肝素/血小板因子4抗体在维持性血液透析患者中的临床意义

Clinical significance of heparin/platelet factor 4 antibody in maintenance hemodialysis patients

目的分析维持性血液透析(MHD)患者肝素/血小板因子4(H/PF4)抗体的阳性率,并探讨其临床意义。方法选择54例海军军医大学(第二军医大学)长征医院肾内科收治的MHD患者作为研究对象,所有患者以普通肝素/低分子肝素抗凝透析≥3个月,排除感染及其他活动性疾病。收集MHD患者透析前血清,采用颗粒免疫过滤法检测IgG型H/PF4抗体。比较H/PF4抗体阳性与阴性患者的一般情况、血红蛋白水平、血小板计数、抗凝方式(普通肝素/低分子肝素)、抗凝剂剂量及透析方式(常规血液透析/夜间延长血液透析)的差异。随访3年比较H/PF4抗体阳性与阴性患者血小板变化趋势、血管通路血栓形成发生率、心血管事件、脑血管事件、住院率及死亡率等的差异。结果所有MHD患者H/PF4抗体阳性率为63.0%(34/54)。H/PF4抗体阳性和阴性患者在性别、年龄、透析龄、血红蛋白水平、血小板计数方面的差异均无统计学意义(P均>0.05)。H/PF4抗体阳性与原发病、抗凝方式、抗凝剂剂量及透析方式均无关(P均>0.05)。经过3年的随访,H/PF4抗体阳性和阴性患者的血小板变化趋势无差异(P>0.05)。H/PF4抗体阳性患者与H/PF4抗体阴性患者比较,血管通路血栓形成发生率差异无统计学意义[14.7%(5/34)vs 25.0%(5/20),P>0.05],心血管事件、脑血管事件、住院率及死亡率差异均无统计学意义(P均>0.05)。结论MHD患者H/PF4抗体阳性率高。H/PF4抗体的产生与使用肝素的种类、剂量及透析方式均无关。H/PF4抗体阳性对血小板计数及不良事件包括血栓形成、心脑血管事件等均无明显影响。

Objective To investigate the positive rate of heparin/platelet factor 4(H/PF4)antibody in maintenance hemodialysis(MHD)patients,and to explore its clinical significance.Methods Fifty-four MHD patients treated in the Department of Nephrology of Changzheng Hospital of Naval Medical University(Second Military Medical University)were selected.The dialysis duration(unfractionated heparin/low-molecular-weight heparin)of all patients was more than 3 months,with no infections or other active diseases.Serum samples were collected from the MHD patients before dialysis,and IgG H/PF4 antibody was detected by particle immunofiltration assay.The general condition,hemoglobin level,platelet count,anticoagulant method(unfractionated heparin/low-molecular-weight heparin),anticoagulant dosage,and dialysis mode(conventional hemodialysis/nocturnal extended hemodialysis)were compared between the H/PF4 antibody-positive group and H/PF4 antibody-negative group.After 3 years’follow-up,the change of platelets,the incidence of vascular access thrombosis,cardio-cerebral vascular events,hospitalization rates and mortality were compared between the two groups.Results The positive rate of H/PF4 antibody was 63.0%(34/54)in MHD patients.There were no significant differences in gender,age,dialysis age,hemoglobin level or platelet count between the H/PF4 antibody-positive group and H/PF4 antibodynegative group(P>0.05).The positive H/PF4 antibody was not correlated with primary kidney disease,anticoagulant method,anticoagulant dosage,or dialysis mode(all P>0.05).After 3 years’follow-up,there were no significant differences in the change of platelet,the incidence of vascular access thrombosis(14.7%[5/34]vs 25.0%[5/20]),cardiovascular events,cerebrovascular events,hospitalization rates,or mortality between the two groups(all P>0.05).Conclusion The positive rate of H/PF4 antibody is high in MHD patients.The production of H/PF4 antibody is not related to the heparin type,heparin dosage,or dialysis mode.The positive H/PF4 antibody has no significant effect on platelet counts or adverse events,including thrombosis and cardiovascular events.