摘要
目的通过血栓弹力图(thrombelastography,TEG)等凝血指标,观察慢性肾脏病(chronic kidney disease,CKD)患者凝血状态的变化从而指导临床用药。方法选取2018年2月-2020年10月在苏州大学附属第一医院住院治疗的CKD患者273例,将其分为5组,即CKD1期组、CKD2期组、CKD3期组、CKD4期组、CKD5期组,分析常规凝血功能和TEG等指标在CKD患者各组间的变化。对其中的102例高血压和/或2型糖尿病的患者给予抗血小板治疗,选取其中单纯服用拜阿司匹林100 mg患者12例,单纯服用氯吡格雷75 mg患者90例,按eGFR分为2组,即eGFR正常组[eGFR≥90 mL/(min•1.73 m^(2))]和eGFR低下组[eGFR<90 mL/(min•1.73 m^(2))],比较两组AA途径诱导的抑制率和ADP途径诱导的抑制率,以判断是否对阿司匹林或氯吡格雷敏感。结果血浆活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、凝血时间(TT)、国际标准化比值(INR)、抗凝血酶Ⅲ(ATⅢ)在CKD各组间差异无统计学意义(P>0.05),随着肾功能下降,CKD4-5期组血浆纤维蛋白原(Fbg)水平较CKD1-3期组升高,差异具有统计学意义(P<0.05),CKD4-5期组的反应时间(R)、凝血形成时间(K)均低于CKD1-3期组(P<0.05),CKD4-5期组的夹角(Angle)、血栓最大振幅(MA)、凝血指数(CI)均高于CKD1-3期组,差异有统计学意义(P<0.05)。eGFR与各项常规指标、凝血功能及TEG指标的相关性分析,结果显示hsCRP、PT、Fbg、INR、Angel、MA和CI值与eGFR呈负相关(P<0.05),血红蛋白、血小板、白蛋白、R、K与eGFR呈正相关(P<0.05)。在抗血小板治疗患者中,单纯服用阿司匹林的eGFR正常组(n=6)与eGFR低下组(n=6)之间AA途径诱导的抑制率差异无统计学意义[(55.7±33.5)%vs(50.3±47.4)%,P>0.05],而单纯服用氯吡格雷的eGFR正常组(n=18)ADP途径诱导的抑制率高于eGFR低下组(n=72)[(58.4±26.3)%vs(39.4±25.0)%,P<0.01]。结论随着肾功能恶化,CKD患者的血液呈现高凝状态,可通过TEG与凝血常规等检测方法结合,�
Objective To observe the changes of coagulation state in patients with chronic kidney disease(CKD)and to guide clinical medication by thrombelastography(TEG)and other coagulation indicators.Methods 273 patients with CKD hospitalized in the First Affiliated Hospital of Soochow University from February 2018 to October 2020 were retrospectively selected and divided into five groups:Stage 1 CKD group,Stage 2 CKD group,Stage 3 CKD group,Stage 4 CKD group and Stage 5 CKD group.The changes of routine coagulation and TEG in CKD patients were analyzed.102 patients with hypertension and/or type 2 diabetes mellitus were treated with antiplatelet therapy.12 patients who took aspirin 100 mg alone and 90 patients who took clopidogrel 75 mg alone were divided into two groups according to eGFR:normal eGFR group[eGFR>90 mL/(min•1.73 m2)]and low eGFR group[eGFR<90 mL/(min•1.73 m2)].TEG was used to compare the inhibitory rate of AA pathway induced by aspirin and the inhibition rate of ADP pathway induced by clopidogrel in the two groups to determine whether they were sensitive to aspirin or clopidogrel.Results There was no statistical difference in plasma activated partial thrombin time(APTT),prothrombin time(PT),thrombin time(TT),international normalized ratio(INR)and antithrombinⅢ(ATⅢ)(P>0.05).With the decline of renal function,the levels of plasma fibrinogen(Fbg)in Stage 4-5 CKD group were significantly higher than those in Stage 1-3 CKD group(P<0.05).The reaction time(R)and clotting time(K)in Stage 4-5 CKD group were lower than those in Stage 1-3 CKD group(P<0.05).The rate of clot propagation(Angle),maximal amplitude(MA)and clot index(CI)values in Stage 4-5 CKD group were higher than those in Stage 1-3 CKD group(P<0.05).The correlation analysis showed that eGFR was negatively correlated with hsCRP,PT,Fbg,INR,Angel,MA and CI(P<0.05),and positively correlated with hemoglobin,platelet,albumin,R and K(P<0.05).The inhibitory rate of AA pathway induced by aspirin was not statistically different between normal eGFR group(n=6)a
作者
王一琳
陆金花
陈凤玲
殷莺
黄莺
尤冰
WANG Yi-lin;LU Jin-hua;CHEN Feng-ling;YIN Ying;HUANG Ying;YOU Bing(Department of Hemodialysis Center,First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China;Department of Gerontology,First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China)
出处
《中国血液流变学杂志》
CAS
2021年第4期500-505,共6页
Chinese Journal of Hemorheology
关键词
慢性肾脏病
凝血功能
血栓弹力图
chronic kidney disease
coagulation function
thrombelastography
