肾综合征出血热临床诊疗进展

肾综合征出血热（Hemorrhagic fever with renal syndrome，HFRS）为布尼亚病毒科汉坦病毒属中的某些病毒感染引起的自然疫源性疾病。本文从HFRS发病机理、临床表现、早期诊断原则以及各期的治疗进行介绍。     

Pulmonary edema in patients with hemorrhagic fever with renal syndrome]

Eight patients suffering from hemorrhagic fever with renal syndrome (HFRS) running a severe course complicated by pulmonary edema developed absolute hyperhistaminemia and hyperserotoninemia, histamine and serotonin accumulation in tissues. These amines inactivation in blood and lungs and excretion of catecholamines with urine got disturbed. High blood and lung tissue levels of biologically active substances resultant in enhanced permeability of the vascular wall and alveolar epithelium, hemodynamic disturbances due to hypoexcretory hypercatecholaminemia are thought to underlie the occurrence of this grave HFRS complication.     

Diagnosis of hemorrhagic fever with renal syndrome

The authors observed 22 patients with hemorrhagic fever with the renal syndrome (HFRS). The diagnosis turned out to be difficult in outpatient clinics as all the patients were referred to hospital with erroneous diagnoses. Epidemiological causes of infection of HFRS were indicated. The authors singled out 3 periods in a course of this disease with characteristic symptoms. The diagnosis was confirmed serologically in the reaction of indirect immunofluorescence, a 4-fold increase and over in antibody titer was observed. A case history was presented.     

Outcome of antibiotic therapy in patients with hemorrhagic fever with renal syndrome

AIM: To evaluate effects of antibiotics in the treatment of hemorrhagic fever with renal syndrome (HFRS). MATERIAL AND METHODS: Clinico-laboratory comparisons were conducted in patients with HFRS who received antibiotics (n = 153) and did not (n = 104) in combined treatment of their disease. RESULTS: HFRS patients treated with antibiotics had weakness, poor appetite, hyperemia of the face, enanthema, hemorrhagic eruption, coated tongue, abdominal distention, thirst, xerostomia, oligoanuria, polyuria significantly longer. Antibiotics raise blood levels of urea and creatinine, urinary levels of protein, ESR, later normalization of renal function, number of plasmic cells and eosinophils, etc. CONCLUSION: This study evidently shows a negative influence of antibiotics on the course of hemorrhagic fever with renal syndrome.     

异搏定对肾综合征出血热急性肾功能衰竭的防治作用研究

目的：为了有效降低肾综合征出血热（ＨＦＲＳ）的病死率，探讨异搏定预防ＨＦＲＳ急性肾功能衰竭（急性肾衰）的疗效。方法：采用匹配比较方法，观察异搏定对ＨＦＲＳ患者急性肾衰的临床疗效。治疗组和对照组各８０例，两组患者年龄、性别、入院时病程、早期预定病情程度和肾损害情况均相似（Ｐ均＞０．０５）。两组均用以平衡盐液为主的综合液体疗法、对症、利尿等治疗；在此基础上治疗组加用异搏定注射液。连续观察尿量、血小板数和血尿素氮的变化；检测两组患者血浆内皮素（ＥＴ）和血清尿调蛋白（ＴＨＰ）值的变化。结果：治疗组治疗后第１天尿量即明显增加，迅速进入多尿期，越少尿期率高达９５％，明显优于对照组（Ｐ＜０．０５），且尿蛋白消失和尿素氮恢复正常早，并发症少，病死率低，与对照组比较均有显著性差异（Ｐ均＜０．０１）；血浆ＥＴ及血清ＴＨＰ在治疗后治疗组均低于对照组（Ｐ均＜０．０１）。结论：①异搏定有阻止ＨＦＲＳ肾脏病理改变进程，提高越少尿期率的作用。②治疗组治疗后ＥＴ值明显低于对照组，说明血浆ＥＴ可能参与了ＨＦＲＳ的发病过程；ＴＨＰ治疗后治疗组亦明显低于对照组，这也证实了异搏定对保护肾脏功能，缩短肾衰病程有重要作用。     

肾综合征出血热病患者肾血流动力学的彩色多普勒检测

目的探讨肾综合征出血热（HFRS）病程各期几项超声检测指标的临床意义。方法二维超声显像和彩色多普勒超声对经血清IGM抗体证实的48例HFRS患者和42例健康人的肾脏进行检查,对比分析HFRS各期肾实质厚度、主肾动脉、叶间动脉、段动脉及弓形动脉的血流动力学及主肾动脉血流量的变化。结果HFRS发热期,肾实质增厚,各级肾动脉的血流参数及肾血流量与对照组比较差异无显著性;少尿期、移行期及多尿期,肾实质厚度、各级肾动脉的各项血流参数及主肾动脉血流量与对照组比较有统计学意义,随病程的进展有其自身规律。结论二维超声在HFRS的早期诊断中有重要意义,主肾动脉的阻力指数与肾血流量结合对临床补液有指导作用,HFRS各期肾各级分支动脉的血流参数与主肾动脉的血流参数有类似的意义,考虑日常工作中用主肾动脉的血流参数替代各级分支动脉的血流参数。     

连续性肾脏替代疗法在重症肾综合征出血热少尿期的应用

目的评价和比较连续性肾脏替代疗法与血液透析在重症肾综合征出血热少尿期治疗中对预后的影响.方法 31例重症肾综合征出血热少尿期患者分为两组,采用CVVH治疗者11例为治疗组,血液透析治疗20例为对照组,两组性别、年龄及肾功能均匹配,分别观察两组患者的预后和并发症的发生情况. 结果两组在预后和并发症方面有明显差别,治疗组11例全部存活,仅一例合并感染.对照组出现并发症15例;主要为出血、感染、低血压、失衡综合征和二次肾功能衰竭,其中3例因二次肾功能衰竭而死亡. 结论连续性肾脏替代疗法较血液透析有更好的清除尿毒症毒素, 纠正水、电解质、酸碱平衡失调及清除炎性介质的作用, 可减少并发症. 作为治疗重症肾综合征出血热少尿期的有效方法, 可替代血液透析.     

The diagnostic significance of alveomucin in patients with hemorrhagic fever with renal syndrome

The article considers the results of analysis of serum alveomucin levels in 97 patients with hemorrhagic fever with renal syndrome depending on the form and period of disease. It is demonstrated that in patients with hemorrhagic fever with renal syndrome and clinical radiologic symptoms of lung affection already in initial period of disease the level of serum alveomucin is reliably higher than in the control group and the group of patients with hemorrhagic fever with renal syndrome and without lung affection. The correlation analysis revealed the reverse dependence between the level of alveomucin and arterial blood saturation with oxygen in patients with hemorrhagic fever with renal syndrome and disease form of medium severity.     

Tubulointerstitial changes in patients with a history of hemorrhagic fever with renal syndrome

Altogether 85 patients with a history of hemorrhagic fever and the nephrotic syndrome (HFNS) were examined at different stages after the disease, characterizing the status of the tubulointerstitial apparatus of the kidneys. Almost half of the patients who suffered this disease manifested a decrease in the capacity of the kidneys for osmotic concentration of urine under the conditions of deprivation for 36 hours, and in acid-secretory function of the kidneys under induced acidosis and clearance of uric acid. Ultrasonic studies demonstrated that part of the patients had uni- or bilateral indurations in the renal parenchyma. In 16% of the examined, these alterations may be related to superaddition of pyelonephritis after HFNS. The nature of tubulointerstitial lesions remains unknown in other cases and thus requires a further study. The recovery of tubular functions of the kidneys following HFNS continues for 3 years. In view of this fact patients with a history of this disease need prolonged follow-up.