纤维蛋白原、D-二聚体及血栓四项在中老年肾病综合征患者检测中的应用价值  

The application value of fibrinogen,D-dimer and thrombosis four items in middle-aged and elderly nephrotic syndrome patients

作　　者：张盼 王禺[1] 李秀娥[1] 王彩娥 刘媛 Zhang Pan;Wang Yu;Li Xiu′e;Wang Cai′e;Liu Yuan(Department of Clinical Laboratory,Xi′an No.1 Hospital,Xi′an 710002,China;Department of Clinical Laboratory,Xi′an No.5 Hospital,Xi′an 710082,China)

机构地区：[1]西安市第一医院检验科,西安710002 [2]西安市第五医院检验科,西安710082

出　　处：《中国临床实用医学》2024年第5期29-34,共6页China Clinical Practical Medicine

摘　　要：目的探讨纤维蛋白原(FIB)、D-二聚体及血栓四项在中老年肾病综合征(NS)患者检测中的应用价值。方法本研究为回顾性病例对照研究,选取2022年10月至2024年3月西安市第一医院经检验科检验的84例确诊NS的中老年患者,男52例,女32例,年龄(55.14±6.89)岁,年龄范围46~76岁。根据肾小球滤过率的高低将NS患者分为代偿期组与不完全代偿期组,每组42例。比较代偿期组与不完全代偿期组患者FIB、D-二聚体及血栓四项[凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制剂复合物(PIC)、组织型纤溶酶原激活物-纤溶酶原激活物抑制剂复合物(t-PAIC)及血栓调节蛋白(TM)]的水平,对上述指标进行多因素二元logistic回归模型分析,得出NS伴肾功能不完全代偿的危险因素,并绘制受试者操作特征曲线,比较危险因素单独及联合检测的诊断效能。结果代偿期组患者D-二聚体[(4.13±1.11)μg/ml]及血栓四项[TAT(5.41±1.41)μg/L、PIC(0.95±0.18)μg/ml、t-PAIC(15.78±2.34)μg/L、TM(14.06±2.59)TU/ml]水平均低于不完全代偿期组[(5.23±1.17)μg/ml、(7.60±1.79)μg/L、(1.07±0.24)μg/ml、(17.01±2.45)μg/L、(17.80±3.60)TU/ml],差异有统计学意义(P<0.05)。多因素二元logistic回归分析结果显示,D-二聚体(OR=2.727,95%CI:1.226~6.065)、TAT(OR=1.848,95%CI:1.125~3.036)、PIC(OR=1.567,95%CI:1.091~1.934)、TM(OR=1.693,95%CI:1.144~2.504)升高是NS患者出现肾功不完全代偿的危险因素(P<0.05)。四项(D-二聚体、TAT、PIC及TM)联合检测NS进展的诊断效能(曲线下面积为0.952)高于各项单独检测(曲线下面积为0.774、0.837、0.768、0.804)。结论D-二聚体、TAT、PIC及TM四项联合检测评估中老年NS严重程度的诊断效能较高。ObjectiveTo investigate value of fibrinogen(FIB),D-Dimer and thrombosis four items in middle-aged and elderly nephrotic syndrome(NS)patients.MethodsThis study was a retrospective case-control study,a total of 84 middle-aged and elderly patients with NS admitted to department of Clinical Laboratory in Xi′an No.1 Hospital from October 2022 to March 2024,including 52 males and 32 females,aged(55.14±6.89)years old,the age ranging from 46 to 76 years old.According to the glomerular filtration rate,NS patients were divided into compensated group and incomplete compensated group,with 42 cases in each group.The levels of FIB,D-dimer and thrombus four items[thrombin-antithrombin complex(TAT),plasmin-antiplasmin complex,PAP/α2-plasmininhibitor-plasmin complex(PIC),tissue plasminogen activator-plasminogen activator inhibitor complex(t-PAIC)and thrombomodulin(TM)]were compared between the compensated and incomplete compensated groups.Multivariate binary logistic regression model was used to analyze the above indicators,and the risk factors of NS with incomplete renal function compensation were obtained,and the receiver operating characteristic curve of subjects were drawn to compare the diagnostic efficiency of single and combined detection of risk factors.ResultsThe levels of D-dimer[(4.13±1.11)μg/ml]and thrombosis four items[TAT(5.41±1.41)μg/L,PIC(0.95±0.18)μg/ml,t-PAIC(15.78±2.34)μg/L,TM(14.06±2.59)TU/ml]in compensated group were lower than that in incomplete compensated group[(5.23±1.17)μg/ml],[(7.60±1.79)μg/L,(1.07±0.24)μg/ml,(17.01±2.45)μg/L,(17.80±3.60)TU/ml],and the difference was statistically significant(P<0.05).The results of multivariate logistic regression analysis showed that D-dimer(OR=2.727,95%CI:1.226 to 6.065),TAT(OR=1.848,95%CI:1.125 to 3.036),PIC(OR=1.567,95%CI:1.091 to 1.934),TM(OR=1.693,95%CI:1.144 to 2.504)were risk factors for incomplete renal function compensation in NS patients(P<0.05).The diagnostic efficacy of the four combined tests(D-dimer,TAT,PIC and TM)for NS progression(

关 键 词：肾病综合征 纤维蛋白原 D-二聚体 血栓四项 

分 类 号：R692[医药卫生—泌尿科学]