肾综合征出血热合并急性胰腺炎2例及文献复习

Two Cases Report of HFRS Complicated with AP and Literature Review

目的:提高对肾综合征出血热合并急性胰腺炎的认识。方法:报道2例肾综合征出血热合并急性胰腺炎患者的诊疗资料,并结合相关文献对其可能的发病机制、临床特征、诊疗方式及可能有关的预后因素进行分析。结果:患者因发热、腰痛、头痛入院,结合血小板低、肾功能损伤及肾综合征出血热特异性抗体IgM、IgG阳性,诊断为肾综合征出血热。但患者腹痛、恶心、呕吐,用肾综合征出血热的一元论观点难以解释,完善血清淀粉酶、脂肪酶检查,腹部CT提示胰腺炎,最终确诊。其中1例行有创呼吸机辅助呼吸,床旁持续血液滤过治疗后出现多器官功能衰竭死亡,另1例转上级医院后1周随访,同样因出现多器官功能障碍家属放弃治疗。检索国内外文献15篇,报道肾综合征出血热合并急性胰腺炎共39例,37例(94.9%)患者无传染源接触史,3例(7.7%)误诊,5例(12.8%)行床旁持续血液滤过治疗。肾综合征出血热还可合并其他疾病,包括肺水肿、横纹肌溶解等。结论:肾综合征出血热合并急性胰腺炎较少见,临床特征、实验室检查及腹部CT对诊断极为重要,以提高对该病的认识,提高医师早诊断早治疗能力,降低患者死亡率。

Objective:To understand the hemorrhagic fever with renal syndrome(HFRS)complicated with acute pancreatitis(AP).Methods:The diagnosis and treatment of 2 cases of HFRS complicated with AP were reported,and the possible pathogenesis,clinical features,diagnosis,treatment and prognostic factors were analyzed.Results:The 2 patients have fever,backache,abdominal pain,bleeding specific antibody IgG and IgM positive,blood amylase elevated,and abdominal CT were considered HFRS complicated with AP;one patient died of multiple organ failure due to invasive ventilator-assisted respiration and bedside continuous hemofiltration treatment;the other case was transferred to a superior hospital,but had multiple organ dysfunction one week later,and the family members decided to give up.15 literatures at home and abroad were searched,including 39 cases of HFRS complicated with AP,37 cases(94.9%)had no contact history of infectious source,3 cases(7.7%)were misdiagnosed,and 5 cases(12.8%)were treated with bedside continuous hemofiltration.HFRS can also complicated with other diseases,including pulmonary edema,rhabdomyolysis,etc.Conclusion:HFRS complicated with AP is rare.Clinical features,laboratory examination and abdominal CT are very important for diagnosis.To improve the understanding of the disease,early diagnosis and early treatment is the key to reduce mortality.