维持性血液透析患者肝素-血小板因子4抗体的相关研究

Study of anti-heparin/platelet factor 4 antibodies in maintenance hemodialysis patients

目的检测维持性血液透析(MHD)患者肝素-血小板因子4(AHPF4)抗体水平,探讨该抗体与MHD患者血管通路栓塞的关系以及该抗体在持续使用肝素或低分子肝素抗凝的MHD患者体内存在的时间。方法选择两个血液净化中心血液透析患者共计148例,两个中心各74例,所有患者均接受3个月以上MHD并以肝素抗凝。采用酶联免疫吸附法检测AHPF4抗体。然后将其中一个血液净化中心的74例患者作为低分子肝素组(L组),改用低分子肝素抗凝;将另一中心的74例患者作为肝素组(G组),继续使用普通肝素抗凝。所有AHPF4抗体阳性患者均于2个月及4个月后再次抽血复查抗体情况。结果 148例采用肝素抗凝的MHD患者中AHPF4抗体的阳性率为8.1%。回顾分析得出抗体阳性患者与抗体阴性患者两年内的血管通路栓塞事件相比差异有统计学意义,P<0.05。G组在分组前AHPF4抗体阳性有5例,2个月及4个月后复查仍有4例为阳性。L组在分组前AHPF4抗体阳性有7例,2个月后复查仍为7例阳性,4个月后复查6例为阳性。结论 AHPF4抗体在采用肝素抗凝的MHD患者中的发生率为8.1%。AHPF4抗体阳性的MHD患者较AHPF4抗体阴性患者2年内血管通路栓塞事件的发生率高。AHPF4抗体在持续使用肝素或低分子肝素抗凝的MHD患者体内短期(4个月)内不会完全消失。

Objective To evaluate the level of anti-heparin/platelet factor 4 （AHPF4） antibodies in maintenance hemodialysis （MHD）patients receiving heparin administration,and therefore to study the relationship between AHPF4 antibody and thrombosis in vascular access in MHD patients,and to figure out the presenting time of AHPF4 antibody in MHD patients receiving either heparin or low molecular weight heparin administration as anticoagulant.Methods A total of 148 patients were selected from two blood purification centers,74 cases from each center and all of them receiving maintenance hemodialysis and heparine administration as anticoagulant for at least 3 months.AHPF4 antibody was measured by means of ELISA.Then the 74 cases in one center were switched to low molecular weight heparin administration and acted as Group L,while the other 74 cases in another center still receiving heparin administration and acted as Group H.All cases with positive AHPF4 antibody received follow-up evaluation of the antibody two and four months later.Results The positive rate of AHPF4 antibody was 8.1% in the 148 MHD patients receiving heparin administration as anticoagulant.By means of retrospective analysis,there was a statistical difference in the incidence of access thrombosis between AHPF4-positive and negative cases during the past two years,P0.05.Five patients in Group G were AHPF4 antibody-positive before grouping and four of them remained positive after two and four months.Seven patients in Group L were AHPF4 antibody-positive before grouping and remained positive two months later.While one case turned to be negative four months later.The number turned out to be six after four months.Conclusions （1）The positive rate of AHPF4 antibody in MHD patients receiving heparin administration as anticoagulant was 8.1%.（2）AHPF4 antibody-positive MHD patients had a higher incidence of access thrombosis during the past two years,compared to AHPF4 antibody-negative MHD patients.（3）AHPF4 antibody will not completely disappear in MHD patients either maintained in heparin administration or switched to low molecular weight heparin administration as anticoagulant in a short term （four months）.