Clinical Significance Of Soluble Endothelial Cell Protein C Receptor And Thrombomodulin In Patients With Primary Nephritic Syndrome

Objective:Compare the levels of plasma soluble EPCR (sEPCR) and soluble TM (sTM) in patients with primary nephrotic syndrome and in normal control group, to explore the significance of sEPCR and sTM in patients with primary nephrotic syndrome.Methods:From August 2009 to May 2010, 65 cases of patients with primary nephrotic syndrome who were hospitalized in the First Affiliated Hospital of Soochow University were enrolled in this study. 65 cases were performed renal biopsy and divided groups according to different pathology types:26 patients with membranous nephropathy(MN), 19 patients with minimal change disease(MCD), 20 patients with mesangial proliferative glomerulonephritis(MsPGN). 7 patients with membranous nephropathy stage I,16 patients with stage II and 3 patients with stage III.40 cases of healthy controls were also enrolled. Plasma sEPCR and sTM were measured by the enzyme-linked immunosorbent assay(ELISA); Hemagglutination and D-dimer were detected routine. And the clinical and laboratory data of the patients were collected.Result:1. The levels of plasma sEPCR in patients with primary nephrotic syndrome were significantly higher than that of in controls(P<0.05),the levels of plasma sTM were significantly higher than that of in controls(P<0.01).2. The levels of plasma sEPCR in PNS patients among different pathology type groups: Compared with patients with membranous nephropathy, mesangial proliferative glomerulonephritis and minimal change nephritis, the levels of sEPCR in membranous nephropathy showed statistic differences with mesangial proliferative glomerulonephritisa and minimal change nephritis(P<0.05), there were higher tendency of sEPCR levels in membranous nephropathy than minimal change nephritis and mesangial proliferative glomerulonephritisa. There were higher tendency of sEPCR levels in membranous nephropathy stage II than membranous nephropathy stage I and III, but there were no significant differences (P>0.05).The levels of plasma sTM: there were no significant differences between membranous nephropathy group and other pathology type groups(P>0.05).3. the levels of plasma fibrinogen (FIB) and D-dimer(D-Di)in patients with primary nephrotic syndrome were significantly higher than that of in control(sP<0.05, P<0.01), the levels of plasma antithrombase(AT-III)were lower than that of in controls(P<0.05).4. There was no correlation between the levels of plasma sEPCR and plasma sTM in patients with primary nephrotic syndrome (r=0.115, P>0.05).5. As for the levels of plasma sEPCR in PNS patients, a positive correlation was found with plasma D-dimer(r=0.528 , P<0.05), a negative correlation was found with albumin(ALB) (r=-0.632,P<0.05); the levels of plasma sTM had positive correlation with 24h urine protein (r=0.548, P<0.05)and positive correlations with TC(r=0.625,P<0.05), TG(r=0.568,P<0.05).Conclusion:1. The levels of plasma sEPCR in patients with primary nephrotic syndrome were significantly higher than that of in controls, a positive correlation was found with plasma D-dimer and a negative correlation was found with albumin. The results suggest that sEPCR may play a role in the pathogenesis of hypercoagulabale state in PNS. The levels of sEPCR to higher may be a new mechanism of thrombokinesis in patients with NS. The levels of sEPCR may be a new marker with NS in hypercoagulable state.2. The levels of plasma sEPCR in patients with membranous nephropathy increased most obviously, may be one of new mechanisms to explain why thrombokinesis easy to be found in membranous nephropathy.3. The levels of plasma sTM in patients with primary nephrotic syndrome were significantly higher than that of in controls, there was no correlation with the levels of plasma sEPCR.