新型冠状病毒感染诱发的非典型溶血性尿毒综合征1例

doi:10.3969/j.issn.1674-8115.2026.06.016

摘要/Abstract

摘要：

非典型溶血性尿毒综合征（atypical hemolytic-uremic syndrome，aHUS）是一类临床罕见且病情危重的血栓性微血管病（thrombotic microangiopathy，TMA），其核心发病机制为补体系统替代途径的失控激活。近年来，随着相关临床研究与病例报道的积累，严重急性呼吸综合征冠状病毒2（severe acute respiratory syndrome coronavirus 2，SARS-CoV-2）感染已被证实是诱发aHUS的重要因素之一。该文报道1例有葡萄糖-6-磷酸脱氢酶缺乏症相关溶血性贫血病史的男性患者。该患者因“胸闷、胸痛2 d”入院，病程中逐渐出现微血管性溶血性贫血、血小板减少及急性肾损伤等典型aHUS临床表现；同时，SARS-CoV-2核酸检测结果呈阳性，结合患者病史、症状、实验室检查并排除其他TMA病因，最终确诊为SARS-CoV-2感染诱发的aHUS。患者入院后，临床给予糖皮质激素联合血浆置换及依库珠单抗的综合治疗方案，经规范治疗后病情得到有效控制并维持稳定。该病例报道可为SARS-CoV-2感染相关aHUS（尤其合并既往有溶血性疾病病史患者）的临床诊疗提供参考。

关键词: 非典型溶血性尿毒综合征, 血栓性微血管病, 血浆置换, 依库珠单抗, 严重急性呼吸综合征冠状病毒2（SARS-CoV-2）

Abstract:

Atypical hemolytic-uremic syndrome (aHUS) is a rare and life-threatening thrombotic microangiopathy (TMA) characterized by uncontrolled activation of the complement system's alternative pathway. In recent years, accumulating clinical evidence and case reports have established severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as a significant trigger for aHUS. This report describes a male patient with a prior history of hemolytic anemia associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency. He was admitted because of chest tightness and chest pain for two days. During hospitalization, he progressively developed typical features of aHUS, including microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). Concurrently, nucleic acid testing for SARS-CoV-2 yielded positive results. Based on the patient's medical history, clinical presentation, laboratory findings, and the exclusion of other causes of TMA, a diagnosis of SARS-CoV-2-induced aHUS was established. Following admission, the patient received a multimodal therapeutic regimen consisting of glucocorticoids, plasma exchange (PE), and eculizumab. With timely and standardized intervention, his condition was effectively controlled and remained stable. This case may provide a reference for the clinical diagnosis and management of SARS-CoV-2-associated aHUS, particularly in patients with a history of hemolytic disorders.

Key words: atypical hemolytic-uremic syndrome, thrombotic microangiopathy, plasma exchange, eculizumab, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

中图分类号:

R512.99

邓佳仪, 王光璞, 白寿军, 李吉. 新型冠状病毒感染诱发的非典型溶血性尿毒综合征1例[J]. 上海交通大学学报（医学版）, 2026, 46(6): 824-828.

Deng Jiayi, Wang Guangpu, Bai Shoujun, Li Ji. A case of atypical hemolytic-uremic syndrome induced by severe acute respiratory syndrome coronavirus 2[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(6): 824-828.

图/表 1

参考文献 23

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Laboratory parameter	Reference range	Date
Laboratory parameter	Reference range	2025/7/23	2025/7/31	2025/8/2	2025/8/3	2025/8/6	2025/8/12	2025/8/18	2025/8/27	2025/9/10
WBC/(×10⁹·L^-1)	3.5‒9.5	14.86	9.53	36.30	23.81	7.43	4.82	2.53	2.99	3.94
Hb/(g·L^-1)	130‒175	84	82	57	59	42	52	50	55	70
PLT/(×10⁹·L^-1)	125‒350	155	225	199	169	47	73	97	169	189
D-dimer/(mg·L^-1)(FEU)	<0.55	33.41	5.74	>40	>40	19.97	10.57	9.81	4.48	2.31
PCT/(ng·mL^-1)	<0.046	26.340	‒	‒	91.380	8.810	0.242	0.111	0.367	0.077
IL-6/(pg·mL^-1)	<7	20.64	‒	‒	27.40	3.62	11.86	7.68	7.25	5.10
LDH/(U·L^-1)	120‒250	2 168	‒	3 046	2 628	678	530	372	273	179
IBil/(μmol·L^-1)	2‒19	22.6	‒	33.9	16.2	12.5	5.2	4.9	3.9	2.3
Haptoglobin/(mg·dL^-1)	32‒205	1.9	‒	22.7	2.9	4.6	2.4	45.4	20.4	129.8
SCr/(μmol·L^-1)	57‒111	445	528	546	537	370	203	217	190	118
Urea/(mmol·L^-1)	3.6‒9.6	27.0	29.8	31.9	36.6	35.2	20.5	15.6	12.5	8.7
eGFR/[mL·(min·1.73 m²)^-1]	>90	11.4	10.3	9.1	9.7	14.2	29.4	27.1	31.8	56.6
C3/(g·L^-1)	0.9‒1.8	‒	‒	‒	0.925	0.486	0.688	0.890	0.892	1.110
C4/(g·L^-1)	0.1‒0.4	‒	‒	‒	0.242	0.090	0.167	0.258	0.259	0.281

Laboratory parameter	Reference range	Date
Laboratory parameter	Reference range	2025/7/23	2025/7/31	2025/8/2	2025/8/3	2025/8/6	2025/8/12	2025/8/18	2025/8/27	2025/9/10
WBC/(×10⁹·L^-1)	3.5‒9.5	14.86	9.53	36.30	23.81	7.43	4.82	2.53	2.99	3.94
Hb/(g·L^-1)	130‒175	84	82	57	59	42	52	50	55	70
PLT/(×10⁹·L^-1)	125‒350	155	225	199	169	47	73	97	169	189
D-dimer/(mg·L^-1)(FEU)	<0.55	33.41	5.74	>40	>40	19.97	10.57	9.81	4.48	2.31
PCT/(ng·mL^-1)	<0.046	26.340	‒	‒	91.380	8.810	0.242	0.111	0.367	0.077
IL-6/(pg·mL^-1)	<7	20.64	‒	‒	27.40	3.62	11.86	7.68	7.25	5.10
LDH/(U·L^-1)	120‒250	2 168	‒	3 046	2 628	678	530	372	273	179
IBil/(μmol·L^-1)	2‒19	22.6	‒	33.9	16.2	12.5	5.2	4.9	3.9	2.3
Haptoglobin/(mg·dL^-1)	32‒205	1.9	‒	22.7	2.9	4.6	2.4	45.4	20.4	129.8
SCr/(μmol·L^-1)	57‒111	445	528	546	537	370	203	217	190	118
Urea/(mmol·L^-1)	3.6‒9.6	27.0	29.8	31.9	36.6	35.2	20.5	15.6	12.5	8.7
eGFR/[mL·(min·1.73 m²)^-1]	>90	11.4	10.3	9.1	9.7	14.2	29.4	27.1	31.8	56.6
C3/(g·L^-1)	0.9‒1.8	‒	‒	‒	0.925	0.486	0.688	0.890	0.892	1.110
C4/(g·L^-1)	0.1‒0.4	‒	‒	‒	0.242	0.090	0.167	0.258	0.259	0.281