特发性膜性肾病凝血功能障碍与血小板功能亢进的关联  

Coagulation disorders and platelet hyperactivity in idiopathic membranous nephropathy

作　　者：刘蕾[1] 乐伟波[1] 徐孝东[1] 刘正钊[1] 秦华章 周敏林[1] 施劲松[1] 李丽娟[1] 谌达程[1] 任强[1] 刘志红[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所

出　　处：《肾脏病与透析肾移植杂志》2017年第2期108-112,152,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金(81500547);国家科技支撑计划课题(2015BAI12B02;2015BAI12B05);江苏省科技计划项目(BE2016747)

摘　　要：目的:探讨特发性膜性肾病患者凝血功能障碍的具体表现及影响因素。方法:回顾性分析2012年1月至2016年9月在南京总医院国家肾脏病临床研究中心经肾活检确诊的242例肾病综合征状态的特发性膜性肾病患者血栓弹力图R时间、K时间、α角、MA值和CI,并将81例蛋白尿定量≤1 g/24h的特发性膜性肾病患者作为对照组。结果:组间比较提示肾病综合征状态的特发性膜性肾病患者MA值显著高于对照组(69.6 mm vs65.1 mm,P<0.01),而两组之间R时间无明显差异(6.0 min vs 6.1 min,P=0.72)。单因素线性相关分析发现,肾病综合征状态的特发性膜性肾病患者血清白蛋白水平与血栓弹力图的MA值(r=-0.19,P<0.01)、α角(r=-0.16,P=0.01)和CI(r=-0.13,P=0.05)呈负相关,与K时间(r=0.12,P=0.06)呈正相关,与R时间(r=0.01,P=0.87)无明显关联。多元线性回归分析提示血白蛋白是特发性膜性肾病患者MA值的独立相关因素。在肾病综合征状态的特发性膜性肾病患者中,抗磷脂酶A2受体(PLA2R)抗体阳性组和PLA2R抗体阴性组之间各项临床指标和血栓弹力图指标均无明显差异。结论:特发性膜性肾病患者凝血功能障碍与血小板功能亢进关系密切,而血小板功能亢进与肾病综合征状态有关,与抗PLA2R抗体无明显关系。提示抗凝治疗联合抗血小板治疗可能会减少特发性膜性肾病患者血栓事件的发生率。Objective：To investigate the specific manifestation and influencing factors of the coagulation disorders in patients with idiopathic membranous nephropathy （IMN）. Methodology： Two hundred forty two patients with nephrotie syndrome, who were diagnosed as IMN by renal biopsy from January 2012 to September 2016 in our clinical research center, were enrolled into this respective study. Their R time, K time, ct angle, MA value, and coagulation index （CI） in thrombrone-lastogram （TEG） were analyzed. Besides, 81 IMN patients with 24h urinary protein less than lg were regarded as control group. Results：Significant difference was noticed in MA value between IMN with nephrotic syndrome group and control group （69. 6 vs 65.1 mm,P〈0. 01） , but not in R time（6. 0 vs 6. 1 min,P=0. 72）. With regard to IMN patients with nephrotic syndrome, correlation analysis showed that serum albumin was negatively related to MA value （r = -0. 19,P〈0. 01） , α angle（r=-0. 16,P=0. 01）and CI（r=-0. 13,P=0. 05） , positively related to K time（r=0. 12,P= 0. 06 ）, but not related to R time（ r = 0. 01, P = 0. 87）. Multiple linear regression analysis indicated that serum albumin was an independent relevant factor of platelet hyperactivity in IMN. And there were no differences in all the clinical characteristics and TEG parameters between anti-PLA2R（＋） and anti-PLA2R（-） IMN patients with nephrotic syndrome. Conclusion： Platelet hyperactivity is correlated closely to the coagulation disorders of IMN. Platelet hyperactivity is related to nephrotic syndrome state, but not PLA2R antibody. These results indicate that combination of anticoagulant and anti-platelet therapy may decrease the incidence of thromboembolic events in IMN.

关 键 词：特发性膜性肾病 肾病综合征 血小板功能亢进 血栓弹力图 

分 类 号：R692[医药卫生—泌尿科学]