The Clinical Study Of Coagulation Related Indexes And Prognosis Of Membranous Neohropathy

Objective:To explore the correlation between coagulation indexes and the prognosis of membranous nephropathy(MN),and to screen other risk factors affecting the prognosis of MN,so as to provide a theoretical basis for early evaluation of disease prognosis and the formulation of the best treatment plan.Methods:We selected 107 Nephrotic Syndrome(NS)patients who were diagnosed as MN by kidney biopsy in the Affiliated Bethune Hospital of Shanxi Medical University from July1,2013 to January 1,2020 using a retrospective research method.basic information such as gender,age,height,weight,and prothrombin time(PT),activated partial prothrombin time(APTT),thrombin time(TT),fibrinogen(FIB),antithrombin Ⅲ(AT-Ⅲ),D-dimer,platelet(PLT)serum albumin(ALB),red blood volume distribution width(RDW),serum creatinine(Scr),glomerular filtration rate(e GFR),24 h urine protein and other laboratory indicators were collected.The observation period was 6 months.All patients were followed up for 24 h urinary protein,ALB,Scr and other indexes after 6 months of treatment.According to the 2012 guidelines of Kidney Disease Improving Global Outcomes(KDIGO),the efficacy of MN was classified into complete response group,partial response group and non-response group.Multivariate Logistic regression was used to analyze the risk factors affecting the prognosis of MN.Pearson linear correlation was used to analyze the correlation between risk factors and other renal indicators.Receiver operator characteristic(ROC)curve was employed to evaluate the diagnostic efficacy of risk factors in predicting MN prognosis.Results:1.Compared with complete response group and partial response group,TT,FIB and 24 h urinary protein levels were significantly increased in non-response group.The prevalence of hypertension,TT,FIB,white blood cell count,RDW,urea and 24 h urinary protein levels were significantly higher in partial response group than the complete response group.There was statistically significant difference between groups(P < 0.05).2.Logistic regression analysis showed that hypertension,24 h urinary protein and FIB were independent risk factors for poor prognosis of MN(OR=0.512,P=0.043;OR=0.822,P=0.047;OR=0.912,P=0.034).3.Pearson’s linear analysis showed that FIB was positively correlated with urea,Scr and 24 h urinary protein(r=0.165,0.342,0.432),and negatively correlated with e GFR(r=-0.251).Hypertension was positively correlated with 24 h urinary protein(r=0.119),and negatively correlated with e GFR(r=-0.163).24 h urine protein was positively correlated with Scr(r=0.452).The difference was statistically significant(P<0.05).4.The areas under the ROC curve for hypertension,24 h urine protein and FIB were 0.725,0.823 and 0.650,respectively.Among them,24 h urine protein showed the highest diagnostic efficiency and sensitivity for the prognosis of MN,the cut-off value of24 h urine protein was 8.16 g.Conclusion:Hypertension,24 h urinary protein and FIB are the risk factors affecting the prognosis of MN.FIB level can reflect the situation of kidney injury in early MN patients.24 h urinary protein has the highest efficacy and sensitivity in the diagnosis of MN prognosis.These findings provide a new scientific basis for clinical work.