每日一题_2022.12.12

A 58-year-old man with nephrotic syndrome is brought by ambulance to the emergency department with altered mental status. His wife reports that this morning he had difficulty moving the right side of his body, and that she couldn’t arouse him from an afternoon nap. On physical examination the patient is obtunded and has absent right-sided movement. His International Normalized Ratio (INR) is = 0.5. CT angiogram of the brain is shown in the image. What is the most likely etiology of this patient’s symptoms?

1例58岁男性肾病综合征患者被救护车带到急诊科，精神状态改变。他的妻子报告称，今天早晨他难以移动他身体的右侧，并且她无法从午睡中唤醒他。体格检查：患者反应迟钝，右侧运动消失。他的国际标准化比值 (INR) = 0.5。图像中显示了脑部 CT 血管造影。该患者症状最可能的病因是什么？

(A) Decreased antithrombin III levels

(B) Decreased factor II levels

(C) Decreased fibrinogen levels

(D) Increased protein C levels

(E) Increased protein S levels

答案解析：

该患者患有继发于高凝状态的大面积左侧大脑中动脉卒中。肾病综合征患者由于抗凝血酶Ⅲ、蛋白 C 和蛋白 S 的肾丢失而发生血栓栓塞事件的风险增加，这些物质通常作为抗凝剂发挥作用。肾病综合征患者也通常存在导致高凝状态的其他因素，包括血液浓缩、纤维蛋白原增加和血小板增多。肾病综合征患者的精神状态或神经系统改变应非常谨慎。INR <1表示患者易于形成血凝块，INR>1表示患者出血风险增加。

正确答案：A