Christidou Fotini, Bamichas Gerasimos, Galaktidou Grammate, Fragidis Stylianos, Gionanlis Lazaros, Frangia Theodora, Bischiniotis Theodoros, Sombolos Kostas
Nephrology Department G.H. G. Papanikolaou, Thessaloniki, Greece.
Ren Fail. 2008;30(9):861-4. doi: 10.1080/08860220802353835.
It has been reported that hemodialysis (HD) stimulates hepatocyte growth factor (HGF) release, but it is not clear if this stimulation is due to HD itself or to heparin used during HD. To clarify this issue, we undertook the present study.
We studied 18 HD patients using high-flux dialyzers, during a single 4-hr hemodialysis session (session A). The dialyzers were pre-rinse with normal saline without heparin, and HD was started with zero ultrafiltration and without anticoagulation. Anticoagulation was administered as IV injection (80 IU/kg of LMWH enoxaparin sodium) 10 min after the beginning of HD. HD was continued for 10 more minutes and then as prescribed. HGF serum levels were measured before the beginning of the HD session (sample t0) as well as 10 and 20 minutes after the beginning of the session (samples t10 and t20). In six more patients (controls), the same study was repeated but without the administration of LMWH during the first 20 min of HD initiation (session B).
In comparison with t0, t10 HGF serum levels changed significantly in neither session A nor in session B. However, at t20, HGF levels increased significantly in session A compared with t0 (increment 666.3 +/- 211.0%, p < 0.0001) and t10 (increment 894.2 +/- 506.0%, p < 0.0001), but not in session B. No differences were found between sessions A and B at samples t0 and t10 (p = NS). HGF serum levels at t20 in session A were found to be higher compared with corresponding levels in session B (p < 0.0001).
Elevated HGF serum levels at the beginning of high-flux HD session are due to LMWH administration.
据报道，血液透析（HD）可刺激肝细胞生长因子（HGF）释放，但尚不清楚这种刺激是由于HD本身还是HD期间使用的肝素所致。为阐明这一问题，我们进行了本研究。
我们使用高通量透析器对18例HD患者进行了研究，透析时间为单次4小时（A组）。透析器先用不含肝素的生理盐水预冲洗，HD开始时超滤率为零且不进行抗凝。HD开始10分钟后静脉注射抗凝剂（80 IU/kg低分子肝素钠）。HD再持续10分钟，然后按规定进行。在HD开始前（样本t0）以及开始后10分钟和20分钟（样本t10和t20）测量血清HGF水平。另外对6例患者（对照组）重复相同研究，但在HD开始的前20分钟不给予低分子肝素（B组）。
与t0相比，A组和B组的t10时血清HGF水平均无显著变化。然而，在t20时，A组的HGF水平与t0相比显著升高（升高666.3±211.0%，p<0.0001），与t10相比也显著升高（升高894.2±506.0%，p<0.0001），而B组未升高。在样本t0和t10时，A组和B组之间无差异（p=无统计学意义）。发现A组t20时的血清HGF水平高于B组相应水平（p<0.0001）。
高通量HD开始时血清HGF水平升高是由于给予了低分子肝素。
