血栓调节蛋白、超敏C反应蛋白与儿童原发性肾病综合征高凝状态的相关性

Correlation of soluble thrombomodulin and high sensitive C reactive protein with hypercoagulability in children with primary nephrotic syndrome

目的探讨原发性肾病综合征（PNS）患儿可溶性血栓调节蛋白（sTM）及超敏C反应蛋白（hs-CRP）与高凝状态及预测血栓形成指标的相关性。方法选取2010年1月至2014年1月天津市第二儿童医院肾内科住院的临床诊断为初发和激素停药6个月以上复发的64例PNS患儿为研究组；选取同期因腹股沟疝拟行择期手术的外科住院患儿30例为对照组。入选患儿均抽取静脉血，采用酶联免疫吸附试验检测血浆sTM水平，采用免疫比浊法检测血浆hs-CRP水平，同时检测患儿血脂及纤维蛋白原（Fb）等血栓形成指标。对2组患儿的各项检查指标进行比较及相关性分析。结果研究组患儿血浆sTM水平显著高于对照组[（1.63±0.68） μg/L比（0.30±0.24） μg/L]，2组比较差异有统计学意义（t＝12.545，P〈0.05）；研究组患儿尿蛋白转阴后血浆sTM水平显著低于激素治疗前[（1.05±0.56） μg/L比（1.63±0.68） μg/L]，二者比较差异有统计学意义（t＝6.298，P〈0.05）。研究组PNS患儿sTM水平与24 h尿蛋白定量、低密度脂蛋白、载脂蛋白B、脂蛋白a、Fb均呈正相关（r＝0.379、0.203、0.184、0.177、0.224，均P〈0.05）。研究组PNS患儿血浆hs-CRP水平显著高于对照组[（1.9±1.7） mg/L比（0.7±0.6） mg/L]，2组比较差异有统计学意义（t＝3.487，P〈0.05）；研究组PNS患儿尿蛋白转阴后血浆hs-CRP水平显著低于激素治疗前[（0.4±0.3） mg/L比（1.9±1.7） mg/L]，差异有统计学意义（t＝5.473，P〈0.05）。PNS患儿血浆hs-CRP水平与血浆清蛋白呈负相关（r＝－0.194，P〈0.05），与Fb呈正相关（r＝0.257，P〈0.01）。PNS患儿血浆sTM水平与血浆hs-CRP水平呈正相关（r＝0.395，P〈0.05）。结论sTM可能通过对凝血过程及血脂的双重影响，参与PNS高凝状态的形成过程，sTM可作为反映PNS高凝状态及预测血栓形成的一个参考指标。血浆hs-CRP水平反映PNS患儿体内的微炎症状态，通过对凝血过程的影响，参与PNS高凝状态的形成，hs-CRP可作为PNS活动期高凝状态的监测指标。

Objective To explore the correlations of soluble thrombomodulin （sTM） and high sensitive C reactive protein（ hs - CRP） levels with the hypercoagulable state and indicators of predicting thrombosis in children with primary nephrotic syndrome（PNS）. Methods Sixty - four PNS patients who had primary clinical diagnosis or recurrence after hormone withdrawal for 6 months or more hospitalized in Department of Urology, the Second Children＇s Hospital of Tianjin from January 2010 to January 2014 were selected as PNS group. Thirty patients with inguinal hernia undergoing elective surgery hospitalized in Department of Surgery, the Second Children＇s Hospital of Tianjin from January 2010 to January 2014 were selected as control group. All the selected patients were extracted for venous blood samples, and the double - antibody sandwich enzyme - linked immunosorbent assay was used to detect plasma sTM levels, while immunoturbidimetric assay was used to detect plasma hs - CRP levels ; the indicators of predicting thrombosis as blood lipid and fibrinogen（Fb） etc. were simultaneously detected. Inspection results were compared and the correlation was analyzed by using statistical methods. Results The level of plasma sTM in children with PNS was significantly higher than that in the control group [ （ 1.63 ± 0. 68 ） μg/L vs. （0.30 ± 0.24 ）μg/L ], and the difference was statisti- cally significant between the 2 groups（ t = 12. 545 ,P 〈 0.05 ）. The level of plasma sTM in PNS group with urine protein negative was significantly lower than that before hormone treatment[ （ 1.05 ±0.56） μg/L vs. （ 1.63 ±0.68） μg/L] , and there was a statistically significant difference （ t = 6. 298, P 〈 0.05 ）. The level of plasma sTM in children with PNS had positive correlation with 24 h urinary protein, low density lipoprotein, apolipoprotein B, lipoprotein a and Fb （r = 0. 379,0.203,0. 184,0. 177,0.224, all P 〈 0.05 ）. The level of plasma hs - CRP in children with PNS was significantly higher than that in the control group[ （ 1.9 ± 1.7） mg/L vs. （0.7 ±0. 6） mg/L] ,and the difference was statistically significant between the 2 groups （ t = 3. 487, P 〈 0.05 ）. In PNS group, the level of plasma hs - CRP with urine protein negative was significantly lower than that before hormone treatment[ （0.4 ±0.3） mg/L vs. （ 1.9 ± 1.7） mg/L] ,and there was a statistically significant difference（ t = 5. 473 ,P 〈 0.05 ）. The level of plasma hs - CRP in children with PNS was negatively correlated with plasma albumin （ r = - 0. 194, P 〈 0.05 ）, but positively correlated with Fb （ r = 0. 257, P 〈 0.01 ）. Plasma sTM and hs - CRP levels in children with PNS were positively correlated （ r = 0. 395, P 〈 0.05 ）. Conclusions sTM involves in the formation process of PNS hypercoagulable state possibly through dual influencing by blood coagulation process and blood lipids, sTM may be used as one of the reference indicators for PNS activity and prediction of thrombosis. Plasma hs - CRP reflects the micro - inflammatory state in children with PNS, and involves in the formation of hypercoagulability by effecting blood coagulation process, and should be used as indicators for monitoring the hypercoagulability of active PNS.