Correlation of soluble thrombomodulin and high sensitive C reactive protein with hypercoagulability in children with primary nephrotic syndrome

Objective To explore the correlations of soluble thrombomodulin(sTM) and high sensitive C reactive protein(hs-CRP) levels with the hypercoagulable state and indicators of predicting thrombosis in children with primary nephrotic syndrome(PNS). Methods Sixty-four PNS patients who had primary clinical diagnosis or recurrence after hormone withdrawal for 6 months or more hospitalized in Department of Urology, the Second Children′s Hospital of Tianjin from January 2010 to January 2014 were selected as PNS group.Thirty patients with inguinal hernia undergoing elective surgery hospitalized in Department of Surgery, the Second Children′s Hospital of Tianjin from January 2010 to January 2014 were selected as control group.All the selected patients were extracted for venous blood samples, and the double-antibody sandwich enzyme-linked immunosorbent assay was used to detect plasma sTM levels, while immunoturbidimetric assay was used to detect plasma hs-CRP levels; the indicators of predicting thrombosis as blood lipid and fibrinogen(Fb)etc.were simultaneously detected.Inspection results were compared and the correlation was analyzed by using statistical methods. Results The level of plasma sTM in children with PNS was significantly higher than that in the control group[(1.63±0.68) μg/L vs.(0.30±0.24) μg/L], and the difference was statistically significant between the 2 groups(t=12.545, P<0.05). The level of plasma sTM in PNS group with urine protein negative was significantly lower than that before hormone treatment[(1.05±0.56) μg/L vs.(1.63±0.68) μg/L], and there was a statistically significant difference(t=6.298, P<0.05). The level of plasma sTM in children with PNS had positive correlation with 24 h urinary protein, low density lipoprotein, apolipoprotein B, lipoprotein a and Fb(r=0.379, 0.203, 0.184, 0.177, 0.224, all P<0.05). The level of plasma hs-CRP in children with PNS was significantly higher than that in the control group[(1.9±1.7) mg/L vs.(0.7±0.6) mg/L], and the difference was statistically significant between the 2 groups(t=3.487, P<0.05). In PNS group, the level of plasma hs-CRP with urine protein negative was significantly lower than that before hormone treatment[(0.4±0.3) mg/L vs.(1.9±1.7) mg/L], and there was a statistically significant difference(t=5.473, P<0.05). The level of plasma hs-CRP in children with PNS was negatively correlated with plasma albumin(r=-0.194, P<0.05), but positively correlated with Fb(r=0.257, P<0.01). Plasma sTM and hs-CRP levels in children with PNS were positively correlated(r=0.395, P<0.05). Conclusions sTM involves in the formation process of PNS hypercoagulable state possibly through dual influencing by blood coagulation process and blood lipids.sTM may be used as one of the reference indicators for PNS activity and prediction of thrombosis.Plasma hs-CRP reflects the micro-inflammatory state in children with PNS, and involves in the formation of hypercoagulability by effecting blood coagulation process, and should be used as indicators for monitoring the hypercoagulability of active PNS. Key words: Nephrotic syndrome, primary; Thrombomodulin; High sensitivity C reactive protein; Child