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目的提高对肾病综合征合并门静脉血栓形成的认识,探讨相关治疗心得。方法报告1例以门静脉血栓形成为首发表现的肾病综合征病例,并复习相关文献。结果男性,52岁,因“腹痛、腹胀伴蛋白尿1周”入院。当地以“急腹症”收住入院,予以相应抗炎、解痉、制酸等处理无好转,彩超提示“门静脉栓塞”,并行DSA检查确诊,同时发现大量蛋白尿、低蛋白血症,考虑肾病综合征合并门静脉血栓,用尿激酶等治疗无好转而转来本院。入院后给予以肝素、东菱克栓酶以及糖皮质激素等联合治疗。腹痛、腹胀等症状明显好转,复查尿蛋白转阴,多次复查彩超提示门静脉血栓进行性缩小,门静脉高压表现好转。出院随访至今病情稳定。结论深静脉血栓形成为肾病综合征严重并发症,以门静脉血栓形成且为首发症状较罕见,且病情较重。早期(6 h内)尿激酶溶栓效果最佳,后期可以东菱克栓酶(DF-521)、肝素等为主要治疗手段;在治疗血栓时应同时治疗原发疾病—肾病综合征。
Objective To improve the understanding of nephrotic syndrome associated with portal vein thrombosis and explore the related treatment experience. Methods One case of nephrotic syndrome with portal vein thrombosis as the first manifestation was reported, and the related literature was reviewed. Results Male, 52 years old, admitted to hospital for “abdominal pain, abdominal distension with proteinuria for 1 week”. The local hospital with “acute abdomen” admitted to hospital, to be the corresponding anti-inflammatory, antispasmodic, acid and other treatment did not improve, color Doppler prompts “portal vein embolization,” DSA confirmed by concurrent diagnosis and found a large number of proteinuria, hypoproteinemia, consider Nephrotic syndrome with portal vein thrombosis, urokinase therapy without improvement and transferred to our hospital. Admitted to give heparin, bolt and glucocorticoid and other joint treatment. Abdominal pain, abdominal distension and other symptoms were significantly improved, urine protein recurred negative review, repeated examination of color Doppler prompt portal vein thrombosis was reduced, portal hypertension showed improved performance. After discharge from hospital, his condition was stable. Conclusion Deep vein thrombosis is a serious complication of nephrotic syndrome. The first symptom of portal vein thrombosis is rare and the condition is serious. Urokinase thrombolytic therapy was the best in the early stage (within 6 hours), DF-521 and heparin were the main treatments in the later stage. Nephrotic syndrome was also treated in the treatment of thrombus.