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目的探讨溶血尿毒综合征(HUS)的临床特征、实验室检查、治疗方法及影响预后的相关因素。方法回顾性分析1998-2010年本院32例HUS住院患儿临床资料,组间比较采用t检验、Wilcoxon符号秩检验、Fisher’s精确概率法。对HUS患儿预后进行多因素非条件Logistic回归分析。结果 1.HUS患儿32例分为2组。腹泻后HUS(D+HUS)占同期收治HUS的53.13%(17/32例),7例透析治疗,病死率11.76%。无腹泻HUS(D-HUS)占46.87%(15/32例),9例透析治疗,病死率6.67%。2组平均病死率9.38%。2.平均少尿及无尿持续时间D-HUS组明显长于D+HUS组(P<0.05)。3.平均接受透析时间D-HUS组明显长于D+HUS组(P<0.05)。患儿平均住院时间>15 d者D-HUS组多于D+HUS组(P=2.67×10-6)。4.少尿持续时间长、PLT低水平、BUN高水平、Scr高水平、pH值低水平与预后明显相关(Pa<0.05)。透析治疗介入较晚、LDH高水平与预后显著相关(Pa<0.01)。结论儿童D-HUS较之D+HUS病情重,病程长。少尿持续时间长、LDH高水平者病死率高。早期诊断、早期透析治疗是降低病死率的关键。
Objective To investigate the clinical features, laboratory tests, treatment and prognostic factors of hemolytic uremic syndrome (HUS). Methods The clinical data of 32 HUS inpatients from 1998 to 2010 in our hospital were retrospectively analyzed. The t-test, Wilcoxon signed-rank test and Fisher’s exact test were used to compare the two groups. The prognosis of children with HUS multivariate non-conditional Logistic regression analysis. 32 children with HUS were divided into two groups. HUS (D + HUS) after diarrhea accounted for 53.13% (17/32 cases) of HUS during the same period, and dialysis treatment was performed in 7 cases with a mortality rate of 11.76%. No diarrhea HUS (D-HUS) accounted for 46.87% (15/32 cases), dialysis treatment in 9 cases, the mortality rate of 6.67%. The average mortality of the two groups was 9.38%. The mean duration of oliguria and anuria was significantly longer in D-HUS group than in D + HUS group (P <0.05). The mean time of hemodialysis was significantly longer in D-HUS group than in D + HUS group (P <0.05). The average length of hospital stay> 15 d in D-HUS group was higher than that in D + HUS group (P = 2.67 × 10-6). 4. Oliguria has long duration, low level of PLT, high level of BUN, high level of Scr, low level of pH and prognosis (Pa <0.05). Dialysis treatment intervention later, high level of LDH and prognosis were significantly related (Pa <0.01). Conclusion Children D-HUS than D + HUS disease severity, longer duration. Oliguria for a long time, high levels of LDH high mortality. Early diagnosis, early dialysis treatment is the key to reducing mortality.