肾病综合征合并深静脉血栓和肺栓塞的诊治

Diagnosis and treatment of deep vein thrombosis and pulmonary embolism in nephrotic syndrome

目的 研究肾病综合征 (NS)高凝状态所致深静脉血栓形成 (DVT)和肺栓塞 (PE)的发生率 ,抗凝治疗的指征和临床效果。方法 5 4例NS患者 ,男性 31例 ,女性 2 3例 ;平均年龄 (44 13± 15 88)岁 ,2 4小时尿蛋白 (8 4 3± 5 6 4 ) g ,血浆白蛋白 (2 0 4 8± 5 4 1) g/L。采用巨聚合人血清白蛋白 (99mTc -MAA)核素深静脉造影(RNV)及肺显像诊断下肢DVT和PE ,并评价低分子量肝素 (LMWH)皮下注射和口服抗血小板凝集药物治疗的临床效果。结果 诊断下肢DVT4 1/5 4例 ,占 76 % ,有临床表现者占 14 8% ;PE 32 /5 4例 ,占 5 9 2 5 % ,有临床症状者占 7 4 %。PE由下肢DVT引起的占 70 7%。经LMWH治疗后 ,无 1例患者死于肺栓塞。结论 DVT是NS最重要的并发症之一 ,RNV能早期诊断下肢DVT和PE ,尽早抗凝治疗能改善NS的预后 。

Objectives To investigate the incidence of deep vein thrombosis (DVT) of lower limbs and pulmonary embolism (PE) caused by hypercoagubility in patients with nephrotic syndrome and to estimate the indication and clinical effect of anticoagulation therapy. Methods 54 patients with nephrotis syndrome(thirty-one males and twenty-three females with mean age: 44 13±15 88, 24 hours proteinuria:8 43±5 64g, albuminemia: 20 48±5 41g/L) were enrolled in this study.DVT of lower limbs and PE were confirmed by radionuclide imaging (RNV) with 99mTc-MAA and the clinical effect of subcutaneous injection of low molecular weight heparin (LMWH) and oral antiplatelet coagulation therapy were evaluated as well. Results 41 out of 54 cases (76%) had DVT of lower limbs, 14 8% of which had clinical manifestations. 32 out of 54 cases (59 25%) had PE, 7 4% of which had symptoms. 70 7% of PE were caused by DVT of lower limbs. No patient died of PE after the LMWH treatment.Conclusions DVT is one of the most important complications of NS. RNV can be used to make early diagnosis of DVT of lower limbs and PE. Early anticoagulation therapy might ameliorate the prognosis of NS and lower the mortality of PE.