切换至 "中华医学电子期刊资源库"

中华实验和临床感染病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (01) : 57 -61. doi: 10.3877/cma.j.issn.1674-1358.2016.01.013

临床论著

恶性疟合并溶血尿毒综合征的诊疗探讨
王爱彬1, 田地1, 蒋荣猛1, 李辉1, 王琳1, 倪亮1, 徐艳利1, 宋蕊1, 卢联合1, 陈志海1,()   
  1. 1. 100015 北京,首都医科大学附属北京地坛医院感染性疾病诊疗中心、感染病科国家临床重点专科
  • 收稿日期:2014-04-27 出版日期:2016-02-15
  • 通信作者: 陈志海

Diagnosis and treatment of hemolytic uremic syndrome in cases with Falciparum malaria

Aibin Wang1, Di Tian1, Rongmeng Jiang1, Hui Li1, Lin Wang1, Liang Ni1, Yanli Xu1, Rui Song1, Lianhe Lu1, Zhihai Chen1,()   

  1. 1. The Center of Infectious Diseases (National Clinical Key Specialty for Infection Diseases), Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2014-04-27 Published:2016-02-15
  • Corresponding author: Zhihai Chen
引用本文:

王爱彬, 田地, 蒋荣猛, 李辉, 王琳, 倪亮, 徐艳利, 宋蕊, 卢联合, 陈志海. 恶性疟合并溶血尿毒综合征的诊疗探讨[J]. 中华实验和临床感染病杂志(电子版), 2016, 10(01): 57-61.

Aibin Wang, Di Tian, Rongmeng Jiang, Hui Li, Lin Wang, Liang Ni, Yanli Xu, Rui Song, Lianhe Lu, Zhihai Chen. Diagnosis and treatment of hemolytic uremic syndrome in cases with Falciparum malaria[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2016, 10(01): 57-61.

目的

探讨恶性疟引起的溶血尿毒综合征(HUS)的诊断及治疗要点。

方法

对本院2008至2014年13例恶性疟引起的溶血尿毒综合征患者的临床特点、辅助检查及治疗情况进行回顾性分析。

结果

入组患者中男性12例,女性1例,年龄22~60岁,均符合恶性疟疾合并溶血尿毒综合征的诊断。其中10例合并脑型疟,1例合并消化道出血,2例出现呼吸循环衰竭。经抗疟原虫治疗、激素治疗、补液对症治疗以及呼吸机、血液透析滤过等,入组的13例患者中1例死亡,1例自动出院,11例治愈出院,其中5例因急性肾功能衰竭行血液透析滤过治疗肾功能恢复,随访11例治愈患者均未出现慢性肾功能损害,2例病例出现再燃。

结论

疟疾的早期诊断及治疗,对控制溶血及阻止脏器损害具有重要作用;大剂量长疗程使用蒿甲醚可增强抗疟原虫效果,早期应用激素可有效阻止溶血,减轻肾脏损害,对严重溶血、急性肾功能衰竭病例应及时采取血液透析滤过治疗,以降低病死率。

Objective

To explore the clinical features and therapeutic strategy for hemolytic uremic syndrome (HUS) associated with falciparum malaria.

Methods

The medical records of 13 patients with HUS who were admitted to Beijing Ditan Hospital, Capital Medical University from 2008 to 2014 were reviewed, retrospectively. The clinical features, auxiliary examination results and therapeutic strategy were assessed, respectively.

Results

Among the 13 cases, 12 cases were male and 1 was female; ages of the 13 patients were ranged from 22 to 60 years old. Every patient conformed to the diagnosis of HUS associated with falciparum malaria. There were 10 patients developed cerebral malaria, one case was secondary to gastrointestinal bleeding and 2 patients had respiratory and circulatory failure. After treatments of anti-malaria, hormone therapy, ventilator-assisted and continuous venovenous hemodiafiltration (CVVHDF), etc, one patient died, one patient was discharged by his own accord, and 11 patients were cured with no chronic renal damage. Five patients with acute renal failure were recovered by CVVHDF. During the follow up visiting, two of them recrudesced.

Conclusions

Early diagnosis and treatment of malaria play important roles in hemolysis and organ damage. High-dose, long period of treatment with the artemether can strengthen resistance to malaria. Early application of hormone could prevent hemolysis and alleviate kidney damage effectively. In order to reduce mortality, patients who have severe hemolysis or acute renal failure should be treated with hemodiafiltration therapy in time.

表1 13例恶性疟疾合并HUS的主要症状及体征
表2 13例恶性疟疾合并HUS主要辅助检查
[1]
中华人民共和国卫生部. 疟疾诊断标准.中华人民共和国卫生行业标准[S]. WS259-2006:3-5.
[2]
李志辉. 溶血尿毒综合征的诊断和治疗[J]. 实用儿科临床杂志,2011,26(5):386-388.
[3]
焦炳欣,华文浩,陈志海, 等. 三种检测方法在疟疾诊断和疗效中的应用评估[J]. 中国医药导报,201,27:98-102.
[4]
焦炳欣,郭杰,陈志海, 等. 荧光定量PCR技术在疟疾诊断中的应用[J/CD]. 中华实验和临床感染病杂志:电子版,2012,6(4):308-311.
[5]
陈灏珠主编. 实用内科学[M]. 12版. 北京:人民卫生出版社,2005,5,652-660.
[6]
姜新春. 重症恶性疟疾192例临床分析[J]. 中国医学创新,2010,7(15):45-48.
[7]
Nanda NK, Das BS. Presence of pro-oxidants in plasma of patients suffering from falciparum malaria[J]. Trans R Soc Trop Med Hyg,2000,94(6):684-688.
[8]
Lacerda MV, Mourão MP, Coelho HC, et al. Thrombocytopenia in malaria:who cares?[J]. Mem Inst Oswaldo Cruz,2011,8,106( Suppl 1):52-63.
[9]
区德锦,邹春燕,黄亚铭. 疟疾患者血小板减少及其机制探讨[J]. 中华传染病杂志,2012,30(6):382-384.
[10]
陈万新,樊丽华,刘军, 等. 29例疟疾病人的外周血象及骨髓象分析[J]. 中国寄生虫学与寄生虫病杂志,2003,21(5):292-294.

URL    
[11]
邹洋,冯曼玲. 疟疾合并肾功能受损临床分析[J]. 中国热带病学,2010,10(4):464-478
[12]
Wodd Health Organization. Guidelines for the treatment of malaria, second edition[EB/OL]. 2012.

URL    
[13]
Sá JM, Chong JL, Wellems TE. Malaria drug resistance: new observations and developments[J]. Essays Biochem,2011,51:137-160.

URL    
[14]
Al-Harthi SA. Malaria drug resistant:current situation with reference to Saudi Arabia[J]. J Egypt Soc Parasitol,2011,12,41(3):553-564.
[15]
易著文,张辉. 溶血尿毒综合征发病机制及诊治进展[J]. 实用儿科临床杂志,2011,26(18):1385-1387.
[1] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1061-1067.
[2] 江泽莹, 王安婷, 王姣丽, 陈慈, 周秋玲, 黄燕娟, 周芳, 薛琰, 周剑烽, 谭文勇, 杜美芳. 多种植物油组分预防肿瘤放化疗相关毒性反应的效果分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 523-527.
[3] 朴广昊, 李屹洲, 刘瑞, 赵建民, 王凌峰. 皮肤撕脱伤撕脱皮瓣活力早期评估与修复的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 528-532.
[4] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[5] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[6] 杨瑞洲, 李国栋, 吴向阳. 腹股沟疝术后感染的治疗方法探讨[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 715-719.
[7] 赵立力, 王魁向, 张小冲, 李志远. 血沉与C-反应蛋白比值在假体周围感染中的诊断价值分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 351-355.
[8] 钟广俊, 刘春华, 朱万森, 徐晓雷, 王兆军. MRI联合不同扫描序列在胃癌术前分期诊断及化疗效果和预后的评估[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 378-382.
[9] 袁媛, 赵良平, 刘智慧, 张丽萍, 谭丽梅, 閤梦琴. 子宫内膜癌组织中miR-25-3p、PTEN的表达及与病理参数的关系[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1016-1020.
[10] 陆志峰, 周佳佳, 梁舒. 虚拟现实技术在治疗弱视中的临床应用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 891-895.
[11] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[12] 岳瑞雪, 孔令欣, 郝鑫, 杨进强, 韩猛, 崔国忠, 王建军, 张志生, 孔凡庭, 张维, 何文博, 李现桥, 周新平, 徐东宏, 胡崇珠. 乳腺癌HER2蛋白表达水平预测新辅助治疗疗效的真实世界研究[J]. 中华临床医师杂志(电子版), 2023, 17(07): 765-770.
[13] 周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
[14] 李变, 王莉娜, 桑田, 李珊, 杜雪燕, 李春华, 张兴云, 管巧, 王颖, 冯琪, 蒙景雯. 亚低温技术治疗缺氧缺血性脑病新生儿的临床分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 639-643.
[15] 戴俊, 李硕, 曹影, 汪守峰, 宋红毛, 蔡菁菁, 邵敏, 陈莉, 程雷, 怀德. 鼻内镜下改良高选择性翼管神经低温等离子消融术对中重度变应性鼻炎的效果研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 689-693.
阅读次数
全文


摘要