糖尿病肾病血液透析患者内皮细胞功能及凝血纤溶系统的变化

The changes of endothelial cell function and coagulation-fibrinolysis system in maintenance hemodialysis patients with diabetic nephropathy

目的观察糖尿病肾病(DN)血液透析患者内皮细胞功能和凝血、纤溶系统变化。方法选取2003-03～2003-12北京同仁医院血液透析中心的28例DN、34例非DN维持性血液透析(MHD)患者及40名健康对照者,比较两组患者一次血液透析前后的变化。结果(1)DN组和非DN组的血浆血浆凝血酶调节蛋白(TM)、血浆纤溶酶原激活物抑制剂-1(PAI-1)、凝血酶-抗凝血酶复合物(TAT)、抗纤溶酶复合物(PAP)质量浓度均较正常对照组明显增高,P均<0.01;但两组间各项指标差别无显著性。(2)两组患者透析后血浆PAI-1质量浓度均较透析前显著性降低;TAT和PAP质量浓度均较透析前明显升高,P均<0.001;但两组指标间差异无显著性。(3)两组患者透析前血浆TM质量浓度均与透析年限呈正相关,P均<0.05。结论DN及非DNMHD患者均有明显的内皮细胞功能障碍及凝血、纤溶系统损害,血液透析可以加重这种损害。

Objective To find out the changes of endothelial cell function and coagulation - fibnnolysls system in maintenance hemodialysis （MHD） patients with diabetic nephropathy （DN）. Methods The plasma levels of TM, PAl - 1, TAT and PAP in 28 DN - MHD, 34 non - DN MHD and 40 controls were measured by ELISA. Results （ 1 ） The levels of TM, PAI- 1, TAT and PAP in both DN group and non - DN group were significantly higher than those in control group, P 〈0, 001. （2） In two MHD groups, the post - HD levels of PAI - 1 were obviously lower than pre - HD levels, P 〈 0. 001 ; the post - HD levels of TAT and PAP were significantly higher than that of pre - HD, P 〈 0. 001, but there were no significant differences between the two MHD groups. （3） There is significant positive correlation between HD duration and plasma levels of TM in both MHD groups, P 〈 0. 05. Conclusion There were dysfunction of endothelial cells and coagulation - fibrinolysis in both DN and non - DN MHD patients and HD may impose the damage.