Saxena R, Batra V V, Singh N D
Department of Haematology, All India Institute of Medical Science, New Delhi.
Indian J Pathol Microbiol. 2000 Jul;43(3):319-23.
Nephrotic syndrome is a hypercoagulable state with variable prevalence of clinical thrombosis. The role of platelet aggregation, fibrinogen and antithrombin III and protein S levels in the pathogenesis of hypercoagulable state in these patients is controversial. Since no study on Indians is available, the clinical and laboratory profile of 22 patients of nephrotic syndrome (age 18-35 years with an MF ratio of 4:3), have been studied. The coagulation profile revealed a prolonged APTT in 12 patients (54.5%), and a prolonged TT in four (18.1%). In the rest APTT and TT were normal. PT was raised in two patients. Fibrinogen, an acute phase reactant was raised in five patients (22.7%). Antithrombin III levels were reduced in 19 patients (86.4%), normal in one and raised in two patients. Free Protein S levels were high in 12(54.5%), normal in seven and decreased in three patients. Platelet aggregation with adrenaline and adenosine diphosphate was raised in 6 patients. Ultrasonographically detected deep vein thrombosis was seen in one patient only (4.5%) who had ATIII levels of 48%. This low incidence can be explained by elevated protein S levels which was found to be raised in 12(54.5%) cases, protein S being an anticoagulant factor. This low level of clinical thrombosis in Indian patients of nephrotic syndrome may be an ethnic variable factor. It is thus concluded that although patients with nephrotic syndrome have a hypercoagulable state, clinical thrombosis is rarely seen in Indian patients with nephrotic syndrome.
肾病综合征是一种具有临床血栓形成发生率各异的高凝状态。血小板聚集、纤维蛋白原、抗凝血酶III及蛋白S水平在这些患者高凝状态发病机制中的作用存在争议。由于尚无针对印度人的研究，故对22例肾病综合征患者（年龄18 - 35岁，男女比例为4:3）的临床及实验室特征进行了研究。凝血指标显示，12例患者（54.5%）活化部分凝血活酶时间（APTT）延长，4例患者（18.1%）凝血酶时间（TT）延长。其余患者APTT和TT正常。2例患者凝血酶原时间（PT）升高。作为急性期反应物的纤维蛋白原在5例患者（22.7%）中升高。19例患者（86.4%）抗凝血酶III水平降低，1例正常，2例升高。12例患者（54.5%）游离蛋白S水平升高，7例正常，3例降低。6例患者肾上腺素和二磷酸腺苷诱导的血小板聚集增强。超声检查仅在1例患者（4.5%）中发现深静脉血栓形成，该患者抗凝血酶III水平为48%。这种低发生率可通过12例（54.5%）患者中升高的蛋白S水平来解释，蛋白S是一种抗凝因子。印度肾病综合征患者临床血栓形成水平较低可能是一个种族可变因素。因此得出结论，尽管肾病综合征患者处于高凝状态，但印度肾病综合征患者临床血栓形成很少见。
