Impact of acute kidney injury on coagulation in adult minimal change nephropathy.
Impact of acute kidney injury on coagulation in adult minimal change nephropathy.
复制标题
急性肾损伤对成人微小病变肾病凝血功能的影响
DOI：
10.1097/md.0000000000005366
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发表时间：
2016-11
期刊：
影响因子：
1.6
通讯作者：
Chen XM
中科院分区：
文献类型：
--
作者：
Huang MJ;Wei RB;Su TY;Wang Y;Li QP;Yang X;Lv XM;Chen XM
肾病综合征（NS）患者存在高凝状态，更易发生静脉血栓栓塞（VTE）。然而，急性肾损伤（阿基），NS的常见并发症，是否影响高凝状态和静脉血栓栓塞很少阐明。本研究对2011年至2016年连续入选的269例NS合并微小病变（MCD）患者的凝血功能进行观察，探讨NS合并AKI患者凝血功能的变化及相关影响因素。阿基组91例，非AKI组178例。采用1：1倾向评分匹配（PSM）方法匹配基线信息。比较凝血生物标志物，并记录血栓形成事件。采用线性相关分析检测D-二聚体与临床资料的相关性，PSM方法提供了88例MCD伴阿基和非AKI患者的配对，基线信息无差异。MCD-AKI患者的D-二聚体、纤维蛋白原和血栓弹力图参数最大振幅（MA）、G值显著高于无阿基的MCD患者的水平（D-二聚体：1.8 [1.0，3.3] vs 1.1 [0.6，1.7] mg/L，P <0.001;纤维蛋白原：7.0±2.0 vs 6.5 ± 1.4 g/L，P = 0.036; MA：74.6 ± 5.0 vs 70.5 ± 5.3 mm，P = 0.020; G：15.7 ± 5.3 vs 12.5 ± 3.3，P = 0.034）。 对于MCD患者，D-二聚体>1 mg/L的患者的血清肌酐、白色细胞计数和白细胞介素-6水平显著高于D-二聚体<1 mg/L的患者。 相关分析显示，D-二聚体水平与血肌酐、白色细胞计数和白细胞介素-6呈正相关（r分别为0.410，P =<0.001; r = 0.248，P =<0.001; r = 0.306，P =<0.001）。 调整倾向评分值后，阿基组发生5起深静脉血栓形成事件，非AKI组发生1起肺栓塞事件。阿基与VTE的发生率相关，但差异无统计学意义（RR：4.9，95%CI：0.6-42.7，P = 0.154）; MCD-NS合并阿基患者的高凝状态更严重，这可能与阿基的活动性炎症介导凝血系统激活有关。
AbstractA hypercoagulable state exists in patients with nephrotic syndrome (NS), which more easily leads to venous thromboembolism (VTE). However, whether acute kidney injury (AKI), a common complication of NS, affects the hypercoagulable state and VTE has rarely been elucidated. In this study, we aimed to explore coagulation changes and analyze relevant influencing factors in NS-AKI patients.A total of 269 consecutive NS patients with minimal change disease (MCD) between 2011 and 2016 were included in this observational study. Ninety-one cases were in the AKI group and 178 cases in the non-AKI group. The 1:1 propensity score matching (PSM) method was applied to match the baseline information. The coagulation biomarkers were compared, and the thrombosis events were recorded. Linear correlation was performed to detect any relation between D-dimer and clinical data.The PSM method gave matched pairs of 88 MCD patients with AKI and non-AKI patients, resulting in no differences in baseline information. The D-dimer, fibrinogen, and thromboelastography parameters maximum amplitude (MA), G values of the MCD-AKI patients were significantly higher than the levels of the MCD patients without AKI (D-dimer: 1.8 [1.0, 3.3] vs 1.1 [0.6, 1.7] mg/L, P < 0.001; fibrinogen: 7.0±2.0 vs 6.5 ± 1.4 g/L, P = 0.036; MA: 74.6 ± 5.0 vs 70.5 ± 5.3 mm, P = 0.020; G: 15.7 ± 5.3 vs 12.5 ± 3.3, P = 0.034). For the MCD patients, the serum creatinine, white blood cell count, and interleukin-6 levels in the patients with D-dimers >1 mg/L were significantly higher than those of patients with D-dimers ⩽1 mg/L. The correlation analysis showed that the D-dimer level was correlated with serum creatinine, white blood cell count, and interleukin-6 (r = 0.410, P = < 0.001; r = 0.248, P = < 0.001; r = 0.306, P = < 0.001, respectively). Five deep vein thrombosis events occurred in the AKI group and 1 pulmonary embolism event occurred in the non-AKI group after adjusting the propensity score value. AKI appeared to have an association with higher incidence of VTE, but the difference was not statistically significant (RR: 4.9, 95% CI: 0.6–42.7, P = 0.154).The MCD-NS patients complicated with AKI had a more severe hypercoagulable state, which might be associated with the active inflammation of AKI that mediated activation of the coagulation system.