Małyszko J, Małyszko J, Pietraszek M, Azzadin A, Myśliwiec M, Buczko W
Klinika Nefrologii Akademii Medycznej, Białymstoku.
Pol Arch Med Wewn. 1993 Aug;90(2):105-11.
Haemorrhagic diathesis is a serious complication of uraemia. Desmopressin is known to shorten prolonged bleeding time in uraemia but mechanism of the haemostatic action of this drug remains still unknown. The aim of the work was to study the effect of desmopressin on some haemostatic parameters in relation to plasma and platelet serotonin. Desmopressin was administered i.v. to 33 haemodialysed patients (age range 27-66 years) in a dose of 0.4 microgram/kg b.w., 90 minutes after desmopressin infusion bleeding time became significantly shorter (p < 0.001) and correlated with the shortening of the euglobulin clot lysis time (r = -0.43, p < 0.05). Tissue plasminogen activator activity increased (p < 0.01) and its inhibitor (PAI) activity decreased (p < 0.001) after desmopressin infusion. A correlation between the fall in platelet serotonin content and changes in tissue plasminogen activator and PAI activities was found (r = 0.55, p < 0.01 respectively). A rise in plasma serotonin concentration was observed. In vitro desmopressin inhibited 14C serotonin uptake in a dose-dependent manner. After 2 hours of platelet incubation with desmopressin in a concentration of 4 ng/ml 16% of 14C serotonin was released. A possibility of serotoninergic mechanism in the haemostatic action of desmopressin is suggested.
出血素质是尿毒症的一种严重并发症。已知去氨加压素可缩短尿毒症患者延长的出血时间，但该药物止血作用的机制仍不清楚。这项工作的目的是研究去氨加压素对一些与血浆和血小板血清素相关的止血参数的影响。对33例接受血液透析的患者（年龄范围27 - 66岁）静脉注射去氨加压素，剂量为0.4微克/千克体重，去氨加压素输注90分钟后出血时间显著缩短（p < 0.001），并与优球蛋白凝块溶解时间的缩短相关（r = -0.43，p < 0.05）。去氨加压素输注后组织纤溶酶原激活物活性增加（p < 0.01），其抑制剂（PAI）活性降低（p < 0.001）。发现血小板血清素含量的下降与组织纤溶酶原激活物和PAI活性的变化之间存在相关性（r分别为0.55，p < 0.01）。观察到血浆血清素浓度升高。体外实验中，去氨加压素以剂量依赖的方式抑制14C血清素的摄取。血小板与浓度为4 ng/ml的去氨加压素孵育2小时后，16%的14C血清素被释放。提示去氨加压素止血作用中存在血清素能机制。
