目的:探讨特发性膜性肾病患者凝血功能障碍的具体表现及影响因素。方法:回顾性分析2012年1月至2016年9月在南京总医院国家肾脏病临床研究中心经肾活检确诊的242例肾病综合征状态的特发性膜性肾病患者血栓弹力图R时间、K时间、α角、MA值和CI,并将81例蛋白尿定量≤1 g/24h的特发性膜性肾病患者作为对照组。结果:组间比较提示肾病综合征状态的特发性膜性肾病患者MA值显著高于对照组(69.6 mm vs65.1 mm,P<0.01),而两组之间R时间无明显差异(6.0 min vs 6.1 min,P=0.72)。单因素线性相关分析发现,肾病综合征状态的特发性膜性肾病患者血清白蛋白水平与血栓弹力图的MA值(r=-0.19,P<0.01)、α角(r=-0.16,P=0.01)和CI(r=-0.13,P=0.05)呈负相关,与K时间(r=0.12,P=0.06)呈正相关,与R时间(r=0.01,P=0.87)无明显关联。多元线性回归分析提示血白蛋白是特发性膜性肾病患者MA值的独立相关因素。在肾病综合征状态的特发性膜性肾病患者中,抗磷脂酶A2受体(PLA2R)抗体阳性组和PLA2R抗体阴性组之间各项临床指标和血栓弹力图指标均无明显差异。结论:特发性膜性肾病患者凝血功能障碍与血小板功能亢进关系密切,而血小板功能亢进与肾病综合征状态有关,与抗PLA2R抗体无明显关系。提示抗凝治疗联合抗血小板治疗可能会减少特发性膜性肾病患者血栓事件的发生率。 Objective: To investigate the specific manifestations and influencing factors of coagulopathy in idiopathic membranous nephropathy patients. Methods: A retrospective analysis of 242 patients with idiopathic nephrotic syndrome diagnosed by renal biopsy in the National Center for Nephrology Clinical Research Center of Nanjing General Hospital from January 2012 to September 2016 was conducted to investigate the relationship between thromboelastogram R, K Time, α angle, MA value and CI, and 81 patients with idiopathic membranous nephropathy with proteinuria ≤1 g / 24h were taken as the control group. Results: The comparison between groups suggested that the MA value of patients with idiopathic membranous nephropathy with nephrotic syndrome was significantly higher than that of the control group (69.6 mm vs 65.1 mm, P <0.01), while there was no significant difference in R time between the two groups min vs 6.1 min, P = 0.72). The results of one-way linear correlation analysis showed that serum albumin level was significantly correlated with MA value (r = -0.19, P <0.01), alpha angle (r = -0.16, P = 0.01) and CI (r = -0.13, P = 0.05). There was a positive correlation between K (r = 0.12, P = 0.06) and R time (r = 0.01, P = 0.87). Multivariate linear regression analysis showed that serum albumin was an independent factor related to MA value in patients with idiopathic membranous nephropathy. In patients with idiopathic membranous nephropathy with nephrotic syndrome, there was no significant difference in each clinical index and thromboelastomatous index between anti-PLA2R antibody-positive group and PLA2R antibody-negative group. Conclusion: The coagulation dysfunction in idiopathic membranous nephropathy patients is closely related to the platelet function. However, the platelet function is related to the status of nephrotic syndrome and not to the anti-PLA2R antibody. Tip anticoagulant therapy combined with antiplatelet therapy may reduce the incidence of thrombotic events in patients with idiopathic membranous nephropathy.