成人肾病综合征并发肺血栓栓塞的临床特征及危险因素分析

目的 探讨成人肾病综合征并发肺血栓栓塞（PTE）的临床特征及危险因素。 方法 对 60 例临床怀疑并发 PTE 的肾病综合征患者进行回顾性研究， 据电子计算机断层扫描肺动脉造影（CTPA）分成 PTE 组 32 例与无 PTE 组 28 例， 对所有患者的性别、年龄、起病时间、临床症状、实验室检查及病理类型等进行单因素分析， 使用 Logistic 回归分析筛选出危险因素,根据筛选出的危险因素利用受试者工作特征(ROC) 曲线， 确定基于评价指标在肾病综合征并发 PTE 的阈值。 结果 单因素分析显示， 2 组患病时间、血红蛋白、血浆白蛋白、总胆固醇、低密度脂蛋白胆固醇、 D-二聚体以及 P2 亢进差异有统计学意义（P＜ 0.05）。 Logistic 回归分析显示高浓度 D-二聚体是肾病综合征并发 PTE 的危险因素。 ROC 曲线分析显示 D-二聚体诊断肾病综合征并发 PTE 的最佳临界值为 1 015.50 μg/L。 结论 D-二聚体是肾病综合征并发 PTE 的危险因素， 当肾病综合征患者 D-二聚体＞ 1 015.50 μg/L 时需警惕 PTE 的发生。

Analysis of clinical features and risk factors for adult nephrotic syndrome with pulmonary thromboembolism

Objective To investigate the clinical features and risk factors of adult nephrotic syndrome with pulmonary thromboembolism (PTE). Methods Sixty patients diagnosed with nephrotic syndrome and clinically suspected with PTE were enrolled in this retrospective study. Patients were divided into PTE group (n=32) and no-PTE group (n=28) according to the results of computed tomographic pulmonary angiography (CTPA). The single factor analysis and Logistic repression analysis were used to analyse risk factors including age, gender, onset time, clinical symptoms, laboratory examination and pathological types. According to the independent risk factors, the receiver-operating characteristic curve (ROC curve) was used to determine PTE threshold value based on the evaluation index in nephrotic syndrome. Results Single factor analysis showed that there were significant differences in disease duration, hemoglobin, serum albumin, total cholesterol, low-density lipoprotein cholesterol, D-dimer and physical examination in P2 hyperthyroidism between two groups (P < 0.05). Logistic regression analysis showed that D-dimer was independent risk factor of PTE. The analysis of ROC curve indicated that D-dimer optimal threshold was 1 015.50 μg/L. Conclusion D-dimer is an independent risk factor of PTE in patients with nephrotic syndrome. When D-dimer is greater than 1 015.50 μg/L, should pay attention to the occurrence of PTE.