双重血浆分子吸附系统临床治疗过程中甲磺酸萘莫司他与普通肝素抗凝效果研究*

doi:10.3969/j.issn.1672-5069.2025.03.020

摘要/Abstract

摘要： 目的比较双重血浆分子吸附系统(DPMAS)治疗肝衰竭(LF)患者过程中应用甲磺酸萘莫司他(NM)与普通肝素(UFH)的抗凝效果。方法 2023年5月～2024年5月山西白求恩医院消化内科接受治疗的LF患者27例,均接受DPMAS治疗。常规检测凝血酶原时间(PT)、部分活化的凝血酶原时间(APTT)和血小板(PLT)计数,自动计算凝血酶原时活动度(PTA)和国际标准化比值(INR)。结果纳入的27例LF患者共接受了62例次DPMAS治疗,其中应用UFH抗凝21例次,NM抗凝41例次;在DPMAS治疗后,NM抗凝组APTT和INR延长率分别为1.3(-3.6,9.0)%和2.5(-8.5,16.6)%,显著低于UFH抗凝组【分别为271.1(49.0,816.5)%和68.9(44.8,118.8)%,P<0.05】,PTA和PLT计数下降率分别为(4.2±23.7)%和4.6(1.3,7.6)%,显著低于UFH 抗凝组【分别为(46.5±24.3)%和(13.0±12.6)%,P<0.05】;NM抗凝组低血压发生率为9.8%,与UFH抗凝组的14.3%比,无显著性差异(P>0.05),治疗期间和治疗结束后24 h内未发生明显的活动性出血。结论对于接受DPMAS治疗的LF患者,应用NM抗凝对凝血功能指标和PLT计数的影响相对较小,但可能会出现抗凝不足导致机器频繁报警,应用例数也还少,需要进一步观察。

关键词: 肝衰竭, 双重血浆分子吸附系统, 甲磺酸萘莫司他, 普通肝素, 抗凝

Abstract: Objective This clinical trial was conducted to compare anticoagulational effect of nafamostat mesylate (NM) and unfractionated heparin (UFH) during double plasma molecular adsorption system (DPMAS) treatment in patients with liver failure(LF). Methods We retrospectively analyzed clinical materials of LF patients underwent DPMAS treatment in Department of Gastroenterology, Shanxi Bethune Hospital between May 2023 and May 2024. During the procedure, NM as an anticoagulant was given at dose of 60 mg for piping with thereafter 35 mg.h^-1maintaining. Prothrombin time activity(PTA), international normalized ratio (INR), activated partial thromboplastin time (APTT) and blood platelet counts were routinely detected. Results 27 patients with LF were enrolled and received 62 times of DPMAS treatments, of which UFH was used in 21 times and NM was used in 41 times; after DPMAS treatment, elongation APTT and INR in NM group were 1.3(-3.6, 9.0)% and 2.5(-8.5, 16.6)%, both significantly less than [271.1(49.0, 816.5)% and 68.9(44.8, 118.8)%, respectively, P<0.05] in UFH group, and reduction rates of PTA and PLT counts were (4.2±23.7)% and 4.6(1.3, 7.6)%, both significantly lower than [(46.5±24.3)% and (13.0±12.6)%, respectively, P<0.05] in UFH group; there was no significant difference as respect to incidences of hypotension (9.8% vs. 14.3%, P>0.05), and no bleeding was found between the two groups. Conclusion Impact of nafamostat mesylate on coagulation function tests and platelet counts in patients with LF during DPMAS treatment is relatively small, and needs further clinical investigation as a limited cases observed.

Key words: Liver failure, Dual plasma molecular adsorption system, Nafamostat mesylate, Unfractionated heparin, Anticoagulation

张文睿, 赵凝慧, 姚若煜, 王瀚, 姚佳. 双重血浆分子吸附系统临床治疗过程中甲磺酸萘莫司他与普通肝素抗凝效果研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 398-401.

Zhang Wenrui, Zhao Ninghui, Yao Ruoyu, et al. Comparison of nafamostat mesylate and unfractionated heparin for anticoagulation during double plasma molecular adsorption system treatment in patients with liver failure[J]. Journal of Practical Hepatology, 2025, 28(3): 398-401.

参考文献

[1] 中华医学会肝病学分会重型肝病与人工肝学组,肝衰竭诊治指南(2018年版). 实用肝脏病杂志, 2019, 22(2): 164-171.
[2] Rosa-Diez G J, Joannes-Boyau O. The use of adsorption in extracorporeal liver support: the double plasma molecular adsorption system (DPMAS). Contrib Nephrol, 2023, 200: 210-217.
[3] 马元吉, 杜凌遥, 白浪, et al. 人工肝治疗的抗凝剂应用进展及选择策略. 临床肝胆病杂志, 2022, 38(10): 2396-2401.
[4] Yao J, Li S, Zhou L, et al. Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure. J Clin Apher, 2019, 34(4): 392-398.
[5] 中华医学会肝病学分会重型肝病与人工肝学组, 白浪, 陈煜, 等. 人工肝血液净化技术临床应用专家共识(2022年版). 实用肝脏病杂志, 2022, 25(3): 457-468.
[6] 袁素娥, 周阳, 谭德明, 等. 肝素在分子吸附再循环治疗肝衰竭中的应用及对凝血指标的影响. 中南大学学报(医学版), 2011, 36(9): 830-835.
[7] Arepally G M, Cines D B. Pathogenesis of heparin-induced thrombocytopenia. Transl Res, 2020, 225: 131-140.
[8] Chlebowski M M, Baltagi S, Carlson M, et al. Clinical controversies in anticoagulation monitoring and antithrombin supplementation for ECMO. Crit Care, 2020, 24(1): 19.
[9] 丁小强, 毛永辉. 甲磺酸萘莫司他的血液净化抗凝应用专家共识. 上海医学,2021,32: 1-35.
[10] Choi J Y, Kang Y J, Jang H M, et al. Nafamostat mesilate as an anticoagulant during continuous renal replacement therapy in patients with high bleeding risk: a randomized clinical trial. Medicine (Baltimore), 2015, 94(52): e2392.
[11] Beurskens D M H, Huckriede J P, Schrijver R, et al. The anticoagulant and nonanticoagulant properties of heparin. Thromb Haemost, 2020, 120(10): 1371-1383.
[12] Leberzammer J, Von Hundelshausen P. Chemokines, molecular drivers of thromboinflammation and immunothrombosis. Front Immunol, 2023, 14: 1276353.
[13] Dyla A, Mielnicki W, Bartczak J, et al. Effectiveness and safety assessment of citrate anticoagulation during albumin dialysis in comparison to other methods of anticoagulation. Artif Organs, 2017, 41(9): 818-826.
[14] 杜涛, 毕伟红, 王婷, 等. 局部枸橼酸抗凝在血浆吸附及血浆置换治疗严重肝损害中的有效性及安全性. 临床消化病杂志, 2022, 34(3): 193-198.
[15] Legrand M, Tolwani A. Anticoagulation strategies in continuous renal replacement therapy. Semin Dial, 2021, 34(6): 416-422.
[16] Uchiba M, Okajima K, Abe H, et al. Effect of nafamostat mesilate, a synthetic protease inhibitor, on tissue factor-factor VIIa complex activity. Thromb Res, 1994, 74(2): 155-161.
[17] Sundaram S, Gikakis N, Hack C E, et al. Nafamostat mesilate, a broad spectrum protease inhibitor, modulates platelet, neutrophil and contact activation in simulated extracorporeal circulation. Thromb Haemost, 1996, 75(1): 76-82.
[18] 王新月, 周莉, 董金玲,等. 双重血浆分子吸附系统治疗肝衰竭患者应用甲磺酸萘莫司他与肝素抗凝有效性与安全性比较研究. 实用肝脏病杂志, 2023, 26(6): 843-846.
[19] Han W, San Bok J, Cho H J, et al. Single-center experience of extracorporeal membrane oxygenation mainly anticoagulated with nafamostat mesilate. J Thorac Dis, 2019, 11(7): 2861-2867.
[20] Hwang S D, Hyun Y K, Moon S J, et al. Nafamostat mesilate for anticoagulation in continuous renal replacement therapy. Int J Artif Organs, 2013, 36(3): 208-216.

双重血浆分子吸附系统临床治疗过程中甲磺酸萘莫司他与普通肝素抗凝效果研究^*

Comparison of nafamostat mesylate and unfractionated heparin for anticoagulation during double plasma molecular adsorption system treatment in patients with liver failure

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