肾病综合征患者凝血分子标志物测定的临床价值

The value to detect the molecular markers in the patients with nephritic syndrome

目的:观察45例原发性肾病综合征(N S)患者血浆止凝血分子标志物的变化,探讨其临床价值。方法:对照组25人,年龄(25.6±6.50)岁。患者组45人,年龄(29.87±10.87)岁。分别检测血浆血管性血友病因子(vW F)、D二聚体(D-D im er)、抗凝血酶Ⅲ(A TⅢ)、凝血酶原时间(PT)、活化部分凝血活酶时间(A PTT)及纤维蛋白原(FIB)含量。结果:(1)两组观察对象PT、A PTT无明显改变(P>0.05)。N S患者vW F、D-D im er、FIB均高于正常对照组(P<0.01),而A TⅢ明显低于正常对照(P<0.01)。(2)以血白蛋白(A IB)、24h尿蛋白(24H PR)、血胆固醇(C H)、血甘油三酯(TG)、血小板(PLT)为对象,观察止凝血指标与上述因素的相关性。结果显示vW F分别与C H、TG呈显著正相关(P<0.01及P<0.05)。A TⅢ与A IB呈显著正相关(P<0.01)而与24H PR呈显著负相关(P<0.01)。D二聚体与所有单因素之间无明确相关性。结论:vW F、A TⅢ、D二聚体分别从血管内皮细胞、抗凝、纤溶系统等不同角度反映了患者血液流变学状态,测定方法简便、性质稳定、结果可靠,是反映N S患者血栓前状态的良好指标。

Objective To study the changes of a series parameters of the hemorrheology coagulation and fibrinolytic system in the patients with nephritic syndrome. Method The lever of plasma vonwillebrand factor(vWF),D Dimer,antithrombin Ⅲ(ATⅢ),and prothrombin time(PT),activated partial thromboplestime(APTT),fibrinogen(Fbg) were measured in the 25 normal controls and 45 patients. We analysised the data with SPSS statistics software. Results (1)There were no significant differences in PT,APTT between both groups(P >0.05). The lever of vWF,D dimer,Fib was obviously higher but ATⅢwas obviously lower in patients than those in normal controls(P< 0.01). (2)vWF had positive correlation with cholesterol(CH),triglyceride(TG)(P< 0.01 and P< 0.05). ATⅢhad positive correlation with seroalbumin(P< 0.01) but had negative correlation with 24 hour proteins(P< 0.01). D Dimer had no correlation with each signal factor. Conclusion The lever of plasma vWF,ATⅢ,D Dimer reflected the blood hemodynamic state from the angles of the vascular endothelium,anticoagulation and fibrinolytic system separately. They were reliable and stable. So we think they may be regarded as the preferred index to show the prethrombotic state in the patients with nephritic syndrome.