CAJ | 학술논문

目的：分析急性肾梗死（ARI）的临床病例特点、治疗方法和效果，探讨ARI的病因及诊疗策略。方法回顾分析北京大学第三医院2012年3月至2015年3月在急诊诊断为ARI的32例患者的临床表现、辅助检查、治疗和预后等资料。结果32例患者引起 ARI 的病因主要为：恶性肿瘤史（18.7%）、动脉粥样硬化（15.6%）和心脏性因素（9.4%）；最常见的部位为左肾上极；最常见的症状和体征是腰痛（84.4%）和肾区叩痛（93.8%）；常见的实验室检查异常是血中性粒细胞百分比水平升高（71.9%），血乳酸脱氢酶水平升高（71.9%），蛋白尿（75.0%），尿潜血（65.6%）。32例患者均具有典型的ARI的腹部增强CT表现，从初诊到腹部增强CT检查确诊ARI的平均时间为（6.34±4.55）h。所有患者均接受低分子肝素抗凝治疗和（或）介入治疗，全部患者出院时临床症状均有所改善。结论 ARI无明确病因，由于其发病率低，临床表现和实验室检查缺乏特异性，极易误诊。早期诊断依赖及时的腹部增强CT检查。抗凝治疗和（或）介入治疗对患者均可获益。
목적：분석급성신경사（ARI）적림상병례특점、치료방법화효과，탐토ARI적병인급진료책략。방법회고분석북경대학제삼의원2012년3월지2015년3월재급진진단위ARI적32례환자적림상표현、보조검사、치료화예후등자료。결과32례환자인기 ARI 적병인주요위：악성종류사（18.7%）、동맥죽양경화（15.6%）화심장성인소（9.4%）；최상견적부위위좌신상겁；최상견적증상화체정시요통（84.4%）화신구고통（93.8%）；상견적실험실검사이상시혈중성립세포백분비수평승고（71.9%），혈유산탈경매수평승고（71.9%），단백뇨（75.0%），뇨잠혈（65.6%）。32례환자균구유전형적ARI적복부증강CT표현，종초진도복부증강CT검사학진ARI적평균시간위（6.34±4.55）h。소유환자균접수저분자간소항응치료화（혹）개입치료，전부환자출원시림상증상균유소개선。결론 ARI무명학병인，유우기발병솔저，림상표현화실험실검사결핍특이성，겁역오진。조기진단의뢰급시적복부증강CT검사。항응치료화（혹）개입치료대환자균가획익。
Objective To investigate the etiology and treatment strategy of acute renal infarction by analyzing the clinical characteristics, treatment and prognosis of patients with acute renal infarction. Methods We retrospectively reviewed the medical records of 32 patients diagnosed as acute renal infarction from March 2012 to March 2015 at Peking University Third Hospital. Results Among the 32 patients with acute renal infarction the most common causes were history of malignancy (18.7%), atherosclerosis (15.6%) and cardiogenic (9.4%). The most common locations of the acute renal infarction was upper pole of the left kidney. The common symptoms and signs included Lumbago (84.4%) and renal pain (93.8%). The common abnormalities in laboratory tests included elevated N%(71.9%), elevated LDH (71.9%), proteinuria (75.0%) and hematuria (65.6%). Typical enhanced CT manifestations appeared in all the 32 cases of patients with acute renal infarction. The time from presentation to receiving computer tomography examination was (6.34±4.55)h. All the patients received anticoagnlation and (or) interventional therapy, and symptoms were relieved in all the patients. Conclusion Without a clear etiology, the diagnosis of acute renal infarction is often delayed or unrecognized because of its non-specific presentation and the rarity of the disease. The early diagnosis of acute renal infarction needs timely abdominal enhanced CT examination in the emergency department. Anticoagulant therapy and (or) intervention therapy is beneficial.