尿毒症血液透析患者血浆血小板相关抗体IgG的变化及其对出血并发症的影响

Change in plasma antiplatelet associated antibody and its effect on the complications of bleeding in patients with uremia during hemodialysis

目的：观察尿毒症血液透析（血透）患者血浆血小板相关抗体ＩｇＧ（ＰＡＩｇＧ）的变化及其对出血并发症的影响。方法：使用酶联免疫吸附法检测１７例尿毒症患者血透前、后血浆ＰＡＩｇＧ的含量。结果：尿毒症患者透析后血小板计数〔（９．１４±３．８２）×１０９／Ｌ〕较透析前〔（８．６３±３．６５）×１０９／Ｌ〕升高，血小板聚集率较正常参考值明显降低（Ｐ均＜０．０１）；尿毒症患者血浆ＰＡＩｇＧ较正常参考值显著增高，透析后血浆ＰＡＩｇＧ〔（４６．８±３５．９）ｎｇ／１０７ＰＡ〕较透析前〔（６２．４±４６．８）ｎｇ／１０７ＰＡ〕明显降低（Ｐ＜０．０１），但仍高于正常参考值。结论：血浆ＰＡＩｇＧ增高并非血小板减少的主要原因。血小板的功能不能充分发挥，血小板的内在缺陷是出血并发症的重要原因之一。测定血浆ＰＡＩｇＧ可为尿毒症出血并发症的防治提供参考依据。

Objective:To investigate the significance of change in antiplatelet associated antibody (PAIgG) and its effect on the development of complications in patients with uremia during hemodialysis.Methods:In 17 patients with uremia,plasma PAIgG concentrations were determined by enzymelinked immunoabsorbent assay before and after hemodialysis.Results:The blood platelet counts after hemodialysis 〔(914±382)×109/L〕 was higher than befrte hemodialysis 〔(863±365)×109/L〕 in uremia patients;the platelet aggregation rate was decreased significantly than reference value (all P<001).The plasma PAIgG concentration was increased markedly in patients with uremia,and it was decreased markedly after hemodialysis 〔(468±359) ng/107 PA〕 than before hemodialysis〔(624±468) ng/107 PA,P<001〕,but still higher than normal value. Conclusions:These data suggest that increase of the PAIgG may not be the major important factor associated with platelet reduction and complication of bleeding.The bleeding appears to be related to the dysfunction of platelet in patients with uremia.