維持透析患者における血管内皮傷害に関する研究 ： 凝固・線溶能およびトロンボモジュリンからの検討

Abstract

This study was performed to evaluate the degree of vascular endothelial damage by examining coagulation activity, fibrinolytic activity and vascular endothelial cell function in patients undergoing maintenance hemodialysis treatment (MDT). Twenty-seven patients with chronic renal failure due to primary glomerular disease were enrolled in this study. The items measured were fibrinogen, antithrombin-Ⅲ (ATⅢ), thrombinantithrombin Ⅲ complex (TAT) as parameters for coagulation activity, plasminogen (Plg), α₂-plasmin inhibitor (α₂-PI), α₂-plasmin inhibitor-plasmin complex (PIC), D-dimer, plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA) antigen and its activity for fibrinolytic activity, and von Willebrand factor antigen (vWF : Ag) and thrombomodulin (TM) for vascular endothelial cell function. Predialysis levels of fibrinogen, TAT, PIC, D-dimer, vWF : Ag and TM in MDT patients increased significantly compared with those in normal subjects, while ATⅢ, Plg, α₂PI, PAI-1 and t-PA antigen decreased signigicantly. During single hemodialysis, TAT, PIC, D-dimer, t-PA antigen and its activity, vWF : Ag and TM increased significantly, while PAI-1 apparently decreased. In addition, t-PA activity was consistently elevated during single hemodialysis. There was a positive correlation between predialysis level of TM and duration of MDT. These results suggest that TAT, PIC and D-dimer can be used as good indicators in the coagulation-fibrinolysis system function even in patients with impaired renal function, and that TM is also an excellent indicator in finding out the condition of vascular endothelial injury. Meanwhile, it seemed quite plausible that long-term MDT facilitates the thromboembolic lesion and the atherosclerosis in MDT patients.