胡桃夹综合征合并肾脏疾病临床分析

发布时间：2018-07-21 15:34

【摘要】：目的分析儿童胡桃夹综合征合并肾脏疾病的临床及诊疗特点,为临床提供参考。方法回顾性分析2009年1月—2013年12月本院肾内科收治入院的共157例诊断胡桃夹综合征患者的临床资料,按其是否合并肾脏疾病分为两组,胡桃夹综合征合并肾脏疾病者为混合组,共78例,单纯胡桃夹综合征者为单一组,共79例。分析该两组患者临床表现、辅助检查特点和治疗情况。结果157例患者男女比例为87：70,年龄4岁-15岁。两组年龄无统计学差异。男性患者比例在混合组占66.7%,在单一组占44.3%,差异有统计学意义。混合组有肉眼血尿表现者多于单一组(47.4%比26.6%,P=0.007),有蛋白尿表现者在混合组中多于单一组(74.4%比50.6%,P=0.002),腰腹痛、乏力、头昏头痛、浮肿表现在两组间无明显差异。混合组血尿水平高于单一组[Adiss计数RBC 125(22.4-946)(万/12h)比45(0.56-368)(万/12h),P=0.009],混合组尿蛋白量大于单一组[0.19(0.08-0.57)g/d比0.06(0.02-0.15)g/d,P=0.001]。混合组血尿素氮水平高于单一组[(5.00±2.11)mmol/L比(4.11±1.15)mmol/L,P=0.015]。两组经影像学检查肠系膜上动脉和腹主动脉间夹角度数、左肾静脉扩张狭窄段内径比差异均无统计学意义。随访混合组20例患者,经治疗后19例临床症状消失,1例感冒后肉眼血尿反复。单一组随访21例患者,经保守治疗观察2月-4年后,19例临床症状消失,2例感冒后肉眼血尿反复。结论胡桃夹综合征以血尿为主要临床表现,通常预后较好。可单发也可与肾脏疾病共存,对于有肉眼血尿和蛋白尿NCS患者,尤其是合并大量蛋白尿和血尿素氮增高时,需警惕是否合并肾脏疾病可能,必要时可行病理活检明确,以避免延误肾脏疾病的治疗。
[Abstract]:Objective to analyze the clinical and clinical features of Nutcracker syndrome complicated with renal disease in children and to provide reference for clinical practice. Methods the clinical data of 157 patients with Nutcracker syndrome who were admitted to our hospital from January 2009 to December 2013 were analyzed retrospectively. The patients were divided into two groups according to whether they were complicated with renal diseases. There were 78 cases of Nutcracker syndrome complicated with renal disease, and 79 cases of simple Nutcracker syndrome. The clinical manifestations, auxiliary examination features and treatment of the two groups were analyzed. Results the male to female ratio of 157 patients was 87: 70, aged 4-15 years. There was no significant difference in age between the two groups. The proportion of male patients was 66.7% in the mixed group and 44.3% in the single group. In the mixed group, there were more unaided hematuria (47.4% vs 26.6P0.007) and more proteinuria in the mixed group (74.4% vs 50.6P 0.002). The symptoms of abdominal pain, fatigue, dizziness and edema in the mixed group were not significantly different between the two groups. The level of hematuria in the mixed group was higher than that in the single group [Adiss count RBC125 (22.4-946) (10000 / 12h) vs 45 (0.56-368) (10,000 / 12h), urinary protein content in the mixed group was higher than that in the single group [0.19 (0.08-0.57) g / d ratio 0.06 (0.02-0.15) g / d = 0.001]. The blood urea nitrogen level in the mixed group was higher than that in the single group [(5.00 卤2.11) mmol / L vs (4.11 卤1.15) mmol / L]. There was no significant difference in the angle between superior mesenteric artery and abdominal aorta and the ratio of internal diameter of dilated stenosis of left renal vein between the two groups. Twenty patients in the mixed group were followed up. After treatment, 19 cases had disappeared clinical symptoms and 1 case had repeated hematuria after colds. 21 patients were followed up in a single group. After 2 months to 4 years of conservative treatment, 19 cases of clinical symptoms disappeared and 2 cases had repeated hematuria after colds. Conclusion the main clinical manifestation of nutcracker syndrome is hematuria, and the prognosis is usually good. It can also coexist with renal disease alone. For patients with NCS with gross hematuria and proteinuria, especially in patients with hyperproteinuria and elevated blood urea nitrogen, it is necessary to be alert to the possibility of renal disease, and to make it clear that pathological biopsy is feasible if necessary. To avoid delays in the treatment of kidney disease.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R692

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