维持血液透析患者外周血b-FGF与内瘘功能异常的相关性研究

发布时间：2018-06-15 17:23

本文选题：微炎症状态 + 碱性成纤维细胞生长因子　；参考：《石河子大学》2015年硕士论文

【摘要】：目的:自体动静脉内瘘的通畅率随透析月龄的增加而逐渐降低,其发病机理可能是血管内皮功能损伤、血管通透性性改变导致动静脉内瘘的血管内皮细胞、平滑肌细胞失控性增生,造成自体动静脉内瘘静脉段血管加速动脉硬化,静脉段血管管腔狭窄,最终导致动静脉内瘘功能丧失。碱性成纤维细胞生长因子、血管内皮生长因子具有能促进血管内皮细胞及平滑肌细胞生长、增殖和分化。本研究探讨透析患者外周血碱性成纤维细胞生长因子水平与动静脉内瘘静脉段动脉硬化样病变、血管狭窄、血栓形成等因素造成动静脉内瘘功能异常的相关性,为早期预防自体内瘘功能异常的发生提供理论依据。方法:选择新疆石河子大学医学院第一附属医院血液净化中心维持血液透析的患者24例,分为2组:(1)内瘘功能正常组:男9例,女7例,平均透析年龄(49.58±11.6)岁,平均使用自体动静脉内瘘透析月龄(34±6.69)个月,16例患者基础病变分别是慢性肾炎8例,高血压肾损伤6例,多囊肾2例;(2)内瘘功能异常组:男3例,女5例,平均年龄(57.75±9.91)岁,平均使用自体动静脉内瘘透析月龄(56.5±14.36)月,8例患者基础病变是慢性肾炎6例,高血压肾损伤1例,多囊肾1例;选择门诊体检患者16例为正常对照组,晨起空腹抽血检测入组对象血红蛋白(Hemoglobin)、白蛋白(Alb)、电解质、全段甲状旁腺激素(intact parathyroid hormone),ELISA方法检测检测两组碱性成纤维细胞生长因子(basic fibroblast growth factor,b FGF),血管内皮细胞生长因子(vascular endothelial growthfactor,VEGF)、白介素-1β(Interleukin-1β,IL-1β)水平,比较各组之间生化指标、FGF、VEGF、IL-1β的差异性及相关性。结果:(1)各组间性别、年龄、血钙差异无统计学意义(P0.05),与内瘘功能正常组相比,内瘘功能异常组透析月龄长,差异有统计学意义(P0.05);内瘘功能异常组与内瘘正常组间血钙、血磷、尿素氮、血肌酐、低密度脂蛋白、胆固醇、甘油三脂、全段甲状旁腺、血红蛋白差异无统计学意义(P0.05)。(2)各组b-FGF、VEGF、IL-1β结果显示:与正常组相比,维持血液透析患者血清b-FGF、VEGF、IL-1β水平较正常组显著偏高,差异有统计学意义(P0.05);维持血液透析患者内瘘功能正常组与内瘘功能异常组血清b-FGF、VEGF、IL-1β水平差异无统计学意义;(3)单因素相关分析:血清b-FGF与透析月龄、磷、IL-1β、VEGF、全段甲状旁腺激素、低密度脂蛋白、收缩压呈正相关(r=0.836、0.459、0.52、0.527、0.711、0.427、0.472,P0.01),与舒张压呈正相关(r=0.371,P0.05)。结论:1)维持透析患者外周血b FGF水平与内瘘功能异常无明显相关性。2)改善微炎症状态,血脂代谢紊乱,控制透析患者血压对延长内瘘使用寿命有一定的获益。
[Abstract]:Objective: the patency rate of autologous arteriovenous fistula decreases with the increase of dialysis age. The pathogenesis of arteriovenous fistula may be the injury of vascular endothelial function and the change of vascular permeability leading to vascular endothelial cells of arteriovenous fistula. The proliferation of smooth muscle cells was out of control, which resulted in arteriosclerosis, stenosis of vascular lumen, and loss of arteriovenous fistula function in autologous arteriovenous fistula. Basic fibroblast growth factor, vascular endothelial growth factor can promote the growth, proliferation and differentiation of vascular endothelial cells and smooth muscle cells. The purpose of this study was to investigate the correlation between the level of basic fibroblast growth factor in peripheral blood of dialysis patients and arteriosclerotic lesions of arteriovenous fistula segment, vascular stenosis, thrombosis and other factors, which resulted in abnormal function of arteriovenous fistula. To provide a theoretical basis for early prevention of spontaneous fistula dysfunction. Methods: Twenty-four patients with normal internal fistula function were divided into two groups: male 9, female 7, mean dialysis age 49.58 卤11.6 years. The average age of autologous arteriovenous fistula was 34 卤6.69 months (n = 16): chronic nephritis (n = 8), hypertensive renal injury (n = 6) and polycystic kidney (n = 2). In the group of abnormal internal fistula, there were 3 males and 5 females with an average age of 57.75 卤9.91 years. The average age of autologous arteriovenous fistula for dialysis months was 56.5 卤14.36 months. The basic pathological changes were chronic nephritis in 6 cases, hypertensive kidney injury in 1 case and polycystic kidney in 1 case. In the morning, fasting blood samples were used to detect hemoglobin hemoglobinine, albumin Albbumin, electrolytes, hemoglobinins, and electrolytes. Total parathyroid hormone intact parathyroid hormoneine Elisa was used to detect the levels of basic fibroblast growth factor (parathyroid), vascular endothelial cell growth factor (VEGF) and interleukin-1 尾 -Interleukin-1 尾 (IL-1 尾) in two groups, and to compare the difference and correlation of biochemical index FGFVEGF-1 尾 between the two groups. Results there was no significant difference in sex, age, blood calcium between groups (P 0.05). Compared with normal internal fistula group, the age of dialysis was longer in the group with abnormal internal fistula function and the difference was statistically significant (P 0.05), the blood calcium and phosphorus in the group with abnormal internal fistula function and normal group of internal fistula were higher than those in the group with normal internal fistula function. Urea nitrogen, serum creatinine, low density lipoprotein, cholesterol, triglyceride, whole parathyroid gland and hemoglobin had no significant difference. The serum levels of b-FGFV VEGF IL-1 尾 in hemodialysis patients were significantly higher than those in normal controls. There was no significant difference in serum b-FGFV FG IL-1 尾 levels between patients with normal fistula function and those with abnormal internal fistula function in hemodialysis patients. There was no significant correlation analysis between serum b-FGF and dialysis age, phospho-IL-1 尾 VEGF, whole parathyroid hormone. Low density lipoprotein (LDL) was positively correlated with systolic blood pressure (SBP) (0.836 ~ 0.459) and 0.527 ~ (0.711) ~ (0.427) ~ (0.427) ~ (0.472) P _ (0.01), and was positively correlated with diastolic blood pressure (P ~ (0.05) and diastolic blood pressure (P _ (0.371g) ~ (-1). Conclusion: (1) there is no significant correlation between the level of bFGF in peripheral blood and the function of internal fistula in dialysis patients. 2) improving the state of microinflammation, disorder of blood lipid metabolism, and controlling blood pressure of dialysis patients have certain benefits in prolonging the service life of internal fistula.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5

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