慢性肾脏病患者血栓弹力图、凝血参数等指标的分析及临床意义

目的通过常规凝血、血栓弹力图（thrombelastography,TEG）等指标,观察慢性肾脏病（chronic kidney disease,CKD）患者凝血状态的变化。方法回顾性选取我院2012年1月-2013年1月90例CKD患者将其分为5组,即CKD 1-2期组、CKD 3期组、CKD 4期组、CKD 5期未透析组及CKD 5期透析组,分析常规凝血功能和TEG等指标在CKD患者各组间的变化。结果 CKD 5期未透析组及透析组的血浆纤维蛋白原（Fib）显著高于CKD 1-2期组（P〈0.05）,其血浆D-二聚体（D-Dimer）也显著高于CKD 1-2期和CKD 3期组（P〈0.05）,而血浆抗凝血酶Ⅲ（AT-Ⅲ）则显著低于CKD 1-2期及CKD 3期组（P〈0.05）。血栓弹力图CKD 5期透析组反应时间（reaction time,R）值、K时间值均低于CKD 1-2期组（P〈0.05）,CKD 5期未透析组及CKD 4期组的最大振幅（maximal amplitude,MA）、G值、综合凝血指数（clot index,CI）均显著高于CKD 1-2期组及CKD 3期组（P〈0.05）。eGFR与各指标的相关性分析结果显示Fib、D-Dimer、MA、G和CI值与eGFR呈负相关（P〈0.05）,AT-Ⅲ、R、K与eGFR呈正相关（P〈0.05）。多元线性回归分析显示CI值的变化与eGFR存在直线回归关系,且与eGFR呈负相关（P〈0.05）。结论 CKD 3-5期患者出现贫血现象和高凝状态,进行凝血参数和TEG等检测利于CKD患者高凝状态的判断。

Thrombelastography and coagulation parameters in chronic kidney disease patients and theirs clinical significance

Objective To observe the thrombelastography（TEG） and coagulation parameters in chronic kidney disease（CKD） patients.Methods Ninety CKD patients were divided into stage 1-2 CKD group,stage 3 CKD group,stage 4 CKD group,non-hemodialysis stage 5 CKD group and dialysis stage 5 CKD group.Their TEG and coagulation parameters were analyzed.Results The plasma levels of fibrinogen and its D-dimer were significantly higher whereas the plasma antithrombase Ⅲ level was significantly lower in non-hemodialysis stage 5 CKD group and dialysis stage 5 CKD group than in stage 1-2 CKD group and stage 3 CKD group（P〈0.05）.TEG showed that the reaction time and K-time were significantly shorter in dialysis stage 5 CKD group than in stage 1-2 CKD group（P〈0.05）.The maximal amplitude,G value and clotting index were significantly higher in non-hemodialysis stage 5 CKD group and stage 4 CKD group than in stage 1-2 CKD group and stage 3 CKD group（P〈0.05）.Correlation analysis showed that the estimated GFR was negatively related with the plasma fibrinogen and its D-dimer levels,maximal amplitude,G value,clotting index and positively related with the plasma antithrombase Ⅲ level,reaction time and K-time（P〈0.05）.Multivariate linear regression analysis showed that the clotting index was negatively related with the estimated GFR（P〈0.05）.Conclusion Anemia,coagulation parameters and TEG contribute to the diagnosis of hypercoagulability in patients with CKD at stage 3-5.