Clinical implication of microproteinuria and urine enzyme in the detection of early renal damage by antibiotics / 中国基层医药

Objeetive To analyze the clinical significance of serial microproteinuria and urease detection in early diagnosis of antibiotics damage to kidney by observing the changes of urine microalbumin/creatinine ratio (mAlb/Cr),transferrin (TRF),IgG,α1-microglobulin (α1-M G),β2-microglobulin (β2-M G),retinol-binding pmtein(RBP) and N-acetyl-β-D-glucosaminidase(NAG).Methods A total of 161 children with pneumonia whose test results were normal of urine protein,blood urea nitrogen (BUN) and serum creatinine (Scr),and had no related history of kidney diseases were selected.All the patients were divided into three groups according to antibiotics for the treatment,the penicillins (penicillin G,amoxicillin and potassium clavulanate,ticarcillin and potassium clavulanate) group,the cephalosporins (cefazolin,cefuroxime,ceftriaxone,cefoperazone,ceftazidime) group and the macrolides (erythromycin,azithromycin) group.Changes of mAlb/Cr,TRF,IgG,α1-MG,β2-MG,RBP,NAG,BUN,Scr levels of the patients one week before and after use the antibiotics were observed,and statistically analyzed.Results In the penicillins group and macrolides group,the results showed that none of the serial microproteinuria and urease changed(all P ＞ 0.05).In the cephalosporins group,the urine mAlb/Cr,TRF,β2-MG and NAG were higher than before using the antibiotics [(15.56 ± 5.98) mg/g vs.(21.08 ± 10.88) mg/g,(1.61 ± 0,14)mg/L vs.(1.66 ±0.14) mg/L,(0.25 ±0.09)mg/L vs.(0.28 ±0.11)mg/L,(4.62 ±3.80) U/L vs.(4.98 ±3.97) U/L,t =-5.11,-3.24,-2.29,-2.04,P ＜ 0.05 ～ 0.001].The levels of BUN and Scr revealed no change in all the patients(all P ＞ 0.05).Conclusion Combined detection of serial microproteinuria and urease has great clinical significance in judgment and warning of early renal damage by antibiotics.

Effect of nebulized hypertonic saline solution for bronchiolitis in infant / 中国基层医药

Objective To assess the efficacy and safety of nebulized hypertonic saline solution in infant with bronchiolitis.Methods From January 2014 to January 2016,95 patients at 3-13 months old in our hospital who diagnosed as bronchiolitis were randomly divided into three groups.On the basis of conventional suit support treatment,the observation group A was given nebulized 3％ hypertonic saline (n =32),the observation group B was given nebulized 3％ hypertonic saline and salbutamol (n =32),and the control group C was given nebulized normal saline (0.9％) and salbutamol (n =31),this therapy was repeated every 6 hours until discharge.The Lowell score,clinical symptoms remission time,days of hospitalization and incidence rate of adverse reaction of the three groups were compared.Results After treatment,the symptoms and signs of the three groups were all improved.The Lowell scores were lower in the two observation groups compared to the control group C in 24,48,72 hours after treatment[(5.81 ±1.53) points and (5.85 ± 1.37) points vs.(6.61 ± 1.54) points,(4.75 ± 1.34) points and (4.72 ± 1.30) points vs.(5.52 ± 1.29) points,(3.19 ± 1.15) points and (3.22 ± 1.16) points vs.(3.90 ± 1.01) points,Z =-1.999,-2.241,-2.518 and-2.002,-2.335,-2.316,all P ＜ 0.05).And the cough,wheezing remission time and pulmonary rales disappearance time,days of hospitalization in the two observation groups were also shorter,there were statistically significant differences [(6.63 ± 1.41) d and (6.56 ± 1.37) d vs.(7.35 ± 1.25) d,(5.19 ± 1.03) d and (5.25 ± 1.05)d vs.(5.87 ± 1.09)d,(5.75 ±1.34)d and (5.72 ± 1.51)d vs.(6.68 ± 1.60)d,(7.25 ± 1.37)d and (7.16±1.48)d vs.(8.10±l.47)d,Z=-2.498,-2.469,-2.359,-2.213 and-2.982,-2.405,-2.373,-2.222,P ＜0.05,or P ＜0.01)].There were no significant differences in the Lowell score,the length of time of cough,wheeze,lung rales disappears and the length of hospital stay between the observation group A and observation groupB[(5.81 ± 1.53) points vs.(5.85 ± 1.37) points,(4.75 ± 1.34) points vs.(4.72 ±1.30) points,(3.19± 1.15) points vs.(3.22 ± 1.16) points,(6.63 ± 1.41) d vs.(6.56 ± 1.37) d,(5.19 ±1.03)d vs.(5.25 ± 1.05)d,(5.75 ± 1.34) d vs.(5.72 ± 1.51) d,(7.25 ± 1.37) d vs.(7.16 ± 1.48) d,Z =-0.164,-0.021,-0.140,-0.295,-0.167,-0.374,-0.233,all P ＞ 0.05].Children in three groups had no serious adverse events (all P ＞ 0.05).Conclusion Nebulized hypertonic saline in the treatment of bronchiolitis can relieve symptoms and signs,shorten the hospitalization time,and has less adverse reaction,it is worthy of clinical use.