肾病综合征合并门静脉血栓形成(附1例病例报告)

Nephrotic syndrome complicated with thrombosis of portal vein

目的提高对肾病综合征合并门静脉血栓形成的认识,探讨相关治疗心得。方法报告1例以门静脉血栓形成为首发表现的肾病综合征病例,并复习相关文献。结果男性,52岁,因“腹痛、腹胀伴蛋白尿1周”入院。当地以“急腹症”收住入院,予以相应抗炎、解痉、制酸等处理无好转,彩超提示“门静脉栓塞”,并行DSA检查确诊,同时发现大量蛋白尿、低蛋白血症,考虑肾病综合征合并门静脉血栓,用尿激酶等治疗无好转而转来本院。入院后给予以肝素、东菱克栓酶以及糖皮质激素等联合治疗。腹痛、腹胀等症状明显好转,复查尿蛋白转阴,多次复查彩超提示门静脉血栓进行性缩小,门静脉高压表现好转。出院随访至今病情稳定。结论深静脉血栓形成为肾病综合征严重并发症,以门静脉血栓形成且为首发症状较罕见,且病情较重。早期(6 h内)尿激酶溶栓效果最佳,后期可以东菱克栓酶(DF-521)、肝素等为主要治疗手段;在治疗血栓时应同时治疗原发疾病—肾病综合征。

Objective To elevate the recognition in a nephrotic syndrome complicated with thrombosis of portal vein, approach what should be gainned from learning for therapy in it. Methods A case of nephrotic syndrome was reported;who began with thrombosis of portal vein, and related pertinent literature was reviewed. Results A male,52 years old, sufferred form abdominal pain ,abdominal distention and hyperproteinuria for a week. He was admitted for being diagnosed＂ acute abdomen＂ in the locality, and felt unimproved after being treated with anti - inflammatory, spasmolysis and antiacid medicine and so on. Portal vein embolization was found with color transonogram, and was final diagnosed with digital subtraction angiography （DSA）. Meanwhile, a great quantity proteinum and hypoproteinemia were found. Then nephrotic syndrome complicating with thrombosis of portal vein was diagnosed . After being treated with urokinase （UK） ,the man felt unimproved yet,and turned to our hospital. After hospital admission,the man was adminned with therapeutic alliance, such as heparin, DF -521 and glucocorticosteroid. Abdominal pain and abdominal distention took a favorable turn obviously, and urine protein turned to negative, and portal, phlebothrombosis was prompted to minification gradually by color transonogram, many times, portal hypertension symptom turned to better. During follow - up visit,his pathogenetic condition was stable. Conclusion Deep venous thrombosis formation is a severe complication in nephrotic syndrome, it is more rare as the first symptom in NS, and pathogenetic condition is more serious. The effect after treatment of UK thrombolysis is the best in earlier period（ within six hours） , DF -521 and heparin may be used as the primary therapeutic tool during later period. The primarily disease - NS, should be treated when the thrombus is being treated.