肝素/血小板因子4抗体在维持性血液透析患者中的临床意义

目的 分析维持性血液透析（MHD）患者肝素/血小板因子4（H/PF4）抗体的阳性率，并探讨其临床意义。方法 选择54例海军军医大学（第二军医大学）长征医院肾内科收治的MHD患者作为研究对象，所有患者以普通肝素/低分子肝素抗凝透析≥3个月，排除感染及其他活动性疾病。收集MHD患者透析前血清，采用颗粒免疫过滤法检测IgG型H/PF4抗体。比较H/PF4抗体阳性与阴性患者的一般情况、血红蛋白水平、血小板计数、抗凝方式（普通肝素/低分子肝素）、抗凝剂剂量及透析方式（常规血液透析/夜间延长血液透析）的差异。随访3年比较H/PF4抗体阳性与阴性患者血小板变化趋势、血管通路血栓形成发生率、心血管事件、脑血管事件、住院率及死亡率等的差异。结果 所有MHD患者H/PF4抗体阳性率为63.0%（34/54）。H/PF4抗体阳性和阴性患者在性别、年龄、透析龄、血红蛋白水平、血小板计数方面的差异均无统计学意义（P均>0.05）。H/PF4抗体阳性与原发病、抗凝方式、抗凝剂剂量及透析方式均无关（P均>0.05）。经过3年的随访，H/PF4抗体阳性和阴性患者的血小板变化趋势无差异（P>0.05）。H/PF4抗体阳性患者与H/PF4抗体阴性患者比较，血管通路血栓形成发生率差异无统计学意义[14.7%（5/34）vs25.0%（5/20），P>0.05]，心血管事件、脑血管事件、住院率及死亡率差异均无统计学意义（P均>0.05）。结论 MHD患者H/PF4抗体阳性率高。H/PF4抗体的产生与使用肝素的种类、剂量及透析方式均无关。H/PF4抗体阳性对血小板计数及不良事件包括血栓形成、心脑血管事件等均无明显影响。

Clinical significance of heparin/platelet factor 4 antibody in maintenance hemodialysis patients

Objective To investigate the positive rate of heparin/platelet factor 4 (H/PF4) antibody in maintenance hemodialysis (MHD) patients, and to explore its clinical significance. Methods Fifty-four MHD patients treated in the Department of Nephrology of Changzheng Hospital of Naval Medical University (Second Military Medical University) were selected. The dialysis duration (unfractionated heparin/low-molecular-weight heparin) of all patients was more than 3 months, with no infections or other active diseases. Serum samples were collected from the MHD patients before dialysis, and IgG H/PF4 antibody was detected by particle immunofiltration assay. The general condition, hemoglobin level, platelet count, anticoagulant method (unfractionated heparin/low-molecular-weight heparin), anticoagulant dosage, and dialysis mode (conventional hemodialysis/nocturnal extended hemodialysis) were compared between the H/PF4 antibody-positive group and H/PF4 antibody-negative group. After 3 years'' follow-up, the change of platelets, the incidence of vascular access thrombosis, cardio-cerebral vascular events, hospitalization rates and mortality were compared between the two groups. Results The positive rate of H/PF4 antibody was 63.0% (34/54) in MHD patients. There were no significant differences in gender, age, dialysis age, hemoglobin level or platelet count between the H/PF4 antibody-positive group and H/PF4 antibody-negative group (P>0.05). The positive H/PF4 antibody was not correlated with primary kidney disease, anticoagulant method, anticoagulant dosage, or dialysis mode (all P>0.05). After 3 years'' follow-up, there were no significant differences in the change of platelet, the incidence of vascular access thrombosis (14.7%[5/34] vs 25.0%[5/20]), cardiovascular events, cerebrovascular events, hospitalization rates, or mortality between the two groups (all P>0.05). Conclusion The positive rate of H/PF4 antibody is high in MHD patients. The production of H/PF4 antibody is not related to the heparin type, heparin dosage, or dialysis mode. The positive H/PF4 antibody has no significant effect on platelet counts or adverse events, including thrombosis and cardiovascular events.