Relationship Between High Fibrinogen And Clinical Related Indicators In Patients With Nephrotic Syndrome

Objective: To analyze the relationships between fibrinogen(FIB)level with other clinical features including high sensitivity C-reactive protein(hs-CRP),erythrocyte sedimentation rate(ESR)and so on and explore the influence factors for FIB,which might help to guide treatment and contribute to reduce the risk of thromboembolic events in primary nephrotic syndrome.Methods:Cross-sectional study was applied.209 patients with primary nephrotic syndrome admitted to the First People’s Hospital of Suzhou University from July 2012 to July 2017 were collected.Collectting the general clinical data and laboratory test results at the time of admission to the hospital,including gender,age,Mean arterial pressure(MAP),Prothrombin time(PT),Activated partial thromboplastin time(APTT),Fibrinogen,Neutrophil count(NE),Lymphocyte count(LY),Hemoglobin(HGB),Platelet count(PLT),Serum albumin(ALB),globulin(GLB),Albumin globulin ratio(A/G),Prealbumin(PAB),Total cholesterol(TC),Triglyceride(TG),Low density lipoprotein cholesterol(LDL—C),High-density lipoprotein cholesterol(HDL—C)、 Blood urea nitrogen(BUN),Blood Uric Acid(UA),Serum creatinine(Scr),High-sensitivity C-reactive protein,Erythrocyte sedimentation rate(ESR),etc.The patients was divided into hyperfibrinogen group(FIB>5 g/L)with 67 cases and normal fibrinogen group(FIB≤5 g/L)with 142 cases based on the value of fibrinogen.The differences between the two groups were analyzed.The Spearman correlation method was used to analyze the relationships between fibrinogen and high-sensitivity C-reactive protein,erythrocyte sedimentation rate,platelet count,Albumin globulin ratio,white blood cell and other factors,and multiple stepwise linear regression was used to analyze the independent risk factors for fibrinogen.Results: 1.A total of 209 NS patients were collected,including 132 males(63.2%),77 females(36.8%),The average age was(47.57±17.96)years old.Of which 67 cases were hyperfibrinogen group(32.06%),The average age was(43.36±18.33)years old,The ratio of male to female was 40/27,males accounted for 59.70%;Of which 142 cases were normal fibrinogen group(67.94%),the average age was(49.56±17.50)years old,the ratio of male to female was 92/50,and males accounted for 64.79%.The average age(43.36±18.33)and mean arterial pressure(98.19±13.29)in hyperfibrinogen group were lower than in the normal fibrinogen group in average age(49.56±17.50)and mean arterial pressure(103.26±15.55).There was a statistically significant difference between the two groups(P<0.05).2.Of the 209 patients with primary nephrotic syndrome,121 had Pathological results,membranous nephropathy in 62 cases(50.8%),minimal change disease in 32 cases(26.2%),mesangial proliferative glomerulonephritis in 11 cases(9.0%),IgA nephropathy in 8 cases(6.6%),mocal segmental glomerulosclerosis in 5 cases(4.1%),membrane proliferative glomerulonephritis in 3 cases(2.5%),88 cases were not do pathological examination.The nephrotic syndrome patients complicated with hypertension in 83 cases(39.7%),diabetes in 21 cases(10.0%),coronary heart disease in 5 cases(2.4%),hypothyroidism or subclinical hypothyroidism in 15 cases(7.2%),and 3 cases(1.4%)had a history of thrombosis.Among them,membranous nephropathy complicated with hypertension in 22 cases(26.51%),diabetes in 6 cases(28.57%),coronary heart disease in 1 case(20%),hypothyroidism or hypothyroidism in 3 cases(20%),and 1 case(33.33%)had a history of thrombosis.Minimal change disease complicated with hypertension in 5 cases(6.02%),diabetes in 0 cases,coronary heart disease in 0 cases,hypothyroidism or subnormal hypothyroidism in 1 case(6.67%),and 0 cases of thrombosis.3.Patients in hyperfibrinogen group had higher PT,APTT,HGB,TC,TG,LDL-C and GLB than patients in normal fibrinogen group.There were statistically significant differences between the two groups(t value or Z value were 2.862,3.356,3.265,6.090,2.190,6.046,2.324,respectively.P <0.05);The PAB and ALB in the patients with high fibrinogen group were lower than those in the normal fibrinogen group.There were statistically significant differences between the two groups(t values were-5.495,-5.484,P<0.05).4.Spearman correlation analysis showed that FIB level with hs-CRP(r=0.251,p<0.001),ESR(r=0.636,p<0.001),TC(r=0.510,p<0.001),TG(r=0.302,p <0.001),LDL-C(r=0.483,p<0.001),PLT(r=0.330,p<0.001),GLB(r=0.287,p<0.001)were positively correlated(P<0.05);FIB with ALB(r=-0.426,p<0.001),A/G(r=-0.552,p<0.001),PAB(r=-0.431,p<0.001)were negatively correlated(P<0.05);there were no correlation in FIB with NE,LY and eGFR(P>0.05).5.The hs-CRP,ESR,PLT,TG,and LDL-C levels were higher in the hyperfibrinogen group than in the normal fibrinogen group.There were a statistically significant differences between the two groups(t value or Z value were 3.616,7.020,and 4.055,2.190,6.046,respectively.P <0.05);Patients in hyperfibrinogen had lower A/G than in normal fibrinogen group,there was a statistically significant difference between the two groups(t =-7.738,P < 0.05).There was no significant difference in NE and LY between the two groups(P>0.05).6.Multiple linear regression analysis showed that there were significant positive correlation between FIB and hs-CRP(b=0.082,<0.001),ESR(b=0.012,p<0.001),PLT(b=0.003,p=0.001),LDL-C(b=0.139,p<0.001),TG(b=0.074,p=0.016),There was a significant negative correlation between FIB and A/G(b=-0.759,p= 0.005).hs-CRP,ESR,A/G,PLT,LDL-C,TG are independently related with FIB.Conclusion: 1.In recent years,patients with primary nephrotic syndrome in our hospital have a higher proportion of pathological types of mesangial nephropathy.2.Fibrinogen level is associated with hs-CRP,ESR,TC,TG,LDL-C,PLT,GLB,ALB,A/G,PAB,and hs-CRP,ESR,A/G,PLT,LDL-C,TG are independent risk factors for hyperfibrinogenemia in patients with nephrotic syndrome.3.The degree of inflammation reactions is aggravated with the increase of fibrinogenemia in patients with nephrotic syndrome.4.The increase of platelet counts in peripheral blood is correlated with higher level of plasma fibrinogen,which may aggravate coagulation functions in patients with nephrotic syndrome.