目的 探讨壳多糖酶-3样蛋白1(chitinase-3-like protein 1，CHI3L1)与血液透析伴糖尿病患者动静脉内瘘(arteriovenous fistula，AVF)静脉流出道内膜增生的相关性。 方法 选取舟山医院肾内科2023年1月─2023年12月确诊终末期肾病并接受维持性血液透析患者30例，分为糖尿病组和非糖尿病组(n=15/组)。收集一般资料、AVF重建手术及透析资料、实验室数据等，检测糖脂代谢指标并分析其与内膜增生的关联；AVF重建手术中留取静脉流出道病变部位头静脉0.5 cm，行苏木精-伊红染色、弹性纤维范吉森染色、免疫组化及蛋白质免疫印迹检测CHI3L1表达。 结果 糖尿病组患者内膜厚度、中膜厚度、内膜/中膜厚度比值较非糖尿病组更为严重(t=14.642、12.547、27.462，均P＜0.001)，且糖尿病组患者血管内膜CHI3L1表达水平高于非糖尿病组(t=7.888，P＜0.001)。Logistic多因素回归分析显示：空腹血糖(OR=0.243，95% CI：0.086～0.687，P=0.008)、糖化血红蛋白(OR=0.039，95%CI：0.002～0.701，P=0.028)、三酰甘油(OR=0.235，95%CI：0.042～0.875，P=0.048)、总胆固醇(OR=0.096，95%CI：0.015～0.629，P=0.015)、  低密度脂蛋白胆固醇(OR=0.214，95%CI：0.079～0.580，P=0.002)为血液透析伴糖尿病患者AVF静脉流出道内膜增生的独立危险因素；CHI3L1表达与血管内膜增生呈正相关(r=0.717，P＜0.001)。 结论 CHI3L1与血液透析伴糖尿病患者AVF静脉流出道内膜增生密切相关，可能是该类患者内膜增生的潜在生物标志物；糖脂代谢紊乱可通过内皮损伤、炎症激活上调 CHI3L1，加剧内膜增生。

Objective To investigate the correlation between chapossidase-3-like protein 1 (CHI3L1) and intimal hyperplasia in venous outflow of arteriovenous fistula (AVF) in hemodialysis patients with diabetes.  Methods A total of 30 patients diagnosed with end-stage renal disease and receiving maintenance hemodialysis via AVF at the Department of Nephrology, Zhoushan Hospital from January 2023 to December 2023 were enrolled in this study. They were divided into diabetes group (n=15) and non-diabetes group (n=15). General data, AVF reconstruction surgery, dialysis, and laboratory results were collected. Glucose and lipid metabolism indicators were measured, and the correlation between these indicators and the intimal hyperplasia was analyzed. A segment of 0.5cm cephalic vein sample from venous outflow of the AVF was obtained during AVF reconstruction surgery. The samples were subjected to hematoxylin-eosin staining, van Gieson staining for elastic fibers, and immunohistochemistry and western blot for CHI3L1 expression.  Results Patients in diabetes group exhibited increased thickness of intima and media and higher ratio of intima-media thickness of the cephalic vein samples compared with those in non-diabetes group (t=14.642, 12.547, and 27.462, respectively; P＜0.001). Moreover, CHI3L1 expression increased significantly in diabetes group than in non-diabetes group (t=7.888, P＜0.001). Fasting blood glucose (OR=0.243, 95% CI: 0.086～0.687, P=0.008), glycated hemoglobin (OR=0.039, 95% CI: 0.002～0.701, P=0.028), triglycerides (OR=0.235, 95% CI: 0.042～0.875, P=0.048), total cholesterol (OR=0.096, 95% CI: 0.015～0.629, P=0.015), and low-density lipoprotein cholesterol (OR=0.214, 95% CI: 0.079～0.580, P=0.002) were the independent risk factors for intimal hyperplasia in venous outflow of AVF in hemodialysis patients with diabetes mellitus. CHI3L1 expression was positively correlated with the intimal hyperplasia (r=0.717, P＜0.001).  Conclusion Intimal hyperplasia in the venous outflow of AVF is closely correlated with the higher CHI3L1 expression, which may serve as a potential biomarker for intimal hyperplasia in AVF in hemodialysis patients with diabetes. Abnormal glucose and lipid metabolism may aggravate intimal hyperplasia in AVF through intimal injury and inflammation activated CHI3L1 expression.