慢性淋巴细胞白血病合并肾病综合征、急性肾功能不全治疗1例并文献复习  

One case of chronic lymphocytic leukemia complicated with nephrotic syndrome and acute renal insufficiency and literature review

作　　者：任鲁颖 张传霞 董彬[1] REN Luying;ZHANG Chuanxia;DONG Bin(Department of Nephrology,Jining Hospital of Xiyuan Hospital,China Academy of Chinese Medical Sciences,Shandong Province,Jining272100,China;Department of Endocrinology,Jining Hospital of Xiyuan Hospital,China Academy of Chinese Medical Sciences,Shandong Province,Jining272100,China)

机构地区：[1]中国中医科学院西苑医院济宁医院肾病科,山东济宁272100 [2]中国中医科学院西苑医院济宁医院内分泌病科,山东济宁272100

出　　处：《中国当代医药》2024年第5期170-173,178,共5页China Modern Medicine

摘　　要：本文报道了1例确诊为慢性淋巴细胞白血病(CLL)2年的患者,以肾病综合征为首发表现,因患者初始拒绝使用糖皮质激素,临床采用了先给予环磷酰胺静滴而后因出现急性肾功能不全给予甲泼尼龙治疗的个体化方案,在治疗肾病的同时,仔细观察了甲泼尼龙及环磷酰胺在使用过程中对患者淋巴细胞的影响,特别是在疾病的诱导缓解期对淋巴细胞的骤升给予了及时合理的对症处理,经过积极治疗,患者肾病完全缓解。本文还通过文献复习,汇总归纳了CLL合并肾病时的治疗选择,分析认为CLL和肾病之间是否存在因果关系以及CLL是否需要治疗,很大程度上决定了肾脏病的治疗策略,同时肯定了糖皮质激素在CLL合并肾病综合征患者中的正向作用,以期为临床诊疗此类疾病提供参考依据。This study reports a case diagnosed with chronic lymphocytic leukemia(CLL)for 2 years,with nephrotic syndrome as the initial presentation.Due to the initial refusal of glucocorticoids,the patient was given Cyclophosphamide intravenous drip and then Methylprednisolone treatment for acute renal insufficiency.The effects of Methylprednisolone and Cyclophosphamide on the patient's lymphocytes were carefully observed,especially the sudden rise of lymphocytes was given timely and reasonable symptomatic treatment in the induced remission period of the disease.After active treatment,the patient had complete remission of kidney disease.This paper also summarized the treatment options for CLL complicated with nephropathy through literature review,and analyzed that whether there is a causal relationship between CLL and nephropathy and whether CLL needs treatment determines the treatment strategy for kidney disease to a large extent,and confirmed the positive effect of glucocorticoids in patients with CLL complicated with nephrotic syndrome.In order to provide reference for clinical diagnosis and treatment of such diseases.

关 键 词：慢性淋巴细胞白血病 肾病综合征 急性肾功能不全 文献复习 

分 类 号：R733.72[医药卫生—肿瘤]