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目的探讨维持性血液透析患者检测纤维蛋白单体的临床意义。方法对维持性血液透析患者脑梗死组、无脑梗死组及正常对照组进行凝血酶原时间(prothrombin time,PT)、活化的部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thormbin time,TT)、纤维蛋白原降解产物(fibrinogen degradation product,FDP)、D二聚体(D dimer,DDI)和纤维蛋白单体(fibrin monomer,FM)定量检测,测定三酰甘油(triacylglycerol,TG)、胆固醇(cholesterin,TC)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL)和低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL)等指标并进行统计学分析。心功能分级依据美国纽约心脏病理学(New York heart association,NYHA)分级标准。结果维持性血液透析患者无脑梗死组与对照组比较TG(LSD-t=9.701,P<0.001)、TC(LSD-t=5.779,P<0.001)、HDL(LSD-t=4.742,P<0.001)和LDL(LSD-t=3.152,P<0.001)差异有统计学意义。脑梗死组与对照组比较TG(LSD-t=9.791,P<0.001)、TC(LSD-t=13.509,P<0.001)、HDL(LSD-t=5.251,P<0.001)和LDL(LSD-t=3.152,P<0.001)差异也有统计学意义。无脑梗死组与对照组比较TT、PT和APTT差异无统计学意义(P>0.05)。脑梗死组与对照组比较TT、PT和APTT差异也无统计学意义(P>0.05)。无脑梗死组和对照组比较FDP(LSD-t=8.524,P<0.001)、DDI(LSD-t=16.269,P<0.001)和FM(LSD-t=31.144,P<0.001)差异有统计学意义。脑梗死组和对照组比较FDP(LSD-t=49.621,P<0.001)、DDI(LSD-t=16.757,P<0.001)和FM(LSD-t=46.445,P<0.001)差异也有统计学意义。无脑梗死组和脑梗死组比较TG、TC、HDL和LDL差异无统计学意义(P>0.05)。无脑梗死组和脑梗死组比较FDP(LSD-t=1.607,P=0.175)和DDI(LSD-t=1.734,P=0.189)差异无统计学意义。无脑梗死组和脑梗死组比较FM差异有统计学意义(LSD-t=15.017,P<0.001)。无脑梗死患者心功能Ⅰ~Ⅱ级组与Ⅲ~Ⅳ级组比较FM差异有统计学意义(t=16.097,P<0.001)。脑梗死患者Ⅰ~Ⅱ级组与Ⅲ~Ⅳ级组比较FM差异也有统计学意义(t=19.769,P<0.001)。结论 FM水平可能是判别维持性血液透析患者有无脑梗死的敏感指标。
Objective To investigate the clinical significance of detecting fibrin monomer in maintenance hemodialysis patients. Methods The levels of prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time in maintenance hemodialysis patients with cerebral infarction, non-cerebral infarction and normal control group were compared. The levels of thrombin time (TT), fibrinogen degradation product (FDP), D dimer (DDI) and fibrin monomer (FM) were measured and the levels of triacylglycerol (TG), cholesterin (TC), high density lipoprotein cholesterol (HDL) and low density lipoprotein cholesterol (LDL) were determined and statistically analyzed. Cardiac function was graded according to New York Heart Association (NYHA) grading standards. (LSD-t = 4.772, P <0.001), HDL (LSD-t = 4.742, P < 0.001) and LDL (LSD-t = 3.152, P <0.001), the difference was statistically significant. (LSD-t = 13.509, P <0.001), HDL (LSD-t = 5.251, P <0.001) and LDL (LSD- t = 3.152, P <0.001) The difference was also statistically significant. There was no significant difference in TT, PT and APTT between the group without cerebral infarction and the control group (P> 0.05). There was no significant difference in TT, PT and APTT between cerebral infarction group and control group (P> 0.05). There were statistically significant differences in FDP (LSD-t = 8.524, P <0.001), DDI (LSD-t = 16.269, P <0.001) and FM (LSD-t = 31.144, P <0.001) significance. The differences of FDP (LSD-t = 49.621, P <0.001), DDI (LSD-t = 16.757, P <0.001) and FM (LSD-t = 46.445, P <0.001) in cerebral infarction group and control group were also statistically significant . There was no significant difference in TG, TC, HDL and LDL between the group without cerebral infarction and the group with cerebral infarction (P> 0.05). There was no significant difference in the FDP (LSD-t = 1.607, P = 0.175) and DDI (LSD-t = 1.734, P = 0.189) between the group without cerebral infarction and the group with cerebral infarction. There was a significant difference in FM between the group without cerebral infarction and the group with cerebral infarction (LSD-t = 15.017, P <0.001). There was significant difference in FM between Ⅰ ~ Ⅱ group and Ⅲ ~ Ⅳ group in patients without cerebral infarction (t = 16.097, P <0.001). There was also significant difference in FM between Ⅰ ~ Ⅱ group and Ⅲ ~ Ⅳ group in patients with cerebral infarction (t = 19.769, P <0.001). Conclusion The level of FM may be used as a sensitive indicator of cerebral infarction in maintenance hemodialysis patients.