The Change And Clinical Significance Of Blood Clotting Activity And Platelet Parameters In Chronic Renal Failure

Background and objective: The patients of chronic renal failure always have disorders of mechanism of coagulation and hemostasis, and both of them will further aggravate after the dialysis treatment. There are often simultaneously two kinds of mutually contradictory tendencies clinically, which is hypercoagulability and hemorrhage. Coagulation disorders is also one of the important reasons of lesions sustainably developing and renal function progressively deteriorating. Thromboembolic complications (such as Ischemic heart disease and cerebral apoplexy, etc) and hemorrhagic diseases (such as alimentary tract hemorrhage and cerebral hemorrhage, etc) often aggravate the condition of disease or become the primary cause of death in patients with chronic renal failure. Therefore, the effective prevention and the forecast to it has become the hot spot of clinical research. The objective of this study was to confirm the hypercoagulabale state and hemorrhagic tendency exsiting in chronic renal failure and then expound the mechanism of chronic renal failure leading to thromboembolic and hemorrhagic disease by detecting the marker of hypercoagulabale state and hemorrhagic tendency.Materials and Methods: Selected objects are divided into normal control group, chronic renal failure group, chronic renal failure complicated with thrombosis group and chronic renal failure complicated with hemorrhage group, according to different phases, primary diseases and treatment, patients of chronic renal failure are divided into different subgroups, to observe APTT, PT, FIB, PLT, MPV, PDW. The measurement data was expressed as mean±standard deviation ((x|-)±s). Variance of the two groups was analysed by t-test, Variance of the multigroup used analysis of variance, statistical significance was defined as P<0.05.Results:1. The levels of serum APTT, PT decreased significantly in CRF group compared with the control group, the serum APTT has statistical significance between two groups (P<0.05); The level of serum FIB increased significantly in CRF group compared with the control group, the differentia had the statistical significance between two groups (P<0.01); The levels of serum PLT, MPV, PDW all decreased significantly in CRF group compared with the control group, the differentia all had the statistical significance (P<0.05, P<0.01, P<0.05).2. The levels of serum APTT, PT decreased significantly in CRF 3,4,5 period groups compared with the control group,and the GFR is more lower, the differentia is more obvious. The differentia of CRF 4,5 period have statistical significance (P<0.05, P<0.01); The levels of serum FIB increased significantly in CRF group ompared with the control group, and the GFR is more lower, the differentia is more obvious. The differentia of CRF 3,4,5 period all had statistical significance (P<0.01); The levels of serum PLT decreased significantly in CRF 3,4,5 period groups compared with the control group, and the GFR is more lower,the differentia is more obvious. The differentia of CRF 4, 5 period have statistical significance (P<0.05, P<0.01), the differentia among CRF 3,4,5 period had statistical significance (P<0.01). The levels of serum MPV decreased significantly in CRF 3,4,5 period groups compared with the control group, and the GFR is more lower, the differentia is more obvious, the differentia of CRF 3,4,5 period all had statistical significance (P<0.05, P<0.01, P<0.01), the differentia among CRF 3,4,5 period had statistical significance (P<0.01). The levels of serum PDW increased slightly in CRF 3 period groups and decreased significantly in CRF 4,5 period groups compared with the control group, and the GFR is more lower, the decreased differentia is more obvious. The differentia of CRF 4,5 period had statistical significance (P<0.05, P<0.01), the differentia among CRF 3,4,5 period had statistical significance(P<0.01).3. The levels of serum APTT, PT decreased significantly in chronic glomerulonephritis group and diabetic nephropathy group compared with the control group (P<0.01, P<0.05); The levels of serum FIB all increased significantly in each primary disease group compared with the control group (P<0.01, P<0.05); The levels of serum PLT, MPV, PDW decreased significantly in chronic glomerulonephritis group and hypertensive nephropathy group compared with the control group (P<0.01, P<0.05); The levels of serum MPV, PDW decreased significantly in chronic interstitial nephritis group compared with the control group (P<0.05).4. The levels of serum APTT, PT, PLT, MPV, PDW decreased and the levels of serum FIB increased in hematodialysis group compared with the control group (P<0.01). The levels of serum APTT, PT, PLT decreased in hematodialysis group compared with the CRF 5 period group (pretherapy), the serum PT, PLT has statistical significance (P<0.05, P<0.05). The levels of serum FIB, MPV, PDW increased slightly in hematodialysis group compared with the CRF 5 period group, there was no significant difference. The levels of serum APTT, PT, PLT, MPV, PDW all decreased and the levels of serum FIB increased in peritoneal dialysis group compared with the control group, the serum PT, FIB, MPV, PDW has statistical significance (P<0.05, P<0.01, P<0.01, P<0.01). The levels of serum PT,MPV,PDW decreased in peritoneal dialysis group compared with the CRF 5 period group, the serum PDW has statistical significance (P<0.05). The levels of serum APTT, PT, PLT, MPV, PDW all decreased and the levels of serum FIB increased in expectant treatment group compared with the control group (P<0.01, P<0.05).5. The levels of serum APTT, PT, MPV, PDW decreased in chronic renal failure complicated with thrombosis group compared with chronic renal failure group, the serum APTT, PDW has statistical significance (P<0.05, P<0.01). The levels of serum APTT, PT increased and the levels of serum FIB, PLT, MPV, PDW all decreased in chronic renal failure complicated with hemorrhage group compared with chronic renal failure group, the serum APTT, PLT has statistical significance (P<0.01).Conclusion:1. The levels of serum APTT, PT decreased significantly in chronic renal failure patients,FIB increased significantly; the alteration above in chronic glomerulonephritis group and diabetic nephropathy is more significant; and there is trendancy that the GFR is more lower the differentia is more obvious.2. The levels of serum PLT, MPV, PDW decreased significantly in chronic renal failure patients; the alteration above in chronic glomerulonephritis group and hypertensive nephropathy is more significant; and there is trendancy that the GFR is more lower the differentia is more obvious.3. The levels of serum APTT still decreased significantly after hemodialysis and expectant treatment, and decreased more significantly than pre-treatment, FIB increased obviously. The levels of serum PLT decreased significantly after hemodialysis.4. The levels of serum APTT decreased in chronic renal failure complicated with thrombosis. The levels of serum APTT, PT increased and the levels of serum PLT decresed in chronic renal failure complicated with hemorrhage.5. Monitoring the coagulation and the blood platelet parameters in the chronic renal failure patient, is helpful to provide the corresponding laboratory inspection standard of diagnosis of the thrombokinesis and hemorrhage for clinician; may also provides the reference for the kind of abnormal index patients in clinical whether need anticoagulate and hemostasis treatment, and also provides the powerful help for judging the condition, promptly correcting thrombokinesis and hemorrhage tendency and observating curative effect.