成人链球菌感染后溶血尿毒综合征的临床特点分析

doi:10.3969/j.issn.1002-1949.2019.10.011

Chinese Journal of Critical Care Medicine

2019, Vol. 39

Issue (10): 971-975 DOI: 10.3969/j.issn.1002-1949.2019.10.011

Clinical characteristics of hemolytic uremic syndrome after streptococcal infection in adult

Dong Gui-ying, Guo Yang, Deng Yong-mei, Zhu Ji-hong

Department of Emergency, Peking University People s Hospital, Beijing 100044, China

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Abstract Objective Analyze the clinical characteristics, diagnosis and treatment of hemolytic uremic syndrome(HUS) after streptococcus infection in adults. Methods The general condition, clinical manifestation, laboratory examination, treatment and prognosis of 9 adult patients with hemolytic uremic syndrome after streptococcal infection (including 1 case in Peking University People's Hospital and 8 cases reported in literature) were analyzed comprehensively. The clinical characteristics, treatment and prognostic factors were summarized. Results Among the 9 patients, there were 3 males and 6 females, aged 18~83 years. ① Clinical manifestations: fever in 8 cases, consciousness disorder in 1 case (case 2), all patients had different degrees of renal function damage, anemia and thrombocytopenia. ②Laboratory results: except for two patients who did not describe the results of blood smear, other patients had broken red blood cells. There were 7 cases of PLT<50×109/L and 2 cases of （50~100）×109/L. There were 4 cases of Hb < 60 g/L, 4 cases of 60~90 g/L, 1 cases of>90 g/L. LDH increased in 5 cases. In 4 cases, the decrease of haptoglobin was observed in 2 cases, ADAMTS13>10%, C3 in 4 cases and C4 in 3 cases. ③Treatment: 7 cases received blood purification treatment, of which 4 cases underwent plasma exchange and continuous venovenous hemofiltration(CVVH) hemofiltration at the same time, 2 cases underwent CVVH only, and 1 case underwent plasma exchange only. Two cases were treated with hormones. Outcome: 7 patients survived and 2 patients did not receive blood purification treatment. Conclusion Hemolytic uremic syndrome after streptococcal infection in adults is extremely rare. Plasma exchange and hormone are still the main treatment measures. Diagnosis is the key. Once confirmed, the prognosis of patients with combined treatment measures is still acceptable.

Key words： Adult Streptococcal infection Hemolytic uremic syndrome（HUS） Plasma exchange（PE）

Corresponding Authors: Guo Yang, E-mail: edguoyang@163.com

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Cite this article:

Dong Gui-ying,Guo Yang,Deng Yong-mei, et al. Clinical characteristics of hemolytic uremic syndrome after streptococcal infection in adult[J]. Chinese Journal of Critical Care Medicine, 2019, 39(10): 971-975.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2019.10.011 OR http://www.cnemergency.org.cn/EN/Y2019/V39/I10/971

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