应用血栓弹力图监测特发性膜性肾病患者凝血功能

Application of thromboelastograph in monitoring coagulation function in patients with idiopathic membranous nephropathy

目的探讨应用血栓弹力图进行特发性膜性肾病患者凝血功能监测的意义。方法选取住院治疗的特发性膜性肾病(IMN)患者作为研究对象,血栓弹力图(TEG)显示为高凝状态(NS)的为82例设为研究组,另外74例蛋白尿≤1g/24h者为对照组。比较两组患者的基本资料、TEG数据,分析临床指标与TEG之间的相关性,多元线性回归分析寻找最大振幅(MA)的相关因素。结果研究组白蛋白、肾小球滤过率(eGFR)显著低于对照组,总胆固醇、三酰甘油与纤维蛋白原(FIB)显著高于对照组(P<0.05)。研究组R时间与对照组差异无统计学意义(P>0.05),MA值显著高于对照组,K时间显著短于对照组,α角显著大于对照组(P<0.05)。R时间与红细胞比容、血小板计数(PLT)和白蛋白(Alb)无相关性;MA值与PLT正相关,与红细胞比容、Alb呈负相关;K时间与红细胞比容、Alb正相关,与PLT负相关;α角与PLT正相关,与红细胞比容、Alb呈负相关。高红细胞比容、PLT数量增加、Alb水平与年龄升高为NS状态IMN患者MA值的独立相关因素。结论应用血栓弹力图进行特发性膜性肾病患者凝血功能监测,能够全面检测血小板功能,反映患者是否处于高凝状态,指导抗血小板与抗凝治疗。

Objective To explore the significance of thrombelastogram in monitoring coagulation function in patients with idiopathic membranous nephropathy(IMN).Methods Inpatients with IMN were selected as subjects.Thromboelastograms(TEG)of 82 patients showed hypercoagulable state(NS)were set as study group,and the other 74 cases with proteinuria less than 1 g/24 h were the control group.The baseline data and TEG data of the two groups were compared,and the correlation between clinical index and TEG was analyzed.The related factors of MA value is analyzed by Multiple linear regression.Results The serum albumin and eGFR of the study group were significantly lower than those in the control group,and the total cholesterol,triglyceride and FIB of the study group were significantly higher than those in the control group(P<0.05).There was no significant difference in R time between the two groups(P>0.05),and the MA value of the study group was significantly higher than that of the control group.The time of K of the study group was significantly shorter than that of the control group,and the alpha angle of the study group was significantly greater than that of the control group(P<0.05).R time wasn′t correlated with hematocrit value,PLT and Alb.MA was positively related to PLT,and negatively related with hematocrit value and Alb.K time was correlated with hematocrit value and Alb,and negatively correlated with PLT.Alpha angle was positively related to PLT,and was negatively correlated with hematocrit value and Alb.High hematocrit,PLT quantity increases,elevated Alb and age were independent factors related to NS status of patients with IMN.Conclusion Thrombotic elasmogram can be used to monitor the coagulation function of patients with IMN,which can comprehensively detect the platelet function,indicating whether the patients are in hypercoagulant state,and guiding the antiplatelet and anticoagulant therapy.