The Value Of Coagulation And Platelet Parameters In The Pathological Staging Of Idiopathic Membranous Nephropathy

Objectives:To investigate the relationship between coagulation function,platelet parameters and other laboratory parameters in IMN patients with different pathological stages by retrospectively analyzing the coagulation function,platelet parameters and some clinical laboratory parameters and pathological data of patients with idiopathic membranous nephropathy,and to provide a basis for assessing the pathological stages of IMN patients by laboratory parameters.Methods:Ninety-eight patients with IMN diagnosed by renal puncture biopsy in the nephrology department of the First Affiliated Hospital of Kunming Medical University from June 2019 to October 2022 were selected,and the 98 study subjects were divided into stage I-II group(76 patients)and stage Ⅲ group(22 patients)according to the pathological stage of renal puncture pathology.General information of the patients was collected including height,weight,gender,age at onset,systolic blood pressure(SBP),diastolic blood pressure(DBP),and smoking history.Pathological data and laboratory parameters were collected including hemoglobin(HGB),platelet count(PLT),platelet distribution width(PDW),platelet pressure product(PCT),mean platelet volume(MPV),serum albumin(Alb),triglycerides(TG),total cholesterol(TC),free cholesterol(FC),high-density lipoprotein cholesterol(HDL-C)(LDL-C),blood creatinine(Scr),blood urea nitrogen(BUN),blood uric acid(SUA),prothrombin time(PT),activated partial thromboplastin time(APTT),prothrombin time(TT),fibrinogen(FIB),fibrinogen lysis product(FDP),D-dimer(D-D),antithrombin-III(AT-III),serum complement C3(C3),immunoglobulin A(Ig A),immunoglobulin G(Ig G),immunoglobulin M(Ig M),serum complement C4(C4),and total 24-hour urinary protein(24h-UTP).Patients’ body mass index(BMI),and estimated glomerular filtration rate(e GFR)were calculated.The differences between the two groups’ general data and clinical laboratory indices were compared.Logistic backward stepwise regression analysis was used to study the influencing factors related to the pathological staging of IMN patients,and ROC curves were drawn to analyze the predictive value of each factor on the pathological staging of IMN patients.Results:1.Compared with the general data of the two groups,patients with stage Ⅲ IMN had a younger age of onset and a higher proportion of interstitial fibrosis(P<0.05),while the differences in BMI,SBP,DBP,tubular atrophy,interstitial inflammatory cell infiltration,and smoking history were not statistically significant(P>0.05).2.Compared with the laboratory parameters of the two groups,HDL-C was lower in patients with stage Ⅲ IMN than in patients with stages Ⅰ-Ⅱ(P<0.05),while the differences between HGB,Alb,BUN,Scr,SUA,TC,FC,TG,LDL-C,24h-UTP,e GFR,Ig G,Ig A,Ig M,C3 and C4 were not statistically significant(P>0.05).3.Compared with the coagulation function of patients in both groups,TT and APTT were lower in stage Ⅲ IMN patients than in stage Ⅰ-Ⅱ patients(P<0.05),and the differences between FDP,D-D,AT-III,PT and FIB were not statistically significant(P>0.05).4.Compared with the platelet parameters in both groups,PDW was higher in stage III IMN patients than in stage Ⅰ-Ⅱ patients(P<0.05),while the differences between PLT,PCT and MPV were not statistically significant(P>0.05).5.Multi-factor regression analysis showed that TT,PDW and HDL-C were independent factors influencing pathological staging in IMN patients(P<0.05),with TT and HDL-C being protective factors and PDW being risk factors.6.The ROC curves showed that the area under the curve(AUC)of TT,PDW and HDL-C predicting pathological staging in IMN patients were 0.738,0.714 and 0.656,respectively.Conclusions:1.Age at onset,interstitial fibrosis,APTT,TT,PDW,and HDL-C differed between pathological stages in IMN patients,but the age at onset,interstitial fibrosis,and APTT did not independently affect the pathological stages in IMN patients.2.TT,PDW and HDL-C were independent influences on the pathological staging of IMN patients and were able to predict the pathological staging of IMN patients.3.This study shows that dynamic monitoring of coagulation function and platelet parameters can help determine the disease progression of IMN patients,help identify the tendency of blood hypercoagulation in IMN patients at different pathological stages,and provide a reference basis for clinical guidance of anticoagulation therapy.