儿童肾病综合征合并血栓栓塞23例回顾分析  

Nephrotic syndrome complicated with thromboembolism in children-retrospective analysis of 23 cases

作　　者：陈鹭[1] 王辉[1] 沈颖[1] 

机构地区：[1]首都医科大学附属北京儿童医院肾脏内科,北京100045

出　　处：《中国实用儿科杂志》2012年第6期428-431,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨儿童肾病综合征合并血栓、栓塞事件的诊治方法。方法对首都医科大学附属北京儿童医院肾脏内科2006年1月至2010年12月收治的肾病综合征并发血栓、栓塞事件的患儿进行回顾性分析,对患儿性别、血栓栓塞发病年龄、临床表现、部位、血化验指标、尿化验指标、肾病综合征病程、治疗应用激素类型、疗程及血栓、栓塞治疗疗效等进行总结。结果肾病综合征合并血栓、栓塞患儿共23例,男女比例4.75:1,血栓、栓塞平均发病年龄(8.17±4.12)岁,其中动脉血栓1例,静脉血栓14例,栓塞事件9例(1例合并静脉血栓)。患儿24h尿蛋白定量(132.65±46.79)mg/(m2·h),血清白蛋白(12.73±4.06)g/L,18例纤维蛋白原升高,22例D-二聚体>0.5mg/L。给予抗凝溶栓治疗,除1例患儿因经济因素放弃治疗外,22例患儿(包括1例动脉血栓)症状消失,复查凝血功能及影像学检查均有所改善,无溶栓抗凝不良事件发生。结论肾病综合征患儿大量蛋白尿、低白蛋白血症、高胆固醇血症、应用类固醇激素、持续应用强利尿剂等可能是血栓、栓塞的危险因素,纤维蛋白原、D-二聚体异常增高对血栓、栓塞疾病有重要的提示意义。Objective To discuss the clinical manifestations and therapeutic methods of nephrotic syndrome（NS） complicated with thromboembolism（TE） in children. Methods The clinical data of NS complicated with TE between 2006 and 2010 were retrospectively analysed. Gender, the onset age of TE, site, clinical manifestations, blood/urine indices, the course of NS, the use of steroids and curative effects were investigated. Results Totally 23 cases of NS complicated with TE were found in our study. The ratio of boys to girls was 4.75：1 and the average age was （8.17 ± 4.12） years old. There was 1 case with arterial thrombosis, 14 cases with venous thrombosis and 9 cases with embolism. In these 23 cases, urinary protein quantity for 24 hours was （132.65 ± 46.79） mg/（m2· h） and serum albumin was （12.73 ± 4.06）g/L. The elevation of fibrinogen and D-dimer were seen in 18 and 22 children respectively. Symptoms, coagulative function and imaging performances were improved in 22 children, 1 child gave up treatment for economic difficulties. There was no thrombolysis-related adverse event. Conclusion The diagnosis of TE should be considered when nephrotic syndrome is complicated with massive proteinuria, hypoalbuminemia, hypereholesteraemia, using of steroids and diuretics. Fibrinogen and D-dimer increase are predictive for the diagnosis of TE.

关 键 词：肾病综合征 儿童 血栓栓塞 高凝状态 

分 类 号：R72[医药卫生—儿科]