妇产科疾病中非典型溶血尿毒综合征13例临床分析

发布时间：2018-06-24 14:27

本文选题：非典型溶血尿毒综合征 + 妇产科　；参考：《中国妇产科临床杂志》2017年01期

【摘要】：目的分析妇产科疾病中非典型溶血尿毒综合征病因、临床及实验室特点和治疗及转归,为该病的诊治提供实践依据。方法回顾性分析贵州省人民医院妇产科2009年1月至2015年12月13例a HUS病因、临床表现和实验室检查结果,比较患者治疗前后的实验室指标变化情况。结果 13例非典型溶血尿毒综合征患者平均年龄为(32±6.39)岁,均与妊娠有关,其中死胎5例(38.5%)、胎盘早剥3例(23.1%)、妊娠合并高血压3例(23.1%)、妊娠合并感染2例(15.4%)。临床表现以阴道流血及血尿多见,其次是消化系统及中枢神经系统症状,皮肤黏膜出血也较常见。13例患者入院后均行妊娠终止术,并接受血浆置换、血液透析、抗感染及降压等对症支持治疗。随访3个月,9例完全有效,2例部分有效;肾功能正常9例,2例发展至终末期肾病;2例死亡,没有复发病例。11例治疗有效的患者,其治疗后血红蛋白及血小板明显升高,血肌酐、血尿素氮及乳酸脱氢酶明显降低,血清补体C3和B因子水平得到显著恢复,差异均有统计学意义(P0.001)。结论妇产科疾病中非典型溶血尿毒综合征多由异常妊娠引发,临床以阴道流血及血尿表现多见,及时去除病因,并采取血浆置换和血液透析治疗,大部分患者治疗有效,预后较好。
[Abstract]:Objective to analyze the etiology, clinical and laboratory characteristics, treatment and outcome of atypical hemolytic uremic syndrome in obstetrics and gynecology, and to provide practical basis for diagnosis and treatment of the disease. Methods the etiology, clinical manifestation and laboratory results of 13 patients with aHUS from January 2009 to December 2015 in Guizhou Provincial people's Hospital were analyzed retrospectively, and the changes of laboratory indexes before and after treatment were compared. Results the mean age of 13 patients with atypical hemolytic uremic syndrome was (32 卤6.39) years old, all of them were related to pregnancy, including dead fetus in 5 cases (38.5%), placental abruption in 3 cases (23.1%), pregnancy with hypertension in 3 cases (23.1%) and infection in 2 cases (15.4%). The clinical manifestations were vaginal bleeding and hematuria, followed by digestive system and central nervous system symptoms, and 13 patients with mucosal bleeding were treated with termination of pregnancy, plasma exchange and hemodialysis. Anti-infection and hypotension and other symptomatic support treatment. 9 cases were completely effective and 2 cases partially effective, 9 cases with normal renal function developed to end stage nephropathy 2 cases died, and 11 cases with no recurrence were treated effectively. After treatment, hemoglobin and platelets were significantly increased and serum creatinine was found. The levels of blood urea nitrogen and lactate dehydrogenase decreased significantly, and the levels of complement C3 and factor B recovered significantly (P0.001). Conclusion atypical hemolytic uremic syndrome in gynecology and obstetrics is caused by abnormal pregnancy. Vaginal bleeding and hematuria are the most common clinical manifestations. The etiology is removed in time, and plasma exchange and hemodialysis are used to treat most of the patients. The prognosis is good.
【作者单位】：贵州省人民医院妇科;贵州省人民医院肾内科;

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