肾病综合征合并脑梗死62例临床分析

目的 探讨肾病综合征(NS)合并脑梗死患者的临床特点及潜在发病机制。方法 收集NS合并脑梗死患者的临床表现、实验室及影像学检查,回顾性分析其临床资料。结果 收集到NS合并脑梗死患者共62例,占同期4584例NS患者的1.35%,其中男47例(75.81%),女15例(24.19%),发病年龄20～80岁,平均年龄(58.87±11.67)岁。33例(53.23%)脑梗死发生于NS发病6个月内; 35例行肾穿刺活检中31例是膜性肾病(88.57%); 32例(51.61%)血浆白蛋白水平低于20 g/L; 42例(66.74%)纤维蛋白原水平升高; 29例行D-二聚体检查中18例其水平升高(62.07%); 10例(16.13%)以脑梗死为NS的首发症状,48例(77.41%)出现非单一动脉供血区的2个及以上病灶。结论 脑梗死多发生于NS发病6个月内,NS病理类型以膜性肾病为主,多数患者血浆白蛋白水平明显降低,血浆D-二聚体、纤维蛋白原水平升高,部分患者表现为无症状脑梗死,部分患者以脑梗死为NS的首发症状,多数患者脑内出现多发性病灶,其发病机制可能与血液的高凝状态有关。

Clinical analysis of nephrotic syndrome with Ischemic stroke

ObjectiveTo investigate the clinical characteristics and potential pathogenesis of nephrotic syndrome(NS)with ischemic stroke.Methods The clinical manifestations,laboratory and imaging examinations of patients with NS and ischemic stroke were collected and their clinical data were retrospectively analyzed.Results A total of 62 patients with NS and ischemic stroke were collected,accounting for 1.35% of 4,584 patients with NS in the same period,47 patients(75.81%)of men and 15 patients(24.19%)of women,The onset age was ranged from 20 to 80 years,with an average age of(58.87±11.67)years.33 patients(53.23%)of ischemic stroke occurred within 6 months after NS onset.31(88.57%)out of the 35patients of renal biopsy were membranous nephropathy.Plasma albumin in 32 patients(51.61%)was lower than 20g/L.42 patients(66.74%)had elevated fibrinogen.18(62.07%)out of 29 patients had elevated D-dimer.10 patients(16.13%)presented with ischemic stroke as the primary manifestation of NS,and 48 patients(77.41%)presented with 2 or more lesions in the non-single artery blood supply area.Conclusion Ischemic stroke often occured within 6 months of NS onset,the most pathological type are membranous nephropathy,most patients had significantly depressed levels of Plasma albumin,elevated levels of D-dimmer and fibrinogen.Some patients presented with silent brain infarcts and some presented with ischemic stroke as the primary manifestation of NS,most patients had multiple lesions in the brain.its pathogenesis might be associated with the elevated hypercoagulability.