不同抗凝剂及透析膜对维持性血稼患者止凝血状态的影响

目的：观察不同抗凝剂及透析膜透析对维持性血液透析（MHD）患者止凝血状态的影响。方法：10例MHD患者自身对照,先后给予普通肝素（UFH）、低分子量肝素（LMWH）抗凝以及醋酸膜（CA）聚砜膜（PS）进行140及APTT、血清BUN水平。结果：透析前各组血浆D－二聚体、GMP－140水平及APTT间差异均不显著。透析后,各组血浆D－二聚体及GMP－140显著升高（P＜0．05）,其中GMP－140升高度UFH－CA组显著于其他三组（P＜0．05）,UFH抗凝组较LMWH抗凝组APTT明显延长（P＜0．05）。透析器复用三次后,KT／V均明显下降（P＜0．01）,UFH抗凝组较LMWH抗凝组下降明显（P＜0．05）。结论PS膜血小板的活化作用弱于CA膜／与UFH相比,LMWH抗凝对纤溶系统、血小板及APTT的影响较小,有助于改善透析膜生物相容性和减少出血倾向。     

透析膜对血浆细胞因子水平的影响及临床意义

探讨使用不同透析器膜材料的血透患者血浆ＩＬ－１和ＴＮＦα的水平变化及其与临床的关系。     

不同透析膜对维持性血液透析患者微炎症状态的影响

目的:探讨不同透析膜对维持性血液透析患者血清C反应蛋白(CRP)、白介素-6(IL-6)及肿瘤坏死因子(TNF-α)水平的影响。方法:选取维持性血液透析患者60例,随机分成铜仿膜(CUP)组、血仿膜(HE)组、聚砜膜(F6)组,各20例。另选取尿毒症非透析患者20例作为非透析组,20例健康体检者为正常对照组,监测透析前、后血炎症因子CRP、IL-6、TNF-α的水平。结果:非透析组及透析组透析前患者血CRP、IL-6、TNF-α水平均高于正常对照组(P0.01),CUP组透析后CRP、IL-6、TNF-α水平较透析前明显上升(P0.05或P0.01),HE组及F6组透析后CRP、IL-6、TNF-α水平与透析前比较,差异无统计学意义(P0.05)。结论:尿毒症患者体内存在微炎症状态,血液透析会进一步加重炎症反应,与透析膜的生物相容性直接有关。     

应用扫描电镜技术评价透析膜凝血活性的影响

行维持性血液透析 (ＭＨＤ)时 ,血液与透析膜接触可引起血小板活化和凝血 ,导致血管通路堵塞及血栓形成 ,从而影响透析效果。以往的研究多注重生化指标的检测 ,而对透析器中空纤维表面血栓形成及细胞聚集的形态学异常却少见报道。本组采用自身对照的方法 ,应用扫描电镜技术及血浆血小板α颗粒膜蛋白 (ＧＭＰ 14 0 )水平的检测 ,比较分析不同抗凝剂对不同透析膜凝血活性的影响。一、对象与方法1.对象 :ＭＨＤ患者 10例 ,均为原发性慢性肾小球肾炎 ,平均年龄 5 4岁 ,透析龄 1～ 3年。整体尿素清除率 (ＫＴ/Ｖ)为1 0 %～ 1 6 % ,红细胞压积 >2 …     

透析膜生物相容性与临床关系

透析膜生物相容性与临床关系王质刚关键词血液透析；透析膜；生物相容性与血液透析有关的生物相容性（ｂｉｏｃｏｍ－ｐａｔｉｂｉｌｉｔｙ，ＢＣ）是指血液和透析膜（血／膜）接触产生的一种特殊反应，也有作者称为“炎症反应”。这种反应有时很轻，不出现临床症状，患者...     

不同透析膜对维持性血液透析患者血sCD23的影响

尿毒症患者常伴有免疫功能紊乱[1] 。血液透析 (ＨＤ)不仅不能改善患者的免疫功能 ,而且一些相关因素如透析膜生物不相容性等也可介导免疫功能障碍 ,并导致一系列急、慢性炎症反应[2 ] 。目前研究发现 ,ＣＤ2 3/ｓＣＤ2 3在免疫系统中起重要的调控作用 ,是多功能受体分子[3 ,4] 。ｓＣＤ2 3是ＣＤ2 3的水解片段 ,通过对尿毒症患者及ＨＤ患者的ｓＣＤ2 3水平检测 ,可以了解患者的免疫功能状态[5] 。因此 ,我们通过观察不同膜材料透析器初用、复用 ,对维持性血液透析 (ＭＨＤ)患者血清ｓＣＤ2 3的影响 ,探讨它们对ＭＨＤ患者Ｂ淋巴细胞免疫功…     

不同生物相容性透析膜对维持性血液透析患者血管内皮细胞的影响

目的探讨不同生物相容性透析膜对维持性血液透析(MHD)患者血管内皮细胞的影响。方法选取首都医科大学附属北京朝阳医院肾内科透析室2006年5月至10月32例MHD患者作为研究对象,并随机分为2组:血仿膜组和聚砜膜组,每组各16例。分别于透析前后采集血样,Percoll密度梯度离心法测定血循环内皮细胞(CEC)数量,血浆一氧化氮(NO)的测定用硝酸盐还原酶法,血浆不对称二甲基精氨酸(ADMA)用高效液相色谱法(HPLC)。并采集健康对照组血样12例。结果MHD患者透析前CEC数量高于正常对照组,两实验组之间透析前比较差异无统计学意义。血仿膜组和聚砜膜组透析后CEC数量均较透析前明显增高,透析后和透析前比较差异有统计学意义(P<0.01);透析后血仿膜组CEC数量高于聚砜膜组,组间比较差异有统计学意义(P<0.01)。血浆两组NO、ADMA浓度透析后较透析前均有显著下降(P<0.01)。两组间透析后,NO浓度差异无统计学意义。血仿膜组CEC数量与血浆NO、ADMA浓度呈显著负相关(分别为r=-0.532和r=-0.432,P<0.05);而聚砜膜组CEC数量与血浆NO、ADMA浓度虽然也呈负相关,但无统计学意义。结论MHD患者血管内皮细胞受生物相容性的影响,合成膜对血管内皮细胞的影响较小。不同生物相容性透析膜对血管内皮细胞的损伤有可能是通过抑制内皮细胞NO合成酶通路而导致的。     

不同生物相容性透析膜对红细胞免疫功能的影响

目的了解血液透析病人透析过程中红细胞免疫功能指标的动态改变及不同生物相容性的透析膜对其变化的影响。方法分别采用铜仿膜(Cu膜)、聚砜膜(Ps膜)、聚甲基丙烯酸甲脂膜(PMMA膜),观察了透析过程中不同时相的红细胞免疫功能指标RBCC     

不同透析膜对细胞因子基因表达和血浆水平的影响

血液透析中透析膜的生物相容性问题一直是血液净化领域的研究热点 ,它直接影响了透析患者的生存质量和病死率。近年来 ,随着免疫学和分子生物学技术的发展 ,人们认识到外周血单个核细胞 (ＰＢＭＣ)在与透析相关的许多因素的刺激下 ,可被激活表达细胞因子基因 ,分泌合成多种细胞因子 ,如白细胞介素 1β(ＩＬ 1β)、肿瘤坏死因子α(ＴＮＦα)、白细胞介素 6 (ＩＬ 6 ) ,与血液透析的急慢性并发症有关。本研究观察了应用不同透析膜进行维持性血液透析患者的ＩＬ 1β、ＴＮＦα、ＩＬ 6的基因表达和血浆水平 ,为提高透析质量 ,选择透析膜提供…     

不同透析膜的生物特性及临床应用

血液透析最早应用的纤维素透析膜由天然棉花制成，能够激活补体和白细胞、诱发炎症反应，称为“生物不相容性”(bioincompatibility)生物膜。随着科技的发展，生物膜可以通过化学方法合成，并对纤维素膜的羟基进行修饰，激活补体的作用减弱，生物相容性改善。因此，铜仿膜等生物膜被称为“未修饰的纤维素膜”，与之相对应的是后期出现的生物相容性更好的“修饰性／再生纤维素膜”。     

不同血液净化技术对维持性血透患者血小板活化的影响

目的探讨两种常见血液净化方式-血液透析及血液透析滤过对血小板活化功能的影响。方法用ELISA法检测13例血液透析（HD）患者和13例血液透析滤过（HDF）患者血液净化前后P-选择素水平。结果HD组和HDF组治疗前P-一选择素水平无显著差异（P〉0．05）,治疗后两组P-选择素水平均显著升高俨〈0．01）,而HD组显著高于HDF组俨〈0．05）。结论HD和HDF均可导致血小板活化,而前者活化血小板的程度高于后者。     

The use of a low-flux hemo-dialyzer is associated with impaired platelet aggregation in patients undergoing chronic hemodialysis

In patients with chronic hemodialysis (HD), both abnormal thrombotic and bleeding events are commonly observed. Uremic platelet dysfunction is one of the important attributing factors. Moreover, HD may also result in aggregation dysfunction of platelets during the therapeutic procedure. However, how the HD process affects platelet and coagulation function is unknown and dialyzer membrane flux could have an impact on it. We aimed to compare the impacts of low-flux and high-flux HD on the platelet function of patients undergoing chronic HD. This was a cross-sectional study conducted in the HD unit of E-Da hospital in Taiwan. A total of 78 patients with maintenance HD three times per week for more than one year, including 40 with high- and 38 with low-flux hemodialysis, were recruited. Their platelet functions were evaluated using an in vitro platelet function analyzer (PFA-100) before and after the HD session. Of the 78 patients undergoing HD, 60 (76%) had prolonged pre-dialysis collagen/epinephrine (CEPI) and collagen/adenosine diphosphate closure times. Those receiving low-flux dialyzer had a significant increase in CEPI closure time (pre-dialysis 212.3 ± 62.1 seconds. post-dialysis 241.5 ± 64.3 seconds, P = .01), but not collagen/adenosine diphosphate closure time, after HD. After adjusting confounding factors, only the low-flux dialyzer demonstrated an independent association with the prolonged CEPI closure time after HD therapy (odds ratio = 23.31, 95% CI: 1.94–280.61, P = .01). We observed that impaired platelet aggregation is prevalent in patients undergoing chronic HD. Therefore, the use of low-flux dialyzers may further worsen platelet aggregation after dialysis. Patients with uremic bleeding diathesis should take precautions. We suggest that further studies using flow cytometry should be conducted to explore the mechanism of dialysis flux and platelet activity during HD.     

Clinical manifestations and laboratory findings in patients with lupus anticoagulants

Clinical and laboratory features were evaluated in 48 patients with lupus anticoagulants and the efficiency of three different assays in the detection of lupus anticoagulants was compared. The diagnosis of lupus anticoagulants was based on a prolonged activated partial thromboplastin test not corrected in a mixture of 1:1 with normal plasma and lack of specific inhibitors against coagulation factors. Platelet neutralization procedure was positive for lupus anticoagulants in 98% of the patients, tissue thromboplastin inhibition ratio in 79%, and kaolin clotting time index in 77%. At least one of the assays was positive in 100% of the cases. The largest minority of the patients (31%) suffered from systemic lupus erythematosus. The others had a variety of non-immunological disorders. In the 13 patients who had been operated on, only 1 with renal failure developed hemorrhagic complications after renal biopsy due to thrombocytopathy. The incidence of recurrent spontaneous miscarriage, immune thrombocytopenia and positive direct antiglobulin test, anti-nuclear and anti-DNA antibodies and VDRL was significantly higher in patients with lupus anticoagulants and systemic lupus erythematosus compared to patients with lupus anticoagulants but without systemic lupus erythematosus.     

常规血液透析和血液透析滤过对骨代谢标记物的影响

目的:分析不同透析方式[常规血液透析(HD)与血液透析滤过(HDF) ]对HD患者骨代谢的影响探讨可能的原因.方法:入选30例维持性血液透析患者,随机分为HD组((n=15)和HDF组(n=15),15例健康体检者作为正常对照组.比较入组时、透析10个月后及单次两组患者透析前后血骨钙素(BGP),β-Ⅰ型胶原C-末端肽(β-CTX),I型前胶原氨基端前肤肽PINP),甲状旁腺素(PTH)的变化,并比较各组间是否存在差别.结果:入组时两组BGP,β-CTX,PINP及PTH水平差异无统计学意义(P＞0.05),10个月后HD组患者透析前BGIβ-CTX,PINP及PTH均高于HDF组(P＜0.05),同时两组均显著高于对照组(P＜0.01).透析后HD组患者β-CTX明显下降(P＜0.05),但PTH无明显变化.HDF组患者透析后BGP,β-CTX,PTH均有显著下降,其下降幅度大于HD组.两组患者透析前后PINP均无变化.结论:采用HDF可降低透析患者的骨转运指标,尤其对高PTH患者代谢指标改善效更佳.     

贫血对维持性血液透析患者心脏结构及功能的影响

目的　探讨维持性血液透析 (MHD)患者贫血与心脏结构及功能损害的关系。方法　收集本院 47例 MDH伴贫血患者的年龄、血压、血常规、超声心动图资料 ,治疗后 ,按照 Hb水平是否达到 90 g/L分为两组 ,进行治疗前后自身对照及两组之间比较 ,观察贫血的改善与否对血透患者心脏结构和功能的影响。结果　逐步回归分析显示贫血和高血压是引起心肌肥厚的独立危险因素。直线相关分析表明左室心肌重量指数 (LVMI)、左房内径 (LA)、左室舒张末期内径 (LVEDD)均与血红蛋白浓度 (Hb)和红细胞压积 (Hct)呈明显负相关 (P<0 .0 5)。治疗后 ,36例患者 Hb>90 g/L,1 1例 Hb<90 g/L。两组之间比较 ,>90 g/L组的心脏结构及功能明显改善 ,>90 g/L组自身前后比较 ,心脏结构及功能也明显改善 ;<90 g/L组心脏结构及功能有进一步恶化趋势。结论　贫血可以导致 MHD患者心脏肥大 ,心腔扩大 ,静息状态下心脏舒张功能受损而收缩功能代偿尚好。贫血改善有助于心脏结构及功能的恢复。     

Effect of dialyzer membranes on mortality in uremic patients undergoing long-term hemodialysis: A Nationwide population-based study using the Taiwan Dialysis Registry Data System 2005–2012

The characteristics in dialyzer are associated with mortality in patients with end-stage renal disease (ESRD) receiving hemodialysis (HD). This study is to investigate the effects of dialyzer membranes on 3-year mortality in ESRD patients. From the long-term nationwide population database. Prevalent HD patients during 2005–2012 were enrolled. Our main analysis to calculate the effect was cox regression multivariate model. Overall, the mean age of all population (N = 73 565) was 61.0 ± 13.6 years, the observation period is 2.46 years ±0.98 within 3 years and 64.6% used polysulfone (PS), polymethyl methacrylate (PMMA) (11.6%), polyethersulfone (11.4%), and cellulose triacetate (CTA) (10.7%), ethylene vinyl alcohol (EVAL) (hazard ratio [HR] 2.72, 95% confidence interval [CI] 1.71–4.33) and CTA (HR 1.35, 95% CI 1.12–1.64) were associated with higher mortality than PS, but PMMA was not. EVAL and CTA adversely affected mortality and PMMA had no protective role. Further investigations on membrane characters on HD patients are warranted. Taipei Medical University (TMU) (TMU-JIRB (No. N201804051).