在定期血液透析治疗期间补充介导透析反应:一个病例报告
Ákos Pethő1, Karolina Schnabel2, László Dézsi3,4
1Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Korányi S. U. 2/a, 1083, Budapest, Hungary. petho.akos@med.semmelweis-univ.hu.
Journal of medical case reports
|February 7, 2024
概括
治疗后期发生了一种罕见的血液透析反应 (HDR),模仿与补充激活相关的伪过敏 (CARPA). 这一案例突出了血液透析期间可能出现的晚期CARPA反应,可能与聚硫透析剂材料变化有关.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 免疫学 免疫学 免疫学
- 材料科学 材料科学 材料科学
背景情况:
- 血液透析反应 (HDR) 与补充激活相关的伪过敏 (CARPA) 有相似之处,这种过敏反应是对静脉注射 (纳米) 药物的过敏反应.
- 从动物模型中了解CARPA的病理机制,典型的CARPA类反应发生在使用多硫透析器的血液透析早期.
- 本报告详细介绍了首次记录的透析反应,该反应发生在血液透析疗程结束时.
研究的目的:
- 报告一个晚期发生的血液透析反应的独特病例.
- 讨论这种不寻常反应背后的潜在机制.
- 为了解血液透析患者的CARPA类反应做出贡献.
主要方法:
- 一个52岁的男性在慢性血液透析治疗3年的病例报告.
- 在透析治疗的第三个小时内观察CARPA反应.
- 管理包括系统循环,血压监测和支持措施.
主要成果:
- 患者在透析后期经历了CARPA类反应 (低血压,胸痛,呼吸障碍).
- 随着调整血速度,患者的位置和液体的使用,症状自发消失.
- 血液透析治疗在没有进一步的并发症的情况下结束.
结论:
- 虽然历史上有报道,但由于材料修改,多硫透析器的CARPA类反应变得不那么频繁.
- 观察到的晚发反应可能是由最近发现的血栓素-B2增加,肺动脉压和在体外血液再输注期间的补体激活的结果解释的.
- 这一案例强调了识别和管理非典型的HDR的重要性,即使是在治疗后期出现的HDR也是如此.
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