Lizakowski Slawomir, Zdrojewski Zbigniew, Jagodzinski Piotr, Rutkowski Boleslaw
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland.
Scand J Urol Nephrol. 2007;41(3):237-42. doi: 10.1080/00365590601016511.
Nephrotic syndrome (NS) is associated with numerous blood coagulation abnormalities and a marked predisposition to thromboembolism. Fibrin formation within the glomeruli occurs in various forms of human and experimental glomerulonephritis and may play an important role in progressive glomerular injury. The aim of this study was to measure the plasma concentrations of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) and intravascular thrombin generation markers and to analyze their relationships in patients with primary glomerulonephritis.
The study population comprised 57 patients (mean age 35.2 years; range 18-63 years) with primary glomerulonephritis: 36 with NS (NS group) and 21 without (non-NS group). The control group consisted of 24 sex- and age-matched healthy volunteers. TF and TFPI antigen, prothrombin fragment F 1+2 (PF 1+2) and thrombin-antithrombin III complex (TAT) concentrations in plasma were estimated using commercially available kits.
Serum TF and TFPI concentrations in both the NS and non-NS groups were higher than those observed in the control group. Moreover, there were significant differences in TF and TFPI concentrations between the NS and non-NS groups. TF:TFPI ratios in both the examined groups were constant and significantly higher than those in the control group. Positive correlations between TF and both PF 1+2 and TAT concentrations in the total cohort of patients were shown. Furthermore, a positive correlation between TF and TFPI concentrations was observed.
Our data support the hypothesis concerning activation of coagulation pathways in patients with primary glomerulonephritis. An inadequate TFPI concentration as a result of an elevated TF:TFPI ratio characterizes not only patients with clinical manifestations of NS but also patients with mild proteinuria.
肾病综合征（NS）与多种血液凝固异常及血栓栓塞的显著易感性相关。肾小球内纤维蛋白形成见于各种人类和实验性肾小球肾炎，可能在进行性肾小球损伤中起重要作用。本研究的目的是测量原发性肾小球肾炎患者血浆组织因子（TF）和组织因子途径抑制物（TFPI）浓度以及血管内凝血酶生成标志物，并分析它们之间的关系。
研究人群包括57例原发性肾小球肾炎患者（平均年龄35.2岁；范围18 - 63岁）：36例患有NS（NS组），21例未患（非NS组）。对照组由24名年龄和性别匹配的健康志愿者组成。使用市售试剂盒测定血浆中TF和TFPI抗原、凝血酶原片段F 1+2（PF 1+2）和凝血酶 - 抗凝血酶III复合物（TAT）的浓度。
NS组和非NS组的血清TF和TFPI浓度均高于对照组。此外，NS组和非NS组之间的TF和TFPI浓度存在显著差异。两个研究组的TF:TFPI比值恒定且显著高于对照组。在全部患者队列中，TF与PF 1+2和TAT浓度之间呈正相关。此外，还观察到TF与TFPI浓度之间呈正相关。
我们的数据支持原发性肾小球肾炎患者凝血途径激活的假说。TF:TFPI比值升高导致TFPI浓度不足不仅是NS临床表现患者的特征，也是轻度蛋白尿患者的特征。
