血清PDPN及Angptl4水平对膜性肾病高凝状态的诊断价值  

Diagnostic value of serum levels of PDPN and Angptl4 with hypercoagulability in membranous nephropathy

作　　者：钱瑾 陈卫东 张倩文 QIAN Jin;CHEN Weidong;ZHANG Qianwen(The First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,Anhui,China)

机构地区：[1]蚌埠医学院第一附属医院,安徽蚌埠233000

出　　处：《西部医学》2024年第12期1803-1808,共6页Medical Journal of West China

基　　金：安徽省重点研究与开发计划项目(202004j07020011)。

摘　　要：目的 探讨血清平足蛋白(PDPN)及血管生成素样蛋白4(Angptl4)水平与膜性肾病(MN)高凝状态的相关性分析及其诊断价值。方法 选择2021年12月—2022年9月在蚌埠医学院第一附属医院肾内科经肾脏活检确诊的45例MN患者(MN组)、19例IgA患者(IgA组)及20例其他类型患者(其他类型组)作为观察对象,30名健康体检者作为对照组。MN组根据是否形成高凝状态分为高凝亚组(n=26)和非高凝亚组(n=19)。应用酶联免疫吸附法对血清中PDPN及Angptl4水平进行了测定,对各组PDPN及Angptl4水平进行比较分析。结果 MN组血清PDPN水平高于IgA组、其他类型组和对照组,与IgA组、对照组差异有统计学意义(P<0.05),与其他类型组比较差异无统计学意义(P>0.05)。MN组血清Angptl4水平低于IgA组、其他类型组和对照组,MN组与IgA组、对照组比较差异有统计学意义(P<0.05),与其他类型组比较差异无统计学意义(P>0.05)。血清PDPN水平与24 h尿蛋白及纤维蛋白原呈显著正相关,血清Angptl4水平与Alb、PT及APTT呈显著正相关,与胆固醇呈显著负相关(P<0.05)。高凝组PDPN、CH、D-二聚体及纤维蛋白原高于非高凝组,Angptl4、Alb及PT低于非高凝组,差异有统计学意义(P<0.05)。多因素回归分析表明,高水平血清PDPN是评价高凝状态的重要危险因素(OR=1.007,95%CI:1.000~1.013,P=0.036)。PDPN预测MN患者形成高凝状态的曲线下面积为0.705(95%CI:0.550~0.860,P=0.020),灵敏度、特异度分别为80.8%、57.9%。结论 高水平血清PDPN是PMN发生高凝状态的重要危险因素,对高凝状态具有一定的诊断价值,能否作为标志物进行预防性抗凝还有待进一步研究,而血清Angptl4水平无诊断意义。Objective To investigate the correlation of serum podoplanin(PDPN)and angiopoietin-like protein 4(Angptl4)levels with the hypercoagulable state of membranous nephropathy(MN)and their diagnostic value.Methods 45 patients with MN,19 patients with IgA nephropathy and 20 patients with other glomerular diseases diagnosed by renal biopsy in the Department of Nephrology of the First Affiliated Hospital of Bengbu Medical College from December 2021 to September 2022 were selected as the study subjects,and 30 healthy physical examiners were used as the control group.According to the formation of hypercoagulable state,the MN group was divided into hypercoagulable group(n=26)and non-hypercoagulable group(n=19).The serum levels of PDPN and Angptl4 were measured by applying enzyme-linked immunosorbent assay(ELISA),and the levels of PDPN and Angptl4 in each group were compared and analyzed.Results Serum PDPN levels were higher in the MN group than in the IgA nephropathy group,other pathological types and the control group.The serum PDPN level of MN group was statistically significant different from IgA nephropathy group and control group(P1<0.05,P3<0.01),but wasn't statistically significant different from other pathological type groups(P2>0.05).Serum Angptl4 levels in the MN group were lower than those in the IgA nephropathy group,the other pathological types and the control group.The serum Angptl4 level of MN group was statistically significant different from IgA nephropathy group and control group(P1<0.05,P3<0.01),but had no statistically significant differences with other pathological type groups(P2>0.05).In MN patients,serum PDPN level was positively correlated with 24h urinary protein and fibrinogen;serum Angptl4 level was positively correlated with albumin,prothrombin time and activated partial thrombin time,and negatively correlated with serum cholesterol(P<0.05).PDPN,cholesterol,D-dimer and fibrinogen were higher in the hypercoagulable group than in the non-hypercoagulable group,while Angptl4,albumin and prothrombin tim

关 键 词：膜性肾病 平足蛋白 血管生成素样蛋白4 高凝状态 

分 类 号：R692[医药卫生—泌尿科学]