中国血液净化

中国血液净化

• 临床研究 • 上一篇    下一篇

糖尿病与非糖尿病维持性血液透析患者内皮细胞损伤和组织因子变化分析

  

  1. 首都医科大学附属北京同仁医院肾内科
  • 收稿日期:2012-02-29 出版日期:2012-09-12 发布日期:2013-01-04
  • 通讯作者: 黄雯

Analyses of endothelial cell injury and tissue factor change in maintenance hemodialysis patients with type II diabetes and without diabetes

  • Received:2012-02-29 Online:2012-09-12 Published:2013-01-04

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摘要： 【摘要】目的 探讨不同原发病的维持性血液透析(maintenance hemodialysis，MHD)患者内皮细胞损伤和凝血机制紊乱的发病机制。 方法 应用酶联免疫吸附试验(ELISA) 测定42例MHD患者(MHD组) 和22例健康志愿者(对照组)血浆可溶性血管细胞黏附分子1(Soluble vascular cell adhension molecule-1，sVCAM-1)、血管性假性血友病因子(Von willebrand factor，vWF) 和组织因子(Tissue factor，TF)水平,并对检测结果进行统计学分析。 结果　MHD组血浆sVCAM-1、vWF和TF的水平与对照组比较差异有统计学意义(t值分别为-7.809，-6.559，-16.821，P值分别为0.005，0.004，0.000),MHD糖尿病组sVCAM-1、vWF和TF水平与非糖尿病组比较差异亦有统计学意义(t值分别为       -20.605，12.792，8.600，P值分别为0.046，0.032，0.047); Logistic回归分析表明：sVCAM-1、vWF和TF与糖尿病的发生有关(P＜0.05)。血液透析组经1次透析后，血浆vWF含量明显高于透析前(t’值为-5.943，P=0．000)，血浆TF 含量高于透析前，但无统计学差异(t’值为-3.558，P＝0.205)，糖尿病组与非糖尿病组间二者差值均无统计学差异(t’值分别为-3.058，-2.241，    -5.931，-8.439，p值分别为0.070,0.302,0.085,0.155)，MHD患者透析前后vWF 差值与透析年限呈正相关(P＜0.05)。 结论 HD患者无论原发病是否为糖尿病，均存在内皮细胞受损以及高凝状态，体外血液净化过程进一步加重了这种异常，且随着透析龄的延长而加剧。

关键词:  糖尿病, 血液透析, 内皮, 可溶性血管细胞黏附分子1, 血管性假性血友病因子, 组织因子

Abstract: 【Abstract】Objective To investigate the pathogenesis of endothelial cell injury and coagulation disorder in hemodialysis patients with different primary diseases. Methods Enzyme linked immunosorbent assay was used to measure the plasma soluble vascular cell adhesion molecule-1 (sVCAM-1), von Willebrand factor (vWF) and tissue factor (TF) in maintenance hemodialysis patients (MHD group, n=42) and healthy volunteers (control group, n=22).  Results (a) The levels of sVCAM-1, vWF and TF were significantly higher in MHD group than in control group (t=-7.809, -6.559 and -16.821, respectively; P =0.005, 0.004 and 0.000, respectively). The levels of sVCAM-1, vWF and TF were significantly higher in MHD patients with type II diabetes (2-DM) than those without diabetes (t=-20.605, 12.792 and 8.600, respectively; P=0.046, 0.032 and 0.047, respectively); (b) Logistic regression analysis showed that sVCAM-1, vWF and TF levels correlated to the presence of 2-DM. (c) vWF level after a hemodialysis session increased significantly as compared to the level before the hemodialysis session (t=-5.943, P = 0.000). TF level increased after a hemodialysis session but without statistical significance (t=-3.558, P =0.205). The differences of vWF and TF levels before and after hemodialysis sessions were insignificant between MHD patients with 2-DM and those without diabetes (t=-3.058, -2.241, -5.931, and -8.439, respectively; P =0.070, 0.302, 0.085, and 0.155, respectively). The difference of vWF level before and after hemodialysis sessions correlated positively with hemodialysis age (r=0.328, P＜0.05).  Conclusion Endothelial cell injury and hypercoagulation state exist in MHD patients with 2-MD as well as in those with other primary diseases. These changes aggravate after hemodialysis especially in those with longer hemodialysis age.

Key words: Diabetes mellitus, Hemodialysis, Endothelium, Soluble vascular cell adhesion molecule-1, von Willebrand factor, Tissue factor