目的:观察临床表现肾病综合征(NS)的膜性肾病患者静脉血栓栓塞症(VTE)的发生率,并探讨发生肾静脉血栓(RVT)的危险因素. 方法:临床诊断NS且经肾活检确诊膜性肾病的患者100例,采用双源CT血管成像观察VTE的发生率. 结果:36例(36％)患者共计发生血栓部位78处,平均每例2.2处.RVT 33例(33％),下腔静脉19例,髂静脉2例,生殖静脉5例,胭静脉2例.17例(17％)患者发现肺动脉栓塞(PE),其中9例有胸闷、呼吸困难等症状.RVT中仅2例有肉眼血尿,5例有腰痛症状.与无血栓组相比,血栓组蛋白尿明显高于无血栓组(P＜0.05).两组患者其他指标(如血清白蛋白、血清肌酐、镜下血尿及肾小管功能)均无明显差异.凝血指标中,血栓组患者D二聚体阳性率显著高于无血栓组(P＜0.01),血小板计数低于无血栓组(P＜0.05).两组患者血清抗凝血酶Ⅲ水平下降率无明显差异. 结论:膜性肾病NS患者的血栓栓塞症发生率高达36％,其中RVT 33％,PE 17％.多数患者并无典型血栓栓塞的临床症状,D二聚体阳性率与血栓栓塞密切相关.因此,临床医师必须意识到RVT是膜性肾病的常见并发症,应常规行D二聚体监测,必要时行CT血管成像检查,以确诊有无RVT和PE.%Objective; To investigate the incidence of venous thromboembolic complications in membranous nephropathy ( MN ) patients with nephrotic syndrome ( NS ). Methodology; A total of one hundred unselected MN patients with NS were enrolled into this study. The diagnosis of venous thromboembolic complications was based on contrast-enhanced dual source computed tomography ( CT) angiography. Results: Venous thrombosis was demonstrated in 36patients (36%). Thirty-three patients (33%) had renal vein thrombosis (RVT),and 17,(17%) "had pulmonary embolism ( PE) . Flank pain was noted in 5, and marcroscopic hematuria in only 2 cases with RVT, Dyspnea and chest pain were present in 9 patients and hemoptysis in 4 with PE. The mean of protein excretion 24hr was higher in RVT patients,but no significant difference was found in the plasma albumin, serum creatinine, cholesterol, triglycerides, and hematuria between RVT and remaining patients. The positive rate of D-dimer was significantly increased in patients with thrombosis when compared with those without thrombus. There was no significant difference in the plasma level of antithrombin M. Conclusion; Thromboembolic complications were confirmed in 36% in MN patients with NS. RVT and PE were common and associated with a few clinical markers. The positive rate of D-dimer was higher in patients with thrqjhbosis. Clinicians should monitor RVT and PE as a common complication in MN patients.
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