Pub Date : 2021-01-01DOI: 10.3760/cma.j.cn101070-20210913-01109
Bao-Ping Xu, Z. Wei, G. Lu, Yuejie Zheng, Xuefeng Wang, L. Feng, Zhengde Xie, Gang Liu, Yi Jiang, Xing-wang Li, R. Jiang, Jikui Deng, Miao Liu, Xia-min Lu, R. Jin, Z. Liu, Yunxia Shang, S. Shu, Y. Bai, Min Lu, Wanjun Luo, Yuxia Cui, Leping Ye, Likai Lin, Dongchi Zhao, A. Shen, J. Shao, Lijuan Xiong, Li-Wei Gao, Tianyou Wang, Z. Zhao, Yonghong Yang, K. Shen
Pub Date : 2021-01-01DOI: 10.3760/cma.j.cn101070-20210902-01057
Yuejie Zheng, Xuefeng Wang, L. Feng, Zhengde Xie, Yi Jiang, G. Lu, Xing-wang Li, R. Jiang, Jikui Deng, Miao Liu, Bao-Ping Xu, Z. Wei, Gang Liu, Xia-min Lu, R. Jin, Z. Liu, Yunxia Shang, S. Shu, Y. Bai, Min Lu, Wanjun Luo, Yuxia Cui, Leping Ye, Likai Lin, Dongchi Zhao, A. Shen, J. Shao, Lijuan Xiong, Li-Wei Gao, Tianyou Wang, Z. Zhao, Yonghong Yang, K. Shen
Pub Date : 2020-04-08DOI: 10.3760/CMA.J.CN101070-20200308-00347
Xu-Hua Ge, H. Miao
Sepsis-associated encephalopathy (SAE) is a serious complication of sepsis, which can greatly increase the mortality of patients with sepsis, and may result in prolonged cognitive dysfunction in SAE survivors.Therefore SAE has received more and more attention in the field of critical illness.However, there are few studies on the mechanism of poor prognosis and possible predictors of SAE, and no specific rehabilitation methods have been reported.In this article, progress in the research on the prognosis and rehabilitation of SAE is summarized, in order to provide a reference for the long-term prognosis and rehabilitation treatment of severe sepsis in children. Key words: Sepsis-associated encephalopathy; Prognosis; Rehabilitation
{"title":"Prognosis and rehabilitation of sepsis-associated encephalopathy","authors":"Xu-Hua Ge, H. Miao","doi":"10.3760/CMA.J.CN101070-20200308-00347","DOIUrl":"https://doi.org/10.3760/CMA.J.CN101070-20200308-00347","url":null,"abstract":"Sepsis-associated encephalopathy (SAE) is a serious complication of sepsis, which can greatly increase the mortality of patients with sepsis, and may result in prolonged cognitive dysfunction in SAE survivors.Therefore SAE has received more and more attention in the field of critical illness.However, there are few studies on the mechanism of poor prognosis and possible predictors of SAE, and no specific rehabilitation methods have been reported.In this article, progress in the research on the prognosis and rehabilitation of SAE is summarized, in order to provide a reference for the long-term prognosis and rehabilitation treatment of severe sepsis in children. \u0000 \u0000Key words: \u0000Sepsis-associated encephalopathy; Prognosis; Rehabilitation","PeriodicalId":9843,"journal":{"name":"中华实用儿科临床杂志","volume":"35 1","pages":"419-421"},"PeriodicalIF":0.0,"publicationDate":"2020-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48221016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-08DOI: 10.3760/CMA.J.CN101070-20190322-00230
Bixian Yang, Rui Zhang, Liqiang Zhang, Jie Ma, J. Yao, Ying Wu, R. Wu
Objective To investigate the related factors of the serum sickness morbidity in the treatment of children with acquired aplastic anemia (AA) by rabbit antithymosinglobulin (ATG), summarize the clinical characte-ristics of serum sickness and evaluate the influence of serum sickness on the prognosis of AA. Methods The data of patients diagnosed as AA after treated with immunosuppressive therapy (IST) in Beijing Children′s Hospital, Capital Medical University, from March 2016 to December 2018 were collected, and the onset time, clinical manifestations, treatment, and prognosis of serum sickness were analyzed. Results A total of 48 cases were enrolled, with the median age of 5 years and 5 months (ranging from 2 years and 1 month to 15 years and 6 months), and the proportion of male to female was 1.4∶1.0, 75.0% of the patients(36/48 cases) developed serum sickness.The median onset time was the 11th day and 72.2% of the patients (26/48 cases) occurred from the 7th to the 14th day during IST.The 3 main clinical manifestations included arthralgia (63.9%, 23 cases), fever (52.7%, 19 cases) and rash (52.7%, 19 cases). There was no significant difference in peripheral blood leukocytes, neutrophils and lymphocytes between the patients with serum sickness and patients without serum sickness before IST and during serum sickness (all P>0.05). The incidence of serum sickness in children who received continuous glucocorticoid prophylaxis after IST (2/12 cases, 16.6%) was lower than that of those who did not (34/36 cases, 94.4%), and the difference was significant (χ2=29.037, P 0.05). Conclusion Children with AA are prone to develop serum sickness after IST treatment.The peak period of incidence of serum sickness is the second week during IST, and the main clinical manifestations of serum sickness include arthralgia, fever, and rash.There is no correlation between the incidence of serum sickness and the blood routine test before IST and during serum sickness.The incidence of serum sickness can be reduced by giving glucocorticoid prophylaxis, and glucocorticoid is still effective after the onset of the serum sickness.There is no correlation between the morbidity of serum sickness and the prognosis of AA treated with IST. Key words: Child; Aplastic anemia; Immunosuppressive therapy; Serum sickness
{"title":"A single-center study of serum sickness caused by rabbit antithymosinglobulin therapy in children with acquired aplastic anemia","authors":"Bixian Yang, Rui Zhang, Liqiang Zhang, Jie Ma, J. Yao, Ying Wu, R. Wu","doi":"10.3760/CMA.J.CN101070-20190322-00230","DOIUrl":"https://doi.org/10.3760/CMA.J.CN101070-20190322-00230","url":null,"abstract":"Objective \u0000To investigate the related factors of the serum sickness morbidity in the treatment of children with acquired aplastic anemia (AA) by rabbit antithymosinglobulin (ATG), summarize the clinical characte-ristics of serum sickness and evaluate the influence of serum sickness on the prognosis of AA. \u0000 \u0000 \u0000Methods \u0000The data of patients diagnosed as AA after treated with immunosuppressive therapy (IST) in Beijing Children′s Hospital, Capital Medical University, from March 2016 to December 2018 were collected, and the onset time, clinical manifestations, treatment, and prognosis of serum sickness were analyzed. \u0000 \u0000 \u0000Results \u0000A total of 48 cases were enrolled, with the median age of 5 years and 5 months (ranging from 2 years and 1 month to 15 years and 6 months), and the proportion of male to female was 1.4∶1.0, 75.0% of the patients(36/48 cases) developed serum sickness.The median onset time was the 11th day and 72.2% of the patients (26/48 cases) occurred from the 7th to the 14th day during IST.The 3 main clinical manifestations included arthralgia (63.9%, 23 cases), fever (52.7%, 19 cases) and rash (52.7%, 19 cases). There was no significant difference in peripheral blood leukocytes, neutrophils and lymphocytes between the patients with serum sickness and patients without serum sickness before IST and during serum sickness (all P>0.05). The incidence of serum sickness in children who received continuous glucocorticoid prophylaxis after IST (2/12 cases, 16.6%) was lower than that of those who did not (34/36 cases, 94.4%), and the difference was significant (χ2=29.037, P 0.05). \u0000 \u0000 \u0000Conclusion \u0000Children with AA are prone to develop serum sickness after IST treatment.The peak period of incidence of serum sickness is the second week during IST, and the main clinical manifestations of serum sickness include arthralgia, fever, and rash.There is no correlation between the incidence of serum sickness and the blood routine test before IST and during serum sickness.The incidence of serum sickness can be reduced by giving glucocorticoid prophylaxis, and glucocorticoid is still effective after the onset of the serum sickness.There is no correlation between the morbidity of serum sickness and the prognosis of AA treated with IST. \u0000 \u0000 \u0000Key words: \u0000Child; Aplastic anemia; Immunosuppressive therapy; Serum sickness","PeriodicalId":9843,"journal":{"name":"中华实用儿科临床杂志","volume":"35 1","pages":"436-439"},"PeriodicalIF":0.0,"publicationDate":"2020-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42841471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-08DOI: 10.3760/CMA.J.CN101070-20190130-00072
Xiao Xu, Zhixia Yue, Yan Su, Bin Li, Bei Li, Wen Zhao, Qian Zhao, M. Jin, Da-wei Zhang, Yi Liu, W. Guo, Xiao-li Ma
Objective To summarize and analyze the results of chromosome karyotype in children with neuroblastoma (NB) with bone marrow metastasis at first diagnosis, and to discuss the clinical significance. Methods G-banding was applied to the analysis of chromosome karyotype of patients who were regularly treated in the Hematological and Oncology Center in Beijing Children′s Hospital from January 2015 to December 2017, and all the patients were followed up until December 31, 2018.Their clinical features and prognosis were analyzed. Results (1) There were 120 cases with bone marrow metastasis, including 74 boys and 46 girls, and 98 cases (81.7%) were ≥ 18 months.Among 60 cases with normal chromosome, 56 cases (93.3%) were in International Neuroblastoma Staging System(INSS)-Ⅳ phase, and 4 cases in INSS-Ⅳs phase; there were 2 low-risk (LR) cases, 9 intermediate-risk (MR) cases, and 49 high-risk (HR) cases (81.7%); 7 cases had MYCN gene amplifications.All 60 patients with chromosome abnormalities were in INSS-Ⅳ phase; there was 1 case in MR and 59 cases (98.3%) in HR; 14 cases had MYCN gene amplifications.(2) Among 60 children (50%) with chromosome abnormalities, 4 children had number abnormalities, 14 children had structural abnormalities, and 42 children had both number and structural chromosome abnormalities.Chromosome 21, 10, 11 deletions were the most common in number abnormalities; structural abnormalities involving 11q, 1p, 3p segments had a high incidence.(3) Seventeen cases of children with normal chromosome had tumor progression or recurrence during the 4 to 44-month follow-up period, and 31 cases of children with chromosome abnormalities had tumor progression or recurrence during the 2 to 42-month follow-up period.The 3-year overall survival rate and event-free survival rate of all children were 60.0% and 48.4%, respectively; children in the normal chromosome group had a 3-year overall survival rate of 74.2% and an event-free survival rate of 65.7%; the 3-year overall survival rate and event-free survival rate of children with chromosome abnormalities were 47.5% and 24.9%, respectively.Most children suffering from tumor progression or recurrence had chromosome 10 deletion, and abnormal structure of 11q, 1p, 2p segments. Conclusion The chromosomal abnormality rate of Nb children's tumor cells is high, but the repetition rate is low, and the individual difference is obvious.The deletion of chromosome 10, abnormal regional structure of 11q, 1p and 2p segments may be poor prognostic factors for NB.Chromosome karyotype analysis of bone marrow samples is feasible, which can provide a basis for more accurate risk stratification and treatment. Key words: Neuroblastoma; Bone marrow metastasis; Chromosome karyotype
{"title":"Chromosome karyotype of bone marrow and its clinical significance in the first diagnosis of neuroblastoma with bone marrow metastasis","authors":"Xiao Xu, Zhixia Yue, Yan Su, Bin Li, Bei Li, Wen Zhao, Qian Zhao, M. Jin, Da-wei Zhang, Yi Liu, W. Guo, Xiao-li Ma","doi":"10.3760/CMA.J.CN101070-20190130-00072","DOIUrl":"https://doi.org/10.3760/CMA.J.CN101070-20190130-00072","url":null,"abstract":"Objective \u0000To summarize and analyze the results of chromosome karyotype in children with neuroblastoma (NB) with bone marrow metastasis at first diagnosis, and to discuss the clinical significance. \u0000 \u0000 \u0000Methods \u0000G-banding was applied to the analysis of chromosome karyotype of patients who were regularly treated in the Hematological and Oncology Center in Beijing Children′s Hospital from January 2015 to December 2017, and all the patients were followed up until December 31, 2018.Their clinical features and prognosis were analyzed. \u0000 \u0000 \u0000Results \u0000(1) There were 120 cases with bone marrow metastasis, including 74 boys and 46 girls, and 98 cases (81.7%) were ≥ 18 months.Among 60 cases with normal chromosome, 56 cases (93.3%) were in International Neuroblastoma Staging System(INSS)-Ⅳ phase, and 4 cases in INSS-Ⅳs phase; there were 2 low-risk (LR) cases, 9 intermediate-risk (MR) cases, and 49 high-risk (HR) cases (81.7%); 7 cases had MYCN gene amplifications.All 60 patients with chromosome abnormalities were in INSS-Ⅳ phase; there was 1 case in MR and 59 cases (98.3%) in HR; 14 cases had MYCN gene amplifications.(2) Among 60 children (50%) with chromosome abnormalities, 4 children had number abnormalities, 14 children had structural abnormalities, and 42 children had both number and structural chromosome abnormalities.Chromosome 21, 10, 11 deletions were the most common in number abnormalities; structural abnormalities involving 11q, 1p, 3p segments had a high incidence.(3) Seventeen cases of children with normal chromosome had tumor progression or recurrence during the 4 to 44-month follow-up period, and 31 cases of children with chromosome abnormalities had tumor progression or recurrence during the 2 to 42-month follow-up period.The 3-year overall survival rate and event-free survival rate of all children were 60.0% and 48.4%, respectively; children in the normal chromosome group had a 3-year overall survival rate of 74.2% and an event-free survival rate of 65.7%; the 3-year overall survival rate and event-free survival rate of children with chromosome abnormalities were 47.5% and 24.9%, respectively.Most children suffering from tumor progression or recurrence had chromosome 10 deletion, and abnormal structure of 11q, 1p, 2p segments. \u0000 \u0000 \u0000Conclusion \u0000The chromosomal abnormality rate of Nb children's tumor cells is high, but the repetition rate is low, and the individual difference is obvious.The deletion of chromosome 10, abnormal regional structure of 11q, 1p and 2p segments may be poor prognostic factors for NB.Chromosome karyotype analysis of bone marrow samples is feasible, which can provide a basis for more accurate risk stratification and treatment. \u0000 \u0000 \u0000Key words: \u0000Neuroblastoma; Bone marrow metastasis; Chromosome karyotype","PeriodicalId":9843,"journal":{"name":"中华实用儿科临床杂志","volume":"35 1","pages":"430-435"},"PeriodicalIF":0.0,"publicationDate":"2020-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41358237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-08DOI: 10.3760/CMA.J.CN101070-20191110-01116
Linnan Zhang, Yu-feng Liu, S. Su, Linlin Wei, Bai Li, Haiyan Rao, S. Mao
Objective To discuss whether platelet distribution width (PDW) can effectively predict the prognosis of neuroblastoma (NB). Methods The clinical data of 67 NB patients in the First Affiliated Hospital of Zhengzhou University between January 2014 and January 2018 were retrospectively analyzed.They were divided into low PDW group and high PDW group according to the PDW level, and the differences in clinical indicators between the 2 groups were compared.The prognostic effects of PDW were assessed by using the Kaplan-Meier method and Cox regression model. Results Among the 67 patients, 41 cases were male, 26 cases were female, with the ratio of male to female being 1.58∶1.00, and the average age was 44 months (2-156 months). Five cases were in stage Ⅰ, 1 case in stage Ⅱ, 15 cases in stage Ⅲ and 46 cases in stage Ⅳ.At the first time of diagnosis, there were 14 cases with age ≤ 18 months, 53 cases with age > 18 months, 47 cases with neuron specific enolase (NSE) level ≥ 100 μg/L, 20 cases with NSE level 0.05). The proportion of high-risk patients, the level of NSE, bone marrow metastasis rate, MYCN gene amplification rate and the red blood cell distribution width in the high PDW group were significantly higher than those in the low PDW group, but the high PDW group had a lower level of thrombocytocrit than the low PDW group, and the differences were statistically significant(all P<0.05). Survival analysis revealed that the 2-year overall survival of the low PDW group was significantly higher than that of the high PDW group (69.8% vs.25.3%, χ2=15.761, P<0.05). Univariate analysis showed that NSE (HR=6.606, 95%CI: 2.018-21.620), MYCN gene (HR=1.977, 95%CI: 0.794-4.919), tumor risk stratification (HR=5.926, 95%CI: 1.416-24.794), PDW (HR=4.036, 95%CI: 1.957-8.322), and red blood cell distribution width (HR=1.120, 95%CI: 1.005-1.249) were the adverse factors affecting the overall survival, and thrombocytocrit was a protective factor for the prognosis of NB.Multivariate analysis indicated that PDW was an independent risk factor of NB (HR=2.524, 95%CI: 1.017-6.264, P=0.046). Conclusions There is a good consistency between the increase of PDW and the known prognostic risk factors, elevated tumor markers and bone marrow metastasis.Increased PDW is associated with poor prognosis in NB patients, and PDW is an independent risk factor for the poor prognosis of NB. Key words: Neuroblastoma; Platelet distribution width; Prognosis; Overall survival
{"title":"Predictive value of platelet distribution width on prognosis of neuroblastoma","authors":"Linnan Zhang, Yu-feng Liu, S. Su, Linlin Wei, Bai Li, Haiyan Rao, S. Mao","doi":"10.3760/CMA.J.CN101070-20191110-01116","DOIUrl":"https://doi.org/10.3760/CMA.J.CN101070-20191110-01116","url":null,"abstract":"Objective \u0000To discuss whether platelet distribution width (PDW) can effectively predict the prognosis of neuroblastoma (NB). \u0000 \u0000 \u0000Methods \u0000The clinical data of 67 NB patients in the First Affiliated Hospital of Zhengzhou University between January 2014 and January 2018 were retrospectively analyzed.They were divided into low PDW group and high PDW group according to the PDW level, and the differences in clinical indicators between the 2 groups were compared.The prognostic effects of PDW were assessed by using the Kaplan-Meier method and Cox regression model. \u0000 \u0000 \u0000Results \u0000Among the 67 patients, 41 cases were male, 26 cases were female, with the ratio of male to female being 1.58∶1.00, and the average age was 44 months (2-156 months). Five cases were in stage Ⅰ, 1 case in stage Ⅱ, 15 cases in stage Ⅲ and 46 cases in stage Ⅳ.At the first time of diagnosis, there were 14 cases with age ≤ 18 months, 53 cases with age > 18 months, 47 cases with neuron specific enolase (NSE) level ≥ 100 μg/L, 20 cases with NSE level 0.05). The proportion of high-risk patients, the level of NSE, bone marrow metastasis rate, MYCN gene amplification rate and the red blood cell distribution width in the high PDW group were significantly higher than those in the low PDW group, but the high PDW group had a lower level of thrombocytocrit than the low PDW group, and the differences were statistically significant(all P<0.05). Survival analysis revealed that the 2-year overall survival of the low PDW group was significantly higher than that of the high PDW group (69.8% vs.25.3%, χ2=15.761, P<0.05). Univariate analysis showed that NSE (HR=6.606, 95%CI: 2.018-21.620), MYCN gene (HR=1.977, 95%CI: 0.794-4.919), tumor risk stratification (HR=5.926, 95%CI: 1.416-24.794), PDW (HR=4.036, 95%CI: 1.957-8.322), and red blood cell distribution width (HR=1.120, 95%CI: 1.005-1.249) were the adverse factors affecting the overall survival, and thrombocytocrit was a protective factor for the prognosis of NB.Multivariate analysis indicated that PDW was an independent risk factor of NB (HR=2.524, 95%CI: 1.017-6.264, P=0.046). \u0000 \u0000 \u0000Conclusions \u0000There is a good consistency between the increase of PDW and the known prognostic risk factors, elevated tumor markers and bone marrow metastasis.Increased PDW is associated with poor prognosis in NB patients, and PDW is an independent risk factor for the poor prognosis of NB. \u0000 \u0000 \u0000Key words: \u0000Neuroblastoma; Platelet distribution width; Prognosis; Overall survival","PeriodicalId":9843,"journal":{"name":"中华实用儿科临床杂志","volume":"35 1","pages":"440-444"},"PeriodicalIF":0.0,"publicationDate":"2020-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49465176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-08DOI: 10.3760/CMA.J.CN101070-20191108-01113
T. Jiang, Wen-xian Ou-yang, Y. Tan, Lian Tang, Hui Zhang, Z. Kang, Xi Zheng, Shuangjie Li
Objective To investigate the etiology, prognosis and prognostic factors of pediatric acute liver failure(PALF), in order to provide the basis for clinical treatment of PALF. Methods The clinical data of children with PALF hospitalized at Hunan Children′s Hospital from May 2008 to May 2018 were collected, and the causes and prognosis were analyzed.According to the prognosis, the patients were divided into the death group and the survival group, whose biochemical indexes were then compared.After that, the statistical analysis of different data were carried out by using t-test, Wilcoxon test and χ2 test separately. Results In 120 PALF cases, there were 68 males and 52 females, and there were 36 infants, 34 toddlers, 22 preschoolers and 28 school-age children.Twenty cases (16.7%) were caused by sepsis, 19 cases (15.8%) by genetic metabolic diseases, 18 cases (15.0%) by poisoning, 12 cases (10.0%) by viral infection, 6 cases (5.0%) by drugs, 1 case (0.8%) by bile polyp, and 1 case (0.8%) by tumor disease.Besides, the etiology of 43 cases (35.9%) was unknown.Among the cases with known etiologies, genetic metabolic and infectious diseases were the main cause of disease in infants, toddler patients were mostly caused by infectious diseases and drug/toxicants, and drug/toxicants and hereditary metabolic diseases were the dominant cause of disease in school-age children and preschoolers.Mortality rate of children with PALF was 50.0%.Among them, the mortality of Epstein-Barr virus-associated hemophagocytic syndrome, sepsis, Citrin deficiency and Tyrosinemia was higher than that of other diseases.Compared with the survival group, the total bilirubin (TB)[159.00(73.05, 274.00) μmol/L vs.62.75(2.65, 221.75)μmol/L], direct bilirubin(DB)[83.00(41.43, 160.00) μmol/L vs.38.74(10.98, 128.75) μmol/L], prothrombin time (PT)[39.60(24.93, 62.60) s vs.24.65(21.43, 29.83) s], international standardized ratio (INR)[3.40(2.30, 6.74) vs.2.09(1.85, 2.84)], and blood ammonia (NH3) levels [109.50(85.25, 149.75) μmol/L vs.80.00(60.25, 102.75) μmol/L] in the death group were significantly increased, and the diffe-rences were statistically significant(all P<0.05); while the levels of albumin[(28.72±5.88) g/L vs.(33.69±4.96) g/L], alanine aminotransferase (ALT) [586.50(223.25, 1 082.00) U/L vs.1 434.00(615.00, 3 334.50) U/L]and aspartate aminotransferase (AST) [827.50(545.00, 2 024.00) U/L vs.1 663.50(821.00, 4 886.75) U/L]in the death group were significantly decreased, and the differences were statistically significant(all P<0.05). However, the blood glucose and cholesterol levels in both groups had no statistically significant difference. Conclusion The mortality of children with PALF is high, and different age groups have different etiologies.The increase of TB, DB, PT, INR, NH3 and the ratio of hepatic encephalopathy, and the decrease of albumin, AST and ALT suggest poor prognosis. Key words: Child; Acute liver failure; Etiology; Prognosis
{"title":"Analysis of etiology and prognosis of 120 children with pediatric acute liver failure","authors":"T. Jiang, Wen-xian Ou-yang, Y. Tan, Lian Tang, Hui Zhang, Z. Kang, Xi Zheng, Shuangjie Li","doi":"10.3760/CMA.J.CN101070-20191108-01113","DOIUrl":"https://doi.org/10.3760/CMA.J.CN101070-20191108-01113","url":null,"abstract":"Objective \u0000To investigate the etiology, prognosis and prognostic factors of pediatric acute liver failure(PALF), in order to provide the basis for clinical treatment of PALF. \u0000 \u0000 \u0000Methods \u0000The clinical data of children with PALF hospitalized at Hunan Children′s Hospital from May 2008 to May 2018 were collected, and the causes and prognosis were analyzed.According to the prognosis, the patients were divided into the death group and the survival group, whose biochemical indexes were then compared.After that, the statistical analysis of different data were carried out by using t-test, Wilcoxon test and χ2 test separately. \u0000 \u0000 \u0000Results \u0000In 120 PALF cases, there were 68 males and 52 females, and there were 36 infants, 34 toddlers, 22 preschoolers and 28 school-age children.Twenty cases (16.7%) were caused by sepsis, 19 cases (15.8%) by genetic metabolic diseases, 18 cases (15.0%) by poisoning, 12 cases (10.0%) by viral infection, 6 cases (5.0%) by drugs, 1 case (0.8%) by bile polyp, and 1 case (0.8%) by tumor disease.Besides, the etiology of 43 cases (35.9%) was unknown.Among the cases with known etiologies, genetic metabolic and infectious diseases were the main cause of disease in infants, toddler patients were mostly caused by infectious diseases and drug/toxicants, and drug/toxicants and hereditary metabolic diseases were the dominant cause of disease in school-age children and preschoolers.Mortality rate of children with PALF was 50.0%.Among them, the mortality of Epstein-Barr virus-associated hemophagocytic syndrome, sepsis, Citrin deficiency and Tyrosinemia was higher than that of other diseases.Compared with the survival group, the total bilirubin (TB)[159.00(73.05, 274.00) μmol/L vs.62.75(2.65, 221.75)μmol/L], direct bilirubin(DB)[83.00(41.43, 160.00) μmol/L vs.38.74(10.98, 128.75) μmol/L], prothrombin time (PT)[39.60(24.93, 62.60) s vs.24.65(21.43, 29.83) s], international standardized ratio (INR)[3.40(2.30, 6.74) vs.2.09(1.85, 2.84)], and blood ammonia (NH3) levels [109.50(85.25, 149.75) μmol/L vs.80.00(60.25, 102.75) μmol/L] in the death group were significantly increased, and the diffe-rences were statistically significant(all P<0.05); while the levels of albumin[(28.72±5.88) g/L vs.(33.69±4.96) g/L], alanine aminotransferase (ALT) [586.50(223.25, 1 082.00) U/L vs.1 434.00(615.00, 3 334.50) U/L]and aspartate aminotransferase (AST) [827.50(545.00, 2 024.00) U/L vs.1 663.50(821.00, 4 886.75) U/L]in the death group were significantly decreased, and the differences were statistically significant(all P<0.05). However, the blood glucose and cholesterol levels in both groups had no statistically significant difference. \u0000 \u0000 \u0000Conclusion \u0000The mortality of children with PALF is high, and different age groups have different etiologies.The increase of TB, DB, PT, INR, NH3 and the ratio of hepatic encephalopathy, and the decrease of albumin, AST and ALT suggest poor prognosis. \u0000 \u0000 \u0000Key words: \u0000Child; Acute liver failure; Etiology; Prognosis","PeriodicalId":9843,"journal":{"name":"中华实用儿科临床杂志","volume":"35 1","pages":"422-425"},"PeriodicalIF":0.0,"publicationDate":"2020-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48748338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-08DOI: 10.3760/CMA.J.CN101070-20190219-00113
Y. Xiong, C. Zhu, Li Zhao, Qing-xiong Zhu
Escherichia coli is a common intestinal colonization bacterium in human body.It causes infectious diarrhea if it turns into a pathogenic bacterium under certain conditions.In a few cases, it can cause extraintestinal infections, such as bacterial meningitis, lower respiratory tract infection, biliary tract infection, and urinary tract infection, etc.With the increasing of antibiotic abuse, the pathogenesis of Escherichia coli in different infectious diseases has its own characteristics.The hazards, pathogenesis and treatment progress of different infectious diseases were reviewed in this paper. Key words: Escherichia coli; Infectious diarrhea; Bacterial meningitis; Urinary tract infection; Lower respiratory tract infection; Biliary tract infection
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