摘要
目的评价血浆置换对儿童溶血尿毒综合征（HUS）的治疗效果。方法回顾性分析2002年1月至2014年1月在中国医科大学附属盛京医院儿肾科住院的20例HUS患儿的临床资料，其中男12例，女8例，年龄2～10岁，全部患儿入院后给予红细胞输注、丙种球蛋白、甲强龙冲击等治疗，效果不佳者行血浆置换治疗，置换后全部患儿序贯糖皮质激素口服或联合应用免疫抑制剂治疗。观察血浆置换前后临床表现、实验室检查，并进行远期随访。结果20例患儿中置换1次8例，2次8例，3次2例，4次2例，其中5例联合血液透析治疗。血浆置换治疗后。患儿临床症状缓解。患儿血红蛋白、乳酸脱氢酶、肌酐、尿素、胆红素水平在血浆置换前后差异有统计学意义（P〈0．05）。1例中途放弃治疗，余19例全部存活，随访0．5～13年，17例血尿常规、肾功能恢复正常，血压持续稳定，病情无复发。1例出现长期高血压，肾功能正常。1例出院3年后复发，未经血浆置换保守治疗后痊愈，已随访10年，血尿常规、肾功能、血压等均正常。结论血浆置换是治疗溶血尿毒综合征的有效手段。
Objective To assess the efficacy of therapeutic plasma exchange（TPE） in pediatric hemolytic uremic syn- drome （HUS）. Methods A retrospective analysis was done in 20 HUS pediatric patients （2-l0 years old） who were hospitalized in Pediatric Nephrology Department of Shengjing Hospital over a period of 13 years （2002 - 2014）.TPE pro- cedures were done after the transfusion of red blood cell and gamma globulin and methylprednisolone pulse therapy, then they were treated with oral glucocorticoid or combined with immunosuppressive treatment sequentially.Pre-and post-pro- cedual symptoms,laboratory profiles and follow-up studies were analyzed to assess the response to TPE therapy. Results 1.1 TPE procedure was carried out once on eight pediatric patients, twice on eight patients, 3 times on two patients and 4 times on two patients; five patients were also performed hemodialysis. All patients were complete responders to TPE procedures. 2.The level of hemoglobin, LDH, ereatinine, urea nitrogen and bilirubin were improved significantly （P 〈 0.05 ） after treatment. 3.Out of 20 patients, 1 was loss of follow-up, the other 19 all survived. During the follow-up of 0.5 to 13 years, 17 patients were in normal condition; 1 patient was with hypertension, but the renal function was normal; 1 patient had a relapse after 3 years, but got well under the conservative treatment and remained normal during the 10- year follow-up. Conclusion Therapeutic plasma exchange is effective in the treatment of patients with HUS.
出处
《中国实用儿科杂志》
CSCD
北大核心
2015年第11期859-863,共5页
Chinese Journal of Practical Pediatrics
关键词
溶血尿毒综合征
血浆置换
儿童
hemolytic uremic syndrome
therapeutic plasma exchange
child
