Canavese C, Stratta P, Pacitti A, Mangiarotti G, Racca M, Oneglio R, Vercellone A
Clin Nephrol. 1982 Feb;17(2):82-9.
In addition to a hemorrhagic diathesis, uremia is accompanied by a clotting tendency, caused by a marked fall in fibrinolytic capacity. Measurement of lysis time of whole blood diluted with phosphate and acetate buffers and of euglobulin lysis times showed that accumulation of inhibitors is primarily responsible. These probably belong to the class of small molecules abnormally retained in uremia. Hemodialysis (HD) offers the best method of correction, mainly because of better elimination of these inhibitors. In contrast, hemofiltration (HF) and, particularly, intermittent peritoneal dialysis (IPD) are much less effective. In IPD, protein loss via the peritoneum is also responsible for a loss of fibrinolytic activators, so that fibrinolysis becomes even poorer, exposing the patient to an increased risk of vascular complications.
除了出血素质外，尿毒症还伴有凝血倾向，这是由纤溶能力显著下降引起的。用磷酸盐和醋酸盐缓冲液稀释的全血溶解时间以及优球蛋白溶解时间的测量表明，抑制剂的积累是主要原因。这些抑制剂可能属于尿毒症时异常潴留的小分子类别。血液透析（HD）是最佳的纠正方法，主要是因为能更好地清除这些抑制剂。相比之下，血液滤过（HF），尤其是间歇性腹膜透析（IPD）的效果要差得多。在IPD中，通过腹膜的蛋白质丢失也导致纤溶激活剂的丢失，从而使纤溶作用更差，使患者面临血管并发症风险增加的问题。
