Salobir Barbara, Sabovic Miso, Zupan Irena Preloznik, Ponikvar Jadranka Buturovic
Department for Pulmonology and Allergic Diseases, University Clinical Center, Ljubljana, Slovenia.
Ther Apher Dial. 2008 Apr;12(2):133-6. doi: 10.1111/j.1744-9987.2008.00558.x.
The factors contributing to platelet dysfunction in hemodialysis patients are still not completely known. We explored whether the fibrinolytic system influences platelet function in hemodialysis patients. We measured standard fibrinolytic parameters and markers of fibrinolysis/coagulation activation, and correlated them to platelet aggregation in 15 hemodialysis patients. Fifteen healthy age-matched volunteers served as controls. Hemodialysis patients had significantly decreased levels of plasminogen (0.76 [0.64-0.86] vs. 0.98 [0.87-1.08] rel, P < 0.001), and increased levels of fibrinogen (4.6 [3.9-5.5] vs. 4.0 [3.4-4.6] g/L, P < 0.05), whereas tissue-type plasminogen activator antigen and plasminogen activator inhibitor (PAI)-1 antigen and PAI activity were comparable to controls. Furthermore, elevated levels of markers of fibrinolysis/coagulation were found in hemodialysis patients: D-dimer (280 [170-460] vs. 135 [120-150] ng/mL, P < 0.01), prothrombin fragments 1 + 2 (1.7 [1.4-1.9] vs. 1.1 [1.0-1.2] nmol/L, P < 0.001), and thrombin-antithrombin complexes (5.2 [4.2-17.7] vs. 0 [0-4.2]microg/L, P < 0.01). The aggregation of platelets (induced by adenosine diphosphate) was slightly impaired in patients compared to controls (72 [43-79] vs. 83 [73-88]%, P = 0.08). Analysis showed that platelet aggregation positively correlated with plasminogen levels (r = 0.48, P < 0.01). No correlation with other fibrinolytic parameters or markers of activation was found. In hemodialysis patients platelet (dys)function appears to be associated with both the fibrinolytic and coagulation systems. We found that platelet aggregation significantly correlates with plasma plasminogen levels. This relation, which has not been hitherto described, seems to be causal and clinically important. Further exploration of this may help us to better understand the mechanisms of platelet dysfunction in hemodialysis patients.
导致血液透析患者血小板功能障碍的因素仍不完全清楚。我们探讨了纤溶系统是否影响血液透析患者的血小板功能。我们测量了标准纤溶参数以及纤溶/凝血激活标志物，并将它们与15例血液透析患者的血小板聚集情况进行关联分析。15名年龄匹配的健康志愿者作为对照。血液透析患者的纤溶酶原水平显著降低（相对值0.76[0.64 - 0.86]对0.98[0.87 - 1.08]，P < 0.001），纤维蛋白原水平升高（4.6[3.9 - 5.5]对4.0[3.4 - 4.6]g/L，P < 0.05），而组织型纤溶酶原激活物抗原、纤溶酶原激活物抑制剂（PAI）-1抗原及PAI活性与对照组相当。此外，血液透析患者中纤溶/凝血标志物水平升高：D - 二聚体（280[170 - 460]对135[120 - 150]ng/mL，P < 0.01）、凝血酶原片段1 + 2（1.7[1.4 - 1.9]对1.1[1.0 - 1.2]nmol/L，P < 0.001）以及凝血酶 - 抗凝血酶复合物（5.2[4.2 - 17.7]对0[0 - 4.2]μg/L，P < 0.01）。与对照组相比，患者（由二磷酸腺苷诱导的）血小板聚集略有受损（72[43 - 79]%对83[73 - 88]%，P = 0.08）。分析表明血小板聚集与纤溶酶原水平呈正相关（r = 0.48，P < 0.01）。未发现与其他纤溶参数或激活标志物有相关性。在血液透析患者中，血小板（功能）异常似乎与纤溶和凝血系统均有关联。我们发现血小板聚集与血浆纤溶酶原水平显著相关。这种此前未被描述的关系似乎具有因果性且具有临床重要性。对此进行进一步探索可能有助于我们更好地理解血液透析患者血小板功能障碍的机制。
