维持性血液透析患者血清抗-PF4/H抗体阳性率、危险因素及与血栓栓塞发病率的相关性  

Positive rate of PF4/H antibody,its risk factors and association with thrombosis in maintenance hemodialysis patients

作　　者：杨杨[1] 孙雪峰[1] 姜世敏[1] 王涌[1] 朱晗玉[1] 谢院生[1] 陈香美[1] 

机构地区：[1]解放军总医院肾脏病科,肾脏疾病国家重点实验室,北京100853

出　　处：《第二军医大学学报》2011年第9期974-978,共5页Academic Journal of Second Military Medical University

基　　金：全军医学科研“十一五”专项基金(08Z034)~~

摘　　要：目的探讨维持性血液透析患者抗-PF4/H抗体的阳性率,分析影响抗体的危险因素及其与血栓栓塞事件的相关性。方法招募解放军总医院血液净化中心157例患者,分别设计横断面和队列研究,利用统计学方法分析抗-PF4/H抗体水平的影响因素及其与血栓栓塞事件的关系。结果 40.8%(64/157)的患者表现为抗-PF4/H抗体阳性;血清抗体阳性组与抗体阴性组患者既往血栓栓塞事件、抗凝剂类型、每周透析总时间和透析龄等因素差异具有统计学意义(P<0.05);抗体阳性患者血栓栓塞事件发生率高于阴性患者(P<0.05),抗-PF4/H抗体对血栓栓塞的危险度RR=2.349。服用阿司匹林或氯吡格雷的抗体阳性患者血栓栓塞发病率低于未服用抗血小板药物的透析患者。结论本组维持性血液透析患者抗-PF4/H抗体阳性率为40.8%,影响该抗体水平的危险因素包括既往血栓栓塞事件、抗凝剂类型、每周透析总时间和透析龄等。该抗体可以作为血栓栓塞事件的标志物,抗血小板药物对预防抗体阳性患者血栓栓塞事件效果显著。Objective To study the positive rate of PF4/H antibodies in maintenance hemodialysis patients,and to analyze its risk factor and association with thrombosis.Methods A total of 157 maintenance hemodialysis patients were recruited in the present study.A cross-sectional and a longitude study were designed,and statistical analysis was used to analyze the risk factors of PF4/H antibody level and its association with thrombosis event.Results We found that 40.8%（64/157） of the patients were positive for PF4/H antibody.Past-thrombosis events,heparin types,duration and weekly dialysis hours were significantly different between antibody-positive group and antibody-negative group（P0.05）.Incidence of thrombosis event in antibody-positive group was significantly lower than that in the antibody-negative group（P0.05）.The risk ratio of antibody positivity for thrombosis event was 2.349.The incidence of thrombotic event in antibody-positive patients who took anti-platelet agents was lower than that in those who did not take.Conclusion The positive rate of PF4/H antibody has been found to be 40.8% in the present group.Thrombosis events,heparin types,duration and weekly dialysis hours are the risk factors of PF4/H antibody level.PF4/H antibody can serve as a marker for thrombotic events,and anti-platelet agents are effective for preventing from thrombotic events in PF4/H antibody positive patients.

关 键 词：肾透析 肝素诱发血小板减低症 抗-PF4/H抗体 血栓栓塞 

分 类 号：R459.52[医药卫生—治疗学]