血液透析患者的高同型半胱氨酸血症、抗心磷脂抗体状态与血管通路血栓形成风险

Hyperhomocysteinemia, anticardiolipin antibody status, and risk for vascular access thrombosis in hemodialysis patients.

作者信息

Manns B J, Burgess E D, Parsons H G, Schaefer J P, Hyndman M E, Scott-Douglas N W

机构信息

Department of Medicine, and Department of Pediatrics and Medical Genetics, University of Calgary, Calgary, Alberta, Canada.

出版信息

Kidney Int. 1999 Jan;55(1):315-20. doi: 10.1046/j.1523-1755.1999.00258.x.

DOI:10.1046/j.1523-1755.1999.00258.x

PMID:9893142

Abstract

BACKGROUND

Vascular access failure is an important cause of morbidity in end-stage renal failure patients on hemodialysis. Currently, little is known about risk factors that predispose certain hemodialysis patients to recurrent access thrombosis. Hyperhomocysteinemia (common in patients with renal failure) predisposes people with normal renal function to recurrent and early-onset venous thrombosis, although the effect on vascular access thrombosis is currently unknown. Previous studies have suggested that high titers of IgG anticardiolipin antibody (IgG-ACA) predispose hemodialysis patients to access thrombosis. This cross sectional study was designed to assess for an association between two predictive variables, hyperhomocysteinemia and elevated titers of IgG-ACA, and vascular access thrombosis in patients undergoing chronic hemodialysis.

METHODS

Risk factors for vascular access thrombosis were documented, and the number of episodes of access thrombosis was recorded for the previous three years in patients undergoing hemodialysis. Midweek predialysis total homocysteine and IgG-ACA levels were measured in all subjects.

RESULTS

Of the 118 patients who were enrolled, 75.4% had a native arteriovenous fistula. Episodes of vascular access thrombosis were recorded for the previous three years; 34 (28.8%, 95% CI 20.9 to 37.9%) patients had 72 episodes of access thrombosis over the period of risk. Mean homocysteine levels were not significantly different between these 34 patients (28.6 micromol/liter, 95% CI 24.5 to 32.7) and the patients who had no episodes of graft thrombosis (29.8 micromol/liter, 95% CI 26.7 to 32.9). Sixty-seven unselected patients had IgG-ACA levels drawn for analysis, and all assays were negative. The only variable that was associated with a higher risk for graft thrombosis was the type of vascular access placed (odds ratio 4.0, 95% CI 1.6 to 9.6 for patients with a synthetic graft compared with those with an arteriovenous fistula).

CONCLUSIONS

No association was found between homocysteine levels or anticardiolipin antibody and vascular access thrombosis in our patient population.

摘要

背景

血管通路失败是终末期肾衰竭患者接受血液透析时发病的重要原因。目前，对于某些血液透析患者易发生反复血管通路血栓形成的危险因素知之甚少。高同型半胱氨酸血症（在肾衰竭患者中常见）使肾功能正常的人易发生反复和早发性静脉血栓形成，尽管其对血管通路血栓形成的影响目前尚不清楚。先前的研究表明，高滴度的IgG抗心磷脂抗体（IgG-ACA）使血液透析患者易发生血管通路血栓形成。本横断面研究旨在评估两个预测变量，即高同型半胱氨酸血症和IgG-ACA滴度升高，与慢性血液透析患者血管通路血栓形成之间的关联。

方法

记录血管通路血栓形成的危险因素，并记录血液透析患者在过去三年中血管通路血栓形成的发作次数。在所有受试者中测量周中透析前的总同型半胱氨酸和IgG-ACA水平。

结果

在纳入的118例患者中，75.4%有自体动静脉内瘘。记录了过去三年中血管通路血栓形成的发作情况；在危险期间，34例（28.8%，95%可信区间20.9%至37.9%）患者发生了72次血管通路血栓形成发作。这34例患者的平均同型半胱氨酸水平（28.6微摩尔/升，95%可信区间24.5至32.7）与未发生移植物血栓形成发作的患者（29.8微摩尔/升，95%可信区间26.7至32.9）之间无显著差异。67例未经过筛选的患者检测了IgG-ACA水平以进行分析，所有检测结果均为阴性。与移植物血栓形成风险较高相关的唯一变量是所采用的血管通路类型（与有动静脉内瘘的患者相比，使用合成移植物的患者的优势比为4.0，95%可信区间1.6至9.6）。