维持性血液透析对患者内皮功能及凝血纤溶的影响

Changes of endothelial cell function and coagulation-fibrinolysis system in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者内皮细胞功能、凝血纤溶系统变化及血液透析对其的影响。方法采用发色底物法、酶联免疫吸附法测定76例MHD患者透析前后凝血酶调节蛋白(TM)、纤溶酶原激活物抑制物-1(PAI-1)、凝血酶-抗凝血酶复合物(TAT)及纤溶酶抗纤溶酶复合物(PAP)水平,并与正常对照组进行比较。结果MHD患者透析前TM、PAI-1、TAT和PAP水平较正常对照组明显升高,分别为(13.2±4.0)μg/Lvs(3.9±1.4)μg/L,(67.8±31.5)μg/Lvs(37.0±5.9)μg/L,(15.8±6.2)μg/Lvs(5.0±2.7)μg/L,(145.2±90.3)μg/Lvs(62.7±13.8)μg/L(P<0.001);一次透析后MHD患者PAI-1水平较透前明显下降,(67.8±31.5)μg/Lvs(38.5±25.2)μg/L,TAT、PAP水平较透前明显升高,(15.8±6.2)μg/Lvs(28.9±15.1)μg/L,(145.2±90.3)μg/Lvs(185.2±110.0)μg/L(均P<0.001);TM、PAI-1水平与维持性血液透析年限成正相关(r分别为0.464、0.435,均P<0.001)。结论MHD患者存在血管内皮细胞功能损伤、高凝状态和纤溶亢进;血液透析过程中凝血、纤溶系统均被激活。体外血液净化过程对MHD患者血管内皮细胞功能、凝血纤溶存在不利影响。

Objective To find out the changes of endothelial cell function and coagulation-fibrinolysis system in maintenance hemodialysis(MHD) patients. Methods Pre- and post-hemodiloysis(HD) levels of thrombomodulin(TM), plasminogen activator inhibitor-1(PAI-1), thrombin-antithrombin complex(TAT) and plasmin-antiplasmin complex(PAP) in 76 MHD patients were measured by subtrate-labeled fluorescent immunoassay and enzyme-linked immunoabsorbent assay,and were compared with those of normal control group. Results The levels of TM, PAI-1, TAT, PAP in MHD patients were significantly higher than those of normal controls,respectively ( 13.2± 4.0) μg/L vs ( 3.9± 1.4) μg/L,( 67.8± 31.5) μg/L vs ( 37.0± 5.9) μg/L,( 15.8± 6.2) μg/L vs ( 5.0± 2.7) μg/L,( 145.2± 90.3) μg/L vs ( 62.7± 13.8) μg/L(P< 0.001). The post-HD level of PAI-1 at first time HD was obviously lower than that of pre-HD level,( 67.8± 31.5) μg/L vs ( 38.5± 25.2) μg/L(All P< 0.001), the post-HD level of TAT, PAP in MDH patients was significantly higher than that of pre-HD level,( 15.8± 6.2) μg/L vs ( 28.9± 15.1) μg/L,( 145.2± 90.3) μg/L vs ( 185.2± 110.0) μg/L(All P< 0.001). There was significant positive correlation between hemodialysis duration and TM, PAI-1 levels (r= 0.464, 0.435 respectively, P< 0.001). Conclusion There were dysfunctions of endothelial cell, hypercoagulable state and fibrinolysis defects in MHD patients. Both the coagulation and fibrinolysis system were activated after one process of dialysis. The significant positive correlation between maintenance hemodialysis duration and the levels of TM, PAI-1 confirmed adverse effects of hemodialysis on endothelial cell function and coagulation-fibrinolysis system.