南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (04): 556-561.doi: 10.12122/j.issn.1673-4254.2020.04.17

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血栓弹力图评估慢性肾脏病患者凝血功能及其高凝状态的危险 因素

吴思弦，袁 浩，周毅峰，龙贞亦，彭亚梦，彭 芳   

  • 出版日期:2020-04-30 发布日期:2020-04-20
  • 基金资助:

Thromboelastography-based assessment of coagulation function in patients with chronic kidney disease and the risk factors of hypercoagulability

  

  • Online:2020-04-30 Published:2020-04-20

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摘要： 目的 应用血栓弹力图分析慢性肾脏病患者凝血变化特征及影响CKD患者高凝状态的危险因素。方法 选取2018年8月 ~2019年5月本院收治的慢性肾脏病患者128例作为观察组，在本院体检的未患肾脏疾病的21名健康成年人作为对照组。比较 不同阶段患者与对照组的常规凝血试验和血栓弹力图指标。根据血栓弹力图最大振幅（MA）将慢性肾脏病患者分为高凝组（MA>68 mm，n=66）和非高凝组（MA≤68 mm，n=62），比较两组间实验室指标，分析慢性肾脏病患者高凝状态影响因素。结果 与对照组相比，慢性肾脏病不同阶段患者纤维蛋白原 、D-二聚体水平明显增高（P<0.05），慢性肾脏病3~4期、慢性肾脏病5期未透析及慢性肾脏病5期血液透析患者反应时间、K-时间降低（P<0.05），而MA、α-角和凝血指数均升高（P<0.05）。高凝组与非高凝组在估算的肾小球滤过率、糖尿病比例、脑卒中史、中性粒细胞百分比、中性粒细胞淋巴细胞比值、红细胞计数、血红蛋白、血小板计数、血清肌酐、血清胱抑素-C、血清白蛋白、脂蛋白等方面差异均有统计学意义（P<0.05）。其中肾小球滤过率、血小板计数和血红蛋白水平是慢性肾脏病患者高凝状态的独立影响因素（P<0.05）。结论 随着病程的进展，慢性肾脏病患者的高凝状态逐渐加剧。肾小球滤过率、血小板计数和血红蛋白是慢性肾脏病患者高凝状态的危险因素。

Abstract: Objective To assess the changes in the coagulation profiles of patients with chronic kidney disease (CKD) using thromboelastography (TEG) and identify the risk factors of hypercoagulation in CKD patients. Methods A total of 128 patients with CKD admitted in Hunan Provincial People’s Hospital between August, 2018 and May, 2019 were recruited. The results of conventional coagulation test and TEG were compared between patients with CKD and 21 healthy control adults. The patients with CKD were divided into hypercoagulation group with a maximum amplitude (MA) >68 mm (n=66) and non-hypercoagulation group (MA≤68 mm, n=62). The laboratory indicators were compared between the groups, and the factors affecting the hypercoagulable state in patients with CKD were analyzed. Results The levels of fibrinogen and D-Dimer increased significantly in patients with CKD at different stages as compared with the control subjects (P<0.05). In the patients with CKD, the reaction time and K time decreased while MA, α-angle and coagulation index increased significantly in patients in stage 3-4 and those in stage 5 either with or without hemodialysis compared with the control group (P<0.05). The estimated glomerular filtration rate (eGFR), percentage of patients with diabetes mellitus, history of stroke, percentage of neutrophils, neutrophil-lymphocyte ratio, red blood cell count, hemoglobin levels, platelet count, serum creatinine, serum cystatin-C, serum albumin, and lipoprotein (a) all differed significantly between hypercoagulation group and non-hypercoagulation group (P<0.05). The eGFR, platelet count and hemoglobin levels were identified as independent factors affecting hypercoagulability in patients with CKD (P<0.05). Conclusions The hypercoagulable state of patients with CKD worsens gradually with the disease progression, and eGFR, platelet count and hemoglobin levels are all risk factors for the hypercoagulable state in patients with CKD.