el-Shahawy M A, Francis R, Akmal M, Massry S G
Division of Nephrology, University of Southern California School of Medicine, Los Angeles 90033.
Clin Nephrol. 1994 May;41(5):308-13.
Uremia may be associated with abnormal hemostasis characterized by a prolonged bleeding time and abnormal in-vitro platelet aggregation. The mechanisms underlying these derangements are not fully elucidated. The present study examined the effect of correction of anemia by recombinant human erythropoietin (r-HuEPO) on these abnormalities in eight dialysis patients. Prior to r-HuEPO therapy the patients had low hematocrits (Hct) (20% +/- 0.7), abnormal bleeding times (23 +/- 1.2 minutes), and marked impairment in platelet aggregation induced by adenosine diphosphate (ADP), epinephrine (Epi), thrombin (Th) and collagen. After correction of the anemia to a Hct of 32% +/- 0.9 over 5 +/- 0.9 months, there were a) significant shortening of the bleeding time (from 23 +/- 1.2 to 10.6 +/- 2.4 minutes, p < 0.01), b) an inverse correlation between the Hct and the bleeding time (r = -0.89, p < 0.001) and c) significant improvement, or normalization of platelet aggregation in response to both concentrations of epinephrine [Epi2 (5.4 x 10(-6) M), 45% +/- 10.5 vs 73.5% +/- 7.3, p < 0.01, and Epi1 (5.4 x 10(-5) M), 49% +/- 10.6 vs 64% +/- 6.6, p < 0.05)], both concentrations of ADP [ADPC'(2 x 10(-6) M), 31% +/- 5.9 vs 60% +/- 9.3, p < 0.05, and ADPB (2 x 10-5), 69.5% +/- 7.6 vs 99% +/- 4.8, p < 0.01], and both concentrations of thrombin [ThC (0.22 u/ml) 28.6% +/- 8.9 vs 80.4% +/- 8.3, p < 0.01, and TH50/50 (0.44 u/ml), 57.8% +/- 6.7 vs 83.3% +/- 9.2, p < 0.01)].(ABSTRACT TRUNCATED AT 250 WORDS)
尿毒症可能与止血异常有关，其特征为出血时间延长和体外血小板聚集异常。这些紊乱背后的机制尚未完全阐明。本研究检测了重组人促红细胞生成素（r-HuEPO）纠正贫血对8例透析患者这些异常情况的影响。在r-HuEPO治疗前，患者的血细胞比容（Hct）较低（20%±0.7），出血时间异常（23±1.2分钟），并且由二磷酸腺苷（ADP）、肾上腺素（Epi）、凝血酶（Th）和胶原蛋白诱导的血小板聚集明显受损。在5±0.9个月内将贫血纠正至血细胞比容为32%±0.9后，出现了以下情况：a）出血时间显著缩短（从23±1.2分钟缩短至10.6±2.4分钟，p<0.01）；b）血细胞比容与出血时间呈负相关（r=-0.89，p<0.001）；c）对两种浓度肾上腺素[Epi2（5.4×10⁻⁶M），45%±10.5对73.5%±7.3，p<0.01，和Epi1（5.4×10⁻⁵M），49%±10.6对64%±6.6，p<0.05]、两种浓度ADP[ADPC'（2×10⁻⁶M），31%±5.9对60%±9.3，p<0.05，和ADPB（2×10⁻⁵），69.5%±7.6对99%±4.8，p<0.01]以及两种浓度凝血酶[ThC（0.22 u/ml）28.6%±8.9对80.4%±8.3，p<0.01，和TH50/50（0.44 u/ml），57.8%±6.7对83.3%±9.2，p<0.01]的反应中，血小板聚集显著改善或恢复正常。（摘要截选至250字）
