Cox S M, Shelburne P, Mason R, Guss S, Cunningham F G
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center 75235-9032.
Am J Obstet Gynecol. 1991 Feb;164(2):587-90. doi: 10.1016/s0002-9378(11)80027-x.
Anemia develops in about a fourth of women whose pregnancy is complicated by pyelonephritis, although its exact mechanism has not been defined clearly. In this study of 18 women with antepartum pyelonephritis, although only a third had anemia (hematocrit less than 30 vol/dl), there was evidence for hemolysis in all 18. Specifically there was a mean decrease in hematocrit of 5 vol/dl from admission to discharge. With scanning electron microscopy, we compared erythrocyte morphologic aberrations that were found in women with renal infection with those of normally pregnant women, and the former had significantly increased proportions of echinocytes in particular, but schistocytes and spherocytes were increased also (total 10.3% vs 1.4%, p less than 0.0001). These changes, especially echinocytosis, have been induced in vitro by lipopolysaccharide, and they are known to lead to premature red blood cell destruction in vivo. We conclude that hemolysis with subsequent anemia in pregnant women with pyelonephritis is caused by lipopolysaccharide-induced red blood cell membrane damage.
在妊娠合并肾盂肾炎的女性中，约四分之一会发生贫血，尽管其确切机制尚未明确界定。在这项针对18例产前肾盂肾炎女性的研究中，虽然只有三分之一的患者有贫血（血细胞比容低于30 vol/dl），但18例患者均有溶血证据。具体而言，从入院到出院血细胞比容平均下降了5 vol/dl。通过扫描电子显微镜，我们比较了患有肾脏感染的女性与正常孕妇的红细胞形态异常情况，前者尤其是棘形红细胞的比例显著增加，裂红细胞和球形红细胞也有所增加（总计10.3%对1.4%，p<0.0001）。这些变化，尤其是棘形红细胞增多，已在体外由脂多糖诱导产生，并且已知它们会导致体内红细胞过早破坏。我们得出结论，肾盂肾炎孕妇发生溶血及随后的贫血是由脂多糖诱导的红细胞膜损伤所致。
