过敏性紫癜性肾炎患儿脂质过氧化及抗氧化水平的动态观察

目的　探讨过敏性紫癜性肾炎 (APN)与脂质过氧化及抗氧化的关系。方法　采用化学分析法检测 18例APN患儿的相关指标。结果　APN急性期患儿血清脂质过氧化物 (LPO)增高 ;全血超氧化物歧化酶 (SOD)、谷胱甘肽过氧化物酶 (GSH - px)、谷胱甘肽 (GSH)降低 (P均 <0 0 1) ;恢复期时 ,LPO和SOD仍与对照组有显著差异 (P均 <0 0 5 ) ,而GSH -px、GSH与对照组无显著差异 (P均 >0 0 5 ) ;相关分析显示 :LPO与SOD无显著相关 (r =0 2 4,P >0 0 5 ) ,LPO与GSH - px、GSH、C3 呈显著负相关 (r =- 0 83,P <0 0 1;r =- 0 72 ,P <0 0 1;r=- 0 5 7,P <0 0 5 )。结论　APN患儿脂质过氧化增强 ,抗氧化机能下降。LPO、SOD、GSH -px、GSH等 4项指标可用以判断病情变化 ,且以GSH - px为最灵敏     

急性肾小球肾炎患儿单核细胞趋化蛋白-1的表达及意义

目的 观察急性肾小球肾炎患儿血清及尿液中单核细胞趋化蛋白-1(MCP.1)水平变化并探讨其临床意义.方法 采用ELISA法测定38例急性肾小球肾炎患儿及30例健康对照儿童的血清及尿液MCP-1水平,按常规方法测定尿肌酐(Ucr)、血肌酐(Scr)、尿蛋白、24 h尿蛋白定量、补体C3,生化方法检测血清超氧化物歧化酶(SOD)和脂质过氧化产物(LPO)含量;同时观察MCP-1水平与肾小球肾炎患儿肾功能、尿蛋白及过氧化损伤的关系.结果 急性肾小球肾炎患儿急性期血清及尿液MCP-1水平较恢复期及正常对照组明显升高(P<0.05),且恢复期MCP-1水平亦明显高于正常对照组(P<0.05);尿MCP-1水平与尿蛋白严重程度及LPO呈显著正相关(r=0.58、0.83,P均<0.05),与SOD水平及Ccr呈显著负相关(r=-0.32、-0.76,P<0.05),与血清MCP-1水平无明显相关(r=0.21,P>0.05);血清MCP-1水平与尿蛋白严重程度、Ccr及SOD、LPO无显著相关(r=0.15~0.28,P均>0.05).结论 急性肾小球肾炎患儿血清及尿液MCP-1水平增高,可能参与了急性肾小球肾炎炎症损伤过程,尿液MCP-1水平变化可作为评估急性肾小球肾炎炎症严重程度的潜在指标.     

甲型肝炎病人过氧化脂质和超氧化物岐化酶的检测

本文运用紫外吸收法及邻苯三酚法对35例急性甲型肝炎(甲肝)患儿血LPO 和SOD 进行了动态现察,探讨了血ALT 与LPO 及SOD 之间的相互关系。结果表明甲型肝炎血LPO 明显升高(P<0.01),SOD 明显降低(P<0.01),两者呈负相关(P<0.001).ALT 升高与LPO 升高呈正相关(P<0.001),ALT 升高与SOD 下降呈负相关(P<0.001)。当ALT 降至80U 以下,血LPO 和SOD则基本恢复到正常水平(P>0.05)。本文研究结果表明,LPO 和SOD 可作为反映甲肝患者肝功能受损的生化指标,有助于临床动态观察病情,判断预后;同时也为临床上使用抗氧化剂或自由基清除剂治疗急性肝炎提供了理论依据。     

系统性红斑狼疮患儿肿瘤坏死因子-α、抗ds-DNA抗体水平变化

目的探讨系统性红斑狼疮（SLE）及狼疮性肾炎（LN）患儿血清肿瘤坏死因子-α（TNF-α）、抗ds-DNA抗体水平的变化及其与病情的相关性。方法选择67例SLE患儿(其中52例为LN患儿),以30例健康体检儿童为对照组,采用酶联免疫吸附法检测血清TNF-α水平,放射免疫法检测抗ds-DNA抗体水平。结果 SLE和LN患儿的血清TNF-α、抗ds-DNA抗体水平均高于对照组,差异均有统计学意义（P均<0.01）;SLE和LN患儿中活动期患儿的血清TNF-α、抗ds-DNA抗体水平均高于静止期患儿,差异均有统计学意义（P均<0.01）;67例SLE患儿TNF-α与SLE疾病活动指数、抗ds-DNA水平均呈明显正相关（P<0.01）。结论 SLE及LN患儿血清TNF-α、抗ds-DNA抗体水平升高,且与病情活动性相关。     

小儿哮喘与肺炎支原体肺炎血中一氧化氮和氧自由基的不同变化及意义

目的：　探讨一氧化氮(NO)、脂质过氧化物(LPO)、血栓素B2 (TXB2 )、循环内皮细胞(CEC)在小儿哮喘及肺炎支原体(MP)肺炎中的作用。方法：　分别检测36例小儿哮喘、40例MP肺炎患儿及15例健康体检儿血NO,LPO,TXB2及CEC水平。结果：　小儿哮喘及MP肺炎急性期血NO,LPO,TXB2,CEC4项指标分别为:哮喘组(162 .27±36.12) μmol/L ,(8.62± 0.87)nmol/ml,(22 9.11± 64.75) pg/ml,(6.13± 1.15)n/0.9μl;MP肺炎组(95.52±33.84)μmol/L ,(5.76± 0 .53)nmol/ml,(388.72±80 .09) pg/ml,(6.36±1.02)n/0 .9μl,分别与对照组 [(68.57±13.80 ) μmol/L ,(4.62± 1.80 )nmol/ml,(105.76±20.10)pg/ml,(4.40±1.04)n/0 .9μl]相比,均增高显著,差异有显著性意义(P<0.01)。其中哮喘组血中NO ,LPO较MP肺炎组增高显著(P<0.01);MP肺炎组TXB2 较哮喘组增高明显 (P<0.01)。恢复期两种疾病所有指标均降低,TXB2,LPO已降至正常范围,而NO ,CEC在两周后[哮喘组(82.64±20.56)μmol/L,(5.41±1.29)n/0.9μl,MP肺炎组 (86.12±21.34)μmol/L,(5.57±1.12 )n/0 .9μl]仍高于正常对照组(P<0.05或0.01)。结论：　本研究提示     

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目的探讨原发性肾病综合征患儿(PNS)血脂代谢紊乱与肾功能改变的关系。方法2004-01—2006-01,根据肾功能检查结果,将广西医科大学第一附属医院儿科收治的76例PNS患儿分成无肾功能损害组(46例)与肾功能损害组(30例),检测血浆总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、非-高密度脂蛋白(non-HDL)、低密度脂蛋白(LDL)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、ApoA1/B、血浆尿素氮(BUN)、肌酐清除率(Ccr)和尿酸(UA)等指标。结果(1)肾功能损害组TG、BUN、Ccr和UA均明显高于无肾功能损害组;(2)76例PNS患儿TG与Ccr及UA呈高度正相关(P<0.01),ApoA1与Ccr呈中度正相关(P<0.05),ApoB与UA呈中度正相关(P<0.05);(3)76例PNS患儿non-HDL与LDL呈高度正相关(P<0.01)。结论PNS合并肾功能损害的血脂代谢紊乱以TG显著增高为特征;TG和non-HDL变化可以作为临床判断PNS患儿肾功能损害程度及调脂措施有效性的指标。     

糖尿病酮症酸中毒患儿氧化应激状况及影响因素分析

目的 探讨糖尿病酮症酸中毒(DKA)患儿血清氧化应激指标的变化及其与代谢参数的相关性.方法 将受试者分为4组:即DKA组22例;血糖控制一般组18例,糖化血红蛋白(HbAlc)＜9%;血糖控制较差组(HbAlc≥9%)22例;健康对照组36例.检测其血清丙二醛(MDA)、一氧化氮(NO)、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)水平,并常规检测空腹血糖、血气、血清离子(K+,Na+,Cl-,P)、肾功能、尿常规、HbAlc.结果 DKA组血清MDA水平显著高于健康对照组(P＜0.01)及血糖控制一般组(P＜0.01),但与血糖控制较差组差异无显著性(P＞0.05);3组糖尿病患儿血清NO水平均显著高于健康对照组(P＜0.01),且血糖控制较差组NO显著高于血糖控制一般组(P＜0.01);3组糖尿病患儿血清GSH-Px水平均显著低于健康对照组(P＜0.01);4组间SOD水平差异无显著性(P＞0.05).相关分析显示糖尿病患儿血清MDA水平与HbAlc呈极显著正相关(r=0.375,P＜0.01),NO与HbAlc呈显著正相关(r=0.250,P＜0.05),DKA患儿血清SOD水平与HbAlc呈显著负相关(r=-0.507,P＜0.05),其他氧化应激指标与代谢参数问无相关性.结论 DKA患儿氧化应激产物显著增加,抗氧化能力降低,这些改变主要应归因于慢性高血糖而不是急性代谢紊乱.     

肾脏疾病儿童血浆促酰化蛋白水平测定的意义

目的 探讨肾脏疾病儿童血浆促酰化蛋白(ASP)与血浆C,、非酯化脂肪酸(NEFA)及血脂的关系.方法 肾脏疾病组48例,健康对照组279例.将48例肾脏疾病儿童分为3组:1.急性链球菌感染后肾小球肾炎(APSGN)组12例;2.狼疮性肾炎(LN)组4例;3.肾病综合征(Ns)组32例.用ELISA方法 检测各组血浆ASP水平,酶学比色法测定其NEFA水平,用酶学比浊法检测其血浆C3、血脂等生化指标.数据采用GraphPad Prism 4.0软件进行统计学分析.结果 1.APSGN组(81.8±24.8)nmol/L、LN组(90.9 ±28.2)nmoL/L和Ns组(101.4 ±399)nmolL血浆ASP水平明显高于健康对照组[(44.3±25.2)mnol/L P.<0.01];APSGN和LN组血浆C3,水平均低于健康对照组(Pa<0.05),Ns组与健康对照组比较C3,无明显变化.2.肾脏疾病各组存在一定程度血脂代谢紊乱.APSGN组血浆三酰甘油(TG)水平高于健康对照组,但无统计学差异(P>0.05),而高密度脂蛋白胆固醇(HDL-C)显著低于健康对照组(P<0.001).LN和NS组存在显著高TG、高TC和高低密度脂蛋白胆固醇(LDL-C)血症,LN组患儿还存在低血浆HDL-C水平(P<0.001),载脂蛋白(Apo)A和ApoB升高仅见于Ns组(P<0.01,0.001);各组NEFA水平无显著变化.3.肾脏疾病患儿血浆ASP水平与TG(r=0.301 P相似文献   

肾病综合征患儿血浆一氧化氮及内皮素检测及其意义

为探讨一氧化氮(NO)及内皮素(ET)与肾病综合征之间的关系,采用比色法和放免法分别检测了活动期肾病综合征患儿59例、治疗后48例的血浆NO及ET水平,并设24例健康儿童作为对照。结果发现肾病综合征活动期血浆NO与ET水平显著高于缓解期,活动期与缓解期血浆NO与ET水平均显著高于对照组(P均<0.01),NO水平与ET水平呈显著正相关(r=0.565,P<0.05),显示NO与ET和肾病综合征的发生有关。     

不同病理类型儿童狼疮性肾炎肾小球细胞凋亡的变化

目的检测不同病理类型狼疮性肾炎(lupusnephritis,LN)患儿肾组织细胞凋亡与增殖,分析LN患儿肾组织细胞凋亡与增殖的关系。方法用原位末端标记法(TUNEL)检测21例Ⅳ型、6例Ⅴ型LN患儿肾组织及9例对照肾组织中的细胞凋亡,用免疫组织化学法检测其细胞增殖(PCNA,增殖细胞核抗原),同时用免疫组织化学及图像分析法检测细胞凋亡相关基因蛋白PDCD5、Caspase-3的表达。结果1.Ⅳ型LN患儿肾小球凋亡细胞数(0.93±0.28)、增殖细胞数(9.97±1.90)及P/A值(11.15±2.49)均明显高于Ⅴ型LN患儿相应指标(0.66±0.11),(4.82±1.46)和(7.25±1.71),P<0.05,P<0.01和P<0.01。2.Ⅳ型和Ⅴ型LN患儿肾组织PDCD5、Caspase-3表达:PDCD5在Ⅳ型LN患儿肾小球的表达强度(0.08±0.02)与V型LN患儿肾小球的表达强度(0.07±0.03)无差异,P均>0.05;Caspase-3在Ⅳ型LN患儿肾小球的表达强度(0.25±0.05)明显高于Ⅴ型LN患儿肾小球的表达强度(0.16±0.03),P<0.01。结论Ⅳ型LN患儿相对于细胞增殖的程度而上调的细胞凋亡远不如Ⅴ型LN患儿;Caspase-3参与LN患儿肾小球细胞凋亡,而PDCD5未起主要作用或其促凋亡作用被抑制。     

狼疮性肾炎患儿血浆miR-145及miR-183表达水平及其诊断价值

目的 探讨狼疮性肾炎（LN）患儿血浆miR-145及miR-183表达水平及其诊断价值。方法 选取2016年1月至2019年5月收治的LN患儿92例为LN组，其中Ⅱ型17例、Ⅲ型15例、Ⅳ型36例、Ⅴ型18例、Ⅵ型6例，另选取健康体检正常儿童40例作为健康对照组。采用系统性红斑狼疮病情活动指数（SLEDAI）评分将92例LN患儿分为LN稳定组（n=34，SLEDAI评分<10分）和LN活动组（n=58，SLEDAI评分≥10分）。实时荧光定量PCR法检测各组血浆miR-145及miR-183表达水平；ROC曲线分析血浆miR-145、miR-183及抗双链DNA（dsDNA）抗体水平对LN的诊断价值；Pearson相关分析LN患儿血浆miR-145及miR-183表达水平与各实验室指标的相关性。结果 LN组、LN活动组和LN稳定组抗dsDNA抗体、C反应蛋白（CRP）、血肌酐（Scr）及血尿素氮（BUN）水平均明显高于健康对照组（P < 0.05），且LN活动组SLEDAI评分、抗dsDNA抗体、Scr及BUN水平均明显高于LN稳定组（P < 0.05）。LN组、LN活动组和LN稳定组补体C3、补体C4及血清白蛋白（ALB）水平均明显低于健康对照组（P < 0.05），且LN活动组ALB水平明显低于LN稳定组（P < 0.05）。LN组、LN活动组和LN稳定组血浆miR-145及miR-183表达水平均明显低于健康对照组（P < 0.01），且LN活动组血浆miR-145及miR-183表达水平均明显低于LN稳定组（P < 0.01）。不同分型LN患儿血浆miR-145及miR-183表达水平均明显低于健康对照组（P < 0.01），且Ⅴ~Ⅵ型组和Ⅳ型组血浆miR-145及miR-183表达水平均明显低于Ⅱ~Ⅲ型组（P < 0.01）。血浆miR-145、miR-183及抗dsDNA抗体水平诊断LN的最佳截断值分别为1.05、0.62、186.30 IU/mL，三项联合诊断LN的曲线下面积（0.896，95% CI：0.835~0.955）最大，其灵敏度（90.5%）和特异度（84.2%）较好，优于各单项诊断价值（P < 0.05）。LN患儿血浆miR-145及miR-183表达水平与SLEDAI评分、抗dsDNA抗体、Scr及BUN水平均呈负相关（P < 0.05），与补体C3、补体C4及ALB水平均呈正相关（P < 0.05）。结论 LN患儿血浆miR-145及miR-183表达水平明显降低，且与LN活动度及病理分型相关，联合抗dsDNA抗体检测对LN诊断具有较高的价值。     

Free oxygen radicals in acute renal failure

OBJECTIVE: To assess the levels of free oxygen radicals in acute renal failure and their predictive value in clinical outcome. DESIGN: Prospective. SETTING: Intensive care unit. METHODS: Study was conducted in 50 children (25 with acute renal failure and 25 age and sex matched controls). Blood urea, serum creatinine, serum protein, uric acid and free oxygen radical markers were estimated in both groups. Superoxide dismutase (SOD), glutathione peroxidase(GPx) and lipid peroxide (LPO) were estimated in blood by standard techniques. RESULTS: Hemolytic uremic syndrome (HUS) was a major cause of acute renal failure (52%), rest were due to acute glomerulonephritis (AGN), septicemia and renal venous thrombosis. In the renal failure group 56% of the patients were dialyzed (peritoneal) and the mortality was 28% (7/25). The levels of SOD, GPx and LPO were significantly raised in renal failure group. Higher values of LPO, SOD and GPx were documented in subjects who expired. The most important independent variable for predicting clinical outcome was LPO with a sensitivity of 89.4%, specificity of 93%, positive predictive value of 95%. CONCLUSION: Levels of free oxygen radicals (SOD, LPO and GPx) are raised in acute renal failure and these enzymes can be used as marker of renal injury. LPO levels are highly sensitivity and specific for predicting the clinical outcome     

双重血浆置换联合激素与免疫抑制剂治疗儿童重症紫癜性肾炎的临床效果

目的 探讨双重血浆置换（DFPP）联合甲泼尼龙（MP）、环磷酰胺（CTX）双冲击疗法治疗儿童重症紫癜性肾炎（HSPN）的临床疗效与安全性。方法 将2014年1月至2018年3月收治的60例重症HSPN患儿随机分为观察组和对照组,每组30例。在常规治疗基础上,对照组予MP+CTX双冲击治疗,观察组在对照组基础上联合采用DFPP治疗,共3个疗程。治疗3个疗程后,比较两组24 h尿蛋白定量、尿系列微量蛋白含量、肾功能指标、不良反应及临床疗效。结果 治疗3个疗程后,观察组24 h尿蛋白定量、尿白蛋白、尿免疫球蛋白G、尿β2微球蛋白、血肌酐及血尿素氮的下降幅度均显著高于对照组（P < 0.05）。治疗结束后,观察组完全缓解患儿达缓解的时间明显短于对照组（P < 0.05）。两组均未发生出血性膀胱炎、血小板下降、溶血等严重不良反应,两组总体不良反应发生率差异无统计学意义（P > 0.05）。结论 DFPP联合MP+CTX双冲击治疗儿童重症HSPN较单纯MP+CTX冲击治疗能进一步减轻肾脏损害,提高临床疗效,且未加重不良反应的发生。     

Effect of vitamin C on oxidative liver injury due to isoniazid in rats

Background:  The aim of the present study was to investigate the effect of different doses of vitamin C on oxidative liver injury due to isoniazid (INH) in rats.
Methods:  Rats were divided into four subgroups, each containing 10 rats. Group 1 was the control group; group 2, INH 50 mg/kg per day; group 3, INH 50 mg/kg per day + low-dose vitamin C (100 mg/kg per day); group 4, INH 50 mg/kg per day + high-dose vitamin C (1000 mg/kg per day). INH and vitamin C were administered into their stomachs through an oral tube. After 21 days, measurements were made in both serum and homogenized liver tissues. The levels of glutathione (GSH), superoxide dismutase (SOD) and other biochemical variables were measured. Malondialdehyde (MDA), glutathione peroxidase (GSH-px) and vitamin C were measured using commercial kits.
Results:  Aspartate amino transferase and alanine aminotransferase in group 2 were higher than those in groups 1, 3 and 4 ( P < 0.008 for both). Serum and tissue levels of MDA in group 2 were higher than that in groups 1 and 3 ( P < 0.008 for both). There was no difference in the SOD levels between the four groups ( P = 0.095). Erythrocyte and tissue GSH in group 2 were higher than that in groups 1 and 3 ( P < 0.008 for both). Interestingly, erythrocyte and tissue GSH in group 4 were lower than those in group 1 ( P < 0.008 for both). Erythrocyte level of GSH-px in group 2 was higher than that in groups 1 and 3 ( P < 0.008 for both).
Conclusions:  INH-induced liver injury is associated with oxidative stress, and co-administration of low-dose vitamin C may reduce this damage effectively in a rat model. The antioxidant effect of high-dose vitamin C does not seem more potent compared to the low dose.     

Ⅲ型或Ⅳ型狼疮性肾炎患儿环磷酰胺诱导治疗3和6个月后序贯吗替麦考酚酯的非随机对照试验

目的 对肾脏病理Ⅲ型或Ⅳ型的狼疮性肾炎(LN)患儿用环磷酰胺(CTX)诱导治疗3和6个月后序贯吗替麦考酚酯(MMF)的疗效和不良反应进行探讨。方法 非随机对照试验。Ⅲ型或Ⅳ型LN患儿,在患儿家长充分知晓CTX诱导治疗3个月(A组)和6个月(B组)后序贯MMF不同方案利弊的前提下,根据患儿家长意愿入A组或B组,考察两组疗效和随访12个月时药物不良反应事件。主要结局指标为有效率(完全缓解+部分缓解),完全缓解:血常规、肾功能、白蛋白、血沉正常,补体C3≥0.73 g·L^-1,C4≥0.1 g·L^-1,抗ds-DNA抗体免疫荧光法和ELISA法检测双阴性,且24 h尿蛋白定量<150 mg;部分缓解:达到以下任意1项,①24 h尿蛋白定量较治疗前降低50%,且总量<3.5 g·24 h^-1,②血肌酐和尿蛋白/肌酐较治疗前改善50％,③血肌酐较治疗前改善50％,尿蛋白/肌酐<1.0,实验室检测均较治疗前有改善。结果 2012年1月至2018年1月符合本文纳入和排标准的33例患儿进入本文分析。A组和B组在发病年龄、肾活检年龄、性别、发病季节、居住环境、肾脏病理类型和自身免疫性疾病家族史差异均无统计学意义。两组治疗前、诱导治疗结束时(A组3个月、B组6个月)和治疗后12个月实验室检查指标(血常规、肾功能、补体、白蛋白、尿蛋白、抗ds-DNA抗体和ESR)差异均无统计学意义。诱导治疗3个月时两组患儿有效率差异无统计学意义,治疗3个月时A组和B组患儿CTX累积用量(mg·kg^-1)分别为(94.0±20.5)和(104.1±34.8),差异无统计学意义(P=0.39),3个月及6个月时CTX平均累积量与治疗有效率不相关(r=0.95,P=0.051)。两组总的药物不良反应发生率差异无统计学意义,药物不良反应主要表现为WBC＜4×10⁹·L^-1、感染、胃肠道不适、月经不规律,均未出现因使用CTX所致的脱发及出血性膀胱炎。结论 Ⅲ型或Ⅳ型LN患儿CTX诱导治疗3和6个月后序贯MMF对治疗结局无影响。     

Ⅲ型或Ⅳ型狼疮性肾炎患儿环磷酰胺诱导治疗3和6个月后序贯吗替麦考酚酯的非随机对照试验

目的 对肾脏病理Ⅲ型或Ⅳ型的狼疮性肾炎(LN)患儿用环磷酰胺(CTX)诱导治疗3和6个月后序贯吗替麦考酚酯(MMF)的疗效和不良反应进行探讨。方法 非随机对照试验。Ⅲ型或Ⅳ型LN患儿,在患儿家长充分知晓CTX诱导治疗3个月(A组)和6个月(B组)后序贯MMF不同方案利弊的前提下,根据患儿家长意愿入A组或B组,考察两组疗效和随访12个月时药物不良反应事件。主要结局指标为有效率(完全缓解+部分缓解),完全缓解:血常规、肾功能、白蛋白、血沉正常,补体C3≥0.73 g·L^-1,C4≥0.1 g·L^-1,抗ds-DNA抗体免疫荧光法和ELISA法检测双阴性,且24 h尿蛋白定量<150 mg;部分缓解:达到以下任意1项,①24 h尿蛋白定量较治疗前降低50%,且总量<3.5 g·24 h^-1,②血肌酐和尿蛋白/肌酐较治疗前改善50％,③血肌酐较治疗前改善50％,尿蛋白/肌酐<1.0,实验室检测均较治疗前有改善。结果 2012年1月至2018年1月符合本文纳入和排标准的33例患儿进入本文分析。A组和B组在发病年龄、肾活检年龄、性别、发病季节、居住环境、肾脏病理类型和自身免疫性疾病家族史差异均无统计学意义。两组治疗前、诱导治疗结束时(A组3个月、B组6个月)和治疗后12个月实验室检查指标(血常规、肾功能、补体、白蛋白、尿蛋白、抗ds-DNA抗体和ESR)差异均无统计学意义。诱导治疗3个月时两组患儿有效率差异无统计学意义,治疗3个月时A组和B组患儿CTX累积用量(mg·kg^-1)分别为(94.0±20.5)和(104.1±34.8),差异无统计学意义(P=0.39),3个月及6个月时CTX平均累积量与治疗有效率不相关(r=0.95,P=0.051)。两组总的药物不良反应发生率差异无统计学意义,药物不良反应主要表现为WBC＜4×10⁹·L^-1、感染、胃肠道不适、月经不规律,均未出现因使用CTX所致的脱发及出血性膀胱炎。结论 Ⅲ型或Ⅳ型LN患儿CTX诱导治疗3和6个月后序贯MMF对治疗结局无影响。     

Role of oxidative stress in the maintenance of inflamation in patients with juvenile rheumatoid arthritis

OBJECTIVE: To determine the level of cellular oxidative stress blood markers and the enzymatic system of antioxidant defense establishing the oxidative profile in patients with Juvenile Rheumatoid Arthritis. METHODS: Case-control study that included 64 patients (46 of female sex) with Juvenile Rheumatoid Arthritis (JRA) following clinical control in the Pediatric Rheumatology Service of the Vall dacute;Hebron Hospital, Barcelona, Spain. The patients were separated in three subtypes based on the pattern of onset within the first six months of disease: polyarticular, pauciarticular and systemic. The control group included 60 patients (38 of female sex) following clinical control to diseases of non inflammatory nature, in the same hospital. The plasmatic levels of malondialdehyde (MDA), lipoperoxide (LPO), hydroperoxide (HPX), carbonile groups (CG) of proteins and gluthathione and the enzymatic activities of Superoxide dismutase (SOD), gluthathione peroxidase (GSH-Px) and gluthathione reductase were determined. RESULTS: The group of patients with JRA presented high concentrations of lipid peroxidation products, evaluated by determining the plasmatic levels of MDA, LPO, and HPX; oxidative damage of the circulate protein, determined by CG contents of plasma proteins; elevation of enzymatic activity of SOD and GSH-Red; decrease of GSH-Px activity and GSH levels. CONCLUSIONS: Our results show the presence of molecular damage determined by oxygen free radicals in the JRA patients. The SOD activity and the changes of gluthathione redox enzymatic cycle confirm the decrease of capacity of cellular defense system against the induced toxicity of oxidative stress in these patients.     

急性肾小球肾炎氧化—抗氧化功能变化及其在治疗上的意义

目的 研究小儿急性肾小球肾炎患儿超氧化物歧化酶（SOD）、脂质过氧化物（LPO），维生素E（VitE）含量的变化及其在治疗上的意义。方法 采用放射免疫分析方法监测血SOD；LPO则采用改奶TBA法测定；VitE应用高压液相法测定。结果 1．肾炎患儿急性期SOD活力降低与恢复期及正常组比较差异显著（P＜0．01），SOD在恢复期活力明显提高，但仍低于正常对照组（P＜0．01）。2．LPO急性期显著升高与对照组相比非常显著（P＜0．01），恢复期LPO下降，但尚未能正常水平（P＜0．01）。3．肾炎患儿血VitE浓度显著低于正常对照组（P＜0．01）。结论 氧化－抗氧化功能失衡参与了肾脏损伤及恢复，可为临床治疗提供依据。     

The effect of hyperbaric oxygen treatment on the inflammatory changes caused by intraperitoneal meconium

Exposure of the peritoneal cavity to meconium causes a marked inflammatory response. The effect of intraperitoneal meconium on intestinal morphology and plasma nitrite and nitrate (NO2(-) + NO3(-)) levels and how this inflammatory process is influenced by hyperbaric oxygen (HBO) treatment were investigated in this study. The purpose was to determine whether HBO treatment could be considered a useful adjunct in the resuscitative treatment of severely ill patients admitted with meconium peritonitis (MP). Rats were divided into three groups. Human meconium (MP group, n=10) and sterile saline (control group, n=10) were injected intraperitoneally for 3 days. The procedure for meconium injection was combined with HBO treatment for the HBO group (n=10). HBO was administered for 7 days. In all groups, peritoneal swap cultures, plasma NO2(-) + NO3(-) levels, intestinal diameters, and macroscopic and microscopic changes in the intestine were determined on the 8th day. Bacterial growth was not detected in the peritoneal swap cultures. There was a significant difference in NO2(-) + NO3(-) levels between the MP and HBO groups ( P<0.05), between the MP and control groups ( P<0.01), and between the HBO and control groups ( P<0.05). Thin fibrinous adhesions in both the MP and HBO groups, and thickened and dilated intestinal loops in the MP group were observed macroscopically. The intestinal diameter in the MP group was significantly greater than in the HBO and control groups. The only microscopic difference was seen in the serosal layer. Compared with the animals in the control and HBO groups, the intestine of the rats in the MP group showed prominent serosal thickening, edema, capillary proliferation and cellular infiltration. The ameliorated inflammatory changes and decreased dilatation of the intestine accompanied by a significant decrease in NO2(-) + NO3(-) levels suggest that as an adjunctive treatment, HBO may have a beneficial effect in the resuscitative treatment of meconium peritonitis.