Pawlicki J, Cierpka L, Król R, Ziaja J
Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland.
Transplant Proc. 2007 Nov;39(9):2754-5. doi: 10.1016/j.transproceed.2007.08.050.
Hemorrhagic diatheses observed in patients with chronic renal failure result from platelet defects, vessel wall damage, and deficiency of II, VII, IX, and X clotting factors. In contrast, increased levels of fibrinogen and von Willebrand factor, as well as decreased plasma fibrinolytic activity, may lead to thrombotic complications in nephrotic syndrome. Successful kidney transplantation may reverse these disturbances. The aim of the study was to analyze plasma coagulation parameters in the early postoperative period.
We studied 40 patients who received cadaveric kidney grafts in 2005 and 2006 for activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen, and D-dimer concentrations as well as antithrombin III and protein C and S activities. Blood was collected before surgery and on postoperative days 1, 7, and 14.
The APTT, PT, and fibrinogen values did not differ before and after transplantation. The activity of antithrombin III pretransplantation was 80.9% +/- 19.3%, increasing to 114.2% +/- 25.5% on postoperative day 14. The activities of protein C and S pretransplantation were 115.1% +/- 32.2% and 120.2% +/- 51.6%, respectively, increasing to 150.2% +/- 56.6% and 139.5% +/- 35.4%, respectively, on postoperative day 14. D-dimer concentrations increased from 252.3 +/- 312.0 ng/mL before transplantation to 951.5 +/- 1170.8 and 739.1 +/- 1049.8 ng/mL on postoperative days 7 and 14, respectively.
Kidney transplantation increased plasma clotting inhibitor activity in the early postoperative period. The high level of D-dimer observed postoperatively suggested increased thrombotic processes in these patients.
慢性肾衰竭患者出现的出血性素质是由血小板缺陷、血管壁损伤以及Ⅱ、Ⅶ、Ⅸ和Ⅹ凝血因子缺乏所致。相比之下，纤维蛋白原和血管性血友病因子水平升高以及血浆纤维蛋白溶解活性降低，可能导致肾病综合征患者出现血栓并发症。成功的肾移植可能会逆转这些紊乱情况。本研究的目的是分析术后早期的血浆凝血参数。
我们研究了2005年和2006年接受尸体肾移植的40例患者，检测其活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原、D - 二聚体浓度以及抗凝血酶Ⅲ、蛋白C和蛋白S活性。在手术前以及术后第1、7和14天采集血液样本。
移植前后APTT、PT和纤维蛋白原的值无差异。移植前抗凝血酶Ⅲ的活性为80.9%±19.3%，术后第14天增至114.2%±25.5%。移植前蛋白C和蛋白S的活性分别为115.1%±32.2%和120.2%±51.6%，术后第14天分别增至150.2%±56.6%和139.5%±35.4%。D - 二聚体浓度从移植前的252.3±312.0 ng/mL分别增至术后第7天的951.5±1170.8 ng/mL和术后第14天的739.1±1049.8 ng/mL。
肾移植在术后早期增加了血浆凝血抑制剂活性。术后观察到的高D - 二聚体水平表明这些患者的血栓形成过程增加。
