血液透析对维持性血液透析患者血浆组织因子、组织因子途径抑制物活性的影响  

The influence of hemodialysis on the activity of tissue factor and tissue factor pathway inhibitor in maintenance hemodialysis patients

作　　者：黄雯[1] 徐丽平[1] 翟艳苓[1] 

机构地区：[1]首都医科大学附属北京同仁医院肾内科,北京100730

出　　处：《中国血液净化》2005年第2期79-82,共4页Chinese Journal of Blood Purification

摘　　要：目的　观察血液透析过程对维持性血液透析 (maintenancehemodialysis,MHD)患者血浆中组织因子 (tissuefactor,TF)及其调节物 -组织因子途径抑制物 (tissuefactorpathwayinhibitor,TFPI)活性的影响。方法　应用发色底物法检测了 4 3名慢性肾衰竭患者的血浆组织因子、组织因子途径抑制物活性 ,其中 2 0例为未进行血液透析的终末期肾病 (end -stagerenaldisease ,ESRD)患者 (肾衰竭组 ) ,2 3例为慢性MHD患者在一次透析开始前 (透析前组 )和透析结束时 (透析后组 )的血浆TF、TFPI活性指标。同时观察透析过程中肝素对血浆TF、TFPI活性的影响。并对 2 3名健康自愿者 (正常对照组 )进行了血浆TF、TFPI活性的测定。结果　①TF活性在肾衰竭组和透析前组均较正常对照组明显升高 ,分别为 [(1.1790± 0 .2 937)nmvs (0 .30 5 5±0 .190 1)nm ;(0 .884 8± 0 .5 4 6 1)nmvs (0 .30 5 5± 0 .190 1)nm ,(P均 <0 .0 1) ];肾衰竭组高于透析前组 ,但差异无显著性 (P >0 .0 5 ) ;②TFPI活性在透析前组和肾衰竭组均较对照组轻度升高 ,且肾衰竭组TFPI活性低于透析前组 ,但P均 >0 .0 5 ,无统计学意义 ;③一次透析过程中 ,透析后组TFPI活性明显高于透析前组[(2 .110 5± 1.36 37)u/mlvs (1.3347± 0 .84 19)u/ml,(P <0 .0 5 )Objective To investigate the effect of hemodialysis on the plasma tissue factor (TF) and tissue factor pathway inhibitor (TFPI) act ivity in maintenance hemodialysis (MHD) patients. Methods The plasma activity of TF and TFPI was measured by chr omogenic assay in 20 non-dialyzed end-stage renal disease (ESRD)patients, 23 MHD subjects and 23 normal controls. Results ①The plasma TF activity in non-dialyzed ESRD patients and MHD ones was higher than that in normal controls (1.1790±0.2937) nm vs. (0. 3055±0.1901) nm;(0.8848±0.5461) nm vs. (0.3055±0.1901)nm,respectively, (P<0.01). However compared with the MHD patients, the plasma TF activity in non-dialyzed ESRD patients was even higher but without significance (P>0.05);②The plasma TFPI activity in ESRD ones was higher than that o f the normal controls (P>0.05). The plasma TFPI activity in MHD patients was higher than that in non-dialyzed patients, but there was no statis tical significance; ③The plasma TFPI activity increased after a hemodialysis s ession (2.1105±1.3637) u/ml vs. (1.3347 ± 0.8419)u/ml, (P<0.05). The plasma TF activity post-hemodialysis decreased in comparis on with pre-HD (0 .6816±0.3798)nm vs. (0.8848±0.5461) nm, (P = 0.071); ④The di fference of TFPI was linear correlated with the dosage of h eparin used during a hemodialysis session (R2=0.190,P<0.05). ⑤ The difference of TF activity was linear correlated with the TFPI activity (r =-0.263,P<0.05). Conclusion In the ESRD patients, the plasma TF activity raised t o a high level, but the TFPI activity increased lighly. However, contrasted to the non-dialyzed patients, the plasma TF activity reduce d while the plasma TFPI act ivity increased in the MHD subjects, which became more significant after hemodia lysis. The difference of the TFPI activity between pre-HD and post-HD was positi vely linear correlated with the dosage of the heparin used in a hemodialysis ses sion. It suggested that the extrinsic coagulation pathway dysfunction might play an important role in the deteri

关 键 词：慢性肾衰竭 组织因子 组织因子途径抑制物 血液透析 肝素 

分 类 号：R692.5[医药卫生—泌尿科学]