低分子肝素对血液透析患者血脂水平及血管内皮舒张功能的影响

目的观察低分子肝素对尿毒症血液透析患者脂质代谢和内皮依赖性血管舒张功能的影响。方法选择上海市利群医院肾内科38例无明显出血倾向的尿毒症患者,随机分成普通肝素（UFH）组（18例）及低分子肝素（LMWH）组（20例）于透析前分别按个体剂量给予普通肝素及低分子肝素钠动脉血路端注射,并在治疗前、治疗后6月及l2月检测血脂、低密度脂蛋白胆固醇（LDL-c）、高密度脂蛋白胆固醇（HDL-c）、基础肱动脉内径、内皮依赖性血流介导的舒张反应（FMD）,以20例血脂正常的成人为对照。结果①两治疗组透析前血清胆固醇（Ch）、三酰甘油（TG）、LDL-c均高于对照组（P〈0.05）;②透析l2月后,UFH组TG显著升高（P〈0.05）,HDL-c较透析前降低,LDL-c显著增高（P〈0.05）;LMWH组TG显著降低（P〈0.05）,HDL-c、LDL-c较透析前无明显改变。③与正常对照组比较,血液透析患者基础肱动脉内径明显增宽,（P〈0.05）,FMD明显受损（P〈0.01）;透析12月后,两治疗组FMD仍低于正常对照,但UFH组较LMWH组明显降低（P〈0.01）。结论血液透析患者存在血脂紊乱和血管内皮功能障碍,长期使用LMWH代替普通肝素抗凝,可部分减轻尿毒症血液透析患者血脂异常,并有助于保持患者血管内皮功能的相对稳定,防止血液透析患者血管内皮功能的进一步损害。

Effect of low molecular weight heparin on blood lipids and dilatation function of vascular endothelia in hemodialysis patients

Objective To investigate the effect of low molecular weight heparin on blood lipids and dilatation function of endothelial function in maintenance hemodialysis patients. Methods We recruited 38 pre-dialysis and uremic patients, and assigned them into two groups： unfractionated heparin group （UFH, n=18） and low molecular weight heparin （Fragmin） group （LMWH, n=20）. Individualized dose of UFH or Fragmin was injected to the arterial route before dialysis. At the time before dialysis and after dialysis for 6 and 12 months, plasma lipids and Iipoproteins were measured, and high-resolution ultrasound examination was performed to measure the baseline diameter and the endothelium-dependent flow-mediate dilation （FMD） of brachial artery. We also included 20 adults with normal serum lipids as the controls. Results Significant increase in serum triglycerides （TG）, total cholesterol （TC） and low density lipoprotein cholesterol （LDL-C） were observed in both groups before hemodialysis. In LMWH group after the dialysis for 12 months, serum TG was decreased, and serum high density lipoprotein cholesterol （HDL-C） and LDL-C remained unchanged as compared with those before dialysis. In UFH group, however, serum TG and LDL-C were elevated, and serum HDL-C was decreased. In the 2 groups, baseline diameter of brachial artery became larger, and the FMD of brachial artery was impaired. After the dialysis for 12 months, the FMD was much lower in UFH group than in LMWH group. Conclusion The long-term use of LMWH instead of conventional heparin during dialysis is beneficial to improve the abnormal serum lipid profiles, to stabilize vascular endothelial function, and to prevent the endothelial function from further injury in hemodialysis patients.