终末期肾病患者动静脉内瘘成形术前血管内膜增生危险因素分析

发布时间：2018-10-21 14:32

【摘要】：目的·观察终末期肾病患者自体动静脉内瘘(AVF)成形术前静脉血管结构,分析术前发生内膜增生的相关危险因素。方法·分别于20例AVF成形术(未狭窄组)中及15例AVF再通术(狭窄组)中截取部分静脉节段,筛查出完整静脉组织(2组各8例),经苏木精-伊红(H-E)染色、Masson染色后进行形态学观察。使用cell Sens软件测量2组静脉增生内膜,将未狭窄组增生内膜厚度与患者肾功能、钙磷代谢、铁代谢、炎症反应进行相关性分析。结果·8例未狭窄组静脉节段中,5例(62.5%)有不同程度的内膜增生,3例(37.5%)有内皮细胞脱落,5例(62.5%)有血管壁胶原化伴平滑肌层的断裂及萎缩。8例狭窄组静脉节段均有血管壁增厚,其中2例(25.0%)平滑肌层完全消失。2组平均内膜厚度(Avg It)差异有统计学意义(P0.01)。未狭窄组的平均内膜/中膜厚度及面积与肾小球滤过率(GFR)呈负相关(P0.05),与血磷、钙磷乘积呈正相关(P0.05)。结论·部分终末期肾病患者AVF术前静脉已出现不同程度的内膜增生,GFR、钙磷代谢与其呈现相关性。术前减少静脉内膜增生危险因素可能是防治AVF狭窄的有效手段。
[Abstract]:Objective to observe the venous vascular structure of autologous arteriovenous fistula (AVF) before (AVF) angioplasty in patients with end-stage nephropathy and to analyze the risk factors of intimal hyperplasia. Methods in 20 cases of AVF angioplasty (non-stenosis group) and 15 cases of AVF recanalization (stenosis group), partial venous segments were amputated, respectively. The intact venous tissues (8 cases in each group) were detected by hematoxylin-eosin (H-E) staining and Masson staining. Cell Sens software was used to measure the intima of venous hyperplasia in two groups. The thickness of intimal hyperplasia in non-stenosis group was correlated with renal function, calcium and phosphorus metabolism, iron metabolism and inflammatory reaction. Results among the 8 cases without stenosis, 5 cases (62.5%) had different degree of intimal hyperplasia, 3 cases (37.5%) had endothelial cell shedding, 5 cases (62.5%) had collagenization of vascular wall with smooth muscle layer rupture and atrophy, and 8 cases of stenosis had vascular wall thickening. The smooth muscle layer disappeared completely in 2 cases (25.0%). The mean intimal thickness (Avg It) of the two groups was significantly different (P0.01). The mean intimal / media thickness and area were negatively correlated with glomerular filtration rate (GFR), positively correlated with blood phosphorus and calcium and phosphorus product (P0.05). Conclusion in some patients with end-stage nephropathy, venous intimal hyperplasia has occurred in different degrees before AVF, and calcium and phosphorus metabolism in GFR, is correlated with it. Reducing the risk factors of intimal hyperplasia before operation may be an effective method to prevent and treat AVF stenosis.
【作者单位】：上海交通大学医学院附属第九人民医院肾脏科;
【基金】：上海市科学技术委员会项目(11DZ1921905)~~
【分类号】：R692.5

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