Costa E, Rocha S, Rocha-Pereira P, Castro E, Reis F, Teixeira F, Miranda V, Do Sameiro Faria M, Loureiro A, Quintanilha A, Belo L, Santos-Silva A
Instituto de Ciências da Saúde da Universidade Católica Portuguesa, Porto, Portugal.
J Vasc Access. 2008 Oct-Dec;9(4):248-53.
This work aimed to study the association between fibrinolytic/endothelial cell function and inflammatory markers in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) and recombinant human erythropoietin (rhEPO) therapies, and its relationship with the type of vascular access (VA) used for the HD procedure. As fibrinolytic/endothelial cell function markers we evaluated plasminogen activator inhibitor type-1 (PAI-1), tissue plasminogen activator (tPA) and D-dimers, and as inflammatory markers; C-reactive protein (CRP), soluble interleukin (IL)-2 receptor (s-IL2R), IL-6 and serum albumin levels. The study was performed in 50 CKD patients undergoing regular HD, 11 with a central venous dialysis catheter (CVC) and 39 with an arteriovenous fistula (AVF), and in 25 healthy controls. Compared to controls, CKD patients presented with significantly higher levels of CRP, s-IL2R, IL-6 and D-dimers, and significantly lower levels of PAI-1. The tPA/PAI-1 ratio was significantly higher in CKD patients. We also found statistical significant correlations in CKD patients between D-dimerslevels and inflammatory markers: CRP, albumin, s-IL2R and IL-6. When comparing the two groups of CKD patients, we found that those with a CVC presented statistically significant lower levels of hemoglobin concentration and albumin, and higher levels of CRP, IL-6, D-dimers and tPA. Our results showed an association between fibrinolytic/ endothelial cell function and increased inflammatory markers in CKD patients. The increased levels of Ddimer, tPA and inflammatory markers in CKD patients using a CVC, led us to propose a relationship between the type of VA chosen for HD, and the risk of thrombogenesis.
这项研究旨在探讨接受血液透析（HD）和重组人促红细胞生成素（rhEPO）治疗的慢性肾脏病（CKD）患者纤溶/内皮细胞功能与炎症标志物之间的关联，以及其与HD治疗中所使用血管通路（VA）类型的关系。作为纤溶/内皮细胞功能标志物，我们评估了纤溶酶原激活物抑制剂-1（PAI-1）、组织型纤溶酶原激活物（tPA）和D-二聚体；作为炎症标志物，我们评估了C反应蛋白（CRP）、可溶性白细胞介素（IL）-2受体（s-IL2R）、IL-6和血清白蛋白水平。该研究纳入了50例接受定期HD治疗的CKD患者，其中11例使用中心静脉透析导管（CVC），39例使用动静脉内瘘（AVF），并纳入了25名健康对照者。与对照组相比，CKD患者的CRP、s-IL2R、IL-6和D-二聚体水平显著升高，而PAI-1水平显著降低。CKD患者的tPA/PAI-1比值显著更高。我们还发现，CKD患者的D-二聚体水平与炎症标志物（CRP、白蛋白、s-IL2R和IL-6）之间存在统计学显著相关性。在比较两组CKD患者时，我们发现使用CVC的患者血红蛋白浓度和白蛋白水平在统计学上显著更低，而CRP、IL-6、D-二聚体和tPA水平更高。我们的结果显示，CKD患者的纤溶/内皮细胞功能与炎症标志物升高之间存在关联。使用CVC的CKD患者中D-二聚体、tPA和炎症标志物水平升高，这使我们推测HD所选择的VA类型与血栓形成风险之间存在关联。
