滥用海洛因合并感染性心内膜炎及急性肾损伤  

Heroin abuse complicated with bacterial endocarditis and acute kidney injury

作　　者：肖观清[1] 孔耀中[1] 邵咏红[1] 刘笑芬[1] 叶佩仪[1] 黄雪芳[1] 

机构地区：[1]广东省佛山市第一人民医院肾内科,528000

出　　处：《临床肾脏病杂志》2013年第6期258-261,共4页Journal Of Clinical Nephrology

基　　金：广东省科技计划项目（2005-66）,广东省医学科研基金项目（A2007625）,佛山市重大科技攻关项目（2005080011）,佛山市重点科技攻关项目（200508001）

摘　　要：目的探讨海洛因依赖者感染性心内膜炎合并急性肾损伤的临床特点及预后。方法海洛因依赖者6例，年龄32-46岁，均为男性，均有静注海洛因史，吸毒年限2～10年。行尿吗啡定性、尿蛋白定量、肝功能、肾功能、免疫功能、丙型肝炎病毒抗体、乙型肝炎病毒表面抗原、血培养、心脏彩超及肾活检检查，予抗感染治疗，比较治疗前、后各项指标的变化。结果6例患者均表现为血象升高、贫血、血尿、蛋白尿、低蛋白血症、血肌酐升高、低补体血症、C-反应蛋白升高。丙型肝炎病毒抗体阳性5例，乙型肝炎病毒表面抗原阳性2例，血培养示金黄色葡萄球菌3例。6例患者心脏彩超均示三尖瓣前瓣赘生物形成。肾脏病理表现为中度系膜增生性肾小球肾炎、新月体性肾炎各2例，IgA肾病、毛细血管内增生性肾炎各1例。经治疗后病情均好转，血象、尿蛋白、尿素氮、肌酐明显下降，血清白蛋白明显上升，贫血、肝功能无明显变化。结论滥用海洛因可导致感染性心内膜炎并发肾小球肾炎，常合并肾病综合征、急性肾损伤，病理类型多样。经抗感染治疗后尿蛋白、肾功能明显好转。Objective To investigate the clinical characteristics and prognosis of bacterial endocarditis complicated with acute kidney injury in heroin addicts. Methods All six heroin addicts were men with 32 to 46-years-old, and intravenous injection of heroin for a period of 2 to 10 years. Following examinations were done on all patients, including qualitative urine morphine, quantitative urinary protein, liver and renal function, immune function, anti-HCV, HBsAg, blood culture, and echocardiography. All patients were subjected to renal biopsy. The changes of these indexes before and after antiinfection treatment were compared. Results All six patients were presented with leukocytosis, anemia, hematuria, proteinuria, hypoproteinemia, increased serum creatinine （SCr）, hypocomplementemia, and increased CRP. Of six patients, five were positive for anti-HCV, two positive for HBsAg, and three cases were detected for staphylococcus aureus by blood culture. Of all six patients, echocardiography showed three tricuspid valve vegetations. Renal pathology showed moderate mesangial proliferative glomerulonephritis and crescentic glomerulonephritis in two cases respectively. IgA nephropathy and endocapillary proliferative glomerulonephritis in one case respectively. After treatment, the white blood cells, urine protein, BUN and SCr were decreased significantly, and serum albumin level was increased significantly, but anemia and liver function had no significant change. Conclusions Heroin abuse can cause bacterial endocarditis complicated with glomerulonephritis, and is often associated with acute kidney injury and nephrotic syndrome. Renal biopsy shows various types of glomerulonephritis. Urinary protein is reduced and renal function improved after anti-infection therapy.

关 键 词：海洛因 心内膜炎 预后 

分 类 号：R542.42[医药卫生—心血管疾病]