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Objective To discuss the diagnosis effect and clinical significance of thrombelastography in chronic kidney disease. Methods From June 2016 to February 2017, two hundred and seventy non-dialysis patients with chronic kidney disease ( CKD) treated in the Fourth Hospital of Hebei Medical University were divided into non-hypercoagulable group and hypercoagulable group according to TEG comprehensive coagulation index. The changes of related clinical indexes between the two groups were analyzed and the related factors affecting the differences between the two groups were studied. Results The correlation between the two groups showed that the coagulation reaction time ( R ) , coagulation formation time ( K ) and albumin in the hypercoagulable group were significantly lower than those in the non-hypercoagulable group ((4. 69±0. 94) min vs. (6. 29±1. 63) min,(0. 93±0. 13) min vs. (1. 51±0. 58) min,(27. 54±7. 81) g/L vs. (34. 26±8. 39) g/L, P= 0. 000 ) Angle angle, maximum thrombus strength ( MA ) , fibrinogen, D-dimer, platelet count, protein/creatinine and protein content in hypercoagulable group were significantly higher than those in non-hypercoagulable group((76. 76±2. 23)°vs. (68. 19±7. 65)°;(75. 13±3. 81)mm vs. (66. 35±7. 81)mm;(4. 28 ±0. 93) g/L vs. (3. 56±1. 10) g/L ;0. 4(0. 15,0. 91) mg/L vs. 0. 22(0. 12,0. 52) mg/L;(276. 03±127. 15) ×109/L vs. (198. 18±78. 46)×109/L;5430(2579,9634) mg vs. 2620(692,5286) mg;4864(2341,7712) mg/g vs. 2557(840,5805) mg/g,P<0. 05). The differences were statistically significant. There was no significant difference in prothrombin, thromboplastin time, thrombin time, total cholesterol, triglyceride, low density lipoprotein,high density lipoprotein,creatinine between the two groups ( P>0. 05) . Correlation analysis of common clinical indicators showed that the comprehensive coagulation index ( CI) was positively correlated with Angle angle,maximum thrombus strength,fibrinogen,platelet count,protein/creatinine and protein quantification (r=0. 532,0. 522,0. 307,0. 354,0. 293,0. 216,P<0. 05),was negatively correlated with coagulation reaction time,coagulation formation time and albumin (r=- 0. 462,- 0. 496,- 0. 360,P<0. 05). Logistic regression analysis showed that platelet count, albumin and fibrinogen were the influencing factors for the grouping of comprehensive coagulation index ( OR ( 95％CI ) :1. 007 ( 1. 002-1. 013 ) , 0. 868 ( 0. 827-0. 912 ) , 1. 510 (1. 042-2. 187),P<0. 05). Conclusion TEG is a more sensitive indicator to reflect the coagulation status of patients with CKD, and has a certain guiding significance for anticoagulation treatment of patients with CKD;platelet count,albumin,fibrinogen are the factors affecting coagulation function of patients.
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Objective:To analyze the factors that affect patient prognosis after radical nephrectomy.Meth-ods:A total of 389 cases of renal cell carcinoma treated with radical nephrectomy between January 1 993 and December 2006 were reviewed.All the data were encoded.inserted into an Excel database and then ana-lyzed by SPSS 1 3.0 software.The cumulative survival rates were calculated by life-table method.We as-sessed the impact of multiple covariates on survival time with the Cox Regression model.Results:The patho-logical results showed that 307 cases were clear call carcinoma,51 cases were papillary renal cell carcinoma,21 cases were chromophobic renal cell carcinoma,2 cases were collecting duct carcinoma.and 8 cases were unclassified.One hundred and ninety-eight cases were of T1N0M0, 113 cases were of T2N0M0, 3 cases were of T1N1M0,10 cases were of T2N1M0, 51 cases were of T3N0M0, and 14 cases were of T3N1M0, Two hundred and sixty-eight cases were followed up.The 1-year survival rate was 96.5%,the 3-year survival rate was 90.7%.the 5-year survival rate was 75.7%.and the 10-year survival rate was 65.8%.Multivariable analysis revealed that significant prognostic factors included TNM stage,Robson stage.vena cava and supplementary treat-ment(X2=22.50.P=0.001).The most important prognostic factor was pathological stage(TNM and Robson).The regression coefficients were 0.533 and 0.674,and the relative risk was 1.941 and 2.01 1(P=0.004 and p=0.002).Conclusion:Radical nephrectomy is safe and effective.TNM stage.Robson stage and vena cava are prognostic factors.Supplementary treatment is a protective factor.