慢性肾脏病合并冠心病房颤应用达比加群酯导致血尿分析  

Analysis of hematuria caused by dabigatran etexilate in the patients with chronic kidney disease and complicated with coronary heart disease

作　　者：张秀丽 程媛 陈建宇 胡豪飞 库明 万启军[1] ZHANG Xiu-li;CHENG Yuan;CHEN Jian-yu(Department of Nephrology,Shenzhen Second People’s Hospital,Shenzhen 5]8000,China)

机构地区：[1]深圳市第二人民医院肾内科,518000

出　　处：《中国实用医药》2020年第16期152-154,共3页China Practical Medicine

基　　金：国家自然基金面上项目资助(项目编号:81670670)。

摘　　要：以往有学者认为抗凝治疗期间出现的肉眼或显微镜下血尿无关紧要,但随着临床抗凝剂应用越来越广泛,尤其是新型抗凝剂的应用,抗凝剂所导致的出血不良事件也随之备受重视。以往的研究结果显示,患者在接受抗凝治疗期间出现肉眼或显微镜下血尿往往预示着不同意义的泌尿系统病损,因此,应进行全面、恰当的泌尿系影像学、尿液及肾功能等全面检查,同时给以及时有效的治疗。达比加群作为一种新型直接口服抗凝药之一,主要用于防治非瓣膜性心房颤动(房颤)、脑卒中及肺栓塞等血栓形成疾病,获得很好的临床效果。但临床上少数患者在使用达比加群进行抗凝治疗时,出现不同程度出血的症状。以往有关这方面的报导为数不多,尤其是该药在慢性肾脏病方面出现此种情况的报导目前尚未所见。本文主要针对1例本科收治的慢性肾脏病合并冠心病非ST段抬高心肌梗死、心房颤动患者应用达比加群所致的血尿的诊断、治疗对策及预后等进行全面系统的分析和总结,旨在为该药对该类患者抗凝治疗中的监测及临床诊治提供有意义的科学依据。In the past,some scholars thought that hematuria under the naked eye or microscope during anticoagulation treatment was irrelevant.But with the clinical application of anticoagulants more and more widely,especially the application of new anticoagulants,the adverse bleeding events caused by anticoagulants have also received much attention.Previous studies have shown that the presence of hematuria under the naked eye or microscope during anticoagulation treatment often indicates different urinary system lesions.Therefore,a comprehensive and appropriate urological imaging,urine and renal function and other comprehensive examination should be carried out,as well as timely and effective treatment.As a new type of direct oral anticoagulant,dabigatran is mainly used for the prevention and treatment of thrombotic diseases such as nonvalvular atrial fibrillation,stroke and pulmonary embolism,and has achieved good clinical results.However,a small number of patients in clinical practice have symptoms of varying degrees of bleeding when using Dabigatran for anticoagulant therapy.In the past,there were few reports about this aspect,especially in the aspect of chronic kidney disease.This article mainly analyzes and summarizes the diagnosis,treatment and prognosis of hematuria caused by application of dabigatran in 1 patient with chronic kidney disease combined with non-ST segment elevation myocardial infarction and atrial fibrillation,aiming to provide a significant scientific basis for the monitoring and clinical diagnosis and treatment of this kind of patients in anticoagulation therapy.

关 键 词：直接口服抗凝药 达比加群酯 慢性肾脏病 冠心病 心房颤动 血尿 

分 类 号：R541.75[医药卫生—心血管疾病] R692[医药卫生—内科学]