慢性肾脏病患者各期凝血功能变化及相关影响因素分析

摘要

Objective To investigate the change of coagulation function of different stages of chronic kidney diseases (CKD),to analyze the factors influencing the coagulation function and to investigate the relation between the change of coagula-tion function with the inflammation and endothelial factors. Methods 150 cases of CKD stage 1-5 in the nephrology department of the Affiliated Hospital of Luzhou Medical College from January 2013 to December 2014 were selected ,including 30 cases in each stage. The related disease history was recorded. The coagulation function was detected. The patients were divided into the high coagulation group(Fg>4 g/L)and the non-high coagulation group(Fg 2-4 g/L). The influence factors related analysis was per-formed. Contemporaneous 30 individuals undergoing the physical examination were selected as the control group. Results (1) The change of coagulation function:Fg,PT and D-D in the patients with CKD stage 1-5 were increased compared with the control group,which was gradually increased with GFR decrease;Fg and D-D had statistical difference between the CKD stage 4 and stage 5,PT had statistical difference between the CKD stage 5 and stage 1(P<0.05).(2)The high coagulation related influence factors:plasma ALB and Ca2+levels in the high coagulation group were significantly lower than those in the non-high coagulation group,the difference was statistically significant(P<0.05);the levels of Scr,TC,ET-1 and CRP,and the occurrence rate of cardio-vascular disease in the high coagulation group were significantly higher than those in the non-high coagulation group,the differ ences were statistically significant(P<0.05). Scr and CRP were the independent risk factors for the high coagulation occurrence (P=0.010,0.038). Conclusion The hypercoagulable state exists in the patients with CKD,which is gradually aggravated with GFR slow down;TC,ET-1,Ca2+and ALB may be the influence factors of CKD hypercoagulable state;SCr and CRP may be its risk factors;the hypercoagulable state in the CKD patients is closely correlated with the inflammation and endothelial dysfunction.%目的研究慢性肾脏病（CKD）患者各期凝血功能变化，分析影响CKD患者凝血功能的相关因素，探讨CKD患者凝血功能变化与炎症、内皮因子的关系。方法选取2013年1月至2014年12月泸州医学院附属医院肾病内科收治的CKD 1～5期患者150例，每期30例，记录相关病史，测定凝血功能。根据纤维蛋白原（Fg）正常值（2～4 g/L）及检测结果将Fg＞4 g/L患者分为高凝组，2～4 g/L患者分为非高凝组，进行影响因素的相关分析。选取同期健康体检者30例作为对照组。结果（1）凝血功能变化：CKD 1～5期患者Fg、凝血酶原时间（PT）、D二聚体（D-D）均较对照组增加，并随肾小球滤过率（GFR）降低而逐渐增高；CKD 4、5期患者Fg、D-D，CKD 5期PT与1期患者比较，差异均有统计学意义（P<0.05）。（2）CKD患者高凝相关影响因素：高凝组患者血浆清蛋白（ALB）、钙离子（Ca2+）水平明显低于非高凝组，差异均有统计学意义（P<0.05）；血肌酐（SCr）、总胆固醇（TC）、内皮素-1（ET-1）、C反应蛋白（CRP）水平及心血管疾病发生率明显高于非高凝组，差异均有统计学意义（P<0.05）。SCr、CRP是CKD患者发生高凝的独立危险因素（P=0.010、0.038）。结论CKD患者存在高凝状态，并随GFR减退而逐渐加重；TC、ET-1、Ca2+、ALB可能是CKD高凝状态的影响因素；SCr、CRP可能是CKD高凝状态的危险因素；CKD患者高凝状态与炎症、内皮功能紊乱密切相关。