B型超声诊断的胡桃夹现象258例临床分析  

Clinical analysis of 258 cases with nut-cracker phenomenon diagnosed by Doppler ultrasound sonography

作　　者：张敬京[1] 杨霁云[1] 

机构地区：[1]北京大学第一医院儿科,100034

出　　处：《中华儿科杂志》2002年第12期720-723,共4页Chinese Journal of Pediatrics

摘　　要：目的　全面分析和评估经B超诊断的胡桃夹现象的临床表现及其意义。方法　回顾性地研究 10年间经多普勒超声诊断的胡桃夹现象的患儿的临床特点。结果　以左肾静脉受压迫前后管径比值为≥ 3作为诊断标准 ,共有 2 5 8例患儿被诊为胡桃夹现象 ,被分为 4组 :( 1)非肾小球性血尿 ,10 9例。其中肉眼血尿的患儿平均年龄为 ( 10 0± 2 7)岁 ,肾静脉压迫前后的管径比值为 ( 4 2±1 4) ;镜下血尿的患儿平均年龄为 ( 8 0± 2 8)岁 ,肾静脉压迫前后的管径比值为 ( 3 1± 1 0 )。 ( 2 )直立性蛋白尿 ,10 8例。其中 5例伴有精索静脉曲张 ,占男孩 8 5 %。肾静脉受压前后的管径比值为 ( 4 9±3 0 )。 ( 3 )同时表现为非肾小球性血尿和直立性蛋白尿者 ,8例。其中一患儿在 10年后的检查中发现仍有蛋白尿和镜下血尿 ,而且肾早期损害指标增高。 ( 4)同时有肾小球性血尿和持续的蛋白尿 ,3 3例。其中 11例患儿接受肾穿刺检查 ,6例为系膜增生性肾小球肾炎 ,5例为IgA肾病。结论　胡桃夹现象最多见的临床表现为非肾小球性血尿或直立性蛋白尿。其也可见于有肾脏基础病的患儿和正常人。故胡桃夹现象的诊断需全面检查及分析 ,并长期随访 。Objective To evaluate the efficacy of non-invasive renal Doppler ultrasound sonography (US) on detecting the nut-cracker phenomenon(NCP) and understand the clinical characteristics of NCP.Methods A total of 258 patients diagnosed as NCP within 10 years were retrospectively analyzed. Results By using Doppler US, when the ratio of anteroposterior(AP) diameter of left renal vein was larger than 3, NCP was diagnosed. the 258 patients with NCP were divided into four groups according to the urinalysis. One hundred and nine cases presented with non-glomerular origin hematuria, which included 54 males and 55 females, aged from 3 to 14 years. The patients with gross hematuria were at an average age of 10.0±2.7 years, and showed a mean ratio of AP diameter of 4.2±1.4. The patients with microscopic hematuria aged 8.0±2.8 years, and showed a mean ratio of AP of 3.1±1.0. One hundred and eight patients had orthostatic proteinuria including 59 males and 49 females, of them 5 (8.5%) had varicocele. Their age was from 6 to 17 years (average 10.9±2.5 years). The ratio of AP diameter was 4.9±3.0. Eight cases with non-glomerular hematuria and orthostatic proteinuria aged from 4 to 14 years (average 8.6±3.7 years). The urinalysis in one of the patients showed completely normal after 6 years. Another patient had persistent proteinuria, microscopic hematuria, and early damage to glomerular function. Thirty-three cases with glomerular hematuria and continuous proteinuria were also diagnosed as NCP according to the ratio of AP diameter by Doppler US, of them 15 cases had acute glomerulonephritis history and in 11 renal biopsy was preformed (6 had mesangial proliferative glomerulonephritis and 5 had IgA nephropathy). Conclusion Doppler US can be used as a non-invasive technique to diagnose the NCP. NCP can be detected in patients with underlying glomerular diseases and in normal people. NCP may beaccompanied by other symptoms, such as varicocele, disturbance of orthostatic regulation and chronic fatigue syndrome. Follow-up m

关 键 词：B型超声 诊断 胡桃夹现象 临床分析 血尿 蛋白尿 儿童 

分 类 号：R445.1[医药卫生—影像医学与核医学]