中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (01): 27-30.doi: 10.3969/j.issn.1671-4091.2026.01.006

• 临床研究 • 上一篇    下一篇

甲磺酸萘莫司他与枸橼酸在尿毒症高危出血患者血液透析中的抗凝效果及安全性比较

胡 雨   余文洪   胡祖海   赵洪雯   谢 攀   彭侃夫   

  1. 400038 重庆，1陆军军医大学第一附属医院肾内科
    401120 重庆，2重庆松山医院肾内科
  • 收稿日期:2025-09-18 修回日期:2025-11-07 出版日期:2026-01-12 发布日期:2025-12-31
  • 通讯作者: 彭侃夫 E-mail:392906786@tmmu.edu.cn
  • 基金资助:
    国家卫生健康委医药卫生科技发展研究中心青年项目(WKZX2023CX14001)；重庆市自然科学基金面上项目(CSTB2023NSCQ-MSX0570)

Comparison of anticoagulant efficacy and safety between nafamostat mesylate and citrate in hemodialysis for uremic patients at high risk of bleeding

HU Yu, YU Wen-hong, HU Zu-hai, ZHAO Hong-wen, XIE Pan, PENG Kan-fu   

  1. Department of Nephrology, Southwest Hospital, Army Medical University, Chongqing 400038, China; 2Department of Nephrology, Chongqing Songshan Hospital, Chongqing 401120, China
  • Received:2025-09-18 Revised:2025-11-07 Online:2026-01-12 Published:2025-12-31
  • Contact: 400038 重庆，1陆军军医大学第一附属医院肾内科 E-mail:392906786@tmmu.edu.cn

摘要： 目的  比较注射用甲磺酸萘莫司他(nafamostat mesylate，NM)与局部枸橼酸抗凝(regional citrate anticoagulation，RCA)在尿毒症高危出血患者血液透析中的抗凝效果、安全性及经济学效益。 方法  回顾性分析2016年1月—2023年12月在陆军军医大学第一附属医院肾内科行血液透析的尿毒症高危出血患者，分为NM组和RCA组，比较2组有效性和安全性，并计算增量成本-效果比(incremental cost-effectiveness ratio，ICRE)。 结果  共纳入91例患者，其中NM组59例、RCA组32例。NM组和RCA组抗凝有效率比较差异无统计学意义(96.61%比87.50%，χ2=2.796，P=0.095)，NM组因凝血事件导致的提前终止率(0比9.38%，χ2=5.720，P=0.017)、3级凝血事件(1.69%比12.50%，χ2=4.665，P=0.031)及低钙血症(0比12.50%，χ2=7.714，P=0.005)均低于RCA组。NM与RCA相比，ICER为-1843.91元。 结论  NM作为血液透析高危出血风险患者的抗凝剂，具有良好的有效性和安全性，并具备良好的成本效益。

关键词: 注射用甲磺酸萘莫司他, 枸橼酸抗凝, 高危出血, 血液透析, 抗凝效果

Abstract: Objective To compare the anticoagulation efficacy, safety, and economic benefits of Nafamostat Mesylate (NM) injection versus Regional Citrate Anticoagulation (RCA) in hemodialysis for uremic patients at high risk of bleeding.  Methods  A retrospective analysis was conducted on uremic patients at high risk of bleeding who underwent hemodialysis in the Department of Nephrology, First Affiliated Hospital of Army Medical University, between January 2016 and December 2023. Patients were divided into the NM group and the RCA group. The effectiveness and safety were compared between the two groups, and the incremental cost-effectiveness ratio (ICER) was calculated.  Results  A total of 91 patients were included, with 59 in the NM group and 32 in the RCA group. No statistically significant difference was found in anticoagulation efficacy between the NM and RCA groups (96.61% vs. 87.50%,  χ²=2.796, P=0.095). The NM group showed lower rates of premature termination due to clotting events (0% vs. 9.38%, χ²=5.720, P=0.017), Grade 3 clotting events (1.69% vs. 12.50%, χ²=4.665, P=0.031), and hypocalcemia (0% vs. 12.50%, χ²=7.714, P=0.005) compared to the RCA group. Compared to RCA, the ICER for NM was -1843.91 Chinese Yuan.  Conclusion  As an anticoagulant for hemodialysis in patients at high risk of bleeding, NM demonstrates favorable efficacy and safety, along with good cost-effectiveness. 

Key words: Nafamostat mesylate, Regional citrate anticoagulation, High-risk bleeding, Hemodialysis, Anticoagulation efficacy

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