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特发性肾病综合征成人血栓栓塞并发症遗传风险因素的评估

Assessment of genetic risk factors for thromboembolic complications in adults with idiopathic nephrotic syndrome.

作者信息

Sahin Melisa, Ozkurt Sultan, Degirmenci Nevbahar Akcar, Musmul Ahmet, Temiz Gokhan, Soydan Mehmet

机构信息

Division of Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.

出版信息

Clin Nephrol. 2013 Jun;79(6):454-62. doi: 10.5414/CN107863.

Abstract

AIMS

Nephrotic syndrome (NS) may occur with acquired hypercoagulability, however, the fact that it is accompanied by an underlying hereditary thrombophilia, especially combined hereditary thrombophilia would lead to thrombotic events. In this study, we aimed to evaluate the contribution of genetic thrombophilia to development of thrombotic events in adult patients with NS.

MATERIAL AND METHODS

Factor V Leiden (FVL), prothrombin, and methylenetetrahydrofolate reductase (MTHFR) gene mutation were studied in 51 newly diagnosed idiopathic NS patients and age- and gender-matched 20 healthy control subjects included in the study. Renal vein Doppler ultrasound was conducted in order to investigate the prevalence of subclinical renal vein thrombosis.

RESULTS

Of 51 patients, 6 (11.8%) were established to have thromboembolic (TE) complications at the time of diagnosis (4 symptomatic, 2 subclinical), and no recurring thrombotic episode was observed. Genetic mutation was established in all patients that were found to have TE complications. Acquired hypercoagulability factors were similar in patients without and with TE complication.

CONCLUSIONS

The coexistence of inherited thrombophilia in NS may facilitate thromboembolic complications. If the cause of thrombosis cannot be explained by the usual factors attributed to the occurrence of thrombosis in NS, screening for the other factors, such as FVL, MTHFR, and prothrombin gene mutation, may be beneficial.

摘要

目的

肾病综合征(NS)可能伴有获得性高凝状态,然而,其伴有潜在的遗传性易栓症,尤其是合并遗传性易栓症时会导致血栓形成事件。在本研究中,我们旨在评估遗传性易栓症对成年NS患者血栓形成事件发生的影响。

材料与方法

对51例新诊断的特发性NS患者以及纳入研究的年龄和性别匹配的20名健康对照者进行了凝血因子V莱顿(FVL)、凝血酶原和亚甲基四氢叶酸还原酶(MTHFR)基因突变研究。为调查亚临床肾静脉血栓形成的发生率,进行了肾静脉多普勒超声检查。

结果

51例患者中,6例(11.8%)在诊断时被确定有血栓栓塞(TE)并发症(4例有症状,2例亚临床),未观察到复发性血栓形成事件。在所有发现有TE并发症的患者中均检测到基因突变。有无TE并发症患者的获得性高凝因素相似。

结论

NS中遗传性易栓症的共存可能促进血栓栓塞并发症的发生。如果血栓形成的原因不能用NS中血栓形成的常见因素来解释,筛查其他因素,如FVL、MTHFR和凝血酶原基因突变,可能是有益的。

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