尿毒症患者血栓前状态的探讨

目的探讨尿毒症患者止血功能的调节及其临床意义。方法采用酶联免疫分析（ELISA）法测定59例尿毒症患者血浆血管性血友病因子（vWF）、同型半胱氨酸（Hcy）、P-选择素（P—selectin）、血栓前体蛋白（TpP）、纤维蛋白肽A（FPA）、凝血酶-抗凝血酶复合物（TAT）、蛋白C（PC）、蛋白S（PS）、D二聚体（D-D）的水平，并比较各指标在尿毒症组与正常组（n=30）间的差异；同时评价尿毒症患者各止血功能指标与血清肌酐（Cr）、肾小球滤过率（GFR）之间的相关性。结果尿毒症患者的血浆vWF、Hcy、TpP、FPA、TAT、PS、D—D含量显著高于正常对照组（P〈0．05或P〈0．01），Pselectin和PC含量显著低于正常对照组（P〈0．01）；在尿毒症组Hcy与GFR（r=-0．369，P=0．04）和Cr（r=0．274，P=0．039）呈显著相关性，尿毒症患者所有检测的止血调节指标中，Hcy、vWF、FPA、TpP具有较高的灵敏度和特异性。结论尿毒症患者止血功能变化以凝血亢进为主，其出血倾向主要是由于血小板活化功能受损，Hcy、FPA和TpP能为临床提供较好尿毒症患者的止血功能调节的实验室诊断依据。

Study of Prethrombotic State in Patients with Uremia

Objective To investigate the adjustment of hemostatic function and its clinical significance in patients with uremia. Methods von Willebrand factor （vWF）, homocysteine （Hcy）, P-selectin, thrombus precursor protein （TpP）, fibrinopeptide A （FPA）, thrombin-antithrombin （TAT）, protein C （PC）, protein S （PS） and D-dimer（D-D） were measured by enzyme-linked immunosorbent assay （ELISA） in 59 patients with uremia was compare with that of normal controls （ n = 30）. To evalute correlation between the concentrations of all these markers and the glomerular filtration rate （ GFR）, creatinine （Cr） in patients with uremia. Results The plasma levels of vWF, Hcy, TpP, FPA, TAT, PS and D-D in patients with uremia were significantly higher than those in controls group （ P 〈 0.05 or P 〈 0.01 ）, and the levels of P-selectin and PC were significantly lower than those in controls group（ P 〈 0.01 ）. Significant correlation of the concentrations of Hcy with GFR（ r = - 0. 369, P = 0.04） and Cr （ r = 0. 274, P = 0. 039 ）. And the Hcy, vWF, FPA and TpP are more sensitive and special tests of same kind tests. Conclusion The hypercoagulability may lead to the variation of hemostatic function in patients with uremia, and the damage of platelet activation may contribute to the bleeding in uremia. Hcy as well as FPA and TpP can be good foundation of clinical diagnosis.