尿毒症自体动静脉内瘘失功患者血浆sEPCR水平变化及意义

发布时间：2018-08-19 19:46

【摘要】：目的探讨尿毒症自体动静脉内瘘(AVF)失功患者血浆可溶性内皮细胞蛋白C受体(sEPCR)水平变化及其临床意义。方法选择经桡动脉-头静脉吻合内瘘行规律血液透析治疗的尿毒症患者42例,其中内瘘失功21例(失功组)、内瘘通畅21例(通畅组);失功组均给予内瘘介入治疗,术后18例AVF通畅。失功组术前及术后2个月、通畅组于透析前分别检测血浆CRP、纤维蛋白原(FIB)、sEPCR水平及WBC计数,分析内瘘失功者血浆sEPCR水平与血浆CRP、FIB水平和WBC计数的关系。结果失功组术前血浆CRP、sEPCR水平均高于通畅组(P均0.05),两组血浆FIB水平及WBC计数比较P均0.05。失功组内瘘介入治疗成功者治疗后血浆CRP、sEPCR水平均低于治疗前(P均0.05),治疗前后血浆FIB水平及WBC计数比较P均0.05。失功组血浆sEPCR水平与血浆CRP水平呈正相关关系(r=0.715,P0.05),与血浆FIB水平和WBC计数无相关性(P均0.05)。结论尿毒症AVF失功者血浆sEPCR水平升高,其水平变化可能参与内瘘失功的形成;介导炎症反应、促进血栓形成可能是其作用机制。
[Abstract]:Objective to investigate the changes and clinical significance of plasma soluble endothelial cell protein C receptor (sEPCR) in patients with autogenous arteriovenous fistula (AVF) failure in uremia. Methods Forty-two patients with uremia treated by regular hemodialysis via radial arterio-cephalic vein anastomosis were selected, including 21 cases of internal fistula failure group and 21 cases of internal fistula patency group, all of which were given interventional treatment of internal fistula. Postoperative AVF was patency in 18 cases. Before and 2 months after operation, plasma CRP, fibrinogen (FIB), EPCR and WBC count were detected in patency group before dialysis. The relationship between plasma sEPCR level and plasma CRP FIB and WBC count in patients with internal fistula failure was analyzed. Results the levels of FIB and WBC in the two groups were significantly higher than those in the unobstructed group before operation (P 0.05). The plasma levels of CRP FIB and WBC in the patients with internal fistula were lower than those before treatment (P 0.05), and the levels of plasma FIB and WBC before and after treatment were all lower than those before and after treatment (P 0.05). There was a positive correlation between plasma sEPCR level and plasma CRP level in dysfunctional group (r = 0.715 P 0.05), but no correlation with plasma FIB level and WBC count (P 0.05). Conclusion the level of plasma sEPCR in uremic patients with AVF dysfunction may be involved in the formation of internal fistula and may be involved in the formation of internal fistula, mediating inflammatory reaction and promoting thrombosis may be the mechanism of its action.
【作者单位】：南通大学第二附属医院;南通大学附属医院;
【分类号】：R692.5

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