The Clinical Significance Of Coagulation Related Indexes In Primary Membranous Nephropathy

Object:By studying the coagulation related indexes in patients with primary membranous nephropathy（PMN）,analyzing the changes of coagulation indexes in PMN patients,exploring the correlation between coagulation related indexes and laboratory indexes,glomerular filtration rate and renal pathology,then further exploring the clinical significance of coagulation related indexes in PMN.Method:A total of 93 patients who were diagnosed with PMN for the first time,met the diagnostic criteria for nephrotic syndrome（NS）and underwent renal biopsy in the Department of Nephrology,China-Japan Union Hospital of Jilin University from June 2012 to October 2021 were selected.A total of 48 healthy people who received routine physical examination in this hospital were collected.General information such as gender,age,and body weight,as well as laboratory indicators related to coagulation function,routine blood test,blood lipids,ions,and renal function were collected,and the esitimate glomerular filtration rate（e GFR）was calculated.SPSS24.0 software was used for analyzing the differences in APTT,PT,and FIB between PMN group and healthy control group;according to the 2020 KDIGO glomerulonephritis guidelines,referring to the clinical indicators of membranous nephropathy progression risk stratification,all PMN group patients were divided into different group according to 24 hours urine protein quantitativean and e GFR.APTT,PT,FIB were compared in each group;the correlation between APTT,PT,FIB and various clinical indicators was analyzed.Result:1.The ratio of male to female in PMN group was 2.1:1,and the average age was 48.46±11.03 years old.2.PT in PMN group was significantly lower than that in healthy control group（P<0.01）,and FIB was significantly higher than that in healthy control group（P<0.01）.3.PMN group was divided into groups according to 24-hour urine protein:<4g/d（group A,n=14）,4-8g/d（group B,n=50）,≥8g/d（group C,n=29）,the FIB of group C was higher than that of group A,and the difference was statistically significant（P<0.05）;according to e GFR grouping:<90ml/min.1.73m~2（group D,n=32）,≥90ml/min.1.73m~2（group E,n=61）,the FIB of group D was higher than that of group E,and the difference was statistically significant（P<0.05）.4.Spearman correlation analysis showed that:APTT in PMN group was positively correlated with TP,Ca,and segmental sclerosis（P all<0.05）,negatively correlated with TC（P<0.05）,and significantly negatively correlated with Urea（P<0.01）;PT was positively correlated with TP（P<0.05）,and negatively correlated with TC,HLD-C,and LDL-C（P all<0.05）;FIB was positively correlated with TC,LDL-C,Mg,Scr,spherosclerosis,renal tubular atrophy and arteriolar wall thickening（P all<0.05）,was significantly positively correlated with crescent formation and 24-hour urine protein quantification（P all<0.01）,and was positively correlated with WBC,PDW,ALB,Zn,e GFR（P all<0.05）.5.Multiple linear regression analysis showed that APTT was negatively correlated with Urea（b=-4.90,P<0.01）;FIB was positively correlated with LDL-C,crescent formation and renal tubular atrophy（b=0.118,b=1.252,b=0.503,P all<0.05）,which was negatively correlated with ALB（b=0.079,P<0.05）.Conclusion:1.Compared with healthy control group,PMN patients had significantly lower PT and higher FIB.2.The increase of FIB is associated with the risk stratification of PMN progression.3.The level of APTT in PMN patients was independently correlated with Urea,and was positively correlated;the level of FIB was independently correlated with ALB,LDL-C,crescent formation,and renal tubular atrophy,among which LDL-C,crescent formation,and renal tubular atrophy were positively correlated,and ALB was negatively correlated.