Low Plasma Activated Protein C-Protein C Inhibitor Complex Concentration Is Associated with Vascular Access Failure in Hemodialysis Patients
Low Plasma Activated Protein C-Protein C Inhibitor Complex Concentration Is Associated with Vascular Access Failure in Hemodialysis Patients
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DOI：
10.1159/000166606
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发表时间：
2008-01-01
影响因子：
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通讯作者：
Kurkus, Jan
中科院分区：
文献类型：
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作者：
Bakoush, Omran;Ohlin, Ann-Kristin;Kurkus, Jan
背景：血管通路失败是终末期肾功能衰竭血液透析（HD）患者的常见病因。凝血系统的激活和血栓的形成在动静脉瘘/移植物（AVFG）复发性失败中起重要作用。凝血酶与血栓调节蛋白（TM）复合激活抗凝蛋白C并产生活化蛋白C（APC），随后由蛋白C抑制剂（PCI）灭活。APC和PCI之间的复合物（P-APC-PCI复合物）的血浆浓度在高凝状态下增加，因此是凝血激活程度的敏感指标。方法：对35例通过功能性AVFG透析的HD患者进行了研究。记录AVFG的通畅时间。血液透析治疗前后采血，分析APC-PCI复合物、可溶性TM浓度和活性、血管性血友病因子抗原和同型半胱氨酸。结果如下：频繁AVFG失败的患者（n = 8）的P-APC-PCI复合物水平（中位数0.09 μ g/l）显著低于不频繁AVFG失败的患者（中位数0.18 μ g/l; n = 27; p = 0.04）。两组之间未发现其他显著差异。结论：因此，低水平的P-APC-PCI复合物可能与HD患者AVFG失败的风险增加有关。需要进一步的前瞻性研究来证实这些结果，并评估预防措施的可能性。版权所有（C）2008 S. Karger AG，巴塞尔
Background: Vascular access failure is a common cause of morbidity in patients with end-stage renal failure on hemodialysis (HD). Activation of the coagulation system and formation of a thrombus play important roles in recurrent arteriovenous fistula/graft (AVFG) failure. Thrombin in complex with thrombomodulin (TM) activates the anticoagulant protein C and creates activated protein C (APC), which is subsequently inactivated by the protein C inhibitor (PCI). The plasma concentration of the complex between APC and PCI (P-APC-PCI complex) is increased in hypercoagulable states and is therefore a sensitive indicator of the degree of activation of blood coagulation. Methods: Thirty-five HD patients dialyzed through a functioning AVFG were studied. The period of patency of AVFGs was recorded. Blood was drawn before and after the HD session for the analysis of the APC-PCI complex, soluble TM concentration and activity, von Willebrand factor antigen and homocysteine. Results: Patients with frequent AVFG failures (n = 8) had a significantly lower level of P-APC-PCI complex (median 0.09 mu g/l) than those with less frequent AVFG failures (median 0.18 mu g/l; n = 27; p = 0.04). No other significant differences were found between the groups. Conclusion: Thus, a low level of P-APC-PCI complex may be associated with an increased risk of AVFG failure in HD patients. Further prospective studies are needed to confirm these results and to evaluate the possibility of prophylactic measures. Copyright (C) 2008 S. Karger AG, Basel