儿童横纹肌溶解症的临床特征分析

Clinical characteristics of rhabdomyolysis in children

目的总结儿童横纹肌溶解症(rhabdomyolysis,RM)的病因、实验室检查及临床特点。方法回顾性收集北京大学第三医院儿科普通病房2010年1月1日至2021年3月31日收治的RM患儿的临床资料及随访情况,分析患儿的临床特点、病因分布情况、实验室检查、治疗及预后转归。结果共纳入24例患儿,男16例,女8例;年龄4~15岁(中位年龄13岁)。病因包括运动性14例(58.3%),非运动性10例(41.7%,其中感染7例,其他病因3例);运动性RM平均年龄(13.50±1.83)岁,非运动性RM平均年龄(8.60±3.72)岁,差异有统计学意义(t=3.848,P=0.002)。主要临床症状表现以肌肉酸痛、尿色异常、肌肉无力为主;血肌酸激酶(creatine kinase,CK)、血肌红蛋白均明显升高。运动性RM患儿CK值中重度升高比例高于非运动性RM患儿(P=0.009)。所有患儿均给予水化碱化治疗,除1例因原发疾病危重死亡外,其他23例患儿均治疗反应良好,随访6个月~11年均未再发RM。结论儿童RM主要病因为运动、感染多见,运动性RM常见于年长儿,运动性RM所致CK水平升高更明显,积极地水化碱化措施可避免急性肾损伤发生。儿童RM大多预后良好。

Objective To summarize the etiology,laboratory examinations and clinical features of rhabdomyolysis(RM)in children.Methods The clinical data of children with RM admitted to the pediatric general ward at Third Hospital of Peking University from January 1st,2010 to March 31st,2021 were collected.The clinical characteristics,etiology distribution,laboratory examinations,treatments and prognosis of the children were analyzed.Results A total of 24 children were included with 16 males and 8 females.The age ranged from 4 to 15 years old,with median age was 13years old.The etiology was exertional diseases in 14 cases(58.3%),non-exertional diseases in ten cases(41.7%,7 cases of infection and 3 cases of other causes).The average age of exertional RM was(13.50±1.83)years,and that of non-exertional RM was(8.60±3.72)years.There was significant difference(t=3.848,P=0.002).The main clinical symptoms were muscle soreness,abnormal urine color and muscle weakness.Serum creatine kinase(CK)and serum myoglobin were significantly increased.The proportion of CK value moderate to severe increased of exercise RM children was significantly higher than that of non-exertional RM children(P=0.009).All children were treated with hydration and alkalization.Except for one case who died of critical primary disease,the other 23 children had good treatment response,and no rhabdomyolysis was found during the follow-up.Conclusion The main causes of rhabdomyolysis in children are exercise and infection.Exertional RM is common in elder children.The increasing of CK level caused by exertional RM is more obvious.Active hydration and alkalization measures could avoid the occurrence of acute kidney injury.Most children with RM have good prognosis.