儿童原发性肾病综合征合并颅内静脉血栓4例病例报告

发布时间：2017-12-28 07:39

  本文关键词：儿童原发性肾病综合征合并颅内静脉血栓4例病例报告　出处：《中国循证儿科杂志》2016年01期 　论文类型：期刊论文

  更多相关文章： 原发性肾病综合征 颅内静脉血栓 头颅MRI 溶栓治疗 儿童

【摘要】：目的通过对原发性肾病综合征合并颅内静脉血栓患儿行临床分析,探讨儿童NS合并颅内静脉血栓早期诊断和治疗的可行方案。方法纳入2012年1月至2015年9月在上海市儿童医院住院的原发性肾病综合征且经头颅CT和(或)MRI确诊的颅内静脉血栓患儿,对其临床症状、实验室指标、影像学检查结果、疗效及预后进行分析。结果 4例原发性肾病综合征合并颅内静脉血栓患儿进入分析,均为男性,年龄5岁4个月至11岁4个月,出现颅内静脉血栓时间距原发性肾病综合征起病时间为1个月至7年余。4例颅内静脉血栓发病时均有神经精神系统症状,查体均未见神经系统阳性体征。3例在颅内静脉血栓发病期间D-二聚体、纤维蛋白原降解产物(FDP)均升高,抗凝血酶Ⅲ(AT-Ⅲ)下降;确诊后D-二聚体、FDP较前继续升高;4例血清白蛋白明显降低,总胆固醇明显升高。4例出现颅内静脉血栓临床症状当日或次日均行头颅MRI增强+MRV+MRA检查,3例为左侧乙状静脉窦血栓,1例为脑栓塞。明确颅内静脉血栓诊断后,3例予尿激酶溶栓,低分子肝素钙和双嘧达莫抗凝治疗;1例脑栓塞患儿予对症和抗凝治疗;4例症状均明显改善。3例出院后6~12个月随访头颅MRI增强+MRV显示颅内异常信号均有不同程度吸收。结论儿童原发性肾病综合征合并颅内静脉血栓易发生于左侧乙状静脉窦。在原发性肾病综合征病程中如出现神经精神系统症状时,应及时行头颅MRI相关序列检查,有助于颅内静脉血栓早期诊断;早期积极溶栓治疗预后良好。
[Abstract]:Objective to analyze the early diagnosis and treatment of children with primary nephrotic syndrome complicated with intracranial venous thrombosis, and to explore the feasible plan for early diagnosis and treatment of NS combined with intracranial venous thrombosis. Methods children with primary nephrotic syndrome and intracranial venous thrombosis diagnosed by CT and / or MRI were enrolled in Shanghai Children's Hospital from January 2012 to September 2015. Their clinical symptoms, laboratory indexes, imaging findings, curative effects and prognosis were analyzed. Results 4 children with primary nephrotic syndrome and intracranial venous thrombosis were enrolled in the analysis. They were all male, aged 5 years, 4 months to 11 years, 4 months. Intracranial venous thrombosis occurred at a time from 1 months to 7 years. There were nervous system symptoms in 4 cases of intracranial venous thrombosis, and no positive signs of the nervous system were found in the examination body. During the onset of intracranial venous thrombosis, D- two dimers and fibrinogen degradation products (FDP) increased, and antithrombin III (AT- III) decreased in 3 cases. After diagnosis, D- two mer and FDP continued to increase, 4 serum albumin decreased significantly, and total cholesterol increased significantly. Cranial MRI enhanced +MRV+MRA examination was performed on the day or the next day in 4 cases of intracranial venous thrombosis, 3 cases were left sigmoid venous sinus thrombosis and 1 cases were cerebral embolism. After definite diagnosis of intracranial venous thrombosis, 3 cases were treated by urokinase thrombolysis, low molecular weight heparin calcium and dipyridamole anticoagulation therapy. 1 cases of cerebral embolism were treated with symptomatic and anticoagulant therapy, and 4 cases were significantly improved. After 6~12 months of 6~12 months follow-up, MRI enhanced +MRV showed that the abnormal signals of intracranial abnormal signals were absorbed in different degrees. Conclusion primary nephrotic syndrome in children with intracranial venous thrombosis occurs easily in the left side of the sigmoid sinus. In the course of primary nephrotic syndrome, if there are neuropsychiatric symptoms, it is necessary to make MRI related sequence examination in time, which is helpful for early diagnosis of intracranial venous thrombosis. Early active thrombolytic therapy has a good prognosis.
【作者单位】： 上海交通大学附属儿童医院肾脏内科;
【基金】：上海市科委基金项目:12ZR1425500
【分类号】：R726.9;R743
【正文快照】： 原发性肾病综合征(NS)是儿童常见的肾脏疾病之一,血栓被认为是NS继感染外,严重威胁患儿生命的并发症[1]。尽管NS合并颅内静脉血栓(CVT)的发生率较低,但病死率高,预后不良。儿童中由于CVT临床表现多样性,容易忽视或误诊,错失合适的干预时机,如能早期诊断和积极抗凝治疗则对于改，

本文编号：1345182