Jamshid Roozbeh, Reza Serati Ali, Abbas Ghaderi, Raha Afshariani
Department of Medicine, Division of Nephrology, Shiraz University of Medical Science, Shiraz, Iran.
Int Urol Nephrol. 2003;35(2):275-82. doi: 10.1023/b:urol.0000020354.61227.40.
Fistula thrombosis in patients on maintenance hemodialysis is an important morbidity factor. Arterial or venous thrombotic events have been described as complications in patients on regular hemodialysis and positive titers of anticardiolipin antibodies (ACLA). This study was designed to evaluate the prevalence of ACLA in hemodialysis patients and it's relation to arteriovenous fistula (AVF) thrombosis.
218 patients with AVF on maintenance hemodialysis were studied prospectively during a period of 14 months for any episode of AVF thrombosis (AVFT), after ACLA was assayed by ELISA in 171 ones. Other risk factors for thrombosis such as presence of diabetes, hypotension during dialysis, using of erythropoietin (rEpo), fistula site, gender, age, dialysis duration, and type of dialyser membrane were accessed.
56% of the patients had IgG ACLA = 10 GPL which was significantly correlated with dialysis duration (23.18 +/- 24.56 months in patients with ACLA = 10 GPL vs 37.73 +/- 36.35 months in patients with 20 = IgG ACLA < 40 GPL). Within 14 months follow up, 39 episodes of AVFT occurred in 34 patients (15.8%). Dialysis duration prior to start of study was 29.16 +/- 22.04 months. In our patients radiocephalic AVFs showed more thrombosis than brachiocephalic ones (23% vs 10%, p = 0.01 by Chi-square). Age more than 50 years old was a risk factor for AVFT (p = 0.034 by Chi-square). Also erythropoietin use (p = 0.011 by chi-square) and ultrafiltration more than 3 liters (average value of 14 months) were correlated with AVFT (p = 0.042 by Chi-square), but there wasn't any correlation between diabetes, presence of ACLA, hypotension during dialysis, gender, and dialysis membranes with AVFT. Ultimately, logistic regression analysis of factors associated with thrombosis was done and only fistula site (p = 0.015, O.R. = 2.87), and Eprex use (p = 0.031, O.R. = 4.05) showed significant correlation with AVFT.
Although incidence of anticardiolipin antibodies was high in our patients, we found no correlation between IgG ACLA and AVFT. Instead, we found that radiocephalic fistulas and Eprex injection were risk factors for AVFT.
维持性血液透析患者的动静脉内瘘血栓形成是一个重要的发病因素。动脉或静脉血栓形成事件已被描述为定期血液透析患者及抗心磷脂抗体（ACLA）滴度阳性的并发症。本研究旨在评估血液透析患者中ACLA的患病率及其与动静脉内瘘（AVF）血栓形成的关系。
对218例维持性血液透析的AVF患者进行了为期14个月的前瞻性研究，观察AVF血栓形成（AVFT）的任何发作情况，其中171例患者通过ELISA检测了ACLA。还评估了其他血栓形成危险因素，如糖尿病的存在、透析期间的低血压、促红细胞生成素（rEpo）的使用、内瘘部位、性别、年龄、透析时间以及透析器膜的类型。
56%的患者IgG ACLA = 10 GPL，这与透析时间显著相关（ACLA = 10 GPL的患者为23.18±24.56个月，而20≤IgG ACLA＜40 GPL的患者为37.73±36.35个月）。在14个月的随访中，34例患者发生了39次AVFT发作（15.8%）。研究开始前的透析时间为29.16±22.04个月。在我们的患者中，桡动脉头静脉内瘘比肱动脉头静脉内瘘显示出更多的血栓形成（23%对10%，卡方检验p = 0.01）。年龄超过50岁是AVFT的一个危险因素（卡方检验p = 0.034）。此外，促红细胞生成素的使用（卡方检验p = 0.011）和超滤量超过3升（14个月的平均值）与AVFT相关（卡方检验p = 0.042），但糖尿病、ACLA的存在、透析期间的低血压、性别以及透析膜与AVFT之间没有任何相关性。最终，对与血栓形成相关的因素进行了逻辑回归分析，只有内瘘部位（p = 0.015，O.R. = 2.87）和促红细胞生成素的使用（p = 0.031，O.R. = 4.05）与AVFT显示出显著相关性。
尽管我们的患者中抗心磷脂抗体的发生率很高，但我们发现IgG ACLA与AVFT之间没有相关性。相反，我们发现桡动脉头静脉内瘘和促红细胞生成素注射是AVFT的危险因素。
