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肾病综合征的肾静脉血栓形成和高凝状态

Author
Jai Radhakrishnan, MD, MS
Section Editors
Richard J Glassock, MD, MACP
Brad H Rovin, MD
Deputy Editor
John P Forman, MD, MSc
Translators
李月红, 主任医师，副教授

引言

肾病综合征患者静脉血栓形成的风险升高，尤其是深静脉血栓形成(deep vein thrombosis, DVT)和肾静脉血栓形成(renal vein thrombosis, RVT)[1-4]。肺栓塞(多数无症状)相对常见，也有脑静脉血栓形成的病例报告[1-4]。肾病综合征患者也会发生动脉血栓形成(如肢体和脑动脉)，发生频率比一般人群更高[4-7]。

本专题将总结肾病综合征出现高凝状态的流行病学和发病机制，以及成人肾静脉血栓形成的临床特点和治疗。肾病综合征及静脉血栓形成原因的概况将单独讨论。 (参见“大量蛋白尿和肾病综合征的概述”和“静脉血栓形成病因概述”)

流行病学

与普通人群的发病率估计值相比，肾病综合征患者动脉及静脉血栓形成的发病率都高得多。一项回顾性研究阐明了其影响程度，这项研究包含298例(主要是成人)肾病综合征患者，平均随访时间为10年[7]。静脉血栓形成的绝对危险度为每年1.0%，是Worcester DVT研究报道的年龄和性别匹配群体年发病率的8倍[8]。动脉血栓形成的绝对危险度是每年1.5%，为普通人群观察值的近8倍[9]。在患者被诊断为肾病综合征的头6个月内，静脉和动脉血栓形成的风险都是最高的(年发病率分别是9.9%和5.5%)[7]。

儿童肾病综合征患者出现血栓栓塞的风险也有所增高。 (参见“儿童肾病综合征的并发症”，关于‘血栓栓塞’一节)

危险因素 — 不同病因的肾病综合征血栓形成的风险不同，膜性肾病患者的风险似乎最高[4,10-13]。一项队列研究阐明了这一点，该研究纳入了1313例由膜性肾病、局灶节段性肾小球硬化或IgA肾病导致特发性肾小球疾病的患者[10]。静脉血栓栓塞事件发病率在膜性肾病(7.9%)和局灶节段性肾小球硬化(3.0%)中比在IgA肾病(0.4%)中高得多。针对蛋白尿程度(膜性肾病和局灶节段性肾小球硬化在就诊时较IgA肾病的蛋白尿程度更重，中位值分别是5.6g/d、3.7g/d、1.6g/d)和血清白蛋白浓度进行校正后，组织学诊断仍是血栓形成的预测因子。 (参见“特发性膜性肾病的治疗”，关于‘抗凝治疗’一节)

                       

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-25.
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