Verbeelen D, Jochmans K, Herman A G, Van der Niepen P, Sennesael J, De Waele M
Department of Medicine, Academisch Ziekenhuis, Vrije Universiteit, Brussels, Belgium.
Nephron. 1991;59(4):567-72. doi: 10.1159/000186645.
Hemodialysis induces thrombocytopenia and activation of coagulation. The severity of this reaction depends on the kind of membrane. In this study, we present the results of determination of platelet count, and of different factors of coagulation in 10 stable dialysis patients. Measurements were performed at the start and after 15 and 45 min of dialysis. Samples were taken before and after the dialyzer. All 10 patients were treated consecutively and in a random order during 14 days with the following membranes: polyacrylonitrile (Filtral 12, Hospal), hemophan (GFS 120 Plus, Gambro, and Bio-Nephros HF Andante, Organon), polysulfone (F6, Fresenius), cuprammonium (AM50-BIO, Asahi) and cellulose acetate (Duo-Flux, Cordis-Dow). The cellulose acetate membrane induced a small but significant drop of mean platelet count [results are mean (SEM)]: from 245,000 (17,000) to 224,000 (16,000)/microliters after 15 min. With the same membrane a dramatic increase after 15 min was noted of 6-keto-PGF1 alpha from 56.3 (9) to 146.7 (35.7) pg/ml. The other membranes did not influence significantly prostanoid levels and platelet count. During dialysis no significant changes of fibrinopeptide A (FPA) and von Willebrand factor (VWF) were observed. Nevertheless, predialysis FPA and beta-thromboglobulin (beta TG) concentrations were lowest after 14 days of treatment with cellulose acetate and polyacrylonitrile membranes. It is concluded that the activation of coagulation depends on the membrane used. The activation may be dominated by one single system (e.g. prostanoids). The different predialysis concentration of some of the factors suggests interference of the dialysis membrane with the activation of coagulation during the interdialytic period.
血液透析可导致血小板减少和凝血激活。这种反应的严重程度取决于膜的种类。在本研究中，我们呈现了10例稳定透析患者血小板计数及不同凝血因子的测定结果。在透析开始时以及透析15分钟和45分钟后进行测量。在透析器前后采集样本。所有10例患者在14天内依次且随机地使用以下膜进行治疗：聚丙烯腈（Filtral 12，Hospal）、血仿膜（GFS 120 Plus，Gambro，以及Bio - Nephros HF Andante，Organon）、聚砜膜（F6，Fresenius）、铜氨膜（AM50 - BIO，旭化成）和醋酸纤维素膜（Duo - Flux，Cordis - Dow）。醋酸纤维素膜导致平均血小板计数出现轻微但显著的下降[结果为均值（标准误）]：15分钟后从245,000（17,000）降至224,000（16,000）/微升。使用同一膜时，15分钟后6 - 酮 - PGF1α从56.3（9）急剧增加至146.7（35.7）pg/ml。其他膜对类前列腺素水平和血小板计数无显著影响。透析期间未观察到纤维蛋白肽A（FPA）和血管性血友病因子（VWF）有显著变化。然而，在用醋酸纤维素膜和聚丙烯腈膜治疗14天后，透析前FPA和β - 血小板球蛋白（βTG）浓度最低。得出的结论是，凝血激活取决于所使用的膜。激活可能由单一系统主导（如类前列腺素）。某些因子透析前浓度的差异表明透析膜在透析间期对凝血激活有干扰。
