新型冠状病毒感染对维持性血液透析患者凝血功能的影响

Effect of SARS⁃CoV⁃2 infection on coagulation function in maintenance hemodialysis patients

目的:分析维持性血液透析(MHD)患者新型冠状病毒(SARS⁃CoV⁃2)感染后凝血功能的变化及可能的因素。方法:回顾性分析2022年1月至2023年3月于武汉大学人民医院血透中心行维持性血液透析治疗的235例患者,根据纳排标准纳入122例患者,并根据患者感染SARS⁃CoV⁃2行前后对照,比较感染前后患者各项指标变化。根据患者纤维蛋白原水平将患者分为高凝组和非高凝组。结果:SARS⁃CoV⁃2感染后,MHD患者白蛋白、血红蛋白明显下降,而C反应蛋白、血小板、活化部分凝血活酶时间、纤维蛋白原、D⁃二聚体明显升高,提示患者存在高凝倾向。与非高凝组相比,高凝组患者抗凝血酶Ⅲ活性升高,血尿素氮和血白蛋白水平降低。结论:SARS⁃CoV⁃2感染可能导致MHD患者凝血功能异常,出现高凝倾向,且可能与白蛋白水平降低相关,应密切监测SARS⁃CoV⁃2感染患者凝血功能,并根据具体情况及时动态调整透析处方。

Objective:To analyze the changes in coagulation function and possible factors after severe acute respiratory syndrome coronavirus 2(SARS⁃CoV⁃2)infection in maintenance hemodialysis(MHD)pa⁃tients.Methods:A total of 235 patients receiving maintenance hemodialysis treatment in the Hemodi⁃alysis Center of Renmin Hospital of Wuhan University from January 2022 to March 2023 were retro⁃spectively analyzed,and 122 patients were included.The changes in various indexes of patients be⁃fore and after infection with SARS⁃CoV⁃2 were compared according to self⁃control before and after in⁃fection.Patients were divided into hypercoagulable group and non⁃hypercoagulable group according to their fibrinogen levels.Results:After SARS⁃CoV⁃2 infection,albumin and hemoglobin decreased sig⁃nificantly in MHD patients,while C⁃reactive protein,platelet,activated partial thromboplastin time,fibrinogen,and D⁃dimer increased significantly,suggesting that patients had a tendency to hypercoag⁃ulation.AntithrombinⅢactivity was increased and blood urea nitrogen and blood albumin levels were decreased in the high coagulation group as compared with the non⁃high coagulation group.Con⁃clusion:SARS⁃CoV⁃2 infection may lead to abnormal coagulation function and hypercoagulation ten⁃dency in MHD patients,which may be related to decreased albumin level.It is necessary to closely monitor the coagulation function of patients infected with SARS⁃CoV⁃2,and dynamically adjust dialy⁃sis prescription according to the specific situation.