| ObjectiveTo investigate the status of intestinal protein loss in children with acute infective diarrhea.Subjects and Methods1. Subjects1.1 Acute diarrhea group: 125 patients with acute diarrhea were researched from the Department of Gastroenterology of Guangzhou Women and Children's Medical Center between Feb.2009 and Oct.2010.All their data should be integrated.1.2 Control group. 49 children hospitalized with "gastrointestinal foreign body" or "esophageal stenosis, after the esophageal balloon enlargements" in the Department of Gastroenterology in the same period.2. Methods2.1 To collect the general data of the case and control groups, including age, gender, feeding patterns, weight and the diarrhea episode before admission.2.2 To gather the test results for their level of serum total protein (TP), albumin (ALB), and prealbumin (PA), C-reactive protein (CRP), and the routine and pathogenic examination for the stool systematically.2.3 To collect the venous blood and the 24-hour stool of case group and control group within 3 days after admission. Repeat 2 or 3 times if necessary, and then take the mean value.2.4 To measure the concentration of theα1-AT in serum and stool by Enzyme-linked immunosorbnent assay (ELISA). 2.5 Using Curve Expert 1.4 to process the ELISA results.2.6 Using SPSS 16.0 to analyze the results between acute diarrhea group and control group. The test results of TP, ALB, PA, CRP, the total volume of stool per day, theα1-AT level in serum and stool, theα1-AT clearance were expressed in x±s style. And these indexes between virus group, bacterial group and control group were analysised by One–Way ANOVA, the detection rate for intestinal protein loss between these groups was analysised by Chi-Square test or Fisher exact test; a=0.05,difference was considered statically significantly for P<0.05.2.7 To follow the prognosis for the acute diarrhea children with intestinal protein loss. To recheck the examination test for TP, ALB, PA, CRP, the total volume of stool per day, theα1-AT level in serum and stool and theα1-AT clearance.Results1. 125 children with acute infective diarrhea were researched. And the number of the rotavirus/adenovirus virus group and bacterial group was 73 and 52 respectively.2. 13 patients had intestinal protein loss within the 125 patients with acute infective diarrhea. Compared with the control group, this onset frequency was of statistically significance. The intestinal protein loss occurs in 8 cases of virus infection, 5 cases of bacterial infection.3. Compared with the control group, the mean value of TP, ALB, PA, CRP, the serum and fecalα1-AT concentration and theα1-AT clearance in virus group has no difference;But the stool volume per day and theα1-AT Clearance in virus group was significantly higher than the control group.4. Compared with control group, the mean value of TP, ALB, the fecalα1-AT concentration in the bacterial group has no difference;But the PA was significantly lower than the control group, and the CRP, serumα1-AT concentration, the whole volume of stool per day, and theα1-AT clearance was significantly higher than the control group.5. Compared with the bacterial group, the mean value of TP, ALB, and the stool volume per day, the fecalα1-AT concentrations in virus group has no difference. But the mean value of PA, CRP, the serumα1-AT concentration was significantly lower than the bacterial group; theα1-AT clearance was higher than the bacterial group. 6. Four children with intestinal protein loss entered the period of persistent diarrhea. One child was diagnosed with eosinophilic gastroenteritis through the endoscopic and pathological examinations. And the remaining three children were improved after regular treatment.ConclusionIntestinal protein loss can occur in children with acute infective diarrhea; Theα1-AT clearance in acute infective diarrhea children was significantly higher than the control group; The fecalα1-AT clearance in the rotavirus and adenovirus group was slightly higher than the bacterial group; But the fecalα1-AT concentration in acute diarrhea children and the control group has no significant difference. Objective1. To research the common risk factors for persistent and chronic diarrhea in children.2. To explore the situation for intestinal protein loss in children with persistent and chronic diarrhea and investigate the common causes for childhood with persistent or chronic and intestinal protein loss.3. To investigate the common manifestation, endoscopic features and pathological characters for the basis disease for persistent or chronic diarrhea.Subjects and methods1. Subjects1.1 Case Group: 35 patients diagnosed with persistent diarrhea and 25 patients with chronic diarrhea from the Department Gastroenterology in Guangzhou Women and Children's Medical Center between Feb.2009 and Oct.2010.1.2 Acute diarrhea Group: the same as the acute diarrhea in the first chapter.1.3 Control group: the same as the control group in the first chapter.2. Methods2.1 To collect the general data of case and control groups, including age, gender, feeding patterns, weight, maternal education level, living environment, whether to use antibiotics before admission and the family history of allergies.2.2 To gather the test results for their level of serum total protein (TP), albumin (ALB), and prealbumin(PA), C-reactive protein(CRP), and the routine and pathogenic examination for the stool systematically.2.3 To collect the venous blood and the 24-hour stool of case group and control group within 3 days after admission. Repeat 2 or 3 times if necessary, and then take the mean value.2.4 To measure the concentration of theα1-AT in serum and stool by Enzyme-linked immunosorbnent assay (ELISA).2.5 Using Curve Expert 1.4 to process the ELISA results.2.6 Using SPSS 16.0 to analysis risk factors for persistent or chronic diarrhea by chi-square test from the following aspects: age, sex, feeding patterns, maternal educational level, living environment, whether to use antibiotics and the family history of allergies by Chi-Square test or Fisher exact test; The results of TP, ALB, PA, CRP, the total volume of stool per day, theα1-AT level in serum and stool, theα1-AT clearance between the persistent group, chronic group, acute infective group and control group by One–Way ANOVA; The detection rate for intestinal protein loss between these groups was analysised by Chi-Square test or Fisher exact test; a=0.05,difference was considered statically significantly for P<0.05.Results1. The persistent or chronic diarrhea easily occurs in the younger children, and these who were gotten antibiotics in the diarrhea episode. And the persistent diarrhea was also related to the children's age, feeding patterns and maternal education.2. Allergic enteropathy and lactose intolerance are the common causes of persistent diarrhea; and the chronic diarrhea usually due to inflammatory bowel disease, eosinophilic gastroenteritis and allergic gastroenteritis.3.The persistent and chronic diarrhea group can easily undergo intestinal protein loss than the active infectious group and control group.4. Compared with the control group, TP, ALB and PA level in the persistent group was significantly reduced; CRP, FV, S-α1-AT, F-α1-AT, C-α1-AT in the persistent group was significantly higher.5. Compared with the acute infective diarrhea, TP, ALB and PA level in the persistent group was significantly reduced; F-α1-AT, C-α1-AT in the persistent group was significantly higher; There is no significance in CRP, FV and S-α1-AT. 6. Compared with the control group, TP, ALB and PA level in the chronic group was significantly reduced; FV, F-α1-AT and C-α1-AT in the chronic group was significantly higher; There is no significance in CRP and S-α1-AT between the two groups.7. Compared with the acute infective diarrhea, TP, ALB, PA and CRP level in the chronic group was significantly reduced; F-α1-AT, C-α1-AT in the chronic group was significantly higher; There is no significance in FV and S-α1-AT.8. Compared with the persistent group, TP, ALB and PA level in the chronic group was significantly reduced; F-α1-AT and C-α1-AT in the chronic group was significantly higher; there is no significance in CRP, FV and S-α1-AT between the two groups.9. The clinical manifestation in persistent and chronic group was varied.The endoscopic and pathological examinations of these diseases had specific characteristics. The treatment is mainly related to the primary disease.Conclusion1. The persistent or chronic diarrhea easily occurs in the younger children, and these who were gotten antibiotics in the diarrhea episode. And the persistent diarrhea was also related to the children's age, feeding patterns and maternal education.2. Allergic enteropathy and lactose intolerance are the common causes of persistent diarrhea; and the chronic diarrhea usually due to inflammatory bowel disease, eosinophilic gastroenteritis and allergic gastroenteritis.3. The children with persistent or chronic diarrhea easily underwent intestinal protein loss. And intestinal protein loss occurs in the chronic diarrhea more obviously than in persistent group.4. The fecal a1-AT concentration and clearance in the chronic and persistent group was significantly higher than the acute group and the control group.And the fecal a1-AT concentration and clearance in the chronic group was higher than persistent group.5. The endoscopic and pathological examinations of these children with diarrhea and intestinal protein loss had specific characteristics. And the treatment is mainly for the primary disease; The prognosis was closely related with etiologic factors and early standard treatment was necessary. |
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