【摘要】：目的:探討特發(fā)性膜性腎病患者凝血功能障礙的具體表現(xiàn)及影響因素。方法:回顧性分析2012年1月至2016年9月在南京總醫(yī)院國(guó)家腎臟病臨床研究中心經(jīng)腎活檢確診的242例腎病綜合征狀態(tài)的特發(fā)性膜性腎病患者血栓彈力圖R時(shí)間、K時(shí)間、α角、MA值和CI,并將81例蛋白尿定量≤1 g/24h的特發(fā)性膜性腎病患者作為對(duì)照組。結(jié)果:組間比較提示腎病綜合征狀態(tài)的特發(fā)性膜性腎病患者M(jìn)A值顯著高于對(duì)照組(69.6 mm vs65.1 mm,P0.01),而兩組之間R時(shí)間無明顯差異(6.0 min vs 6.1 min,P=0.72)。單因素線性相關(guān)分析發(fā)現(xiàn),腎病綜合征狀態(tài)的特發(fā)性膜性腎病患者血清白蛋白水平與血栓彈力圖的MA值(r=-0.19,P0.01)、α角(r=-0.16,P=0.01)和CI(r=-0.13,P=0.05)呈負(fù)相關(guān),與K時(shí)間(r=0.12,P=0.06)呈正相關(guān),與R時(shí)間(r=0.01,P=0.87)無明顯關(guān)聯(lián)。多元線性回歸分析提示血白蛋白是特發(fā)性膜性腎病患者M(jìn)A值的獨(dú)立相關(guān)因素。在腎病綜合征狀態(tài)的特發(fā)性膜性腎病患者中,抗磷脂酶A2受體(PLA2R)抗體陽(yáng)性組和PLA2R抗體陰性組之間各項(xiàng)臨床指標(biāo)和血栓彈力圖指標(biāo)均無明顯差異。結(jié)論:特發(fā)性膜性腎病患者凝血功能障礙與血小板功能亢進(jìn)關(guān)系密切,而血小板功能亢進(jìn)與腎病綜合征狀態(tài)有關(guān),與抗PLA2R抗體無明顯關(guān)系。提示抗凝治療聯(lián)合抗血小板治療可能會(huì)減少特發(fā)性膜性腎病患者血栓事件的發(fā)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), 偽 -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.
【作者單位】： 南京大學(xué)醫(yī)學(xué)院附屬金陵醫(yī)院(南京軍區(qū)南京總醫(yī)院)腎臟科國(guó)家腎臟疾病臨床醫(yī)學(xué)研究中心全軍腎臟病研究所;
【基金】：國(guó)家自然科學(xué)基金(81500547) 國(guó)家科技支撐計(jì)劃課題(2015BAI12B02,2015BAI12B05) 江蘇省科技計(jì)劃項(xiàng)目(BE2016747)
【分類號(hào)】：R692

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