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 serum fibrin monomer level and its clinical significance in maintenance hemodialysis (MHD) patients. Methods Blood coagulation factors including prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT), fibrin degradation products including fibrinogen degradation product (FDP), D dimmer (DDI) and fibrin monomer (FM), and biochemistry indices including triacylglycerol (TG), cholesterol (TC), high density lipoprotein cholesterol (HDL) and low density lipoprotein cholesterol (LDL) were assayed in MHD patients with and without cerebral infarction, and normal controls. Cardiac functional grading was performed according to the classification standards from New York Heart Association. Results There were obvious differences in TG, TC, HDL, and LDL between MHD patients without cerebral infarction and normal controls and between MHD patients with cerebral infarction
and normal controls (For comparison between MHD patients without cerebral infarction and normal controls: LSD-t=9.701, P＜0.001 for TG; LSD-t=5.779, P＜0.001 for TC; LSD-t=4.742, P＜0.001 for HD; LSDt= 3.152, P＜0.001 for LDL. For comparison between MHD patients with cerebral infarction and normal controls: LSD-t=9.791, P＜0.001 for TG; LSD-t=13.509, P＜0.001 for TC; LSD-t=5.251, P＜0.001 for HDL; LSD-t=3.152, P＜0.001 for LDL). There were no statistical differences in TT, PT and APTT, but obvious differences in FDP, DDI and FM between MHD patients without cerebral infarction and normal controls and between patients with cerebral infarction and normal controls (For comparison between MHD patients without cerebral infarction and normal controls: LSD-t=8.524, P＜0.001 for FDP; LSD-t=16.269, P＜0.001 for DDI; LSD-t=31.144, P＜0.001 for FM. For comparison between MHD patients with cerebral infarction and normal controls: LSD-t=49.621, P＜0.001 for FDP; LSD-t=16.757, P＜0.001 for DDI; LSD-t=46.445, P＜0.001 for FM). There were no statistical differences in TG, TC, HDL, LDL, FDP and DDI, but significant difference in FM (LSD-t=15.017, P＜0.001) between patients with cerebral infarction and those without cerebral infarction. There was significant difference in FM between MHD patients without cerebral infarction with cardiac function I- II grades and those with cardiac function III-IV grades (t=16.097, P＜0.001) and between MHD patients with cerebral infarction with cardiac function I-II grades and those with cardiac function III-IV grades (t=19.769, P＜0.001). Conclusion FM level may be a sensitive and accurate marker for the diagnosis of cerebral infarction in MHD patients.