血栓弹力图在评价肾病综合征患者高凝状态中的作用

摘要

Objective To determine the relationship between conventional coagulation examinations and Thromboelastograph ( TEG ) parameters in hypercoagulability in nephrotic syndrome.Methods We recruited 60 in - patients with nephrotic syndrome from Division of Nephrology in Shanghai Changzheng Hospital and divided them as the chronic glomerlular nephritis ( CGN ) group ( 20 patients ) and the nephrotic syndrome ( NS ) group ( 40 patients ).Routine TEG, conventional coagulation examinations and blood routine tests had been taken out on admission.Results No significant differences was noticed in results from routine blood tests and conventional coagulation parameters between the two groups [platelet ( 179.40 ± 21.22 ) × 109/L vs.( 170.50 ± 32.83 ) × 109/L, P ＞ 0.05; hemoglobin ( 126.60 ± 23.73 ) g/L vs.( 128.80 ± 26.83 ) g/L, P ＞ 0.05; international normalized ratio ( INR ) ( 1.01 ± 0.10 ) vs.( 1.01 ± 0.11 ), P ＞ 0.05; activated partial thromboplastin time ( APTT ) ( 30.30 ± 2.61 ) s vs.( 28.81 ± 5.46 ) s, P ＞ 0.05; prothrombin time ( PT ) ( 12.80 ± 1.00 ) s vs.( 12.86 ± 1.32 ) s, P ＞0.05]Significant differences existed between TEG parameters of the two groups, with R and K values lower in the NS group than those in the CGN group [R value ( 5.43 ± 0.56 ) s vs.( 6.18 ± 0.61 ) s, P ＜ 0.05; K value ( 1.42 ± 0.36 ) s vs.( 2.08 ±0.32 ) s, P ＜ 0.05]and ANGLE and CI values higher in the NS group [Angle ( 68.33 ± 4.38 )°vs.(59.30 ±2.77)°, P＜0.05; CI ( 1.35 ± 1.03 ) vs.( -0.78 ±0.60), P ＜0.05], suggesting the presence of hypercoagula-tion status in the NS group.Conclusion TEG might be a much more sensitive method to reveal the existence of hypercaogula-tion status in NS patients compared to conventional coagulation examinations.Hypercoagulability in nephrotic syndrome is more related to hyperfibrinogenemia than affected by platelet number, which is a good news when it comes to anticoagulant therapy.%目的 研究血栓弹力图(TEG)与常规凝血功能检查在肾病综合征高凝状态中的关系,以评价TEG对肾病综合征高凝状态的诊断作用.方法 选择第二军医大学附属长征医院肾内科住院患者60例,其中慢性肾炎患者20例,肾病综合征患者40例,所有患者入院时均行常规凝血功能、血常规及TEG检测.结果 (1)血红蛋白、血小板和凝血功能各指标在慢性肾炎组和肾病综合征组间差异均无统计学意义[国际标准化比率(1.01±0.10)和(1.01±0.11),P ＞0.05;活化部分凝血活酶时间(30.3±2.6)s和(28.8±5.5)s,P ＞0.05;凝血酶原时间(12.8±1.0)s和(12.9±1.3)s,P ＞0.05;血小板 (179.4±21.2)×109/L和(170.5±32.8)×109/L,P ＞0.05;血红蛋白 (126.6±23.7)g/L和(128.8±26.8)g/L,P ＞0.05];(2)TEG显示肾病综合征患者的R时间、K时间均较慢性肾炎者显著降低[R时间(5.43±0.56)s和(6.18±0.61]s,P ＜0.05;K时间(1.42±0.36)s和(2.08±0.32)s,P ＜0.05],Angle及Cl升高[Angle (68.33±4.38)°和(59.30±2.77)°,P ＜0.05;Cl值(1.35±1.03)和(-0.78±0.60),P ＜0.05],血栓最大弹力度、估计的溶解百分数、LY30在两组间差异无统计学意义( P ＞0.05).结论 与其他常规凝血功能检查比较,TEG是反映肾病综合征患者高凝状态的一个更为敏感的指标.肾病综合征高凝状态与纤维蛋白升高有关,而受血小板的影响较小,这对肾病综合征的抗凝治疗有一定指导意义.