투석막에 따른 염증성 싸이토카인의 생성 및 응고기전 활성화에 관한 연구

초록

Background:Blood-dialyzer membrane interaction in hemodialysis has the potential to activate blood coagulation and fibrinolysis, and it might elicit production of inflammatory cytokine such as TNF-α by monocytes activation. The aim of the present study was to; i) assess changes in coagulation status, fibrinolytic activity and plasma level of TNF-α during hemodialysis; ii) determine whether the extent of activation is dependent on the dialyzer material used. Methods:Twenty-five end-stage renal failure patients who had undergone maintenance hemodialysis were included in the study. Patients were randomly divided into two groups; one using hemophan dialyzer membrane (n=13) and the other using polysulfone dialyzer membrane (n=12). On sixth dialysis session, blood samples were obtained before and at the end of hemodialysis. Thrombin-antithrombin complex (TAT) and D-dimer, each reflecting in vivo thrombin generation and fibrin degradation product respectively, were measured for coagulatory and fibrinolytic activity. Tissue plasminogen activator (tPA), plasminogen activator inhibitor-1(PAI-1), and fibrinogen were measured. Activated partial thromboplastin time (aPTT) was measured for efficancy of anticoagulant. Plasma level of TNF-α was also measured. Results:During hemodialysis, plasma level of TNF-α did not change. Between hemophan dialysis and polysulfone dialysis group, the change in plasma level of TNF-α (ΔTNF-α) was not different. Significant changes were observed in aPTT, fibrinogen, TAT, D-dimer, tPA during hemodialysis (p<0.05) except in PAI-1 (p=0.71). Between two groups, changes in aPTT, fibrinogen, D-dimer, PAI-1 and tPA (ΔaPTT, Δfibrinogen, ΔD-dimer, ΔPAI-1, ΔtPA) were not different (p>0.05). However, the change in TAT (ΔTAT) was significantly lower in polysulfone dialysis group (p=0.049). Conclusion:Hemodialysis enhances coagulatory activity despite the use of anticoagulant and also enhances fibrinolytic activity, which is likely the result of tPA release. In activation of coagulatory system, biocompatibility of polysulfone membrane is superior to that of hemophan membrane. Plasma level of TNF-α did not change during hemodialysis, further study should be considered.

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