儿童乙型流感并发横纹肌溶解症临床诊治分析  

Clinical Analysis on Influenza B Associated Rhabdomyolysis in Children

作　　者：李海华[1] 黄秋玲[1] 徐震[1] 孙杰[1] 王家蔚[1] 

机构地区：[1]浙江省湖州市中心医院儿科,313000

出　　处：《中国全科医学》2014年第15期1749-1751,共3页Chinese General Practice

摘　　要：目的总结儿童乙型流感并发横纹肌溶解症(IBAR)的临床表现、实验室检查、并发症、治疗及预后,旨在让临床医生能系统地认识该疾病。方法回顾性分析2008年9月—2013年9月湖州市中心医院儿科收治的11例儿童IBAR的临床资料。结果临床表现有发热11例,肌痛、乏力9例(2例患儿因年龄小于1岁缺乏肌痛自觉症状描述),咽痛4例,咳嗽4例,呕吐或腹泻2例,抽搐2例;尿色改变6例,少尿、无尿2例。实验室检查8例患儿白细胞计数减少,2例合并血小板计数减少。血C反应蛋白均正常。血清生化改变以肌酸激酶(CK)、乳酸脱氢酶(LDH)、肌红蛋白(Mb)升高为主。丙氨酸氨基转移酶(ALT)及肌酸激酶同工酶(CK-MB)明显升高者1例。尿Mb阳性8例,隐血阳性4例,尿常规蛋白阳性1例。5例患儿并发电解质紊乱,2例患儿并发多脏器功能障碍。予抗病毒、抗炎、碱化尿液、水化及并发症治疗。死亡1例,合并多脏器功能障碍。结论儿童IBAR罕见,临床表现不典型,并发肾衰竭预后不好,早期诊断、治疗决定其预后。Objective To summarize the clinical and laboratory manifestations,complications,therapy strategies and prognosis of influenza B associated rhabdomyolysis（IBAR） in children in order to make clinicians have a systematical recognition about the disease.Methods A retrospective analysis was conducted in patients who were diagnosed as IBAR at the Department of Pediatrics of Huzhou Central Hospital from September 2008 to September 2013.Results Clinical manifestations included 11 cases of fever,9 cases of myosalgia and debilitation（two children below one year old could not describe myalgia symptoms）,4 cases of sore throat,4 cases of cough,2 cases of vomit or diarrhea,2 cases of convulsion,6 cases of color changing of urine and 2 cases of oliguria or anuresis.Laboratory test showed that 8 cases had decreased WBC,2 cases had decreased PLT.C reactive protein was normal in all the cases.Increase of CK,LDH,Mb were the main changes of biochemical markers in serum.One case had obviously increased ALT and CK- MB.8 cases had positive urine Mb,4 cases had positive occult blood and one case had urine protein.Antiviral,anti- inflammatory,alkalizing urine,hydration and complications treatment were performed.One case died with multiple organ dysfunction.Conclusion IBAR in children is scarce,and its clinical manifestation,often combined with renal failure,is atypical with bad prognosis.Early recognition and careful medical treatment can improve prognosis.

关 键 词：儿童 流感 人 横纹肌溶解 体征和症状 

分 类 号：R726.855[医药卫生—儿科]