儿童横纹肌溶解症29例临床分析

目的 总结儿童横纹肌溶解症（rhabdomyolysis,RM）的诱因与病例特点,并探讨儿童RM血液净化治疗与常规水化碱化治疗之间的差异.方法 回顾性分析2010年2月至2012年10月北京儿童医院儿童重症监护病房收治的29例RM患儿的临床特点、发病诱因、实验室检查及并发症特点;分析血液净化与水化碱化治疗效果之间的差异.结果 儿童RM的临床特点较不典型.诱发RM的原发病中,最常见为感染性疾病（55.2％,16/29）,其他为先天性及遗传代谢性疾病（17.2％,5/29）,药物因素3例,中毒、糖尿病酮症、电击、剧烈运动、原因不明各1例.实验室检查血清肌酸激酶（creatine kinase,CK）明显升高,伴随电解质紊乱,以低钙、低钾、低磷为主.16例患儿（55.2％,16/29）发生急性肾损伤（acute kidney injury,AKI）.AKI组CK值明显高于13例无AKI组[（54 106±57 542） IU/L vs（16 507±13 284） IU/L,P=0.002].血液净化组（6例）CK清除速度更快,CK降低50％耗时血液净化组明显短于水化碱化组（11例）[2.0（1.5～2.5） dvs3.5（2.0～5.0）d,P=0.015];CK降至2000 IU/L以下耗时血液净化组短于水化碱化组,但差异无统计学意义[4.0（3.5 ～9.0）d vs 8.0（6.0～ 12.0）d,P=0.062].结论 儿童RM病因以感染性疾病为主;AKI和电解质紊乱为常见并发症;血液净化治疗较水化碱化治疗CK下降速度更快.

Clinical analysis of 29 children with rhabdomyolysis

Objective To evaluate the predisposing factors and clinical features of rhabdomyolysis （RM） in children and to investigate the differences in therapeutic effect between blood purification treatment and conventional hydration alkalization treatment.Methods This retrospective analysis included clinical feature,predisposing factors,laboratory examination and complications of 29 RM cases from February 2010 to October 2012 in pediatric intensive care unit of Beijing Children＇s Hospital.We also compared the differences in therapeutic effects between blood purification treatment and conventional hydration alkalization treatment.Results The clinical features of RM in children was not typical.Infectious diseases were the most common cause of RM in children （55.2％,16/29）,followed with congenital and inherited metabolic diseases （17.2％,5/29）,drug induced diseases （3 cases）,poisoning,diabetic ketoacidosis,electrical injury,strenuous exercise and unknown cause （1 case respectively）.Among the laboratory tests,blood creatine kinase （CK）was significantly increased,accompanied by electrolyte imbalances including hypocalcemia,hypokalemia,hypophosphatemia.Sixteen cases （55.2％,16/29） had acute kidney injury （AKI）.AKI group had significantly higher CK values than those without AKI （13 cases） [（54 106 ±57 542） IU/L vs （16 507 ± 13 284） IU/L,P =0.002].Blood purification enhanced the CK clearance.As compared with hydration alkalization group（11 cases）,blood purification group（6 cases） showed a shorter time duration for a 50％ reduction in creatinine clearance [2.0 （1.5 ～ 2.5） d vs 3.5 （2.0 ～ 5.0） d,P =0.015].Blood purification group also had a shorter time duration for CK lowering below 2000 IU/L,but the difference was not statistically significant [4.0 （3.5 ～9.0） d vs 8.0（6.0 ～ 12.0） d,P =0.062].Conclusion Infectious diseases are the most common cause for RM in children;AKI and electrolyte imbalance are common complications;blood purification therapy makes CK drop faster than hydration alkalization treatment.