CAJ | 학술논문

目的寻找治疗常染色体显性多囊肾病(ADPKD)并发肉眼血尿的理想疗法.方法 1993年以来曾在我科住院治疗以及目前在我科多囊肾病专科门诊定期就诊随访的ADPKD患者为对象.收集ADPKD患者出现肉眼血尿时的平均年龄、性别构成、肾功能水平、诱发因素、治疗方案、症状持续时间、血小板计数、凝血参数、肾脏囊肿大小等资料,分别以不同的肉眼血尿诱发因素及治疗方案进行分组,比较其各指标间的差异.结果共筛选出ADPKD患者905例.279例(男150例,女129例)曾有肉眼血尿病史,其中146例能提供完整的病史和治疗经过,而只有101例能提供相关的实验室检查结果.在这101例中,肉眼血尿可出现在慢性肾脏病(CKD)任何一期;GFR为(56.4±44.1)ml·min-1·(1.73 m2)-1;症状持续时间(8.8±8.0)d;男、女患者症状持续时间差异无统计学意义[(8.2±7.3)d比(9.5±8.8)d,P=0.426);凝血参数均在正常参考范围内,其中91例患者血小板计数正常.不同诱发因素导致的肉眼血尿持续时间差异有统计学意义(P＜0.05).卧床休息组症状持续时间显著短于其他组患者(P＜0.05).各组间血小板计数、凝血酶时间和国际标准化比值等差异无统计学意义.结论对出现肉眼血尿的ADPKD患者应首先明确其诱因.卧床休息应作为核心治疗措施.在考虑使用止血药物时建议使用抗纤维蛋白溶解类药物,不需要预防性使用抗生索.
목적 심조치료상염색체현성다낭신병(ADPKD)병발육안혈뇨적이상요법.방법 1993년이래증재아과주원치료이급목전재아과다낭신병전과문진정기취진수방적ADPKD환자위대상.수집ADPKD환자출현육안혈뇨시적평균년령、성별구성、신공능수평、유발인소、치료방안、증상지속시간、혈소판계수、응혈삼수、신장낭종대소등자료,분별이불동적육안혈뇨유발인소급치료방안진행분조,비교기각지표간적차이.결과 공사선출ADPKD환자905례.279례(남150례,녀129례)증유육안혈뇨병사,기중146례능제공완정적병사화치료경과,이지유101례능제공상관적실험실검사결과.재저101례중,육안혈뇨가출현재만성신장병(CKD)임하일기;GFR위(56.4±44.1)ml·min-1·(1.73 m2)-1;증상지속시간(8.8±8.0)d;남、녀환자증상지속시간차이무통계학의의[(8.2±7.3)d비(9.5±8.8)d,P=0.426);응혈삼수균재정상삼고범위내,기중91례환자혈소판계수정상.불동유발인소도치적육안혈뇨지속시간차이유통계학의의(P＜0.05).와상휴식조증상지속시간현저단우기타조환자(P＜0.05).각조간혈소판계수、응혈매시간화국제표준화비치등차이무통계학의의.결론 대출현육안혈뇨적ADPKD환자응수선명학기유인.와상휴식응작위핵심치료조시.재고필사용지혈약물시건의사용항섬유단백용해류약물,불수요예방성사용항생색.
Objective To seauch the ideal management for gross hematuria in autosomal dominant polycystic kidney disease (ADPKD).Methods ADPKD patients who were ever hospitalized and followed up in our department since 1993 were enrolled in the study.Demographic and clinical data were colloected,such as gender,age of gross hematuria,level of renal function,causative factors,management strategies,duration of gross hematuria,blood platelet count,activated partial thromboplastin time,prothrombin time,international normalized ratio,size of kidney cyst and so on.ADPKD patients were divided into different groups according to causative factors or management.The clinical data were compared among groups.Results A total of 905 ADPKD patients were screened,among whom 279 patients ever had gross hematuria (male/female:150/129),One hundred and forty-six patients had integrated therapeutic process records,while only 101patients could provide relevant laboratory examination results.In these 101 patients,gross hematuria was found in any stage of chronic kidney disease (CKD); the average eGFR was (56.4±44.1) mml·min-1 ·(1.73 m2)-1; the duration of gross hematuria was (8.8±8.0) d; no significant difference between male and female in duration of gross hematuria existed [(8.2±7.3) d vs (9.5±8.8) d,P=0.426]; coagulation parameters were all normal.The platelet count was also normal in 91 patients.Duration of gross hematuria among groups divided according to different causative factors was significantly different (P＜0.05).The patients in bed rest group had significantly shorter duration of gross hematuria compared with other groups (P＜0.05).The platelet count,prothromhin time and international normalized ratio were all at similar level in different groups.Conclusions The causative factors in ADPKD patients with gross hematuria should be confirmed as the first step of management strategies.Bed rest is the key point in management.Antifibrinolytic agent is a proper choice in the cases receiving bemostatic drugs.It is unnecessary to use antibiotic agent for prevention.