Movilli Ezio, Brunori Giuliano, Camerini Corrado, Vizzardi Valerio, Gaggia Paola, Cassamali Silvia, Scolari Francesco, Parrinello Giovanni, Cancarini Giovanni C
Chair and Division of Nephrology, Spedali Civili and University of Brescia, University of Brescia, Brescia, Italy.
Blood Purif. 2006;24(4):387-93. doi: 10.1159/000093681. Epub 2006 Jun 1.
Arteriovenous grafts (AVG) and tunneled permanent catheters (TPC) are increasingly being used in hemodialysis (HD) patients. However, their role in baseline inflammatory status has not been fully evaluated. Aim of the study was to evaluate the influence of the current kind of vascular access on the baseline inflammatory status, marked by serum C-reactive protein (CRP), and the response to epoetin therapy in a group of iron-replete HD patients, under steady clinical conditions, without evidence of acute infections and/or inflammatory diseases.
We studied 79 patients who had been on bicarbonate HD for 8-410 months and were receiving epoetin therapy. They all had adequate iron stores and stable hemoglobin (Hb) levels. Exclusion criteria were fever, signs of infection, white blood cell count (WBC) > 10 x 1,000/microl, for at least 4 weeks before study. 48 patients (group A) had arteriovenous fistula (AVF), 18 patients (group B) AVG, 13 patients (group C) TPC. CRP, Hb, transferrin saturation, serum ferritin, WBC, serum albumin, protein catabolic rate, Kt/V, and epoetin dose (U/kg body weight/week) were measured. CRP values were log-transformed to normalize the distribution.
Log-transformed CRP values among the 3 groups were significantly different: group A 1.81 +/- 0.48; group B 2.12 +/- 0.50, and group C 3.00 +/- 0.25 (group A vs. B p < 0.003; group B vs. C p < 0.001; group A vs. C p < 0.0001). CRP and the epoetin dose were directly correlated (r = 0.519; p < 0.0001). The epoetin doses among the 3 groups were significantly different. Multiple regression analysis confirmed AVG and TPC as factors independently influencing CRP levels.
AVG and TPC have a higher degree of chronic inflammation than AVF. The epoetin requirement is increased in TPC and AVG compared with AVF.
动静脉移植物（AVG）和带隧道的永久性导管（TPC）在血液透析（HD）患者中越来越多地被使用。然而，它们在基线炎症状态中的作用尚未得到充分评估。本研究的目的是在一组铁储备充足、临床状况稳定、无急性感染和/或炎症性疾病证据的HD患者中，评估当前血管通路类型对以血清C反应蛋白（CRP）为标志的基线炎症状态以及对促红细胞生成素治疗反应的影响。
我们研究了79例接受碳酸氢盐HD治疗8至410个月且正在接受促红细胞生成素治疗的患者。他们都有足够的铁储备和稳定的血红蛋白（Hb）水平。排除标准为在研究前至少4周有发热、感染迹象、白细胞计数（WBC）>10×1000/微升。48例患者（A组）有动静脉内瘘（AVF），18例患者（B组）有AVG，13例患者（C组）有TPC。测量了CRP、Hb、转铁蛋白饱和度、血清铁蛋白、WBC、血清白蛋白、蛋白质分解代谢率、Kt/V和促红细胞生成素剂量（单位/千克体重/周）。CRP值进行对数转换以使其分布标准化。
三组间经对数转换的CRP值有显著差异：A组1.81±0.48；B组2.12±0.50，C组3.00±0.25（A组与B组比较，p<0.003；B组与C组比较，p<0.001；A组与C组比较，p<0.0001）。CRP与促红细胞生成素剂量直接相关（r = 0.519；p<0.0001）。三组间的促红细胞生成素剂量有显著差异。多元回归分析证实AVG和TPC是独立影响CRP水平的因素。
与AVF相比，AVG和TPC具有更高程度的慢性炎症。与AVF相比，TPC和AVG对促红细胞生成素的需求增加。
