低分子肝素对糖尿病肾衰竭透析患者血脂代谢的临床观察

目的 :通过应用低分子肝素及普通肝素对糖尿病肾衰进行血透 ,了解低分子肝素对糖尿病肾衰血脂代谢的影响。方法 :将 32例糖尿病肾衰患者随机分成实验组 (LMWH组 ,n =16 )和对照组 (UFH组 ,n =16 ) ,LMWH组和UFH组分别使用低分子肝素和普通肝素进行血液透析一年 ,观察两组患者血脂变化情况。结果 :实验过程中LMWH组患者血清胆固醇 (CH)及甘油三酯 (TG)水平明显下降 ,高密度脂蛋白 (HDL)、载脂蛋白A(ApoA1)明显升高 ,均有明显差异 ,具统计学意义。UFH组中CHOL无明显变化 ,TG及LDL明显升高 ,HDL明显降低 ,均有统计学差异。同时对LMWH组和UFH组之间进行比较显示 ,在透析开始时CH、TG、HDL、LDL、ApoA1及ApoB均无统计学差异 ;透析一年后LMWH组与UFH组相比 ,CH、TG、LDL进一步下降 ,HDL、ApoA1明显上升 ,而且具有统计学意义。结论 :LMWH透析可以改善糖尿病肾衰患者的血脂代谢。     

低分子肝素对血液透析患者血小板数量及平均体积的影响

低分子肝素(LMWH)具有对凝血系统影响小,不容易造成患者出血等优点,因此我们比较了它与普通肝素对血小板形态的影响。 材料与方法 1.对象:选择49例维持血液透析患者,男20例,女29例,年龄45-76岁,透析时间1-5年。49例分为普通肝素组(UFH,24例)与低分子肝素组(LMWH,25例)。选择15例正常健康人     

血液透析中应用低分子量肝素的交叉对照、随机、开放、多中心临床研究

目的比较低分子量肝素（Fragmin）与普通肝素（UFH）在血液透析中的抗凝疗效。方法100例慢性维持性血透患者（CHD）通过自身对照，按不同顺序给予Fragmin和UFH各4次作为血液透析抗凝剂，观察透析器凝血，透析器对尿素氮、肌酐清除效力，监测抗Xa活性及白陶土部份凝血活酶时间（KPTT），人工压迫止血时间。结果与UFH相比，Fragmin抗Xa活性明显高于UFH，而对KPTT影响不明显；两种肝素均应用常规剂量时，用Fragmin的透析器对尿素氮、肌酐的清除效力明显优于UFH，压迫止血时间缩短。结论Fragmin的抗凝效果与UFH相似，在血液透析中应用能保证透析效果而不增加出血危险。     

低分子肝素对长期维持性血液透析患者血脂的影响

目的:调查低分子肝素(low molecular weight heparin,LMWH)对维持性血液透析患者血脂代谢的影响.方法:采用对照分析方法,分析血液透析患者长期应用LMWH和普通肝素(unfractionaled heparin,UFH)抗凝对血脂的影响.结果:将普通UFH改为LMWH(吉派林)抗凝,治疗6月、12月、18月时,血液透析患者血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)胆固醇与治疗前均无统计学差异,与UFH组相比,也无统计学差异.结论:长期用某些LMWH抗凝,血液透析患者脂质代谢紊乱并不能得到改善.     

术前应用低分子肝素对非体外循环冠状动脉旁路移植术后早期疗效的影响

摘要：目的探讨术前应用低分子肝素（10wmolecularweightheparin,LMWH）对行非体外循环冠状动脉旁路移植术（off-pumpcoronaryarterybypassgrafting,OPCAB）患者术后早期疗效的影响。方法回顾性分析2011年4月1日至2012年9月30日中国医科大学附属第一医院809例行单纯OPCAB患者的临床资料,根据术前是否应用LMWH分为两组,LMWH组：386例,男290例,女96例;年龄49～81岁;术前停用抗血小板药物后均常规给予低分子肝素（低分子肝素钠或低分子肝素钙,4000U每日2次,皮下注射）抗凝治疗,直至手术前一天早晨。对照组：423例,男321例,女102例;年龄46～78岁;直接停用抗血小板药物,而不应用LMWH或其它抗凝药物。比较两组患者的死亡率、围术期心肌梗死发生率、手术时间、失血量、输血量、术后急性肾功能不全发生率等。结果LMWH组患者术中失血量[（296±94）mlVS．（249±81）ml,P=0．03]、术后胸腔引流量[（526_＋159）mlVS．（410±125）ml,P=0．02]、输红细胞量[（2．6±1．1）UVS．（1．4±0．9）U,P=-0．04]以及手术时间[（172±34）minVS．（154_＋41）min．P=0．04]均显著大于对照组,而两组间手术死亡率（1．0％VS．1．2％,P=I．00）、围术期心肌梗死发生率（4．4％VS．3．8％,P=0．55）差异无统计学意义。结论对于稳定的缺血性心脏病,术前不用LMWH可缩短手术时间、减少失血量和输血量,并不增加手术死亡率以及围术期心肌梗死的发生率。     

低分子量肝素在血液透析中的应用

为探讨低分子量肝素在血液透析中的抗凝作用，选择血液透析患者６０例、１５００例次，分成两组。一组透析中使用肝素抗凝，另一组使用低分子量肝素（ＣＸ）抗凝，分别测量凝血时间、凝血酶原时间、活化部分凝血活酶时间及血小板，进行对照研究。结果发现，ＣＸ比肝素能更有效地抗凝，又能减少出血倾向，透析器复用次数明显增加，活化部分凝血活酶时间降低（Ｐ＜０．０１）。表明低分子量肝素特别适用于有出血倾向者，可代替肝素在血液透析中应用。     

血液透析中心静脉置管出血性并发症的分析

目的回顾性分析血液透析患者临时中心静脉置管出血并发症发生的原因。方法回顾性分析471例接受临时中心静脉置管的血液透析患者资料,分析置管位置（颈内、锁骨下、股静脉）、置管后透析时机（即刻或隔日）、透析中抗凝方式（普通肝素、低分子量肝素和无肝素）与出血并发症的关系。结果①置管后即刻透析患者发生出血并发症的风险较隔日透析高（16．4％ vs 4．2％,P〈0．01）;②低分子量肝素抗凝较普通肝素抗凝出血少（5．2％ vs 13．8％,P〈0．01）。结论恰当的安排透析时机、选用合适的抗凝技术以可有效减少中心静脉置管患者出血并发症的发生。     

改良式吸附法无肝素血液透析临床观察

目的:探讨改良式吸附法无肝素透析(HCHD)的可行性.方法:对39例高危出血倾向的维持性血液透析(MHD)患者行HCHD 80例次,31例高危出血倾向的MHD患者行低分子量肝素(LMWH)抗凝法血液透析72例次,两组进行比较.结果:两组透析前后电解质变化明显(P＜0.01),Kt/V均＞1.2,组间比较无统计学差异(P＞0.05).透析器和血管路凝血发生率组间比较无统计学差异.LMWH组透析后活化部分凝血酶原时间(APTT)轻度延长(P＜0.05),内瘘穿刺点压迫止血时间延长,两组比较有统计学差异(P＜0.01),LMWH组透析后新的出血灶发生率为8.33%.结论:HCHD透析效果确切,简便安全可行.     

低分子肝素在重型肝炎血浆置换中的应用

目的 探讨低分子肝素在重型肝炎血浆置换中的应用.方法 回顾性分析本院92例重型肝炎患者行322次血浆置换(PE)中肝素(HS)及低分子肝素(LMWH)的应用情况,比较二者对患者凝血功能的影响以及安全性.结果 治疗后HS组凝血酶原时间(PT)、凝血酶时间(TT)、凝血活酶时间(APTT)均较LMWH组升高,血小板(PLT)计数较LMWH组下降,以上指标两组比较均具有统计学意义(P＜ 0.05);另外,LMWH组在血浆分离器中凝血发生率及安全性方面优于HS组.结论 低分子肝素安全性高、抗凝效果好且不增加出血倾向,适合在重型肝炎患者血浆置换中应用.     

单剂量低分子量肝素在血液透析抗凝中的应用

对３０例血透患者进行随机交叉对照研究，比较血透前单剂量注射低分子量肝素（ＬＭＷＨ，速避凝）和持续输注普通肝素（ＳＨ）的疗效和安全性。结果：两组体外循环凝血发生率低且无明显差别，但ＬＭＷＨ组透析器复用次数明显延长（Ｐ＜０．０５），第四次透析２小时尿素氮、肌酐清除率及透析器血液间隙容量无明显下降；ＳＨ组则明显下降（Ｐ＜０．０５）。两组均无出血征象，但ＬＭＷＨ组穿刺点压迫时间明显缩短（Ｐ＜０．０５）；而两组透析２小时血浆肝素活性抗－低分子量肝素（ＦＸａ）水平无明显差别，透析４小时ＬＭＷＨ组明显高于ＳＨ组（Ｐ＜０．０５）；ＬＭＷＨ组部分凝血活酶活化时间（ＡＰＴＴ），凝血酶时间（ＴＴ）仅透析２小时轻度延长，透析４小时基本恢复到治疗前水平，ＳＨ组均明显延长（Ｐ＜０．００１）。我们认为血透前单剂量ＬＭＷＨ能有效、完全地代替ＳＨ。     

低分子肝素对血液透析患者脂质代谢影响的临床研究

目的 探讨长期应用低分子肝素抗凝对尿毒症血液透析患者脂质代谢的影响。方法 采用为期１年的长期开放、随机对照的方法,选择３５例无明显出血倾向尿毒症患者,随机分成普通肝素（ＵＦＨ）组（１３例）及低分子肝素（ＬＭＷＨ）组（２２）例,于透前分别按个体剂量给予普通肝素及低分子肝素钠动脉血路端注射,并在治疗前、治疗后６月及１２月检测血脂、脂蛋白、载脂蛋白水平及脂酶活性。结果 （１）两治疗组透析前血甘油三酯（Ｔ     

Effects of Low Molecular Weight Heparin on the Frequencies of Intradialytic Arrhythmias in Hemodialysis Patients

Arrhythmia is known to cause sudden death in hemodialysis patients. Heparin administration releases lipoprotein lipase from the capillary endothelial cell surface, resulting in an increase in the plasma levels of free fatty acids; higher levels of free fatty acids may affect the occurrence of arrhythmias. This study assessed whether the occurrence of arrhythmias during hemodialysis could be suppressed by replacing unfractionated heparin with low molecular weight heparin. Ten dialysis patients who had supraventricular premature contraction and/or ventricular premature contraction were monitored by the Holter electrocardiograph system during hemodialysis. To investigate the effect of each form of heparin on plasma lipid metabolism, the lipoprotein lipase and lipid levels before and during hemodialysis were measured. The occurrence of arrhythmias was significantly suppressed in hemodialysis using low molecular weight heparin, as compared with hemodialysis using unfractionated heparin. Lower lipoprotein lipase and free fatty acids levels were also observed in hemodialysis using low molecular weight heparin. The authors concluded that hemodialysis using low molecular weight heparin instead of unfractionated heparin could be effective in protecting hemodialysis patients with arrhythmias against arrhythmia-related cardiac events.     

Acute Effect of Standard Heparin Versus Low Molecular Weight Heparin on Oxidative Stress and Inflammation in Hemodialysis Patients

Objective. Atherosclerotic cardiovascular diseases caused by traditional and non-traditional risk factors are the most common cause of morbidity and mortality in hemodialysis patients. Recently, much interest has been focused on non-traditional factors, such as oxidative stress, inflammation, and endothelial dysfunction. Hemodialysis patients are not only exposed to oxidative stress but also to inflammation. Although anticoagulants are the most frequently used drugs in hemodialysis patients, their effect upon oxidative stress and inflammation in dialysis patients are still unknown. Methods. Thirty-three hemodialysis patients were randomized into three groups. Group 1 received standard heparin while group 2 received low molecular weight heparin during the dialysis therapy. Group 3 (control group) did not receive any anticoagulant agent. Investigators were blinded to the therapy. Serum concentrations of oxidative stress and inflammation markers, including C-reactive protein, tumor necrosis factor alpha, superoxide dismutase, and malondialdehyde, were measured before and after dialysis session. Results. The oxidative stress and inflammation markers were significantly increased in groups 1 and 3 (p < 0.05 for each) compared to their baseline values. In contrast, baseline and end-treatment values of the oxidative stress and inflammation markers were comparable in the group 2 (p > 0.05). Conclusion. These findings indicate that the type of anticoagulants may take a role in the acute effect of hemodialysis upon oxidative stress and inflammation markers. A comparison of the groups revealed that low molecular weight heparin decreased the oxidative stress and inflammation, whereas standard heparin increased the oxidative stress and inflammation. Low molecular weight heparin appears to have an additive benefit for hemodialysis patients.     

阿加曲班在中心静脉置管诱导血液透析中的应用

目的：探讨阿加曲班在中心静脉置管诱导血液透析中的抗凝效果和出血事件。方法：将104例患者随机分为普通肝素组和阿加曲班组。所有患者在置入右侧颈内静脉置管后接受连续2d的2次诱导血液透析,阿加曲班抗凝剂量按1.5μg·kg^-1·min^-1续由动脉端给予。测定透析前后患者的血常规、肝肾功能、电解质和凝血功能并采用评分方法评价透析器凝血和置管处出血和血肿情况。结果：普通肝素组和阿加曲班组透析器凝血情况无明显差异,但是颈内静脉置管处出血情况,阿加曲班组较普通肝素组显著降低（P〈0.05）,在相同透析器凝血情况下,阿加曲班组APTT和ACT值较肝素组低（P〈0.01）。在透析1h时同时检测阿加曲班组动脉端和静脉端APTT值,两者有统计学差异（P〈0.05）。结论：在达到同样抗凝效果时,阿加曲班较普通肝素所需的APTT和ACT值更低,而且阿加曲班体外的抗凝作用强于体内,因此阿加曲班可能成为血液透析一种新型的替代抗凝药物。     

Haemostatic molecular markers in patients undergoing radical retropubic prostatectomy for prostate cancer and submitted to prophylaxis with unfractioned or low molecular weight heparin.

BACKGROUND: Deep vein thrombosis and subsequently pulmonary embolism are the most common causes of increased post-operative morbidity and mortality in patients with pelvic or abdominal cancer. Aim of the study was to evaluate variations in coagulative parameters induced by two accepted primary prophylaxis patterns: standardized low doses of unfractioned heparin (UFH) or single doses of low molecular weight heparin (LMWH) in cancer patients submitted to radical retropubic prostatectomy. METHODS: Fifty patients (45-75 yr) were randomly assigned two groups. Group 1 received UFH (5000 units s.c. x 3 daily); group 2 received calcium nadroparin (single daily dose of 0.3 ml s.c.). In both groups prophylaxis began preoperatively and was maintained throughout the entire hospital-stay. Blood cell, platelet count, coagulative system exploring tests, thrombotic molecular markers, and physiological inhibitors of coagulation were determined at baseline conditions and on the first and seventh day after surgery. RESULTS: Preoperative values of fibrinogen, F1+2 fragment, TAT and D-dimer resulted over normal range in both groups. A significant increase of these markers was observed also during the post-operative period. PT, aPTT, ATIII, PC, total and free PS showed the most substantial changes on the 1st post operative day, though their values ranged within normal levels on the three sampling times. The levels of haemostatic markers demonstrated a baseline hypercoagulability, probably related to cancer and thrombin activation caused by prostatectomy. Despite this thrombophylic state, neither of the two groups presented symptomatic bleeding or thromboembolic complications. CONCLUSIONS: These results prove that a single daily dose of nadroparin has been safe and efficient as a thrice-daily dose of UFH, with a better risk/benefit relationship.     

番茄红素对血液透析患者静脉铁剂诱导细胞因子的影响

目的：观察维持性血液透析（MHD）患者由静脉铁剂诱导的细胞因子,探讨番茄红素对其的干预作用。方法：60例MHD患者,随机分为两组（对照组和试验组,各30例）。对照组：在患者透析时给予蔗糖铁注射液100mg,2次/周,共10次,观察时间8周。试验组：除蔗糖铁注射液使用外,同时口服番茄红素胶囊,2粒/次,2次/d,用药8周,观察时间8周。观察并比较两组患者治疗前及治疗8周后的白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）、白细胞介素-18（IL-18）、肿瘤坏死因子（TNF-α）等细胞因子指标的变化。结果：两组患者治疗后IL-1β、IL-6、IL-8、TNF-α、IL-18水平较治疗前均有显著性升高（P〈0.01或〈0.05）;但是试验组升高幅度显著性小于对照组（P〈0.01）。试验组患者治疗后IL-10水平较治疗前有显著性升高（P〈0.01）;并且试验组升高幅度显著性大于对照组（P〈0.05）。治疗后两组血清IL-1β、IL-6、IL-8、TNF-α、IL-18水平均与铁蛋白（SF）呈正相关（P〈0.01）。结论：静脉铁剂治疗加剧了MHD患者免疫细胞因子的调节;番茄红素可减少细胞因子过度调节而起到抗炎症作用。     

抗坏血酸对维持性血液透析患者血清Hepcidin的影响

目的：观察抗坏血酸对维持性血液透析（MHD）患者血清铁调素（Hepcidin）的影响。方法：选择符合条件的MHD患者60例,分为治疗组和对照组各30例。治疗组每日口服抗坏血酸300 mg,共12周,对照组不服用抗坏血酸及其他抗氧化剂。检测两组实验前后血清Hepcidin、血红蛋白（Hb）、白蛋白（Alb）、C反应蛋白（CRP）、铁蛋白（SF）、白细胞介素（IL-6）等相关指标,比较两组指标的变化。结果：两组实验前各项指标差异无统计学意义。治疗组口服抗坏血酸12周后,血CRP、IL-6水平下降,差异有统计学意义（P〈0.05）;Hepcidin、SF、Hb、Alb差异无统计学意义。对照组实验前后各项试验指标差异无统计学意义。结论：口服抗坏血酸在一定程度上降低MHD患者血CRP、IL-6水平,但对Hepcidin未产生显著影响。     

The effect of a bolus injection of unfractionated or low molecular weight heparin during aortobifemoral bypass grafting

Eighteen patients undergoing aortobifemoral graft surgery for severe aortoiliac atherosclerotic disease received a bolus injection of 10,000 anti-Xa units of either unfractionated heparin (UFH) or low molecular weight heparin (LMWH) into the distal aorta as prophylaxis against thromboembolic complications related to clamping. Heparin activity was measured by factor Xa inhibition and by prolongation of the APTT. In both groups there was a delay before peak levels of heparin were observed. In the LMWH group, this amounted to 30 min. In the UFH group, APTT was prolonged by 46 s, 7 min after injection but only by 5 s at the end of the operation. In contrast, in the LMWH group, the prolongation in APTT 7 min after injection was less (34 s) but more sustained since a 12.5 s prolongation was still present at the end of the operation. During surgery, heparin activity exceeded 0.7 U/ml in the LMWH group, compared to significantly lower levels in the UFH group (less than or equal to 0.20 U/ml). By the end of the operation no heparin activity was detectable in the UFH group. Protein C antigen decreased after heparin injection and this fall was more pronounced in the UFH group. The level of C1q (a subcomponent of the first component of the complement system) was decreased in the UFH group (P less than 0.04), whereas in the LMWH group C1q levels increased. Platelet aggregation with collagen was inhibited to a significantly greater degree in the LMWH group than the UFH group (54% compared with 23%) (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)