| 郭博慧,芦建伟,李 毅,赵 明,沈海燕,刘亚男,张俊丽.重症蜂螫伤患者的肾脏病理表现[J].,2020,(2):366-369 |
| 重症蜂螫伤患者的肾脏病理表现 |
| Renal Pathological Manifestation of Patiens with Severe Multiple Wasp Stings |
| 投稿时间：2019-04-23 修订日期：2019-05-18 |
| DOI：10.13241/j.cnki.pmb.2020.02.035 |
| 中文关键词: 蜂螫伤 急性肾小管坏死 急性过敏性间质性肾炎 |
| 英文关键词: Wasp stings Acute tubular necrosis Acute allergic interstitial nephritis |
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| 中文摘要: |
| 摘要 目的：探讨重症蜂螫伤患者的肾脏病理改变，以指导临床针对性的治疗提供参考依据。方法：通过对4例重症蜂螫伤患者的临床表现及肾脏病理做病例报告，初步了解重症蜂螫伤患者的肾脏病理改变。记录所有患者的一般情况、实验室结果、治疗过程及预后，并进行肾穿刺活检以明确病理改变。结果：所有患者均为青壮年，均出现了MODS，包括急性肾衰竭、中毒性心肌炎及急性肝损伤。3例患者的肾组织病理为急性肾小管坏死及急性过敏性间质性肾炎，病理切片中可见少量嗜酸性粒细胞及大量淋巴细胞浸润。1例患者为急性肾小管坏死，未见嗜酸性粒细胞浸润。有急性过敏性间质性肾炎的患者使用小剂量激素反应较好，使用激素后肾功能恢复时间更短。结论：在重症蜂螫伤患者肾脏损伤的过程中，除了常见的急性肾小管坏死、血管内溶血、横纹肌溶解及休克等原因外，急性过敏性间质性肾炎也起着重要的作用，对于此类患者，及时使用激素治疗可能是减轻肾脏损伤、促进肾功能恢复的有效方法。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the pathological changes of kidney in patients with severe multiple wasp stings, so as to provide reference for clinical treatment. Methods: The clinical manifestations and renal pathology of 4 patients with severe wasp stings were reported to understand the pathological changes of kidney.The general condition, laboratory results, treatment process and prognosis of all patients were recorded. Renal needle biopsy was performed to determine the pathological changes. Results: All patients were young adults with MODS, including acute renal failure, toxic myocarditis and acute liver injury. The renal histology in 3 patients were acute tubular necrosis and acute allergic interstitial nephritis, with a small amount of eosinophils and a large number of lymphocytes in pathological section.But the last one was acute tubular necrosis with no eosinophils infiltration. Patients with acute allergic interstitial nephritis had better response to low dose prednisone, and the recovery time of renal function was shorter after using prednisone. Conclusion: Besides the common causes of acute tubular necrosis, intravascular hemolysis, rhabdomyolysis and shock, acute allergic interstitial nephritis also plays an important role in the process of kidney injury with severe wasp stings. For such patients, timely use of prednisone may be an effective method to reduce renal injury and promote the faster recovery of renal function. |
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