溶血尿毒综合征临床特征及影响预后因素

目的探讨溶血尿毒综合征(HUS)的临床特征、实验室检查、治疗方法及影响预后的相关因素。方法回顾性分析1998-2010年本院32例HUS住院患儿临床资料,组间比较采用t检验、Wilcoxon符号秩检验、Fisher’s精确概率法。对HUS患儿预后进行多因素非条件Logistic回归分析。结果 1.HUS患儿32例分为2组。腹泻后HUS(D+HUS)占同期收治HUS的53.13%(17/32例),7例透析治疗,病死率11.76%。无腹泻HUS(D-HUS)占46.87%(15/32例),9例透析治疗,病死率6.67%。2组平均病死率9.38%。2.平均少尿及无尿持续时间D-HUS组明显长于D+HUS组(P<0.05)。3.平均接受透析时间D-HUS组明显长于D+HUS组(P<0.05)。患儿平均住院时间>15 d者D-HUS组多于D+HUS组(P=2.67×10-6)。4.少尿持续时间长、PLT低水平、BUN高水平、Scr高水平、pH值低水平与预后明显相关(Pa<0.05)。透析治疗介入较晚、LDH高水平与预后显著相关(Pa<0.01)。结论儿童D-HUS较之D+HUS病情重,病程长。少尿持续时间长、LDH高水平者病死率高。早期诊断、早期透析治疗是降低病死率的关键。

Clinical Features and Prognostic Factors in Children with Hemolytic Uremic Syndrome

Objective To analyze the clinical features,laboratory tests,treatments and correlated factors of prognosis in children with hemolytic uremic syndrome(HUS).Methods The clinical data of 32 children with HUS hospitalized in our hospital from 1998 to 2010 were analyzed retrospectively.The t-test,Wilcoxon signed rank test,Fisher’s exact test were performed for group comparison.Logistic regression analysis was made for the prognosis of children with HUS.Results 1.Thirty-two cases of children were divided into 2 groups including the post-diarrheal HUS(D+HUS) and the non-diarrheal HUS(D-HUS).D+HUS treated in the same period accounted for 53.13%(17/32 cases),in which 7 patients received dialysis treatment and the mortality rate was 11.76%.D-HUS accounted for 46.87%(15/32 cases),in which 9 patients recerived dialysis treatment and the mortality was 6.67%.The mean mortality was 9.38%.2.D-HUS group was significantly greater than D + HUS group(P<0.05) in the average duration of oliguria and anuria.3.The average dialysis time of D-HUS group was significantly greater than D + HUS group(P<0.05).The cases of D-HUS group were more than D + HUS group(P=2.67×10-6) on the length of stay more than 15 days in inpatient.4.Higher level of BUN,higher level of Scr,lower level of PLT,lower level of pH,and longer duration of oliguria were significantly correlated with prognosis(Pa<0.05).Higher level of LDH and delayed intervention of dialysis treatment were much significantly associated with prognosis(Pa<0.01).Conclusions Children with D-HUS have much more severe condition and longer duration than D + HUS.The higher mortality is correlated with longer oliguria and higher level of LDH.Early diagnosis and dialysis treatment are the key to reducing mortality.