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1.
Article in Chinese | WPRIM | ID: wpr-908989

ABSTRACT

Objective:To evaluate the discrimination, reliability and validity of the evaluation system of clinical nurse training based on post competency in hospitals of traditional Chinese and Western medicine.Methods:From August 2018 to January 2019, 271 clinical nurses from a three-A hospital were selected by convenient sampling method. The competency of clinical nurses was assessed on the spot by case tracking method. The discrimination, reliability and validity of the evaluation system were tested by item analysis, Cronbach's α coefficient and confirmatory factor analysis.Results:The evaluation system had good discrimination, reliability and validity. Among the four scales of the evaluation system, there were significant differences in the high score and the low score of all items ( P < 0.05). The Cronbach's α coefficient of each dimension of the four scales was 0.769-0.898. Four structural equation model diagrams were established, the AVE (average variance extracted) of each dimension was 0.51-0.74, factor load was 0.53-0.93, C.R. (composite reliability) was 0.79-0.91, and the discrimination validity was up to the standard. Conclusion:This system provides a reference for the establishment of scientific, objective, measurable and homogeneous clinical nurse training evaluation tools.

2.
Chinese Journal of Nephrology ; (12): 31-35, 2021.
Article in Chinese | WPRIM | ID: wpr-885476

ABSTRACT

Objective:To explore the clinical characteristics of chronic kidney disease (CKD) at the stage 3-5D in children with renal anemia, and provide reference data for standardized diagnosis and treatment.Methods:A single-center retrospective study was conducted to collect clinical data in children with CKD at Beijing Children's Hospital Affiliated to Capital Medical University from January 2016 to December 2018. The patients were divided into CKD stage 3 group, stage 4 group and stage 5 group according to estimated glomerular filtration rate. The indexes of anemia among the groups were compared. Data on anemia indicators, treatment, and anemia improvement in maintenance dialysis children at stage 5D were analyzed.Results:A total of 171 children with CKD were included in the study. The hemoglobin levels in CKD stage 3 group, stage 4 group and stage 5 group were (126.4±20.5) g/L, (90.8±26.0) g/L and (78.7±18.4) g/L, respectively, and there was a statistical difference among the groups ( χ2=61.982, P<0.001; trend test F=71.061, P<0.001). The incidences of anemia in children with CKD stage 3, stage 4 and stage 5 were 27.3% (9/33), 83.3% (25/30) and 95.4% (105/108), respectively. Mild, moderate and severe anemia in children with CKD stage 3 accounted for 15.2%(5/33), 12.1% (4/33) and 0(0), respectively. Mild, moderate and severe anemia in children with CKD stage 4 accounted for 26.7% (8/30), 50.0% (15/30) and 6.7% (2/30), respectively. Mild, moderate and severe anemia in children with CKD stage 5 accounted for 21.3%(23/108), 60.2%(65/108) and 15.8%(17/108), respectively. Anemia type was mostly normocytic anemia. The hemoglobin of 30 children with CKD stage 5D at the initial stage of dialysis was (79.3±16.3) g/L. Twenty-three children with CKD stage 5D received erythropoietin combined with oral iron or intravenous iron therapy. The hemoglobin compliance rates in children with maintenance dialysis in initial phase, 1 month, 2 months and 3 months were 6.7% (2/30), 16.7%(5/30), 63.3%(19/30) and 90.0%(27/30), respectively. The correction time for anemia was (2.5±1.0) months. Twelve children with CKD stage 5D received iron sucrose infusion, and no adverse reaction occurred. Conclusions:Renal anemia has a high incidence in children with CKD. Early and standardized treatment is of great significance to improve outcome of renal anemia. Venous iron infusion is a safe and effective treatment method for children with maintenance dialysis.

3.
Article in Chinese | WPRIM | ID: wpr-882827

ABSTRACT

Objective:To understand clinical characteristics, treatment effects and prognosis of children with methylmalonic acidemia (MMA) presented with hemolytic uremic syndrome(HUS).Methods:The medical records of children with MMA were collected in Beijing Children′s Hospital, Capital Medical University from January 2012 to January 2019, the clinical manifestations, laboratory, imaging material, inspection results, renal pathological, gene analysis, treatment effect, and prognosis of MMA children with renal damage were analyzed, and were followed-up for 1-7 years.Results:Thirty cases were diagnosed as MMA with secondary renal damage.Eight cases(26.67%) showed as MMA-HUS.Age was from 1 month and 14 days to 12 years and 10 months old.There were 4 males and 4 females.The concentration of urine methylmalonic acid increased by 10-62 times.All were combined with hyperhomocysteine(HCY). The level of serum methylmalonic acid(1.5-11.8 mg/L), propylene carnitine(6.33-9.77 μmol/L)and the ratio of propylene /ethylene carnitine (0.24-0.29)were increased.Manifested as the mental and physical development retardation, anemia, jaundice, renal dysfunction, platelet reduction, hematuria, proteinuria in 8 cases, hypertension in 6 cases, frequent vomiting and convulsions in 2 cases.Two cases had a positive family history.Renal pathology showed that mesangial cells and mesangial matrix proliferation broadening, electron dense deposits no mesangial area, renal tubular epithelial cell swelling degeneration, immunofluorescence was negative.Two cases were genetically analyzed. One case was a CblC type MMACHC compound heterozygous mutation[c.80A>G(p.Q27R); c.217C>T(p.R73X)] and CblX type HCFC1 heterozygous mutation [c.3757G>A(p.R1253C)] double mutation; 1 case was a CblC type MMACHC compound heterozygous mutation[c.365A>T(p.H122L); c.609 G>A(p.W203X)]. Children diagnosed were treated with vitamin B 12, etc.Four cases of children gave up.The others, after treatment, were improved. Conclusions:MMA-HUS might be associated with multiple organ failure.Early diagnosis was the key, timely treatment could effectively control the disease, improve the prognosis.It should be followed up for ever.

4.
Chinese Journal of Nephrology ; (12): 26-33, 2020.
Article in Chinese | WPRIM | ID: wpr-799026

ABSTRACT

Objective@#To analyze the Oxford classification (MESTC) and the International Study of Kidney Disease in Children (ISKDC) classification for evaluating the clinical manifestations, histological lesion and short-term prognosis of children with Henoch-Schönlein purpura nephritis (HSPN).@*Methods@#According to the Oxford classification and ISKDC classification, the histological lesions of children with HSPN diagnosed by renal biopsy from Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to December 2018 were re-evaluated. The renal biopsy specimens of the selected subjects were scored according to the Oxford classification and the ISKDC classification. According to whether the first symptom was combined with renal performance, MESTC score and ISKDC classification, children were grouped. The differences in clinicopathological manifestations between the groups were compared. Correlation between MESTC and ISKDC grades was analyzed by nonparametric test rank correlation. Kaplan-Meier survival curve and Log-rank test were used to compare the difference of proteinuria remission rate between the two groups. Univariate and multivariate Cox regression equations were used to analyze the influencing factors of the proteinuria remission rate.@*Results@#A total of 78 children with HSPN were enrolled. There were 37 male patients (47.4%) with age of (10.4±2.9) years. When the patients were divided according to MESTC scores and ISKDC classification, the results showed that the proportion of children with nephrotic-range proteinuria in the group of endocapillary hypercellularity (E1, P=0.008), segmental glomerulosclerosis (S1, P=0.015) and ISKDCⅢ(P=0.041) was higher than that of E0, S0 and ISKDCⅡ groups. The proportion of children with E1 (P=0.015), crescents (C1&C2, P=0.025) or ISKDCⅢ(P=0.017) that had been treated with high-dose methylprednisolone was higher. The result of Kaplan-Meier survival curve showed more difficult for proteinuria remission in children with C2 are than C0&C1 group (P=0.026), while no difference were found when children were grouped by M, E, S, T and ISKDC. Multivariate Cox regression analysis showed that the C2 (HR=0.143, 95%CI 0.020-1.046, P=0.055) might be a risk factor for proteinuria remission, while the P value was close to 0.05.@*Conclusions@#Children with HSPN scored as ISKDCⅢ, E1 and S1 are more likely to show nephrotic-range proteinuria. C2 may indicate that patients are more difficult to achieve proteinuria remission.

5.
Article in Chinese | WPRIM | ID: wpr-864222

ABSTRACT

Galactosemia is a metabolism abnormality caused by enzyme deficiency in the process of lactose metabolism.Patients with galactosemia usually have growth retardation, liver and kidney dysfunction and sepsis.Sometimes, they may also suffer from cataract, neurodevelopmental abnormalities and premature ovarian failure.In this article, the clinical data of a patient with galactosemia and heavy proteinuria who was hospitalized in Beijing Children′s Hospital Affiliated to Capital Medical University were collected.The etiology, clinical manifestations, treatment and follow-up data were analyzed retrospectively.The patient presented with massive proteinuria, and he was diagnosed with galactosemia by blood and urine metabolism screening and genetic testing.After dietary adjustment, the prognosis was good.Children with galactosemia and heavy proteinuria are rare, who should be considered with metabolic diseases in clinical practice, and the timely diagnosis and intervention are required.

6.
Article in Chinese | WPRIM | ID: wpr-864064

ABSTRACT

Objective:To summarize the clinical characteristics of children with Streptococcus pneumoniae associated hemolytic uremic syndrome(SP-HUS). Methods:Clinical data, laboratory results, treatment and prognosis of patients with SP-HUS in Beijing Children′s Hospital, Capital Medical University from January 2010 to December 2017 were retrospectively analyzed.Results:Seven 7 children (5 boys and 2 girls) aged 18-43 months were enrolled.All of them had toxic symptoms and dyspnea.The clinical symptoms were fever and cough in 5 cases, and abdominal pain and vomiting in 2 cases.Five of them had fever and cough for onset, and two had abdominal pain and vomit for onset, hemolytic anemia, thrombocytopenia and decreasing renal function in 3-9 days.Clinical examination showed cardiac dysfunction in 4 cases, septic shock in 2 cases and neurological damage in 2 cases.Five cases had only Streptococcus pneumoniae infection, 2 cases had both Streptococcus pneumoniae and Acinetobacter infections.Both C-reactive protein and procalcitonin were significantly high(80-200 mg/L and 6.43-100.00 μg/L, respectively) in 7 cases.Peripheral blood smear demonstrated fragmented red blood cells.Marrow smear showed inhibition of erythroid proliferation in 4 cases and toxic granules in the granulocytes.The direct Coombs tests were positive in all but 1 case.Serum complement C 3 decreased in acute phase(0.42-0.66 g/L). In the acute stage chest X-ray showed massive consolidation, followed by liquefaction necrosis, cystic segmented encapsulation and void changes.Ultrasound with Doppler revealed enlarged liver and kidney which normalized in 2-3 months and 6-9 months, respectively.All the patients were treated with antimicrobial therapy for 4-8 weeks and received respiratory support, 5 cases received blood purification treatment, and 4 cases received plasmapheresis.Deteriorating hemolysis was not observed following the infusion of frozen plasma.washed type red blood cells or suspension red blood cells in all 7 cases.Platelet numbers gradually recovered in 2-3 weeks.Kidney function improved and normalized in 2-4 weeks.Radiographic demonstrations of the chest normalized gradually in almost 3-6 months. Conclusions:It is necessary to consider the possibility of SP-HUS in very young children with severe pneumonia who showed microangiopathic hemolytic anemia, thrombocytopenia and decreasing renal function.Clinicians should identify high-risk children.Timely respiratory support and blood purification are important to improve prognosis.

7.
Article in Chinese | WPRIM | ID: wpr-864046

ABSTRACT

Streptococcus pneumoniae infections can cause systemic diseases, including urinary system diseases, such as Streptococcus pneumoniae associated hemolytic uremic syndrome, nephrotic syndrome with spontaneous peritonitis caused by Streptococcus pneumoniae infection and recurrent urinary tract infections in infants congenital urinary tract malformation.The early diagnosis and management of these diseases significantly improve the quality of life of children and reduce the mortality.

8.
Article in Chinese | WPRIM | ID: wpr-864015

ABSTRACT

Objective:To investigate the etiology, complications and treatment of children with chronic kidney disease(CKD), in order to provide evidence for the comprehensive management.Methods:The clinical data of 371 children patients with CKD at stage 2 to 5 admitted to the Department of Nephrology, Beijing Children′s Hospital Affiliated to Capital Medical University from January 2012 to December 2018 were collected.The etiology, complications and treatment and other data were retrospectively investigated and analyzed.Results:(1)A total of 371 children with CKD were enrolled, and the male to female ratio was 1.44∶1.00.Thirty-five cases aged from 0 to 3, 54 cases aged from 4 to 6, 189 cases aged from 7 to 12, 93 cases aged from 13 to 18.Eleven cases were diagnosed at stage 2, 59 cases at stage 3, 62 cases at stage 4, and 239 cases at stage 5.(2) In all patients, 135 cases (36.39%) had congenital anomalies of the kidney and urinary tract(CAKUT), 77 cases (20.76%) had glomerular diseases, 21 cases (5.66%) had hereditary kidney diseases, 12 cases (3.23%) had tubulointerstitial diseases, 4 cases (1.08%) had inherited metabolic diseases, 5 cases (1.35%) had other diseases and in 117 cases (31.64%) the causes of disease were unknown.(3) Renal biopsy was performed in 57 cases with the rate of renal biopsy of 15.36%.The main pathologic types included focal segmental glomerulosclerosis(18 cases, 31.58%), sclerosing glomerulonephritis (13 cases, 22.81%) and tubulointerstitial nephropathy (10 cases, 17.54%). (4)Anemia and secondary hyperparathyroidism(SHPT) were the most common complications, accounting for 77.90% (289 cases) and 73.05% (271 cases), respectively, followed by hypertension (183 cases, 49.33%), cardiovascular disease (CVD) (139 cases, 37.47%) and protein-energy wasting (PEW) (51 cases, 13.75%) successively.The incidence of hypertension, anemia, SHPT and CVD in children with CKD at stage 5 were significantly higher than those in CKD at stage 2-4, and the differences were statistically significant( χ2=50.03, 122.36, 77.07, 64.89, all P<0.01). The incidence of hypertension and CVD in patients with glomerular diseases were higher than those in CAKUT patients, and the differences were statistically significant( χ2=65.63, 40.89, all P<0.01). The incidence of PEW in CAKUT was higher than that in patients with glomerular diseases, and the difference was statistically significant( χ2=10.58, P<0.01). (5)Initial renal replacement therapy was performed in 190 children, hemodialysis in 129 cases (67.89%), peritoneal dialysis in 31 cases (16.32%), and 30 cases (15.79%) refused treatment There was no transplant patient in initial treatment modality. Conclusions:In the center, the major cause of CKD stage 2 to 5 in children was CAKUT, but the proportion of CAKUT and glomerular diseases was similar in CKD stage 5.The most common complication of CKD in children is anemia.Hypertension, anemia, SHPT and CVD increased with the progression of CKD staging.SHPT usually occurs in children with CKD stage 4 and 5.The incidence of complications in children with CKD caused by different factors is different.Hemodialysis is the main method of initial renal replacement therapy in the center.

9.
Article in Chinese | WPRIM | ID: wpr-825136

ABSTRACT

@#Using ALK5 inhibitor LY-3200882 as a lead compound, ten structurally novel compounds were designed by bioisosterism, conformational restriction and molecular docking technology. All structures were synthesized and confirmed by 1H NMR and HR-MS. The results of in vitro activity screening showed that most compounds had good kinase inhibitory activity. Among them, compound B4 showed significantly better ALK5 inhibitory activity than LY-3200882 (IC50 = 1.4 nmol/L vs 41.1 nmol/L), and had good inhibitory activity against TGFβ-ALK5-SMAD2/3 signaling pathway in NIH3T3 cells (IC50 = 14.2 nmol/L). Besides, compound B4 had good pharmacokinetic properties, such as oral exposure and bioavailability, which is worthy of further development.

10.
Chinese Journal of Nephrology ; (12): 26-33, 2020.
Article in Chinese | WPRIM | ID: wpr-870933

ABSTRACT

Objective To analyze the Oxford classification (MESTC) and the International Study of Kidney Disease in Children (ISKDC) classification for evaluating the clinical manifestations,histological lesion and short-term prognosis of children with Henoch-Sch(o)nlein purpura nephritis (HSPN).Methods According to the Oxford classification and ISKDC classification,the histological lesions of children with HSPN diagnosed by renal biopsy from Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to December 2018 were re-evaluated.The renal biopsy specimens of the selected subjects were scored according to the Oxford classification and the ISKDC classification.According to whether the first symptom was combined with renal performance,MESTC score and ISKDC classification,children were grouped.The differences in clinicopathological manifestations between the groups were compared.Correlation between MESTC and ISKDC grades was analyzed by nonparametric test rank correlation.Kaplan-Meier survival curve and Log-rank test were used to compare the difference of proteinuria remission rate between the two groups.Univariate and multivariate Cox regression equations were used to analyze the influencing factors of the proteinuria remission rate.Results A total of 78 children with HSPN were enrolled.There were 37 male patients (47.4%) with age of (10.4+2.9) years.When the patients were divided according to MESTC scores and ISKDC classification,the results showed that the proportion of children with nephrotic-range proteinuria in the group of endocapillary hypercellularity (E1,P=0.008),segmental glomerulosclerosis (S1,P=0.015) and ISKDC Ⅲ (P=0.041) was higher than that of E0,S0 and ISKDC Ⅱ groups.The proportion of children with E1 (P=0.015),crescents (C1&C2,P=0.025) or ISKDC Ⅲ (P=0.017) that had been treated with high-dose methylprednisolone was higher.The result of Kaplan-Meier survival curve showed more difficult for proteinuria remission in children with C2 are than C0&C1 group (P=0.026),while no difference were found when children were grouped by M,E,S,T and ISKDC.Multivariate Cox regression analysis showed that the C2 (HR=0.143,95%C1 0.020-1.046,P=0.055) might be a risk factor for proteinuria remission,while the P value was close to 0.05.Conclusions Children with HSPN scored as ISKDC Ⅲ,E1 and S1 are more likely to show nephrotic-range proteinuria.C2 may indicate that patients are more difficult to achieve proteinuria remission.

11.
Article in Chinese | WPRIM | ID: wpr-802861

ABSTRACT

Childhood is a critical time for the development of healthy skeleton.With the development of chronic kidney disease (CKD), there are disorders of mineral and bone metabolism, such as bone transformation, bone mineralization, volume bone and bone strength disorders.The manifestations are bone pain, fracture, growth and development disorders, vascular and soft tissue calcification, which may increase the incidence and mortality of cardiovascular diseases.The decrease of renal 1α-hydroxylase activity leads to the decrease of intestinal calcium absorption, the increase of serum parathyroid hormone (PTH) level and the high transport renal osteopathy.Phosphorus retention aggravates secondary hyperparathyroidism, and high phosphorus can lead to cardiovascular disease.Treatment of hyperphosphatemia and secondary hyperparathyroidism is helpful to improve growth disorders and high transport osteopathy, and to maintain serum calcium, phosphorus and PTH levels within the target normal range of different stages of CKD.Overtreatment can also lead to progression of nonmotile osteopathy, growth failure, hypercalcemia and cardiovascular calcification.Some new drugs, such as calcium-free phosphorus binders and new vitamin D analogues, can effectively inhibit serum PTH levels, providing a choice for the treatment of CKD in children.

12.
Chinese Journal of Nephrology ; (12): 835-840, 2019.
Article in Chinese | WPRIM | ID: wpr-801320

ABSTRACT

Objective@#To observe the value of serum IgG combined with IgE in the diagnosis of steroid-sensitive nephrotic syndrome (SSNS) children.@*Methods@#Children with primary nephrotic syndrome diagnosed in Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to March 2019 were enrolled. According to the 4 weeks steroid therapy, the patients were divided into steroid sensitive group and steroid resistance group. The receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of serum IgG combined with IgE for SSNS.@*Results@#There were no significant differences in age, gender, course of the disease, hemoglobin, platelet, urea nitrogen, creatinine, albumin, globulin, 24 h urine protein, IgA level, IgM level and hematuria between steroid sensitive group and steroid resistance group (all P>0.05). There were significant differences in C3, IgG and IgE levels (all P<0.05). ROC curve analysis showed that the cut-off values of IgG and IgE in the diagnosis of SSNS were 2.57 g/L (AUC=0.717, 95%CI 0.623-0.812, P<0.001) and 174.3 IU/ml (AUC=0.828, 95%CI 0.751-0.905, P<0.001). The area under the ROC curve for IgG<2.57 g/L in combination with IgE>174.3 IU/ml in the diagnosis of SSNS was 0.904 (95%CI 0.834-0.953, P<0.001). Logistic regression showed that children who met both IgG<2.57 g/L and IgE>174.3 IU/ml were 51.00 times more likely to have SSNS than those who did not (P<0.001).@*Conclusion@#IgG combined with IgE can be used as a simple and practical clinical marker for predicting SSNS.

13.
Article in Chinese | WPRIM | ID: wpr-746083

ABSTRACT

Objective To understand the epidemiological characteristics, genomic variations and macrolide resistance of Bordetella pertussis ( B. pertussis) strains circulating in Shenzhen with clinical data analysis, genotype profiling, phylogenetic analysis and antimicrobial susceptibility test. Methods Clinical data of patients with pertussis in Shenzhen Children's Hospital were collected from the electronic medical re-cord system. Genome sequences of 31 B. pertussis isolates were analyzed with next-generation sequencing and de novo assembled. Multilocus sequence typing (MLST) was performed to identify their sequences types. Sequence alignment by BLASTn was used to identify virulence genotypes and mutations in 23S rRNA gene. A phylogenetic tree was constructed to analyze the relationships among them. E-test was used to identify ma-crolide resistance. Results All of the 31 B. pertussis strains were identified as sequence type-2 (ST-2) by MLST with diverse virulence genotypes. Two were prn-deficient strains. Based on the phylogenetic tree, all of the isolates were distant from vaccine strains. Nineteen isolates were resistant to erythromycin with A2047G mutation in 23S rRNA. Conclusions The virulence genotypes of B. pertussis strains in Shenzhen were diverse with increasing non-vaccine genotypes. Macrolide-resistant strains were prevalent. This study might provide reference for improving the prevention, management and vaccination strategy of pertussis.

14.
Article in Chinese | WPRIM | ID: wpr-790266

ABSTRACT

Objective To construct the objective and quantifiable model for evaluating clinical nurses' competency in hospital of Integrated Traditional Chinese and Western Medicine. Methods From December 2016 to August 2017, preliminary formulation of evaluation indicators was constructed through semi-structured interviews, combined with literature analysis. 21 experts from five hospitals of Traditional Chinese Medicine and medical universities were selected using Delphi method for performing two rounds of consultations and weight assignment of indexes. Data was logged and processed using SPSS 16.0. Results The preliminary system of the competency model included four items of Level one and 20 items of Level two. The weight coefficients of the first level indicators were 0.2609, 0.2598, 0.2570 and 0.2224. The positive coefficients from consulations of experts were 100 . 00% and 95 . 24%, respectively . Authority coefficient was 0.88. The coefficients of variation were 0.0923 to 0.1628 and 0.0430 to 0.1827, respectively. Conclusions This model can provide guidance for the training objective of nurses' competency and serve as an instrument for hospital managers to evaluate nurses in hospital of Integrated Traditional Chinese and Western Medicine.

15.
Article in Chinese | WPRIM | ID: wpr-797463

ABSTRACT

Objective@#To construct the objective and quantifiable model for evaluating clinical nurses' competency in hospital of Integrated Traditional Chinese and Western Medicine.@*Methods@#From December 2016 to August 2017, preliminary formulation of evaluation indicators was constructed through semi-structured interviews, combined with literature analysis. 21 experts from five hospitals of Traditional Chinese Medicine and medical universities were selected using Delphi method for performing two rounds of consultations and weight assignment of indexes. Data was logged and processed using SPSS 16.0.@*Results@#The preliminary system of the competency model included four items of Level one and 20 items of Level two. The weight coefficients of the first level indicators were 0.260 9, 0.259 8, 0.257 0 and 0.222 4. The positive coefficients from consulations of experts were 100.00% and 95.24%, respectively. Authority coefficient was 0.88. The coefficients of variation were 0.092 3 to 0.162 8 and 0.043 0 to 0.182 7, respectively.@*Conclusions@#This model can provide guidance for the training objective of nurses' competency and serve as an instrument for hospital managers to evaluate nurses in hospital of Integrated Traditional Chinese and Western Medicine.

16.
Chinese Journal of Nephrology ; (12): 744-751, 2018.
Article in Chinese | WPRIM | ID: wpr-711159

ABSTRACT

Objective To summarize the clinical data of atypical hemolytic uremic syndrome (aHUS) and analyze the treatment and prognosis.Methods A prospective cohort study was conducted on 66 cases in Beijing Children's Hospital affiliated to Capital Medical University from January 2011 to December 2017.The children were divided into positive and negative auto-antibody groups according to the results of anti-factor H autoantibody test.The clinical characteristics,treatment plan and prognosis of the two groups were compared.Results Among the 66 children who met the inclusion criteria,there were 43 cases (65.2%) in the positive group,with an average onset age of (8.0±2.9) years.There were 23 eases (34.8%) in the negative group,with an average onset age of (3.0± 2.6) years.On the basis of plasma treatment,in the positive group,the usage rate of hormone was 83.3% (35/42) and the usage rate of immunosuppressive agents was 42.9%(18/42),while in the negative group,the rates were 63.6%(14/22) and 13.6%(3/22) respectively.The average follow-up time was 19.3 months.One child in each group was lost to follow-up.In the positive group,8 cases recurred (19.0%)and the average recurrence interval time was 16.1 months.In the negative group,7 cases recurred (31.8%) and the average recurrence interval time was 9.3 months.And the recurrent interval time in the positive group was more longer than the negative group (P < 0.05).A total of 85.9%(55/64) children had complete hemolysis control and complete recovery of renal function,in which the positive group was 85.7%(36/42) and negative group was 86.4%(19/22).However,7.8%(5/64) children had abnormal renal function,in which the positive group was 9.5%(4/42) and the negative group was 4.5%(1/22).And 4.7%(3/64) children died,in which the positive group was 2.4%(1/42) and the negative group was 9.1% (2/22).The one left (1.6%) showed dialysis dependence,which was positive for the auto-antibody.Multifactor Cox regression analysis showed that the age of less than 3 years old was the risk factor of poor prognosis (HR=4.651,95%CI 0.988-21.898,P=0.047).Conclusions The positive proportion of anti-factor H autoantibody in children with aHUS is high.The age of these children is older.Individualized therapy based on anti-factor H autoantibody and immunosuppressive therapy is of great significance for disease remission,preventing recurrence and improving the prognosis.Age less than 3 years old is the risk factor for poor prognosis.

17.
Journal of Chinese Physician ; (12): 693-696,700, 2018.
Article in Chinese | WPRIM | ID: wpr-705888

ABSTRACT

Objective This study was to analysis the epidemiologic characteristics of hand-foot-month (HFMD) in Shenzhen during 2015-2016,to provide reference for the prevention and treatment of HFMD.Methods 7 758 statistical data from Shenzhen children's hospital clinical lab during 2015-2016 was included.We used real time fluorescent reverse transcription polymerase chain reaction (RT-PCR) to detect enterovirus general (EV),enterovirus 71 (EV71) and coxsackievirus A group 16 (CoxA16),and analyzed the age,sex and epidemic time of the patients.Results In 2015 and 2016,the positive rate of EV was 67.19% (2679/3987) and 52.61% (1 984/3 771) respectively,with statistically significant difference (x2 =71.84,P < 0.05).The radio of male to female children was 1.91∶1 (1 757/922) and 1.83∶1 (l 283/701) in 2015 and 2016,with statistically significant difference (P < 0.05).The age of the children was < 5 years old,accounting for more than 90% of the total number of patients.April to July and September were the two peaks of HFMD.The enterovirus of hand foot and mouth disease in Shenzhen was dominated by other enteroviruses (more than 82% of the total number of patients).With the increase of age,the proportion of EV71 in children with severe hand and foot was increasing,and the proportion of other enteroviruses was decreasing.Conclusions Vaccination is one of the important measures of HFMD control.It's beneficial for the diagnosis and treatment of HFMD to collected epidemiologic characteristics data about HFMD in Shenzhen.

18.
Article in Chinese | WPRIM | ID: wpr-732855

ABSTRACT

Objective To study the clinical effect of Yiqi-Huoxue decoction on inflammatory factors and renal function with diabetic kidney disease (DN). Methods A total of 95 patients with DN were divided into the control group (n=47) and the treatment group (n=48) randomly. The control group were treated with conventional medicine, and the treatment group were treated with conventional medicine combined with Yiqi-Huoxue decoction. The two groups were treated for 12 weeks. The clinical efficacy of the two groups after treatment were compared. The serum IL-8, TNF-α, CRP and BUN, SCr, UAER of the two groups before and after treatment were compared. The adverse reactions of the two groups during treatment were compared. Results The total efficacy rate of the treatment group was 87.5% (42/48), significantly higher than 51.1%(24/47) of the control group (χ2=14.866, P<0.01). After treatment, the serum L-8 (7.23 ± 2.84 ng/L vs. 11.63 ± 7.20 ng/L, t=3.933), TNF-α (16.71 ± 1.05 ng/L vs. 18.35 ± 1.20 ng/L, t=7.093), CRP (5.63 ± 1.21 mg/L vs. 6.70 ± 1.38 mg/L, t=4.021) of the treatment groupwere significantly lower than those of the control group (P<0.05). After treatment, the BUN (6.03 ± 0.66 mmol/L vs. 8.12 ± 0.78 mmol/L, t=14.109), SCr (90.17 ± 14.30 mmol/L vs. 101.34 ± 18.81 mmol/L, t=3.263), UAER (0.64 ± 0.19 g/24 h vs. 0.96 ± 0.22 g/24h, t=7.592) of the treatment groupwere significantly lower than those of the control group (P<0.01). The adverse reactions rates of treatment group was 6.3% (3/48), control group was 8.5% (4/47), and there was no significantly differences between two groups (χ2=0.178, P=0.673). Conclusions The Yiqi-Huoxue decoction for patients with DN has a good efficacy and low adverse reactions, can reduce the inflammatory factors, improve the inflammatory state and renal function, and it was worthy clinical application.

19.
Chinese Journal of Pediatrics ; (12): 663-667, 2017.
Article in Chinese | WPRIM | ID: wpr-809207

ABSTRACT

Objective@#In order to learn the serum level of galactose-deficient IgA1 (GdIgA1), IgG antibody to galactose-deficient IgA1(GdIgA1-IgG) and the clinical role of them in IgA nephropathy(IgAN) children.@*Method@#We compared blood levels of GdIgA1, GdIgA1-IgG in 33 children with IgAN, 38 children with other renal disease (including focal segmental glomerular nephritis, minimal change disease, Alport syndrome and thin basement membrane nephropathy) as disease controls, 35 healthy children as normal controls with enzyme-linked immunosorbent assay(ELISA). Twenty-four-hour urine protein content and Lee′s pathological classification were collected in IgAN cases. The difference among the three groups were examined by analysis of variance. The specificity and sensitivity of GdIgA1, GdIgA1-IgG to IgA nephropathy were evaluated by ROC curve.The correlations were analyzed by correlation analysis among GdIgA1, GdIgA1-IgG and urine protein content and pathological classification . All statistical analyses were performed by SPSS 18.0. P value of <0.05 was considered statistically significant.@*Result@#The levels of GdIgA1 and GdIgA1-IgG significantly elevated in children with IgAN compared to disease controls and normal controls. GdIgA1(mg/L): 1.728±0.456, 1.123±0.461, 1.410±0.905 (F=15.04, P<0.001); GdIgA1-IgG(g/L): 1.299±0.499, 1.111±0.549, 0.628±0.142 (F=76.96, P<0.001). Area under the curve of ROC of GdIgA1 between IgAN and normal controls was 0.765, with specificity 0.943 and sensitivity 0.697, while the area under the curve of GdIgA1-IgG was 0.969, with specificity 0.971 and sensitivity 0.939.The blood level of GdIgA1-IgG was mildly correlated with both 24-hour urine protein(r=0.364, ) and renal pathological grading(r=0.392) in children with IgAN.@*Conclusion@#The levels of GdIgA1 and GdIgA1-IgG significantly elevated in children with IgAN compared to disease controls and normal controls. GdIgA1-IgG had higher sensitivity in distinguishing IgAN from normal controls, GdIgA1-IgG was mildly correlated with 24-hour urine protein volume and pathological grading in children with IgAN.

20.
Journal of Chinese Physician ; (12): 692-696, 2017.
Article in Chinese | WPRIM | ID: wpr-609968

ABSTRACT

Objective To investigate the effects of tongue cancer resistance-associated protein 1 (TCRP1) in proliferation of chronic myeloid leukemia cells (CML),and explore the new thoughts of pathogenesis of CML.Methods The expression of TCRP1 was detected in the peripheral blood mononuclear cells (PBMC) of CML with real-time quantitative polymerase chain reaction (PCR) and Western blot.After the expression of TCRP1 was interfered in K562 cells,the proliferation of cells was detected by 3-(4,5-dimenthylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay and soft agar colony forming assay,and the expression of protein kinase B (AKT) and its phosphorylation were tested by Western blot.Results In PBMC of CML patients,the mRNA and protein levels of TCRP1 were significantly higher than those of normal controls.The results of MTS assay and soft agar colony forming assay showed that the proliferation of K562 cells was significantly decreased after the expression of TCRP1 was interfered.After knockdown of TCRP1 in K562 cells,the phosphorylation of AKT was significantly decreased while the expression of total AKT did not change.Conclusions The expression of TCRP1 was increased in CML cells.High expression of TCRP1 might contribute to proliferation of K562 cells via the phosphorylation of AKT.

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