摘要
目的通过监测老年患者血液透析过程中抗因子Xa活性评估低相对分子质量肝素(LMWH)抗凝治疗的疗效。方法选择规律使用LMWH的老年血液透析患者95例,采用发色底物法检测原理一步检测抗因子Xa活性,根据抗因子Xa活性分组:A组30例(抗因子Xa活性<0.4 IU/ml),B组45例(0.4 IU/ml≤抗因子Xa活性<1.0 IU/ml),C组20例(抗因子Xa活性≥1.0 IU/ml);同时检测患者的KT/V值、血红蛋白(HGB),血清白蛋白(ALB),C反应蛋白、Ca、P和甲状旁腺激素(PTH)等,用SF-36健康调查量表进行生活质量评分。结果 KT/V值三组分别为:A组1.10±0.08,B组1.45±0.22,C组1.32±0.16;B组和C组高于A组P<0.05;HGB B组108.45±12.82g/L高于A组98.57±6.43g/L和C组95.79±10.54g/L,P<0.05;血清白蛋白分别为A组31.03±2.36g/L、B组39.03±3.17g/L、C组34.91±5.39g/L,B组高于A和C组,P<0.05;抗因子Xa活性≥0.4 IU/ml的老年患者中SF-36健康调查量表各项生活质量评分中生理功能、活力、社会功能、精神健康得分较高;C组血液透析的老年患者出血率为30%;相关分析显示抗因子Xa活性与kt/v、Alb、Hgb呈正相关,与PTH呈负相关。结论长期血液透析老年患者抗因子Xa活性维持在0.4IU/m^1.0 IU/ml的范围安全有效。
Objective To evaluate the efficacy of low-molecular-weight heparin by measurement of an ti-factor Xa activity in elderly maintenance hemodialysis patients.Methods 95 elderly maintenance hemodialysis patients were divided into three groups according to anti-factorXaactivity:groupA (anti-Xaactivity 〈 0.4 IU/ml,n =30),groupB (0.4 IU/ml ≤ anti-factor Xafactor activity 〈 1.0 IU/ml,n =45),groupC (anti-Xa activity≥1.0 IU/ml,n =20).Anti-Xa activity was determined by chromogenic substrate method.KT/V values at the day on hemodialysis were calculated.Blood samples were collected for the determination of hemoglobin(HGB),serum albumin (ALB),serum C-reactive protein (CRP),Ca,P and parathyroid hormone (PTH).The quality of life of patients were assessed by SF-36 Health Survey Scale.Reasuhs Kt/ V values of B,C group were 1.45 ±0.22,1.32 ±0.16,which were significantly higher than A group(1.10 ±0.08,P 〈0.05).The level of HGB in group B(108.45 ± 12.82)g/L was higher than that in group A98.57 ± 6.43g/L and group C95.79 ± 10.54g/L(P 〈0.05).The level of ALB in group B(39.03 ±3.17) g/L was higher than that in group A31.03 ±2.36g/L and group C34.91 ±5.39g/L(P 〈0.05) ;Patients of anti-factor Xa activity ≥ 0.4 IU/ml got less scaled scores of SF-36 (P 〈 0.05) in physical function,vitality,social function,mental health.The incidence of bleeding in group C was 30% ;Anti-Xa activity was positively correlated with KT/V,ALB,HGB,negatively correlated with PTH.Conclusion Anti-factor Xa activity between 0.4 IU-1.0 IU were safe an d efective in elderly hemodialysis patients.Measurement of anti-factor Xa activity in elderly hemodialysis patients could be the most feasible pathway in personalized anticoagulant therapy.
出处
《血栓与止血学》
2014年第6期322-325,共4页
Chinese Journal of Thrombosis and Hemostasis
关键词
抗因子Xa
低相对分子质量肝素
血液透析
Anti-factor Xa activity
Low-molecular-weight heparin
Hemodialysis