目的探讨血栓弹力图(TEG)对膜性肾病(MN)患者高凝状态的诊断价值,对预防及治疗MN血栓形成提供指导依据。方法选择2017年9月至2018年7月在蚌埠医学院第一附属医院肾内科经肾脏活检确诊的61例MN患者和36例微小病变(MCD)患者作为研究对象,20名健康体检者作为对照组。MN和MCD患者按血清白蛋白(Alb)水平(<20 g/L或20~30 g/L)共分为四个亚组。主要观察TEG参数包括反应时间(R时间)、α角、最大振幅(MA)和凝血指数(CI),对MN和MCD四个亚组的TEG参数进行比较分析。结果线性回归分析表明MN患者TEG参数与Alb相关,具有统计学意义(P<0.01)。对照组与患者亚组比较,正常对照组R时间明显高于MN亚组,但与MCD亚组比较无统计学差异。NS患者(MCD和MN)的α角、MA和CI值显著高于健康对照组(P<0.05)。结论 MN患者比正常人和MCD患者更可能存在高凝状态。特别是对于严重低白蛋白血症的MN患者,应加强预防高凝状态。TEG可全面、准确地评估MN患者的高凝状态,相对于常规凝血试验更为敏感,对于MN患者高凝状态的诊断具有一定价值。
Objective Thrombus elasto graph(TEG) was used to investigate the related factors of hypercoagulability in patients with membranous nephropathy(MN). Methods From September 2017 to July 2018, 61 patients with MN and 36 patients with minimal change(MCD) diagnosed by renal biopsy in the First Affiliated Hospital of Bengbu Medical College were selected as the study subjects, and 20 healthy subjects as the control group. MN and MCD patients were divided into two subgroups according to serum albumin(Salb) level(<20 g/L or 20-30 g/L). Main outcome measures included response time(R), angle alpha, maximum amplitude(MA) and coagulation index(CI). TEG parameters and Salb were analyzed by the variance analysis. Results Linear regression analysis showed that TEG parameters in MN patients were correlated with Salb(P<0.01). The R value in normal control group was significantly higher than that in MN subgroup, but there was no significant difference between normal control group and MCD subgroup. The values of alpha, MA and CI in NS patients(MCD, MN) were significantly higher than those in healthy controls(P<0.05). Conclusions Patients with MN tend to have hypercoagulable state more than normal and MCD patients. Hypercoagulability in MN patients involves the acceleration of thrombogenesis, including the endogenous pathway of activation, fibrinogen, platelet function and fibrin-platelet interaction. Hypercoagulability in MCD patients may be due to inactivation of coagulation factors. Especially for patients with severe hypoalbuminemia, MN should be strengthened to prevent hypercoagulability.
Journal Of Clinical Nephrology
Nephrotic syndrome thromboelastography