Prakash R, Miller C C, Suki W N
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Am J Kidney Dis. 1995 Aug;26(2):347-52. doi: 10.1016/0272-6386(95)90656-8.
To investigate the relationship between dialysis access thrombosis (arteriovenous grafts [AVG] and arteriovenous fistulas [AVF]) and the presence of elevated concentration of immunoglobulin G-anticardiolipin antibody (IgG-ACA), we conducted a cross-sectional study of all patients, in a single dialysis facility, who had a minimum of 6 months of uninterrupted hemodialysis. Episodes of thrombosis of AVGs and AVFs in the preceding 30 months were documented and each patient's IgG-ACA titer was determined. Sixteen of 74 patients with AVGs (22%) had a raised titer of IgG-ACA compared with only one of 17 patients (6%) with AVFs. In the patients with AVGs the odds ratio for patients with raised IgG-ACA titer to have experienced two or more episodes of thrombosis, compared with none or only one episode, was 3.7 (95% confidence interval, 1.2 to 11.8; P < 0.04). No events of AVF thrombosis were encountered during the same period. We conclude that in end-stage renal disease patients undergoing hemodialysis, there is a greater prevalence of elevated IgG-ACA titer in patients with AVGs than in patients with AVFs, and this in turn is associated with increased odds of having had recurrent AVG thrombosis.
为了研究透析通路血栓形成（动静脉移植物[AVG]和动静脉内瘘[AVF]）与免疫球蛋白G - 抗心磷脂抗体（IgG - ACA）浓度升高之间的关系，我们对一家透析机构中所有至少进行了6个月不间断血液透析的患者进行了一项横断面研究。记录了前30个月内AVG和AVF的血栓形成事件，并测定了每位患者的IgG - ACA滴度。74例AVG患者中有16例（22%）的IgG - ACA滴度升高，而17例AVF患者中只有1例（6%）升高。在AVG患者中，与无血栓形成或仅有一次血栓形成事件相比，IgG - ACA滴度升高的患者发生两次或更多次血栓形成事件的优势比为3.7（95%置信区间，1.2至11.8；P < 0.04）。同期未遇到AVF血栓形成事件。我们得出结论，在接受血液透析的终末期肾病患者中，AVG患者中IgG - ACA滴度升高的患病率高于AVF患者，这反过来又与AVG复发性血栓形成的几率增加有关。
