Department of Nursing, Federal University of the Valleys of Jequitinhonha and Mucuri, Diamantina, Brazil.
Department of Pharmacy, Laboratory of Immunology, Federal University of the Valleys of Jequitinhonha and Mucuri, Diamantina, Brazil.
Artif Organs. 2022 Sep;46(9):1866-1875. doi: 10.1111/aor.14268. Epub 2022 Apr 27.
Failure to mature the fistula in patients undergoing hemodialysis leads to prolonged use of the central venous catheter (CVC) and can compromise the patency of the catheter and the arteriovenous fistula (AVF) due to thrombus development.
To evaluate hemostatic changes in patients undergoing hemodialysis with prolonged use of CVC or AVF.
Cross-sectional study with a total of 200 adult participants who were divided into the following groups: I:control; II: patients who had 5-8 months of CVC insertion; III: patients who had 9-36 months of insertion; IV patients who had 5-8 months of AVF; and V: patients who had 9-36 months of AVF. Platelet activation was investigated by expressions of GPIIb/IIIa and p-selectin using flow cytometry. The Elisa-thrombomodulin (TM) test was used to compare groups III and V.
The p-selectin percentage expression of group I was 15.30 (12.30-16.80), II 23.25 (20.75-30.55); and III 54.00 (44.75-59.29) were significant (p < 0.001). Groups I, IV, and V were also significant (p < 0.001). The median fluorescence for GPIIb/IIIa for groups I, II, and III were significant (p < 0.0001). As for the Elisa test, an increased absorbance of TM was verified in patients who used the CVC 4372 (3951-4733) compared with those patients who used the AVF 2162 (1932-2485) (p < 0.0001).
It can be concluded that CVC patients had a larger platelet expression of GPIIb/IIIa and p-selectin than AVF patients. The high concentration of TM in CVC patients may suggest a greater stimulation of the intrinsic than extrinsic coagulation pathways.
血液透析患者的瘘管未能成熟会导致中心静脉导管（CVC）的长期使用，并由于血栓形成而影响导管和动静脉瘘（AVF）的通畅性。
评估因 CVC 或 AVF 长期使用而导致血液透析患者止血变化。
共有 200 名成年参与者参与了这项横断面研究，他们被分为以下几组：I：对照组；II：CVC 插入 5-8 个月的患者；III：CVC 插入 9-36 个月的患者；IV：CVC 插入 5-8 个月的患者；V：AVF 插入 9-36 个月的患者。使用流式细胞术通过 GPIIb/IIIa 和 p-选择素的表达来研究血小板活化。使用 ELISA-血栓调节蛋白（TM）试验比较第 III 组和第 V 组。
第 I 组的 p-选择素百分比表达为 15.30（12.30-16.80），第 II 组为 23.25（20.75-30.55），第 III 组为 54.00（44.75-59.29），差异具有统计学意义（p<0.001）。第 I、IV 和 V 组之间的差异也具有统计学意义（p<0.001）。第 I、II 和 III 组的 GPIIb/IIIa 的中位荧光强度差异具有统计学意义（p<0.0001）。对于 ELISA 试验，CVC 组的 TM 吸收度为 4372（3951-4733），AVF 组为 2162（1932-2485），差异具有统计学意义（p<0.0001）。
可以得出结论，与 AVF 患者相比，CVC 患者的血小板 GPIIb/IIIa 和 p-选择素表达更高。CVC 患者中 TM 的高浓度可能提示内源性凝血途径比外源性凝血途径受到更大的刺激。
