胡桃夹现象中血尿合并蛋白尿患者的临床分析

发布时间：2018-01-06 14:30

本文关键词：胡桃夹现象中血尿合并蛋白尿患者的临床分析　出处：《河南中医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的:分析比较胡桃夹现象中血尿合并蛋白尿患者中伴有和不伴有肾小球肾炎的临床特点、实验室检查等因素的差异,为帮助疾病的临床诊断提供有价值的诊断依据;分析胡桃夹现象合并肾小球肾炎患者的实验室检验结果及肾脏病理结果,探讨胡桃夹现象与肾小球疾病之间的关系。方法:收集河南中医学院第一附属医院2010年1月至2015年1月肾内科和儿科门诊及病房收治的存在胡桃夹现象的有血尿、蛋白尿临床表现的患者90例,其中合并肾小球疾病者45例归为甲组,不合并肾小球45例归为乙组。观察两组患者的一般资料如年龄、性别,计算体重指数,观察实验室检验运动前后尿红细胞计数、尿红细胞形态、24H尿蛋白定量、血清白蛋白进行分析比较;观察胡桃夹现象合并肾小球肾炎患者中肾穿刺患者的病理特点。结果:两组患者在年龄、性别、体重指数分布上无显著差异(均为P0.0 5),而从两组患者年龄构成比上看均以1 4~2 9岁居多,体重指数分布构成上均以较低体重指数者为居多。两组患者实验室检查结果存在差异,经检验有统计学意义,两组患者运动前后尿红细胞形态、运动前后尿红细胞计数、24H尿蛋白定量、血清白蛋白的比较存在显著差异(均为P0.0 5)。甲组运动前尿红细胞形态有均一性、非均一性及混合性三种,运动后尿红细胞形态表现为非均一性及混合性,而乙组运动前后尿红细胞形态未发生改变,仍表现为均一性;甲组运动前后尿红细胞计数均高于乙组,且两组患者运动后尿红细胞计数均较运动前明显增多,甲组较乙组红细胞计数变化显著;甲组24H尿蛋白定量水平高于乙组,而血清白蛋白较乙组减少。胡桃夹合并肾小球肾炎患者肾穿刺病理结果显示可见到多种病理类型:微小病变性肾病7例,局灶增生硬化性肾小球肾炎5例,膜性肾病11例,系膜增生性肾病7例,Ig A肾病12例,出现多种免疫复合物:I g A阳性1 7例,I g M阳性1 2例,I g G阳性1 8例,C 3阳性1 5例,C 4阳性1例,C1q阳性2例。结论:(1)胡桃夹综合征可以合并肾小球肾炎;(2)胡桃夹综合征患者出现运动后尿检异常,及生化指标异常时,建议进行肾穿刺;(3)胡桃夹现象合并肾小球肾炎患者的病理结果具有多样性。
[Abstract]:Objective: to analyze and compare the clinical characteristics, laboratory examination and other factors in patients with and without glomerulonephritis in patients with hematuria and proteinuria. In order to help the clinical diagnosis of disease to provide valuable diagnostic basis; The results of laboratory examination and renal pathology in patients with Glomerulonephritis were analyzed. To explore the relationship between nutcracker phenomenon and glomerular disease. Methods:. Collected from January 2010 to January 2015, the first affiliated Hospital of Henan College of traditional Chinese Medicine, Department of Nephrology and Pediatrics outpatients and wards admitted to the existence of walnut clip phenomenon of hematuria. Ninety patients with proteinuria were divided into group A (45 cases with glomerular disease) and group B (45 cases without glomerulus). The general data of the two groups were observed such as age and sex. Body mass index (BMI), urine red blood cell count before and after exercise, urine erythrocyte morphology and 24 H urine protein were measured and compared with those of serum albumin before and after exercise. Results: there was no significant difference in age, sex and body mass index distribution between the two groups (all P0.05). The age composition of the two groups was 14 ~ 29 years old, and the distribution of body mass index was mostly lower body mass index. The results of laboratory examination were different between the two groups. Two groups of patients before and after exercise urine red blood cell morphology, before and after exercise urine red blood cell count before and after exercise 24 H urine protein quantitative. There was significant difference in the comparison of serum albumin (all P 0.05). There were three types of urine erythrocyte morphology before exercise in group A: homogeneity, heterogeneity and mixture. The morphology of urine red blood cells showed heterogeneity and mixture after exercise, but the morphology of urine red blood cells did not change before and after exercise in group B, but still showed homogeneity. Before and after exercise, the urine erythrocyte count in group A was higher than that in group B, and the urine erythrocyte count in group A was significantly higher than that in group B after exercise, and the change of erythrocyte count in group A was significantly higher than that in group B. The quantitative level of 24H urine protein in group A was higher than that in group B. the level of serum albumin in group A was lower than that in group B. Nutcracker combined with glomerulonephritis showed a variety of pathological types: 7 cases of minimal change nephropathy. There were 5 cases of focal proliferative sclerosing glomerulonephritis, 11 cases of membranous nephropathy, 7 cases of Mesangial proliferative nephropathy and 12 cases of IgA nephropathy. Ig M was positive in 12 cases, IgG was positive in 18 cases, and C 3 was positive in 15 cases, and 1 case was positive in C 4. ConclusionNutcracker syndrome can be associated with glomerulonephritis. 2) Nutcracker syndrome patients had abnormal urine examination after exercise and abnormal biochemical indexes, so kidney puncture should be carried out. The pathological results of patients with Glomerulonephritis were diverse.
【学位授予单位】：河南中医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R692

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