血栓弹力图评价慢性肾脏病患者高凝状态的危险因素分析

Risk Factors Analysis of Hypercoagulability in Patients with Chronic Kidney Disease by Thrombelastograph

目的:探讨血栓弹力图评价慢性肾脏病(CKD)患者高凝状态的危险因素。方法:选取221例慢性肾脏病同时进行血栓弹力图检测的患者,根据血栓弹力图血栓最大弹力度(MA值)分为低凝组(MA<69 mm,n=139)和高凝组(MA≥69 mm,n=82),分析两组患者的基本情况包括性别、年龄、身高、体质量,伴发疾病如糖尿病、高脂血症、肾病综合征,用药情况如重组人促红细胞生成素、抗凝和抗血小板药物、激素等,肾功能情况如CKD1-3期和CKD4-5期,血栓弹力图中的凝血参数反应时间(R值)、凝血时间(K值)、夹角α、血栓最大弹力度(MA),其他凝血相关指标血小板计数(Plt)等有无差异,同时采用二元逻辑回归,分析引起高凝的危险因素。结果:两组患者年龄、性别、身高、体质量等比较,差异均无统计学意义(P>0.05),而伴发疾病、用药情况、肾功能、部分凝血及血常规指标(包括血栓弹力图指标)比较,差异均有统计学意义(P<0.05)。高凝的危险因素主要包括糖尿病(OR 1.895,95%CI 1.082~3.318)、肾病综合征(OR 2.501,95%CI 1.429~4.379)、CKD4~5期(OR1.989,95%CI 1.136~3.483)等疾病因素,以及药物因素:重组人促红细胞生成素(OR 2.254,95%CI 1.207~4.208)。结论:对CKD患者而言,糖尿病、肾病综合征、CKD4~5期增加患者高凝状态,肾性贫血患者使用重组人促红细胞生成素亦增加患者高凝风险。

Objective： To evaluate the risk factors of hypercoagulability in the patients with chronic kidney disease（ CKD） by thrombelastograph. Methods： According to the maximal elasticity of thrombus（ MA）,221 patients with chronic kidney disease undergoing thromboelastography were divided into two groups： low coagulation group（ MA 69 mm,n = 139） and high coagulation group（ MA≥69 mm,n = 82）. The basic conditions of the two groups were analyzed respectively,including gender,age,height,weight,concomitant diseases such as diabetes mellitus,hyperlipidemia and nephrotic syndrome,medication situation such as recombinant human erythropoietin,anti-platelet drugs and hormones,renal function such as CKD1-3 stages and CKD4-5 stages,clotting parameter response time（ R value）,clotting time（ K value）,angle α,maximum thrombus（ MA） and the other coagulation-related indicators such as platelet PLT,and binary logistic regression was used to analyze the risk factors causing hypercoagulability. Results： There were no significant differences in age,gender,height and weight etc（ P 0. 05） while there were significant differences in concomitant diseases,drug use,renal function,coagulation indicators including thrombus elasticity and blood index between the groups（ P 0. 05）. The risk factors of hypercoagulation mainly included disease factors（ diabetes OR 1. 895,95% CI 1. 082-3. 318,nephrotic syndrome OR2. 501,95% CI 1. 429-4. 379,CKD4-5 stage OR 1. 989,95% CI 1. 136-3. 483）,and drug factors（ recombinant human erythropoietin r Hu EPO）（ OR 2. 254,95% CI 1. 207-4. 208）. Conclusion： In the patients with CKD,diabetes mellitus,nephrotic syndrome and CKD4-5 stages increase the hypercoagulability of patients,and r Hu EPO also increases the risk of hypercoagulability in the patients with renal anemia.