接受促红细胞生成素治疗的持续性非卧床腹膜透析（CAPD）患者止血的某些方面。

Some aspects of hemostasis in CAPD patients treated with erythropoietin.

作者信息

Małyszko Jolanta, Suchowierska Ewa, Małyszko Jacek S, Myśliwiec Michał

机构信息

Department of Nephrology and Internal Medicine, Medical Academy of Białystok, Zurawia 14, PL-15-540 Białystok, Poland.

出版信息

Kidney Blood Press Res. 2002;25(4):240-4. doi: 10.1159/000066349.

DOI:10.1159/000066349

PMID:12424426

Abstract

BACKGROUND

Bleeding diathesis and simultaneous thrombotic complications may be seen in dialyzed patients. Erythropoietin may shift the precarious balance of the hemostatic system towards thrombosis. Thrombin activatable fibrinolysis inhibitor (TAFI) is a key protein linking coagulation and fibrinolysis.

METHODS

The effects of 3-month erythropoietin treatment on some hemostatic parameters--TAFI, fibrinolytic activity index (FAI), markers of ongoing coagulation (thrombin-antithrombin complexes and prothrombin fragments 1 + 2), marker of ongoing fibrinolysis (plasmin-antiplasmin complexes) and marker of endothelial cell injury (thrombomodulin)--were studied in 17 patients on continuous ambulatory peritoneal dialysis (CAPD). Patients on CAPD not treated with rHuEPO were also studied. Healthy volunteers served as a control group. 2,000 U erythropoietin was given subcutaneously three times a week. Commercially available kits were used to determine hemostatic parameters.

RESULTS

All the hemostatic parameters studied were significantly higher in CAPD patients when compared to the control group. All these hemostatic parameters except the plasmin-antiplasmin complexes did not differ significantly between patients before rHuEPO therapy and patients without rHuEPO. Erythropoietin therapy resulted in a significant decrease in plasmin-antiplasmin complexes, a significant rise in FAI after 3 months of drug administration, and a tendency to decrease the TAFI concentration and activity (after 1 month, p = 0.11 and p = 0.10, respectively; after 3 months p = 0.07 and p = 0.06, respectively). Treatment with erythropoietin did not affect platelet count, prothrombin time, activated partial thromboplastin time, cholesterol, triglycerides, fibrinogen, total protein, albumin, serum iron, ferritin, fibronectin, pH, bicarbonates, creatinine, and urea. Hemoglobin and hematocrit increased significantly after 1 month of the therapy.

CONCLUSION

Short-term treatment with erythropoietin seems to minimally affect hemostasis in CAPD patients.

摘要

背景

透析患者可能会出现出血素质和同时发生的血栓形成并发症。促红细胞生成素可能会使止血系统不稳定的平衡向血栓形成方向转变。凝血酶激活的纤溶抑制物（TAFI）是连接凝血和纤溶的关键蛋白。

方法

在17例持续非卧床腹膜透析（CAPD）患者中研究了3个月促红细胞生成素治疗对一些止血参数的影响，这些参数包括TAFI、纤溶活性指数（FAI）、凝血进行中的标志物（凝血酶 - 抗凝血酶复合物和凝血酶原片段1 + 2）、纤溶进行中的标志物（纤溶酶 - 抗纤溶酶复合物）和内皮细胞损伤标志物（血栓调节蛋白）。还研究了未接受重组人促红细胞生成素（rHuEPO）治疗的CAPD患者。健康志愿者作为对照组。每周皮下注射2000 U促红细胞生成素3次。使用市售试剂盒测定止血参数。

结果

与对照组相比，CAPD患者所有研究的止血参数均显著更高。在接受rHuEPO治疗的患者和未接受rHuEPO治疗的患者之间，除纤溶酶 - 抗纤溶酶复合物外，所有这些止血参数均无显著差异。促红细胞生成素治疗导致纤溶酶 - 抗纤溶酶复合物显著降低，给药3个月后FAI显著升高，TAFI浓度和活性有降低趋势（1个月后，p分别为0.11和0.10；3个月后，p分别为0.07和0.06）。促红细胞生成素治疗不影响血小板计数、凝血酶原时间、活化部分凝血活酶时间、胆固醇、甘油三酯、纤维蛋白原、总蛋白、白蛋白、血清铁、铁蛋白、纤连蛋白、pH、碳酸氢盐、肌酐和尿素。治疗1个月后血红蛋白和血细胞比容显著升高。