Clinical Features of Nephrotic Syndrome with Cerebral Hemorrhage
Clinical Features of Nephrotic Syndrome with Cerebral Hemorrhage
复制标题
肾病综合征合并脑出血的临床特点
DOI：
10.12659/msm.912466
复制
发表时间：
2019-03-24
影响因子：
3.1
通讯作者：
Chen, Li
中科院分区：
文献类型：
--
作者：
Yang, Mengqi;Pan, Xueying;Chen, Li
背景肾病综合征（NS）患者脑出血的报道越来越多。但NS合并脑出血的临床特点及发病机制尚不清楚。材料/方法选择2007年1月至2017年8月在广西医科大学第一附属医院住院的持续性NS合并脑出血患者。收集并分析这些患者的临床表现，实验室测量和神经影像学检查。结果10461例NS患者中15例发生急性脑出血。男9例，女6例，平均年龄（50.87±23.27）岁。在这15例患者中，8例患者确定了常规血管危险因素，所有15例患者均记录了低白蛋白血症和蛋白尿，9例患者观察到凝血功能障碍，13例患者记录到D-二聚体水平升高，11例患者记录到高脂血症，9例患者记录到肾功能受损。出血发生在脑叶（n=9）、基底节（n=3）、小脑（n=2）和大脑半球（n=1）。8例患者在脑出血发生当天处于昏迷状态，而12例患者在出血发生30天后预后不良。结论NS合并脑出血患者预后差。尽管仅在8例患者中确定了常规血管风险因素，但在这15例患者中的大多数中记录了生化异常（低白蛋白血症、蛋白尿、D-二聚体升高和高脂血症）。此外，大多数的突起都发生在叶中。凝血功能障碍可能是NS患者脑出血的潜在发病机制。
Background Cerebral hemorrhage has been increasingly reported in patients with nephrotic syndrome (NS). However, the clinical features and pathogenesis of NS patients with cerebral hemorrhage remain unclear. Material/Methods From January 2007 to August 2017, continuous NS patients with cerebral hemorrhage at the First Affiliated Hospital of Guangxi Medical University were selected. The clinical manifestations, laboratory measurements, and neurological images of these patients were collected and analyzed. Results Acute cerebral hemorrhage was recorded in 15 of 10 461 NS patients. The average age of these 15 patients (9 males and 6 females) was 50.87±23.27 years old. Among these 15 patients, conventional vascular risk factors were identified in 8 patients, hypoalbuminemia and proteinuria were recorded in all 15 patients, coagulopathy was observed in 9 patients, increased D-dimer level was recorded in 13 patients, hyperlipidemia was recorded in 11 patients, and impaired renal function was recorded in 9 patients. The hemorrhage developed in the lobe (n=9), basal ganglia (n=3), cerebellum (n=2), and cerebral hemisphere (n=1). Eight patients were in a coma on the day the cerebral hemorrhage occurred, while 12 patients had a poor prognosis after 30 days of hemorrhage onset. Conclusions Poor prognosis was recorded in NS patients with cerebral hemorrhage. Although conventional vascular risk factors have only been identified in 8 patients, biochemical abnormalities (hypoalbuminemia, proteinuria, elevated D-dimer, and hyperlipidemia) were recorded in the majority of these 15 patients. Furthermore, most of the hemorrhages developed in the lobes. Coagulopathy might be the potential pathogenesis of cerebral hemorrhage in NS patients.