Promet i funkcija trombocita u završnom stadijumu hronične bubrežne insuficijencije
Sažetak
Uvod/Cilj. Završni stadijum hronične bubrežne insuficijencije [end-stage renal disease (ESRD)] karakteriše prisustvo značajnog oštećenja trombocitnih funkcija koje mogu dovesti do krvarećih i tromboznih komplikacija. Cilj rada bio je procena prometa i funkcionalnosti trombocita i korelacija sa zapaljenskim i prokoagulantnim markerima kod bolesnika sa ESRD, kao i poređenje trombocitnih indeksa između bolesnika kod kojih je šećerna bolest etiološki faktor ESRD i bolesnika sa ESRD druge etiologije. Metode. U prospektivno opservaciono kliničko istraživanje uključeno je 63 ispitanika sa ESRD i 30 zdravih osoba usklađenih po starosti i po polu (kontrolna grupa). Određivani su laboratorijski parametri prometa i funkcionalnosti trombocita (broj trombocita, retikulisani trombociti, trombocitni indeksi i agregabilnost trombocita merena impendancom iz pune krvi), zapaljenski i prokoagulantni markeri (broj neutrofila, odnos neutrofila i limfocita, C-reaktivni protein, fibrinogen, D dimer, von Willebrand-ov faktor). Rezultati. U grupi ispitanika sa ESRD u poređenju sa grupom zdravih, promet trombocita (% retikulisanih trombocita) je bio statistički značajno veći (3,8 ± 2,3 vs. 2,3 ± 1,3; p < 0,01), kao i agregabilnost trombocita indukovana sa trombin receptor-aktivirajućim peptidom (TRAP) (p < 0,01), adenozin-difosatom (ADP) (p < 0,05), arahidonskom kiselinom (ASPI) (p < 0,05) i kolagenom (p < 0,05). U ESRD grupi su potvrđene značajno više vrednosti svih zapaljenskih i prokoagulantnih markera u odnosu na zdrave ispitanike (p < 0,01, za sve parametre). Nije utvrđena razlika u ispitivanim parametrima između grupe bolesnika kod kojih je šećerna bolest uzročnik ESRD i grupe bolesnika sa ESRD druge etiologije. Zaključak. Rezultati pokazuju da je povišen promet trombocita u ESRD posledica njihove aktivacije i potrošnje indukovane hiperaktivnošću koagulacionog sistema i hroničnim zapaljenjem. Nijedan od ispitivanih parametara ne predviđa mogućnost pojave krvarenja.
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