Keller F, Hericks K, Schuller I, Passfall J, Joerres A, Meinhold H
Department of General Internal Medicine and Nephrology, Universitäts-Klinikum Steglitz, Germany.
ASAIO J. 1995 Apr-Jun;41(2):173-7.
Clotting of the extracorporal system is the main complication of heparin free hemodialysis performed in patients with an increased risk of bleeding. The authors compared thromboxane B2, platelet factor 4, beta-thromboglobulin, and thromboelastography in systemic blood as markers of thrombogenicity during hemodialysis in eight patients with an increased risk of bleeding. Measurements were performed during hemodialysis with and without heparin. Thromboxane B2 levels in centrifuged blood were evaluated by an 125I assay system using a special extraction with mini-columns and magnetic separation (normal 32-64 pg/ml). At the onset of hemodialysis, thromboxane B2 concentrations in the inflow arterial blood line were lower than normal (30 +/- 23 pg/ml). Thromboxane B2 increased (97 +/- 105 versus 40 +/- 26 pg/ml) and was significantly higher during heparin free hemodialysis than during hemodialysis with heparin (p = 0.01, Wilcoxon matched pairs signed rank test). The highest values were observed in 5 cases with signs of clotting (152 +/- 122 pg/ml). Among the investigated parameters, thromboxane B2 proved to be the most significant serum parameter correlated with platelet activation and the consequently increased risk of incipient clotting during heparin free hemodialysis.
体外循环系统凝血是在出血风险增加的患者中进行无肝素血液透析的主要并发症。作者比较了8例出血风险增加的患者在血液透析期间，作为血栓形成性标志物的全身血液中的血栓素B2、血小板因子4、β-血小板球蛋白和血栓弹性描记术。在有肝素和无肝素的血液透析过程中进行测量。使用特殊的小柱萃取和磁性分离的125I检测系统评估离心血液中的血栓素B2水平（正常范围32 - 64 pg/ml）。在血液透析开始时，流入动脉血路中的血栓素B2浓度低于正常水平（30±23 pg/ml）。血栓素B2升高（97±105对40±26 pg/ml），且无肝素血液透析期间显著高于有肝素血液透析期间（p = 0.01，Wilcoxon配对符号秩检验）。在5例有凝血迹象的病例中观察到最高值（152±122 pg/ml）。在所研究的参数中，血栓素B2被证明是与血小板活化以及因此在无肝素血液透析期间初期凝血风险增加最相关的血清参数。
