不同种类透析膜对维持性血液透析患者P选择素的影响

The effects of different dialyzer membranes on P- setectin in patients with maintenance bemodialysis

目的 观察不同种类透析膜对维持性血液透析患者血小板活化程度的影响。方法 尿毒症维持性血液透析患者采用醋酸纤维素膜(CA)、血仿膜(HE)、聚砜膜(PS)透析器进行透析,采用双抗体夹心ELISA法检测患者初用、复用透析器透析过程中不同时间点(0min、270min)血清P-选择素水平的变化,同时选择尿毒症非透析患者、正常健康者作为对照组检测血清P-选择素水平。结果 尿毒症非透析患者与维持性血液透析患者透析前P-选择素水平较正常对照组增高但无显著性差异(P>0.05)。尿毒症透析患者透析开始15分钟后,P-选择素水平升高,与透前相比有显著差异(P<0.05),随着透析的进行,血清P选择素水平继续呈上升趋势,透析270分钟与透析前相比差异更显著(P<0.001)。不同种类透析膜中,CA对血清P-选择素的影响显著大于HE和PS,三种透析器复用对血透患者血清P-选择素水平影响与初用相比显著下降(P<0.06),三种透析器复用组间比较无显著性差异。结论 HID过程中P-选择素显著升高是导致血透患者凝血功能障碍原因之一,HE和PS对血小板的活化程度弱于CA。

Objective To observe the effect of different dialyzers and the reused dialyzers (used 5 times) on the activation of platelet. Methods The three kinds of dialyzer membranes (cellulose acetate, hemophan, polysulfone) were randomly used on three groups of maintenanc hemodialysis(MHD) patients. The levels of serum P - selectin of each group of patients were measured with ELISA method at different time points (0min, 270min) during HD using new and reused dialyzer membranes. In addition, the levels of serum P- selectin were measured by ELISA in non - dialysis uremic patients and healthy control.Results Compared with the control group, the levels of P- selectin slightly increased in all uremic patients, and there were not significant difference between the dialysis and non - dialysis patients ( P > 0.05). During the course of dialysis, the levels of P- selectin increased rapidly after 15 minutes (compared with the pre- dialysis, P<0.05), and the levels of P -selectin continually increased following HD performed. At 270 minutes after dialysis, compared with the initial levels, it increased significantly ( P < 0.001). There were different effects of three kinds of first using dialysis membranes on the levels of P - selectin. It in patients with CA dialyzers were more than these with PS and HE dialyzers, and there were not significant difference in the levels of P- selectin among the three kinds of reused dialyzers, but there were significantly decreased compared with the first used dialyzers ( P < 0.05). Conclusion The significantly increasing levels of P - selectin are one of the many factors resulting in the dysfunction of hemostatsis and coagulation. The effect of HE and PS on the activation of platelet are less than that of CA.