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求一段論文翻譯,因本人是學(xué)俄語的,應(yīng)該挺簡(jiǎn)單的,謝謝
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How important coadministration of antiplatelet agents is in the pathogenesis of some of these hemorrhagic events is unclear in the context of uremic platelet dysfunction. Antiplatelet agents were administered to 7 of our 10 patients and 1 of the 5 cases described. However, their use would not explain the prolonged APTT seen in 7 of our 10 cases. Four of our patients were on the maintenance hemodialysis program; although the onset of bleeding was on nondialysis days in all patients and the quoted APTTs were 48 hours after hemodialysis, the possible contribution of heparin during dialysis treatment remains unclear. Finally, in our case series, 7 of 10 patients had end-stage renal disease (ESRD), but 1 patient had a CrCl of 30 mL/min (0.50 mL/s) and still experienced a major hemorrhagic event (Fig1). Although there was an overlap with warfarin therapy, he had only been administered 2 doses,and his international normalized ratio was 2.4. LMWHs are derived from standard UFH through controlled chemical or enzymatic degradation, resulting in heterogeneous molecules with individual pharmacological properties. Each commercial product is considered by theWorld Health Organization as a distinct and noninterchangeable drug. There are important differences between LMWHs and UFH, but the clinical relevance of their differences in terms of effectiveness or safety remains unclear. Hence, LMWHs have a reduced ability to catalyze the inhibition of thrombin (IIa), whereas they retain the ability to inhibit Xa activity. The reduced binding of LMWH to plasma proteins and cells (including platelets, endothelial cells, and macrophages) contributes to its more predictable dose response and longer plasma half-life. LMWHs are eliminated primarily by the kidney through glomerular filtration in comparison to UFH, in which renal clearance becomes an important route of elimination only at greater concentrations. |
木蟲 (著名寫手)
| 在尿毒性血小板功能異常下,多種抗血小板藥物聯(lián)用對(duì)一些失血事件的病理進(jìn)程有何重要意義,尚不清楚。抗血小板藥物用于所述的10個(gè)病人中的7個(gè),以及5個(gè)病例中的一個(gè)。然而,這些藥物的使用不能解釋我們?cè)?0個(gè)病例中的7個(gè)中觀察到的APTT的延長(zhǎng)。我們的4個(gè)病人曾在接受維持性血液透析;雖然所有病人滲血的開始是在非透析日,且采用的APTTs值是透析48小時(shí)后的值,透析治療中肝素的可能貢獻(xiàn)尚不清楚。最后,在我們的病例系列里,10個(gè)病人中的7個(gè)患有終末期腎臟病,但是其中1個(gè)病人的CrCl值為30 mL/min (0.50 mL/s),仍然經(jīng)歷了大出血事件(圖1)。盡管和華法林抗凝治療存在一定的重疊,該病人僅使用了2劑量,他的國(guó)際標(biāo)準(zhǔn)化比率為2.4。LMWHs源自化學(xué)降解或酶降解的標(biāo)準(zhǔn)UFH,導(dǎo)致異質(zhì)分子具有各自的藥學(xué)特性。每個(gè)商業(yè)產(chǎn)品都被世界衛(wèi)生組織認(rèn)為是獨(dú)特的不可相互替換的藥物。LMWHs 和 UFH有著重要區(qū)別,但是就療效或安全性而言,它們這些區(qū)別的臨床相關(guān)性仍不清楚。因此, LMWHs抑制凝血酶 (IIa)的催化能力降低了,但是仍然保持其抑制Xa活性的能力。LMWH和血漿蛋白及細(xì)胞(包括血小板、內(nèi)皮細(xì)胞和巨噬細(xì)胞)的結(jié)合力降低,其劑量反應(yīng)具有更好的可預(yù)測(cè)性,并能延長(zhǎng)血漿半衰期。與UFH 相比,LMWHs主要由腎通過腎小球?yàn)V過去除,UFH只有在較高濃度時(shí),腎清除才是一條重要的清除途徑。 |

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