins in mice with viral myocarditis.</p><p><b>METHODS</b>Sixty-five 4-week-old BALB/C mice were randomly divided into 5 groups: normal control, astragaloside control, untreated myocarditis, low-dose and high-dose astragaloside-treated myocarditis. The BALB/C mice in the later three groups were intraperitoneally injected with CVB3. The low-dose and high-dose astragaloside-treated myocarditis groups were given astragaloside of 0.07 and 0.6 mg/kg•d, respectively by intragastric administration. Fifteen days later, the samples of blood and muscular tissues were obtained. The expression of IGF-1 in plasma was measured using ELISA. The levels of IGF-1 and associated proteins in muscular tissues were measured by immunohistochemistry. The expression of IGF-1 mRNA in muscular tissues was examined by RT-polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>The expression of IGF-1 and associated proteins increased significantly in mice infected with CVB3. High-dose astragaloside treatment reduced the expression of IGF-1 and associated proteins, but low-dose astragaloside did not.</p><p><b>CONCLUSIONS</b>High-dose astragaloside may reduce the expression of IGF-1 and associated proteins in mice with acute viral myocarditis, possibly thus providing protective effects on muscular tissues.</p>

Effect of astragaloside on myocardial fibrosis in chronic myocarditis / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the effect of astragaloside (Astr), one of the active components of the Chinese medical herb Astragulus membranaceus, on cardiac fibrosis in chronic myocarditis and its relevant mechanisms.</p><p><b>METHODS</b>Eighty mice were randomized into 3 groups, the control group (n=20), the model group (n=30) and the Astr group (n=30). Mice in the model group and the Astr group were monthly intraperitoneally inoculated with CVB3, but to the control group equal amount of culture fluid was given instead. Mice in the control and the model group were fed with drinking water while those in the Astr group with drinking water containing Astr-sodium carboxymethycellulose at a concentration of 300 mg/L. All the survived mice were sacrificed 3 months later. Heart tissue of mice was stained by picrosirius red for calculating collagen volume fraction (CVF) with an automatic image analysis system. Expressions of transforming growth factor beta1 (TGF-beta1), platelet derived growth factor (PDGF), matrix metalloproteinase 1 (MMP-1), tissue inhibitor of metalloproteinase 1 (TIMP-1), MMP-13 and MMP-14 in heart tissue were detected by Western blot analysis.</p><p><b>RESULTS</b>As compared with the model group, in the Astr group, the mortality and CVF were significantly lower (53.3% vs. 23.3%, chi2 = 4.23, P < 0.05), and (17.4 +/- 1.2% vs. 8.6 +/- 0.9%, chi2 = 5.38, P < 0.05), respectively. As compared with the control group, Western blot analysis showed that expression of TGF-beta1 was decreased, MMP-1 and TIMP-1 were down-regulated, while expressions of MMP-13 and MMP-14 were up-regulated after Astr treatment.</p><p><b>CONCLUSION</b>Astr could lower the mortality and alleviate the myocardial fibrosis of mice with chronic myocarditis. Its antifibrotic effect might be realized by way of inhibiting TGF-beta1 expression and up-regulating the expressions of MMP-13 and MMP-14 in the heart tissues.</p>

Influence of Nano-?-Linolenic Acid on Expression of Macrophage Migration Inhibitory Factor in Viral Myocarditic Mice / 实用儿科临床杂志

Objective To investigate influence of nano-?-linolenic acid on expression of macrophage migration inhibitory factor (MIF) in murine model with viral myocarditis (VM).Methods Eighty male Balb/c mice were randomly divided into 4 groups equally:control group,model group,low and high dose intervention group.Mice in control group were inoculated introperitoneally with Eagle's solution.Every mouse in other groups was treated with 0.1 mL Coxsackie B3 virus(CVB3) intraperitoneally.Then,mice in low and high dose intervention group were treated with 60 and 180 mg/kg nano-?-linolenic acid solution for 1 week,respectively.Mice in control group and model group were treated with 9 g/L saline for 1 week.All mice were killed on day 15.The expression levels of myocardial MIF mRNA and protein were detected by reverse transcriptase polymerase chain reaction(RT-PCR) and immunohistochemistry.Serum MIF concentration were exa-mined by enzymelinked immunosorbent assay(ELISA).Myocardial histopathology was determined with hematoxylin and eosin stain.Results The mortality rate was 0,45%,30% and 20% in control group,model group,low and high dose intervention group,respectively.The mortality rate was significantly lower in high dose intervention group compared with model group (P

Therapeutic Effect of Astragaloside on Chronic Coxsackievirus B_3 Myocarditis in Balb/c Mice / 实用儿科临床杂志

Objective To observe the therapeutic effect of astragaloside on chronic coxsackievirus B3(CVB3)myocarditis in Balb/c mice.Methods Eighty Balb/c mice were randomly divided into 3 groups:astragaloside treatment group(n=30),model of viral myocarditis group(model group)(n=30),and control group(n=20).Mice in the model group and the astragaloside treatment group were monthly intraperitoneally inoculated with CVB3,but equal amount of culture fluid was given instead in control group.The model group and control group were fed with drinking water,astragaloside treatment group were fed with drinking water containing astragaloside at concentration of 300 mg/L for 3 months.Survival rates were determined,myocardial histopathology,collagen volume fraction(CVF) and apoptosis of heart tissue,and CVB3 RNA levels were detected on 3 months later respectively by semiquantitative RT-PCR.Results Compared with model group,in astragaloside treated group,the survival rate on 3 months was significantly improved(59.7% vs 76.7%,?2=4.26 P

Effect of Momordicin on Expression of Tumor Necrosis Factor-? in Balb/c Mice with Viral Myocarditis Caused by Coxsackievirus B_3 / 实用儿科临床杂志

Objective To observe the effect of momordicin on tumor necrosis factor-?(TNF-?) level,mRNA transcription,and protein expression in myocardium of viral myocarditis caused by coxsackievirus B3(CVB3),and explore its therapeutic mechanism on viral myocarditis in Balb/c mice.Methods Fifty Balb/c mice were randomly divided into 3 groups as follows:momordicin treatment group(20 cases),vehicle control group(20 cases) and normal control group(n=10).Mice in the vehicle control group and the momordicin treatment group were intraperitoneally inoculated with CVB3,as for the nomal control group,equal amount of culture fluid was given instead.Momordicin[25 mg/(kg?d)] was administered intraperitoneally daily from day 0 to 6.Myocardial histopathology,cardiac TNF-? antigen,protein and mRNA expression were detected on day 15 after CVB3 inoculation,respectively.Results As compared with model group,in mice treated with momordicin,the histological myocardial lesion was significantly reduced [(3.26 ?0.84) vs(1.56?0.48),t=3.90 P

Microarray analysis of extracellular matrix genes expression in myocardium of mouse with Coxsackie virus B3 myocarditis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Extracellular matrix (ECM) orchestrates cell behaviour including growth, death, apoptosis, adhesion, migration, and invasion by activating several signalling pathways. Certain components of ECM, such as integrins, may act as receptors or co-receptors of enterovirus. ECM-activated gene expressions in myocardium of viral heart disease including myocarditis and partial cardiomyopathy remain elusive. This study was to investigate the expression of ECM-activated genes in myocardium of mouse with viral myocarditis.</p><p><b>METHODS</b>BALB/c mice were infected with Coxsackie virus B3 (CVB3) to establish an animal model of myocarditis. Uninfected mice were also prepared and served as controls. Specific mRNA expression pattern in myocarditic mouse heart was analysed by an in-house cDNA microarray containing 8,192 genes. Overexpressed ECM genes were selected and subsequently confirmed by Northern blot analysis.</p><p><b>RESULTS</b>Nine ECM genes were isolated, from the array of 8,192 genes, as overexpressed genes in hearts of myocarditic mice in comparison with controls. Subsequent Northern blot analysis confirmed that four of the nine genes were highly expressed. Expression of these four genes, Fin15, ILk, Lamr1 and ADAMTS-1, has not been reported previously to be induced by Coxsackie virus.</p><p><b>CONCLUSION</b>CVB3-induced myocarditis is associated with gene expression profiles of certain ECM components.</p>

Expression of Tumor Necrosis Factor Ligand-Related Molecule-1A in Mice with Viral Myocarditis and Role of Astragaloside / 实用儿科临床杂志

Objective To explore the expression of tumor necrosis factor(TNF) ligand-related molecule-1A(TL1A) in mice with viral myocarditis(VM) and the role of astragaloside.Methods Fifty-five male Balb/c mice were randomly divided into 4 groups:control group,model group,low-dose intervention group and high-dose intervention group.Mice in model group,low-dose intervention group and high-dose intervention group were inoculated with 0.1 mL coxsackie B3 virus intraperitoneally.Then,mice in low-dose intervention group and high-dose intervention group were treated with 10 g?L-1 and 90 g?L-1 astragaloside solution,respectively.Mice in control group and model group were treated with 0.1 mL carboxymethycellulose solution.All mice were killed on the 15thday.Histological cross sections of heart were stained with hematoxylin-eosin and myocardial histopathologic scores were counted under optical microscope.The expressions of myocardial TL1A mRNA and protein were detected by reverse transcription polymerase chain reaction and immunohistochemistry.Results The mortality were 0,46.7%,40.0% and 13.3% in control group,model group,low-dose intervention group and high-dose intervention group,respectively.Compared with model group and low-dose intervention group,the mortality was significantly lower in high-dose intervention group(?2=9.46,8.95,Pa

Effect of Nano-?-Linolenic Acid on Expression of Cathepsin B in Mice with Viral Myocarditis / 实用儿科临床杂志

Objective To investigate the effect of nano-?-linolenic acid on the expression of cathepsin B(CB) in mice with viral myocarditis(VM).Methods Eighty male Balb/c mice were randomly divided into 4 groups:control group,myocarditis group,low-dose intervention group and high-dose intervention group,each group had 20 mice.Mice in control group were inoculated introperitoneally with eagle′s solution,every mouse in the last 3 groups was treated with 0.1 mL Coxsackie B3 virus(CVB3) intraperitoneally.Then,mice in low-dose intervention group and high-dose intervention group were treated with 60 mg?kg-1and 180 mg?kg-1 nano-?-linolenic acid solution for 7 days,respectively.Mice in control group and myocarditis group were treated with 9 g?L-1 saline for 7 days.All mice were killed on the 15th day,and the specimens of hearts and serum were conserved.Myocardial histopathology was determined with hematoxylin and eosin stain.The expression levels of myocardial CB mRNA were detected by reverse transcription polymerase chain reaction.Serum CB concentration was examined by enzyme-linked immunosorbent assay.Results The mortality rate was 0,45%,30% and 20% in control group,myocarditis group,low-dose intervention group and high-dose intervention group,respectively;the mortality rate was significantly lower in high-dose intervention group compared with myocarditis group(P0.05).The expression level of CB mRNA and serum CB concentration were markedly higher in myocarditis group than those in control group(Pa

Expression of Coxsackie-Adenovirus Receptor on Leukocytes of Various Types in Peripheral Blood in Children / 实用儿科临床杂志

0.05),but that MFI and/or PPC of CAR in the 2 types cells markedly increased compared with lymphocytes in the same group(Pa

Expression of Insulin-Like Growth Factor-1 and Its Associated Protein of Mice with Viral Myocarditis / 实用儿科临床杂志

Objective To investigate the changes of insulin-like growth factor-1(IGF-1) and its associated protein in Balb/C mice with viral myocarditis.Methods Sixty Balb/C mice were randomly divided into 2 groups:infected group(n=40) and control group(n=20).Mice in infected group were inoculated intraperitoneally with coxsackievirus B3(CVB3) while control mice with 0.1mL of Eagle′s minimal essential medium(EMEM).Blood and myocardial musculature of all mice were collected on the day of 3,7,15 and 30 after inoculation.The expression of IGF-1 and its associated protein in plasma or myocardium were detected respectively by enzyme-labeled immunosorbent assay(ELISA),immunohistochemistry and reverse transcription polymerase chain reaction(RT-PCR).Results The expression of IGF-1 and its associated protein of mice with viral myocarditis was higher than those in control group and gradual ascent after mice being infected with virus.The expression reached summit on d15,then decreased on d30,but still sustain in a high level.The difference was significant(F=19.53 P

Expressions of Macrophage Migration Inhibitory Factor,Tumor Necrosis Factor-? and Interleukin-1? in Serum of Children with Viral Myocarditis / 实用儿科临床杂志

0.05).Conclusions It suggests that immune dysfunction exists in child patients with VM,MIF,TNF-? and IL-1? may play a role in the VM pathogenesis,and they can be a new indicator for VM.