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Objective@#To investigate the value of routine indexes of blood, biochemistry and coagulation in assessing microcirculation in children with sepsis, and explore the related mechanism.@*Methods@#The clinical data of 187 children with sepsis from July 2013 to July 2018 in Wuxi Children′s Hospital of Jiangsu Province were retrospectively analyzed. The lactic acid, D- dimmer (DD), platelet distribution width (PDW), red blood cell volume distribution width (RDW), albumin, capillary refill time (CRT), simplify pediatric clinical illness score (PCIS) and prognosis were observed. The children were divided into 3 groups according to the simplify PCIS: non-severe group (simplify PCIS>80 scores, 96 cases), severe group (simplify PCIS 71 to 80 scores, 64 cases), and extremely severe group (simplify PCIS ≤ 70 scores, 27 cases); the children were divided into 2 groups according to the prognosis: survival group (161 cases) and death group (26 cases); the children were divided into 3 groups according to the CRT: capillary refilling better group (CRT<1.0 s, 99 cases), capillary refilling infaust group (CRT 1.0 to 2.9 s, 60 cases), capillary refilling bad group (CRT ≥ 3.0 s, 28 cases).@*Results@#The lactic acid, DD, PDW, RDW and fatality rate in non-severe group, severe group and extremely severe group were gradually increased: (2.281 ± 1.103), (4.839 ± 2.154), (7.019±3.014) mmol/L; (2.103 ± 0.133), (3.632 ± 0.218), (5.179 ± 0.113) mg/L; 0.122 ± 0.010, 0.149 ± 0.011, 0.177 ± 0.016; 0.137 ± 0.012, 0.151 ± 0.018, 0.169 ± 0.021; 2.08% (2/96), 14.06% (9/64), 55.56% (15/27), while the albumin was gradually decreased: (34.21 ± 13.72), (30.38 ± 18.63), (22.37 ± 16.31) g/L, and there were statistical differences (P<0.01). The lactic acid, DD, PDW and RDW in survival group were significantly lower than those in death group: (3.127 ± 1.312) mmol/L vs. (6.837 ± 2.174) mmol/L, (2.473 ± 1.713) mg/L vs. (4.213 ± 1.101) mg/L, 0.124 ± 0.012 vs. 0.170 ± 0.023 and 0.148 ± 0.022 vs. 0.171 ± 0.017, while the albumin was significantly higher than that in death group: (33.59 ± 16.90) g/L vs. (19.92 ± 18.70) g/L, and there were statistical differences (P<0.01 or <0.05). The lactic acid, DD, PDW and RDW in capillary refilling better group, capillary refilling infaust group and capillary refilling bad group were gradually increased: (2.362 ± 2.131), (5.312 ± 1.114), (8.121 ± 2.213) mmol/L; (2.072 ± 0.213), (3.923 ± 0.178), (5.317 ± 0.517) mg/L; 0.119 ± 0.021, 0.153 ± 0.012, 0.171 ± 0.011; 0.127 ± 0.021, 0.148 ± 0.015, 0.168 ± 0.027; while the albumin was gradually decreased: (35.37 ± 14.11), (31.21 ± 15.13), (22.87 ± 15.22) g/L, and there were statistical differences (P<0.01).@*Conclusions@#The lactic acid, DD, PDW, RDW, ALB and CRT have some value in assessing microcirculation in children with sepsis, and the change of component and construction in microcirculation is the cause of developing of these indexes.
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Objective To investigate the value of routine indexes of blood, biochemistry and coagulation in assessing microcirculation in children with sepsis, and explore the related mechanism. Methods The clinical data of 187 children with sepsis from July 2013 to July 2018 in Wuxi Children′s Hospital of Jiangsu Province were retrospectively analyzed. The lactic acid, D- dimmer (DD), platelet distribution width (PDW), red blood cell volume distribution width (RDW), albumin, capillary refill time (CRT), simplify pediatric clinical illness score (PCIS) and prognosis were observed. The children were divided into 3 groups according to the simplify PCIS: non-severe group (simplify PCIS＞80 scores, 96 cases), severe group (simplify PCIS 71 to 80 scores, 64 cases), and extremely severe group (simplify PCIS≤70 scores, 27 cases); the children were divided into 2 groups according to the prognosis: survival group (161 cases) and death group (26 cases); the children were divided into 3 groups according to the CRT: capillary refilling better group (CRT﹤1.0 s, 99 cases), capillary refilling infaust group (CRT 1.0 to 2.9 s, 60 cases), capillary refilling bad group (CRT ≥ 3.0 s, 28 cases). Results The lactic acid, DD, PDW, RDW and fatality rate in non-severe group, severe group and extremely severe group were gradually increased: (2.281 ± 1.103), (4.839 ± 2.154), (7.019 ± 3.014) mmol/L; (2.103 ± 0.133), (3.632 ± 0.218), (5.179 ± 0.113) mg/L; 0.122 ± 0.010, 0.149 ± 0.011, 0.177 ± 0.016; 0.137 ± 0.012, 0.151 ± 0.018, 0.169 ± 0.021; 2.08% (2/96), 14.06% (9/64), 55.56% (15/27), while the albumin was gradually decreased: (34.21 ± 13.72), (30.38 ± 18.63), (22.37 ± 16.31) g/L, and there were statistical differences (P﹤0.01). The lactic acid, DD, PDW and RDW in survival group were significantly lower than those in death group: (3.127 ± 1.312) mmol/L vs. (6.837 ± 2.174) mmol/L, (2.473 ± 1.713) mg/L vs. (4.213 ± 1.101) mg/L, 0.124 ± 0.012 vs. 0.170 ± 0.023 and 0.148 ± 0.022 vs. 0.171 ± 0.017, while the albumin was significantly higher than that in death group: (33.59 ± 16.90) g/L vs. (19.92 ± 18.70) g/L, and there were statistical differences (P﹤0.01 or﹤0.05). The lactic acid, DD, PDW and RDW in capillary refilling better group, capillary refilling infaust group and capillary refilling bad group were gradually increased: (2.362 ± 2.131), (5.312 ± 1.114), (8.121 ± 2.213) mmol/L; (2.072 ± 0.213), (3.923 ± 0.178), (5.317 ± 0.517) mg/L; 0.119 ± 0.021, 0.153 ± 0.012, 0.171 ± 0.011; 0.127 ± 0.021, 0.148 ± 0.015, 0.168 ± 0.027; while the albumin was gradually decreased: (35.37 ± 14.11), (31.21 ± 15.13), (22.87 ± 15.22) g/L, and there were statistical differences (P﹤0.01). Conclusions The lactic acid, DD, PDW, RDW, ALB and CRT have some value in assessing microcirculation in children with sepsis, and the change of component and construction in microcirculation is the cause of developing of these indexes.
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Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from blood culture of children in a pediatric intensive care unit (PICU),provide reference for empirical treatment of bloodstream infection in critically ill children.Methods Pathogenic bacteria isolated from blood culture of children in a PICU in 2011-2015 were identified and performed antimicrobial susceptibility testing.Results A total of 180 strains of pathogens were isolated from 3 215 blood specimens,the positive rate was 5.60 ％,153 (85.00 ％) of which were grampositive bacteria and 27 (15.00 ％) were gram-negative bacteria.The top five isolated pathogens were Staphylococcus epidermidis (26.67 ％),Staphylococcus hominis (25.00 ％),Staphylococcus haemolyticus (11.66 ％),Escherichia coli (5.55 ％),and Staphylococcus aureus (3.89 ％).The resistance rates of Staphylococcus spp.to linezolid,vancomycin,and quinupristin/dalfopristin were all 0;the detection rates of methicillin-resistant coagulase-negative staphylococci (MRCNS) and methicillin-resistant Staphylococcus aureus(MRSA) were 70.18％ and 42.68％ respectively;Escherichia coli had high resistance rates to ampicillin,cefazolin,ceftriaxone,gentamycin,and compound sulfamethoxazole (50.00 ％-80.00 ％).Conclusion CNS and Escherichia coli are the main pathogens in blood culture of children in PICU,differences in antimicrobial resistance exist among different types of CNS.
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Objective To observe the effect of T cell subset in the children patients with community acquired pneumonia. Methods A total of 36 patients with community acquired pneumonia were enrolled and they were divided into 2 groups according to pathogen, bacterial infection group, and non-bacterial infection group. And in another way they were divided into severe cases group and non-severe cases group. Indexes of T lymphocyte subset CD3+, CD4+, CD8+, CD19+and activity of natural killer (NK) cell were detected in all patients by flow cytometry and compared. Results The levels of CD3+, CD4 +, CD8 +, CD19 + and NK cell had no significant difference between bacterial infection group and non-bacterial infection group (P>0.05). The levels of CD3+, CD4+and CD19+had no significant difference between severe cases group and non-severe cases group (P>0.05). But the level of CD8+ in severe cases group was significantly higher than that in non-severe cases group:(28.4 ± 7.8)%vs. (14.4 ± 3.5)%, P<0.01. The level of NK cell in severe cases group was significantly lower than that in non-severe cases group: (7.3 ± 2.1)%vs. (16.6 ± 5.4)%, P<0.01. Conclusions The children patients with community acquired pneumonia patients may develop into severe pneumonia with high percent of CD8+or low activity of NK cell. So they should be given immune intervention as soon as possible.
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Objective To explore the relationship between the genetic polymorphism and serum concentration of mannan binding lectin (MBL)and the clinical manifestation of the hand-foot-mouth disease (HFMD) children infection by human enterovirus 71 (HEV71).Methods One hundred and thirty-eight children diagnosed as HFMD infected by HEV71 (including 80 mild cases and 58 severe cases) and 40 healthy,symptom-free children were investigated.The concentrations of serum MBL were measured in 40 healthy controls,80 mild HFMD cases and 56 severe HFMD cases at both acute and convalescent phases by a sandwich enzyme immunoassay with a human MBL ELISA kit.And the genomic DNA of all cases were extracted from blood according to standard phenol-chloroform procedure.Six SNPs in the MBL gene(-550G/C,-221G/C and +4C/T of the promoter,CGT52TGT,GGC54GAC,and GGA57GAA of the exon 1) were analyzed by a sequencing-based typing method.Results The MBL serum level of the severe HFMD circulatory respiratory failure group in acute phase was significantly increased compared with severe HFMD encephalitis group,the mild cases and the control,but in the convalescence phase it significantly decreased compared with them.The frequencis of type B/B mutation (+230 of the exon 1),type P/P mutation (+4C/T of the promoter),and type H/H mutation (-550G/C of the promoter) were a significant difference among mild group,severe group and the control(P=0.006,0.043,0.028,respectively).The frequencies of LYPB/LYPB genotype and HYPA/HYPA genotype were a significant difference among mild group,severe groupand the control (P=0.028,0.014,respectively).Conclusion Low MBL protein level as a result genetic polymorphism seems to be correlative with clinical manifestation of HFMD disease.The MBL gene mutation and low MBI.protein level may be used as one of the evaluation method of HFMD severeity.