Department of Immunology, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain.
Kidney Int. 2012 Jun;81(12):1239-44. doi: 10.1038/ki.2011.477. Epub 2012 Feb 22.
Cardiovascular complications are the most important cause of death in patients on dialysis with end-stage renal disease. Antibodies reacting with β-glycoprotein I seem to play a pathogenic role in antiphospholipid syndrome and stroke and are involved in the origin of atherosclerosis. Here we evaluated the presence of anticardiolipin and anti-β-glycoprotein I antibodies together with other vascular risk factors and their relationship with mortality and cardiovascular morbidity in a cohort of 124 hemodialysis patients prospectively followed for 2 years. Of these, 41 patients were significantly positive for IgA anti-β-glycoprotein I, and the remaining had normal values. At 24 months, overall and cardiovascular mortality and thrombotic events were all significantly higher in patients with high anti-β-glycoprotein I antibodies. Multivariate analysis using Cox regression modeling found that age, hypoalbuminemia, use of dialysis catheters, and IgA β-glycoprotein I antibodies were independent risk factors for death. Thus, IgA antibodies to β-glycoprotein I are detrimental to the clinical outcome of hemodialysis patients.
心血管并发症是终末期肾病透析患者死亡的最重要原因。与β-糖蛋白 I 反应的抗体似乎在抗磷脂综合征和中风中起致病作用，并参与动脉粥样硬化的发生。在这里，我们评估了在 124 例前瞻性随访 2 年的血液透析患者中，抗心磷脂和抗β-糖蛋白 I 抗体与其他血管危险因素的存在及其与死亡率和心血管发病率的关系。其中，41 例患者 IgA 抗β-糖蛋白 I 显著阳性，其余患者正常。24 个月时，高抗β-糖蛋白 I 抗体患者的总死亡率、心血管死亡率和血栓事件发生率均显著升高。使用 Cox 回归模型的多变量分析发现，年龄、低白蛋白血症、使用透析导管和 IgAβ-糖蛋白 I 抗体是死亡的独立危险因素。因此，IgA 抗β-糖蛋白 I 抗体对血液透析患者的临床预后不利。
