腹膜透析患者凝血功能状态及其影响因素分析

Analysis of Coagulation function and its influencing factors in Peritoneal Dialysis patients

目的探讨腹膜透析(peritoneal dialysis,PD)患者凝血功能状态及其影响因素。方法对2017年01月~2019年10月于武汉大学人民医院肾内科住院行PD满3月的终末期肾脏病患者进行回顾性分析,根据纤维蛋白原(fibrinogen,FIB)值进行分组,FIB>4g/L为H组(n=64),FIB≤4g/L为N组(n=108),比较2组患者的临床资料,用spearman相关分析探讨各因素与FIB的相关性,用logistic回归分析FIB升高的危险因素。结果PD患者中FIB升高者占37.21%(64/172),logistic回归分析显示总胆固醇(OR=2.394,95%CI 1.410~4.064,P=0.001)、高密度脂蛋白(OR=23.731,95%CI 2.518~242.900,P=0.006)、脂蛋白a(OR=1.002,95%CI 1.000~1.004,P=0.010)、超敏C反应蛋白(OR=1.548,95%CI 1.307~1.833,P<0.001)及合并糖尿病(OR=8.614,95%CI 1.657~44.792,P=0.010)是FIB升高的独立危险因素。结论PD患者处于高凝状态,凝血功能与糖尿病患病情况、脂代谢及微炎症状态相关,调节脂代谢、控制微炎症可能对PD患者凝血功能紊乱的治疗有一定的指导意义。

Objective To investigate the status of coagulation function status and its influencing factors in peritoneal dialysis(PD)patients.Methods Patients who received peritoneal dialysis for more than 3 months in the Department of Nephrology,Renmin Hospital of Wuhan University from January 2017 to October 2019 were included,and their clinical data were retrospectively analyzed.According to the value of fibrinogen(FIB),patients were divided into group H(FIB>4 g/L,n=64)and group N(FIB≤4 g/L,n=108).The clinical data of the two groups were compared.Spearman correlation analysis was used to explore the relationship between clinical data and FIB,and logistic regression was used to analyze the risk factors of FIB elevation.Results 172 PD patients were included.FIB increased in 37.21%patients.Logistic regression analysis showed that total cholesterol(OR=2.394,95%CI 1.410~4.064,P=0.001),high-density lipoprotein(OR=23.731,95%CI 2.518~242.900,P=0.006),lipoprotein-a(OR=1.002,95%CI 1.000~1.004,P=0.010),highsensitive C-reactive protein(OR=1.548,95%CI 1.307~1.83,P=0.000)and diabetes mellitus(OR=8.614,95%CI 1.657~44.792,P=0.010)were risk factors for high FIB.Conclusion PD patients are in a hypercoagulable state,and coagulation function is related to diabetes mellitus,lipid metabolism and micro-inflammation.The regulation of lipid metabolism and the control of micro-inflammation may be helpful to the treatment of coagulation disorder in PD patients.