透析器复用对尿毒症血液透析患者P选择素水平的影响

Effect of reused dialyzer on level of serum P-selectin in uremic patients during maintenance hemodilysis

目的观察维持性血液透析治疗尿毒症患者血清P选择素水平的变化,探讨透析器复用对血液透析患者血小板活化程度的影响。方法采用双抗体夹心ELISA法检测尿毒症维持性血液透析患者初用和复用透析器时患者血清P选择素水平的变化,并加以比较。同时检测健康查体和尿毒症非透析患者的P选择素水平作为对照。结果尿毒症血液透析治疗患者透析前及尿毒症非透析患者血清P选择素水平均较健康查体对照组显著增高。尿毒症患者透析开始15min后,P选择素水平与透前比较即显著升高(P<0.05);随着透析时间的延长,P选择素水平进一步上升。复用透析器透析时,透析患者P选择素水平升高的趋势随使用次数的增多而逐渐下降(P<0.05)。结论血液透析可导致尿毒症患者P选择素水平显著升高,血液透析过程中血-透析膜间相互作用所致的血小板活化可能是导致血透患者发生出、凝血相关透析并发症的重要原因之一,而透析器复用可在一定程度上减少这一现象的发生。

Object To study the changes in levels of serum P- selectin and the influence of reused dialyzer on activation of platelets in uremic patients during maintenance hemodilysis （HI））.Methods Using ELISA method, the levels of serum P- selectin were measured and comparred in different time points （0,15,30,120, and 270 min） in the patients receiving HI） with new and reused dialyzer membranes.Meanwhile, the levels of P - selectin were also measured in non - dialysis uremic patients and healthy controls. Results Compared with the control group, the levels of P- selectin slightly increased in all uremic patients, and there was no 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 continued increasing after completion of HD. In addition, the P- selectin levels in patients undergoing HD with reused dialyzer were significantly lower than in patients with first used dialyzers （ P 〈 0.05） .Condusion In uremic patients, the significantly increased level of P - selectin associated with maintenance hemodilysis is one of many factors resulting in the dysfunction of hemostatsis and coagulation. The reuse of dialyzer may ameliorate the biocompatibility of dialyzer membrane and decrease the dysfunction of hemostatsis and blood coagulation.