儿童胡桃夹现象并肾脏疾病24例  

Nutcracker Phenomenon Complicated with Kidney Diseases in 24 Children

作　　者：张建江[1] 史佩佩[1] 贺晓[2] 张利果[1] 陆凤霞[1] 

机构地区：[1]郑州大学第一附属医院儿内科,郑州450052 [2]郑州大学第一附属医院超声科,郑州450052

出　　处：《实用儿科临床杂志》2011年第17期1322-1324,共3页Journal of Applied Clinical Pediatrics

基　　金：河南省医学科技攻关计划项目(2011020025);郑州市科技局科技攻关计划项目(10PTGG380-5)

摘　　要：目的探讨儿童胡桃夹现象并肾脏疾病的临床特点及诊治情况。方法回顾性调查2009年10月-2010年10月在本院儿内科住院的24例存在胡桃夹现象患儿的临床资料,分析其合并疾病、临床表现、辅助检查特点和治疗情况。结果 24例诊断为胡桃夹现象的患儿中,单纯血尿者、仅存在肾小管损伤者各3例(各12.5%),单纯蛋白尿者8例(33.3%),血尿、蛋白尿者10例(41.7%)。24例中10例并紫癜性肾炎(41.7%),6例并IgA肾病(25.0%),4例并肾病综合征(16.7%),3例并过敏性紫癜(12.5%),1例并乙型肝炎病毒相关性肾炎(4.2%)。10例彩超诊断为胡桃夹现象的患儿尿检存在肾小球源性血尿和(或)蛋白尿,肾脏病理提示并肾小球疾病。4例临床或肾脏病理诊断为肾小球疾病的患儿,尿检存在非肾小球源性血尿或经治疗后仍存在较长时间的轻度血尿和(或)蛋白尿,彩超检查存在胡桃夹现象。患儿均存在血β2微球蛋白、尿β2微球蛋白、N乙-酰-β-氨基葡萄糖苷酶升高。结论胡桃夹现象可与肾脏疾病共同存在。胡桃夹现象易损伤肾小管。必要时应行肾活检以助诊。Objective To investigate the clinical characteristics,diagnosis and treatment of nutcracker phenomenon（NCP） in children complicated with kidney diseases.Methods Retrospective survey was performed in 24 NCP children diagnosed by ultrasound in the First Affiliated Hospital of Zhengzhou University from Oct.2009 to Oct.2010;their complications,clinical manifestations,auxiliary examinations and therapies were analyzed.Results Twenty-four patients were diagnosed as NCP,3 cases（12.5%） of them had simple hematuria,8 cases（33.3%） with simple proteinuria,10 cases（41.7%） with hematuria and proteinuria,3 cases（12.5%） with renal tubule damage.Besides,in 24 NCP children,10 cases（41.7%） were complicated with purpura nephritis,6 cases（25.0%） complicated with IgA nephropathy,4 cases（16.7%） complicated with nephrotic syndrome,3 cases（12.5%） complicated with Henoch-Schonlein purpura,and 1 case（4.2%） complicated with hepatitis B virus-associated glomerulonephritis.Diagnosed by color ultrasound,10 cases NCP children who had renal glomerulus source hematuria and（or） proteinuria,were proved to coexist with glomerular nephritis by renal pathology;of them 4 glomerular nephritis children with manifestation of non-glomerulus haematuria,long-time hematuria and（or） slight proteinuria after treatment,which were difficult to correct during treatment and coexisted with NCP by color ultrasound.Serum β2 microglobulin,urine β2 microglobulin and urine N-acetyl-β-glucosaminidase from 24 cases NCP children were all increased.Conclusions NCP may coexist with kidney diseases.NCP is easy to injure renal tubule.Renal biopsy shall be carried out if it is necessary.

关 键 词：胡桃夹现象 肾脏疾病 血尿 肾活检 肾小管 

分 类 号：R726.9[医药卫生—儿科]