肾病综合征并发深静脉血栓和（或）肺栓塞临床分析

目的 探讨肾病综合征（nephrotic syndrome,NS）并发深静脉血栓形成 （DVT）和（或）肺栓塞（PE）的相关危险因素及诊治体会.方法 对10例确诊的NS并发DVT和（或）PE患者（血栓组）的临床资料进行回顾性分析,并与同期50例NS无血栓患者（无血栓组）的年龄（AGE）、血浆白蛋白（ALB）、24小时尿蛋白定量（24-UP）、总胆固醇（CHOL）、三酰甘油（TG）、血小板（PLT）、纤维蛋白原（FIB）等指标进行比较.结果 血栓组10例,肾活检6例,膜性肾病3例.血栓组AGE、ALB、24-UP、FIB与无血栓组比较差异有统计学意义（P＜0.05）,CHOL、TG、PLT差异无统计学意义（P＞0.05）.血栓组经抗凝、溶栓、下腔静脉滤器植入等治疗后,血栓均基本消失.结论 AGE、ALB、24-UP、FIB在NS并发DVT和（或）PE形成过程中起着非常重要的作用.膜性肾病是NS合并血栓栓塞最常见的病理类型.一旦合并DVT和（或）PE,应根据具体情况选择抗凝、溶栓、介入治疗.经皮放置下腔静脉滤器是预防DVT导致PE的有效方法.

Clinical analysis of deep venous thrombosis and (or) pulmonary embolism in nephrotic syndrome

Objective To explore the related risk factors, diagnosis and treatment of nephrotic syndrome （NS） complicated with deep venous thrombosis （DVT） and （or） pulmonary embolism （PE）. Methods A retrospective study was conducted on the clinical data of 10 cases of nephrotic syndrome complicated with DVT and （or） PE, which was compared with 50 synchronous cases of nephrotic syndrome with no thrombosis as to age （AGE）, plasma albumin （ALB）, 24- hour urine protein （24- UP）, total cholesterol （CHOL）, triglyceride （TG）, platelet （PLT） and fibrinogen （FIB）. Results In the thrombosis group, 6 patients underwent renal biopsy, 3 of whom had membranous nephropathy. There were significant differences in the indicators such as AGE, ALB, 24 - UP, FIB between the thrombosis group and the non - thrombosis group （ P 〈 0.05 ） ; the differences in CHOL, TG and PLT had no statistical significance （ P 〉 0.05 ）. The thrombi disappeared in the thrombosis group following a series of therapies including anticoagulation, thrombolysis, implantation of inferior vena cava filter （ IVCF）, etc. Conclusion AGE, ALB, 24 - UP and FIB play very important roles in the formation of DVT and （or） PE in NS. Membranous nephropathy is the most common pathological type in NS with thromboembolism. In cases of NS complicated with DVT and （or） PE, anticoagulation, thrombolysis or interventional therapy should be conducted as required. Implantation of IVCF is an effective method to prevent DYT leading to PE.