Leitienne P, Trzeciak M C, Adeleine P, Ville D, Dechavanne M, Traeger J, Zech P
Département de Néphrologie, INSERM U 80, Hôpital E. Herriot, Lyon, France.
Int J Artif Organs. 1991 Apr;14(4):227-33.
Eight adults with chronic renal failure were dialyzed using polyacrylonitrile (AN 69) or polysulfone (PS) membranes with a high (HHR) or low (LHR) continuous non-fractionated heparin regimen--a total of either 90 or 50 IU/kg body weight. With the HHR, for a mean anti-Xa (aXa) activity of around 0.40 IU/ml, no plasma activation of coagulation was observed; fibrinopeptide A (FPA) was in agreement with the residual blood volume (RBV) and the state of the bubble trap, especially with the PS membrane. With the LHR, for a mean aXa below 0.21 IU/ml, there was only moderate activation of coagulation. The PS membrane gave different results from the AN 69 membrane, RBV values on the HHR and aXa being lower on both the HHR and LHR, with FPA values being regularly lower on the LHR. The decrease in plasma beta-TG on the LHR was more marked with the PS than with the AN 69 membrane due to loss on dialysis or adsorption, as shown by the arterio-venous difference. The increase in plasma PF4 was related to the effect of heparin. However, there was no platelet activation. On the LHR, platelet count and intraplatelet beta-TG and PF4 levels remained very stable. The two high-flux membranes were very hemocompatible and require only low doses of heparin, but the dialyzer with AN 69 membrane need its geometry improving.
八名慢性肾衰竭成人患者使用聚丙烯腈（AN 69）或聚砜（PS）膜进行透析，采用高剂量（HHR）或低剂量（LHR）持续非分级肝素方案，肝素总量分别为90或50 IU/kg体重。在高剂量方案下，平均抗Xa（aXa）活性约为0.40 IU/ml，未观察到血浆凝血激活；纤维蛋白肽A（FPA）与残余血容量（RBV）及气泡捕捉器状态相符，尤其是使用PS膜时。在低剂量方案下，平均aXa低于0.21 IU/ml时，仅有中度凝血激活。PS膜与AN 69膜的结果不同，高剂量方案下的RBV值以及高、低剂量方案下的aXa值在PS膜上更低，低剂量方案下的FPA值通常也更低。低剂量方案下血浆β-血小板球蛋白（β-TG）的降低在PS膜上比在AN 69膜上更明显，这是由于透析或吸附导致的损失，动静脉差值表明了这一点。血浆血小板第4因子（PF4）的升高与肝素的作用有关。然而，未出现血小板激活。在低剂量方案下，血小板计数以及血小板内β-TG和PF4水平保持非常稳定。这两种高通量膜具有良好的血液相容性，仅需低剂量肝素，但AN 69膜透析器的几何形状需要改进。
