Opatrný K, Vít L, Opatrná S, Bodláková B, Sulková S, Opatrný K, Krist'an M
Interní oddĕlení VFN, Praha, Strahov.
Cas Lek Cesk. 1995 Mar 8;134(5):136-8.
According to some data treatment with human recombinant erythropoietin (EPO) in dialyzed patients leads to a more frequent occurrence of thromboses. One of the possible causes could be reduced fibrinolysis. The objective of the present study was to assess the effect of EPO in dialyzed patients on two key enzymes of fibrinolysis, i.e. the tissue activator of plasminogen (t-PA) and the inhibitor of the plasminogen activator (PAI-1).
In eight patients dialyzed for prolonged periods examined under otherwise equal conditions before EPO treatment (haematocrit 22.9%--median value) and after 9.5 weeks of EPO treatment (Recormon, s.c.) when a haematocrit of 30% was achieved, activities (chromogenic substrates) and antigens (ELISA of t-PA and PAI) were assessed. All examinations were made before and after venous occlusion. Between examinations made before treatment and during EPO treatment no significant difference was found in the t-Pa activities assessed before venous occlusion (before EPO 0.9 IU/ml--during EPO 0.6, not significant Wilcoxon's paired test) nor after venous occlusion (3.2-3.8, n.s.). PAI activities before venous occlusion (10.9 U/ml-18.3, n.s.) and after venous occlusion (9.7-11.5, n.s.) did not differ significantly either, when comparing values before and in the course of EPO treatment. Similarly as in the case of activities in antigens t-PA and PAI no difference was found before and during EPO.
No effect of EPO on the investigated indicators of fibrinolysis was found. The results of the presented investigation are at variance with the idea that EPO reduces fibrinolysis in dialyzed patients and thus contributes to the development of thrombotic complications.
根据一些数据，在透析患者中使用人重组促红细胞生成素（EPO）进行治疗会导致血栓形成的发生率更高。其中一个可能的原因可能是纤维蛋白溶解减少。本研究的目的是评估EPO对透析患者纤溶的两种关键酶，即纤溶酶原组织激活剂（t-PA）和纤溶酶原激活剂抑制剂（PAI-1）的影响。
对8例长期透析患者在EPO治疗前（血细胞比容22.9%——中位数）以及在皮下注射重组促红细胞生成素（Recormon）9.5周后血细胞比容达到30%时，在其他条件相同的情况下进行检查，评估活性（发色底物法）和抗原（t-PA和PAI的ELISA法）。所有检查均在静脉阻塞前后进行。在治疗前和EPO治疗期间进行的检查中，静脉阻塞前评估的t-Pa活性（EPO治疗前0.9 IU/ml——EPO治疗期间0.6，Wilcoxon配对检验无显著性差异）以及静脉阻塞后（3.2 - 3.8，无显著性差异）均未发现显著差异。比较EPO治疗前和治疗过程中的值时，静脉阻塞前（10.9 U/ml - 18.3，无显著性差异）和静脉阻塞后（9.7 - 11.5，无显著性差异）的PAI活性也没有显著差异。与t-PA和PAI抗原活性的情况类似，EPO治疗前和治疗期间未发现差异。
未发现EPO对所研究的纤溶指标有影响。本研究结果与EPO会降低透析患者纤溶并因此导致血栓形成并发症的观点不一致。
