中国血液净化

›› 2005, Vol. 4 ›› Issue (2): 79-82.

• 论著 • 上一篇    下一篇

血液透析对维持性血液透析患者血浆组织因子、组织因子途径抑制物活性的影响

黄 雯 徐丽平 翟艳苓   

  1. 100730 北京，首都医科大学附属北京同仁医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-02-12 发布日期:2005-02-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-02-12 Published:2005-02-12

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摘要：

目的 观察血液透析过程对维持性血液透析 (maintenance hemodialysis, MHD)患者血浆中组织因 子（tissue factor，TF）及其调节物-组织因子途径抑制物（tissue factor pathway inhibitor，TFPI）活性的影响。方法 应用发色底物法检测了43名慢性肾衰竭患者的血浆组织因子、组织因子途径抑制物活性，其中20例为未进行血液透析的终末期肾病（end-stage renal disease, ESRD）患者（肾衰竭组），23例为慢性MHD患者在一次透析开始前（透析前组）和透析结束时（透析后组）的血浆TF、TFPI活性指标。同时观察透析过程中肝素对血浆TF、TFPI活性的影响。并对23名健康自愿者（正常对照组）进行了血浆TF、TFPI活性的测定。结果 ①TF活性在肾衰竭组和透析前组均较正常对照组明显升高，分别为［(1.1790±0.2937)nm vs (0.3055 ± 0.1901)nm；(0.8848±0.5461)nm vs (0.3055± 0.1901)nm， (P均<0.01)］；肾衰竭组高于透析前组，但差异无显著性（P>0.05）；② TFPI活性在透析前组和肾衰竭组均较对照组轻度升高，且肾衰竭组TFPI活性低于透析前组， 但 P均>0.05， 无统计学意义； ③一次透析过程中， 透析后组 TFPI 活性明显高于透析前组 ［(2.1105±1.3637)u/ml vs (1.3347 ± 0.8419)u/ml， (P<0.05)］。透析后 TF活性较透析前降低 ［(0.6816 ± 0.3798)nm vs (0.8848±0.5461)nm，( P=0.071)］；④ MHD患者透析前后TFPI活性差值与透析过程中使用的肝素量有直线相关性(R2＝0.190， P<0.05)。但透析前后 TF活性差值与肝素量无相关；⑤肾脏病患者TF活性与TFPI活性有直线负相关性（r=-0.263, P<0.05）。结论 慢性肾衰竭尿毒症患者有血浆 TF活性的明显升高和TFPI活性的轻度升高。MHD患者的TF活性低于未透析的尿毒症患者，而TFPI活性则有所升高，这种变化在透析结束时更为明显。透析前、后血浆TFPI活性的差值与透析过程中的肝素用量成正相关。提示外源性凝血系统的异常在肾功能不全的发生、发展中起着重要的作用，血液透析及透析过程中的某些因素（如肝素）对这种凝血异常的纠正有一定的作用。

关键词: 慢性肾衰竭, 组织因子, 组织因子途径抑制物, 血液透析, 肝素

Abstract:

Objective To investigate the effect of hemodialysis on the plasma tissue factor (TF) and tissue factor pathway inhibitor (TFPI) activity in maintenance hemodialysis (MHD) patients. Methods　 The plasma activity of TF and TFPI was measured by chromogenic assay in 20 non-dialyzed end-stage renal disease (ESRD)patients, 23 MHD subjects and 23 normal controls. Results ①The plasma TF activity in non-dialyzed ESRD patients and MHD ones was higher than that in normal controls (1.1790±0.2937) nm vs. (0.3055±0.1901) nm；(0.8848±0.5461) nm vs.(0.3055±0.1901)nm，respectively, (P<0.01). However compared with the MHD patients, the plasma TF activity in non-dialyzed ESRD patients was even higher but without significance (P>0.05)； ②The plasma TFPI activity in ESRD ones was higher than that of the normal controls (P>0.05). The plasma TFPI activity in MHD patients was higher than that in non-dialyzed patients, but there was no statistical significance； ③The plasma TFPI activity increased after a hemodialysis session (2.1105±1.3637) u/ml vs. (1.3347 ± 0.8419)u/ml, ( P<0.05). The plasma TF activity post-hemodialysis decreased in comparis on with pre-HD (0.6816±0.3798)nm vs. (0.8848±0.5461) nm, ( P = 0.071)； ④ The difference of TFPI was linear correlated with the dosage of heparin used during a hemodialysis session (R2＝0.190， P<0.05). ⑤ The difference of TF activity was linear correlated with the TFPI activity (r=-0.263, P<0.05). Conclusion In the ESRD patients, the plasma TF activity raised to a high level, but the TFPI activity increased lighly. However, contrasted to the non-dialyzed patients, the plasma TF activity reduced while the plasma TFPI activity increased in the MHD subjects, which became more significant after hemodialysis. The difference of the TFPI activity between pre-HD and post-HD was positively linear correlated with the dosage of the heparin used in a hemodialysis session. It suggested that the extrinsic coagulation pathway dysfunction might play an important role in the deterioration of renal function. Some factors (e.g.heparin) in HD session may have effect on reversing the haemostatic abnormalities. 

Key words: Tissue factor, Tissue factor pathway inhibitor, Hemodialysis, Heparin

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