糖尿病肾病患者凝血功能血浆血红蛋白和D-D水平及其与血液透析动静脉内瘘血栓形成的关系研究

Coagulation Plasma Haemoglobin and D-D Levels in Patients with Diabetic Nnephropathy and The Relationship with Haemodialysis Arteriovenous Fistula Thrombosis

目的:分析糖尿病肾病(DN)患者凝血功能、血浆血红蛋白(Hb)和D-二聚体(D-D)水平及其与血液透析动静脉内瘘(AVF)血栓形成的关系。方法:选取2020年2月至2022年2月在本院确诊的99例DN患者,根据是否形成动静脉内瘘血栓,分为血栓组(n=34)和单纯DN组(n=65),记录两组患者临床资料。采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)和纤维蛋白原(FIB)含量,发色底物法检测抗凝血酶-Ⅲ(AT-Ⅲ)和D-D含量,国际标准化比值(INR)是PT与正常对照PT之比的ISI次方,比色法检测Hb含量,ROC分析上述指标对AVF血栓形成的预测价值。结果:血栓组和单纯DN组患者年龄、性别、身体指数(BMI)、病程和尿素氮水平间差异无统计学意义(P>0.05),单纯DN组患者透析时间和AVF使用时间明显短于血栓组(P<0.05)。单纯DN组患者AT-Ⅲ、PT、APTT、TT、FIB、INR、Hb、D-D水平均明显低于血栓组患者(P<0.05)。AT-Ⅲ、PT、APTT、TT、INR、FIB、Hb和D-D水平检测AVF血栓形成的AUC分别为0.771、0.788、0.748、0.778、0.673、0.778、0.771、0.745。联合检测AUC为0.963,敏感度82.35%,特异度81.54%。结论:凝血功能指标、Hb和D-D含量可以预测血液透析患者AVF血栓形成。

Objective:To analyze the coagulation function,levels of plasma hemoglobin(Hb)and D-dimer(D-D)in patients with diabetic nephropathy(DN)and their relationship with thrombosis of arteriovenous fistula(AVF).Methods:A total of 99 patients with DN confirmed in the hospital were enrolled between February 2020 and February 2022.According to presence or absence of AVF thrombosis,they were divided into thrombosis group(n=34)and simple DN group(n=65).The clinical data in both groups were recorded.The prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB)were detected by freezing method.The level of antithrombase-III(AT-III)and D-D were detected by chromogenic substrates assay.The international normalized ratio(INR)was the ISI power of PT to normal control PT ratio.The level of D-D was detected by immunoturbidimetry.The level of Hb was detected by colorimetry.The predictive value of the above indexes for AVF thrombosis was analyzed by ROC curves.Results:The difference in age,gender,body index(BMI),disease course and blood urea nitrogen between thrombosis group and simple DN group was not statistically significant(P>0.05).The dialysis time and usage time of AVF in simple DN group were significantly shorter than those in thrombosis group(P<0.05),and levels of AT-III,PT,APTT,TT,FIB,INR,Hb and D-D were significantly lower than those in thrombosis group(P<0.05).AUC values of AT-III,PT,APTT,TT,INR,FIB,Hb and D-D for predicting AVF thrombosis were 0.771,0.788,0.748,0.778,0.673,0.778,0.771 and 0.745,respectively.Combined test showed an AUC of 0.963,a sensitivity of 82.35%and a specificity of 81.54%.Conclusion:Coagulation function indexes,Hb and D-D can predict AVF thrombosis in hemodialysis patients.