合并静脉血栓栓塞慢性肾脏病患者的临床特征及预后

Characteristics and outcomes of chronic kidney disease patients with concomitant venous thromboembolism

目的:分析合并静脉血栓栓塞(VTE)的慢性肾脏病(CKD)患者的临床特征及预后。方法:纳入2012年1月至2021年5月国家肾脏疾病临床医学研究中心收治的CKD合并VTE患者,回顾性分析其临床特征及预后。结果:共有682例CKD患者明确诊断合并VTE,其中男性521例(76.4%),420例(61.6%)患者VTE发生于CKD病程前6个月。617例(90.5%)处于肾病综合征(NS)状态,最常见为膜性肾病(MN)372例(54.5%)。VTE最常见为肺动脉栓塞(PE)474例(69.5%),其次是肾静脉栓塞(RVT)337例(49.4%),下肢静脉栓塞(DVT)101例(14.8%);部分患者同时有多部位栓塞,以PE+RVT最常见(196例,28.7%)。405例(59.4%)患者无临床症状,RVT和PE患者中无症状者分别高达82.2%(277/337)和66.7%(316/474)。实验室检查D-二聚体阳性率91.9%(564/614)。随访2年,62例(9.1%)患者VTE复发,55例(8.1%)患者抗凝治疗过程中发生出血事件而减量或停用抗凝剂,共60例出血事件,其中仅1例为临床大出血。结论:CKD患者VTE多发生在病程6月内,男性更为多见,绝大多数患者临床表现为NS,但半数以上患者并无相应的临床症状,因而可能低估PE和RVT的发生。抗凝治疗后,VTE患者复发率低,大出血并发症并不常见。

Objective:To investigate the clinical characteristics and outcomes of chronic kidney disease patients with concomitant venous thromboembolism.Methodology:We retrospectively analyzed the clinical characteristics and outcomes of patients with CKD and VTE between January 2012 and May 2021 from the National Clinical Research Center of Kidney Diseases.Results:A total of 682 CKD patients were confirmed with VTE,of which 521(76.4%)were male and 420(61.6%)had VTE occurring 6 months before the onset of CKD.617 cases(90.5%)were in the state of nephrotic syndrome(NS),with the most common being membranous nephropathy(MN)in 372 cases(54.5%).The most common VTE was pulmonary embolism(PE)in 474 cases(69.5%),followed by renal vein embolism(RVT)in 337 cases(49.4%),and lower limb vein embolism(DVT)in 101 cases(14.8%);some patients had multiple site embolisms simultaneously,with PE+RVT being the most common(196 cases,accounting for 28.7%).405 patients(59.4%)had no clinical symptoms,with 82.2%(277/337)and 66.7%(316/474)of RVT and PE patients having no symptoms,respectively.The positive rate of D-dimer in laboratory tests was 91.9%(564/614).During a 2-year follow-up,62 patients(9.1%)experienced VTE recurrence,and 55 patients(8.1%)experienced bleeding events during anticoagulant therapy and reduced or discontinued anticoagulants.A total of 60 bleeding events occurred,of which only 1 was a clinical major bleeding event.Conclusion:VTE in CKD patients often occurs within 6 months of the disease course,especially in males.The vast majority of patients present with nephrotic syndrome,but more than half of them do not have corresponding clinical symptoms,which may underestimate the occurrence of PE and RVT.After anticoagulant treatment,the recurrence rate of VTE patients is low,and major bleeding complications are not common.