摘要
目的探讨激素联合尿激酶治疗溶血尿毒综合征(HUS)患儿的机制及疗效。方法回顾性分析2010年1月至2016年1月苏州大学附属儿童医院肾脏风湿科收治的9例溶血尿毒综合征患儿的临床资料。其中重症7例,轻症2例,患儿入科后在对症支持治疗的基础上给予甲强龙冲击治疗(250～500 mg/d),3 d后改泼尼松(1 mg·kg^(-1)·d^(-1))口服并逐渐减量,病程中给予尿激酶抗凝治疗(1 500～2 000 IU·kg^(-1)·d^(-1))。其中4例重症HUS患儿因合并大量蛋白尿,完善肾穿刺检查示中-重度系膜增生,后续加用环磷酰胺序贯冲击治疗。结果所有患儿在抗凝过程中无明显出血倾向。7例患儿出院时血红蛋白、血小板恢复正常,肾功能尿素、肌酐正常,尿蛋白好转,血压正常。2例患儿肾功能及血红蛋白接近正常,尿蛋白、尿红细胞正常,血压略高。出院后根据病情门诊规律随诊或定期住院环磷酰胺冲击治疗。所有患儿追踪随访6～12个月,血常规、肾功能均恢复正常,血尿、蛋白尿转阴、血压降至正常,无死亡及慢性透析患儿出现。结论激素联合尿激酶治疗可改善HUS患儿的预后,减少后遗症的发生,是安全有效的。
Objective To explore the efficacy of urokinase combined with hormonal therapy on hemolytic uremic syndrome(HUS)in children.Methods Clinical data of 9 cases of hospitalized children with HUS admitted to the Department of Renal and Rheumatic Immunology in Soochow University Affiliated Children's Hospital from January 2010 to January 2016.Seven cases were severe and 2 cases were mild.All the children received methylprednisolone therapy(250 to 500 mg/d),and a succedent gradually decreased oral intake of prednisone(1 mg·kg^-1·d^-1)three days later.At the same time,all the children were given urokinase therapy(1 500 to 2 000 IU·kg^-1·d^-1).Among them,4 children with severe HUS were complicated with massive proteinuria.Renal puncture examination showed moderate to severe mesangial hyperplasia,and then the children were added with the sequential impact treatment of cyclophosphamide.Results There was no significant bleeding tendency in all children during anticoagulation.When 7 children were discharged from hospital,their hemoglobin and platelets returned to normal,urea renal function and creatinine were normal,urinary protein was improved and blood pressure was normal.The renal function and hemoglobin level of another 2 children were close to normal,urinary protein and urinary red blood cells were normal,and blood pressure was slightly higher.After discharge,regular follow-up or regular hospitalization with cyclophosphamide impact treatment was carried out according to the patients'condition.All children were followed up for 6 to 12 months,whose blood routine and renal function were restored to normal,hematuria and proteinuria turned negative,blood pressure dropped to normal,and there were no death or chronic dialysis children.Conclusions Urokinase combined with hormonal therapy can improve the prognosis of children with HUS and decrease sequelae,which is safe and effective.
作者
杨焕丹
李晓忠
张锐锋
商巧雨
唐韩云
YANG Huandan;LI Xiaozhong;ZHANG Ruifeng;SHANG Qiaoyu;TANG Hanyun(Department of Renal and Rheumatic Immunology,Xuzhou Children's Hospital,Xuzhou,Jiangsu 221000,China;Department of Kidney Immunology,Children's Hospital of Soochow University,Suzhou,Jiangsu 215000,China)
出处
《安徽医药》
CAS
2019年第2期347-350,共4页
Anhui Medical and Pharmaceutical Journal
关键词
溶血尿毒综合征
激素
尿激酶
治疗
Hemolytic uremic syndrome
Hormone
Urokinase
Treatment
