目的:探讨特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者外周血纤维蛋白原/白蛋白比值(fibrinogen/albumin ratio,FAR)、脂蛋白相关磷脂酶 A2(lipoprotein-associated phospholipase A2,Lp-PLA2)水平,分析其对IMN并发血栓的预测价值.方法:选取2020年1月-2023年1月医院收治的60例IMN并发血栓患者作为研究组,另选同期60例IMN无血栓患者作为对照组.比较2组一般资料、24 h尿蛋白定量(24 h Upro)、血脂指标(甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇)、凝血功能指标[凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、活化部分凝血酶原时间(APTT)]、外周血FAR、Lp-PLA2水平.logistic回归分析IMN并发血栓的影响因素.分析研究组外周血FAR、Lp-PLA2水平与IMN并发血栓影响因素的相关性.对比分析含与不含外周血FAR、Lp-PLA2预测方案对IMN并发血栓的预测价值.结果:2组IMN病程、病理分期、24 h Upro、外周血D-D、FIB、APTT、FAR、Lp-PLA2水平比较差异有统计学意义(P＜0.05);IMN病程、病理分期、24 h Upro、外周血D-D、FIB、APTT、FAR、Lp-PLA2水平为IMN并发血栓的影响因素(P＜0.05);外周血FAR、Lp-PLA2联合预测IMN并发血栓的受试者工作特征曲线下面积(AUC)大于单项指标预测(P＜0.05);含FAR、Lp-PLA2预测方案对IMN并发血栓的预测效果较不含FAR、Lp-PLA2预测方案明显改善(P＜0.05).结论:IMN并发血栓患者外周血FAR、Lp-PLA2水平升高,且与血栓易感性密切相关,含外周血FAR、Lp-PLA2预测方案对IMN并发血栓具有一定预测价值.
Exploration on role of peripheral blood FAR and Lp-PLA2 in thrombotic susceptibility of patients with idiopathic membranous nephropathy
Objective:To investigate the levels of fibrinogen/albumin ratio(FAR)and lipoprotein-associated phospholipase A2(Lp-PLA2)in peripheral blood of patients with idiopathic membranous nephropathy(IMN),and analyze their predictive value for thrombosis in IMN.Methods:Sixty patients with IMN complicated by thrombo-sis admitted to the hospital from January 2020 to January 2023 were selected as the study group,and another 60 patients with IMN without thrombosis in the same period were selected as the control group.The general data,24 h urine protein quantification(24 h Upro),lipid indexes(triglycerides,total cholesterol,high-density lipopro-tein cholesterol,low-density lipoprotein cholesterol),coagulation indexes(D-dimer[D-D],prothrombin time[TT],prothrombin time[PT],fibrinogen[FIB])were compared between the two groups.Logistic regression was used to analyze the factors influencing the complication of thrombosis in IMN.The correlation between pe-ripheral blood FAR and Lp-PLA2 levels in the study group and the factors affecting IMN complicating thrombosis was analyzed.The predictive value of the prediction scheme with and without peripheral blood FAR and Lp-PLA2 for IMN complicating thrombosis was compared.Results:There were significant differences in IMN course,path-ological stage,24 h Upro,peripheral blood D-D,FIB,APTT,FAR and Lp-PLA2 levels between the two groups(P＜0.05).The course of IMN disease,pathological stage,24 h Upro,peripheral blood D-D,FIB,APTT,FAR and Lp-PLA2 levels were the influencing factors of IMN complicated with thrombus(P＜0.05).The AUC of pe-ripheral blood FAR and Lp-PLA2 combined predicted thrombus of IMN was greater than that of single index(P＜0.05).The prediction effect of FAR and Lp-PLA2 prediction schemes on thrombosis complicated by IMN was significantly improved compared with that without FAR and Lp-PLA2 prediction schemes(P＜0.05).Conclusion:The levels of FAR and Lp-PLA2 in peripheral blood of patients with IMN complicated with thrombus were in-creased,which was closely related to the susceptibility to thrombus.The prediction scheme including peripheral blood FAR and Lp-PLA2 might have a certain value in predicting thrombus complicated with IMN.
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