去抗原同种异体大隐静脉移至内瘘的临床应用效果

发布时间：2019-06-13 20:17

【摘要】：目的通过比较去抗原同种异体大隐静脉和人工血管两种移植血管材料建立的长期血液透析血管通路的临床应用效果,探讨去抗原同种异体大隐静脉作为移植血管材料的可行性、有效性和安全性,为血管耗竭不能建立自体动静脉内瘘(AVF)的终末期肾病(ESRD)患者寻找一种有效的移植血管材料。方法采用简单随机抽样的方法,将2015年5月至2016年12月间在济南市中心医院血液净化中心采用移植血管建立长期血管通路的患者分为两组:A组去抗原同种异体大隐静脉组12例,B组人工血管(聚四氟乙烯、PTFE)组12例,随访3个月至18个月,从以下几个方面观察去抗原同种异体大隐静脉组(A组)和聚四氟乙烯移植血管组(B组):术后出现疼痛、肿胀、麻木等不适症状的情况,透析充分性(Kt/V),并发症发生前血液透析血流量、穿刺止血时间、通畅率(3个月、6个月、9个月、12个月,15个月、18个月),狭窄、栓塞、感染、血管瘤样扩张、肢体远端缺血征、肿胀手综合征等并发症的发生率以及发生狭窄后移植血管组织形态学观察(HE染色、CTGF、TGF-β1的表达情况)。采用EXCEL进行数据录入,使用SPSS19.0软件进行统计分析。计数资料比较采用Fisher检验,符合正态分布的计量资料用均数±标准差表示,组间比较采用t检验,以P0.05为有统计学意义。结果两组患者的年龄和原发疾病构成,统计学无明显差异(P0.05);A组患者中,有4例患者术后感疼痛,可耐受,1例患者手术侧肢体肿胀,无患者肢体麻木;B组患者中,有6例患者术后感疼痛,其中4例患者药物止痛,4例患者术侧肢体肿胀,2例患者术侧肢体轻度麻木;在随访期间,A组和B组两组患者透析时的Kt/V值都1.4(P0.05);A、B组患者的透析血流量均大于200ml/min,血流量稳定,无血流量不足者(P0.05);A组比B组患者透析结束时穿刺止血时间短,t'=-2.271(P0.05);A组术后3个月、6个月、9个月、12个月、15个月及18个月的通畅率较B组均高;A组患者感染的发病率较B组低(P0.01);两组狭窄、栓塞、血管瘤样扩张、肢体远端缺血征、肿胀手综合征发病率的比较无显著统计学意义(P0.05);A组与B组患者中出现狭窄并发症后的移植血管标本,HE染色观察,内膜明显增厚,可见明显平滑肌细胞增生,CTGF主要在血管内膜及外膜处表达,呈棕黄色,TGF-β1在血管内膜、中膜、外膜均表达,呈棕黄色;。结论1、经去抗原同种异体大隐静脉移植血管内瘘透析的患者能达到充分的透析效果,血流量稳定,止血时间短,感染的发生率较低2、导致移植血管内瘘狭窄主要是内膜增生,内皮细胞与平滑肌纤维细胞是增生的主要成分,特别是平滑肌纤维成分的增生。3、当自体动静脉内瘘无法建立时,去抗原同种异体大隐静脉可作为一种较好的移植血管材料应用在临床。
[Abstract]:Objective to compare the clinical effect of long-term hemodialytic vascular pathway established by antigenic great saphenous vein and artificial blood vessel transplantation materials, and to explore the feasibility, effectiveness and safety of antigen-free great saphenous vein as vascular graft material, and to find an effective vascular graft material for (ESRD) patients with end-stage kidney disease whose vascular depletion can not establish autologous arteriovenous fistula (AVF). Methods A simple random sampling method was used to establish a long-term vascular pathway in the blood purification center of Jinan Central Hospital from May 2015 to December 2016. there were 12 patients in group A and 12 patients in group B (polytetrafluoroethylene, PTFE) group). The patients were followed up for 3 months to 18 months. The symptoms of pain, swelling and numbness, dialysis adequacy (Kt/V), blood flow before complications, puncture hemostasis time, patency rate (3 months, 6 months, 9 months, 12 months, 15 months, 18 months), stenosis, embolism and infection were observed from the following aspects: antigenic great saphenous vein group (group A) and polytetrafluoroethylene transplantation group (group B), such as pain, swelling, numbness and other uncomfortable symptoms, dialysis adequacy (HD), blood flow before complications, puncture hemostasis time, patency rate (3 months, 6 months, 9 months, 12 months, 15 months, 18 months). The incidence of complications such as angiomatoid dilatation, distal limb ischemic sign, swelling hand syndrome and histomorphology (HE staining, expression of CTGF,TGF- 尾 1) after stenosis. EXCEL is used for data input and SPSS19.0 software is used for statistical analysis. The counting data were compared by Fisher test, the measurement data in accordance with normal distribution were expressed by mean 卤standard deviation, and the comparison between groups was carried out by t test, and P 0.05 was statistically significant. Results there was no significant difference in age and primary disease composition between the two groups (P 0.05); A group, 4 patients had postoperative pain and tolerable pain, 1 patient had limb swelling and no limb numbness, 6 patients in group B had postoperative pain, 4 patients had drug analgesia, 4 patients had postoperative limb swelling, 2 patients had mild numbness), 4 patients had postoperative pain, 4 patients had postoperative limb swelling, and 2 patients had mild numbness. During the follow-up period, the Kt/ V values of group A and group B were both 1.4 (P 0.05), A, the blood flow of group B was more than 200ml / min, the blood flow was stable, and there was no insufficient blood flow (P < 0.05). The time of puncture hemostasis at the end of dialysis in group); A was shorter than that in group B (P < 0.05). The patency rate of group A was higher than that of group B at 3 months, 6 months, 9 months, 12 months, 15 months and 18 months after operation. The incidence of infection in group A was lower than that in group B (P 0.01). There was no significant difference in the incidence of stenosis, embolism, angiomatoid dilatation, distal limb ischemia and swollen hand syndrome between the two groups (P 0.05). In group A and group B, the intima were obviously thickened and smooth muscle cells proliferated. CTGF was mainly expressed in intima and adventitia, and TGF- 尾 1 was expressed in intima, media and adventitia, which was brown and yellow in group A and group B. the expression of VEGF 尾 1 in intima, media and adventitia was brown and yellow, and the expression of VEGF 尾 1 in intima, media and adventitia was brown and yellow, respectively. Conclusion 1. The patients with endovascular fistula treated with antigenic great saphenous vein transplantation can achieve sufficient dialysis effect, the blood flow is stable, the hemostatic time is short, the incidence of infection is low 2, resulting in intimal hyperplasia, endothelial cells and smooth muscle fiber cells are the main components of proliferation, especially the proliferation of smooth muscle fibers. 3, when autologous arteriovenous fistula can not be established, Antigenic allogenic great saphenous vein can be used as a good vascular graft material in clinic.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.5

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