糖尿病肾病血液透析患者内皮细胞功能及凝血纤溶系统的变化

目的观察糖尿病肾病(DN)血液透析患者内皮细胞功能和凝血、纤溶系统变化。方法选取2003-03～2003-12北京同仁医院血液透析中心的28例DN、34例非DN维持性血液透析(MHD)患者及40名健康对照者,比较两组患者一次血液透析前后的变化。结果(1)DN组和非DN组的血浆血浆凝血酶调节蛋白(TM)、血浆纤溶酶原激活物抑制剂-1(PAI-1)、凝血酶-抗凝血酶复合物(TAT)、抗纤溶酶复合物(PAP)质量浓度均较正常对照组明显增高,P均<0.01;但两组间各项指标差别无显著性。(2)两组患者透析后血浆PAI-1质量浓度均较透析前显著性降低;TAT和PAP质量浓度均较透析前明显升高,P均<0.001;但两组指标间差异无显著性。(3)两组患者透析前血浆TM质量浓度均与透析年限呈正相关,P均<0.05。结论DN及非DNMHD患者均有明显的内皮细胞功能障碍及凝血、纤溶系统损害,血液透析可以加重这种损害。

The changes of endothelial cell function and coagulation - fibrinolysis system in maintenance hemodialysis patients with diabetic nephropathy

Objective To find out the changes of endothelial cell function and coagulation-fibrinolysis system in maintenance hemodialysis(MHD)patients with diabetic nephropathy(DN).Methods The plasma levels of TM,PAI-1,TAT and PAP in 28 DN-MHD,34 non-DN MHD and 40 controls were measured by ELISA.Results (1)The levels of TM,PAI-1,TAT and PAP in both DN group and non-DN group were significantly higher than those in control group,P<0.001.(2)In two MHD groups,the post-HD levels of PAI-1 were obviously lower than pre-HD levels, P<0.001; the post-HD levels of TAT and PAP were significantly higher than that of pre-HD,P<0.001,but there were no significant differences between the two MHD groups.(3)There is significant positive correlation between HD duration and plasma levels of TM in both MHD groups,P<0.05.Conclusion There were dysfunction of endothelial cells and coagulation-fibrinolysis in both DN and non-DN MHD patients and HD may impose the damage.