血清NSE在金双歧、茵栀黄及蓝光照射治疗 高胆红素血症新生儿脑损伤前后的临床意义

目的分析血清神经元特异性烯醇化酶(NSE)含量在金双歧、茵栀黄及蓝光照射治疗前后高胆红素血症新生儿脑损伤的关系。方法对130例高胆红素血症新生儿在治疗前及治疗后分别采用酶联免疫法测定血清NSE,同时行新生儿神经行为测定(NBNA)评分及急性胆红素脑病(ABE)的胆红素致神经功能障碍(BIND)评分,按血清总胆红素(TBIL)严重程度分为试验组和对照组,试验组包括:轻度升高组(A组):205.2μmol/LTBIL≤256.5μmol/L;中度升高组(B组):256.5μmol/LTBIL≤342.0μmol/L;重度升高组(C组):TBIL342.0μmol/L。对照组:金双歧、茵栀黄及蓝光照射治疗后的患儿TBIL91.9～171.0μmol/L。比较各组高胆红素血症新生儿治疗前后血清NSE、NBNA评分及BIND评分,并对血清NSE与NBNA评分及BIND评分进行相关性分析。结果各组高胆红素血症新生儿血清NSE、NBNA评分及BIND评分治疗前后差异均具有统计学意义(Ps0.05)。血清NSE与NBNA评分呈负相关(r=-0.869,P0.01);血清NSE与BIND评分呈正相关(r=0.577,P0.01)。结论血清NSE水平变化可作为高胆红素血症新生儿脑损伤的检测指标。     

正常顺产儿与早产儿人巨细胞病毒和风疹病毒脐带血清抗体检测分析

通过间接酶联免疫法检测178份新生儿(正常顺产儿为114例,早产儿64例)脐带血血清中人巨细胞病毒(human cytomegalovirus,HCMV)和风疹病毒(rubella virus,RV)IgG和IgM抗体,并分析所测结果与临床表现的相关性。结果表明,178例新生儿脐带血血清中HCMV-IgG阳性标本为168例(94.38%),HCMV-IgM阳性标本为1例(0.56%);RV-IgG阳性标本为119例(66.85%);RV-IgM阳性标本为1例(0.56%)。其中,正常顺产儿脐带血中HCMV-IgM和RV-IgM阳性率均为0.87%(1/114),HCMV-IgG阳性率为94.73%(108/114),RV-IgG阳性率为61.40%(70/114),HCMV和RV IgG两者均阳性者为55.26%(63/114);早产儿HCMV-IgM和RV-IgM均为阴性(0/64),HCMV-IgG阳性率为93.75%(60/64),RV-IgG阳性率为76.56%(49/64),HCMV和RV IgG两者均阳性者为70.31%(45/64)。早产儿与正常顺产儿比较,早产儿的RV-IgG阳性率和HCMV和RV-IgG两者均阳性者均高于正常顺产儿,且差异有统计学意义(P<0.05)。可见,HCMV感染率较高,至今仍无有效的HCMV疫苗,应加大疫苗研发力度。所查新生儿RV-IgG阳性率为66.48%,提示中国33%以上的育龄期妇女有在孕早期暴露感染的机率,国家有必要加大该种疫苗的接种力度。     

双管同步换血治疗新生儿高胆红素血症的临床分析

目的:探讨外周动静脉双管同步换血术治疗新生儿高胆红素血症临床疗效。方法:回顾性分析了采用外周动静脉双管同步换血术治疗的32例高胆红素血症患儿,比较换血前后血清胆红素的变化。结果:32例患者换血前后总胆红素有明显变化,显著下降(P<0.01)。不过在治疗后出现术后感染2例,经对症处理后痊愈。结论:新生儿外周动静脉双管同步换血术治疗新生儿高胆红素血症简单、实用、安全,值得进一步推广应用。     

中药大黄敷脐治疗新生儿高胆红素血症的临床观察

目的观察中药大黄敷脐治疗新生儿高胆红素血症的临床疗效。方法将100例高胆红素血症新生儿随机分为观察组和对照组,对照组50例采取常规治疗,观察组50例在常规治疗基础上加用中药大黄敷脐。结果两组患儿治疗前胆红素值比较无统计学意义(P0.05);治疗后两组患儿每天胆红素下降值、降至正常范围所需时间比较,差异有统计学意义(P0.05)。结论在常规治疗基础上加用中药大黄敷脐治疗新生儿高胆红素血症可迅速降低血清胆红素水平,疗效显著,是一种可靠的治疗方法。     

微生态制剂对新生儿高胆红素血症的预防作用

目的 :探讨微生态制剂预防新生儿高胆红素血症的效果。方法 :74例正常足月新生儿随机分为干预组 39例和对照组 35例 ,出生后 12 h内干预组在常规预防的同时 ,加服微生态制剂金双歧。结果 :新生儿高胆红素血症干预组的发生率为 33.33% ,对照组的发生率为 5 7.14 % ,干预组的发生率较对照组低 (P<0 .0 5 )。结论 :微生态制剂金双歧预防新生儿高胆红素血症有一定效果。     

金双歧治疗新生儿高胆红素血症237例临床分析

目的探讨微生态制剂金双歧（双歧杆菌乳酸杆菌三联活菌片）对新生儿高胆红素血症的临床疗效。方法对成都军区总医院2009年9月至2013年9月237例新生儿高胆红素血症患儿的临床资料并进行回顾性分析。将237例新生儿高胆红素血症患儿随机分为对照组和治疗组,治疗组在常规治疗基础上,加用金双歧。检测治疗前后两组日平均经皮胆红素下降值及黄疸消退时间。结果治疗组与对照组治疗前血清总胆红素比较差异无统计学意义;治疗第5天治疗组血清总胆红素较对照组低,两组比较差异有统计学意义;治疗组在治疗第5天血清总胆红素下降至145μmol/L时间较对照组低,差异有统计学意义。结论应用金双歧治疗新生儿高胆红素血症可迅速降低血胆红素水平,缩短治疗时间,行之有效,值得临床治疗新生儿高胆红素辅助用药。     

新生儿换血中常见护理问题及对策

新生儿高胆红素血症是指新生儿的胆红素代谢及排泄的正常途径改变,使血清内胆红素值超正常范围。临床主要是指以未结合胆红素升高为主的病理性黄疸,重者可引起胆红素脑病而致中枢神经损害。换血是治疗高胆红素血症最迅速的方法。近年来,由于换血法指征的放宽,在新生儿尤其是早产儿临床中应用更为广泛。不仅用于血型不合的溶血病,还用于重症感染,新生儿弥漫性血管内凝血及药物中毒等。     

金双歧治疗新生儿高胆红素血症的临床疗效研究

目的 探讨微生态制剂金双歧(双歧杆菌乳酸杆菌三联活菌片)对新生儿高胆红素血症的临床疗效,以找出能及早有效地纠正新生儿高胆红素血症,预防新生儿胆红素脑病发生的新方法.方法 通过随机抽样、收集青白江区人民医院2007年3月至2011年3月72例新生儿高胆红素血症患儿的临床资料并进行回顾性分析,将72例新生儿高胆红素血症患儿随机分为治疗组40例和对照组32例.对照组给予常规治疗,治疗组在常规治疗基础上,加用金双歧1片(0.5亿)/次,每天3次,温开水溶碎后喂服或经胃管注入,共7～10d.检测治疗前后两组血清胆红素水平、计算日平均经皮测胆红素下降值、平均住院时间和黄疸消退时间.结果 金双歧辅助治疗新生儿高胆红素血症,治疗后治疗组与对照组血清总胆红素水平分别为(58.21 +4.36) μmol/L和(64.16±5.29) μmol/L(P ＜0.01);治疗组和对照组日平均经皮测胆红素下降值、平均住院时间和黄疸退尽平均时间分别为( 10.35±2.46)、(7.68±1.35)μmol/L;( 6/54±2/59)、(9/05 +3/12)d; (6/38±1/38)、( 8/75±2/68)d;差异均有统计学意义(P＜0.01).结论 应用金双歧治疗新生儿高胆红素血症可迅速降低血胆红素水平,缩短治疗时间,预防胆红素脑病的发生疗效确切、安全,可作为治疗新生儿高胆红素血症的方法之一,值得临床应用推广.     

利用ELISA与荧光定量PCR技术筛查新生儿巨细胞病毒感染水平及探讨与肝脏损害的相关性

目的:了解目前淄博地区新生儿感染巨细胞病毒(HCMV)的现状,找出最佳检测方法,提高诊断水平,并探讨巨细胞病毒对肝功能的损害.方法:采用抗体捕获酶联免疫吸附试验(ELISA)及荧光定量PCR(qPCR)对2011年12月至2012年5月出生的2596例新生几分别进行血清HCMV-IgM抗体和尿液HCMV-DNA定量检测,并对符合HCMV感染的阳性标本进行肝功能回顾性分析.结果:用ELISA检测血清CMV-IgM阳性29例(1.117％),用qPCR检测尿液HCMV-DNA阳性39例(1.502％),两种方法阳性符合率71.79％,差异有统计学意义(P＜0.01);共有40例阳性患儿回顾性分析肝功能指标血清总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)均高于正常值,差异均有统计学意义(P＜0.05).结论:淄博地区新生儿巨细胞病毒感染率较高,危害性大,对新生儿早期检测和诊断十分重要,定量荧光PCR法检测敏感性要高于ELISA法检测,具有良好的应用价值;检测出的HCMV感染患儿肝脏易受病毒侵害,造成肝功能损害.     

不同病情高胆红素血症新生儿血清AST、IGF-1、NSE、CysC水平的表达及临床意义

摘要 目的：研究不同病情高胆红素血症新生儿血清谷草转氨酶（AST）、胰岛素样生长因子-1（IGF-1）、神经元特异性烯纯化酶（NSE）、胱抑素C（CysC）水平的表达及临床意义。方法：将我院从2017年1月～2018年12月收治的高胆红素血症新生儿316例作为研究组。按其病情分成轻度组152例、中度组105例以及重度组59例,另取同期健康新生儿100例作为对照组。比较四组新生儿血清AST、IGF-1、NSE、CysC、总胆红素（TSB）水平,分析上述各项指标的关系。此外,比较对照组与研究组的基线资料,分析新生儿高胆红素血症发病的影响因素。结果：轻度组、中度组、重度组血清AST、IGF-1、NSE、CysC、TSB水平均高于对照组,且中度组、重度组上述指标高于轻度组,重度组上述指标高于中度组（P＜0.05）。经Pearson相关性分析可得：高胆红素血症新生儿TSB水平与血清AST、IGF-1、NSE、CysC水平均呈正相关（P＜0.05）。研究组和对照组在母婴血型不合、产前使用催产素、围生期疾病以及TSB、AST、IGF-1、NSE、CysC方面对比差异均有统计学意义（P＜0.05）。经多因素Logistic回归分析可得：新生儿高胆红素血症发病的影响因素为产前使用催产素、围生期疾病以及TSB、AST、IGF-1、NSE、CysC（P＜0.05）。结论：随着高胆红素血症新生儿病情的加剧,血清AST、IGF-1、NSE、CysC水平均逐渐升高且均与血清TSB水平呈正相关,临床工作中可能通过联合检测上述血清学指标辅助评估高胆红素血症新生儿病情,且以上指标水平的升高会增加新生儿高胆红素血症的发病风险。     

检测脊髓灰质炎IgM抗体捕捉法ELISA的建立及其在早期快速诊断中的应用

首次建立了用于脊髓灰质炎快速、分型诊断的血清IgM抗体捕捉法ELISA。检测了52例疑似病人,IgM阳性率为76.9％(40/52),而粪便病毒分离率仅为44.2％(23/52),前者的阳性检出率明显高于后者。做病毒分型诊断结果,与分离病毒中和试验定型的总符合率为92.86％(39/42)。检测601例来自全国各省的脊灰疑似病人血清,其阳性率波动于13％～92.3％,平均为61.1％。阳性率与收集血清的病日相关,发病0～3天收集者,阳性检出率为69.5％,4～25天者为64％,26～54天者为52％,55天以上者则未能检出。本检测方法需时1.5天,简便、敏感、特异,重复性良好,适用于脊灰的早期快速诊断。对其实用性进行了讨论。     

Comparative information value of humoral immunity characteristics in some bacterial and viral infections

Serological examination of 144 patients with different bacterial and viral infections was carried out. Antibodies to Brucella were detected in blood serum in 42 patients (85.7%) with the average titer of 1:996 and in saliva in 41 patients (83.7%) with the average titer of 1:567 by passive hemagglutination test with brucella erythrocyte diagnosticum. Out of 26 dysentery patients, antibodies in blood serum were detected in the diagnostic titer in 17 patients (65.4%) with the average titer of 1:282 and in saliva in 21 patients (80.8%) in the titer of 1:100 and higher. Anti-HAV and anti-HBc IgM were detected in specimens of saliva from patients with serologically confirmed viral hepatitis A and B in 100% of cases. The presence of HBsAg in saliva from hepatitis B patients was established in 95.4% of cases. In blood serum and in specimens of saliva anti-HCV IgM were detected in 100% and 85.7% of cases respectively. Out of 25 women with aggravated obstetric history, IgG antibodies to CMV were detected in blood serum in 23 women (88.5%) and in saliva in 22 women (84.6%). The results of these investigations revealed that the detection rate of antibodies in blood serum and saliva in cases of infections, both bacterial (brucellosis, shigellosis) and viral (hepatitis A, B, C and CMV infection), was not essentially different. The simplicity of obtaining material for analysis make it possible to recommend the use of saliva for diagnosing bacterial and viral infections, especially in mass epidemiological surveys.     

婴儿巨细胞病毒感染31例临床及治疗观察

目的：探讨婴儿巨细胞病毒(CMV)感染的临床特点及治疗。方法：对经酶免疫斑点技术确诊的31例小儿CMV感染,总结其临床特点并选用丙氧鸟苷治疗。结果：高胆红素血症占58．06％,支气管肺炎占25．80％,中枢神经系统损害占16．13％。31例均给丙氧鸟苷治疗,疗程3～8w,结果25例痊愈,5例好转,1例死亡。结论：婴儿巨细胞病毒感染以高胆红素血症、支气管肺炎及中枢神经系统损害为主;丙氧鸟苷是治疗小儿CMV感染的首选药物。     

Cytokine response and polymerase chain reaction study of peripheral blood mononuclear cells in infants with human cytomegalovirus infection

Abstract We tried to detect human cytomegalovirus (HCMV) DNA in CD4 + and CD8 + T lymphocytes from fourteen infants with HCMV hepatitis using polymerase chain reaction (PCR) assay. HCMV was isolated from their urine and anti-HCMV IgM antibody was detected in their sera. One set of primers were designed from a region — a major immediate early (IE) gene. We detected HCMV IE DNA in the specimens obtained from six infants. HCMV IE DNA was detected from CD4 + cells in two cases and from CD8 + cells in one. In three cases, HCMV IE DNA was detected from both CD4 + and CD8 + cells. We also studied the relationship between HCMV infection and serum levels of cytokines. We determined serum levels of interleukin-4 (IL-4), tumor necrosis factor alpha (TNF-α) and soluble interleukin 2 receptor (sIL-2R) which were associated with the activation of T lymphocytes by enzyme immunoassay. In the acute phase of HCMV infection, titers of sIL-2R were correlated with serum levels of liver enzymes in some cases. IL-4 and TNF-α activities were not detected in sera. It is likely that expression of viral genome on T lymphocytes as well as activities of some cytokines are associated with active HCMV infection.     

Immunodiagnosis of Dengue Virus Infection Using Saliva

Keeping in view the complications and the case fatality associated with dengue virus, several serologic tests have been developed. However, the major drawback of these serologic tests is the need for a venous blood sample obtained by invasive venipuncture. As a noninvasive alternative, saliva provides a body fluid that contains antibodies of diagnostic importance. Hence, the detection of DEN-specific IgM and IgG antibodies in serum and saliva from 80 patients was compared. Salivary IgM antibodies were detected in 100% of the serum IgM-positive samples and in 30% of the serum samples that were negative for IgM antibodies. Salivary IgG antibodies were detected in 93.3% of the serum samples that were positive for anti-dengue IgG antibodies and in none of the serum IgG-negative cases. None of the specimens from the healthy controls showed the presence of IgM or IgG antibodies. The detection of both IgG and IgM antibodies in saliva correlated well with the serum IgG and IgM detection by the ELISA test (r = 0.6322 and r = 0.4227). Detection of salivary IgM antibodies by ELISA showed 100% sensitivity, 70% specificity, 90.9% positive predictive value, and 100% negative predictive value. The detection of IgG in saliva proved to be a promising tool as the sensitivity, specificity, positive predictive value, and negative predictive value were found out to be 93.3%, 100%, 100%, and 83.3%, respectively. Thus, from this study we conclude that the detection of DEN-specific salivary IgG and IgM antibodies are useful markers for dengue infection.     

Performance of the immunoglobulin G avidity and enzyme immunoassay IgG/IgM screening tests for differentiation of the clinical spectrum of toxoplasmosis

Toxoplasmosis has been well known as an important human infection to consider especially in pregnant women. Although many serologic methods are available, the diagnosis of toxoplasmosis can be extremely difficult. The presence of increased levels of Toxoplasma-specific IgG antibodies indicates an infection, but it does not differentiate between a recent and past infection. The purpose of our study was to compare the performance of the ELISA T. gondii IgG/IgM test, a widely used enzyme-linked immunosorbent assay, to the ELISA IgG avidity method. One hundred and four serum samples (from 38 males and 66 females) were tested and evaluated from symptomatic patients (chorioretinitis, lymphadenopathy), and from women in their first trimester of pregnancy who were suspected of having toxoplasmosis. The high IgG avidity and ELISA IgG antibody levels were in agreement for 51 of the specimens (49.0%). Thirty-eight discrepant (borderline) results from the IgG avidity method were positive for IgM (3 specimens) and IgG (37 specimens). Interestingly, out of the eight serum samples that were positive for both IgG and IgM antibodies, two samples were low IgG avidity, and three samples were borderline. There was no statistically significant relation observed between the results of the IgG avidity method and the ELISA IgG test, and the IgG avidity method and ELISA IgM test (chi2 = 1.987; p = 0.370 and chi2 = 2.152; p = 0.341, respectively). The IgG avidity method was considered easy to perform and an acceptable approach for the differentiation of discrepant results (recent/chronic) and for the current detection of T. gondii antibodies. We concluded that the determination of IgG avidity is a helpful tool for the diagnosis of the ocular form of toxoplasmosis and it is a safe method for screening this disease in the first trimester of pregnancy.     

早期应用微生态制剂对极低出生体重儿影响的临床观察

目的观察早期应用微生态制剂对极低出生体重儿黄疸、喂养、生长以及免疫功能的影响。方法我院NICU收治的生后24h内极低出生体重儿84例,随机分为观察组46例,对照组38例。观察组生后4h内开始口服或鼻饲胃管服用妈咪爱0.5g,2次/d,连用14d。观察两组达到高胆红素血症标准的人数,以及生后24h、5d总胆红素值;喂养不耐受人数;生后5d生理性体重下降及1个月体重增长情况;生后1个月免疫学指标。并加以对比。结果24h内血清胆红素比较无统计学意义(P0.05),治疗5d后观察组血清总胆红素明显低于对照组(P0.05),观察组出现高胆红素血症人数明显低于对照组(P0.05);观察组喂养不耐受出现例数明显低于对照组(P0.01);观察组生后5d体重下降的克数低于对照组(P0.05),1个月时体重增长克数高于对照组(P0.01);观察组IgA水平较对照组明显增加(P0.05),但IgG及IgM含量与对照组比较差异无统计学意义(P0.05)。结论早期应用微生态制剂能降低血清胆红素水平,对预防极低出生体重儿高胆红素血症有一定作用;能提高喂养的耐受性,有利于患儿生长发育;对极低出生体重儿的肠道功能及免疫功能有明显影响,能增加免疫球蛋白IgA水平,从而促进体液免疫的发展。     

反复呼吸道感染患儿血清微量元素及体液免疫水平测定及临床意义

目的:探讨反复呼吸道感染患儿血清微量元素及体液免疫水平测定及其临床意义。方法:选取2016年1月至2017年1月在我院接受治疗的反复呼吸道感染患儿64例作为观察组,另外选取同期来我院体检的健康儿童60例作为对照组,比较两组儿童血清微量元素钙(Ca)、铁(Fe)、铜(Cu)、锌(Zn)、镁(Mg)等的水平、体液免疫因子免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)水平及血清补体C3、C4、C5水平,并分析其相关性。结果:观察组患儿血清Ca、Fe、Zn水平显著低于对照组儿童(P0.05),两组儿童血清Cu、Mg水平比较差异无统计学意义(P0.05)。观察组患儿血清IgA、IgM、IgG水平低于对照组儿童(P0.05)。两组儿童血清补体C3、C4、C5水平比较差异无统计学意义(P0.05)。经Pearson相关性分析可得:反复呼吸道感染患儿血清Ca、Fe、Zn与血清IgA、IgM、IgG水平呈正相关(P0.05)。结论:反复呼吸道感染患儿存在血清Ca、Fe、Zn微量元素缺乏及血清IgA、IgM、IgG水平降低现象,且它们之间具有正相关关系,可能共同促进反复呼吸道感染的发生。     

The determination in saliva of IgA antibodies to Shigella ribosomes for the diagnosis of dysentery

The levels of antiribosomal antibodies to Shigella ribosomes in serum and saliva samples from 38 dysentery patients (15 S. sonnei cases and 23 S. flexneri cases), 14 patients with salmonellosis and 136 healthy adults were determined in ELISA with ribosomes from S. sonnei R-mutant used as solid-phase antigen. High levels of "normal" antiribosomal IgA, IgG and IgM antibodies were revealed in the sera of healthy persons while the level of salivary IgA antibodies was very low. In dysentery infection no increase in the levels of serum IgG and IgM antibodies and only a slight increase in the level of IgA antibodies were revealed. Local immune response was manifested by the early (on days 2-4 from the onset of infection) and significant augmentation (12- to 16-fold) of salivary antiribosomal IgA antibodies. An increase in the level of these antibodies was registered in 95-100% of dysentery patients but not in patients with salmonellosis, which made it possible to recommend the method for diagnosing shigellosis. Immune response to Shigella ribosomal antigens, in contrast to the response induced by Shigella O-antigen, is almost exclusively local.