特发性膜性肾病凝血功能障碍与血小板功能亢进的关联

发布时间：2018-08-23 12:55

【摘要】：目的:探讨特发性膜性肾病患者凝血功能障碍的具体表现及影响因素。方法:回顾性分析2012年1月至2016年9月在南京总医院国家肾脏病临床研究中心经肾活检确诊的242例肾病综合征状态的特发性膜性肾病患者血栓弹力图R时间、K时间、α角、MA值和CI,并将81例蛋白尿定量≤1 g/24h的特发性膜性肾病患者作为对照组。结果:组间比较提示肾病综合征状态的特发性膜性肾病患者MA值显著高于对照组(69.6 mm vs65.1 mm,P0.01),而两组之间R时间无明显差异(6.0 min vs 6.1 min,P=0.72)。单因素线性相关分析发现,肾病综合征状态的特发性膜性肾病患者血清白蛋白水平与血栓弹力图的MA值(r=-0.19,P0.01)、α角(r=-0.16,P=0.01)和CI(r=-0.13,P=0.05)呈负相关,与K时间(r=0.12,P=0.06)呈正相关,与R时间(r=0.01,P=0.87)无明显关联。多元线性回归分析提示血白蛋白是特发性膜性肾病患者MA值的独立相关因素。在肾病综合征状态的特发性膜性肾病患者中,抗磷脂酶A2受体(PLA2R)抗体阳性组和PLA2R抗体阴性组之间各项临床指标和血栓弹力图指标均无明显差异。结论:特发性膜性肾病患者凝血功能障碍与血小板功能亢进关系密切,而血小板功能亢进与肾病综合征状态有关,与抗PLA2R抗体无明显关系。提示抗凝治疗联合抗血小板治疗可能会减少特发性膜性肾病患者血栓事件的发生率。
[Abstract]:Objective: to investigate the features and influencing factors of coagulation dysfunction in patients with idiopathic membranous nephropathy. Methods: from January 2012 to September 2016, 242 patients with idiopathic membranous nephropathy diagnosed by renal biopsy at the National Nephrology Clinical Research Center of Nanjing General Hospital were analyzed retrospectively. In addition, 81 patients with idiopathic membranous nephropathy whose proteinuria was less than 1 g / 24 h were used as control group. Results: the results showed that the MA value of idiopathic membranous nephropathy patients with nephrotic syndrome was significantly higher than that of control group (69.6 mm vs65.1 / mm P0.01), but there was no significant difference in R time between the two groups (6.0 min vs 6.1 min P0.72). Univariate linear correlation analysis showed that the serum albumin level in idiopathic membranous nephropathy patients with nephrotic syndrome was negatively correlated with the MA value of thromboelastogram (r-0.19, P0.01), 伪 -angle (r-0.16, P0. 01) and CI (r-0.13 P0. 05), but had no significant correlation with K time (r0. 12 P0. 06), but not with R time (r0. 01, P0. 87). Multiple linear regression analysis showed that serum albumin was an independent correlation factor of MA value in idiopathic membranous nephropathy. In the idiopathic membranous nephropathy patients with nephrotic syndrome, there was no significant difference in clinical indexes and thromboelastogram between the positive group of anti-phospholipase A2 receptor (PLA2R) antibody and the negative group of PLA2R antibody. Conclusion: coagulation dysfunction in idiopathic membranous nephropathy is closely related to platelet hyperfunction, while platelet hyperfunction is related to nephrotic syndrome, but not to anti PLA2R antibody. The results suggest that anticoagulant therapy combined with antiplatelet therapy may reduce the incidence of thrombotic events in patients with idiopathic membranous nephropathy.
【作者单位】：南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所;
【基金】：国家自然科学基金(81500547) 国家科技支撑计划课题(2015BAI12B02,2015BAI12B05) 江苏省科技计划项目(BE2016747)
【分类号】：R692

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