慢性肾脏病患者各中医证型凝血及纤溶指标差异

Differences in Coagulation and Fibrinolytic Markers of Different TCM Syndromes in Patients with Chronic Kidney Disease

目的分析凝血及纤溶指标在慢性肾脏病(CKD)不同中医证型中的差异,观察随疾病进展凝血及纤溶指标的变化。方法选择125例CKD患者及97名健康人作为健康对照组,对CKD患者进行中医辨证分型,检测血浆抗凝血酶活性(ATA)、纤维蛋白降解产物(FDP)、纤维蛋白原(FIB)、D-二聚体(D-D)、血栓调节蛋白(TM)、凝血酶-抗凝血酶Ⅲ复合物(TAT)、纤溶酶-抗纤溶酶复合物(PIC)、组织型纤溶酶原激活剂及其抑制剂-1复合物(t-PAIC),比较各中医证型凝血及纤溶指标表达水平。结果各中医证型CKD分期分布差异有统计学意义(P<0.05),气虚证以1~3期为主,阳虚证以4~5期为主;患者组FIB、TM、PIC水平高于健康对照组(P<0.05),ATA水平低于健康对照组(P<0.05)。脾肾阳虚证TM水平高于脾肾气虚证和肺肾气虚证,t-PAIC水平低于脾肾气虚证和肺肾气虚证(P<0.05)。阳虚证TM、PIC水平高于气虚证(P<0.05),t-PAIC水平低于气虚证(P<0.05)。结论CKD患者体内普遍存在高凝状态,且随着疾病进展,气虚发展到阳虚,凝血及纤溶功能紊乱更为严重。凝血及纤溶标志物对慢性肾脏病辨证论治有参考意义。

Objective To analyze the differences between coagulation and fibrinolysis biomarkers in different TCM syndromes of chronic kidney disease(CKD),and to explore the changes of these indicators in the progression of disease,as well as to provide references for clinical diagnosis and treatment of TCM.Methods A total of 125 patients with CKD and 97 healthy controls were enrolled.TCM syndromes were determined.The level of antithrombin activity(ATA),fibrin degradation products(FDP),fibrinogen(FIB),D-dimer(D-D),thrombomodulin(TM),thrombin-antithrombinⅢcomplexes(TAT),plasmin-α2-antiplasmin complexes(PIC)and tissue plasminogen activator inhibitor complexes(t-PAIC)in plasma were detected and compared between different TCM syndromes.Results TCM syndromes were correlated with disease stages(P<0.05).Patients with qi deficiency syndrome were mainly in stage 1-3,while patients with yang deficiency syndrome were mainly in stage 4-5.Levels of FIB,TM and PIC in patients were higher than those of the healthy control group(P<0.05),and ATA were lower than those of the control group(P<0.05).The level of TM in patients with Pi-Shen yang deficiency was higher than that in patients with PiShen qi deficiency and patients with Fei-Shen qi deficiency.The level of t-PAIC was lower than that of patients with Pi-Shen qi deficiency and patients with Fei-Shen qi deficiency(P<0.05).Levels of TM and PIC in yang deficiency syndrome were higher than those in qi deficiency syndrome(P<0.05),while t-PAIC level was lower than that in qi deficiency syndrome(P<0.05).Conclusions CKD patients were commonly suffering from hypercoagulation.The disorder of coagulation and fibrinolysis worsened when qi deficiency developed into yang deficiency.Coagulation and fibrinolysis markers had important significance for syndrome differentiation and treatment for CKD.