维持性血液透析患者凝血因子Ⅻ活性及D-二聚体水平的变化研究

Changes in the Activity of Plasma Coagulation Factor Ⅻ and the Level of D-dimmer in Maintenance Hemodialysis

目的观察维持性血液透析(MHD)患者血浆凝血因子Ⅻ活性(FⅫ:C)及D-二聚体水平的变化,探讨凝血、纤溶的特点及血液透析过程对其影响。方法分别测定70例MHD患者(MHD组)在透析开始时和结束时的血浆FⅫ:C及D-二聚体水平,并与65例健康体检者(对照组)进行对照。结果透析前MHD组患者的血浆FⅫ:C水平为(127.6±37.2)%,高于对照组的(90.0±12.0)%,差异有统计学意义(t=5.52,P<0.01);透析结束时MHD组患者的血浆FⅫ:C水平为(84.3±19.7)%,低于透析前的水平,差异有统计学意义(t=7.58,P<0.01)。透析前MHD组患者的血浆D-二聚体水平为(1.09±1.07)mg/L,高于对照组的(0.35±0.09)mg/L,差异有统计学意义(t=4.11,P<0.01);透析结束时MHD组患者的血浆D-二聚体水平为(1.23±1.19)mg/L,高于透析前的水平,差异有统计学意义(t=7.50,P<0.01)。结论 MHD患者存在着高凝及继发纤溶状态,血液透析过程使其更加明显;血浆D-二聚体水平升高提示高凝继发纤溶存在;MHD患者FⅫ:C明显升高,血液透析过程会使血浆FⅫ:C下降。

Objective To investigate the effects of maintenance hemodialysis on fibrinolysis and coagulation.system through observing changes in the activity of plasma coagulation factor Ⅻ activity（FⅫ：C）as well as the level of D-dimmer in patients undergoing maintenance hemodialysis（MHD）.Methods Pre-and post-hemodialysis（HD）levels of plasma FⅫ：C and D-dimmer were determined in 70 MHD patients（MHD group）,and the results were compared with those in 65 healthy subjects（the control group）.Results The Pre-HD levels of plasma FⅫ：C and D-dimmer were significantly higher in MHD group than in control group（（127.6±37.2）% vs（90.0±12.0）% and（1.09±1.07）mg/L vs（0.35±0.09）mg/L,respectively）（P0.01）.The plasma FⅫ：C significantly decreased after HD（（84.3±19.7）% vs（127.6±37.2）%）（P0.01）,and the plasma D-dimmer significantly increased after HD（（1.23±1.19）mg/L vs（1.09±1.07）mg/L）（P0.01）.Conclution The increased plasma D-dimmer level after HD suggests that HD aggravate the hyperfibrinolysis secondary to the hypercoagulable state in MHD patients.The level of plasmaFⅫ：C rises,in MHD patients,and decreases after HD.