8例溶血性尿毒症综合征临床分析

Clinical analysis of eight cases with hemolytic uremic syndrome

目的探讨溶血性尿毒症综合征（HUS）的临床特点和治疗方法。方法回顾性分析自1997年12月至2007年12月收治的8例HUS患者的临床特点及治疗方法。结果成人7例，儿童1例。诱因为产后3例，呼吸道感染2例，肠道感染1例，呼吸道合并肠道感染1例，无明显诱因1例。8例均表现为溶血性贫血、血小板减少和急性肾衰竭。病情属重型5例，轻型3例。肾损害表现为少尿1例，无尿2例，肉眼血尿3例，高血压8例，水肿6例。8例均采用综合治疗：抗感染、降压等一般治疗；血液透析、改善肾循环、血液灌流、血浆置换、新鲜冰冻血浆输注以及肾上腺皮质激素等。2例治愈，4例好转，2例病情恶化放弃治疗。治疗后血液系统及生化指标均有改善，血红蛋白（Hb）、血小板（PLT）、血肌酐（SCr）、总胆红素（TBIL）、血乳酸脱氢酶（LDH）与治疗前比较，差异有统计学意义（P〈0．05）。结论HUS较罕见，属临床急症，早期诊断、及时正确治疗有助于改善短期预后。

Objective To explore the clinical feature and therapy of 8 cases of hemolytic uremic syndrome （HUS）. Methods The clinical data of 8 cases of HUS in our department from December 1997 to December 2007 were analyzed. Results Among the 8 patients, there were 7 adults and one child. The possible inducement included postpartum （3 cases）, upper respiratory infection （2 cases）, intestinal infection （one case）, upper respiratory combined with intestinal infection （one case）. All patients presented the typical characteristics of microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Three patients suffered from fever and 5 patients had central neurological impairment. There were 3 patients with serious type and 5 with slight type. Renal impairments included oliguresis （one case）, anuresis （2 cases）, gross hematuresis （3 cases）, hypertension （8 cases） and edema （6 cases）. All patients received combined therapy, including anti-infection and controlling blood pressure, hematodialysis, prostaglandin E1, hemoperfusion, plasma exchange, fresh frozen plasma, adrenal cortical hormone, etc. Two patients were cured, 4 patients were improved and the other 2 patients gave up treatment. Hematological and biochemical indicators （Hb, PLT, SCr, TBIL, LDH） were all improved after therapy. Conclusions HUS is a rare and severe syndrome. Early diagnosis and correct therapy could improve the short-term outcome.