胡桃夹综合征并发IgA肾病临床分析

目的 了解胡桃夹综合征并发IgA肾病的临床特点及提高其相应诊治水平。 方法 回顾分析14例胡桃夹综合征并发IgA肾病患者（病例组）及同期36例单纯胡桃夹综合征患者（对照组）的临床资料。所有胡桃夹综合征病例均由彩色多普勒超声和磁共振血管成像（MRA）诊断；IgA肾病均由病理证实。记录两组实验室、影像学资料并进行t检验分析。 结果 两组患者性别、年龄、血压差异无统计学意义。病例组Scr值高于对照组（81.2±21.3） μmol/L比（61.2±11.8） μmol/L，P < 0.01]，尿蛋白量较多（1.1±0.6） g/d比（0.3±0.2） g/d，P < 0.01]，血尿更明显（尿红细胞计分2.3±0.9比1.5±1.3，P < 0.05）。彩色多普勒超声显示两组左肾静脉狭窄处及近肾门处血流速度和内径差异无统计学意义；磁共振血管成像提示两组患者肠系膜上动脉与腹主动脉之间的夹角差异无统计学意义。 结论 对持续存在血尿和蛋白尿、异常红细胞比例较高的胡桃夹综合征患者应考虑存在并发慢性肾炎特别是IgA肾病的可能，应及早行肾活检明确诊断。

Clinical analysis of nutcracker syndrome complicated with IgA nephropathy

Objective To elucidate the clinical features of nutcracker syndrome complicated with IgA nephropathy (IgAN) and to increase its level of diagnosis and treatment. Methods Clinical data of 14 cases of nutcracker syndrome complicated with IgA nephropathy (patient group) and 36 cases of nutcracker syndrome (control group) were analyzed retrospectively. Nutcracker syndrome was diagnosed by ultrasonography and magnetic resonance angiography (MRA) and IgAN by renal biopsy. Differences of clinical data and images in two groups were analyzed. Results Gender, age and blood pressure of two groups were not significantly different. Higher Scr level (81.2±21.3) μmol/L vs (61.2±11.8) μmol/L, P<0.01], more severe proteinuria (1.1 ± 0.6) g/d vs (0.3±0.2) g/d, P<0.01] and hematuria (2.3±0.9 vs 1.5±1.3, P<0.05) in patient group were found. Differences of ultrasonography and MRA in two groups were not significant. Conclusion Renal biopsy should be considered in cases of nutcracker syndrome with persistence of proteinuria, hematuria or abnormal morphology of urinary red blood cell.