狼疮肾炎患者血清D-二聚体水平与疾病活动度及肾损害的关系

Relationship between Serum D-dimer Level and Disease Activity and Renal Damage in Patients with Lupus Nephritis

目的研究狼疮肾炎(LN)患者血清D-二聚体水平与疾病活动度及肾损害的关系。方法纳入2017年1月~2019年12月在武汉大学人民医院肾内科首诊并经肾穿刺活检确诊为LN的患者103例,按照疾病活动程度、病理类型、肾功能状态、尿蛋白水平对患者进行分组,比较各组间患者血清D-二聚体水平差异。比较D-二聚体正常组(n=25)和D-二聚体升高组(n=78)两组间患者临床指标的差异。结果活动组LN患者血清D-二聚体水平高于稳定组(P<0.01)。病理分型为Ⅳ型的患者D-二聚体水平高于Ⅴ型(P<0.05)。肾功能重度损害组D-二聚体水平高于肾功能正常组、轻度损害组(P<0.05)。不同程度蛋白尿患者组间D-二聚体水平比较,差异无统计学意义(P>0.05)。与D-二聚体正常组比较,D-二聚体升高组血肌酐、SLEDAI评分均较高(P均<0.05),病程、血白蛋白、预估肾小球滤过率(eGFR)、血红蛋白、血小板、补体C3、C4水平均较低(P均<0.05)。Spearman相关分析显示,LN患者血清D-二聚体与血肌酐、SLEDAI评分呈正相关(P均<0.05),与白蛋白、eGFR、血红蛋白、血小板、补体C3、C4、C1q水平呈负相关(P均<0.05)。多重线性回归结果表明,补体C3、血红蛋白与血清D-二聚体水平独立相关(P均<0.05)。结论血清D-二聚体升高可反映狼疮活动和肾损害加重,临床应注意监测D-二聚体变化。

Objective To study the relationship between the level of serum D-dimer and disease activity and renal damage in patients with lupus nephritis(LN).Methods A total of 103 patients with LN diagnosed by renal biopsy in the Department of Nephrology of Renmin Hospital of Wuhan University from January 2017 to December 2019 were divided into groups according to disease activity,pathological type,renal function status and proteinuria level,and the differences of serum D-dimer levels in each group were compared.According to the level of serum D-dimer,the patients were divided into two groups:normal D-dimer group(n=25)and elevated D-dimer group(n=78).The differences of general data and clinical indexes between the two groups were compared.Results The level of serum D-dimer in LN active group was higher than that in LN stable group(P<0.01).The level of serum D-dimer in patients with typeⅣLN was higher than that in patients with typeⅤLN(P<0.05).The level of D-dimer in severe renal function damage group was higher than that in normal and mild renal function damage group(P<0.05).There was no significant difference in the level of D-dimer among different degrees of albuminuria(P>0.05).Compared with the normal D-dimer group,the serum creatinine and SLEDAI scores were higher(all P<0.05),while the course of disease,plasma albumin,estimated glomerular filtration rate(eGFR),hemoglobin,platelet,complement C3 and C4 were lower in the D-dimer elevated group(all P<0.05).Spearman correlation analysis showed that serum D-dimer was positively correlated with serum creatinine and SLEDAI scores(all P<0.05),and negatively correlated with albumin,eGFR,hemoglobin,platelets,complement C3,C4 and C1q in patients with LN(all P<0.05).The results of multiple linear regression showed that complement C3 and hemoglobin were independent factors affecting the level of serum D-dimer(all P<0.05).Conclusion The increase of serum D-dimer can reflects the increase of the disease activity of LN and the aggravation of renal damage.Attention should be paid to monitoring the level of serum D-dimer.