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Analysis of High Sensitivity C-reactive Protein Blood Gas, Electrolytes and Myocardio Enzymes in Blood of Children with Diarrhea in Autumn and Winter

Author: GuoChunYan
Tutor: ZhangHuiFeng
School: Hebei Medical University
Course: Pediatrics
Keywords: rotavirus diarrhea high sensitivity-C Reactive Protein infection infantile diarrhea hematopoietic system myocardial enzymes Extraintestinal impairment
CLC: R725.1
Type: Master's thesis
Year: 2011
Downloads: 35
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Abstract


Objective: Through the detection of acute inflammatory markers with high sensitivity CRP, arterial blood gas analysis, electrolytes and myocardial enzymes and other biochemical indicators, we comprehensively understand the systemic effects of children’s diarrhea in autumn and winter as the intestinal virus infection, to offer help for the correct assessment of the condition and clinical treatment.Methods: 47 diarrhea children were collected as the research object, who were hospitalized in the Pediatric Department, the second hospital of Hebei Medical University from October 2010 to February 2011. Including 28 boys and 19 girls , and aged from 35 days to 2 years old. Detailed record their time of onset, accompanying symptoms, stool frequency and duration of diarrhea. All patients were treated with probiotics, bowel mucosa protectant and fluid therapy, some were given antibiotic treatment according to their conditions . Chose 20 cases of epilepsy patients without a recent infection as the control, of which 12 males and 8 females, aged 4 months to 5 years old. The stool samples of the children with diarrhea were collected in the first day of admission, to detect the stool germiculture in the laboratory of the hospital and the rotavirus antigen with Rotavirus Group A Diagnostic Kit(Colloidal Gold Device) at the same time. Two groups of patients were all collected the peripheral blood for the test of high sensitivity C-reactive protein (hs-CRP) and the routine test of blood, used venous blood to inspect myocardial enzymes and electrolytes, and checked arterial blood gas analysis. Learned the general characteristics of infantile diarrhea in autumn and winter and the positive rate of rotavirus infection; viewed the levels of hs-CRP in two groups and the relationship between hs-CRP and the severity of illness; compared the difference of myocardial enzymes in children with rotavirus-positive and negative to know whether the myocardial damage is associated with rotavirus infection; observed the count of neutrophils and platelets in children with rotavirus-positive to evaluate the impact of rotavirus on the hematopoietic system; investigated the relationship between blood lactate levels and stool frequency, to understand the situation of tissue perfusion in children with diarrhea. All statistical analyses were performed with statistical software SPSS13.0, applyed nonparameter test, t test, chi-square test, pearson correlation analysis, datas were showed as mean±standard deviation ( x±s) or median (interquartile spacing) that, P <0.05 was considered statistically significant.Results: 1 All children with diarrhea defecated watery or egg soup-like stool, no mucus and pus with naked eye, no opportunistic pathogen growing in the stool culture. Stool frequency 4-20 times per day. 18 cases with fever, vomiting in 10 cases, 8 cases with varying degrees of dehydration, 8 cases with upper respiratory infection, convulsion seizured in 4 cases , 1 case with sepsis, and 1 case developed a septic shock ; 19 cases with varying degrees of acidosis, hyponatremia in 6 cases, low serum potassium in 6 cases, 5 cases of low blood calcium; normal stool routine test 25 cases, 16 patients with occult blood, fat drops of 7 cases, 6 cases of white blood cells, red blood cells in 3 cases. The average duration of diarrhea after hospitalization was 5.51 days.2 In 47 cases of diarrhea children, 24 patients were tested Rotavirus- positive, the positive rate was 51.06%.3 Relationship between Rotavirus detection rate and gender: within the 28 cases of boys, 11 were rotavirus-positive and 17 were negative; in the 19 cases of girls 13 cases of rotavirus-positive and negative in 6 cases. The positive rate between male and female was no significant difference by chi-square test (x2 = 3.845, P = 0.05).4 Relationship between rotavirus detection rate and age: aged 1 month -3 months 3cases were rotavirus-positive patients,5cases were negative; 3 months -1 year old children, positive in 14 cases, 12 cases were negative ; 1 -2 years old children, 7cases were positive, 6cases were negative. Diarrhea children aged mainly from 3 months to 1 year old. The positive rate of rotavirus between every age group was no significant difference (x2 = 0.71, P> 0.05).5 The content of hs-CRP in children of diarrhea group was 3.2 (17.7) mg/L, and in the control group, 20 cases were all less than 0.5mg/L, the difference was statistically significant (P < 0.01).6 In diarrhea group, the content of hs-CRP<0.5mg/L in 14 cases, accounting for 29.8%; 0.5-5.0mg/L in 10 cases, accounting for 21.3%; 5.0-40 mg/L in 18 cases, accounting for 38.3%;> 40mg/L in 5 cases, accounting for 10.6%.7 In rotavirus-positive group,the blood hs-CRP content was 2.15 (11.425) mg/L, in rotavirus negative group the content was 5.6 (33.4) mg/L. There was no significant difference between two groups (P> 0.05).8 In light diarrhea patients(only with fever or vomiting) ,the blood hs-CRP content was 0.9 (5.4) mg/L ,which was significantly lower than that associated with other symptoms (dehydration, seizures, acidosis, etc.) of severe diarrhea 15.2 (45.6) mg/L (P = 0.001).After a 2-3 days’treatment, along with the condition released, hs-CRP decreased, the difference was statistically significant (Z =- 2.666, P <0.01).9 Diarrhea frequency and hs-CRP levels were positively correlated (Spearman correlation coefficient was 0.448, P <0.01), correlation is not strong.10 Myocardial enzymes CK-MB in children with RV-positive were higher than that of the RV-negative patients, the difference was statistically significant.11 We didn’t found neutropenia or thrombocytopenia syndrome in rotavirus-positive children.12 In diarrhea group blood lactate levels had no correlation with the stool frequency (Spearman correlation coefficient -0.062, P> 0.05).Conclusions: 1 In all cases of diarrhea children, the rotavirus positive rate was 51.06%, rotavirus was the main pathogens in diarrhea children in autumn and winter. 2 The infantile diarrhea occurs mainly in the 3 months -1 year old babies, after a treatment of the probiotics,intestinal mucosa protective agents, rehydration and antibiotic of reasonable, the average duration of diarrhea is 5.51 days.3 The blood hs-CRP increases in diarrhea Children in autumn and winter, and most during 5-40 mg/L, and it’s correlated with the severity of the disease, when the condition improves, hs-CRP decreases.It can be assistant to evaluate the clinical efficacy and direct the treatment.4 The blood hs-CRP increases with rotavirus infection .5 Rotavirus infection has no effect on the peripheral blood system .6 Rotavirus infection is associated with myocardial damage, treatment should be added with appropriate cardiac nutrition drugs.

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