蛋白尿与镰状细胞病患儿三尖瓣反流射流速度升高有关。

Proteinuria is associated with elevated tricuspid regurgitant jet velocity in children with sickle cell disease.

机构信息

Yale University School of Medicine, New Haven, CT, USA.

出版信息

Pediatr Blood Cancer. 2012 Jun;58(6):937-40. doi: 10.1002/pbc.23338. Epub 2011 Oct 11.

DOI:10.1002/pbc.23338

PMID:21990235

Abstract

BACKGROUND

Sickle cell disease (SCD) affects multiple organ systems. Complications of SCD such as pulmonary hypertension (PHT) and sickle cell nephropathy (SCN) are associated with an increased mortality. Both PHT and SCN have some common risk factors. In adults, PHT has been found to be associated with albuminuria, a manifestation of SCN. There is no data on this association in children. We conducted a study to determine if elevated pulmonary artery systolic pressures estimated on echocardiogram was associated with proteinuria in children with SCD.

METHODS

A detailed retrospective chart review was conducted on a cohort of sickle cell patients screened with echocardiograms from June 2005 to July 2010. Patients who had an initial screening echocardiogram and urine analysis within 1 year were included. Longitudinal data from all subsequent echocardiograms and urine analyses were collected.

RESULTS

Eighty-five patients were included. On initial echocardiograms 32.9% had an elevated tricuspid regurgitant jet velocity (TRV) ≥2.5 m/second. On follow up, in the 28 patients with elevated TRV, 49.27% of all repeat echocardiograms showed persistent elevation. In the 57 patients with normal baseline TRV, 73.6% of all repeat echocardiograms continued to have normal TRV. On initial screening 7.14% of patients with elevated TRV had proteinuria compared to 1.75% without elevated TRV. On follow up, 19.08% of repeat urinalysis had proteinuria in patients with elevated baseline TRV compared to 12.35% in patients with normal baseline TRV (P = 0.04).

CONCLUSIONS

Elevated TRV ≥ 2.5 m/second is significantly associated with proteinuria on longitudinal follow up in children with SCD.

摘要

背景

镰状细胞病（SCD）影响多个器官系统。SCD 的并发症，如肺动脉高压（PHT）和镰状细胞肾病（SCN），与死亡率增加有关。PHT 和 SCN 都有一些共同的危险因素。在成年人中，已经发现 PHT 与白蛋白尿有关，白蛋白尿是 SCN 的一种表现。在儿童中，没有关于这种关联的数据。我们进行了一项研究，以确定超声心动图估计的肺动脉收缩压升高是否与 SCD 儿童的蛋白尿有关。

方法

对 2005 年 6 月至 2010 年 7 月期间接受超声心动图筛查的镰状细胞患者队列进行了详细的回顾性图表审查。纳入了在 1 年内进行初始筛查超声心动图和尿液分析的患者。收集了所有后续超声心动图和尿液分析的纵向数据。

结果

共纳入 85 例患者。在初始超声心动图中，32.9%的患者三尖瓣反流速度（TRV）升高≥2.5m/秒。在随访中，在 28 例 TRV 升高的患者中，49.27%的所有重复超声心动图显示持续升高。在基线 TRV 正常的 57 例患者中，73.6%的所有重复超声心动图继续显示正常 TRV。在初始筛查中，7.14%的 TRV 升高患者有蛋白尿，而无 TRV 升高的患者为 1.75%。在随访中，基线 TRV 升高的患者中有 19.08%的重复尿液分析有蛋白尿，而基线 TRV 正常的患者中有 12.35%（P=0.04）。