狼疮性肾炎血凝指标检测的临床意义

The clinical significance of detecting coagulation parameters in patients with lupus nephritis

目的观察41例狼疮性肾炎（LN）患者血浆血管性血友病因子（vWF）、D-二聚体（D-Dimer）、抗凝血酶Ⅲ（ATⅢ）的变化，评价其临床意义。方法对2004年8月至2006年2月期间安徽医科大学附属医院肾内科收治的狼疮性肾炎患者41例及对照组25例分别检测血浆血管性血友病因子（vWF）、D-二聚体（D-Dimer）、抗凝血酶Ⅲ（ATⅢ）及纤维蛋白原（FIB）的含量。结果①LN患者vWF、D-Dimer、纤维蛋白原（Fib）均高于正常对照组（P〈0．01），而ATⅢ明显低于正常对照组（P〈0．01）；②以血清白蛋白（A1B）、24小时尿蛋白（24HPR）、血胆固醇（CH）、血甘油三脂（TG）、血小板（BPC）及狼疮活动指数为对象，分别观察血凝指标与上述各因数的相关性。结果显示，vWF与CH、狼疮活动程度呈显著正相关（P〈0．05）。ATⅢ与Alb呈显著正相关（P〈0．01），而与24HPR呈显著负相关（P〈0．01）。D-Dimer与所有单因素之间无明确相关性。结论vWF、ATⅢ、D-Dimer分别从血管内皮细胞、抗凝、纤溶系统等不同角度反映了LN患者血栓前状态，是早期检测LN患者血栓前状态的良好指标。

Objective To study the changes of von Willebrand factor（vWF）, D-Dimer, antithrombin Ⅲ （ATⅢ） in patients with lupus nephritis and to evaluate their clinical significances. Method Methodology From Aug 2004 to Feb 2006,the levels of the plasma von Willebrand factor（vWF）, D-Dimer,antithrombin Ⅲ （AT Ⅲ ）and fibrinogen （Fbg） were measured in the 25 normal controls （25.6 ± 6. 50 years old） and 44 patients （31.34 ± 9. 01 years old） with lupus nephritis hospitalized in department of nephrology of the First affiliated Hospital of Anhui Medical University. The results were analyzed with SPSS statistics software. Results （1） The level of vWF, D-dimer, Fib was obviously higher but ATⅢ was obviously lower in patients than those in normal controls（P〈0. 01）. （2） vWF had positive correlation with cholesterol（CH） and lupus active indexs respectively （P〈0. 05）. ATⅢ had positive correlation with serum albumin（P〈0. 01） but had negative correlation with 24 hours protein（P〈0. 01 ）. D-Dimer had no meaningful correlation with each single factor. Conclusions The levels of plasma vWF,AT Ⅲ, D-Dimer reflect the prethrombotic state from the respect of the vascular endothelium,anticoagulation and fibrinolytic system respectively. So we think they may be regarded as valuable indexes to demonstrate the prethrombotic state in the patients with lupus nephritis.