Blood Coagulability in Chronic Renal Failure:II. in Non-hemodialysed Patients
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概要
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The blood coagulability of 28 chronic non-hemodialysed renal failure patients was investigated. Systemic diseases such as systemic lupus erythematosus or diabetes mellitus were excluded because of their own coagulation abnormalities. All patients were in uremic state. Fasting blood samples were drawn from antecubital vein early in the morning with 3.8% sodium citrate as the anticoagulant. When not measured immediately, samples were stored at -80°C. Following assessments were performed: PT, APTT, TEG (whole blood method), fibrinogen, factor II, V, VII, VIII, IX, X, XI, XII procoagulant activities, factor VIII related antigen (Laurell's method) (VIIIANG), antigen levels of antithrombin III ATIII), and α2 macrogloburin (α2MG) with Mancini's method, serial dilution protamin sulfate test (SDPS), ethanol gelation test (EG), high molecular weight fibrinogen complex (HMWFC) (gel filtration method), fibrin/fibrinogen degradation products (latex aggregation method) (FDP). BUN, creatinine, blood pH, total CO2 and hematocrit were also determined as the indicators of uremic state. Results were as follows. Shortened results were obtained in APTT (p<0.001), TEG-r (p<0.001) and TEG-K (p<0.001). Increased results were obtained in TEG-ma (p<0.001), fibrinogen (p<0.001), factor V (p<0.05), factor VII (p<0.05), factor VIII (p<0.001), factor IX (p<0.01), VIIIANG (p<0.001), α2MG (p<0.02), FDP (p<0.01), HMWFC (p<0. 001). Positive EG is in 14 of 28. SDPS ×5-11, ×10-14, ×20-3. Mean BUN, creatinine, blood pH, total CO2 and hematocrit were 105±27mg/dl, 12.2±3.9mg/dl, 7.28±0.06, 14.1±3.6mM/L and 20.5±4.8%, respectively. These results indicated that hyper coagulable state and low grade tendency of intravascular coagulation existed in uremia. The precise mechanism of intravascular coagulation was unknown. But increased level of VIIIANG might be indicative of endothelial damage, because VIIIANG was synthesized in vascular endothelial cells. More details remained to be elucidated.
- 一般社団法人 日本血栓止血学会の論文
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