慢性肾脏病病人凝血功能变化与炎症内皮因子及氧化应激关系

ASSOCIATION OF COAGULATION FUNCTION CHANGES WITH INFLAMMATORY ENDOTHELIAL FACTORS AND OXIDATIVE STRESS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

目的了解慢性肾脏病(CKD)病人凝血功能变化与炎症内皮因子及氧化应激关系。方法选取CKD病人110例,根据病人肾小球滤过率(GFR)分为1～5期,每期22例;根据病人纤维蛋白原(FIB)检测结果分成非高凝组(FIB<4g/L)和高凝组(FIB≥4g/L),同时选取同期健康体检者30例作为对照组。检测各组血清血小板(PLT)、清蛋白(ALB)、血红蛋白(Hb)、总胆固醇(TC)、C反应蛋白(CRP)、三酰甘油(TG)、Ca2+及肌酐(CR)水平;应用全自动血凝分析仪分别检测各组血清凝血酶时间(TT)、FIB、活化部分凝血活酶时间(APTT)及血浆凝血酶原时间(PT),ELISA法检测血清内皮素-1(ET-1)、D二聚体(D-D)水平,硫代巴比妥酸法检测丙二醛(MDA)水平,黄嘌呤氧化酶比色法检测超氧化物歧化酶(SOD)水平。分析CKD病人凝血功能状况及高凝状况相关危险因素。结果 4、5期CDK病人血清FIB水平较对照组及1、2期病人明显升高,血清D-D水平较对照组及1期病人明显升高,TT、PT较对照组明显延长,差异均有统计学意义(F=12.466～14.620,P<0.05)。高凝组病人血清MDA、TC、ET-1、CR、CRP水平及心血管病发生率均明显高于非高凝组,SOD、ALB及Ca2+均明显低于非高凝组,差异均有统计学意义(t=10.189～14.083,χ2=10.694,P<0.05);两组病人平均年龄、吸烟人数、TG、PLT、Hb含量差异无统计学意义(P>0.05)。Logistic回归分析显示,病人血清CRP与CR水平为出现高凝状况独立危险因素(P<0.05)。结论 CRP与血CR为引发CKD病人高凝状况独立危险因素,病人高凝状况和体内氧化应激、炎症状况有紧密联系。

Objective To investigate the association of coagulation function changes with inflammatory endothelial factors and oxidative stress in patients with chronic kidney disease(CKD).Methods A total of 110patients with CKD were enrolled,and according to glomerular filtration rate,they were divided into stages 1-5,with 22patients in each stage;according to fibrinogen(FIB),they were divided into non-hypercoagulation group(FIB<4g/L)and hypercoagulation group(FIB≥4g/L).A total of 30individuals who underwent physical examination were enrolled as control group.The serum levels of platelet(PLT),albumin(Alb),hemoglobin(Hb),total cholesterol(TC),C-reactive protein(CRP),triglyceride(TG),calcium(Ca2+),and creatinine(CR)were measured;an automatic blood coagulation analyzer was used to measure serum thrombin time(TT),FIB,activated partial thromboplastin time(APTT),and plasma prothrombin time(PT);ELISA was used to measure the serum levels of endothelin-1(ET-1)and D-dimer(D-D);the thiobarbituric acid method was used to measure the level of malondialdehyde(MDA),and xanthine oxidase colorimetry was used to measure the level of superoxide dismutase(SOD).Coagulation function in CKD patients and risk factors for hypercoagulability were analyzed.Results The patients with stage 4/5CDK had a significantly higher serum level of FIB than those with stage 1/2CDK and the control group,a significantly higher serum level of D-D than those with stage 1CDK and the control group,and significantly longer TT and PT than the control group(F=12.466-14.620,P<0.05).Compared with the non-hypercoagulation group,the hypercoagulation group had significantly higher serum levels of MDA,TC,ET-1,CR,and CRP,a significantly higher incidence rate of cardiovascular diseases,and significantly lower levels of SOD,Alb,and Ca2+(t=10.189-14.083,χ2=10.694,P<0.05),while there were no significant differences between the two groups in mean age,number of patients who smoked,and levels of TG,PLT,and Hb(P>0.05).The logistic regression analysis showed that the serum levels of CRP and creatinine were independent risk factors for hypercoagulability(P<0.05).Conclusion Serum CRP and creatinine are independent risk factors for hypercoagulability in patients with CKD,and hypercoagulability is closely associated with oxidative stress and inflammation in vivo.