Chou Che-Yi, Kuo Huey-Liang, Yung Ya-Fei, Liu Yao-Lung, Huang Chiu-Ching
Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, ROC.
Blood Purif. 2006;24(4):342-6. doi: 10.1159/000092558. Epub 2006 Apr 5.
Vascular access thrombosis (VAT) is one of the most common morbidity in hemodialysis patients. The development of arteriovenous fistula thrombosis is associated with vascular intimal hyperplasia. Some studies suggested that serum C-reactive protein (CRP) predicts the development of vascular intima hyperplasia that conduces vascular access stenosis and thrombosis. This study aimed to access the clinical usefulness of CRP in predicting VAT in hemodialysis patients.
We retrospectively reviewed all prevalent hemodialysis patients with native arteriovenous fistula (nAVF) between November 2001 and November 2004. The CRP levels and relation to the development of VAT was analyzed with Kaplan-Meier analysis in four groups of patients divided according to their serum CRP levels. Besides serum CRP levels, other factors possibly influencing vascular access thrombosis were also considered: gender, age, diabetes, aspirin, smoking, statin, serum albumin, hematocrit, cholesterol > 200 mg/dl, Calcium-phosphate product, and intact parathyroid hormone > 200 pg/ml.
We retrospectively reviewed 223 chronic hemodialysis patients. 198 patients with forearm nAVF and 25 with upper arm nAVF were included. Of the above 223 patients, 51 experienced one or more VAT episodes. In Kaplan-Meier survival analysis, patients with serum CRP levels > 0.8 mg/dl were prone to develop VAT (log-rank, p < 0.001). In a multivariate Cox regression model, serum CRP greater than 0.8 mg/dl was confirmed to be an independent predictor of VAT with a relative risk of 16.6 times (95% CI, 7.85-35.1). The area under the receiver operator characteristic (ROC) curve of CRP > 0.8 mg/dl in predicting VAT events is 0.785 (95% CI, 0.712-0.858; p < 0.001). Sensitivity and specificity of CRP (> 0.8 mg/dl) in predicting VAT were 80.4 and 72.7%.
The serum CRP levels not only predict cardiovascular disease and mortality in hemodialysis patients but also predict the development of vascular access thrombosis in chronic hemodialysis patients.
血管通路血栓形成（VAT）是血液透析患者中最常见的并发症之一。动静脉内瘘血栓形成的发展与血管内膜增生有关。一些研究表明，血清C反应蛋白（CRP）可预测导致血管通路狭窄和血栓形成的血管内膜增生的发展。本研究旨在评估CRP在预测血液透析患者VAT中的临床实用性。
我们回顾性分析了2001年11月至2004年11月期间所有患有自体动静脉内瘘（nAVF）的血液透析患者。根据血清CRP水平将患者分为四组，采用Kaplan-Meier分析方法分析CRP水平与VAT发生的关系。除了血清CRP水平外，还考虑了其他可能影响血管通路血栓形成的因素：性别、年龄、糖尿病、阿司匹林、吸烟、他汀类药物、血清白蛋白、血细胞比容、胆固醇>200mg/dl、钙磷乘积以及全段甲状旁腺激素>200pg/ml。
我们回顾性分析了223例慢性血液透析患者。其中包括198例前臂nAVF患者和25例上臂nAVF患者。在这223例患者中，51例发生了一次或多次VAT事件。在Kaplan-Meier生存分析中，血清CRP水平>0.8mg/dl的患者更容易发生VAT（对数秩检验，p<0.001）。在多变量Cox回归模型中，血清CRP大于0.8mg/dl被确认为VAT的独立预测因子，相对风险为16.6倍（95%CI，7.85-35.1）。CRP>0.8mg/dl预测VAT事件的受试者操作特征（ROC）曲线下面积为0.785（95%CI，0.712-0.858；p<0.001）。CRP（>0.8mg/dl）预测VAT的敏感性和特异性分别为80.4%和72.7%。
血清CRP水平不仅可以预测血液透析患者的心血管疾病和死亡率，还可以预测慢性血液透析患者血管通路血栓形成的发展。
