以肾损伤起病的主动脉夹层患者的临床特点及预后转归  

Clinical characteristics and prognosis of acute aortic dissection with kidney injury

作　　者：王杨 李喆 孙志远 许书添 张雷 李世军 WANG Yang;LI Zhe;SUN Zhiyuan;XU Shutian;ZHANG Lei;LI Shijun(National Clinical Research Center of Kidney Diseases,Jinling Hospital,Nanjing University School of Medicine,Nanjing 210016,China;Department of Medical Imagine,Jinling Hospital,Nanjing University School of Medicine,Nanjing 210016,China;Department of Cardiovascular and Thoracic Surgery,Jinling Hospital,Nanjing University School of Medicine,Nanjing 210016,China)

机构地区：[1]东部战区总医院国家肾脏疾病临床医学研究中心,全军肾脏病研究所,南京210016 [2]东部战区总医院医学影像科,南京210016 [3]东部战区总医院胸心外科,南京210016

出　　处：《肾脏病与透析肾移植杂志》2021年第3期228-233,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：江苏省临床医学中心项目(YXZXA2016003)。

摘　　要：目的:总结以肾损伤起病的主动脉夹层患者的病程特点和预后转归。方法:回顾性分析2010年1月至2020年12月因肾损伤就诊于国家肾脏疾病临床医学研究中心,确诊为急性主动脉夹层患者的临床表现,实验室检查及预后转归资料。结果:8例患者均为因肾损伤起病,后确诊为主动脉夹层,其中急性A型主动脉夹层3例,B型夹层5例;7例既往有控制不理想的高血压病史,1例为马凡综合征。肾外表现多为一过性或持续性腰疼、腹痛、肢体麻木等;多数患者表现为急性肾损伤,快速进入无尿并开始透析(6±2d);相较于非肾损伤的患者,7例患者病程中出现血脑利钠肽前体水平显著升高。所有患者均有D-二聚体升高。7例患者接受了外科治疗,1例因病情原因失去手术机会;共7例患者接受术后随访,其中3例摆脱透析,4例规律透析治疗。结论:以肾损伤起病的患者合并如下特点应警惕急性主动脉夹层的可能:既往有控制不佳的高血压病史,或具有典型马凡氏综合征体态特点;发病过程中有一过性腰腹疼痛、肢体麻木等表现;血脑利钠肽前体或D-二聚体显著升高。Objective:To summarize the characteristics and prognostic outcome of acute aortic dissection which was symbolic of kidney injury.Methodology:Retrospective analysis of clinical manifestations,laboratory examinations and prognostic outcomes of patients who were diagnosed with acute aortic dissection those with the presentation of kidney injury from January 2010 to December 2020.Results:8 patients complain of kidney injury as the first symptom and diagnosed with acute aortic dissection,including 3 cases of type A and five of type B.7 patients had history of hypertension and poor blood pressure controlling,1 has the typical presentation of Marfan syndrome.The extrarenal manifestations are mainly intermittent back pain or abdominal pain and limb numbness.Most patients present with acute kidney injury,and progressed to quickly anuria and hemodialysis(6±2 day).Compare with the no kidney injury patient,nearly all patients had a high level of pro-brain natriuretic peptide and d-dimer.7 patients received surgery.During the follow-up,1 case was lost,7 cases survived,of which 3 cases were free of hemodialysis and 4 cases had need maintance dialysis treatment.Conclusion:Patients with unexplained kidney injury combined with the following characteristics should consider the possibility of acute aortic dissection:history of hypertension with poor controlling or a typical Marfan’s syndrome features:Waist and abdominal pain,numbness of limbs and other manifestations during the onset;N-terminal pro-brain natriuretic peptide or D-dimer increased significantly.

关 键 词：急性主动脉夹层 急性肾损伤 脑利钠肽前体 马凡综合征 

分 类 号：R543.1[医药卫生—心血管疾病]