蛋白C抗凝系统在尿毒症维持性血液透析中的变化及意义

目的 :探讨血浆抗凝因子蛋白 C(PC)、蛋白 S(PS)及血栓调节蛋白 (TM)在尿毒症、凝血异常导致出血并发症中的作用。方法 :采用双抗夹心酶联免疫吸附法 (EL ISA)及发色底物法测定 4 5例尿毒症血液透析 (血透 )患者及正常对照组血浆 PC抗原 (PC:Ag)、PC活性 (APC)、血浆总 PS(TPS)、血浆游离 PS(FPS)及 TM含量。结果 :尿毒症患者 PC:Ag、TPS、FPS、TM和 D二聚体 (DD)含量及 APC明显高于正常对照组 (P<0 .0 5或P<0 .0 0 1) ;维持性血透患者血浆 APC、TPS、FPS及 DD血透后明显升高 (P<0 .0 5或 P<0 .0 0 1) ;TM血透后明显降低 (P<0 .0 0 1) ;有出血并发症者血浆 PC:Ag、FPS、DD含量及 APC明显升高 (P<0 .0 5或 P<0 .0 1)。结论 :尿毒症患者蛋白 C抗凝活性降低 ,与尿毒症时高凝倾向和血栓形成有关。血透可激活原本已处于高凝状态的凝血系统 ,使体内蛋白 C抗凝途径的抗凝活性增强。

Significance of change in protein C anticoagulant activity in patients undergoing maintenance hemodialysis

Objective:To investigate the potential roles of protein C (PC),protein S(PS) and thrombomo dulin(TM) in the development of coagulantfibrinolytic dysfunction in patients with uremia.Methods:Using enzymelinked immunosorbent assay (ELISA) method,plasma levels of PC antigen,total and free protein S antigen (TPS and FPS),TM,Ddimer(DD) and PC activity were measured in 45 patients undergoing maintenance hemodialysis and normal controls.Results:Patients with endstage renal insufficiency had a higher PC antigen,TPS,FPS,TM,DD levels,as well as PC activity compared with the normal controls ( P <0 05 or P <0 001).In uremic patients after maintenance hemodialysis treatment,PC activity,TPS,FPS,and DD levels were significantly elevated compared with those proior to hemodialysis ( P <0 05 or P <0 001).In addition,progressive increase in PC antigen,FPS,DD levels and PC activity were observed in patients with uremic bleeding after hemodialysis treatment( P <0 05 or P <0 01).Conclusions:These data suggested that a reduction in PC activity might be related to bleeding and thrombosis in uremic patients,and impairment in PC activation seems to be reversible since hemodialysis could increase the functional PC.