14例妊娠相关溶血尿毒症综合征临床分析

doi:10.12280/gjszjk.20240380

摘要/Abstract

摘要：

目的：提高对妊娠相关溶血尿毒症综合征（hemolytic uremic syndrome，HUS）的认识及诊治水平。方法：回顾性分析2008年5月—2024年2月在天津医科大学总医院住院分娩的14例妊娠相关HUS患者的临床特征、治疗措施及预后。结果：14例患者均并发子痫前期，11例发生于产后；均出现少尿或无尿伴溶血性贫血、血小板减少及急性肾损伤；血浆疗法和连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）是主要治疗方法，经过结合低分子肝素、糖皮质激素综合治疗均好转出院，血浆置换联合CRRT治疗者远期预后较好；随访0.5~14年，1例肾移植，7例发生慢性肾脏病（chronic kidney disease，CKD），6例痊愈，无死亡病例。结论：妊娠相关HUS发病罕见，病情凶险预后极差，应尽早诊断，及时给予血液净化及综合治疗有助于病情改善。

关键词: 非典型溶血尿毒综合征, 妊娠并发症, 先兆子痫, 连续性肾替代疗法, 血浆置换

Abstract:

Objective: To improve the understanding and diagnostic and treatment level of pregnancy-associated hemolytic uremic syndrome (HUS). Methods: The clinical data of 14 patients with pregnancy-associated HUS who were hospitalized and delivered in the Tianjin Medical University General Hospital from May 2008 to February 2024 were retrospectively analyzed, including the clinical characteristics, treatment methods and prognosis. Results: Preeclampsia was complicated in all of 14 patients, in which 11 cases occurred in the postpartum period. All of 14 patients presented with oliguria or anuria with hemolytic anemia, thrombocytopenia, and acute kidney injury. Plasma exchange and continuous renal replacement therapy (CRRT) were the main treatment methods, combined with low molecular heparin, glucocorticoids and other comprehensive treatment. All of patients were discharged after effective comprehensive treatment, confirming that the plasma exchange combined with CRRT has a better long-term prognosis. Within a follow-up visit of 0.5 to 14 years, 1 case received renal transplantation, 7 cases suffered from chronic kidney disease (CKD), 6 cases were cured, and there were no fatal cases. Conclusions: Pregnancy-associated HUS as a disease of rare onset and very poor prognosis should be diagnosed as early as possible, and the timely administration of blood purification and comprehensive treatment will help to improve the conditions of disease.

Key words: Atypical hemolytic uremic syndrome, Pregnancy complications, Pre-eclampsia, Continuous renal replacement therapy, Plasma exchange

高晓丽, 苏婧, 李增彦, 李洁. 14例妊娠相关溶血尿毒症综合征临床分析[J]. 国际生殖健康/计划生育杂志, 2024, 43(6): 458-461.

GAO Xiao-li, SU Jing, LI Zeng-yan, LI Jie. Clinical Analysis of 14 Cases of Pregnancy-Associated Hemolytic Uremic Syndrome[J]. Journal of International Reproductive Health/Family Planning, 2024, 43(6): 458-461.

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