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26例儿童横纹肌溶解综合征致急性肾衰竭临床分析
Acute renal failure caused by rhabdomyolysis in children: a clinical analysis of 26 cases
目的 探讨儿童横纹肌溶解综合征 （RM）致急性肾衰竭 （ARF）的临床特点及预后。方法 对77例RM患儿中合并ARF 的26例患儿的临床资料、实验室检查、治疗转归进行分析。结果 合并ARF的26例RM患儿病因均为非创伤性疾病，感染 （69%）、糖尿病 （12%）、代谢性疾病 （8%）是前3位病因。合并ARF的RM患儿出现频率前5位的临床表现包括发热 （69%）、多脏器功能障碍 （69%）、抽搐 （46%）、少尿或无尿 （35%）、茶色尿 （27%）。26例合并ARF的RM患儿血肌酸激酶 （CK）均 > 1000IU/L，伴AST升高的26例，ALT升高的25例，CK-MB升高的25例，LDH升高23例。合并ARF的RM患儿中22例检测了血肌红蛋 （Mb），均有增高。合并ARF的26例RM患儿CK降至1000IU/L以下的平均时间为10±5d。常规治疗基础上接受持续静脉-静脉血液滤过治疗的10例患儿的CK恢复时间与非血液净化治疗者的差异无统计学意义 （P > 0.05）。合并ARF的26例RM患儿中7例放弃治疗，19例肾功能均恢复正常。结论 急性肾衰竭及多脏器功能障碍是儿童RM的主要并发症，合并ARF的RM患儿原发病主要是感染性疾病，CK是诊断RM的主要指标。早期诊断、合理治疗可使ARF逆转，改善预后。
Objective To investigate the clinical features and prognosis of acute renal failure (ARF) caused by rhabdomyolysis (RM) in children. Methods A retrospective analysis was performed for the clinical data, laboratory examination, and prognosis of 26 RM children with ARF. Results The causes for all 26 RM children with ARF were non-traumatic diseases, and the three most common causes were infection (69%), diabetes (12%), and metabolic disease (8%). In the RM children with ARF, the five most frequent clinical manifestations were fever (69%), multiple organ dysfunction syndrome (69%), convulsion (46%), oliguria or anuria (35%), and tea-colored urine (27%). All 26 children had a serum creatine kinase (CK) level of >1 000 IU/L, among whom 26 had increased aspartate aminotransferase, 25 had increased alanine aminotransferase, 25 had increased creatine kinase isoenzyme, and 23 had increased lactate dehydrogenase. Serum myoglobin (Mb) was measured in 22 children and was found to increase in all these children. The mean time for CK to decrease to below 1 000 IU/L was 10±5 d. There was no significant difference in the time to CK recovery between the 10 children who were treated with conventional treatment as well as continuous venous-venous hemofiltration and those who were not treated with blood purification (P > 0.05). Of all 26 RM children with ARF, 7 were withdrawn from the treatment, and 19 had normal renal function after treatment. Conclusions ARF and multiple organ dysfunction syndrome are major complications in RM children. The major primary disease for RM children with ARF is infectious disease. CK is the major marker for the diagnosis of RM. Early diagnosis and appropriate treatment may reverse ARF and improve prognosis.
横纹肌溶解综合征 / 急性肾衰竭 / 血液净化 / 肌酸激酶 / 肌红蛋白 / 儿童
Rhabdomyolysis / Acute renal failure / Blood purification / Creatine kinase / Myoglobin / Child
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