抗心磷脂抗体与肾病综合征病人肾静脉血栓的关系

The relation between anticardiophospholipid antibody and renal venous thrombosis in the patients with nephrotic syndrome

目的探讨抗心磷脂抗体 (ACL)与肾病综合征 (NS)病人肾静脉血栓 (RVT)的关系。方法选择63例住院的原发性NS病人 ,抽取静脉血 ,用ELISA法检测IgG型ACL ,同时行双肾增强CT扫描 ,以观察病人有无RVT形成 ,并检测血液流变学指标、纤维蛋白原定量、血ATm活性、24h尿蛋白定量、血浆白蛋白水平 ,之后按检查结果分为RVT组与非RVT组 ,以及ACL阳性组和ACL阴性组。分别对组间数据进行分析。结果63例患者中共有RVT者14例(22.22 % ) ,ACL阳性19例 (30.16 % )。RVT组的ACL阳性率、24h尿蛋白定量、纤维蛋白原定量及血浆粘度均显著高于非RVT组 (P<0.05或P<0.001) ,而血浆白蛋白水平和血ATm活性则显著低于非RVT组 (P<0.05)。ACL阳性组的RVT阳性率、24h尿蛋白定量、纤维蛋白原定量及血浆粘度均显著高于ACL阴性组 (P<0.05或P<0.01) ,而ATm活性及血浆白蛋白则显著低于ACL阴性组 (P<0.05)。结论ACL在NS中有较高的阳性率 ,ACL阳性者伴有明显的高凝状态 ,并和RVT形成有显著相关性 ,是RVT形成的重要指标。对ACL阳性的NS病人应施行肝素。

Objective To search the relation between anticardiophospholipid antibody (ACL) and renal venous thrombosis (RVT) in the patients with nephrotic syndrome (NS). Methods To select 63 inpatients with primary nephrotic syndrome, to draw venous blood and detect IgG type ACL with ELISA approach, simultaneously to perform contrast CT scanning so as to determine whether RVT exists. To examine blood hydrodynamic index as well as the quantity of fibrinogen, blood Atms activity, 24h urine protein quantity, serous albumen level. Then to divide these patients into RVT group and non_RVT group, ACL positive group and ACL negative group. To analyse data of these groups respectively. Results Among the selected 63 cases, 14 cases suffered from RVT and 19 cases are ACL positive. In RVT group, the positive rate of ACL, 24h urine protein quantity, fibrinogen quantity and serous viscosity are all markedly higher than those in non_RVT group; on the contrary serous albumen level and blood Atm activity are notably lower than those in non_RVT group. In the ACL positive group, the incidence of RVT, 24h urine protein quantity, fibrinogen quantity and serous viscosity are markedly higher than those in the ACL negative group, while Atm activity and serous albumen are markedly lower than those in the ACL negative group. Conclusion The positive rate of ACL is very high in the patients with NS, while the ACL positive patients accompany markedly high coagulation condition, this is notably conductive to the formation of RVT. Active anticoagulation treatment with drugs such as heparin and urokinase for the ACL positive patients is necessary.