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目的探讨肾病综合征并发脑梗死猝死的临床特点及相关危险因素。方法纳入本院2005年1月—2015年6月确诊为肾病综合征并发脑梗死猝死的患者52例作为观察组,同时选取肾病综合征无并发脑梗死猝死的患者52例作为对照组,观察两组患者的相关实验室检查指标,包括白蛋白、纤维蛋白原、血小板、D-二聚体、甘油三酯等,采用回归分析的方法对肾病综合征并发脑梗死猝死的相关危险因素进行分析,计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果肾病综合征并发脑梗死猝死患者高脂血症(69.23%)、纤维蛋白原增高(76.92%)、血小板增高(46.15%)及脑水肿(61.54%)发生情况明显大于对照组(23.08%、19.23%、11.54%、28.85%),两组对比差异均有统计学意义(均P<0.05),肾病综合征并发脑梗死猝死患者的白蛋白为(21.63±4.69)g/L,低于对照组的(33.59±5.94)g/L,差异有统计学意义(P<0.05),观察组的纤维蛋白原、血小板、D-二聚体、甘油三酯、总胆固醇水平均明显高于对照组[(6.78±1.58)g/L、(268.51±62.85)×109、(10.89±2.77)g/L、(3.52±1.09)、(7.63±1.25)mmol/L、(2.10±1.69)g/L、(215.66±57.26)×109、(1.29±0.25)g/L、(2.48±1.20)、(6.95±1.29)mmol/L],两组对比差异均有统计学意义(均P<0.05);此外,分析显示,低蛋白血症、甘油三酯增高、总胆固醇增高、血小板增高、纤维蛋白原增高、D-二聚体增高与肾病综合征并发脑梗死猝死的发生具有相关性,是其危险因素。结论肾病综合征并发脑梗死猝死的发生与蛋白代谢紊乱、高凝状态、脂类代谢有密切的相关性,低蛋白血症、甘油三酯增高、总胆固醇增高、血小板增高、纤维蛋白原增高、D-二聚体增高是肾病综合征并发脑梗死猝死发生的危险因素。
Objective To investigate the clinical features and related risk factors of sudden death in patients with nephrotic syndrome complicated by cerebral infarction. Methods Fifty-two patients with nephrotic syndrome and sudden death from cerebral infarction admitted to our hospital from January 2005 to June 2015 were selected as the observation group. Fifty-two patients with nephrotic syndrome without sudden death from cerebral infarction were selected as the control group. Two Group of patients with laboratory tests related indicators, including albumin, fibrinogen, platelets, D-dimer, triglyceride and so on, using regression analysis of nephrotic syndrome associated with cerebral infarction and related risk factors for sudden death, Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The incidence of hyperlipidemia (69.23%), fibrinogen (76.92%), thrombocytopenia (46.15%) and cerebral edema (61.54%) were significantly higher in nephrotic syndrome patients with sudden cerebral infarction than those in control group (23.08% 19.23%, 11.54%, 28.85% respectively). There was significant difference between the two groups (all P <0.05). The albumin in patients with nephrotic syndrome complicated by sudden cerebral infarction was (21.63 ± 4.69) g / L, Group (33.59 ± 5.94) g / L, the difference was statistically significant (P <0.05). The levels of fibrinogen, platelet, D-dimer, triglyceride and total cholesterol in the observation group were significantly higher than those in the control group (6.78 ± 1.58) g / L, (268.51 ± 62.85) × 109, (10.89 ± 2.77) g / L, (3.52 ± 1.09), (7.63 ± 1.25) mmol / L and (2.10 ± 1.69) g / L , (215.66 ± 57.26) × 109, (1.29 ± 0.25) g / L, (2.48 ± 1.20) and (6.95 ± 1.29) mmol / L respectively. There was significant difference between the two groups (all P <0.05) In addition, the analysis shows that hypoalbuminemia, increased triglycerides, increased total cholesterol, elevated platelets, increased fibrinogen, increased D-dimer and nephrotic syndrome associated with sudden cerebral infarction is associated with the risk is its risk factor. Conclusions The incidence of sudden death in patients with nephrotic syndrome complicated by cerebral infarction is closely related to disorders of protein metabolism, hypercoagulable state and lipid metabolism. Hypoproteinemia, increased triglycerides, increased total cholesterol, increased platelets, increased fibrinogen, Increased D-dimer is a risk factor for sudden death in patients with nephrotic syndrome complicated by cerebral infarction.