Fabrizi F, Sangiorgio R, Pontoriero G, Corti M, Tentori F, Troina E, Locatelli F
Nephrology and Dialysis Division, Lecco Hospital, Italy.
J Nephrol. 1999 Mar-Apr;12(2):89-94.
Data are few and conflicting about the prevalence and risk factors for antiphospholipid (aPL) antibodies in end-stage renal disease (ESRD). We studied the prevalence, risk factors and clinical manifestations of lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) among ESRD patients (chronic hemodialysis (HD) patients and kidney transplant recipients) and blood donors. LA was assessed in a large cohort (n=180) of patients by the activated partial thromboplastin time (aPTT), dilute Russel's viper venom test (dRVVT) and lupus anticoagulant-sensitive aPTT reagent (PTT-LA). IgM- and IgG-aCL were measured by a solid-phase enzyme-linked immunosorbent assay (ELISA) in 111 patients (61.5%). The prevalence of aPL was low but, it was higher in ESRD than blood donors (8.8% (16/180) vs. 0%, P=0.005); the frequency of aCL was also higher in ESRD than controls (10.8% (12/111) vs. 0%, P=0.002). LA was similar in the study and control groups (2.2% (4/180) vs. 0%, NS). Among HD patients and kidney allograft recipients there was no difference in LA (3.9% (4/101) vs. 0% (0/79), NS) and aCL frequency (18.6% (8/43) vs. 5.9% (4/68), NS). aPL was not associated with sex, age, time on HD, post-transplantation follow-up, ESRD etiology, thrombotic or hemorrhagic events, or type of HD membrane; however, these findings must be interpreted with caution, given the low frequency of aPL. In one HD patient LA activity was associated with multiple thrombosis of the access graft and native veins. In summary, the prevalence of aPL in ESRD is low but nevertheless higher than controls; LA does not appear to be related to membrane bio-incompatibility and it may be linked to vascular thrombosis; the lack of concordance between LA and aCL was apparent. Further studies are needed to clarify the issue of aPL in ESRD. LA testing should be incorporated into the diagnostic evaluation of recurrent thrombotic episodes in patients on HD.
关于终末期肾病（ESRD）患者抗磷脂（aPL）抗体的患病率及危险因素，相关数据较少且存在矛盾之处。我们研究了ESRD患者（慢性血液透析（HD）患者及肾移植受者）和献血者中狼疮抗凝物（LA）及抗心磷脂抗体（aCL）的患病率、危险因素及临床表现。通过活化部分凝血活酶时间（aPTT）、稀释蝰蛇毒时间（dRVVT）及狼疮抗凝物敏感的aPTT试剂（PTT-LA）对一大组（n = 180）患者进行LA评估。采用固相酶联免疫吸附测定（ELISA）法对111例患者（61.5%）检测IgM-和IgG-aCL。aPL的患病率较低，但ESRD患者中的患病率高于献血者（8.8%（16/180）对0%，P = 0.005）；ESRD患者中aCL的频率也高于对照组（10.8%（12/111）对0%，P = 0.002）。研究组和对照组中LA的情况相似（2.2%（4/180）对0%，无显著性差异）。在HD患者和肾移植受者中，LA（3.9%（4/101）对0%（0/79），无显著性差异）及aCL频率（18.6%（8/43）对5.9%（4/68），无显著性差异）无差异。aPL与性别、年龄、HD时间、移植后随访、ESRD病因、血栓形成或出血事件、或HD膜类型无关；然而，鉴于aPL的低频率，这些发现必须谨慎解读。在1例HD患者中，LA活性与动静脉内瘘及自身静脉的多处血栓形成有关。总之，ESRD患者中aPL的患病率较低，但仍高于对照组；LA似乎与膜生物不相容性无关，可能与血管血栓形成有关；LA与aCL之间缺乏一致性是明显的。需要进一步研究以阐明ESRD中aPL的问题。LA检测应纳入HD患者复发性血栓形成发作的诊断评估中。
