Analysis of the Efficacy of Plasma Exchange Combined with Hemodialysis on Three Cases of Postpartum Hemolytic Uremic Syndrome

doi:10.12280/gjfckx.20200681

Abstract

Abstract:

Objective: To explore the efficacy of plasma exchange (PE) combined with hemodiafiltration (HDF) on postpartum hemolytic uremic syndrome (PHUS). Methods: The clinical data of 3 cases of PHUS patients treated with PE combined with HDF admitted to Tianjin First Central Hospital from September 2017 to September 2019 were retrospectively analyzed. The changes of clinical symptoms and laboratory examination results before and after treatment were compared and analyzed, and follow-up was conducted. Results: After PE combined with HDF, the clinical symptoms of the patients were significantly improved, platelets (PLT) and lactate dehydrogenase (LDH) returned to normal, hemoglobin (Hb) and renal function both improved. Follow-up for 2-4 months showed that 2 patients recovered, while 1 patient was left with chronic renal insufficiency due to severe renal injury. Conclusions: PE combined with HDF can be used as an effective treatment for PHUS. Early diagnosis and timely treatment are conducive to the recovery of PHUS patients, which is great significance to improve the prognosis and ensure mother′s health.

Key words: Puerperal disorders, Hemolytic-uremic syndrome, Plasma exchange, Hemodiafiltration, Diagnosis, Treatment outcome

LIU Hong-yu, ZHAO Xiu-bao, LIU Wei. Analysis of the Efficacy of Plasma Exchange Combined with Hemodialysis on Three Cases of Postpartum Hemolytic Uremic Syndrome[J]. Journal of International Obstetrics and Gynecology, 2021, 48(3): 264-267.

Figures/Tables 4

References 17

[1]	Bruel A, Kavanagh D, Noris M, et al. Hemolytic Uremic Syndrome in Pregnancy and Postpartum[J]. Clin J Am Soc Nephrol, 2017,12(8):1237-1247. doi: 10.2215/CJN.00280117. doi: 10.2215/CJN.00280117
[2]	李金凤, 张震宇, 路军丽. 产后溶血性尿毒症综合征1例伴文献回顾[J]. 中国计划生育和妇产科, 2017,9(5):74-76. doi: 10.3969/j.issn.1674-4020.2017.05.21. doi: 10.3969/j.issn.1674-4020.2017.05.21
[3]	Huerta A, Arjona E, Portoles J, et al. A retrospective study of pregnancy-associated atypical hemolytic uremic syndrome[J]. Kidney Int, 2018,93(2):450-459. doi: 10.1016/j.kint.2017.06.022. doi: 10.1016/j.kint.2017.06.022
[4]	刘祉君, 张惠民, 查艳, 等. 妇产科疾病中非典型溶血尿毒综合征13例临床分析[J]. 中国妇产科临床杂志, 2017,18(1):65-66. doi: 10.13390/j.issn.1672-1861.2017.01.023. doi: 10.13390/j.issn.1672-1861.2017.01.023
[5]	许咏梅, 周信芳, 梁宝权. 产后溶血性尿毒症综合征6例临床分析[J]. 中华妇幼临床医学杂志(电子版), 2014,10(4):118-120.doi: 10.3877/cma.j.issn.1673-5250.2014.04.029. doi: 10.3877/cma.j.issn.1673-5250.2014.04.029
[6]	苏华燕, 曾蕾. 血浆置换治疗HELLP综合征并发多脏器功能障碍综合征疗效分析[J]. 吉林医学, 2016,37(3):527-529. doi: 10.3969/j.issn.1004-0412.2016.03.005. doi: 10.3969/j.issn.1004-0412.2016.03.005
[7]	刘利江. 连续性血液透析滤过与间歇性血液透析治疗肾衰竭的临床疗效观察[J]. 临床医药文献电子杂志, 2019,6(50):53. doi: 10.16281/j.cnki.jocml.2019.50.037. doi: 10.16281/j.cnki.jocml.2019.50.037
[8]	钟耀翠. 慢性肾衰竭尿毒症应用高通量血液透析与血液透析滤过进行治疗的效果比较[J]. 中国医学创新, 2018,15(7):8-12. doi: 10.3969/j.issn.1674-4985.2018.07.003. doi: 10.3969/j.issn.1674-4985.2018.07.003
[9]	姚运海, 甘建和, 赵卫峰. 血浆置换联合持续性肾脏替代治疗对HBV相关慢加急性肝衰竭合并急性肾损伤患者预后的影响[J]. 临床肝胆病杂志, 2019,35(5):1065-1069. doi: 10.3969/j.issn.1001-5256.2019.05.026. doi: 10.3969/j.issn.1001-5256.2019.05.026
[10]	王琦, 卢光新, 胡俊华, 等. 床旁血浆置换联合血液滤过治疗高脂血症性重症急性胰腺炎的临床分析[J]. 中华胰腺病杂志, 2018,18(5):343-345. doi: 10.3760/cma.j.issn.1674-1935.2018.05.013. doi: 10.3760/cma.j.issn.1674-1935.2018.05.013
[11]	孟启勇. 血浆置换联合血液透析滤过治疗重型肝炎肝肾综合征的临床效果观察[J]. 吉林医学, 2019,40(6):1351-1352. doi: 10.3969/j.issn.1004-0412.2019.06.090. doi: 10.3969/j.issn.1004-0412.2019.06.090
[12]	刘莉, 吕蓉蓉, 陈光耀, 等. 35例小儿肝功能衰竭PE联合CVVHDF技术治疗的疗效及预后分析[J]. 肝脏, 2019,24(9):1028-1031. doi: 10.3969/j.issn.1008-1704.2019.09.016. doi: 10.3969/j.issn.1008-1704.2019.09.016
[13]	孙慧芝. 单纯血浆置换和血浆置换联合血液滤过治疗重症肝炎的效果[J]. 临床医药文献电子杂志, 2020,7(40):43.
[14]	李鑫, 张竹华, 李潘孝. 血浆置换联合血液滤过治疗爆发性药物性肝炎的疗效分析[J]. 中外医疗, 2019,38(4):69-71. doi: 10.16662/j.cnki.1674-0742.2019.04.069. doi: 10.16662/j.cnki.1674-0742.2019.04.069
[15]	李国梁, 索朗曲珍, 党宗辉, 等. 西藏自治区产后溶血性尿毒症综合征11例临床分析[J]. 中华围产医学杂志, 2018,21(9):599-603. doi: 10.3760/cma.j.issn.1007-9408.2018.09.005. doi: 10.3760/cma.j.issn.1007-9408.2018.09.005
[16]	Kourouklaris A, Ioannou K, Athanasiou I, et al. Postpartum thrombotic microangiopathy revealed as atypical hemolytic uremic syndrome successfully treated with eculizumab: a case report[J]. J Med Case Rep, 2014,8:307. doi: 10.1186/1752-1947-8-307. doi: 10.1186/1752-1947-8-307
[17]	Goodship TH, Cook HT, Fakhouri F, et al. Atypical hemolytic uremic syndrome and C3 glomerulopathy: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference[J]. Kidney Int, 2017,91(3):539-551. doi: 10.1016/j.kint.2016.10.005. doi: 10.1016/j.kint.2016.10.005

病例	年龄（岁）	孕产次	孕龄（周）	妊娠合并症	分娩方式	产后发病时间（d）	起病时血压（mmHg）	起病时尿蛋白
1	27	G₁P₀	35⁺³	轻度子痫前期,尿蛋白+	剖宫产	2	151/99	++
2	31	G₁P₀	35⁺⁶	重度子痫前期,尿蛋白+++	剖宫产	1	150/100	++++
3	29	G₁P₀	足月	产后活动性出血,子宫全切术后	顺产	3	160/90	++

病例	年龄（岁）	孕产次	孕龄（周）	妊娠合并症	分娩方式	产后发病时间（d）	起病时血压（mmHg）	起病时尿蛋白
1	27	G₁P₀	35⁺³	轻度子痫前期,尿蛋白+	剖宫产	2	151/99	++
2	31	G₁P₀	35⁺⁶	重度子痫前期,尿蛋白+++	剖宫产	1	150/100	++++
3	29	G₁P₀	足月	产后活动性出血,子宫全切术后	顺产	3	160/90	++

时间	溶血指标			肾功能指标
时间	Hb（g/L）	LDH（U/L）	PLT（×10⁹/L）	肌酐（μmol/L）	尿素氮（mmol/L）	24 h尿量（mL）
治疗前	66.00±9.85	2 841.63±882.97	32.33±2.52	353.35（285.43,371.97）	15.63±3.93	250.00（130.00,2 125.00）
治疗后	97.33±0.57	285.46±149.11	228.67±31.97	180.10（134.55,1 257.61）	8.15±3.05	2 150.00（2 150.00,2 225.00）
t或T	5.418	4.430	10.410	6.000	1.976	4.000
P	0.032	0.047	0.009	0.250	0.187	0.500

时间	溶血指标			肾功能指标
时间	Hb（g/L）	LDH（U/L）	PLT（×10⁹/L）	肌酐（μmol/L）	尿素氮（mmol/L）	24 h尿量（mL）
治疗前	66.00±9.85	2 841.63±882.97	32.33±2.52	353.35（285.43,371.97）	15.63±3.93	250.00（130.00,2 125.00）
治疗后	97.33±0.57	285.46±149.11	228.67±31.97	180.10（134.55,1 257.61）	8.15±3.05	2 150.00（2 150.00,2 225.00）
t或T	5.418	4.430	10.410	6.000	1.976	4.000
P	0.032	0.047	0.009	0.250	0.187	0.500