巴特综合征临床分析

目的 总结巴特综合征的临床特点,探讨其发病机制.方法 回顾性分析天津医科大学总医院内分泌科2006年11月至2010年5月的6例巴特综合征病例.结果 6例患者发病年龄13～35岁,男女比例为5∶1.临床上以乏力(6/6)、发作性四肢软瘫(1/6)、肢体麻木(5/6)、手足搐搦(4/6)等为主要表现;血压正常;实验室检查出现持续性低血钾、代谢性碱中毒(6/6),有血浆肾素活性(6/6)、血管紧张素Ⅱ(6/6)及醛固酮(2/6)升高;三角肌活检病理:肌纤维肿胀变性坏死、肌细胞纤维化和肌横纹消失,多种免疫复合物沿肌膜沉积;肾穿刺病理:肾小球旁器增生(5/6)和肾脏多种免疫复合物沉积.补钾及甲泼尼龙等治疗后症状缓解.结论 巴特综合征的临床特点包括乏力、肢体麻木抽搐、正常血压、低血钾性碱中毒及高肾素活性.检查电解质、血气分析及肾素血管紧张素醛固酮水平可明确诊断.不排除免疫因素参与本疾病过程.

Abstract：

Objective To summarize the clinical characteristics of Bartter syndrome and investigate its pathogenesis. Methods The clinical data of 6 cases of Bartter syndrome at our hospital from November 2006 to May 2010 were analyzed retrospectively. Results The onset age of Bartter syndrome was 13-35years old. The main symptoms included weakness (6/6), paralysis ( 1/6 ), numbness ( 5/6 ) and tetany (4/6). All patients had normal blood pressure. The biochemical tests showed persistent hypokalemia, metabolic alkalosis (6/6) and hyperreninemia. The pathological examination of deltoid muscle biopsy showed the swelling, degeneration and necrosis of myocytes and the deposition of immunocomplex in myolemma. And the pathological examination of renal biopsy showed the hyperplasia of juxtaglomerular apparatus (5/6) and the deposition of immunocomplex.All symptoms were relieved after a therapy of potassium supplementation or a combination of indomethacin, spironolactone and immunosuppressant.Conclusion When such clinical features as weakness, paralysis, tetany, hypokalemic alkalosis and normotension are encountered, Bartter syndrome should be suspected. Serum electrolytes, blood gas analysis and activation of the renin-angiotensin-aldosterone system should be examined for a definite diagnosis. The treatment of choice includes potassium and magnesium supplementation or in combination with prostaglandin synthetase inhibitor, aldosterone antagonist and immunosuppressant. Immunologic mechanism may participate in the course of Bartter syndrome.

Clinical analysis of 6 cases of Bartter syndrome

Objective To summarize the clinical characteristics of Bartter syndrome and investigate its pathogenesis. Methods The clinical data of 6 cases of Bartter syndrome at our hospital from November 2006 to May 2010 were analyzed retrospectively. Results The onset age of Bartter syndrome was 13-35years old. The main symptoms included weakness (6/6), paralysis ( 1/6 ), numbness ( 5/6 ) and tetany (4/6). All patients had normal blood pressure. The biochemical tests showed persistent hypokalemia, metabolic alkalosis (6/6) and hyperreninemia. The pathological examination of deltoid muscle biopsy showed the swelling, degeneration and necrosis of myocytes and the deposition of immunocomplex in myolemma. And the pathological examination of renal biopsy showed the hyperplasia of juxtaglomerular apparatus (5/6) and the deposition of immunocomplex.All symptoms were relieved after a therapy of potassium supplementation or a combination of indomethacin, spironolactone and immunosuppressant.Conclusion When such clinical features as weakness, paralysis, tetany, hypokalemic alkalosis and normotension are encountered, Bartter syndrome should be suspected. Serum electrolytes, blood gas analysis and activation of the renin-angiotensin-aldosterone system should be examined for a definite diagnosis. The treatment of choice includes potassium and magnesium supplementation or in combination with prostaglandin synthetase inhibitor, aldosterone antagonist and immunosuppressant. Immunologic mechanism may participate in the course of Bartter syndrome.