慢性肾脏病患者凝血功能变化及与肾功能指标的相关性

Changes of Coagulation Parameters and Its Correlation with Renal Functionin Patients with Chronic Kidney Disease

目的:分析不同分期慢性肾脏病(CKD)患者凝血功能的改变。方法:选择2021-01-2022-04由武汉大学人民医院确诊为CKD患者266例,按临床分期不同,将患者分为1-3期组即实验1组(n=110),4期组即实验2组(n=48)、5期组即实验3组(n=108)。测定所有患者肝、肾功能、血糖、血尿酸和凝血相关检查项目,分析CKD患者凝血功能与肾功能指标的相关性。结果:与实验1组相比,实验2组和实验3组血肌酐(Cr)升高,肾小球滤过率(eGFR)水平降低(P<0.05),血浆纤维蛋白原(FIB)、D-二聚体和纤维蛋白降解产物(FDP)水平显著升高(P<0.01),实验3组PT延长、PT-INR增大(P<0.05或P<0.01)。与实验2组比较,实验3组患者Cr升高,eGFR水平降低(P<0.01)。相关性分析显示血尿素氮(BUN)、Cr与PT、PT-INR、FIB、D-二聚体及FDP呈正相关,eGFR与PT、PT-INR、FIB、D-二聚体及FDP呈负相关(P<0.01);多重线性回归分析显示,CKD患者BUN、Cr和eGFR均与FIB和D-二聚体存在显著相关关系(P<0.01)。结论:CKD患者存在显著的凝血异常,对CKD患者高凝、血栓形成的早期预防是必要的,监测这些凝血参数对患者出血和血栓的防治具有重要意义。

Objective:To analyze the changes of coagulation function in patients with chronic kidney disease(CKD)in different stages.Method:A total of 266 patients with CKD from January 2021 to April 2022 were enrolled.110 patients with CKD stage 1-3 were enrolled in experimental group 1,48 patients with CKD stage 4 were included in experimental group 2.And 108 patients with CKD stage 5 were included in experimental group 3.Liver and kidney function,blood glucose,uric acid and clotting related examination items were measured in all patients,and the changes of clotting function and its correlation with renal function indexes in patients with CKD were analyzed.Results:Compared with experimental group 1,plasma FIB,D-dimer,FDP levels,serum creatinine(Cr)BUN in experimental groups 2 and 3 were significantly increased,while eGFR level was decreased,the differences were statistically significant(P<0.05).In addition,compared with experimental group 1,PT in experimental group 3 was prolonged and PT-INR was increased,the differences were statistically significant(P<0.05).Compared with experimental group 2,serum Cr and blood urea nitrogen(BUN)were increased and eGFR was decreased in experimental group 3(P<0.01).Correlation analysis showed that BUN,Cr were positively correlated with PT,PT-INR,FIB,D-dimer and FDP,eGFR was negatively correlated with PT,PT-INR,FIB,D-dimer and FDP(P<0.01).Multiple linear regression analysis showed that BUN,Cr and eGFR in CKD patients were significantly correlated with FIB and D-dimer(P<0.01).Conclusion:CKD patients have significant coagulation abnormalities.Therefore,early prevention of hypercoagulability and thrombosis in patients with CKD is necessary,and monitoring these coagulation parameters is of great significance for the prevention and treatment of bleeding and thrombosis in CKD patients.