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(P<0.01)。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(P<0.05),与血磷、钙磷乘积呈正相关(P<0.05)。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。
To observe the vascular structure before autogenous arteriovenous fistula (AVF) construction in patients with end-stage renal disease (ESRD) and analyze the risk factors of the pre-existing venous neointimal hyperplasia. Methods · The 8 vein samples were screened from 20 ESRD patients at their first time of the AVF construction (non-stenosis group), and the other 8 vein samples were screened from 15 ESRD patients attheir at least second time of the AVF repair operation (stenosis group). Sections were prepared and stained with hematoxylin & eosin (H-E) or Masson’s trichrome for observation. The intimal thickness was measured by the cellSens software, and its correlation with patients’ renal function, calciumphosphorus metabolism, iron metabolism and inflammatory reaction in the non-stenosis group were analyzed. Results · In the non-stenosis group,there were varying degrees of intimal hyperplasia in 5 (62.5%) cases, loss of endothelial cell layer in 3 (37.5%) cases, and vascular wall replacement bycollagenous with atrophy or loss of muscle layer in 5 (62.5%) cases. In the stenosis group, almost all vein samples showed general thickening of the walland 2 (25.0%) totally lost the muscle layer. Avg It of those two groups were statistically significant (P<0.01). In the non-stenosis group, both of average I/M thickness and average I/M area were negatively related to glomerular filtration rate (GFR) (P<0.05) and positively related to serum phosphorus and calcium-phosphorus product (P<0.05). Conclusion · Some apparently normal vein of ESRD patients showed varying degrees of intimal hyperplasia before AVF construction. The intimal hyperplasia had a remarkable correlation with GFR or calcium-phosphorus metabolism. Early intervention of the intimal hyperplasia prior to AVF construction may be a new prevention and control means.
作者
范晶娴
庄峰
卢建新
王应灯
FAN Jing-xian;ZHUANG Feng;LU Jian-xin;WANG Ying-deng(Department of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China)
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2017年第2期212-217,共6页
Journal of Shanghai Jiao tong University:Medical Science
基金
上海市科学技术委员会项目(11DZ1921905)~~
关键词
终末期肾病
自体动静脉内瘘
内膜增生
end-stage renal disease
autogenous arteriovenous fistula
intimal hyperplasia
