Changes of coagulation function and influence factors of hypercoagulability in patients with chronic kidney disease

doi:10.3969/j.issn.1673-8640.2021.05.008

Abstract

Abstract:

Objective To investigate the changes of coagulation function and the influence factors of hypercoagulability in patients with chronic kidney disease（CKD）. Methods A total of 240 patients with CKD were enrolled from January 2016 to December 2018 in Nanjing Drum Tower Hospital. According to glomerular filtration rate,CKD patients were classified into 5 stages. According to the results of fibrinogen（Fib）,the patients with CKD were classified into non-hypercoagulable group and hypercoagulable group. Totally,45 healthy subjects were enrolled as control group. The general data,coagulation function results and other related laboratory indexes of each group were analyzed. Results Compared with control group,the levels of Fib and D-dimer（DD） of patients with CKD4 and CKD5 were higher（P<0.05）,and the results of antithrombin Ⅲ（ATⅢ） were lower（P<0.05）. The results of Fib,DD and ATⅢ in patients with CKD5 had statistical significance compared with the other 4 groups and control group（P<0.05）. Glomerular filtration rate was negatively correlated with Fib and DD（r=-0.652,P=0.003;r=-0.732,P=0.001,respectively） and positively correlated with ATⅢ（r=0.765,P<0.001）. Binary Logistic regression analysis showed that creatinine（Cr） and C-reactive protein（CRP） were independent risk factors for hypercoagulability in patients with CKD [odds ratio （OR）=1.352 and 1.052,95% confidence intervals（CI）were 1.089-1.664 and 0.989-1.122],while ATⅢ was its protective factor（OR=0.792,95%CI0.771-0.994）. Conclusions There exists coagulation disorder in patients with CKD,and it aggravates with the progression of the disease. Monitoring the coagulation function of patients with CKD plays a role in preventing complications and improving prognosis.

Key words: Coagulation function, Hypercoagulable state, Chronic kidney disease

CLC Number:

R446.11

XIE Hui, SHEN Han. Changes of coagulation function and influence factors of hypercoagulability in patients with chronic kidney disease[J]. Laboratory Medicine, 2021, 36(5): 500-503.

Figures/Tables 4

References 16

[1]	HERON M. Deaths:leading causes for 2016[J]. Natl Vital Stat Rep, 2018,67(6):1-77.
[2]	王善志, 朱永俊, 李国铨, 等. 中国成人慢性肾脏病患病率的Meta分析结果及对比[J]. 中华肾脏病杂志, 2018,34(8):579-586.
[3]	邢小平, 唐吉斌, 王传发, 等. 慢性肾脏病患者甲状旁腺激素水平与肾功能的关系[J]. 检验医学, 2019,34(5):405-407.
[4]	LIANG C C, WANG S M, KUO H L, et al. Upper gastrointestinal bleeding in patients with CKD[J]. Clin J Am Soc Nephrol, 2014,9(8):1354-1359. DOI URL
[5]	上海慢性肾脏病早发现及规范化诊治与示范项目专家组, 高翔, 梅长林. 慢性肾脏病筛查诊断及防治指南[J]. 中国实用内科杂志, 2017,37(1):28-34.
[6]	RODRIGO E, PICH S, SUBIRANA I, et al. A clinical-genetic approach to assessing cardiovascular risk in patients with CKD[J]. Clin Kidney J, 2017,10(5):672-678. DOI URL
[7]	HUANG M, WEI R B, WANG Y, et al. Blood coagulation system in patients with chronic kidney disease:a prospective observational study[J]. BMJ Open, 2017,7(5):e14294.
[8]	NUNNS G R, MOORE E E, CHAPMAN M P, et al. The hypercoagulability paradox of chronic kidney disease:the role of fibrinogen[J]. Am J Surg, 2017,214(6):1215-1218. DOI URL
[9]	WU R, KONG Y, YIN J, et al. AntithrombinⅢis a novel predictor for contrast induced nephropathy after coronary angiography[J]. Kidney Blood Press Res, 2018,43(1):170-180. DOI URL
[10]	曹盛吉, 赵乙洁, 王少华. 慢性肾脏病患者凝血指标与低分子肝素量相关性研究[J]. 国际检验医学杂志, 2017,38(23):3345-3347.
[11]	王玉洁, 胡承刚, 甘林望, 等. 慢性肾脏病患者各期凝血功能变化及相关影响因素分析[J]. 现代医药卫生, 2015,31(24):3706-3708.
[12]	TAVARES I, MOREIRA L, COSTA P P, et al. Fibrinogen A alpha-chain amyloidosis:a non-negligible cause of chronic kidney disease in dialysis patients[J]. Amyloid, 2017,24(sup 1):153-154.
[13]	梁莹, 王妍春. 慢性肾脏病微炎症状态的诊断与治疗[J]. 实用医学杂志, 2016,32(7):1186-1188.
[14]	林伟平, 吴勇. 慢性肾脏病病人凝血功能变化与炎症内皮因子及氧化应激关系[J]. 青岛大学学报(医学版), 2019,55(1):99-102.
[15]	LU Z, WANG F, LIANG M, et al. Serpin C1/antithrombin Ⅲ in kidney-related diseases[J]. Clin Sci(Lond), 2017,131(9):823-831. DOI URL
[16]	LEVY J H, SNIECINSKI R M, WELSBY I J, et al. Antithrombin:anti-inflammatory properties and clinical applications[J]. Thromb Haemost, 2016,115(4):712-728. DOI URL

组别	例数	性别		年龄/岁	吸烟史/例	糖尿病史/例	心血管疾病史/例	血栓史/例	出血史/例
组别	例数	男/例	女/例	年龄/岁	吸烟史/例	糖尿病史/例	心血管疾病史/例	血栓史/例	出血史/例
对照组	45	25	20	42.18±10.12	3	0	0	0	0
CKD1期组	40	23	17	40.22±9.66	7	0	0	0	0
CKD2期组	42	24	18	43.56±11.17	5	1	0	0	0
CKD3期组	53	30	23	44.36±9.55	8	1	1	0	0
CKD4期组	56	34	22	56.22±15.48^*	11	2	3	1	1
CKD5期组	49	26	23	60.15±13.65^*	9	3	5	4	2

组别	例数	性别		年龄/岁	吸烟史/例	糖尿病史/例	心血管疾病史/例	血栓史/例	出血史/例
组别	例数	男/例	女/例	年龄/岁	吸烟史/例	糖尿病史/例	心血管疾病史/例	血栓史/例	出血史/例
对照组	45	25	20	42.18±10.12	3	0	0	0	0
CKD1期组	40	23	17	40.22±9.66	7	0	0	0	0
CKD2期组	42	24	18	43.56±11.17	5	1	0	0	0
CKD3期组	53	30	23	44.36±9.55	8	1	1	0	0
CKD4期组	56	34	22	56.22±15.48^*	11	2	3	1	1
CKD5期组	49	26	23	60.15±13.65^*	9	3	5	4	2

组别	例数	PT/s	Fib/（g/L）	APTT/s	DD/（μg/mL）	ATⅢ/%
对照组	45	12.1±0.7	3.1±0.6	38.1±4.4	0.25±0.12	101.1±9.8
CKD1期组	40	12.5±0.6	3.2±0.8	36.9±5.1	0.24±0.13	98.2±10.1
CKD2期组	42	12.4±0.8	3.4±0.9	37.8±3.8	0.27±0.16	98.1±11.1
CKD3期组	53	12.2±0.6	3.6±0.6	38.1±4.3	0.44±0.28	85.1±8.5
CKD4期组	56	12.6±1.1	4.0±0.9	38.5±6.1	0.51±0.31	78.5±6.8
CKD5期组	49	11.3±0.9	4.6±1.3	40.2±4.9	0.83±0.33	70.2±8.5
F值		2.264	35.056	0.524	4.689	5.565
P值		0.114	<0.001	0.754	0.013	0.007

组别	例数	PT/s	Fib/（g/L）	APTT/s	DD/（μg/mL）	ATⅢ/%
对照组	45	12.1±0.7	3.1±0.6	38.1±4.4	0.25±0.12	101.1±9.8
CKD1期组	40	12.5±0.6	3.2±0.8	36.9±5.1	0.24±0.13	98.2±10.1
CKD2期组	42	12.4±0.8	3.4±0.9	37.8±3.8	0.27±0.16	98.1±11.1
CKD3期组	53	12.2±0.6	3.6±0.6	38.1±4.3	0.44±0.28	85.1±8.5
CKD4期组	56	12.6±1.1	4.0±0.9	38.5±6.1	0.51±0.31	78.5±6.8
CKD5期组	49	11.3±0.9	4.6±1.3	40.2±4.9	0.83±0.33	70.2±8.5
F值		2.264	35.056	0.524	4.689	5.565
P值		0.114	<0.001	0.754	0.013	0.007

组别	例数	性别		年龄/ 岁	吸烟史/ 例（%）	糖尿病史/ 例（%）	心血管疾病史/例（%）
组别	例数	男/例	女/例	年龄/ 岁	吸烟史/ 例（%）	糖尿病史/ 例（%）	心血管疾病史/例（%）
非高凝状态组	135	79	56	44.13±8.01	20（14.8）	4（2.9）	2（1.5）
高凝状态组	105	58	47	49.22±10.21	20（19.0）	3（4.7）	5（4.8）
统计值		0.177		0.529	2.695	0.039	5.975
P值		0.674		0.697	0.101	0.843	0.015
组别	Hb/ （g/L）	PLT计数/（×10⁹/L）	TC/ （mmol/L）	TG/ （mmol/L）	Alb/ （g/L）	Cr/ （μmol/L）	CRP/ （mg/L）
非高凝状态组	92.66±26.55	201.00±55.22	3.8±0.8	1.7±0.6	46.12±6.23	156.11±42.31	4.41±2.65
高凝状态组	86.11±30.21	194.00±88.21	5.7±1.1	2.4±1.2	29.12±8.15	551.00±204.10	10.21±7.11
统计值	0.500	1.773	6.907	0.900	26.255	33.210	27.681
P值	0.506	0.231	0.039	0.379	0.002	<0.001	<0.001