临床儿科杂志 ›› 2014, Vol. 32 ›› Issue (8): 785-.doi: 10.3969 j.issn.1000-3606.2014.08.022

• 罕见病 疑难病 • 上一篇    下一篇

儿童Bartter 综合征15 例临床分析

杨雪钧,李秋   

  1. 重庆医科大学附属儿童医院( 重庆 400014)
  • 收稿日期:2014-08-15 出版日期:2014-08-15 发布日期:2014-08-15

Analysis of 15 case with Bartter syndrome and literature review

Yang Xuejun, Li Qiu   

  1. Children`s Hospital of Chongqing medical university, Chongqing 400014, China
  • Received:2014-08-15 Online:2014-08-15 Published:2014-08-15

摘要: 目的 探讨儿童Bartter综合征的临床表现、诊断及治疗。方法 回顾性分析15例Bartter综合征患儿的临床资料。结果 15例患儿中表现为生长发育迟滞14例(93.3%),纳差12例(80.0%),呕吐7例(46.7%),腹泻5例(33.3%),多饮多尿5例(33.3%),乏力4例(26.7%)。15例患儿均有低氯血症、低钾血症,其中重度低钾血症10例,12例患儿出现代谢性碱中毒。15例患儿中经典型Bartter综合征10例、新生儿型Bartter综合征3例、变异型Bartter综合征(Gitelman综合征)2例。15例患儿均给予大剂量补钾等纠正水电解质酸碱平衡紊乱,口服螺内酯、布洛芬悬液及卡托普利后,症状基本控制。结论 儿童出现不明原因持续性低钾低氯性代谢性碱中毒及生长发育迟滞时需警惕该病可能,结合临床表现及氢氯噻嗪试验基本可诊断,基因诊断是最可靠的方法。目前主要以补钾、补镁、醛固酮拮抗剂、前列腺素拮抗剂等综合治疗为主,需终生治疗。

Abstract: Objective To investigate the clinical manifestations, diagnosis and treatment of Bartter syndrome in children. Methods Clinical data of 15 patients with Bartter syndrome in Children`s Hospital Affiliated to Chongqing Medical University was analyzed, and pertinent literatures were reviewed. Results Bartter syndrome is an autosomal recessive inherited renal disorder characterized by hypokalemia, hypochloremia, metabolic alkalosis, vomiting, growth retardation, the activation of the renin-aldosterone axis, normal blood pressure. Genetic analysis is the most reliable way for diagnosis. Comprehensive therapy with antisterone, indomethacin, catopril and potassium have remarkable effect. Conclusions Bartter syndrome should be considered when children have unreasonable continuous hypokalemia, hypochloremia, metabolic alkalosis and growth retardation. It can be clinically diagnosed by clinical manifestation and hydrochlorothiazide test, and genetic analysis is the most reliable way. It can be ameliorated by potassium and magnesium supplementation, antialdosterone medications, prostaglandin inhibitors and antisterone. Considering the following electrolyte disturbances, infections, growth retardation, kidney failure and even death,Bartter syndrome need lifelong treatment, early diagnosis and treatment is of the most importance.