胡桃夹综合征合并肾脏疾病95例临床分析  

Clinical Analysis of 95 Cases of Nutcracker Syndrome Complicated with Renal Disease

作　　者：金麒敏 欧键俊 卢富华[2] JIN Qimin;OU Jianjun;LU Fuhua(The Second Clinical Medical School,Guangzhou Onivecsity of Chinese Medicine,Guangzhou 510405)

机构地区：[1]广州中医药大学第二临床医学院,广州510405 [2]广东省中医院大德路总院,广州510120

出　　处：《中国中西医结合肾病杂志》2021年第12期1057-1060,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家中医药管理局黄春林全国名老中医传承工作室研究项目(No.2012KT1301);广东省中医院中医药科学技术研究专项项目(YN2019ML06)。

摘　　要：目的:分析胡桃夹综合征(Nutcracker syndrome,NCS)临床特征及其与肾脏疾病的关系,以避免胡桃夹综合征合并肾脏疾病的漏诊。方法:研究对象为2012年12月—2020年9月广东省中医院收治的95例临床表现为蛋白尿和(或)血尿,且入院查左肾静脉彩超提示胡桃夹综合征的患者,主要分析其主要临床表现及实验室检查特点。结果:95例诊断为胡桃夹综合征的患者中,有13例临床表现为孤立性蛋白尿,24例临床表现为孤立性血尿,55例临床表现为蛋白尿合并血尿,2例表现为双下肢水肿,1例表现为入院前尿蛋白阳性,其中47例NCS患者进行了肾穿刺,其病理结果主要以IgA肾病为主,同时伴有微小病变型肾病、膜性肾病等肾脏疾病。结论:NCS患者合并肾脏疾病并不少见,可与多种肾小球疾病共同存在,因此诊断NCS时,需根据病情及时肾穿刺活检术,24 h尿蛋白定量较少或非肾小球源性血尿的患者,应紧密跟踪随访,防止漏诊误诊的发生,而24 h尿蛋白定量较多及出现肾小球源性血尿的患者,更应该行肾穿刺活检术,从而指导合适的治疗方案,以防延误病情。Objective:The clinical characteristics of Nutcracker syndrome(NCS)and its relationship with renal diseases were analyzed to avoid the missed diagnosis of Nutcracker syndrome with renal diseases.Methods:The subjects of this study were 95 patients admitted to Guangdong Hospital of Traditional Chinese Medicine from December 2012 to September 2020 with clinical manifestations of proteinuria and/or hematuria,who were admitted to the hospital for examination of color doppler ultrasonography of the left renal vein indicating nutcrate syndrome.The main clinical manifestations and laboratory examination characteristics were analyzed.Results:Among the 95 patients diagnosed with nutcrate syndrome,13 presented isolated proteinuria,24 presented isolated hematuria,55 presented proteinuria with hematuria,2 presented edema of lower limbs,and 1 presented positive proteinuria before admission.Among them,renal puncture was performed in 47 NCS patients,and the pathological results were mainly IgA nephropathy,accompanied by renal diseases such as micropathologic nephropathy and membranous nephropathy.Conclusion:Renal diseases in patients with NCS are not uncommon,and can co-exist with a variety of glomerular diseases.Therefore,timely renal biopsy should be performed according to the diagnosis of NCS.Patients with low urinary protein quantity or non-glomerular hematuria within 24 hours should be closely followed up to prevent missed diagnosis and misdiagnosis.In contrast,renal biopsy should be performed in patients with high urinary protein content at 24 h and with glomerulus-derived hematuria,so as to guide appropriate treatment to prevent delay of the disease.

关 键 词：胡桃夹综合征 血尿 蛋白尿 肾穿刺活检 漏诊 

分 类 号：R692[医药卫生—泌尿科学]