Araújo Nordeval Cavalcante, Suassuna José Hermógenes Rocco
Universidade do Estado do Rio de Janeiro, Departamento de Nefrologia, Rio de Janeiro, RJ, Brasil.
J Bras Nefrol. 2021 Jan-Mar;43(1):61-67. doi: 10.1590/2175-8239-JBN-2020-0116.
Inflammation promotes the progression of chronic renal failure, and the start of dialysis worsens inflammation. The enlargement of the spleen is associated with inflammation, and patients on hemodialysis may show a large spleen. The aim of the present study was to compare the spleen size of patients undergoing hemodialysis versus controls to update this thread.
Controls and patients were eligible to participate in the study provided they were negative for serological markers of hepatitis B and C viruses and HIV, if they had no lymphoproliferative disorder, and if they were at least 18 years of age. Age, sex, and the duration of dialysis were recorded. Laboratory variables (hemoglobin, hematological cell count, serum creatinine) and the underlying cause of end-stage renal disease were analyzed. The spleen sizes of the patients were divided into tertiles.
The 75 controls and 168 patients selected were sex-matched. The patients were older, had larger spleens and lower platelet counts than controls. The relationship between spleen size and age in the controls and patients was quite similar. The patients in the first tertile of spleen size compared with those in the third were older and had a higher platelet counts. The underlying disease and dialysis vintage had no effect on spleen size.
The patients had larger spleens and a greater range of spleen sizes than the controls. In patients, the association between larger and smaller spleen with lower and higher platelet counts, respectively, sparked the speculation of occurrence of hypersplenism and hyposplenism.
炎症促进慢性肾衰竭的进展，而开始透析会使炎症恶化。脾脏肿大与炎症相关，接受血液透析的患者可能会出现脾脏肿大。本研究的目的是比较接受血液透析的患者与对照组的脾脏大小，以更新这一思路。
只要对照组和患者的乙肝、丙肝病毒及艾滋病毒血清学标志物呈阴性，没有淋巴增殖性疾病，且年龄至少18岁，就有资格参与本研究。记录年龄、性别和透析时间。分析实验室变量（血红蛋白、血细胞计数、血清肌酐）以及终末期肾病的潜在病因。将患者的脾脏大小分为三个三分位数。
选取的75名对照组和168名患者在性别上相匹配。患者比对照组年龄更大，脾脏更大，血小板计数更低。对照组和患者中脾脏大小与年龄的关系相当相似。脾脏大小处于第一个三分位数的患者与处于第三个三分位数的患者相比，年龄更大，血小板计数更高。潜在疾病和透析时间对脾脏大小没有影响。
与对照组相比，患者的脾脏更大，脾脏大小范围更广。在患者中，脾脏大小与血小板计数的关系分别为脾脏越大血小板计数越低、脾脏越小血小板计数越高，这引发了对脾功能亢进和脾功能减退发生情况的推测。
