紫癜性肾炎儿童凝血和纤溶系统的变化特点及其临床意义  

Changes of coagulation and fibrinolysis system in children with Henoch-Schonlein purpura nephritis and its clinical significance

作　　者：钦云峰 闵芳梅[1] Qin Yunfeng;Min Fangmei(Department of Paediatrics,the First People's Hospitalof Huzhou,Huzhou,Zhejiang,313000,China)

机构地区：[1]湖州市第一人民医院儿科,浙江省313000

出　　处：《中国基层医药》2019年第23期2903-2906,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 探讨紫癜性肾炎儿童凝血和纤溶系统的变化特点及其临床意义.方法 选择湖州市第一人民医院2013年1月至2016年12月诊治的过敏性紫癜患儿73例为过敏性紫癜组、过敏性紫癜性肾炎患儿73例为紫癜性肾炎组、健康体检儿童73例为对照组.测定三组儿童血浆中抗凝血酶Ⅲ活性(ATⅢ)、纤维蛋白原降解产物(FDP)、D二聚体(D-D)、凝血酶原激活抑制物-1(PAI-1)和组织型纤溶酶原激活物(t-PA)、纤维蛋白原(FIB)水平及24 h尿蛋白排泄量.结果 过敏性紫癜组和紫癜性肾炎组FIB、ATⅢ%、FDP、D-D、PAI-1和t-PA水平[(2.89 ± 0.76)g/L,(3.51 ± 0.81)g/L;(145.72 ± 8.46)%,163.24 ± 9.05)%;(1.31 ± 0.67)mg/L,(1.54 ± 0.72)mg/L;(0.87 ± 0.52)mg/L,(1.18 ± 0.67)mg/L;(66.47 ± 2.58)ng/L,(91.02 ± 3.24)ng/L;(16.34 ± 0.98)μg/L,(12.35 ± 1.06)μg/L]均高于对照组[(1.88 ± 0.54)g/L、(119.48 ± 8.92)%、(0.92 ± 0.33)mg/L、(0.32 ± 0.18)mg/L、(31.25 ± 3.02)ng/L、(6.82 ± 0.75)μg/L](t =9.256、18.236、4.462、8.540、75.760、65.912;14.306、29.423、6.688、10.591、115.297、36.387,均P<0.05),过敏性肾炎组FIB、ATⅢ、FDP、D-D、PAI-1水平均高于过敏性紫癜组(t=4.769、12.083、1.998、3.123、50.644,均P<0.05),过敏性肾炎组 t-PA 低于过敏性紫癜组(t=23.165,P <0.05).紫癜性肾炎组24 h 尿蛋白排泄量[(1.48 ± 0.89)g/24 h]高于过敏性紫癜组[(0.11 ± 0.02)g/24 h]和对照组[(0.10 ± 0.05)g/24 h](t =13.149、13.227,均P<0.05),过敏性紫癜组与对照组比较差异无统计学意义(t=1.587,P>0.05).紫癜性肾炎患者24 h尿蛋白排泄量与ATⅢ、FDP、D-D、IL-33呈显著正相关(r=0.502、0.546、0.483,均P<0.05),与FIB、PAI-1和t-PA无显著相关性(r=0.189、0.213、-0.175,均P>0.05).结论 紫癜性肾炎患儿处于高凝和纤溶亢进状态,凝血和纤溶紊乱与患儿的肾脏损害关系密切.Objective To investigate the changes of coagulation and fibrinolysis system in children with Henoch-Schonlein purpura nephritis and its clinical significance.Methods From January 2013 to December 2016,73 children with Henoch-Schonlein purpura inthe First People's Hospital of Huzhouwere selected as the Henoch-Schonlein purpura group,73 children with Henoch - Schonlein purpura nephritis were selected as the Henoch -Schonlein purpura nephritis group,and 73 healthy children were selected as the control group.Antithrombin III activity(AT III),fibrinogen degradation products(FDP),plasma D -dimer(D -D),prothrombin activator inhibitor -1(PAI-1),tissue plasminogen activator(t-PA),fibrinogen(FIB)levels and 24 -hour urinary protein excretion were measured in three groups.Results The levels of FIB,AT III%,FDP,D-D,PAI-1 and t-PA in the Henoch-Schonlein purpura group and the Henoch-Schonlein purpura nephritis group[(2.89 ± 0.76)g/L,(3.51 ± 0.81)g/L;(145.72 ± 8.46)%,(163.24 ± 9.05)%;(1.31 ± 0.67)mg/L,(1.54 ± 0.72)mg/L;(0.87 ± 0.52)mg/L,(1.18 ± 0.67)mg/L;(66.47 ± 2.58)ng/L,(91.02 ± 3.24)ng/L;(16.34 ± 0.98)μg/L,(12.35 ± 1.06)μg/L] were higher than those in the control group[(1.88 ± 0.54)g/L,(119.48 ± 8.92)%,(0.92 ± 0.33)mg/L,(0.32 ± 0.18)mg/L,(31.25 ± 3.02)ng/L,(6.82 ± 0.75)μg/L](t =9.256,18.236,4.462,8.540,75.760,65.912;14.306,29.423,6.688,10.591,115.297,36.387,all P<0.05).The levels of FIB,AT III%,FDP,D-D and PAI-1 in theHenoch -Schonlein purpura nephritis group were higher than those in the Henoch -Schonlein purpura group(t=4.769,12.083,1.998,3.123,50.644,all P <0.05),and t -PA in the Henoch -Schonlein purpura nephritis group was lower than that in Henoch-Schonlein purpura group(t=23.165,P <0.05).The 24 -hour urinary protein excretion in theHenoch-Schonlein purpura nephritis group[(1.48 ± 0.89)g/24h]was higher than that in the Henoch-Schonlein purpura group[(0.11 ± 0.02)g/24h] and control group[(0.10 ± 0.05)g/24h](t=13.149,13.227,all P<0.05).There was no statistically significant difference between Heno

关 键 词：紫癜 过敏性 肾炎 抗凝血酶Ⅲ活性 纤维蛋白原降解产物 血浆D二聚体 

分 类 号：R72[医药卫生—儿科]