Yu A, Egberg N, Jacobson S H
Department of Clinical Chemistry, Danderyd Hospital, Stockholm, Sweden.
Scand J Clin Lab Invest. 2003;63(2):127-33.
Impaired haemostasis is common in patients with end-stage renal disease, and may cause either thrombotic or bleeding complications. The purpose of this study was to assess whether plasma markers of coagulation activation in patients undergoing chronic haemodialysis (HD) can identify high-risk individuals, and to test the relevancy of type of vascular access or dialysis filter. We measured plasma levels of prothrombin fragment 1+2, fibrin D-dimers and tissue factor in 82 HD patients before and after dialysis. Clinical endpoints during the year following blood sampling were thrombosis in blood access, changes in blood access, other thromboembolic events, bleeding complications, ischaemic vascular disease, or death. We found elevated baseline levels of all three parameters in HD patients, compared to normal reference ranges. Plasma levels of all parameters (particularly fibrin D-dimers) were significantly higher in patients with prosthetic grafts and central venous dialysis catheters than in patients with native vessels. Patients with AV-fistulas or grafts who had bleeding complications (n=7) had significantly higher plasma levels of fibrin D-dimer and prothrombin fragment 1+2. Bleeding complications also occurred more frequently among the patients with prosthetic grafts (3/18) or central venous dialysis catheters (3/11) compared with those with grafts from native vessels (1/53). Other than a bleeding tendency, our data do no show any correlation between coagulation parameters and other clinical complications during haemodialysis. In conclusion, we found elevated plasma levels of markers of coagulation activation among HD patients. High levels of D-dimers and prothrombin fragment 1+2 correlated to bleeding diathesis instead of thromboembolism, and this tendency was most pronounced in patients with prosthetic grafts.
终末期肾病患者常出现止血功能受损，可能导致血栓形成或出血并发症。本研究的目的是评估慢性血液透析（HD）患者的凝血激活血浆标志物是否能识别高危个体，并检验血管通路类型或透析滤器的相关性。我们测量了82例HD患者透析前后血浆中凝血酶原片段1+2、纤维蛋白D-二聚体和组织因子的水平。采血后一年内的临床终点为血液通路血栓形成、血液通路变化、其他血栓栓塞事件、出血并发症、缺血性血管疾病或死亡。我们发现，与正常参考范围相比，HD患者所有这三个参数的基线水平均升高。人工血管和中心静脉透析导管患者的所有参数（尤其是纤维蛋白D-二聚体）血浆水平显著高于自体血管患者。有出血并发症的动静脉内瘘或人工血管患者（n=7）的纤维蛋白D-二聚体和凝血酶原片段1+2血浆水平显著更高。与自体血管人工血管患者（1/53）相比，人工血管（3/18）或中心静脉透析导管患者（3/11）出血并发症也更常见。除出血倾向外，我们的数据未显示凝血参数与血液透析期间的其他临床并发症之间存在任何相关性。总之，我们发现HD患者凝血激活标志物的血浆水平升高。高水平的D-二聚体和凝血酶原片段1+2与出血素质相关而非血栓栓塞，这种倾向在人工血管患者中最为明显。
