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恶性高血压性血栓性微血管病的临床病理分析 被引量:3
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作者 王文荣 李秋芬 毛俐婵 《浙江临床医学》 2020年第7期974-976,共3页
目的分析恶性高血压(MHT)性血栓性微血管病(TMA)的临床病理特点与预后的相关性.方法2010年9月至2019年9月经肾活检确诊的MHT患者21例,分为肾炎组(GN组,7例)和原发性高血压组(HT组,14例).结果所有患者均有肾功能不全和蛋白尿.两组患者发... 目的分析恶性高血压(MHT)性血栓性微血管病(TMA)的临床病理特点与预后的相关性.方法2010年9月至2019年9月经肾活检确诊的MHT患者21例,分为肾炎组(GN组,7例)和原发性高血压组(HT组,14例).结果所有患者均有肾功能不全和蛋白尿.两组患者发病年龄、病程、血压、尿蛋白水平、血尿、贫血及血小板减少发生率差异无统计学意义.HT组肥胖、糖尿病比例高于GN组.GN组血白蛋白水平显著低于HT组.两组患者肾组织病理学特点、免疫荧光和电镜结果存在差异.GN组患者肾小球、小管间质及血管病变程度一致,动脉病变以慢性病变为主.HT组肾小球病变轻,肾小球硬化比例明显低于GN组,小动脉可见急性、慢性病变并存.HT组2例患者就诊后1年尿检转阴,血肌酐仍上升,行肾活检仍可见小动脉急性病变,其中1例6年后进展至终末期肾衰.结论恶性高血压性血栓性微血管病的肾组织病理特点、免疫荧光、电镜改变及预后与病因有关,肾活检是明确病因的有效手段.经过积极降压治疗部分患者可好转,部分患者动脉病变仍可进展. 展开更多
关键词 恶性高血压 血管性微血管病
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Thrombotic microangiopathy-like disorder after living-donor liver transplantation:A single-center experience in Japan 被引量:1
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作者 Tomohide Hori Toshimi Kaido +20 位作者 Fumitaka Oike Yasuhiro Ogura Kohei Ogawa Yukihide Yonekawa Koichiro Hata Yoshiya Kawaguchi Mikiko Ueda Akira Mori Yasutsugu Takada Hiroto Egawa Atsushi Yoshizawa Shinji Uemoto Hajime Segawa Kimiko Yurugi Takuma Kato Kanako Saito Linan Wan Mie Torii Feng Chen Ann-Marie T Baine Lindsay B Gardner 《World Journal of Gastroenterology》 SCIE CAS CSCD 2011年第14期1848-1857,共10页
AIM:To investigate thrombotic microangiopathy (TMA)in liver transplantion,because TMA is an infrequent but life-threatening complication in the transplantation field. METHODS:A total of 206 patients who underwent livi... AIM:To investigate thrombotic microangiopathy (TMA)in liver transplantion,because TMA is an infrequent but life-threatening complication in the transplantation field. METHODS:A total of 206 patients who underwent living-donor liver transplantation (LDLT) were evaluated,and the TMA-like disorder (TMALD) occurred in seven recipients. RESULTS:These TMALD recipients showed poor outcomes in comparison with other 199 recipients. Although two TMALD recipients successfully recovered,the other five recipients finally died despite intensive treatments including repeated plasma exchange (PE) and re-transplantation. Histopathological analysis of liver biopsies after LDLT revealed obvious differences according to the outcomes. Qualitative analysis of antibodies against a disintegrin-like domain and metalloproteinase with thrombospondin type 1 motifs (ADAMTS-13) were negative in all patients. The fragmentation of red cells,the microhemorrhagic macules and the platelet counts were early markers for the suspicion of TMALD after LDLT. Although the absolute values of von Willebrand factor (vWF) and ADAMTS-13 did not necessarily reflect TMALD,the vWF/ADAMTS-13 ratio had a clear diagnostic value in all cases. The establishment of adequate treatments for TMALD,such as PE for ADAMTS-13 replenishment or treatments against inhibitory antibodies,must be decided according to each case. CONCLUSION:The optimal induction of adequate therapies based on early recognition of TMALD by the reliable markers may confer a large advantage for TMALD after LDLT. 展开更多
关键词 Thrombotic microangiopathy Liver transplan-tation von Willebrand factor A disintegrin-like domain and metalloproteinase with thrombospondin type 1 motifs COMPLICATION
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