本文關(guān)鍵詞：兒童原發(fā)性腎病綜合征合并顱內(nèi)靜脈血栓4例病例報(bào)告　出處：《中國(guó)循證兒科雜志》2016年01期 　論文類(lèi)型：期刊論文

  更多相關(guān)文章： 原發(fā)性腎病綜合征 顱內(nèi)靜脈血栓 頭顱MRI 溶栓治療 兒童

【摘要】：目的通過(guò)對(duì)原發(fā)性腎病綜合征合并顱內(nèi)靜脈血栓患兒行臨床分析,探討兒童NS合并顱內(nèi)靜脈血栓早期診斷和治療的可行方案。方法納入2012年1月至2015年9月在上海市兒童醫(yī)院住院的原發(fā)性腎病綜合征且經(jīng)頭顱CT和(或)MRI確診的顱內(nèi)靜脈血栓患兒,對(duì)其臨床癥狀、實(shí)驗(yàn)室指標(biāo)、影像學(xué)檢查結(jié)果、療效及預(yù)后進(jìn)行分析。結(jié)果 4例原發(fā)性腎病綜合征合并顱內(nèi)靜脈血栓患兒進(jìn)入分析,均為男性,年齡5歲4個(gè)月至11歲4個(gè)月,出現(xiàn)顱內(nèi)靜脈血栓時(shí)間距原發(fā)性腎病綜合征起病時(shí)間為1個(gè)月至7年余。4例顱內(nèi)靜脈血栓發(fā)病時(shí)均有神經(jīng)精神系統(tǒng)癥狀,查體均未見(jiàn)神經(jīng)系統(tǒng)陽(yáng)性體征。3例在顱內(nèi)靜脈血栓發(fā)病期間D-二聚體、纖維蛋白原降解產(chǎn)物(FDP)均升高,抗凝血酶Ⅲ(AT-Ⅲ)下降;確診后D-二聚體、FDP較前繼續(xù)升高;4例血清白蛋白明顯降低,總膽固醇明顯升高。4例出現(xiàn)顱內(nèi)靜脈血栓臨床癥狀當(dāng)日或次日均行頭顱MRI增強(qiáng)+MRV+MRA檢查,3例為左側(cè)乙狀靜脈竇血栓,1例為腦栓塞。明確顱內(nèi)靜脈血栓診斷后,3例予尿激酶溶栓,低分子肝素鈣和雙嘧達(dá)莫抗凝治療;1例腦栓塞患兒予對(duì)癥和抗凝治療;4例癥狀均明顯改善。3例出院后6~12個(gè)月隨訪頭顱MRI增強(qiáng)+MRV顯示顱內(nèi)異常信號(hào)均有不同程度吸收。結(jié)論兒童原發(fā)性腎病綜合征合并顱內(nèi)靜脈血栓易發(fā)生于左側(cè)乙狀靜脈竇。在原發(fā)性腎病綜合征病程中如出現(xiàn)神經(jīng)精神系統(tǒng)癥狀時(shí),應(yīng)及時(shí)行頭顱MRI相關(guān)序列檢查,有助于顱內(nèi)靜脈血栓早期診斷;早期積極溶栓治療預(yù)后良好。
[Abstract]:Objective to analyze the early diagnosis and treatment of children with primary nephrotic syndrome complicated with intracranial venous thrombosis, and to explore the feasible plan for early diagnosis and treatment of NS combined with intracranial venous thrombosis. Methods children with primary nephrotic syndrome and intracranial venous thrombosis diagnosed by CT and / or MRI were enrolled in Shanghai Children's Hospital from January 2012 to September 2015. Their clinical symptoms, laboratory indexes, imaging findings, curative effects and prognosis were analyzed. Results 4 children with primary nephrotic syndrome and intracranial venous thrombosis were enrolled in the analysis. They were all male, aged 5 years, 4 months to 11 years, 4 months. Intracranial venous thrombosis occurred at a time from 1 months to 7 years. There were nervous system symptoms in 4 cases of intracranial venous thrombosis, and no positive signs of the nervous system were found in the examination body. During the onset of intracranial venous thrombosis, D- two dimers and fibrinogen degradation products (FDP) increased, and antithrombin III (AT- III) decreased in 3 cases. After diagnosis, D- two mer and FDP continued to increase, 4 serum albumin decreased significantly, and total cholesterol increased significantly. Cranial MRI enhanced +MRV+MRA examination was performed on the day or the next day in 4 cases of intracranial venous thrombosis, 3 cases were left sigmoid venous sinus thrombosis and 1 cases were cerebral embolism. After definite diagnosis of intracranial venous thrombosis, 3 cases were treated by urokinase thrombolysis, low molecular weight heparin calcium and dipyridamole anticoagulation therapy. 1 cases of cerebral embolism were treated with symptomatic and anticoagulant therapy, and 4 cases were significantly improved. After 6~12 months of 6~12 months follow-up, MRI enhanced +MRV showed that the abnormal signals of intracranial abnormal signals were absorbed in different degrees. Conclusion primary nephrotic syndrome in children with intracranial venous thrombosis occurs easily in the left side of the sigmoid sinus. In the course of primary nephrotic syndrome, if there are neuropsychiatric symptoms, it is necessary to make MRI related sequence examination in time, which is helpful for early diagnosis of intracranial venous thrombosis. Early active thrombolytic therapy has a good prognosis.
【作者單位】： 上海交通大學(xué)附屬兒童醫(yī)院腎臟內(nèi)科;
【基金】：上海市科委基金項(xiàng)目:12ZR1425500
【分類(lèi)號(hào)】：R726.9;R743
【正文快照】： 原發(fā)性腎病綜合征(NS)是兒童常見(jiàn)的腎臟疾病之一,血栓被認(rèn)為是NS繼感染外,嚴(yán)重威脅患兒生命的并發(fā)癥[1]。盡管NS合并顱內(nèi)靜脈血栓(CVT)的發(fā)生率較低,但病死率高,預(yù)后不良。兒童中由于CVT臨床表現(xiàn)多樣性,容易忽視或誤診,錯(cuò)失合適的干預(yù)時(shí)機(jī),如能早期診斷和積極抗凝治療則對(duì)于改，

本文編號(hào)：1345182