Tomura S, Nakamura Y, Doi M, Ando R, Ida T, Chida Y, Ootsuka S, Shinoda T, Yanagi H, Tsuchiya S, Marumo F
Institute of Community Medicine, University of Tsukuba, Japan.
Am J Kidney Dis. 1996 Jun;27(6):848-54. doi: 10.1016/s0272-6386(96)90523-5.
Mortality rates associated with cardiovascular disease (CVD) are high in long-term dialysis patients. Increased levels of plasma fibrinogen (FBG), coagulation factor VII (FVII), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) as well as hyperlipidemia are regarded as important risk factors for CVD. To investigate whether there are differences in the risk of CVD between chronic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, serum lipid levels and plasma FBG, FVII, t-PA, and PAI-1 levels were measured in 17 patients on HD and 17 patients on CAPD. FBG was measured by the thrombin time method, FVII activity (FVIIc) by the chromogenic prothrombin time method, and t-PA and PAI-1 activity by the chromogenic substrate assay. No difference was found in body mass index (BMI) between HD and CAPD patients. Total cholesterol (TC), TC/high-density lipoprotein (HDL)-C ratio, low-density lipoprotein (LDL)-C, and triglycerides (TG) were significantly increased, and HDL-C was significantly decreased in CAPD patients compared with HD patients. FBG and FVIIc were significantly elevated in CAPD patients compared with controls or HD patients. T-PA activities were significantly higher in HD and CAPD patients than in controls. CAPD patients showed significantly higher PAI-1 activities than controls or HD patients. Significant positive correlations were found between FBG or FVIIc and TC, between FBG and LDL-C or TG, and between FVIIc and LDL-C in these patients. T-PA showed significant negative correlations with FBG, PAI-1, TC, LDL-C, and TG. There was a significant positive correlation between PAI-1 and TG and a significant negative correlation between PAI-1 and HDL-C. We conclude that CAPD patients may have a greater risk of CVD than do HD patients, and that coagulation and fibrinolytic activity are correlated with lipid disorders in these patients.
长期透析患者中，与心血管疾病（CVD）相关的死亡率很高。血浆纤维蛋白原（FBG）、凝血因子VII（FVII）、组织纤溶酶原激活物（t-PA）和纤溶酶原激活物抑制剂-1（PAI-1）水平升高以及高脂血症被视为CVD的重要危险因素。为了研究慢性血液透析（HD）患者和持续性非卧床腹膜透析（CAPD）患者之间CVD风险是否存在差异，对17例HD患者和17例CAPD患者的血脂水平以及血浆FBG、FVII、t-PA和PAI-1水平进行了测量。FBG采用凝血酶时间法测量，FVII活性（FVIIc）采用发色底物法测量，t-PA和PAI-1活性采用发色底物法测量。HD患者和CAPD患者的体重指数（BMI）没有差异。与HD患者相比，CAPD患者的总胆固醇（TC）、TC/高密度脂蛋白（HDL）-C比值、低密度脂蛋白（LDL）-C和甘油三酯（TG）显著升高，HDL-C显著降低。与对照组或HD患者相比，CAPD患者的FBG和FVIIc显著升高。HD患者和CAPD患者的t-PA活性显著高于对照组。CAPD患者的PAI-1活性显著高于对照组或HD患者。在这些患者中，FBG或FVIIc与TC之间、FBG与LDL-C或TG之间以及FVIIc与LDL-C之间存在显著正相关。t-PA与FBG、PAI-1、TC、LDL-C和TG之间存在显著负相关。PAI-1与TG之间存在显著正相关，PAI-1与HDL-C之间存在显著负相关。我们得出结论，CAPD患者可能比HD患者有更大的CVD风险，并且这些患者的凝血和纤溶活性与脂质紊乱相关。
