Table of Content

20 February 2020, Volume 35 Issue 2

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Personal prevention and control of outbreaks of  corona virus disease  2019

Chen Yantian, Guo Yihua, Su Xuetang

2020, 35(2):  101-105.  doi:10.3969/j.issn.1004-583X.2020.02.001

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Corona virus disease  2019 (COVID19) outbreaks in China.  Because of the sudden outbreak,  rapid development,  large scale of the epidemic and the lack of specific drug treatment,  all provinces and cities of our country have launched the firstlevel response mechanism for major public health emergencies,  which has attracted the attention of  World Health Organization(WHO). This article discusses the prevention and control measures combined with clinical experience during the outbreak of  COVID19  to provide a reference for people from all walks of life.

Re-discussion about CT signs of novel coronavirus pneumonia

Zhang Yan1a, Nan Chengrui1b, Liu Haixia2, Li Hui3, Yang Hua1a, Liu Huaijun1a

2020, 35(2):  106-112.  doi:10.3969/j.issn.1004-583X.2020.02.002

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Objective  To search for the characteristic CT signs of the new coronavirus pneumonia(NCP) and to explore its clinical significance from the perspective of imaging pathology. Methods  CT images of 40 NCP patients in Hebei Province were collected and a total of 459 lesions in 234 lung segments on 72 sides were analyzed. Meanwhile,  CT images of totally 258 lesions in 79 lung segments on 28 sides of 20 non NCP patients randomly selected and treated in our hospital were compared with those of NCP patients above. Results  In NCP group,  the lesions were mostly located in the lower lobe of two lungs (30 cases,  accounting for 23.44%  respectively),  with bilateral involvement (32 cases,  accounting for  80.00%). The proportion of lesions involving 5 pulmonary lobes was relatively large,  with little difference in the distribution of left and right lung,  and only 1 case (2.50%)  with pleural effusion. There were significant differences between NCP group and nonNCP group in fanshaped shape,  peripheral distribution,  pulmonary hyperemia or pulmonary edema,  accompanied by vascular thickening and bronchial wall thickening. These suggested that the lesions of NCP were initially in the periphery and gradually infiltrate and fuses on the basis of fanshaped structures. And the lesions were mostly accompanied by vascular thickening and pulmonary hyperemia,  but with little bronchial wall thickening. Conclusion  The CT signs of NCP are characteristic，and they may be more likely to invade blood vessels and cause vasculitis,  which may lead to pulmonary edema and cardiopulmonary circulation disorder.

Interpretation of the consensus on Management of Patients with Inflammatory Bowel Disease during Epidemic of  Novel Coronavirus Pneumonia

Liang Xiaonan, Li Hui, Wang Dong, Zhang Xiaolan

2020, 35(2):  113-115.  doi:10.3969/j.issn.1004-583X.2020.02.003

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Novel coronavirus pneumonia (NCP) is prevalent in Wuhan, Hubei province and other areas. Patients with inflammatory bowel disease (IBD) may have difficulties in medical care due to the epidemic situation, and they are more susceptible to the virus than the healthy people. In order to ensure that  IBD patients can go through the danger  safely and smoothly, the IBD Group of  Chinese Medical Association Digestive Diseases Branch published Management of Patients with Inflammatory Bowel Disease during Epidemic of Novel Coronavirus Pneumonia. This paper will interpret the consensus  to deepen the understanding of clinicians, patients and the related personnel.

A metaanalysis: efficacy of highflow nasal  cannula  oxygen therapy in adult  patients with severe immunosuppression

Gan Wanling1, Xu Juling1, Yao Huiping2, Wen Huan1, Chen Yan1

2020, 35(2):  116-122.  doi:10.3969/j.issn.1004-583X.2020.02.004

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Objective  To systematically evaluate the efficacy of Highflow  nasal cannula oxygen therapy(HFNC)  in adult  patients with  severe  immunosuppression.Methods  Databases including PubMed, Embase, Cochrane Library, Ovid, EBSCO, WanFang, VIP, CNKI, CBM were searched by computer to collect the RCT studies about the efficacy of HFNC in adult  patients with severe immunosuppression.The retrieval time limit was from the establishment of the database to May 2019.  In order to avoid omission, the  references  included  in  the literature were  searched  manually. Revman 5.3 software was used for metaanalysis.Results  A total of 8 studies involving  1 302  patients were included. Metaanalysis  results showed that HFNC could reduce the intubation rate of patients compared with  conventional oxygen therapy (OR=0.77,  95%CI ［0.60, 0.97］,  Z=2.19,  P=0.03), but there was no statistical difference in reducing intubation rate  compared with noninvasive ventilation (OR=0.43,  95%CI［0.17,  1.08］,  Z=1.80,  P=0.07). The results of two subcombinations showed that the intubation rate of severe immunosuppressive patients  was  significantly  reduced  by  HFNC  compared with control oxygen therapy (combination:OR=0.74,  95%CI［0.58,  0.93］,  Z=2.58,  P=0.01),  but there was no significant difference in reducing mortality,  infection rate and shortening ICU  hospitalization time (case fatality rate: OR=0.84,  95%CI［0.66,  1.08］,  Z=1.34,  P=0.18,  infection rate: OR=0.80,  95%CI［0.56,  1.15］,  Z=1.19,  P=0.24,  ICU hospitalization time: OR=0.19,  95%CI［-2.51,  2.12］,  Z=0.16,  P=0.87).In sensitivity analysis HFNC could significantly reduce ICU hospitalization time compared with control oxygen therapy.Conclusion  Compared with the  control oxygen therapy,  HFNC can significantly reduce the intubation rate of patients,  but it can not reduce the mortality and infection rate of patients.

Association between rs312691 polymorphism and susceptibility to thyrotoxic periodic paralysis: a metaanalysis

Yan Tong, Zhong Xiaowei, Fu Xuquan, Li Huaqi, Liu Yidong, Huang Xiaofei

2020, 35(2):  123-128.  doi:10.3969/j.issn.1004-583X.2020.02.005

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Objective  To determine whether rs312691 polymorphism downstream of KCNJ2 confers susceptibility to thyrotoxic periodic paralysis (TPP). Methods  Pubmed,  Embase,  Wanfang Chinese Periodical Database and China National Knowledge Infrastructure were systematically searched for control study related rs312691 polymorphism to thyrotoxic periodic paralysis. A metaanalysis was conducted on the association between the rs312691 polymorphism and TPP. Results  A total of 7  comparison studies including 610 patients and 351 controls were considered in the metaanalysis. The metaanalysis showed a positive  association between TPP and allele C of the rs312691 polymorphism in all study subjects (OR=3.072，95%CI 2.5903.643，P＜0.001). Stratification by HardyWeinberg equilibrium of the control group also identified  significant positive association between this polymorphism and the susceptibility of TPP (OR=2.804，95%CI 2.3043.413,  P<0.001). Conclusion  This metaanalysis shows that the rs312691 polymorphism confers susceptibility to thyrotoxic periodic paralysis.

Clinical value of Gal3,  sST2,  and BNP in heart failure patients with preserved ejection fraction  in predicting major cardiovascular adverse events

Zhou Yi, Li Li

2020, 35(2):  129-133.  doi:10.3969/j.issn.1004-583X.2020.02.006

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Objective  To observe the clinical value of galectin3 (Gal3),  soluble suppression of tumorigenicity2 (sST2),  and brain natriuretic peptide (BNP) in heart failure with preserved ejection fraction (HfpEF) in predicting major cardiovascular adverse events(MACE).Methods  A total of 126 patients diagnosed as HfpEF and treated in our hospital were selected as HfpEF group,  and 60 healthy people who underwent physical examination in our hospital during the same period were selected as healthy control group. The serum Gal3,  sST2 and BNP levels were measured by enzymelinked immunosorbent assay (ELISA). The serum Gal3,  sST2,  BNP,  LAVI,  and LVEF were compared between two groups,  the relation among the levels of the items,  cardiac function classification and MACE,  and the sensitivity and specificity of serum Gal3,  sST2 and BNP  in predicting MACE    were also observed.Results  The levels of serum Gal3,  sST2,  BNP and LAVI in HfpEF group were significantly higher than those in healthy control group (P<0.01), and the levels increased as the rise of heart failure classification(P<0.01). The serum Gal3,  sST2,  BNP,  and LAVI in MACE group in patients with HfpEF were significantly higher than those in nonMACE group (P<0.01). The serum Gal3,  sST2 and BNP in patients with HFpEF had higher sensitivity and specificity in predicting MACE. Combined detection (Gal3+sST2+BNP) in predicting MACE had higher diagnostic efficiency,  its sensitivity and specificity were 96.4% and 91.8%,  respecticely. And its area under the curve (AUC) was significantly higher than Gal3 (Z=3.328, P<0.01),  sST2(Z=2.316, P<0.01) and BNP (Z=2.985, P<0.01). Conclusion  The serum Gal3, sST2 and BNP levels are related to the severity of HfpEF, and have important clinical value in predicting MACE.

Effects of early heparin therapy on patients with acute STsegment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Wang Haiyan1, Tian Li1, Zhao Ying2, Li Zhijuan1, Shi Jianping1, Fu Xianghua3

2020, 35(2):  134-138.  doi:10.3969/j.issn.1004-583X.2020.02.007

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Objective  To determine the effects of heparin therapy before primary percutaneous coronary intervention (pPCI) on patients with acute STsegment elevation myocardial infarction (STEMI). Methods  A total of 117 STEMI patients were consecutively enrolled and randomly divided into observation group and control group. The STEMI patients of  observation group were immediately  given intravenous injection of 5 000 U unfractionated heparin, while those in  control group received the same dose of unfractionated  heparin during the surgery. The activation time of heparin,  activated coagulation time (ACT) before PCI,  peak value of myocardial injury markers,  index of  microcirculation resistance(IMR) of myocardia,  and other evaluation indexes of myocardial perfusion were observed. Major adverse events (MAES) after the operation were also recorded. Results  Compared with the control group,  observation group had significantly earlier administration of heparin (about 28 min),  longer ACT  (P=0.000),  and lower rate of high thrombus load (25.00% vs  43.90%, P=0.032); imagingready infarct related artery(IRA) TIMI flow rate 01 lower (45.00% vs  68.40%，P=0.011),  higher rate of  TIMI myocardial perfusion grading(TMPG) 3(75.30% vs 56.10%，P=0.032),  lower IMR (P=0.007) lower peak value of CKMB(P=0.007),  and smaller perfusion defect area(PDA) (P=0.031). Conclusion  Early heparin therapy before pPCI can improve IRA opening,  reduce total myocardial ischemia time,  and myocardial infarction area,  and ameliorate myocardial perfusion.  And it does not increase the risk of MAES.

Clinical value of serum sST2,  BNP and PAPPA in predicting adverse pregnancy outcomes in pregnancyinduced hypertension patients with heart failure

Cai Huili

2020, 35(2):  139-143.  doi:10.3969/j.issn.1004-583X.2020.02.008

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Objective  To observe the clinical value of serum soluble growth stimulating factor2 (sST2),  brain natriuretic peptide (BNP),  and pregnancyassociated plasma proteinA (PAPPA) in predicting adverse pregnancy outcomes in pregnancyinduced hypertension(PIH) patients with heart failure(HF). Methods  Totally 126 PIH patients with HF in our hospital were selected as PIH&HF group. PIH patients and people having pregnancy test in our hospital during the same period were selected as PIH  group (45 cases) and normal pregnancy group (45 cases),  respectively. The serum sST2,  BNP and PAPPA levels in each group were measured by enzymelinked immunosorbent assay(ELISA). The changes of serum sST2,  BNP and PAPPA levels were observed in each group,  and  their relationship with  PIH severity, HF classification,  and adverse pregnancy outcomes in patients of PIH&HF group was also analyzed,  as well astheir diagnostic efficacy in predicting adverse pregnancy outcomes. Results  The serum levels of sST2,  BNP and PAPPA in PIH&HF group were significantly higher than those in PIH group and normal pregnancy group (P<0.01),  while the levels in PIH group were significantly higher than those in normal pregnancy group (P<0.01).The serum sST2,  BNP and PAPPA levels in PIH&HF group increased as the rise of PIH  severity and cardiac function (P<0.01). The serum sST2,  BNP,  and PAPPA levels in PIH&HF group were significantly higher in adverse pregnancy outcomes group than those in good pregnancy outcomes group (P<0.01). Conclusion  The serum sST2,  BNP and PAPPA levels are related to the severity of PIH with HF,  and have high efficacy and important clinical value in predicting adverse pregnancy outcomes.

Retrospective analysis of hemorrhage complications within 24 hours  after intravenous  thrombolysis of atropase in acute ischemic stroke

Guo Zhenyuan, Yang Xuehua

2020, 35(2):  144-147.  doi:10.3969/j.issn.1004-583X.2020.02.009

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Objective  To retrospectively investigate the hemorrhage complications within 24 hours after intravenous thrombolysis of atropase in acute ischemic stroke (AIS). Methods  The data of  200 AIS patients treated by intravenous thrombolysis of atropase were collected, including age, sex, past medical history, bad hobby,  blood sugar, blood pressure, blood fat, liver and kidney function, platelet count, coagulation functionand so on. Bleeding complications and related risk factors were analyzed after intravenous thrombolytic therapy. Results  Systematic and intracranial hemorrhage occurred in 41 of 200 patients with thrombolysis,  with a bleeding rate of 20.5%(41/200) and a cerebral hemorrhage conversion rate of only 1.5%(3/200),  There were 21 cases of gingival bleeding, 9 cases of tongue bleeding,  2 cases of tongue and gingival bleeding, 1 case of subcutaneous bleeding, 3 cases of gastrointestinal bleeding, 1 case of urinary tract bleeding, 2 cases of intrainfarction focus bleeding, 1 case of tongue and intrainfarction focus bleeding,  and 1 case of intraventricular hemorrhage. And no severely disabled or fatal case caused by bleeding was found. Multivariate regression analysis showed that atrial fibrillation was an independent risk factor for bleeding after thrombolysis(P<0.05). Conclusion  The bleeding conversion rate of intravenous thrombolysis of atropase is very low,  and atrial fibrillation is an independent risk factor for bleeding after thrombolysis. Intravenous thrombolysis of atropase is effective and safe for acute cerebral infarction,  but the treatment should be individualized.

Analysis of rebleeding after aneurysmal subarachnoid hemorrhage

Lin Na1, Cao Lei2

2020, 35(2):  148-152.  doi:10.3969/j.issn.1004-583X.2020.02.010

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Objective  To evaluate the clinical characteristics and risk factors of rebleeding after aneurysmal subarachnoid hemorrhage (aSAH), and provide guidances for the prevention of aSAH rebleeding. Methods  The clinical characteristics, imaging data, treatment and prognosis of 12 patients with rebleeding were analyzed. Results  The first symptoms of 12 patients with rebleeding were headache in 10 cases(83%),  disturbance of consciousness in 8 cases(67%),  with hunt Hess grade ⅢⅣ in 8 cases(67%) and improved Fisher grade ⅢⅣ in 10 cases (83%) on admission. A total of 7 patients (58%) had rebleeding within the first 24 hours after SAH.The mean arterial pressure after admission dramatically increased at rebleeding. The responsible aneurysms were located in the anterior cerebral artery (ACA) and anterior communicating artery (AComA) in 4 cases (33%),  and there were 5 patients (42%) of multiple aneurysms.All patients received aneurysms treatment. After SAH, acute hydrocephalus occurred in 9 cases (75%),  outdoor drainage in 6 cases (50%),  decompressive craniectomy in 1 case (8%),  and death in 5 cases (42%).Conclusion  Rebleeding after SAH has high mortality and poor prognosis.In order to reduce the disability and mortality rate,  intervention in the risk factors should be actively done.

Effects  of trazodone on mood and sleep quality in patients with Parkinson's disease

Liu Jiao1, Wang Qian1, Wang Dongyu2

2020, 35(2):  153-157.  doi:10.3969/j.issn.1004-583X.2020.02.011

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Objective  To investigate the clinical effects of trazodone on mood and sleep disorders in patients with Parkinson’s disease (PD) and observe the adverse reactions during the treatment. Methods  There were 39 patients of PD with anxiety (anxiety group),  34 cases of PD with depression (depression group),  27 cases of PD with sleep disorder (sleep disorder group),  25 cases of PD combined with anxiety,  depression,  and sleep disorders (complicated group). All patients were treated with trazodone. The patients were evaluated for anxiety,  depression,  sleep quality  before and after  treatment. The clinical effects on different groups were evaluated and the adverse reactions of patients were recorded at the same time.Results  After treatment,  the scale scores of anxiety,  depression,  and sleep in the patients were significantly lower than before,  and the scores of each scale decreased with the treatment prolonged(P<0.05).Conclusion  Trazodone can improve the mood and sleep disorder of patients significantly.

Security analysis of physical activity in vitreous hemorrhage of proliferative diabetic retinopathy

Huang Mingke, Meng Fanyi

2020, 35(2):  158-161.  doi:10.3969/j.issn.1004-583X.2020.02.012

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Objective  To investigatethe safety and potential value of physical activity in patients with proliferative diabetic retinopathy(PDR) by comparing the differences in the form and intensity of physical activity between patients with vitreous hemorrhage and those without significant vitreous hemorrhage of PDR. Methods  A total of 67 patients who had no fibroplasia of PDR were included in the study. Of which, 36 patients with early vitreous hemorrhage(<1 month) were in study group, and 31 patients without vitreous hemorrhage were in control group. Physical activities of patients were assessed by the International Physical Activity Questionnaire(IPAQ). And age, course of diabetes, best corrected visual acuity(BCVA), height, body mass index(BMI), HbA1c, lipid and blood pressure were also measured to investigate the predisposing factors of vitreous hemorrhage and compare the difference of physical activity between two groups. Results  No vitreous hemorrhage induced by physical activity was seen in 36 patients with PDR. Many patients in study lacked some physical activity. The time and number of participants of moderate or severe physical activity, total physical activity, energy consumption,leisure and sportsrelated physical activity in study group were significantly lower than those in control group(P＜0.05). Sedentary behaviorwas significantly prolonged, and sleep time was significantly shorter in study group; BMI, triglyceride, systolic blood pressure in study group were significantly higher than those in control group(P＜0.05). Conclusion  No vitreous hemorrhage induced by physical activities was seen, and different physical activities may be safe and beneficial to the PDR patients with no fibroplasia,so reducing sedentary behavior and improving sleep quality should be advocated.

Effect of endostatin combined with cisplatin on elderly cancer patients with malignant ascites

Lu Yalei1, Song Lina2, Shan Yujie1, Zhang Xiaolin3a, Jia Jinhai3b

2020, 35(2):  162-165.  doi:10.3969/j.issn.1004-583X.2020.02.013

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Objective  To adopt intraperitoneal  administration and observe the control group(Cisplatin) and combination group(endostatin combined with cisplatin)in order to see the effects on elderly patients with malignant ascites in clinical efficacy,  the improvement of life quality and immunity.Methods  Totally sixtyfour elderly patients diagnosed with malignant ascites were collected. And they were divided into control group and combination group. Patients in control group were given 30 mg of cisplatin  by intraperitoneal  administration on day 1,  day 4,  day 7,  respectively. And one cycle of treatment was  21 days. Patients in combination group were given 30 mg of cisplatin  and 45 mg of  endostatin (Endostar)  by intraperitoneal administrationon day 1,  day 4,  day 7,  respectively. And one course of treatment was 21 days. All  patients in two groups were treated for two cycles. The efficacy evaluation criteria(RECIST)was used to evaluate clinical efficacy of  two groups,  and the side effects were evaluated by NCI. The improvement of anxiety and depression was evaluated by psychological questionnaire,  and the level of CD4/CD8 was monitored before and after treatment.Results  The efficacy of  experimental group was higher than that of  control group,  which significantly improved the anxiety and depression of the patients; the CD4/CD8 of  experimental  group was not significantly lower than that of  control group. Conclusion  Endostar  combined with cisplatin can improve the remission rate of ascites without obvious side effects,  and they can also improve the state of anxiety and depression without reducing the immunity of patients.

Risk factors and drug resistance of   Carbapenemresistant  Enterobacter  in malignant tumor patients

Yin Haiqing1a, Yao Baoguo2a, Chen Wanzhen1b, Su Li2b

2020, 35(2):  166-169.  doi:10.3969/j.issn.1004-583X.2020.02.014

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Objective  To explore the risk factors and drug resistance of Carbapenemresistant Enterobacter(CRE) in malignant tumor patients  to provide a basis for the prevention and treatment of hospital infection. Methods  A retrospective analysis of 82 malignant tumors patients infected with CRE from January 2014 to December 2018 was conducted and the drug resistance was also analyzed. Besides, 165 cases of malignant tumors patients sensitive to  CRE  infection were selected as the control group. Then, logistic regression analysis was carried out  to investigate infection risk factors. Results  All patients with CRE showed a high drug resistance to cefepime and amoxicillin/clavulanic acid (>90%), and klebsiella pneumoniae had a high drug resistance to ceftriaxone and ceftazidime (>90%). And, Escherichia  coli  showed a high drug resistance to ceftriaxone (93.1%). In addition, CRE was highly sensitive to tigecycline, among which Klebsiella pneumoniae was 92.7% and the rest was 100%. Escherichia coli in CRE also had a good sensitivity to amikacin (72.4%). Logistic multiplefactor regression analysis indicated that previous use of carbapeem antibiotics was the independent risk factor for patients infected with CRE. Conclusion  CRE patients with malignant tumors have a good sensitivity to tigecycline and a high drug resistance rate. Age (great than or equal to 60 years old), chemotherapy, combined diabetes and previous use of carbapeem antibiotics are the risk factors for CRE infection. A previous use of carbapeem antibiotics is the independent risk factor for the CRE infection of malignant tumors patients. Therefore, the department of hospital infection should purposefully strength prevention and control.

Distribution and drug resistance of  Streptococcus pneumoniae infection in children

Li Xiaa, Ma Gaoxib, Hu Linglingc，Dong Fengmeib

2020, 35(2):  170-173.  doi:10.3969/j.issn.1004-583X.2020.02.015

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Objective  To explore the distribution and drug resistance of Streptococcus pneumoniae infection in children in a top three hospital. Methods  All samples from August 2018 to July 2019 were collected, including sputum, blood, cerebrospinal fluid, pleural fluid, alveolar lavage fluid, pus, pharyngeal swab, and etc (the same kind of children's samples  not  included repeatedly). Then identification and drug sensitivity test of pathogen strains were performed. Results  Among 1 903 cases of Streptococcus pneumoniae, 1 401 (73.62%) were children under 3 years old, 423 (22.20%) were children aged from 3 to 5 years old and 71 (3.73%) were children over 5 years old. The detection rate of Streptococcus pneumoniae in children within 5 years old  was  the highest, with a total of  1 832starins(96.27%). In different areas of the hospital, Streptococcus pneumoniae infection was the most common at department of paediatrics (59.85%), followed by department of respiratory (19.02%). The sputum was the most as a source of samples(79.09%),  followed by blood (7.62%). The detection rate of Streptococcus pneumoniae was the highest in winter, And the detection rate was significantly higher in autumn and winter than that in spring and summer (P<0.05).  The resistance rates of Streptococcus pneumoniae  to erythromycin, tetracycline and compound neoforman were 96.38%, 84.06% and 64.74%, respectively. No vancomycin and linezolid resistant strains were found. The sensitivity of Streptococcus pneumoniae to ceftriaxone, cefotaxime, etapamil, levofloxacin, ofloxacin, moxifloxacin and chloramphenicol was over 80%.Conclusion  Children under 5 years old are prone to Streptococcus pneumoniae  infection. Clinicians should choose antibiotics carefully and reasonably according to the results of drug sensitivity. At present, the third generation of cephalosporins can still be the first choice for treatment.

Clinical characteristics and influencing factors of EpsteinBarr virus with mycoplasma pneumoniae infection in children

Zhai Jin1,2, Xu Jun1, He Ping1, Hua Shenghao1, Feng Tao1

2020, 35(2):  174-176.  doi:10.3969/j.issn.1004-583X.2020.02.016

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Objective  To investigate the clinical characteristics and influencing factors of  mycoplasma pneumoniae (MP) infection with EpsteinBarr (EB) virus in children. Methods  The research subjects of this experiment included 87 cases of hospitalized children with EB virus complicated with MP infection as observation group. And 70 patients with simple MP infection at the same time were selected as control group. The differences in general data, laboratory results and clinical conditions between two groups were compared and analyzed. Results  EB virus combined with MP infection was mostly seen in preschool children and the gender difference was not obvious. Blood routine examination showed that white blood cells of children with MP and EB virus infection were significantly higher than thoseof children with MP infection alone (P<0.05).  Serum biochemistry showed transient elevation of AST, ALT and CKMB. Imageological examination suggested that the degree of pulmonary substantive lesion was higher in children with concurrent  infection and pleural effusion was more likely to happen. The clinical features of children with concurrent infection showed that lymph nodes were more prone to swelling, and the extension of fever duration. Conclusion  Compared with MP infection alone，the clinical manifestation of EB virus combined with MP infection is more serious and often involves multiple organs.

Clinical related factors of obese children

Li Chao1, Song Wenhui2

2020, 35(2):  177-180.  doi:10.3969/j.issn.1004-583X.2020.02.017

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Objective  To investigate the incidence of hypertension,   nonalcoholic fatty liver disease,  abnormal glucose metabolism,  and blood lipid disorders in obese children by analyzing the blood lipids,   fasting blood glucose,   fasting insulin,   liver function,   and liver color Doppler ultrasound,  to help early identification and intervention of childhood obesity.Methods  Physical examination was performed on 103 obese children,   thenthe testing results of their blood lipids,  liver function,   fasting blood glucose,   fasting insulin,   2 h postprandial blood glucose,   and liver ultrasound were analyzed.Results  The survey found that there were statistically significant differences in triglyceride,   total cholesterol,   high density lipoprotein (HDL),   low density lipoprotein,   diastolic and systolic blood pressure,   and insulin resistance index among three groups of obese children (P<0.05). With the increase of body weight,   nonHDLC,   blood pressure,   and insulin resistance index showed an upward trend,  while HDLC decreased. Of 103 obese children,  19 (18.4%)  had hypertension; 36(35.0%) had dyslipidemia; 18 (175.5%)  had abnormal glucose metabolism,  of which,   2 cases(1.9%) had type 2 diabetes,  and children with the type 2 diabetes were moderately to severely. There were 24 patients (23.3%) with nonalcoholic fatty liver,   including 14 (13.6%)  with abnormal liver function.Conclusion  Childhood obesity can cause blood glucose,  abnormal blood lipids,  insulin resistance,  which increases the risk of hypertension, nonalcoholic fatty liver and diabetes in children. The obese childern must lose their weight  and do regular physical examinations to adjust the levels of various indicators and reduce the incidence of various complications caused by obesity.