尿毒症患者血浆凝血因子的变化及其临床意义

The Change of Plasma Coagulant Faetiors in Patients with Uremia and its Significance

目的研究凝血因子Ⅴ、Ⅶ、Ⅷ、Ⅹ、Ⅺ的活性在尿毒症中的变化,并探讨其临床意义。方法血浆 FⅤ： C、FⅦ：C、FⅧ：C、FⅩ：C、FⅪ：C 检测采用一期法,在 ACL 2000全自动凝血仪上进行测定。对50例尿毒症患者血透前、后的各个凝血因子、临床相关资料等作分析比较,以80例健康者作为对照。结果尿毒症患者血透前组血浆 FⅤ：C、F Ⅶ：C、FⅧ：C、FⅩ：C、FⅪ：C 分别为114.16%±34.12%、199.32%±34.56%、181.05%±56.11%、118.56%±26.81%和 156.57%±39.25%；尿毒症患者血透后组血浆 FⅤ：C、FⅦ：C、FⅧ：C、FⅩ：C、FⅪ：C 分别为108.29%±35.16%、 162.36%±32.39%、132.36%±59.32%、95.86%±12.23%和139.39%±41.16%,分别与健康对照组比较,患者组的 FⅤ：C、FⅦ：C、FⅧ：C、FⅩ：C、FⅪ：C 均明显高于对照组(P 值均＜0.05～0.01)。同时,尿毒症患者血透前组凝血因子超过其临界值的发生率分别为：23%、59%、51%、36%、43%；尿毒症患者血透后组分别为：21%、52%、46%、31%、39%,均明显高于对照组的10%,显示尿毒症时存在着明显的高凝状态。尿毒症患者血透后组与透前组相比,透后组的凝血因子 FⅦ：C、FⅧ：C、FⅩ：C、FⅪ：C 水平明显低于透前组(P 值均＜0.05～0.01)。FⅦ：C 与 BUN、Cr 呈正相关。结论尿毒症患者存在多个凝血因子活性水平增高,提示凝血因子活性水平增高可能是尿毒症患者易患血栓性疾病的一个危险因素；血透能减低凝血因子升高程度。

Objective To study the change of plasma coagulant factor V、Ⅶ、Ⅷ、X andⅪ in uremia, aha to study its clinical significance. Methods The activities of plasma FV：C、FⅦ：C、FⅧ：C、FⅩ：C、FⅪ：C were examined by ALC 2000 fully auto-coagulant with the first stage method. 50 patients with uremia （before and after hemodialysis）, and 80 healthy adults （control group） were contrasted. Results The plasma FV：C、FⅦ：C、FⅧ：C、FⅩ：C、FⅪ：C in patients with uremia before hemodialysis were 114. 16% ＋ 34.12%, 199.32%＋34.56%, 181.05% ＋56. 11%, 118.56% ＋26.81%, 156.57% ＋39.25%, respectively, the plasma FV：C、FⅦ：C、FⅧ：C、F Ⅹ：C、FⅪ：C in patients were with uremia after hemodialysis were 108.29% ＋35. 16%, 162.36% ＋32.39%, 132.36% ＋59.32%, 95.86% ＋12.23% and 139.39% ＋41.16% , respectively. Compared with the contrast group, the FⅦ：C、FⅧ：C、FⅩ：C、FⅪ：C were dramatically higher than the contrast group（ P 〈 0.05 - 0.01 ）. Meanwhile, the occurrence rates of exceeding its critical value in the group of before hemodialysis were 23%, 59% ,51%, 36% and 43%, respectively. The occurrence rates of exceeding its critical value in the group of after hemodialysis were 21%, 52%, 46%, 31% and 39%, respectively. Both were dramatically higher than the 10% of contrast group. This showed that there existed highly coagulant station in uremia. The FⅦ：C、FⅧ：C、FⅩ：C、FⅪ：C in patients with uremia after hemodialysis were dramatically lower than in patients with uremia before hemodialysis （P 〈0.05 -0.01）. The FⅧ：C showed positive relation with BUN and Cr. Conclusion There exists increment of activities of many coagulant factors in patients with uremia. This indicates that the increment of activities of coagulant factors might be a risk factor making patients with uremia vulnerable to thrombotic disease, that hemodialysis can reduce the extent of increment of coagulant factors.