成人胡桃夹综合征合并IgA肾病30例临床分析
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摘要
目的分析胡桃夹综合征合并IgA肾病患者的临床特点,提高临床医师诊治水平。方法以30例成人胡桃夹综合征合并IgA肾病患者为Ⅰ组,同期90例已行左肾静脉多普勒检查后无合并胡桃夹综合征的成人IgA肾病患者为Ⅱ组,同期60例单纯胡桃夹综合征患者为Ⅲ组。回顾性分析该3组患者的临床、实验室检查、影像学及病理资料。结果Ⅰ组中男女比为1∶3.29,女性明显多于男性。Ⅰ组及Ⅲ组体质量指数(BMI)低于Ⅱ组,Ⅰ组血清C3水平明显低于Ⅱ组,Ⅰ组中患者低C3血症发生率为56.7%,高于Ⅱ组的26.7%(P<0.01)。Ⅰ组及Ⅲ组左肾静脉的狭窄处内径明显窄于Ⅱ组左肾静脉的狭窄处内径(P<0.01)。结论长期胡桃夹综合征合并低C3血症成人患者,建议行肾活检明确诊断;成人女性瘦长体型IgAN患者及伴血C3下降的IgAN患者均建议行左肾静脉彩色多普勒检查,以明确是否存在胡桃夹综合征。
Objective To analyze the clinical features of nutcracker syndrome complicated with IgA nephropathy, so as to improve the accuracy of diagnosis and efficiency of treatment. Methods Thirty cases of patients with nutcracker syndrome complicated with IgA nephropathy were designated as group I; 90 cases of adult patients with IgA nephropathy without nutcracker syndrome, who had undergone left renal vein Doppler examination, as group II; and 60 cases of patients with single nutcracker syndrome as group III. Clinical, laboratory, imaging and pathological data of patients in the three groups were analyzed retrospectively. Results The ratio of male to female in group I was 1∶3.29, which showed that females were significantly more than males. The body mass index in groupⅠand Ⅲ were lower than group Ⅱ. The hypo-C3-emia rate in group I was 56.7%, higher than that in group II(P<0.01). The inner diameter at the left renal vein site with stenosis with groupⅠand Ⅲ was evidently narrower than that with groupⅡ(P<0.01). Conclusions It's recommended that, those adult patients with long-term nutcracker syndrome with hypo-C3-emia should undergo renal biopsy for a definitive diagnosis; and left renal vein Doppler ultrasonic examination should be taken into account for those slim female adults with IgA nephropathy with decreased serum C3 level.
Objective To analyze the clinical features of nutcracker syndrome complicated with IgA nephropathy, so as to improve the accuracy of diagnosis and efficiency of treatment. Methods Thirty cases of patients with nutcracker syndrome complicated with IgA nephropathy were designated as group I; 90 cases of adult patients with IgA nephropathy without nutcracker syndrome, who had undergone left renal vein Doppler examination, as group II; and 60 cases of patients with single nutcracker syndrome as group III. Clinical, laboratory, imaging and pathological data of patients in the three groups were analyzed retrospectively. Results The ratio of male to female in group I was 1∶3.29, which showed that females were significantly more than males. The body mass index in groupⅠand Ⅲ were lower than group Ⅱ. The hypo-C3-emia rate in group I was 56.7%, higher than that in group II(P<0.01). The inner diameter at the left renal vein site with stenosis with groupⅠand Ⅲ was evidently narrower than that with groupⅡ(P<0.01). Conclusions It's recommended that, those adult patients with long-term nutcracker syndrome with hypo-C3-emia should undergo renal biopsy for a definitive diagnosis; and left renal vein Doppler ultrasonic examination should be taken into account for those slim female adults with IgA nephropathy with decreased serum C3 level.
引文
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[2] 任虹蓉,张爱平,姜晓宇,等.胡桃夹综合征合并肾小球疾病患者临床与病理分析[J].临床误诊误治,2016,29(4) :79-83.
[3] 王耀敏,张晓辉,何强,等.胡桃夹综合征并发IgA肾病临床分析[J].中华肾脏病杂志,2010,26(1):25-27.
[4] Ma Z,Liu X,Ning Y.Nutcracker phenomenon in combination with glomerular nephritis in isolated hematuria patients[J].Int Urol Nephrol,2013,45(3):809-816.
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[6] 黄鑫,王渊,唐莎,等.左肾静脉压迫综合征合并IgA肾病患者临床分析[J].临床肾脏病杂志,2015,15(1):16-20.
[7] He Y,Wu Z,Chen S.Nutcracker syndrome-how well do we know it [J].Urology,2014,83(1):12-17.
[8] Knoop T,Vikse BE,Svarstad E,et al.Mortality in patients with IgA nephropathy[J].Am J Kidney Dis,2013,62(5):883-890.
[9] Kang SH,Choi SR,Park HS,et al.The Oxford Classification as a predictor of prognosis in patients with IgA nephropathy[J].Nephrol Dial Transplant.2012,27(1):252-258.
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[11] 邓卫,周倩,刘文婷,等.不同性别原发性IgA肾病患者的临床病理特征[J].中华肾脏病杂志,2015,31(8):561-566.
[12] 王伟杰,刘岷.体质量指数在成人胡桃夹现象中的诊断价值[J].医学综述,2010,16(4):639-640.
[13] 郭宗运,李霞,周世菊,等.表现为微量白蛋白尿 IgA 肾病伴低 C3血症患者的预后危险因素分析[J].中国医师进修杂志,2016,39(5):406-411.
[14] 章晓炎,谢静远,王伟铭,等.补体C3系膜区沉积与低C3血症在IgA肾病中的意义[J].中华肾脏病杂志,2014,30(3):187-194.
[15] Onda K,Ohsawa I,Ohi H,et al.Excretion of complement proteins and its activation marker C5b9 in IgA nephropathy in relation to renal function [J].BMC Nephrol,2011,12:64.
[16] Kim SJ,Koo HM,Lim BJ,et al.Decreased circulating C3 levels and mesangial C3 deposition predict renal outcome in patients with IgA nephropathy[J].PLoS One,2012,7(7):e40495.DOI:10.1371/journal.pone.0040495.
[17] Gulleroglu K,Gulleroglu B,Baskin E.Nutcracker syndrome[J].World J Nephrol,2014,3(4):277-281.
[2] 任虹蓉,张爱平,姜晓宇,等.胡桃夹综合征合并肾小球疾病患者临床与病理分析[J].临床误诊误治,2016,29(4) :79-83.
[3] 王耀敏,张晓辉,何强,等.胡桃夹综合征并发IgA肾病临床分析[J].中华肾脏病杂志,2010,26(1):25-27.
[4] Ma Z,Liu X,Ning Y.Nutcracker phenomenon in combination with glomerular nephritis in isolated hematuria patients[J].Int Urol Nephrol,2013,45(3):809-816.
[5] 关米洁,李彤,何永成,等.胡桃夹综合征合并IgA肾病12例临床分析[J].实用医学杂志,2014,30(19):3148-3150.
[6] 黄鑫,王渊,唐莎,等.左肾静脉压迫综合征合并IgA肾病患者临床分析[J].临床肾脏病杂志,2015,15(1):16-20.
[7] He Y,Wu Z,Chen S.Nutcracker syndrome-how well do we know it [J].Urology,2014,83(1):12-17.
[8] Knoop T,Vikse BE,Svarstad E,et al.Mortality in patients with IgA nephropathy[J].Am J Kidney Dis,2013,62(5):883-890.
[9] Kang SH,Choi SR,Park HS,et al.The Oxford Classification as a predictor of prognosis in patients with IgA nephropathy[J].Nephrol Dial Transplant.2012,27(1):252-258.
[10] Moriyama T,Tanaka K,Iwasaki C,et al.Prognosis in IgA nephropathy:30-year analysis of 1,012 patients at a single center in Japan[J].PLoS One,2014,9(3):e91756.
[11] 邓卫,周倩,刘文婷,等.不同性别原发性IgA肾病患者的临床病理特征[J].中华肾脏病杂志,2015,31(8):561-566.
[12] 王伟杰,刘岷.体质量指数在成人胡桃夹现象中的诊断价值[J].医学综述,2010,16(4):639-640.
[13] 郭宗运,李霞,周世菊,等.表现为微量白蛋白尿 IgA 肾病伴低 C3血症患者的预后危险因素分析[J].中国医师进修杂志,2016,39(5):406-411.
[14] 章晓炎,谢静远,王伟铭,等.补体C3系膜区沉积与低C3血症在IgA肾病中的意义[J].中华肾脏病杂志,2014,30(3):187-194.
[15] Onda K,Ohsawa I,Ohi H,et al.Excretion of complement proteins and its activation marker C5b9 in IgA nephropathy in relation to renal function [J].BMC Nephrol,2011,12:64.
[16] Kim SJ,Koo HM,Lim BJ,et al.Decreased circulating C3 levels and mesangial C3 deposition predict renal outcome in patients with IgA nephropathy[J].PLoS One,2012,7(7):e40495.DOI:10.1371/journal.pone.0040495.
[17] Gulleroglu K,Gulleroglu B,Baskin E.Nutcracker syndrome[J].World J Nephrol,2014,3(4):277-281.