Opatrný K, Vít L, Opatrná S, Sulková S, Bodláková B
Interní oddĕlení Strahov 1. LF UK a VFN, Praha.
Cas Lek Cesk. 1994 May 30;133(11):346-9.
Haemodialysis patients with chronic renal failure suffer not only from thromboses of the vascular access but frequently also from atherosclerosis with thrombotic complications. Knowledge of the etiopathogenesis of thrombotic complications in haemodialysis patients are incomplete. The aim of the present study was to evaluate fibrinolysis at the level of plasminogen activation under conditions of a dynamic test, using methods which reflect sensitively and specifically the activity of the tissue-type plasminogen activator (t-PA) and the activity of the inhibitor of the tissue-type plasminogen activator (PAI-1).
The group of examined subjects was formed by 16 patients (9 men and 7 women, mean age 42 years, range 26-63) who suffered from chronic renal failure (causes: 9x chronic glomerulonephritis, 6x interstitial nephritis, 1x polycystic kidneys) treated by long-term haemodialysis on average for 52 (20-110) months; the control group of 11 healthy volunteers was very close as regards age distribution. t-PA and PAI-1 were examined after stimulation by venous occlusion (VO). In healthy subjects VO significantly raises the t-PA activity (first value before, second after VO: t-PA 0.81-2.19 IU/ml, p < 0.01), specific t-PA activity (0.19-0.31 IU/ng, p < 0.05) and t-PA/PAI (0.06-0.24 IU/U, p < 0.01, decreases PAI activity (11.80-10.98 U/ml, p < 0.05) and specific PAI activity (0.52-0.40 U/ng, p < 0.01). In the group of haemodialysis patients VO did not change significantly the t-PA activity (p = NS), the specific t-PA activity (p = NS), nor the ratio of t-PA/PAI (p = NS); the PAI declined significantly (13.78-10.65 U/ml, p < 0.05), similarly as the specific PAI activity (0.97-0.65 U/ng, p < 0.01). From comparison of the results of fibrinolysis from healthy and dialysis subjects ensues that the response to VO in dialysis patients differs from that in healthy subjects.
Dialysis patients have impaired fibrinolysis manifested by a lacking rise of activity of the plasminogen tissue activator after stimulation by venous occlusion. The small rise of t-PA activity after venous occlusion can contribute to the development of thrombotic complications in haemodialyzed patients.
慢性肾衰竭的血液透析患者不仅会发生血管通路血栓形成，还常常并发动脉粥样硬化及血栓性并发症。目前对于血液透析患者血栓性并发症的发病机制了解尚不完整。本研究的目的是在动态试验条件下，采用能够灵敏且特异反映组织型纤溶酶原激活物（t-PA）活性及组织型纤溶酶原激活物抑制剂（PAI-1）活性的方法，评估纤溶酶原激活水平的纤溶作用。
研究对象包括16例患者（9例男性，7例女性，平均年龄42岁，范围26 - 63岁），他们患有慢性肾衰竭（病因：9例慢性肾小球肾炎，6例间质性肾炎，1例多囊肾），平均接受长期血液透析52（20 - 110）个月；11名健康志愿者作为对照组，年龄分布与之相近。通过静脉闭塞（VO）刺激后检测t-PA和PAI-1。在健康受试者中，VO可显著提高t-PA活性（VO前第一个值，VO后第二个值：t-PA 0.81 - 2.19 IU/ml，p < 0.01）、特异性t-PA活性（0.19 - 0.31 IU/ng，p < 0.05）以及t-PA/PAI（0.06 - 0.24 IU/U，p < 0.01），降低PAI活性（11.80 - 10.98 U/ml，p < 0.05）和特异性PAI活性（0.52 - 0.40 U/ng，p < 0.01）。在血液透析患者组中，VO并未显著改变t-PA活性（p = 无显著性差异）、特异性t-PA活性（p = 无显著性差异）以及t-PA/PAI比值（p = 无显著性差异）；PAI显著下降（13.78 - 10.65 U/ml，p < 0.05），特异性PAI活性也同样下降（0.97 - 0.65 U/ng，p < 0.01）。通过比较健康受试者和透析患者的纤溶结果可知，透析患者对VO的反应与健康受试者不同。
透析患者存在纤溶功能受损，表现为静脉闭塞刺激后纤溶酶原组织激活物活性缺乏升高。静脉闭塞后t-PA活性的微小升高可能导致血液透析患者血栓性并发症的发生。
