摘要： 目的 探讨治疗前血浆纤维蛋白原（Fg）水平在特发性膜性肾病（IMN）中的意义。方法 随访确诊IMN并采用激素联合环磷酰胺治疗的137例患者。分析治疗前后Fg及24 h尿蛋白定量、血白蛋白、胆固醇、低密度脂蛋白、血钙、25-羟维生素D3水平变化情况，以及治疗前Fg与上述指标的相关性及预测临床疗效的准确性。结果 治疗前Fg水平与治疗前及随访的24 h尿蛋白定量呈正相关，与血白蛋白呈负相关，与治疗前及治疗后3、6个月低密度脂蛋白、总胆固醇呈正相关（P < 0.05）。随访9个月患者完全缓解组与未缓解组、部分缓解组初始Fg水平组间均有统计学差异（P < 0.05），当治疗前Fg水平> 9.4 g/L时，治疗9个月后只有20%的患者完全缓解；Fg水平< 4.0 g/L时，治疗9个月后有85%的患者完全缓解。结论 治疗前血浆Fg水平可能在评估IMN预后中发挥作用。

血浆纤维蛋白原水平在特发性膜性肾病中的临床意义

郝相楠¹, 李亚², 王冬冬³, 栾军军¹, 周华¹

1. 中国医科大学附属盛京医院肾内科, 沈阳 110004;
2. 保定市第二中心医院肾内科, 河北 保定 072750;
3. 南京医科大学第四附属医院肾内科, 南京 210000

收稿日期:2021-01-26出版日期:2021-11-30发布日期:2021-11-04
通讯作者:周华E-mail:huazhou_cmu@163.com
作者简介:郝相楠(1995-),女,硕士研究生.
基金资助:国家自然科学基金（81770698；81370835）


关键词: 特发性膜性肾病, 血浆纤维蛋白原, 预后
Abstract: Objective To investigate the significance of pre-treatment plasma fibrinogen level in idiopathic membranous nephropathy. Methods One hundred and thirty-seven patients with idiopathic membranous nephropathy were treated with a hormone-linked cyclophosphamide treatment regimen and followed for 24 months. The changes in 24-hour urine protein, serum albumin, low-density lipoprotein, serum calcium, 25-hydroxyvitamin D3, and fibrinogen levels in patients with idiopathic membranous nephropathy before and after treatment were retrospectively analyzed. The correlation between the fibrinogen levels and above-mentioned indices before treatment;and the accuracy of predicting clinical efficacy using fibrinogen levels after 9 months of treatment were analyzed. Results There was a significant positive correlation between the fibrinogen levels and urine protein quantitation (P < 0.05) and a significant negative correlation between the fibrinogen and serum albumin levels (P < 0.05) before treatment and at 3, 6, and 9 months after treatment. Low-density lipoprotein and total cholesterol were positively correlated with fibrinogen before treatment and 3 and 6 months after treatment (P < 0.05). There was a significant difference between the pre-treatment fibrinogen levels of the patients in the complete remission group and those in the non-remission and the partial remission group (P < 0.05). Only 20% of the patients with pre-treatment fibrinogen level > 9.4 g/L achieved complete remission after 9 months of treatment. In contrast, 85% of the patients with fibrinogen levels < 4.0 g/L achieved complete remission after 9 months of treatment. Conclusion Pre-treatment levels of plasma fibrinogen may be helpful in assessing the prognosis of idiopathic membranous nephropathy.
Key words: idiopathic membranous nephropathy, plasma fibrinogen, prognosis
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