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Chapter 4 CLINICO-LABORATORY FEATURES of FUNCTIONAL DISORDERS of the GASTROENTERIC TRACT At CHILDREN With LAKTAZNOJ INSUFFICIENCY

Some clinical implications of functional disorders of a gastroenteric tract (FRZHKT) at children of early age - infantile intestinal gripes (MKK), infantile regurgitations (MS), the abdominal distention, a watery chair, can be also signs laktaznoj failures (LN).

Various degree morfofunktsionalnoj dismaturities GASTROINTESTINAL TRACT which can influence both structure and current FRZHKT, and on productivity of therapy is Thus possible.

For diagnostics LN as possible reason FRZHKT for all children of the basic and control groups (OG and the KG) have been carried out the hydrogen respiratory test (VDT). By results of VDT at 23 (37 %) children OG it has been taped LN, at 39 (63 %) the test was negative. From them on thoracal feeding was 22 (95,7 %) the child, on artificial feeding - 1 (4,3 %) the child. In a drawing 19 distribution of children with LN on age is shown.

% 52,2

60


50

30,4

40

30

17,4

20

10

0

1-2 mes 3-4 mes 5-6 mes

the Drawing 19. Distribution of children with LN on age

LN it became perceptible at children of 1-2 months is more often - 12 (52,2 %), are more rare in 3-4 months - 7

(20,4 %) and 5-6 months - 4 (17,4 %).

Features of clinical semiology of functional disorders of a gastroenteric tract at laktaznoj failures

Results of a mark estimation of expression of infantile intestinal gripes (MKK) depending on age at children with LN are presented in table 17.

Table 17. Results of a mark estimation of expression MKK depending on age at children with LN

MKK 1-2 months

(n=12)

3-4 months

(n=7)

5-6 months

(n=4)

t p

Frequency of attacks

1,50±0,15

2,57±0,29

1,00±0,13

t 1-3 =3,64 < 0,002
t 1-5 =1,82 =0,090
t 3-5 =3,89 < 0,004

Rhythm MKK

1,00±0,09

1,14±0,14

1,00±0,16

t 1-3 =0,88 > 0,10
t 1-5 =0,00 > 0,10
t 3-5 =0,00 > 0,10

the Score

2,50±0,17

3,71±0,35

2,00±0,19

t 1-3 =3,50 < 0,003
t 1-5 =1,57 > 0,10
t 3-5 =3,56 < 0,007

the Mark estimation of expression MKK depending on age has shown, that frequency of attacks is more expressed at the age of 3-4 months, and their rhythm essentially did not differ. On score MKK have been more expressed at the age of 3-4 months.

Duration MKK at children with LN has on the average made 3,86±0,09 hour. The most long MKK became perceptible at the age of 3-4 months - 4,14±0,23 hour, per 1-2 months - 3,75±0,07 hour, per 5-6 months - 3,75±0,14 hour, authentic differences is not taped (p> 0,05).

Duration MKK at children with LN depending on age is presented in a drawing 20.

4,14

3,75

3,75

4,2

4,1

4

3,9

3,8

3,7

3,6


3,5

1-2 mes 3-4 mes 5-6 mes

the Drawing 20. Duration MKK at children with LN depending on age

Frequency MS depending on age had no authentic differences. Plentiful MS became perceptible at the age of 1-2 months is more often. On score MS have been more expressed at the age of 3-4 months. In table 18 comparative results of a mark estimation of expression MS depending on age are presented.

Table 18. Results of a mark estimation of expression MS depending on age

MS 1-2 months (n=12) 3-4 months (n=7) 5-6 months (n=4) t p

Frequency

2,16±0,11

2,57±0,20

2,00±0,21

t 1-3 =1,96 =0,066
t 1-5 =0,71 > 0,10
t 3-5 =1,84 > 0,10

Volume

1,91±0,08

1,85±0,14

1,00±0,15

t 1-3 =0,40 > 0,10
t 1-5 =5,59 < 0,001
t 3-5 =3,89 < 0,004

the Score

4,07±0,17

4,42±0,26

3,00±0,24

t 1-3 =1,18 > 0,10
t 1-5 =3,27 < 0,006
t 3-5 =3,62 < 0,006

Frequency of a chair at children at the age of 1-2 months was authentically above, than in 5-6 months. Results of an estimation of frequency of a chair depending on age are presented in table 19.

Table 19. Frequency of a chair depending on age

Frequency of a chair

1-2 months

(n=12)

3-4 months

(n=7)

5-6 months

(n=4)

t p

3,66±0,22

3,28±0,42

2,50±0,28

t 1-3 =0,89

t 1-5 =2,89

t 3-5 =1,29

> 0,10

= 0,012

AND gt; 0,10

In a drawing 21 expression MKK, MS and frequencies of a chair depending on age is shown.


5

4,5

4

3,5

3

2,5

2

1,5

1

0,5

0

4,07

3,66

2,5

4,42

3,71

3,28

3

2,5

2

1-2 mes 3-4 mes 5-6 mes MKK MS Frequency of a chair

the Drawing 21. Expression MKK, MS and frequencies of a chair depending on age

the Analysis of features of clinical semiology FRZHKT at children with LN has shown, that the most frequent and long MKK become perceptible in 3-4 months. MS in 3-4 months, the most plentiful is more often became perceptible - in 1-2 months. Frequency of a chair above in 1 2 months.

Data of the hydrogen respiratory test at children with laktaznoj insufficiency

According to the hydrogen respiratory test (VDT) all value of hydrogen at children with LN were authentically above, than in KG (p< 0,001). Data VDT of children with LN and KG are presented in table 20 and in a drawing 22.

Table 20. Data VDT of children with LN and KG

hydrogen Level

(ppm)

LN

(n=23)

KG

(n=40)

t p
Basal 19,17±2,57 4,57±0,68 6,80 < 0,001
In 30 minutes 24,13±2,96 6,77±0,73 7,12 < 0,001
In 60 minutes 34,00±3,29 6,52±0,61 10,50 < 0,001
the Gain in 60 minutes 14,82±1,26 1,95±0,48 11,15 < 0,001


35

30

25 19,17

20

15

10

5

0

4,57

34

6,77 6,52

0

14,82

1,95

Basal Through 30 mines Through 60 mines the Gain through 60

mines

LN KG

the Drawing 22. Data VDT of children with LN and KG

the Analysis of data VDT depending on age of children with LN has shown, that the highest level of hydrogen (basal, in 30 minutes and in 60 minutes) became perceptible at children of 1-2 months. The gain of level of hydrogen in 60 minutes after a load had no authentic differences of dependence on age (p> 0,05). Data VDT depending on age of children with LN are presented in table 21 and in a drawing 23.

Table 21. Data VDT depending on age of children with LN

hydrogen Level (ppm) 1-2 months (n=12) 3-4 months (n=7) 5-6 months (n=4)

t

p

Basal

24,58±4,00

15,00±2,41

10,25±4,13

t 1-3 =1,70 =0,10
t 1-5 =1,92 =0,07
t 3-5 =1,07 =0,31

In 30 minutes

26,66±4,97

22,57±4,20

19,25±4,42

t 1-3 =0,56 =0,58
t 1-5 =0,81 =0,43
t 3-5 =0,50 =0,62

In 60 minutes

38,91±5,51

31,57±3,31

23,50±4,66

t 1-3 =0,95 =0,35
t 1-5 =1,52 =0,14
t 3-5 =1,43 =0,18
the Gain in 60 minutes

14,33±1,86

16,57±2,60

13,25±1,70

t 1-3 =0,71

t 1-5 =0,31

t 3-5 =0,88

=0,48

= 0,75

= 0,38

ppm

45


40

38,91

35

30

26,66

25

24,58

20

15

14,33

10

5

31,57

22,57

16,57

15

23,5

19,25

13,25

10,25

Basal

Through 30 mines

Through 60 mines

the Gain through 60 mines

0

1-2 mes 3-4 mes 5-6 mes

the Drawing 23. Data VDT depending on age of children with LN

Level kalprotektina at children with laktaznoj insufficiency

the Analysis of data of level kalprotektina in a feces has shown, that at children with LN level kalprotektina authentically above, than in KG. Level kalprotektina at children with LN is presented in table 22 and in a drawing 24.

Table 22. Level kalprotektina at children with LN and KG

Level kalprotektina (mkg/g) LN

(n=23)

KG

(n=40)

t p
522,21±27,84 82,92±6,47 19,38 < 0,001


600

500

522,21

400

300


200

100

82,92

0

LN KG

the Drawing 24. Level kalprotektina at children with LN and KG

As a result of the analysis of data of level kalprotektina at children OG depending on presence LN authentic differences also have been taped. Level kalprotektina at children with LN and KG are presented in table 23 and in a drawing 25.

Table 23. Level kalprotektina depending on presence LN

Level kalprotektina (mkg/g)

FR with LN (n=23) FR without LN (n=39) t p
522,21±27,84 239,82±24,35 7,37 < 0,001


600

500

522,21


400

300

200

239,82

100

0

FR with LN FR without LN

the Drawing 25. Level kalprotektina depending on presence LN

At a level estimation kalprotektina in a feces at LN depending on age authentic differences have been taped. Level kalprotektina at the age of 1-2 months was authentically above, than in 5-6 months. Level kalprotektina depending on age is presented in table 24 and in a drawing 26.

Table 24. Level kalprotektina depending on age

Level kalpro - tektina (mkg/g) 1-2 months

(n=12)

3-4 months

(n=7)

5-6 months

(n=4)

t p

579,41±29,38

501,28±43,44

387,25±83,62

t 1-3 =1,54

t 1-5 =2,80

t 3-5 =1,35

> 0,10

= 0,014

AND gt; 0,10


700

600

500

400

579,41

501,28

387,25

300

200

100

0

1-2 mes 3-4 mes 5-6 mes

the Drawing 26. Level kalprotektina at LN depending on age

By us it is spent korelljatsionnyj the analysis between level kalprotektina in a feces and all clinico-laboratory indicators at children with LN. All statistically significant indicators (except for results bakterilogicheskogo the analysis) are presented in table 25.

Table 25. Dependence of level kalprotektina in a feces and clinico-anamnesticheskih signs at children with LN (n=23)

THE SIGN r p rs p
Age -0,56 0,005 -0,52 0,011
in Volume of regurgitations 0,54 0,007 0,55 0,006
Expression of an abdominal distention 0,47 0,022 0,43 0,039
chair Volume 0,54 0,007 0,52 0,010
the Lactemia -0,47 0,022 -0,43 0,039
Age of the beginning of symptoms 0,47 0,022 0,48 0,021
Complications in sorts -0,50 0,014 -0,53 0,010
applying Term to a breast -0,51 0,012 -0,44 0,034
Insufficient increases of weight -0,51 0,012 -0,43 0,041
Basal level of hydrogen 0,61 0,002 0,68 < 0,001
hydrogen Level in 30 minutes after a load 0,47 0,022 0,40 0,058
hydrogen Level in 60 minutes after a load 0,58 0,003 0,55 0,006

the Note: the Fat font notes statistically significant correlations

Analyzing features of clinical semiology FRZHKT at children with LN, it is possible to make following conclusions:

1. LN is more characteristic to children with FRZHKT, mainly at the age of 1-2 months (52,2 %). MKK and MS at LN are more expressed at the age of 3-4 months, and age of 1-2 months more frequent chair becomes perceptible.

2. At LN the raised level of hydrogen in exhaled air, mainly at the age of 1-2 months, and a gain of level of hydrogen in 60 minutes after a load above at the age of 3-4 months becomes perceptible.

3. At LN the raised level kalprotektina in a feces, mainly at the age of 1-2 months becomes perceptible.

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Scientific source KUBALOVA Saida Sultanovna. CLINICAL VALUE LAKTAZNOJ of INSUFFICIENCY And MICROBIC DISTURBANCES AT FUNCTIONAL DISORDERS of the GASTROENTERIC TRACT At CHILDREN of EARLY AGE. The dissertation on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg - 2014. 2014

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  4. Chapter 4 CLINICO-LABORATORY FEATURES of FUNCTIONAL DISORDERS of the GASTROENTERIC TRACT At CHILDREN With LAKTAZNOJ INSUFFICIENCY