Deguchi K, Izumi K, Noguchi M, Wada H, Shirakawa S
2nd Department of Internal Medicine, Faculty of Medicine, Mie University, Japan.
Thromb Res. 1988 Jan 1;49(1):69-77. doi: 10.1016/0049-3848(88)90360-x.
Dysfunction of vascular endothelial cells and accelerated calcification of the abdominal aorta were found in patients on maintenance hemodialysis. Indicators of vascular wall function, expressed as the amount of plasminogen activator and von Willebrand factor released during venous occlusion, suggested that the cubital venous wall in patients has normo- or hyper-responsiveness to occlusion. Calcification of the abdominal aorta on CT scan image was observed in most of patients including those of the ages of twenties years. The mean aortic calcification index (ACI), as an indicator of organic changes in vascular wall, was significantly higher in dialysis patients than in the nondialysis subjects. However, the mean values of indicators for vascular wall function decreased and ACI increased, as the period of treatment with hemodialysis became longer. A significant negative correlation was found between the mean ACI and most indicators of vascular wall function. The function of cubital vein was suggested to decrease in association with the progress in mural calcification of the abdominal aorta. We conclude that the alteration of the coagulation-fibrinolysis system induced by repeated hemodialysis may result from and continue to exacerbate endothelial damage, the consequence of which may be atherosclerosis.
维持性血液透析患者存在血管内皮细胞功能障碍以及腹主动脉钙化加速的情况。血管壁功能指标，以静脉闭塞期间释放的纤溶酶原激活物和血管性血友病因子的量来表示，提示患者的肘静脉壁对闭塞具有正常或高反应性。在大多数患者中，包括二十多岁的患者，CT扫描图像上观察到腹主动脉钙化。作为血管壁器质性改变指标的平均主动脉钙化指数（ACI），透析患者显著高于非透析受试者。然而，随着血液透析治疗时间延长，血管壁功能指标的平均值下降而ACI升高。平均ACI与大多数血管壁功能指标之间存在显著负相关。提示肘静脉功能随着腹主动脉壁钙化的进展而降低。我们得出结论，反复血液透析引起的凝血-纤溶系统改变可能源于并持续加剧内皮损伤，其后果可能是动脉粥样硬化。
