慢性肾脏病伴心脑血管病患者凝血、抗凝及纤溶指标变化分析

Changes of coagulation,anticoagulation and fibrinolysis indexes in chronic kidney disease patients complicated with cardio-cerebrovascular diseases

目的研究慢性肾脏病(chronic kidney disease,CKD)伴心脑血管病患者凝血、抗凝及纤溶指标变化,为鉴别诊断肾脏病伴发心脑血管病提供参考依据。方法收集2019年10月至2020年9月就诊于南京鼓楼医院肾脏科98例CKD患者血液样本,根据是否伴有心脑血管病分为2组:无心脑血管病(A组)31例,伴有心脑血管病(B组)67例。用凝固法检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT),用Clauss法检测纤维蛋白原(Fib),用免疫比浊法检测D-二聚体(D-D);用化学发光免疫测定法检测患者抗凝及纤溶指标,包括:血栓调节蛋白(TM)、凝血酶-抗凝血酶Ⅲ复合物(TAT)、纤溶酶-纤溶酶抑制剂复合物(PIC)、组织型纤溶酶原激活剂-抑制剂1复合物(t-PAIC),统计分析两组间各指标的差异。ROC曲线分析有显著差异指标对CKD患者伴发心脑血管疾病的预测价值。结果B组Fib、D-D、TM、TAT、PIC、t-PAIC水平显著高于A组(P<0.05);两组间PT、APTT、TT水平差异无统计学意义(P>0.05)。Fib、D-D、TM、PIC预测CKD患者伴发心脑血管疾病的价值较高,ROC曲线下面积分别为0.742、0.858、0.927、0.738(P<0.05)。结论CKD伴心脑血管病患者Fib、D-D、TM、TAT、PIC、t-PAIC水平有显著改变且Fib、D-D、TM、PIC对其有一定的预测价值。监测上述指标可以辅助临床诊断,减少CKD患者心脑血管事件发生。

Objective To investigate the changes of coagulation,anticoagulation and fibrinolysis indexes in chronic kidney disease(CKD)patients complicated with cardio-cerebrovascular diseases,and then provide the evidence for the differential diagnosis of renal disease complicated with cardio-cerebrovascular diseases.Methods Blood samples were collected from 98 CKD patients admitted at the Department of Nephrology,Nanjing Drum Tower Hospital during October 2019 and September 2020.According to the presence or absence of cardio-cerebrovascular diseases,the patients were divided into two groups:group A(n=31)without cardio-cerebrovascular disease and group B(n=67)with cardio-cerebrovascular diseases.Prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)were detected by the coagulation method,fibrinogen(Fib)was detected by the Clauss method,and D-Dimer(D-D)by the immunoturbidimetry.The anticoagulation and fibrinolysis indexes,including thrombomodulin(TM),thrombin antithrombinⅢcomplex(TAT),plasmin-plasmin inhibitor complex(PIC)and tissue-type plasminogen activator-plasminogen activator inhibitor-1 complex(t-PAIC)were detected by the chemiluminescence immunoassay.The differences of these indexes between groups A and B were analyzed.The ROC curve was used to analyze the predictive value of indexes with significant difference in CKD patients complicated with cardio-cerebrovascular diseases.Results The levels of plasma Fib,D-D,TM,TAT,PIC and t-PAIC in group B were significantly higher than those in group A(P<0.05).There was no significant difference in plasma PT,APTT and TT levels between groups A and B(P>0.05).Fib,D-D,TM and PIC had higher value in predicting the CKD patients complicated with cardio-cerebrovascular diseases,and their areas under the ROC curve were 0.742,0.858,0.927 and 0.738,respectively(P<0.05).Conclusion The levels of plasma Fib,D-D,TM,TAT,PIC and t-PAIC in CKD patients complicated with cardio-cerebrovascular diseases have significant changes,and Fib,D-D,TM and PIC have certain predictive value.Monitoring these indexes may be helpful for the clinical diagnosis of CKD complicated with cardio-cerebrovascular diseases and reducing the occurrence of cardio-cerebrovascular events in CKD patients.