Vitamin D deficiency is a global public health problem.Vitamin D is well known for its classic role in the maintenance of bone mineral density.In addition,vitamin D is also closely related to many infectious diseases.This article describes the physiology of vitamin D and methodology for 25-hydroxyvitamin D or 25(OH) D.The factors that influence vitamin D levels in children and the relationship between vitamin D deficiency in children and infectious diseases are introduced.

Objectives To study the signiifcance of ifbrin related markers such as ifbrin monome (FM), D-dimer (D-D), fibrinogen and fibrin degradation products (FDP) in diagnosis of pre-disseminated intravascular coagulation (pre-DIC) state in children with severe pneumonia. Methods A total of 213 children with severe pneumonia in pediatric intensive care unit were divided into pre-DIC group and case control group according to the occurrence of pre-DIC. And 40 healthy children were included as normal control group. FM、D-D、FDP、prothrombin time (PT)、activated partial thromboplastin time (APTT)、ifbrinogen (FIB)、platelet count (PLT)、thrombomodulin (TM) levels were analyzed. Receiver operating characteristic curve was used to evaluate the above indexes. Results All the markers but FIB showed signiifcant difference among the three groups (P<0 . 05 ). The differences of FM、D-D、FDP、APTT in paired comparison among the three groups were also signiifcant (P<0.01), Pre-DIC group had the highest level and case control group was the second. Pre-DIC group had higher PT than that of the other two groups (P<0 . 05 ), but PT levels in normal control group and the control group are of no signiifcant difference (P>0 . 05 ). Compared with those in normal control group, TM and PLT levels were signiifcantly higher in the other two groups (P<0 . 01 ), but the differences of TM and PLT in pre-DIC group were not signiifcant in comparison to those in case control group (P>0 . 05 ). FM、D-D、FDP had larger area under curves (AUC) for pre-DIC than other indexes ( 0 . 84、0 . 76、0 . 64 , respectively). The AUC for the joint detection of the three indexes was 0 . 85 . Conclusions Fibrin related markers such as FM、D-D and FDP are valuable indexes in diagnosis of pre-DIC state in children with severe pneumonia, the joint detection of the three indexes would help to improve diagnostic accuracy.

Objective To study the change and clinical significance of coagulation and fibrinolytic function in neonatal sepsis. Methods 86 neonates inpatients in the neonatology department of our hospital were selected and divided into the ordinary infection group(30 cases)and the sepsis group(56 cases),and 30 healthy neonates were selected as the normal control group.Plasma AT-Ⅲactivity,DD level and PLT count were detected immediately after admission and the detection results were analyzed.Results Com-pared with the control group and the ordinary infection group,the AT-Ⅲ activity and the PLT count in the sepsis group were sig-nificantly decreased,while the DD level was significantly increase,the difference had statistical significance(P <0.01).The differ-ences of the three indexes had no statistical significance between the normal control group and the ordinary infection group(P >0.05);however,the AT-Ⅲ activity and the PLT count in the DIC group were significantly decreased and the DD level was signifi-cantly increased(P <0.01),the occurrence rate of abnormal three indexes was 83.33%(15/18)in the DIC group,which was signifi-cantly higher than that in the non-DIC group(χ2 =17.75,P =0.00).Conclusion The obvious dysfunction of coagulation and fibri-nolysis exists in neonatal sepsis,which is related with the severity degree of disease.The joint detection of AT-Ⅲ activity,DD level and PLT count is helpful for the early diagnosis of DIC in neonatal sepsis.

10.3969/j.issn.1000-3606.2013.06.009

Abstact:Objective To investigate the clinical value of mean platelet mass(MPM)and the procalcitonin(PCT)in diagnosis of Kawasaki disease (KD).Methods A Total of 117 children with KD in the acute stage and 126 children of the control group were detected respectively and compared each other.The indexes contain MPM,PLT,MPV,PDW and PCT.Mean-while,the comparison of each index’s positive rate and the linear correlation analysis of each index were conducted.Results①The level of MPM of the KD group was significant lower than that of the control group,PLT,MPV and PCT significant higher than those (P<0.05,α=0.05).The difference of PDW between the two groups was no statistical significance (P>0.05,α=0.05).②The positive rate of the MPM was significant higher than that of the other indexes (P<0.05,α=0.05). Conclusion The detection of MPM is helpful to the diagnosis of KD and can be used as an indicator of KD clinically.

Objective To study the effects of matrine on inducing autophagy and autophagic death in BEL-7402 cells. Methods BEL-7402 cells were cultured in RPMI1640 alone or exposed to different concentration of matrine. Cell growth inhibition was assessed by MTT assay. Apoptosis was evaluated by flow cytometry. Autophagosome marker LC3 was examined by immunofluorescence microscopy. The ultrastructure change of cells was analyzed by transmission electron microscope. Results The cell proliferation was inhibited by matrine in a dose dependent manner. Its IC50 value was 1.1 mg/mL at 48 h. Treatment with 0.6-1.6 mg/mL matrine for 12 h induced apoptosis of BEL-7402 cells and the apoptosis rate reached (44.88?0.78)% at concentration of 1.2 mg/mL. The autophagy positive cells were greatly increased after 1.2 mg/mL matrine treated in BEL-7402 cells and the number of cells reached (63.16?0.29)%. Morphological features of typical autophagic death were apparent in the cytoplasm at the ultrastructural level. Conclusion Matrine could induce autophagy and autophagic death of BEL-7402 cells in vitro.

Objective To study the changes and clinical value of platelet(PLT)parameters and coagulation indicators in children with severe pneumonia.Methods 97 children were divided into severe pneumonia groupⅠand severe pneumonia groupⅡ according to whether children were associated with other diseases besides severe pneumonia,and 30 healthy chil-dren were in control group.The levels of PLT count,mean platelet volume(MPV),prothrombin time(PT),activated par-tial thromboplastin time(APTT),fibrinogen(FIB),antithrombin-Ⅲ(AT-Ⅲ),and D-dimer(DD)among three groups were compared.Results The differences of PLT,MPV,DD and AT-Ⅲ activities were all significant among three groups (all P < 0.05).PLT,MPV and DD levels in group Ⅰ were all significantly higher than those of control group ([454.00±157.00]×109/L vs [300.00±63.00]×109/L ;[9.66±1.24]fL vs [8.90±0.37]fL;[0.47±0.37] mg/L vs [0.27±0.06]mg/L,respectively);AT-Ⅲ activity in groupⅠ was lower than control group([79.91 ± 20.34]% vs[107.03±8.11]%)(both P <0.05).AT-Ⅲ activity and PLT level in group Ⅱwas (66.11±11.12)%and (279.00±185.00)×109/L respectively,which were both significantly lower than group Ⅰ,MPV and DD level was (10.37± 1.51)fL and (0.70±0.46)mg/L respectively,which were both higher than groupⅠ (both P <0.05).Conclusion There is obvious coagulation dysfunction in children with severe pneumonia.The changes in PLT,MPV,AT-Ⅲ and DD levels are associated with the severity of pneumonia.

Objective To investigate the level of 25-hydroxyvitamin D[25(OH)D]and relationship to C-reactive protein(CRP) and procalcitonin(PCT)in children with severe pneumonia.Methods Serum 25 (OH)D levels of 86 cases of children with severe pneumonia,81 cases of children with mild pneumonia and 85 cases of children in healthy control group on admission were deter-mined by ELISA respectively and compared.At the same time,CRP and PCT were tested and the correlation to 25(OH)D in chil-dren with severe pneumonia was analyzed.Results There are statistical differences among three groups(P <0.05,α=0.05 ).The mean values of serum 25 (OH)D were (62.03 ±17.94),(68.90 ±15.22)and (82.21 ±17.89)μmol/L in severe pneumonia pa-tients,mild pneumonia patients and healthy children respectively,furthermore,prevalence of vitamin D deficiency of the sever pneu-monia group was significantly higher than that of the case-control group and normal group (P < 0.05,α= 0.05 ).The level of 25(OH)D was not significantly related to CRP and PCT level in children with severe pneumonia(P <0.05,α=0.05).Conclusion The mean level of vitamin D in children with severe pneumonia was significantly lower,which may be associated with the occurrence and develop-ment of severe pneumonia in children.

Objective To study the clinical value of serum N-terminal pro-brain natriuretic peptide (NT-ProBNP) and cardiac troponin I (cTnI) levels in children with severe pneumonia. Methods A total of 72 children with severe pneumonia in pediatric intensive care unit were divided into heart failure (HF) group and non-HF group according to the occurrence of heart failure, and 30 healthy children were selected as control group. Serum NT-ProBNP and cTnI levels were detected and analyzed. Results Compared with control group, NT-ProBNP and cTnI levels were signiifcantly higher (P<0.01) in HF and non-HF group. The levels of NT-ProBNP and cTnI in HFgroup were both signiifcantly higher (P<0.01) than that in non-HFgroup. Serum NT-ProBNP level was positively related to the level of cTnI(P=0.000) in children with severe pneumonia. The abnormal rate of cTnI in HF group was significantly higher (P=0.037) than that in non-HFgroup. The difference of the abnormal rate of NT-ProBNP between the two groups was not signiifcant (P=0.375), however, the abnormal rate of NT-ProBNP was signiifcantly higher (P=0.036) than that of cTnI in non-HF group. Conclusions There was obvious myocardial damage in children with severe pneumonia. NT-ProBNP and cTnI could be important serological markers to assist diagnosis of myocardial damage and its severity.

Objective To investigate the clinical value of plasmatic heparin-binding protein in early diagnosis and severity gradation of neonatal sepsis.Methods Thirty-nine patients with general sepsis,37 patients with severe sepsis and 16 patients with septic shock were recruited as corresponding study groups respectively,who all had been admitted to the Neonatal Intensive Care Units(NICU)of Hunan Children′s Hospital from December 2016 to August 2017,meanwhile,34 patients with local infection and 35 patients with non infection were enrolled as relevant control group respectively who all had been admitted to each neonatal ward in the retrospective study.The level of the heparin-binding protein(HBP), procalcitonin (PCT)and high sensitive C-reactive protein(hs-CRP)of all patients were detected respectively at the beginning of hospitalization.The difference of each group was compared by use of nonparametric statistics and the efficacy of every index on diagnosis of infection and sepsis was assessed with the receiver operating characteristic curve(ROC).Results The level of HBP in sepsis group,severe sepsis group and septic shock group HBP(H=91.764,P<0.01), PCT(H=51.757,P<0.01)and hs-CRP(H=28.418,P<0.01)are significantly higher than those in local infection group and non infection group;Plasmic HBP levels of severe sepsis group[52.35(33.65,88.15)(ng/ml)]and septic shock group[73.55(60.61,145.51)(ng/ml)]are statistically higher than general sepsis group[34.12(23.04,41.79)(ng/ml)](H=24.092, P<0.01).There are no statistically differences of serum PCT and hs-CRP among these three groups[(HPCT=1.909,Hhs-CRP=0.292),P>0.05].The area under the curve(AUC)of HBP in diagnosis of neonatal sepsis and infection are 0.885 and 0.904 respectively,more higher than PCT and hs-CRP;With the cut off value of 19.8 ng/ml,the sensitivity and specificity of HBP on diagnosis of infection are 85.7%and 82.9%respectively;the sensitivity and specificity 80.4% and 88.4% for neonatal sepsis with the cut-off value of 28.0 ng/ml respectively.Conclusion HBP probably has the better clinical value than PCT and hs-CRP in the early diagnosis and severity gradation of neonatal sepsis.