摘要
目的探讨胡桃夹综合征(nutcracker syndrome,NCS)与原发性肾小球疾病之间的相互关系。方法收集2006年8月—2015年4月我院诊断为NCS患者46例(NCS组),其中合并原发性肾小球疾病21例(合并亚组),单纯NCS 25例(单纯亚组);另选择同期、同年龄段、性别比例相似的经肾穿刺活检术证实为单纯原发性肾小球疾病患者53例作为对照组,分别收集上述病例的临床及病理资料进行回顾性分析。结果 NCS组与对照组比较,体重指数、平均动脉压、24 h尿蛋白定量、多形尿红细胞比例均降低,差异有统计学意义(P<0.05)。合并亚组与单纯亚组比较,24 h尿蛋白定量高,尿红细胞形态均一,差异有统计学意义(P<0.05);超声检查显示两亚组肠系膜上动脉与腹主动脉间夹角,左肾静脉(LRV)狭窄处内径、LRV近肾门处内径及其二者比值比较差异均无统计学意义(P>0.05);病理检查显示合并亚组中合并免疫球蛋白A(Ig A)肾病10例(47.6%),系膜增生性肾小球肾炎8例(38.1%),轻微病变肾病2例(9.5%),毛细血管内增生性肾小球肾炎1例(4.8%)。结论 NCS好发于体型瘦高者,对伴有肾小球性血尿或中重度蛋白尿且无肾穿刺活检术禁忌证的NCS患者,应考虑合并肾小球疾病的可能,及早行肾穿刺活检术明确诊断。NCS合并原发性肾小球疾病时,以Ig A肾病居多。
Objective To investigate mutual relationship between nutcracker syndrome and primary glomerular disease. Methods 46 patients with nutcracker syndrome（ NCS group） during August 2006 to April 2015,including 21 patients of glomerular nephritis complicated with nutcracker syndrome were selected as combined group and 25 cases of nutcracker syndrome as pure group（ n = 25）. At the same time,53 cases of non-NCS glomerular diseases confirmed by biopsy with the same age and gender were selected as control group. The clinical and pathological data of these cases were analyzed retrospectively.Results Compared with control group in NCS group,body mass index,mean arterial pressure,24 h urine protein quanta,and polymorphic urine red blood cell proportion were reduced with statistically significant difference（ P〈0. 05）. Compared with pure group in the combined group,24 h urine protein quanta was high,red cell morphology of urinary was uniform,and the difference was statistically significant（ P〈0. 05）; ultrasound examination showed that difference between the two groups had no statistical significance,such as in angle of SMA and AA,LRV narrow diameter,LRV near the renal hilum diameter and the ratio between of the two groups（ P〉0. 05）. Pathological examination showed that these were 10 cases of immunoglobulin A（ IgA） nephropathy（ 47. 6%）,8 cases of mesangial proliferative glomerulonephritis（ 38. 1%）,2 cases of mild lesions nephropathy（ 9. 5%）,1 case of capillaries proliferative glomerulonephritis（ 4. 8%） in combined group. Conclusion NCS tends to occur in slim patients. NCS patients with glomerular hematuria or moderately and severe proteinuria as well as without renal biopsy contraindications,should be suspected as having glomerular disease,and should undergo renal biopsy as soon as possible in order to make definitive diagnosis and receive correct treatment in time. In case of NCS complicated with idiopathic glomerular disease,the incidence of IgA nephropathy is high.
出处
《临床误诊误治》
2016年第4期79-83,共5页
Clinical Misdiagnosis & Mistherapy
关键词
肾胡桃夹综合征
肾小球疾病
活组织检查
针吸
血尿
蛋白尿
Renal nutcracker syndrome
Kidney glomerulus disease
Biopsy
needle
Hematuria
Proteinuria
