本文選題：非典型溶血尿毒綜合征 + 婦產(chǎn)科　； 參考：《中國婦產(chǎn)科臨床雜志》2017年01期

【摘要】：目的 分析婦產(chǎn)科疾病中非典型溶血尿毒綜合征病因、臨床及實驗室特點和治療及轉(zhuǎn)歸,為該病的診治提供實踐依據(jù)。方法 回顧性分析貴州省人民醫(yī)院婦產(chǎn)科2009年1月至2015年12月13例a HUS病因、臨床表現(xiàn)和實驗室檢查結(jié)果,比較患者治療前后的實驗室指標變化情況。結(jié)果 13例非典型溶血尿毒綜合征患者平均年齡為(32±6.39)歲,均與妊娠有關,其中死胎5例(38.5%)、胎盤早剝3例(23.1%)、妊娠合并高血壓3例(23.1%)、妊娠合并感染2例(15.4%)。臨床表現(xiàn)以陰道流血及血尿多見,其次是消化系統(tǒng)及中樞神經(jīng)系統(tǒng)癥狀,皮膚黏膜出血也較常見。13例患者入院后均行妊娠終止術,并接受血漿置換、血液透析、抗感染及降壓等對癥支持治療。隨訪3個月,9例完全有效,2例部分有效;腎功能正常9例,2例發(fā)展至終末期腎病;2例死亡,沒有復發(fā)病例。11例治療有效的患者,其治療后血紅蛋白及血小板明顯升高,血肌酐、血尿素氮及乳酸脫氫酶明顯降低,血清補體C3和B因子水平得到顯著恢復,差異均有統(tǒng)計學意義(P0.001)。結(jié)論 婦產(chǎn)科疾病中非典型溶血尿毒綜合征多由異常妊娠引發(fā),臨床以陰道流血及血尿表現(xiàn)多見,及時去除病因,并采取血漿置換和血液透析治療,大部分患者治療有效,預后較好。
[Abstract]:Objective to analyze the etiology, clinical and laboratory characteristics, treatment and outcome of atypical hemolytic uremic syndrome in obstetrics and gynecology, and to provide practical basis for diagnosis and treatment of the disease. Methods the etiology, clinical manifestation and laboratory results of 13 patients with aHUS from January 2009 to December 2015 in Guizhou Provincial people's Hospital were analyzed retrospectively, and the changes of laboratory indexes before and after treatment were compared. Results the mean age of 13 patients with atypical hemolytic uremic syndrome was (32 鹵6.39) years old, all of them were related to pregnancy, including dead fetus in 5 cases (38.5%), placental abruption in 3 cases (23.1%), pregnancy with hypertension in 3 cases (23.1%) and infection in 2 cases (15.4%). The clinical manifestations were vaginal bleeding and hematuria, followed by digestive system and central nervous system symptoms, and 13 patients with mucosal bleeding were treated with termination of pregnancy, plasma exchange and hemodialysis. Anti-infection and hypotension and other symptomatic support treatment. 9 cases were completely effective and 2 cases partially effective, 9 cases with normal renal function developed to end stage nephropathy 2 cases died, and 11 cases with no recurrence were treated effectively. After treatment, hemoglobin and platelets were significantly increased and serum creatinine was found. The levels of blood urea nitrogen and lactate dehydrogenase decreased significantly, and the levels of complement C3 and factor B recovered significantly (P0.001). Conclusion atypical hemolytic uremic syndrome in gynecology and obstetrics is caused by abnormal pregnancy. Vaginal bleeding and hematuria are the most common clinical manifestations. The etiology is removed in time, and plasma exchange and hemodialysis are used to treat most of the patients. The prognosis is good.
【作者單位】： 貴州省人民醫(yī)院婦科;貴州省人民醫(yī)院腎內(nèi)科;

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