老年维持性血液透析患者内皮细胞损伤和外源性凝血机制的变化

Endothelial cell injury and the changes of extrinsic coagulation mechanism in elderly patients on maintenance hemodialysis

目的:探讨血液透析对老年尿毒症患者内皮功能和外源性凝血机制的影响。方法:正常对照组选取老年健康自愿者22例。肾衰竭组选取首都医科大学附属北京同仁医院住院的终末期肾病(end-stage renal disease,ESRD)患者19例,年龄≥60岁。血液透析组25例,为首都医科大学附属北京同仁医院血液透析中心接受常规血液透析治疗3个月以上的ESRD患者,年龄≥60岁。分别检测各组血浆血管性血友病因子(vWF)和组织因子(TF)含量。结果:血浆vWF、TF含量在肾衰竭组和血液透析组均较正常对照组明显增高(P<0.01);血浆vWF、TF含量血液透析组明显高于肾衰竭组(P<0.01);血液透析组患者经一次透析后,血浆vWF含量明显高于透析前,有统计学差异(P<0.01),血浆TF含量高于透析前,但无统计学差异(P=0.205);血液透析组患者透析前后vWF差值与透析年限呈正相关(r=0.328,P<0.05)。结论:老年慢性肾衰竭患者存在内皮细胞损伤和外源性凝血系统的启动,这种变化随着透析龄的延长而加重,而与肾功能受损程度无关。血液透析这一体外血液净化过程加重了老年慢性肾衰竭患者的血管内皮细胞功能障碍和外源性凝血机制的异常。

Objective To investigate the effect of maintenance hemodialysis （MHD） on the endothelial function and extrinsic coagulation in elderly patients with end-stage renal disease （ESRD）. Methods Plasma levels of vWF and TF in 19 patients aged 60 or older with ESDR, 25 ESRD patients who had undergone hemodialysis for more than 3 months, and 22 healthy elderly controls were measured. Results In ESRD patients and MHD patients, plasma levels of vWF and TF were significantly elevated, as compared to the controls （P 〈 0.01 ）. Plasma levels of vWF and TF were markedly higher in MHD patients than in ESRD patients （P 〈 0.01）. vWF level was significantly increased as compared to the baseline （P 〈 0.01 ）, while there was no significant difference in TF level （P = 0.205）. The difference value of vWF was positively related with hemodialysis duration （r = 0.328, P 〈 0.05 ）. Conclusions Elderly ESRD patients have endothelial cell injury and the opening of the extrinsic coagulation pathway. These changes are aggravated with prolonged hemodialysis duration but are not associated with the severity of renal dysfunction. MHD may aggravate the dysfunction of the vascular endothelial cells and the impaired extrinsic coagulation mechanism.