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动脉粥样硬化栓塞性疾病的诊断与预后

[Diagnosis and prognosis of atheroembolic disease].

作者信息

Rodríguez Jornet A, Andreu F J, Orellana R, Ibeas J, Vallvé M, Esteve V, Valenzuela M P, García García M

机构信息

Servicios de Nefrología, Corporación Parc Taulí, Sabadell.

出版信息

Nefrologia. 2005;25(6):637-44.

Abstract

Atheroembolic disease is recognized as an iatrogenic complication from an invasive vascular procedure, such as manipulation of the aorta during angiography or vascular surgery, and after anticoagulant and fibrinolytic therapy. Cholesterol crystal embolism is caused by showers of cholesterol crystals from an atherosclerotic aorta that occlude small arteries. The kidney is a frequent target organ for cholesterol emboli because of proximity of the renal arteries to abdominal aorta and it receive an enormous amount of blood flows. We describe the epidemiologic agents of 19 cases that were diagnosed by histologic sections of the affected tissues; the eosinophilia and the renal failure are the clinical features that guide to the diagnosis, in patients with ischemic nephropathy and general atherosclerosis. 53% among patients had a previous invasive procedure and 26% occurred spontaneously. We remark the importance of the kidney's biopsy in diagnosis of the atheroembolic disease and their bad prognosis with 63% of death rate in 18 months of average follow-up. We report patients with the multiple cholesterol emboli syndrome mimicking systemic vasculitis: they died by multivisceral acute failure. The subacute presentation of atheroembolic disease with progressive renal failure treated with hemodialysis is a sign of bad prognosis. The knowledge of the disease and their prevention are the better treatment.

摘要

动脉粥样硬化栓塞性疾病被认为是一种侵入性血管操作引起的医源性并发症,如血管造影或血管手术期间对主动脉的操作,以及抗凝和纤维蛋白溶解治疗后。胆固醇晶体栓塞是由来自动脉粥样硬化主动脉的胆固醇晶体簇阻塞小动脉所致。由于肾动脉靠近腹主动脉且血流量巨大,肾脏是胆固醇栓子常见的靶器官。我们描述了19例经受影响组织组织学切片诊断的病例的流行病学因素;嗜酸性粒细胞增多和肾衰竭是缺血性肾病和全身性动脉粥样硬化患者诊断的临床特征。53%的患者曾有过侵入性操作,26%为自发发生。我们强调肾脏活检在动脉粥样硬化栓塞性疾病诊断中的重要性,以及其不良预后,平均随访18个月死亡率为63%。我们报告了表现为多发性胆固醇栓子综合征、酷似系统性血管炎的患者:他们死于多脏器急性衰竭。动脉粥样硬化栓塞性疾病伴进行性肾衰竭、接受血液透析治疗的亚急性表现是预后不良的迹象。了解该疾病及其预防是最佳治疗方法。

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