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目的观察糖尿病肾病(DN)血液透析患者内皮细胞功能和凝血、纤溶系统变化。方法选取2003-03～2003-12北京同仁医院血液透析中心的28例DN、34例非DN维持性血液透析(MHD)患者及40名健康对照者,比较两组患者一次血液透析前后的变化。结果(1)DN组和非DN组的血浆血浆凝血酶调节蛋白(TM)、血浆纤溶酶原激活物抑制剂-1(PAI-1)、凝血酶-抗凝血酶复合物(TAT)、抗纤溶酶复合物(PAP)质量浓度均较正常对照组明显增高,P均<0.01;但两组间各项指标差别无显著性。(2)两组患者透析后血浆PAI-1质量浓度均较透析前显著性降低;TAT和PAP质量浓度均较透析前明显升高,P均<0.001;但两组指标间差异无显著性。(3)两组患者透析前血浆TM质量浓度均与透析年限呈正相关,P均<0.05。结论DN及非DNMHD患者均有明显的内皮细胞功能障碍及凝血、纤溶系统损害,血液透析可以加重这种损害。
Objective To investigate the changes of endothelial cell function, coagulation and fibrinolysis system in hemodialysis patients with diabetic nephropathy (DN). Methods 28 cases of DN, 34 cases of non-DN maintenance hemodialysis (MHD) patients and 40 healthy controls were collected from hemodialysis center of Beijing Tongren Hospital from 2003-03 to 2003-12. The changes of hemodialysis patients before and after hemodialysis were compared between the two groups. RESULTS: Plasma concentrations of thrombomodulin (TM), plasma plasminogen activator inhibitor-1 (PAI-1), thrombin-antithrombin complex (TAT) , Anti-plasmin complex (PAP) were significantly higher than the normal control group, P <0.01; however, there was no significant difference between the two groups. (2) The plasma PAI-1 concentration in both groups after dialysis was significantly lower than that before dialysis; the levels of TAT and PAP were significantly higher than those before dialysis (P <0.001), but there was no significant difference between the two groups. (3) The plasma concentrations of TM before dialysis in both groups were positively correlated with the duration of dialysis (all P <0.05). Conclusions Both DN and non-DNMHD patients have obvious endothelial cell dysfunction and coagulation and fibrinolytic system damage. Hemodialysis may aggravate this damage.