尿蛋白与血浆白蛋白的比值及血浆TFPI水平对膜性肾病患者血栓诊断的价值

The value of the ratio of urine protein to plasma albumin and plasma TFPI level in the diagnosis of thrombosis in patients with membranous nephropathy

目的:探讨尿蛋白和血浆白蛋白的比值及血浆组织因子途径抑制物(tissue factor pathway inhibitor,TFPI)水平对膜性肾病(membranous nephropathy,MN)患者血栓诊断的价值。方法:选取原发性MN及非MN的患者62例,所有患者的24 h尿蛋白定量均≥3. 5 g,血浆白蛋白<40 g/L,并排除长期应用影响出凝血的药物、近期有手术史、长期卧床和制动1周以上的患者。MN患者40例,血栓事件发生者9例;非MN患者22例,血栓事件发生者0例。检测TFPI、血浆白蛋白及相关临床指标。结果:MN组血浆TFPI水平显著高于非MN组(P=0. 001),MN血栓组显著高于非血栓组(P=0. 001)。且血浆TFPI水平与血浆白蛋白呈显著负相关(r=-0. 537,P=0. 000),与24 h尿蛋白、胆固醇、纤维蛋白原、血小板呈显著正相关(r=0. 461、0. 357、0. 520、0. 455,P<0. 05)。MN组尿蛋白与血浆白蛋白的比值显著高于非MN组(P=0. 013),MN血栓组该比值显著高于非血栓组(P=0. 000)。ROC曲线显示血浆TFPI水平对MN患者血栓的预测价值较大(AUC=0. 944),尿蛋白与血浆白蛋白的比值对血栓的预测价值优于尿蛋白定量及血浆白蛋白的单独检测(AUC分别为0. 900、0. 823和0. 806)。结论:MN患者在高凝状态下存在TFPI反馈性升高;血浆TFPI水平对血栓栓塞事件诊断的敏感性及特异性高;尿蛋白与血浆白蛋白的比值对血栓栓塞事件具有良好的诊断价值,且优于24 h尿蛋白定量及血浆白蛋白的单独检测。

Objective: To investigate the diagnostic value of the ratio of urinary protein to plasma albumin and plasma TFPI level in patients with membranous nephropathy( MN). Methods: A total of 62 patients with primary MN( n = 40) or non-MN( n = 22)were selected from Jan to Oct 2018. There were 9 cases of thrombosis in the MN group and 0 case in the non-MN group. All patients had 24 h urine protein quantitation ≥ 3. 5 g and plasma albumin < 40 g/L. Patients with long-term use of drugs that affect blood clotting,recent history of surgery,long-term bed rest,and immobility for more than 1 week were excluded. Fasting blood was collected in the morning to measure TFPI level,plasma albumin and related clinical indicators. Results: The plasma TFPI level was significantly higher in the MN group than that in the non-MN group( P = 0. 001),and also significantly higher in the MN with thrombosis group than that in the MN without thrombosis group( P = 0. 001). Plasma TFPI level was significantly negatively correlated with plasma albumin( r =-0. 537, P = 0. 000), and positively correlated with 24 h urine protein, cholesterol, fibrinogen and platelets( r = 0. 461,0. 357,0. 520,0. 455 respectively,P < 0. 05). The ratio of urinary protein to plasma albumin in MN group was significantly higher than that in non-MN group( P = 0. 013),and the ratio in MN with thrombosis group was significantly higher than that in MN without thrombosis group( P = 0. 000). The ROC curve showed that the plasma TFPI level had a greater predictive value for thrombosis in MN patients( AUC = 0. 944). The predictive value of the ratio of urinary protein to plasma albumin for thrombosis was superior to the detection of urine protein and plasma albumin alone( AUC = 0. 900,0. 823,0. 806 respectively). Conclusions:MN patients have a feedback increase of TFPI in the hypercoagulable state. Plasma TFPI level has high sensitivity and specificity for the diagnosis of thromboembolism. The ratio of urinary protein to plasma albumin has a good diagnostic value for thromboembolism.