Association of the levels of heavy metals and trace elements during pregnancy with congenital heart defects in offspring: a prospective cohort study / 中国当代儿科杂志

OBJECTIVES@#To study the association of the levels of heavy metals and trace elements during pregnancy with congenital heart defects (CHD) in offspring, and to establish a model for predicting the probability of CHD based on the levels of heavy metals and trace elements during pregnancy.@*METHODS@#Based on the prospective birth cohort study in Gansu Provincial Maternal and Child Health Hospital in 2010-2012, a nested case-control study was conducted for the follow-up observation of 14 359 pregnant women. Among the pregnant women, 97 pregnant women whose offspring were diagnosed with CHD during follow-up were enrolled as the CHD group, and 194 pregnant women whose offspring had no CHD were selected as the control group. Inductively coupled plasma mass spectrometry was used to measure the levels of heavy metals and trace elements in maternal blood samples and fetal umbilical cord blood samples. A multivariate logistic regression analysis was used to evaluate the association between heavy metal and trace elements and CHD in offspring. A nomogram model for predicting the probability of CHD in offspring was established based on the levels of heavy metals and trace elements during pregnancy.@*RESULTS@#Compared with the control group, the CHD group had significantly higher levels of aluminum (Al), natrium (Na), calcium (Ca), titanium (Ti), selenium (Se), strontium (Sr), stannum (Sn), stibium (Sb), barium (Ba), and thorium (Th) in maternal blood samples (P<0.05), as well as significantly higher levels of Al, zinc (Zn), magnesium (Mg), kalium (K), Ca, Ti, chromium (Cr), copper (Cu), arsenic (As), Se, Sr, argentum (Ag), cadmium (Cd), Sn, and plumbum (Pb) in umbilical cord blood (P<0.05). The multivariate logistic regression analysis showed that the increase in the Sb level in maternal blood was associated with the increase in the risk of CHD in offspring [adjusted odds ratio (aOR)=4.81, 95% confidence interval (CI): 1.65-14.07, P=0.004], while in umbilical cord blood, the high levels of Al (aOR=4.22, 95%CI: 1.35-13.16, P=0.013), Mg (aOR=8.00, 95%CI: 1.52-42.08, P=0.014), and Pb (aOR=3.82, 95%CI: 0.96-15.23, P=0.049) were significantly associated with the risk of CHD in offspring. The levels of Al, Th, and Sb in maternal blood and levels of Al, Mg, and Pb in umbilical cord blood were included in the predictive model for CHD in offspring based on the levels of heavy metals and trace elements during pregnancy, and the calibration curve of the nomogram predictive model was close to the ideal curve.@*CONCLUSIONS@#Increases in the levels of Al, Th, Sb, Mg, and Pb during pregnancy may indicate the increase in the risk of CHD in offspring, and the nomogram predictive model based on these indices can be used to predict the probability of CHD in offspring.

Changes of heart-type fatty acid-binding protein in children with chronic heart failure and its significance / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study serum levels of heart-type fatty acid-binding protein (h-FABP) in children with chronic heart failure (CHF), and the correlation between heart function and the level of h-FABP, with the aim of studying the significance of h-FABP in CHF.</p><p><b>METHODS</b>Thirty-six children with CHF, including 16 cases of endocardial fibroelastosis (EFE) and 20 cases of dilated cardiomyopathy (DCM) were enrolled in the study. Thirty healthy children sevred as the control group. Serum levels of h-FABP were determined using ELISA, and left ventricular ejection fraction (LVEF), cardiac index (CI) and fractional shortening of the left ventricle (LVSF) were measured by two-dimensional echocardiography in the CHF group.</p><p><b>RESULTS</b>Mean levels of h-FABP in the CHF group were significantly higher than in the control group (21.7±4.3 ng/mL vs 6.2±1.7 ng/mL; P<0.01). The worse the heart function, the higher the h-FABP levels (P<0.01). Mean levels of h-FABP in both the EFE and DCM groups were significantly higher than in the control group (P<0.01). Serum h-FABP concentrations were negatively correlated with LVEF, CI and LVSF (r=-0.65, -0.64 and -0.71 respectively; P<0.01) in the CHF group.</p><p><b>CONCLUSIONS</b>Serum h-FABP levels increase in children with CHF and are closely related to the severity of the condition. Serum h-FABP levels can be used as a biomarker for the diagnosis of heart failure and the evaluation of its severity.</p>

Levels of serum brain natriuretic peptide and the correlation to heart function in children with Kawasaki disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study serum levels of brain natriuretic peptide (BNP) in children with Kawasaki disease (KD) and the correlation between BNP levels and the heart function.</p><p><b>METHODS</b>Forty-three children with KD and thirty healthy children were enrolled. Serum levels of BNP were measured using ELISA. KD children received an echocardiographic examination, including measurements of left ventricular ejection fraction (LVEF), left ventricular shorten fraction (LVSF), cardiac index (CI) and left ventricular inflow velocity through the mitral annulus.</p><p><b>RESULTS</b>Mean serum level of BNP at the acute stage in children with KD was significantly higher than that at the recovery stage as well as the control group (p<0.01). The LVEF, LVSF and CI levels at the acute stage were significantly lower than those at the recovery stage in children with KD (p<0.05). The linear regression analysis showed that the BNP level was negatively correlated with the levels of LVEF, LVSF and CI (r=-0.63, -0.52, -0.53, p<0.05).</p><p><b>CONCLUSIONS</b>The serum BNP levels increase significantly in KD children at the acute stage, and are negatively correlated with the levels of LVEF, LVSF and CI. Measurement of serum BNP level is useful for the early diagnosis of KD.</p>

Serum brain natriuretic peptide in children with Kawasaki disease / 世界急诊医学杂志（英文）

BACKGROUND:Kawasaki disease (KD) is a common cause of acquired heart disease in children. Recent studies have focused on the biochemical markers of the myocardium, their high sensitivity and specificity and significance in the diagnosis of KD. This study aimed to determine the serum level of brain natriuretic peptide (BNP) and its relation with the heart function of children with KD and to explore its clinical value in diagnosis of KD. METHODS:Forty-three KD children, aged from 5 months to 8 years (mean 2.3±0.6 years ), were admitted to Qingdao Children's Hospital from February 2007 to April 2009. Among them 27 were male, and 16 female. The 43 patients served as a KD group. Patients with myocarditis, cardiomyopathy, congenital heart disease and other primary heart diseases were excluded. Thirty healthy children, aged from 3 months to 15 years (mean 2.5±0.8 years) or 17 males and 13 females served as a control group. There were no significant differences in age and gender between the two groups (P>0.05). In the KD group, ELISA was used to measure the levels of serum BNP in acute and convalescent stages;and in the control group, the levels of serum BNP were measured once randomly. Left ventricular ejection fraction (LVEF), left ventricular shorten fraction (LVSF), cardiac index (CI) and left ventricular inflow velocity through the mitral annulus (including E-velocity and A-velocity) were measured by two-dimensional echocardiography in the acute and convalescent stages in the KD group. All data were expressed as mean±SD. The methods of analysis included Student's t test and the linear regression analysis test. P<0.05 was considered statistically significant. RESULTS:The level of serum BNP in the acute stage (517.26±213.40) ng/ml was significantly higher than that in the convalescent stage (91.56±47.97) ng/ml in the control group (37.55±7.56) ng/ml (P<0.01). The levels of LVEF, LVSF and CI in the acute stage were significantly lower than those in the convalescent stage (P<0.05), but the E/A level was not significantly different between the acute and convalescent stages (P>0.05). Linear regression analysis showed that the BNP level was negatively correlated with the levels of LVEF, LVSF and CI(r=-0.63, -0.52, -0.53, P<0.05) , but not significantly correlated with the E/A level (r=-0.18, P>0.05). CONCLUSION:The levels of serum BNP are significantly increased in KD patients, and are negatively correlated with the levels of LVEF, LVSF, and CI. The detection of serum BNP level is of clinical significance in the diagnosis of KD.

Levels of serum heart-type fatty acid-binding protein and its clinical significance in children with Kawasaki disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>This study examined serum level of heart-type fatty acid-binding protein (h-FABP) in children with Kawasaki disease (KD) in order to assess its value in KD.</p><p><b>METHODS</b>Forty children with KD and 30 healthy children were enrolled. Serum levels of h-FABP and cardiac troponin I (cTnI) were measured using ELISA. Serum creatine kinase-MB (CK-MB) level was detected using an autoanalyer. The KD group was classified into two subgroups, with or without coronary artery lesions, based on the findings of the echocardiography.</p><p><b>RESULTS</b>Mean serum levels of h-FABP (18.17+/-13.38 ng/mL vs 6.25+/-1.70 ng/mL; P<0.01) and cTnI (0.27+/-0.22 ng/mL vs 0.11+/-0.02 ng/mL; P<0.05) in the KD group was significantly higher than those in the control group. There was no significant difference in serum CK-MB concentrations between the two groups. Twenty-six patients (65%) and eight patients (20%) showed abnormally increased h-FABP and cTnI levels respectively in the KD group, but none of the control group showed increased levels of both. In the KD group, the percentage of patients with increased h-FABP was significantly higher than those with increased CTnI (P<0.01). The patients with coronary artery lesions had higher serum h-FABP level than those without (28.14+/-14.26 ng/mL vs 11.52+/-6.28 ng/mL; P<0.01).</p><p><b>CONCLUSIONS</b>Serum levels of h-FABP and cTnI increase and can be used as the biomarkers of myocardial damage in children with KD. h-FABP appears to be more sensitive and specific. Detection of serum h-FABP level is useful for diagnosis of KD and coronary artery lesions secondary to KD.</p>

Serum levels of fatty acid-binding protein and brain natriuretic peptide in children with pneumonia complicated by acute congestive heart failure / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To assess the values of serum fatty acid-binding protein (FABP) and brain natriuretic peptide (BNP) in pneumonia complicated by acute congestive heart failure (CHF) in children.</p><p><b>METHODS</b>Serum levels of FABP and BNP were determined using ELISA in 36 children with pneumonia complicated by CHF (pneumonia group) and 28 healthy children (control group).</p><p><b>RESULTS</b>Serum levels of FABP and BNP in the pneumonia group at the acute stage were significantly higher than those in the control group and those at the recovery stage (P<0.01). Compared with the control group, serum levels of FABP and BNP in the pneumonia group at the recovery stage increased significantly (P<0.01). At the acute stage, 35 patients (97.2%) showed increased serum FABP level but 28 (77.8%) showed increased serum BNP level (P<0.05) in the pneumonia group. At the recovery stage, the incidence of abnormal serum FABP (72.2%) was significantly higher than that of BNP (44.4%) in the pneumonia group (P<0.05).</p><p><b>CONCLUSIONS</b>Serum levels of FABP and BNP can be regarded as biochemical markers of myocardial damage in children with pneumonia complicated by CHF and serum FABP appears to be a more sensitive one. Serum FABP and BNP remained at higher levels through the recovery stage, suggesting that myocardial damage existed though the clinical symptoms were improved at the stage.</p>

Significance of Peptide Brain Natriuretic Peptide in Children with Acute Congestive Heart Failure / 实用儿科临床杂志

Objective To detect brain natriuretic peptide(BNPs) level in serum in order to confirm its applical value.Methods Forty-eight patients with congestive heart failure(CHF) were chosen,which included 36 patients with pneumonia,12 patients with congenital heart diseases.Forty heathy children were chosen as control group.BNPs level of two groups were detected by enzyme label.Results The level of BNP in patients with CHF(that′s positive group) was obviously higher than that in control group in the stage of CHF and recoverty(t=14.30,20.38 all P0.05),this included that the cardiac function had significantly changes in the stage of CHF,at the same time,the level of BNP had negative correlation to CI and LVEF(r=-0.61,-0.79 all P

Changes of Soluble Tumor Necrosis Factor-? Receptor Type 1 in Cerebrospinal Fluid of Children with Virus Encephalitis and Its Clinical Significance / 实用儿科临床杂志

Objective To explore the changes of soluble tumor necrosis factor receptor type 1(sTNFR1)in children with acute virus encephalitis(VE)and its clinical significance.Methods The levels of tumor necrosis factor-?(TNF-?),sTNFR1 and neuron specific enolase(NSE)in cerebrospinal fluid were determined by enzyme-linked immunosorbent assay(ELISA)in 55 children who were admitted with VE,including 25 cases with severe VE(SVE)and 30 cases with mild VE(MVE).Fifteen cases without VE were as control group.Results The levels of TNF-?,sTNFR1 in cerebrospinal fluid in encephalitis children were significantly higher than that in control group(Pa

Changes of Serum Cardiac Muscle Enzymogram and Heart Function before and after Interventional Therapy in Ventricular Septal Defect Patients and Its Clinical Significance / 实用儿科临床杂志

Objective To explore the changes of cardiac muscle enzymogram and heart function before and after transactheter closure of ventricular septal defect(VSD).Methods The serum levels of cardiac troponin(cTnI),carcatine kinase(CK),lactie dehydrogenase(LDH),aspartate aminotransferase(AST)and the left ventricular ejection fraction(LVEF)were detected by two-dimensional echocardiography,and the change before and after intervention was analyzed.Results The serum level of cTnI in VSD patients after treatment was markedly higher than that before intervention[(0.29?0.17)?g/L vs(0.02?0.01)?g/L,t=9.0 P0.05).Conclusion Catheterization to treat VSD may have influence on enzymogram and the heart function,which may be related to the minor myocardial damage during the operation.