The Clinico-pathologic Features of Hepatitis B Virus-associated Glomerulonephritis

The frequency of hepatitis B Surface antigen (HBsAg) was studiedin the sera of 311 patients with various forms of primary glomerulonephritisand 43 patients with lupus nephritis. HBs antigenaemia was detectedin 69 of the 311 patients (22 per cent) with primary glomerulonephritisand this prevalence of HBaAg carrier was significantly higherthan that in the general population (p<0. 001). These patientshad no clinical or biochemical findings to suggest acute orchronical liver disease. A higher HBs antigenaemia carrier ratewas not observed in patients with lupus nephritis. Three glomerulopathologicalentities, membranous nephropathy. IgA nephropathy, and mesangialproliferative glomerulonephrities, were found to be associatedwith a higher prevalence of HBs antigenaemia compared with thegeneral population (p<0. 001). Glomerular deposits of HBsAgand/or hepatitics core antigen (HBcAg) were detected in 41,61, and 60 per cent of renal biopsy specimens from patientswith membranous nephropathy, Iga nephropathy, and mesangialproliferative glomerulonephritis associated with persistentHBs antigenaemia respectively. During the mean study periodof 40 months (range 12–180), 14 per cent of these patientswith hepatitis-associated glomerulonephrities developed progressiverenal failure, althrough none required maintenanece dialysis.Our study suggests that hepatitis B virus antigenaemia may playa significant role in the developement of specific forms ofglomerulonephritis and that these hepatities B virus-associatedglomerulonephritides can run an indolent but relentless progressiveclinical course.     

小儿常见肾脏疾病尿电导率的变化分析

目的：检测小儿常见肾脏疾病尿电导率的变化,探讨该指标的临床意义。方法选择2011年3月至2012年3月本院小儿肾脏内科收治的首次诊断为肾脏疾病患儿986例及同期健康体检儿童350例的尿液,利用 Sysmex 公司的全自动尿液分析仪 UF-1000i 分别测定其尿电导率的变化。根据临床诊断将肾脏疾病患儿分为肾病综合征组、肾小球肾炎组、肾功能不全组、紫癜性肾炎组和狼疮性肾炎组。其中216例进行肾穿刺活检。根据肾穿刺活检病理诊断结果将患儿分为系膜增生性肾小球肾炎组、毛细血管内增生性肾小球肾炎组、膜性肾病组、IgA 肾病组、IgM 肾病组、过敏性紫癜性肾炎组和狼疮性肾炎组。结果1．肾病综合征组、肾小球肾炎组、肾功能不全组、紫癜性肾炎组、狼疮性肾炎组患儿的尿电导率明显低于健康对照组,差异具有统计学意义（P ＜0．05）。2．系膜增生性肾小球肾炎组、毛细血管内增生性肾小球肾炎组、膜性肾病组、IgA 肾病组、过敏性紫癜性肾炎组和狼疮性肾炎组患儿尿电导率明显低于健康对照组,差异具有统计学意义（P ＜0．05）。3．IgM 肾病组与健康对照组相比,尿电导率差异无统计学意义（P ＞0.05）。结论尿电导率可以作为小儿肾脏功能和尿液浓缩功能的重要指标。     

123例老年肾脏病患者的肾病理和临床特征分析

目的：探讨老年人原发性肾小球疾病及继发性肾脏疾病肾活检病理类型及临床特点。方法：回顾分析2003年—2005年123例年龄≥65岁,资料完整,并经临床和肾活检确诊为原发性肾小球疾病或继发性肾脏疾病患者的肾脏活组织病理和临床资料,并与同期367例中青年患者的肾脏活组织检查和临床资料进行对比。结果：①老年患者原发性肾小球疾病中膜性肾病最为常见,占原发肾脏疾病的31.46%,其次为IgA肾病（25.84%）。中青年患者原发肾脏疾病中以IgA肾病最为常见,占39.49%,其次为系膜增生性肾小球肾炎,占22.88%。②老年IgA肾病患者病理以局灶节段性肾小球硬化（FSGS）为主,占21.74%,而中青年患者以弥漫系膜增生为主,占30.95%。③糖尿病肾病是老年人最常见的继发性肾脏疾病,占32.35%,狼疮性肾炎是中青年患者最常见的继发性肾脏疾病,占58.33%。④老年肾脏疾病患者尿蛋白定量（3.60±0.78g.24h^-1）显著高于中青年组（2.19±0.68g.24h^-1）,P〈0.05。高血压的发生率显著增高（73.98%比30.51%,P〈0.01）。结论：老年患者肾脏病理类型与中青年患者不一致,老年原发性肾小球疾病以膜性肾病为主,IgA肾病的病理类型以FSGS为主;中青年患者原发性肾小球疾病以IgA肾病为主,IgA肾病的病理类型以弥漫系膜增生为主。老年患者继发性肾脏疾病的发生率高,以糖尿病肾病最为常见。肾脏病理类型的不同,是老年肾脏病患者临床表现中尿蛋白多和高血压的发生率增高的原因之一。     

Renal Disease in Adult Indians: A Clinicopathological Study of 2827 Patients

Nephrotic syndrome was the commonest clinical presentation among2827 consecutive adult Indian patients from whom adequate kidneydiopsies were obtained for suspected renal disease. In 83 percent of cases the nephrotic syndrome was due to minimal changedisease, focal segmental glomerulosclerosis, mesangiocapillaryglomerulonephritis, membranous glomerulonephritis, lupus glomerulonephritisor diabetic glomerulosclerosis. Amyloidosis, usually secondaryto tuberculosis or leprosy, was present in only 34 patients.Acute nephritis, the next most frequent clinical presentation,was due to diffuse endocapillary proliferative, crescen-ticor mesangial proliferative glomerulonephritis in 88 per centof cases, almost half of whom had elevated serum streptococcalantibody titres. Eosinophilia showed a highly significant associationwith diffuse endocapillary proliferative and mesangiocapillaryglomerulonephritis. Idiopathic IgA nephropathy was present inonly 10, and antiglomerular basement membrane antibody diseasein only one, of the 238 patients whose biopsies were studiedby immunofluorescence. Complications of pregnancy accounted for 70 per cent of casesof cortical necrosis. Acute gastroenteritis, septicaemia, abortions,snake bite and allopathic and indigenous medicines were importantcauses of acute tubular necrosis.     

Renal disease in adult Indians: a clinicopathological study of 2,827 patients

Nephrotic syndrome was the commonest clinical presentation among 2827 consecutive adult Indian patients from whom adequate kidney biopsies were obtained for suspected renal disease. In 83 per cent of cases the nephrotic syndrome was due to minimal change disease, focal segmental glomerulosclerosis, mesangiocapillary glomerulonephritis, membranous usually secondary to tuberculosis or leprosy, was present in only 34 patients. Acute nephritis, the next most frequent clinical presentation, was due to diffuse endocapillary proliferative, crescentic or mesangial proliferative glomerulonephritis in 88 per cent of cases, almost half of whom had elevated serum streptococcal antibody titres. Eosinophilia showed a highly significant association with diffuse endocapillary proliferative and mesangiocapillary glomerulonephritis. Idiopathic IgA nephropathy was present in only 10, and antiglomerular basement membrane antibody disease in only one, of the 238 patients whose biopsies were studied by immunofluorescence. Complications of pregnancy accounted for 70 per cent of cases of cortical necrosis. Acute gastroenteritis, septicaemia, abortions, snake bite and allopathic and indigenous medicines were important causes of acute tubular necrosis.     

Deposits of IgD in renal disease. Immunohistological study of 180 renal biopsies

Abstract. IgD deposits have been investigated by an indirect immunofluorescence technique in 180 renal biopsies carried out on patients with various renal diseases. IgD was not present in nephrotic syndrome with minimal changes or focal glomerulosclerosis, in mesangial proliferative glomerulonephritis, in chronic advanced glomerulonephritis, in rheumatoid purpura and in other various nephropathies with predominant non-glomerular lesions. Significant deposits of IgD were identified in 12 out of 16 cases of membranoproliferative glomerulonephritis, in 15 out of 23 cases of membranous nephropathy, in 11 out of 21 cases of focal proliferative glomerulonephritis with mesangial IgA deposits, in 2 out of 5 cases of proliferative glomerulonephritis with crescents and in 1 out of 6 cases of proliferative exudative glomerulonephritis. All cases of lupus nephritis and nephritis associated with mixed cryoglobulinaemia showed IgD deposits. In diabetic glomerulosclerosis, IgD was found in 1 out of 4 biopsies and only in the exudative lesions. In 5 out of 8 cases of amyloidosis anti-IgD serum stained the amyloid substance irregularly. In such cases IgD was found in association with other immunoglobulins and complement with the same localization. These findings suggest that IgD may participate in the immunological processes which lead to the development of glomerular deposits, mainly in cases of chronic glomerular diseases.     

Deposits of IgD in Renal Disease. Immunohistological Study of 180 Renal Biopsies

Abstract. IgD deposits have been investigated by an indirect immunofluorescence technique in 180 renal biopsies carried out on patients with various renal diseases.
IgD was not present in nephrotic syndrome with minimal changes or focal glomerulosclerosis, in mesangial proliferative glomerulonephritis, in chronic advanced glomerulonephritis, in rheumatoid purpura and in other various nephropathies with predominant non-glomerulor lesions.
Significant deposits of IgD were identified in 12 out of 16 cases of membranoproliferative glomerulonephritis, in 15 out of 23 cases of membranous nephropathy, in 11 out of 21 cases of focal proliferative glomerulonephritis with mesangial IgA deposits, in 2 out of 5 cases of proliferative glomerulonephritis with crescents and in 1 out of 6 cases of proliferative exudative glomerulonephritis.
All cases of lupus nephritis and nephritis associated with mixed cryoglobulinaemia Bhowed IgD deposits.
In diabetic glomerulosclerosis, IgD was found in 1 out of 4 biopsies and only in the exudative lesions.
In 5 out of 8 cases of amyloidosis anti-IgD serum stained the amyloid substance irregularly. In such cases IgD was found in association with other immunoglobulins and complement with the same localization. These findings suggest that IgD may participate in the immunological processes which lead to the development of glomerular deposits, mainly in cases of chronic glomerular diseases.     

Hepatitis b infection in renal transplant recipients (author's transl)]

During a period of 4 1/2 years the incidence and clinical course of endemic hepatitis B infection was studied in 43 renal transplant recipients with an observation time of 3 to 47 (average: 26.3) months after surgery. During the investigation period 27 out of 43 patients (62.8 per cent) had hepatitis B infection. In 8 patients HBs antigenaemia persisted after chronic dialysis treatment. After surgery HBs antigenaemia was detected for the first time in 7 patients. Recurrence of HBs antigenaemia was noted in one patient. In 7 further cases with HBs antigenaemia after transplantation regular controls of HBsAg and HBsAb were not available before transplantation. In 2 patients HBs antibodies were detectable at the time of transplantation; 2 further patients developed HBs antibodies postoperatively. Hepatitis B infection showed a mild and persistent clinical course. 6 out of 7 icteric patients simultaneously had other severe mycotic and viral infections. Therefore, the conclusion was drawn that in patients with coexisting multiple infections liver damage is not necessarily attributable to HBs antigenaemia.     

乙型肝炎病毒相关性肾炎的临床与病理分析

目的探讨乙型肝炎病毒（HBV）相关性肾炎临床病理特点。方法分析17例HBV相关性肾炎的临床表现及肾活检病理、免疫荧光和超微病理特点。结果17例HBV相关性肾炎临床表现以肾病综合征最常见10例（58.82%）,肾炎综合征7例（41.18%）。病理类型多样化,其中膜性肾病（MN）8例（47.06%）,系膜增生性肾炎（MsPGN）7例（41.18%）,系膜毛细血管性肾炎（MPGN）1例（5.88%）,IgA肾病（IgAN）1例（5.88%）。免疫荧光检查5.88%的病例呈＂满堂亮＂现象;电镜观察HBV相关性膜性肾病易见电子致密物系膜沉积。结论HBV-GN的病理类型以HBV-MN为主,多见于中青年人,肾组织HBVAg免疫组化标志为诊断HBV-GN的重要指标。鉴于HBV相关性肾炎的一些病理特点与狼疮性肾炎相似,有必要结合临床对二者进行鉴别。     

Immunohistochemical study of the human glomerular C3b receptor in normal kidney and in seventy-five cases of renal diseases: loss of C3b receptor antigen in focal hyalinosis and in proliferative nephritis of systemic lupus erythematosus.

The presence and distribution of C3b receptors in normal human kidneys and in biopsies from 75 patients with renal disease were investigated by immunohistochemical techniques using monospecific rabbit antibody to the 205,000-mol wt glycoprotein that is the C3b receptor of human peripheral blood cells. Anti-C3b receptor bound exclusively to podocytes in normal renal cortex, and was homogeneously distributed on the plasma membrane of these cells. Biosynthesis of the receptor by the podocyte was suggested by the presence of antigenic activity in the Golgi apparatus. Although occupancy of receptor sites following the interaction of kidney sections with aggregated IgG preincubated with normal serum inhibited binding to glomeruli of C3b coated cells, the C3b receptor remained accessible to anti-C3b receptor antibody. No staining of podocytes was found in extra-capillary proliferating cells in rapidly progressive glomerulonephritis (GN). Segmental loss of staining was found in focal hyalinosis, nodular diabetic glomerulosclerosis, and amyloidosis while no detectable C3b receptor antigen was found in severe proliferative nephritis of systemic lupus erythematosus (SLE). Normal staining of podocytes was found in other nephropathies with endocapillary proliferation such as acute GN and mesangial GN and in renal diseases associated with immune deposits containing C3 such as mesangial proliferative and membranous SLE nephritis, idiopathic membranous GN, membranoproliferative GN types I and II, mesangial GN with IgA or C3 deposition and Henoch Schönlein's purpura. Loss of C3b receptor antigen in the diffuse proliferative nephritis of SLE distinguishes it both from nonproliferative lupus nephritis and other immunologically mediated proliferative GN.     

Renal disorders in patients with collagen vascular diseases

Membranous nephropathy, mesangial proliferative glomerulonephritis and renal amyloidosis are common renal pathology in RA patients. However, IgA nephropathy and diffuse thinning of glomerular basement membrane are described as common and characteristic renal lesions in Japanese RA patients. Glomerular filtration rate may decrease significantly in active lupus nephritis, but renal plasma flow does not change or even increase. These findings seem to be characteristic of SLE patients with active renal disorders. Therefore, filtration fraction may be a useful clinical parameter to evaluate SLE patients. Scleroderma renal crisis(SRC) has been believed to be the most serious renal disorder in systemic sclerosis (SSc). Recently, the presence of an antibody to RNA polymerase has been associated with a high prevalence of SRC.     

超声引导下经皮肾穿刺活检的临床意义

目的探讨灰阶B超引导下对肾脏疾病患者进行经皮肾组织穿刺活检的临床价值。方法采用GE200Pro黑白超声仪、穿刺探头、自动活检枪及组织切割针对肾下极进行穿刺，穿刺组织分别送光镜、电镜及免疫学检查。结果36例患者利用组织切割针进行肾穿刺，取出组织44条，电镜共检出452个肾小球送病理学检查，检出弥漫系膜增生性肾小球肾炎17例，IgA肾病8例，糖尿病肾病伴乙型肝炎相关肾炎1例，狼疮性肾炎2例，糖尿病肾病3例，局灶系膜增生性肾小球肾炎2例，肾小球轻微病变3例。结论经皮肾穿刺活检，对了解肾脏疾病的病理类型，指导临床治疗及判断疾病预后具有十分重要的意义。该方法操作简便、成功率高、并发症少，值得推广。     

Clinicopathological features of childhood nephrotic syndrome in northern Nigeria

The clinicopathological features of childhood nephrotic syndrome in northern Nigeria were studied in 100 consecutive patients. The patients presented with gross anasarca and very low serum albumin, which was less than 15 g/l in 30 patients. The three most frequent histological diagnoses in 98 renal biopsies were membranoproliferative glomerulonephritis (25), quartan malarial nephropathy (20), and proliferative glomerulonephritis (19): together they accounted for 65 per cent of all biopsies. Only nine patients had minimal change nephropathy. Antigens were detected by immunofluorescence in the glomeruli of 70 of 76 biopsies (92 per cent): Plasmodium malariae was detected in 25 per cent and hepatitis B surface antigen in 24 per cent. The disease was characterized by progressive deterioration in renal function and a high mortality rate of 13 per cent. Nine of the 13 deaths occurred within one year of diagnosis.     

乙型肝炎病毒相关性肾炎13例临床与病理分析

目的：探讨乙型肝炎病毒相关性肾炎的临床与病理特点。方法：经临床病理活检确诊的乙型肝炎病毒相关性肾炎患者13例，根据乙型肝炎免疫组织化学染色结果分为两组：Ⅰ组(HBsAg阳性组)：7例；Ⅱ组(HBsAg HBcAb阳性组)：6例。并对两组的临床诊断、病理类型及免疫荧光的情况进行分析。结果：①临床诊断：Ⅰ组：肾病综合征4例(占57．14％)．慢性肾炎2例(占28．57％)，急性肾炎1例(占14．29％)；Ⅱ组：肾病综合征(占83．33％)．慢性肾炎1例(占16．67％)；②病理类型：I组：膜性肾病2例(占28．57％)．系膜增生2例(占28．57％)．弥漫硬化1例(占14．29％)，膜增殖2例(占28．57％)；Ⅱ组：膜性肾病3例(占50％)，系膜增生1例(占16．67％)，弥漫硬化2例(占33．33％)；③免疫荧光：免疫球蛋白沉积以IgA IgG IgM为主．其中Ⅱ组5例(占71．43％)，Ⅱ组5例(占83．33％)，补体C3沉积Ⅰ组6例(占85．71％)，Ⅱ组6例(占100％)。结论：乙型肝炎病毒相关性肾炎，临床表现多样化．病理轻重不一，易误诊，应肾活检。     

Patterns of glomerulonephritis in Zimbabwe: survey of disease characterised by nephrotic proteinuria

Ninety-eight Zimbabweans with glomerulonephritis characterised by nephrotic proteinuria were studied. There was no evidence to implicate Schistosoma mansoni or S. haemotobium in the aetiology, although schistosomiasis was diagnosed in 54 patients in the series. Similarly, Plasmodium malariae proved unimportant as a cause of the nephrotic syndrome, only one patient showing focal segmental glomerulosclerosis which was associated with subclinical quartan malarial infection. Nevertheless, infections were shown to play a major role in the genesis of glomerulonephritis which was associated with beta-haemolytic streptococcal, hepatitis B and syphilitic infection in 45 patients in the series. The major patterns of disease in childhood proved to be membranous glomerulopathy associated with hepatitis B antigenaemia. In young adults post-streptococcal proliferative glomerulonephritis constituted the commonest disease pattern. In older adult patients a miscellany of primary and secondary glomerulonephritides was encountered but proliferative glomerulonephritis, which was both idiopathic and streptococcus-related, predominated.     

In vitro fixation of guinea pig complement by renal biopsies.

The in vitro fixation of heterologous complement by cryostat sections of human renal biopsy material was studied to determine the mechanism of complement activation. Various types of guinea pig sera with different parts of the complement system inhibited were used, the fixation of complement being detected by direct immunofluorescence. Cases of idiopathic focal nephritis with mesangial IgA (mesangial IgA disease), Henoch-Sch?nlein purpura (HSP) and mesangio-capillary glomerulonephritis (MCGN) fixed complement by the alternative pathway alone and in systemic lupus erythematosus (SLE) both the classical and alternative pathways were involved. Only one of the seven cases of membranous glomerulonephritis fixed complement and this was by the classical pathway. After prior treatment with C3b inactivator, the in vitro complement fixation in mesangial IgA disease, HSP and MCGN was greatly reduced. In SLE it was slightly reduced and in membranous glomerulonephritis there was no change. This is a convenient method of studying the biological properties of complexes which is believed to reflect the in vivo behaviour of the tissue deposited complex.     

Study of lupus nephritis: its classification and the significance of subendothelial deposits

This study describes the clinical and pathological characteristics of 74 patients with lupus nephritis classified according to renal biopsy findings using light, electron and immunofluorescent microscopy, and further, assesses the significance of subendothelial deposits in evaluating disease activity. In membranous lupus nephritis (14 cases), many cases showed normal renal function even with the nephrotic syndrome, although five cases had little or no urinary abnormalities. Glomerular cellular proliferation was very mild and subepithelial deposits with a few mesangial deposits were the main pathological alterations. Mesangial proliferative lupus nephritis (17 cases) clinically had very mild renal disease. Renal biopsies in this group revealed mesangial deposits with slight cellular proliferation. Although clinical features of mild diffuse proliferative lupus nephritis (16 cases) were similar to those of mesangial lupus nephritis, glomerular loop deposits were seen in addition to mesangial deposits. In moderate diffuse proliferative lupus nephritis (17 cases), renal function was slightly decreased, moderate proteinuria with haematuria were found, and C3 level was low. Renal biopsies showed active proliferative changes, and subendothelial deposits were frequently seen. In severe diffuse proliferative lupus nephritis (10 cases), the duration from onset of SLE to renal biopsy was short. Impairment of renal function, and nephrotic syndrome with haematuria and hypocomplementemia were frequent. Only three patients survived in this group. Renal biopsies demonstrated highly active proliferative and necrotizing changes, and electron microscopy showed massive subendothelial and mesangial deposits accompanied by subepithelial and intramembranous deposits. The amount of subendothelial deposits correlated with those of mesangial deposits and subepithelial deposits in the cases with diffuse proliferative lupus nephritis. Urinary protein loss and histologic activity showed statistically significant correlations with the amount of subendothelial deposits, but C3 levels and creatinine clearance revealed negative correlations with those deposits.     

Renal disorders in rheumatoid arthritis]

Glomerulonephritis has been believed to be a rare complication in rheumatoid arthritis (RA). However, recent studies have revealed a focal segmental increase in mesangial cells and matrix in RA patients with hematuria. In our series, proteinuria, hematuria or both abnormalities were recognized in 74 (22%) out of 336 RA cases. Among 119 patients examined by renal biopsy, mild mesangial proliferative glomerulonephritis (GN) was found in 25 patients, of which 22 demonstrated mesangial IgA deposits, by immunofluorescent microscopy. Membranous nephropathy was noticed in 26 cases. Three cases of membranous nephropathy had no history of gold or D-penicillamine treatment. Electron microscopy revealed diffuse thinning of the glomerular basement membrane in 12 cases. The average thickness of the glomerular basement membrane was significantly thinner in RA patients than in normal subjects. The immunological processes associated with rheumatoid factor do not seem to be related to the renal lesions in RA patients.     

Monocyte procoagulant activity in glomerulonephritis associated with systemic lupus erythematosus.

Monocyte infiltration and activation of the coagulation system have been implicated in the pathophysiology of glomerulonephritis. In this study, spontaneous procoagulant activity (PCA) was measured in circulating mononuclear cells to determine whether elevated PCA correlated with the presence of proliferative glomerulonephritis in patients with systemic lupus erythematosus (SLE). No increase in PCA was found in 20 patients with end-stage renal failure, 8 patients with glomerulonephritis without SLE, and 10 patients undergoing abdominal surgical or orthopedic procedures as compared with 20 normal controls. In eight patients with SLE but with no apparent active renal disease, PCA was not elevated above normal basal levels. Seven additional patients with SLE who had only mesangial proliferation on biopsy also had no increase in PCA. In contrast, eight patients with focal or diffuse proliferative lupus nephritis, and one patient with membranous nephritis who ultimately developed a proliferative lesion, had a marked increase in PCA with greater than 100 times the base-line levels. The activity was shown to originate in the monocyte fraction of the mononuclear cells and was shown to be capable of cleaving prothrombin directly. The prothrombinase activity was not Factor Xa, because it was not neutralized by anti-Factor X serum and was not inhibited by an established panel of Factor Xa inhibitors. Monocyte plasminogen activator determinations did not correlate with renal disease activity. We conclude that monocyte procoagulant activity, a direct prothrombinase, seems to correlate with endocapillary proliferation in lupus nephritis and could be a mediator of tissue injury.     

可溶性内皮细胞蛋白C受体及血栓调节蛋白在肾病综合症患者血浆中的变化及临床意义

目的检测。肾病综合征（NS）患者血浆中可溶性内皮细胞蛋Sc受体（sEPCR）及血栓调节蛋白（sTM）的水平,初步探讨其临床意义。方法采用酶联免疫双抗夹心法对65例NS及48名正常对照组血浆的sEPCR及sTM进行检测,同步检测各组血浆D-聚体（D-Di）的水平。结果NS组患者血浆sEPCR,sTM及D-Di较正常对照组显著升高（P〈0．05）。其中,膜性肾病组血浆sEPCRJk平比微小病变组及系膜增生组高,差异有统计学意义（P〈0．05）。而sTM及D．Di各病理组之间无显著性差异（P〉0．05）。结论sEPCR及sTM参与NS高凝状态,可作为评估Ns高凝状态的新指标。