Abstract
Keeb kwm: Daim ntawv qhia no qhia txog ib qhotxawv txawv ua rau lub raum tsis ua hauj lwm ina yav tas los tus neeg mob noj qab nyob zoo. Nws tau tsim thrombotic microangiopathy (TMA) uas tau kuaj pom tom qab yug me nyuam, yuav tsum tau lim ntshav thiab eculizumab, nrog rau kev rov ua haujlwm ntawm lub raum ([chronic raum (CKD) theem 3].
Cov ntaub ntawv nthuav qhia: Tus neeg mob tau raug ntxias los ntawm lub sijhawm vim preeclampsia, nrog kev xa khoom nyuaj los ntawmmob hnyav tom qab yug me nyuamlos ntawm uterine atony. Nws txuas ntxiv muaj kev kub ntxhov siab tom qab yug me nyuam thiab tsim kho mob raum raug mob (AKI) ntxiv nrog rau cov zis tso zis tsawg thiab ua pa nyuaj uas yuav tsum tau kho ntshav qab zib. Labs qhia hemolysis nrog elevated lactate dehydrogenase, qis haptoglobin, anemia, thiab thrombocytopenia, tab sis lwm yam tsis zoo tshaj plaws kev kuaj mob immunology. Thaum kho kom ruaj khov, tus neeg mob tau txais lub raum biopsy, ua raws li TMA. Kev kho mob tau pib nrog eculizumab, ib qho tshuaj tiv thaiv kab mob monoclonal rau lub davhlau ya nyob twg txuas ntxiv blockade. Nws cov xwm txheej kho mob tau zoo dua qub (nrog rau cov cim ntawm hemolysis thiab infammation) nrog rau kev kho lub raum hloov thiab ntxiv blockade. Thaum tso tawm, nws tau tso zis ntau ntxiv thiab tau muab tshuaj 3 hnub hauv ib lub lis piam ntawm hemodialysis thiab ob zaug txhua hli eculizumab infusions. Los ntawm 6 lub lis piam tom qab yug me nyuam, hemodialysis raug txiav tawm thiab nws cov eculizumab tau txiav tawm mus rau txhua hli infusions. Eculizumab raug txiav tawm ntawm 12 lub hlis tom qab yug menyuam.
Kev ntsuam xyuas caj ces rau kev hloov pauv ntawm qhov kev sib txuas ntxiv yog qhov tsis zoo. Tus neeg mob muaj qhov seem 3 CKD nrog rau lub raum ua haujlwm ruaj khov, xav tau ob tus neeg ua haujlwm rau kev tswj ntshav siab, suav nrogACE inhibitor rau cov nyhuv antiproteinuric.
Cov ntsiab lus: Cov ntaub ntawv no qhia txog qhov txawv txav ntawm lub raum tsis ua haujlwm hauv tus neeg mob vim yog TMA hauv lub sijhawm tom qab yug menyuam. Nws xav tau ib ntus hemodialysis (HD) rau lub sijhawm luv luv, txawm li cas los xij, nws tau kho tau zoo nrog eculizumab thiab muaj peev xwm txiav tau 1 xyoos tom qab yug me nyuam. Nws muajseem theem 3 CKDthiab tsis muaj cov cim qhia ntxiv lossisCov tsos mob ntawm TMA.
Keywords: TMA, Pregnancy, Pediatric, Case report,lim ntshav
Keeb kwm
Qhov xwm txheej ntawm cev xeeb tub mob raum raug mob (PR-AKI) tau nce siab hauv Tebchaws Meskas hauv kaum xyoo dhau los, nrog kev kwv yees tsis ntev los no ntawm qhov tshwm sim yog 2.3 txog 4.5 rau 10,000 khoom xa tuaj [1–3] . Txawm li cas los xij, qhov tshwm sim ntawm kev xeeb tub uas cuam tshuam nrog thrombotic microangiopathy yog qhov tsawg, kwv yees li ntawm 1 ntawm 25,{13}} cev xeeb tub. Kev kuaj mob tuaj yeem nyuaj, raws li preeclampsia, HELLP syndrome, thiab TMA muaj cov yam ntxwv sib tshooj, thiab kev kuaj mob ntawm cev xeeb tub nrog HUS feem ntau yog ib qho ntawm kev cais tawm. Tsis tas li ntawd, lub luag haujlwm ntawm eculizumab hauv kev xeeb tub-txuas TMA tseem tab tom tshawb nrhiav [4, 5]. Cov ntaub ntawv no qhia txog qhov nyuaj ntawm kev kuaj mob thiab qhov hnyav ntawm
Kev nthuav qhia ntawm TMA tom qab yug me nyuam thiab kev siv hluav taws xob ntawm eculizumab rau tus kab mob no.
Case nthuav qhia
Tus neeg mob yog {{0}} tus poj niam muaj hnub nyoog G1P0 uas tsim mob raum mob hnyav tom qab yug menyuam. Kev xeeb tub tau nyuaj los ntawm preeclampsia ua rau induckev ua haujlwm ntawm 37 lub lis piam gestation. Thaum lub sij hawm delivery vs Ua ntej xa khoom, ntshav creatine yog<0.5mg/dl thiab urinalysis yog tsis muaj proteinuria, tab sis covtus neeg mob qhia mob taub hau thiab malaise. Txog 3 h poskev yug me nyuam, nws tsim mob hnyav tom qab yug me nyuamthib ob rau uterine atony, uas nws xav tau 3.6lntawm cov khoom siv ntshav. Tom qab ntawd, nws tau sau tseg tias muajmob siab heev, nrog ntshav siab nyeem ntawv>160/90 mmHg. Nws tsim oliguria tsis tebrau fuid resuscitation los yog diuretic kho. Vim kev loj hlobThaum ua pa nyuaj, nws raug xa mus rau tus neeg lauskho mob ICU (MICU) rau kev tswj xyuas ntxiv.
MICU chav kawm
Thaum tuaj txog ntawm ICU, lub hauv siab ntsuas pom pom cov kab mob tshiab, thiab tus neeg mob tau txais kev kho mob ntsws ntsws hauv tsev kho mob. Thawj cov ntshav kab lis kev cai loj hlob coagulase-tsis zooStaphylococcus, kho nrog vancomycin rau 72h.Nws cov ntshav creatinine (Cr) thaum nkag mus rau MICUyog 2.24 mg/dL). Muab qhov kev tshawb pom no nrog rautsis tu ncua oligo-anuria, txoj cai sab hauv jugular hemodialysis catheter tau muab tso rau, thiab nws tau pib rautom qab yug me nyuam hnub peb. Lub raum ultrasound thaum lub sijhawm ntawdib txwm.
Kev soj ntsuam ntxiv ntawm kev kuaj pom pom muaj proteinuria (cov zis protein rau creatinine piv 19,000mg/g), transaminitis (AST 37 unit/L, ALT 229 unit/L), mob ntshav siab(Hgb poob ntawm 10.5 mus rau 7.1 g / dL), thrombocytopenia (101K/mcl nadir, nrog rau kev hloov ntshav platelet tsis ntev los nomuab rau HD catheter tso), thiab nce LDH(2679 units / L; ib txwm<325units/L). She was diagnosed Nrog hemolysis, nce siab enzymes, thiab qis platelets(HELLP) Syndrome. Nws nyob tsis tu ncua hyperhnyav yuav tsum tau nce koob tshuaj beta blockers. Vimua rau mob ntshav siab tsis tu ncua thiab ua rau lub ntsws tsis zooedema, nws raug pauv los ntawm lub tsev kho mob neeg laus mus rau lublub tsev kho mob menyuam yaus hauv zos rau kev tswj xyuas ntxiv ntawm kev tshaj tawmhnub tim 7.
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