胡桃夹综合征合并原发性肾小球疾病的临床病理分析

Clinical and Pathological Study of Nutcracker Syndrome Combined with Primary Glomerular Disease

摘要: 目的：探究胡桃夹综合征(Nutcracker Syndrome, NCS)合并原发性肾小球病患者的临床病理特征，强调肾穿刺活检在针对该类疾病进一步明确诊断中的合适切点及重要性，从而精准确诊并实施有效治疗。方法：纳入青岛大学附属医院2016年2月至2023年12月经肾静脉彩色多普勒超声检查确诊的107例NCS患者，将经卧床休息连续两次24 h尿蛋白定量水平皆高于0.3克的患者按照主观接受肾穿刺活检意愿分为两组，将小于0.3克的NCS患者作为对照组，比较不同组别患者一般资料及临床特征，分析预后。结果：NCS患者最易合并IgAN (62.79%)，以eGFR与24 h尿蛋白排泄量为标准设置随访终点，在肾穿刺活检指导下行药物治疗的患者获得更好的预后。结论：充分卧床休息后24 h尿蛋白排泄量 > 0.3 g的NCS患者，应积极考虑肾穿刺活检所带来的获益。

Abstract: Objective: To investigate the clinicopathological characteristics of patients with Nutcracker Syndrome (NCS) combined with primary glomerulopathy, and to emphasize the importance of renal puncture biopsy in further clarifying the diagnosis of this type of disease, so as to accurately confirm the diagnosis and implement effective treatment. Method: 107 patients with NCS diagnosed by color Doppler ultrasonography of renal veins in the Affiliated Hospital of Qingdao University from February 2016 to December 2023 were included, and those with quantitative protein levels higher than 0.3 g in two consecutive 24 h urines at bed rest were divided into two groups according to their subjective willingness to accept nephron puncture biopsy, and those with less than 0.3 g were divided into a control group, and the patients in the different groups were compared with respect to general data and clinical characteristics, and the prognosis was analyzed. Result: NCS patients were most likely to be combined with IgAN (62.79%), and the follow-up endpoints were set by eGFR and 24 h urinary protein excretion, and the patients who underwent medication under the guidance of renal puncture biopsy had a better prognosis. Conclusion: The benefit of renal puncture biopsy should be actively considered in those with NCS with 24 h urine protein excretion > 0.3 g after adequate bed rest.