抗Ⅹa因子活性评估血液透析低分子肝素抗凝的效果  

Evaluation of anticoagulant effect and predicted dose of low molecular weight heparin in hemodialysis by anti-Ⅹa factor activity

作　　者：王振兴 毛永辉[1] 王源 付沛颉 党心 徐冷楠[1] Wang Zhenxing;Mao Yonghui;Wang Yuan;Fu Peijie;Dang Xin;Xu Lengnan(Department of Nephrology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100005,China)

机构地区：[1]北京医院肾内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100005

出　　处：《中华预防医学杂志》2024年第2期254-260,共7页Chinese Journal of Preventive Medicine

基　　金：中央高校基本科研业务费专项资金资助(3332020070);中央高水平医院临床科研业务费(BJ-2022-129,BJ-2022-105)。

摘　　要：本研究使用抗Ⅹa因子活性探讨低分子肝素(LMWH)在血液透析(hemodialysis,HD)时的合理剂量及防止体外滤器凝血(ECC)的策略。回顾性病例对照研究纳入2020年12月至2021年1月期间在北京医院血液净化中心使用LMWH抗凝的维持性血液透析(MHD)的患者,收集患者体重、身高、基础肾脏病、透析龄等基础数据以及透析前、透析中及透析后的抗Ⅹa因子活性等实验室检查结果。共入组46例患者,其中凝血组5例(10.9%)、非凝血组41例(89.1%),HD开始后0.5 h抗Ⅹa因子活性达峰值,将4 h抗Ⅹa因子水平纳入受试者工作特征曲线(ROC曲线),分析结果显示ROC曲线下面积(AUC)为0.802(95%置信区间:0.651~0.954,P=0.029),截点值为0.31 IU/ml(敏感性1,特异性0.683)。建议以体表面积作为基准估算血液透析LMWH抗凝剂量,HD 4 h抗Ⅹa因子活性≤0.31 IU/ml,对ECC具有较高的诊断价值。此外,二分类logistic回归分析结果显示,透析龄是ECC的独立危险因素(OR值1.319,95%CI 1.052~1.654,P=0.017)。综上,本研究揭示了透析龄可能是HD患者ECC的危险因素以及HD 4 h抗Ⅹa因子活性≤0.31 IU/ml可作为潜在的ECC的诊断截点,为预防血液透析滤器凝血的监测提供参考依据。The purpose of this study was to explore the reasonable dose of low molecular weight heparin(LMWH)in hemodialysis(HD)and the strategy of preventing extracorporeal circuit coagulation(ECC).A retrospective case-control study included patients who used LMWH for anticoagulation during maintenance hemodialysis(MHD)in the Hemodialysis Center of Beijing Hospital from December 2020 to January 2021.Basic data such as weight,height,basic kidney disease,dialysis age and anti-Ⅹa factor activity before,during and after dialysis were collected.A total of 46 patients were enrolled in this study,including 5 patients in coagulation group(10.9%)and 41 patients in non-coagulation group(89.1%).The anti-Ⅹa factor activity reached its peak at 0.5 h after the start of HD.The level of anti-Ⅹa factor was incorporated into the receiver operating characteristic curve(ROC curve).The results showed that the area under the ROC curve(AUC)was 0.802(95%confidence interval:0.651-0.54,P=0.029),and the cutoff was 0.31 IU/ml(sensitivity 1,specificity 0.683).It is suggested that the body surface area should be used as the basis to estimate the anticoagulant dose of LMWH in HD,and the activity of HD 4 h anti-Ⅹa factor≤0.31 IU/ml,which is of diagnostic value for ECC.In addition,the results of binary logistic regression analysis showed that dialysis age was an independent risk factor for ECC(OR value 1.319,95%CI 1.052-1.654,P=0.017).In summary,this study reveals that dialysis age may be a risk factor for ECC and that the activity of HD 4 h anti-Ⅹa factor≤0.31 IU/ml can be used as a potential diagnostic cut-off point for ECC in HD patients,which provides a scientific basis for monitoring strategies to prevent blood coagulation in HD filters.

关 键 词：血液透析 低分子肝素 抗凝 抗Ⅹa因子活性 

分 类 号：R692.5[医药卫生—泌尿科学]