D二聚体与原发性肾病综合征临床及病理的相关分析

Relationship of D-Dimer with clinical and pathological data in patients with primary nephrotic syndrome

目的 对血清D二聚体（D-Dimer,简称D-D）与原发性肾病综合征（primary nephrotic syndrome,PNS）临床及病理资料相关性进行分析,探讨血清D-D在PNS中的临床意义.方法 符合肾病综合征的诊断标准及本研究排除标准的肾病综合征患者为PNS组,健康体检者为对照组,收集一般临床指标和患者的病理资料,进行病例对照研究与临床及病理资料分析.结果 （1）120例PNS患者血清D-D水平较60例正常人的血清D-D水平明显升高,差异有统计学意义（P＜0.05）.（2）临床资料显示120例PNS患者中,血清D-D水平与C-反应蛋白（CRP）、24 h尿蛋白之间存在正相关（r=0.429,P=0.000;r=0.481,P=0.000）,但与白蛋白（Alb）、血尿素氮（BUN）、血肌酐（SCr）、血清三酰甘油（TG）、血清总胆固醇（CHOL）之间无相关性（P＞0.05）.（3）微小病变型肾病、系膜增生性肾小球肾炎、系膜毛细血管性肾小球肾炎、膜性肾病及局灶性节段性肾小球硬化5种病理类型间血清D-D水平相比有统计学意义（P＜0.05）,其中微小病变型肾病和膜性肾病患者的血清D-D水平均较其他3种病理类型患者的血清D-D水平明显升高,有统计学意义（P＜0.05）,而微小病变型肾病和膜性肾病患者间及其余3种病理类型患者间的血清D-D水平相比无统计学意义（P＞0.05）.结论 PNS存在高凝状态,血清D-D水平可间接提示蛋白尿严重程度,并且可能间接预测PNS病理的类型.

Objective To investigate the relationship of serum D-Dimer with clinical and patho- logical data in patients with primary nephrotic syndrome. To ensure its clinical significance in primary nephrotic syndrome. Methods There are two groups in this research, one of group is primary ne- phrotic syndrome group,the patients are diagnosed in accordance with nephrotic syndrome diagnostic criteria and exclusion criteria to rule out secondary nephrotic syndrome, and the other group is a con- trol from health checks people. To obtain general clinic information, such as serum D-Dimer, serum C- reactive protein, albumin, blood urea nitrogen, serum creatinine, cholesterol, triglyceride and renal pa- thology. Results C）Compared with normal controls, the level of serum D-Dimer in primary nephrotic syndrome group was significantly increased（P0. 05）. OClinical datas in primary nephrotic syndrome group show that there is a positive correlation between the level of serum D-Dimer and two parame- ters.. 24 h urine protein and C-reactive protein, No correlation was found in the the level of serum D- Dimer with albumin, blood urea nitrogen, serum creatinine, cholesterol and triglyceride level, P0. 05. （）The pathological datas in primary nephrotic syndrome group show the level of serum D-Dimer was statistically significant between five types of pathology including minimal change nephrosismesangial proliferative glomerulonephritis,Mesangial capillaries proliferative glomerulonephritis,membranous ne- phropathy and focal segmental glomerulosclerosis,The level of serum D-Dimer was higher in pationswith minimal change nephrotic syndrome and membranous nephropathy than the rest of the other three types of pathology （P-0. 05）. No correlation was found in the level of serum D-I）imer with other groups of renal pathology（P0. 05）. Conclusions Primary nephrotic syndrome has hypercoagulable state, the level of serum D-Dimer can indirectly reflect the degree of proteinuria, and may be indirectly predicted the pathological types of primary nephrotic syndrome.