D-二聚体、纤溶酶原激活物抑制物在急性肾衰竭患者血液净化中的临床意义

Clinical Significance of D-D and PAI in acute renal failure patients during blood purification

目的探讨急性肾衰竭(ARF)时D-二聚体(D-D)、纤溶酶原激活物抑制物(PAI)在不同的血液净化方法中的动态变化及临床意义。方法对我院2007年1月—2010年3月急诊住院58例ARF患者血液净化前、净化后4 h及38例健康人进行血浆中D-D含量及PAI水平测定。ARF患者血液净化方法随机采用血液透析(HD)(31例)、血液透析滤过(HDF)(27例)。结果 ARF患者D-D含量及PAI水平较对照组明显升高[D-D(0.83±0.04)与(0.48±0.03)mg/L,P=0.000 2;PAI(14.95±0.73)与(8.03±0.30)103kat/L,P<0.0001;]HD治疗4 h后D-D含量和PAI活性较治疗前升高[D-D(0.89±0.05)与(1.48±0.37)mg/L,P=0.018;PAI(14.89±1.78)与(22.10±3.56)103kat/L,P=0.025],而HDF治疗后D-D含量和PAI无明显变化[D-D(0.91±0.06)与(1.12±0.09)mg/L,P=0.65;PAI(15.81±1.98)与(16.10±2.56)103kat/L,P=0.86]。结论 ARF患者D-D、PAI水平升高,存在凝血-纤溶系统的紊乱,HD可以加重这种改变,而采用HDF治疗可避免对患者凝血机能的影响,在急性肾衰竭治疗中有一定临床价值。

Objective To study the dynamic changes and clinical significance of D-D and PAI in acute renal failure patients during blood purification.Methods 58 ARF patients（experimental group）were divided in to HD group and HDF group.Plasma D-D level and PAI activity were determined before and 4 hours after treatment.Normal control group consisted of 38 healthy people.ARF patients were randomly purged blood by HD（31 cases） and HDF（27 cases）.Results Plasma D-D level and PAI activity in ARF patients were obviously higher than hose in control group[D-D（0.83±0.04）vs（0.48±0.03）mg/L）,P=0.0002;PAI（14.95±0.73）vs（8.03±0.30）103kat/L,P0.0001],In HD group,the plasma D-D level and PAI activity increased continuously,there were significant differences[D-D（0.89±0.05）vs（1.48±0.37）mg/L）,P=0.018;PAI（14.89±1.78）vs（22.10±3.56）103kat/L,P=0.025].In HDF group,no significant differences of D-D level and PAI activity before and 4h after treatment[D-D（0.91±0.06）vs（1.12±0.09）mg/L）,P=0.65;PAI（15.81±1.98）vs（16.10±2.56）103kat/L,P=0.86].Conclusion There was a disorder of coagulation and fibrinolysis system in ARF patients,and HD can aggravate these changes.HDF may decrease these changes and improve the clinic effects.