枸橼酸与肝素抗凝在急性肾衰竭合并高尿酸血症间歇性肾脏替代治疗中的应用效果比较  

Citrate Versus Heparin Anticoagulation in Intermittent Renal Replacement Therapy for Acute Renal Failure with Hyperuricemia

作　　者：黄燕[1] 吴桃红 徐承云[1] 黄翀[1] 顾云雨 HUANG Yan;WU Tao-hong;XU Cheng-yun;HUANG Chong;GU Yun-yu(Department of Nephrology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院肾脏内科,南昌330006

出　　处：《南昌大学学报（医学版）》2023年第6期44-49,共6页Journal of Nanchang University：Medical Sciences

基　　金：江西省卫健委科技计划(SKJP220211565)。

摘　　要：目的 比较枸橼酸与肝素抗凝在急性肾功能衰竭合并高尿酸血症患者采用间歇性肾脏替代治疗(IRRT)中的应用效果。方法 回顾性分析2021年在南昌大学第二附属医院行IRRT的60例急性肾功能衰竭合并高尿酸血症患者临床资料,按IRRT抗凝方案不同分为枸橼酸组(n=33)和肝素组(n=27)。比较2组患者行IRRT治疗前24 h内及治疗结束1 h内凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)及血小板、Ca^(2+)、血肌酐、血尿酸、β2微球蛋白(β2-MG)水平,并观察2组治疗过程中滤器及管路凝血情况和治疗后72 h出血情况。结果 2组治疗前APTT、PT值及血小板、Ca^(2+)水平差异均无统计学意义(P>0.05),枸橼酸组治疗前后Ca^(2+)水平比较差异有统计学意义(P<0.05),肝素组治疗前后APTT值比较差异有统计学意义(P<0.05),2组治疗后APTT、PT值及Ca^(2+)水平比较差异有统计学意义(P<0.05)。枸橼酸组治疗前后血肌酐、血尿素、尿酸、β2-MG水平比较差异有统计学意义(P<0.05),2组治疗后血肌酐、尿酸、血尿素水平比较差异无统计学意义(P>0.05),但2组治疗后β2-MG水平比较差异有统计学意义(P<0.05)。2组患者行IRRT治疗后滤器凝血、出血情况比较差异均无统计学意义(P>0.05)。结论 枸橼酸和肝素抗凝剂在急性肾功能衰竭合并高尿酸血症患者行IRRT中的抗凝效果有部分差异,前者安全性更高;二者治疗效果相当,均能降低血肌酐、尿酸、血尿素、β2-MG水平。Objective To compare the efficacies of citric acid and heparin anticoagulation in intermittent renal replacement therapy(IRRT) for acute renal failure complicated by hyperuricemia.Methods Clinical data of 60 patients with acute renal failure and hyperuricemia admitted to the Second Affiliated Hospital of Nanchang University in 2021 were analyzed retrospectively.According to the anticoagulant regimens,the patients were divided into citric acid group(n=33) and heparin group(n=27).Prothrombin time(PT),activated partial thromboplastin time(APTT),and levels of platelets,Ca~(2+),creatinine,uric acid and beta-2-microglobulin(β2-MG) were compared between the two groups within 24 hours before IRRT and 1 hour after the end of treatment.In addition,clotting in filter and tube during treatment and bleeding at 72 hours after treatment were observed in both groups.Results There were no significant differences between the two groups in APTT,PT and levels of platelets and Ca~(2+) before treatment,as well as in creatinine,uric acid and urea levels after treatment(P>0.05).The differences before and after treatment were statistically significant in Ca~(2+),creatinine,uric acid,urea and β2-MG levels in the citric acid group,as well as in APTT in the heparin group(P<0.05).After treatment,there were significant differences in APTT,PT and Ca~(2+) and β2-MG levels between the two groups(P<0.05).However,the difference was not significant in β2-MG levels between the two groups(P>0.05).Moreover,there were no significant differences in filter coagulation and bleeding between the two groups after IRRT(P>0.05).Conclusion There are differences in anticoagulation effect between citric acid and heparin in IRRT for acute renal failure with hyperuricemia.Citrate acid is superior to heparin in the safety.These two anticoagulants are comparable in reducing creatinine,uric acid,urea and β2-MG levels.

关 键 词：间歇性肾脏替代治疗 急性肾功能衰竭 高尿酸血症 肝素 枸橼酸 

分 类 号：R692.5[医药卫生—泌尿科学]