原发性肾病综合征合并血栓栓塞的临床研究

Research of Thromboembolism Complications in Primary Nephrotic Syndrome

目的:肺栓塞及下肢深静脉血栓是影响肾病综合征(Nephrotic Syndrome,NS)预后的重要因素,但在其发生率以及治疗方面仍存在争议。本文将通过回顾性的病例研究对NS患者中血栓栓塞事件的发生率、危险因素以及是否需要早期干预等问题进行探讨。方法:收集上海交通大学医学院附属新华医院肾内科2014年1-12月诊断为原发性NS患者,并同时收集患者基本临床信息,血栓检查结果以及NS相关血液及尿液检查结果等在内的临床资料,采用多种统计方法分析血栓发生率及其危险因素,并进一步讨论NS患者的预防性抗凝措施。结果:NS患者下肢静脉血栓或肺栓塞的发生率均为15.4%,两种血栓同时发生的概率为9.6%。NS患者血栓事件的发生率与D-二聚体、血浆白蛋白、病程、病理类型呈明显相关,且具有统计学意义。结论:NS患者血栓栓塞的发生率与D-二聚体、血浆白蛋白、病程、病理类型呈显著相关,膜性肾病患者血栓栓塞发生率最高。如NS患者合并高危因素,建议定期筛查,综合评估后预防性抗凝。

Objectives:Although thromboembolic events usually occurs in nephrotic syndrome(Nephrotic Syndrome,NS),the incidence and risk factors is still debatable.To further study the relevant problem,we performed a series of clinical research.Methods:All the NS patients between January to December in 2014 enrolled in nephrology department of Xinhua hospital were contained.The clinical data such as gender,duration of disease,pathological type,24-hour urinary protein quantification,low density lipoprotein,platelet,plasma albumin,D-D dimer,fibrinogen were all collected.Variance analysis,T-test and Logistic regression analysis were all used to analyze the incidence of thrombosis and its risk factors.Meanwhile,the preventive anticoagulation measures for NS patients were further discussed.Results:Both of the incidences of PE and lower extremity DVT in NS were 15.4%.The incidence of cooccurrence of PE and DVT was 9.6%.The incidence of PE and DVT was significantly correlated with D-dimer,plasma albumin,course of disease and pathological type,which had statistical significance.Conclusions:The incidence of thrombosis in NS patients was significantly correlated with D-dimer,plasma albumin,duration of disease and pathological type,NS patients with high incidence of thromboembolism is suggested anticoagulation.