中国血液净化

›› 2007, Vol. 6 ›› Issue (10): 538-542.

• 论著 • 上一篇    下一篇

维持性血液透析患者微炎症状态与血管通路失功的相关研究

李 立1 王笑云1 刘殿阁2 刘必成2 高 民2
  

  1. 210029 南京，1. 南京医科大学第一附属医院肾脏科，2. 东南大学肾脏病研究所 东南大学附属中大医院肾脏科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-10-12 发布日期:2007-10-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-10-12 Published:2007-10-12

RichHTML

0

PDF

712

摘要： 目的 血管通路失功是维持性血液透析(MHD)患者常见而严重的临床并发症，对透析效果有直接的影响。本研究拟探讨微炎症反应在MHD患者血管通路失功中的作用。方法 选择南京医科大学第一附属医院及东南大学附属中大医院肾脏科的47例尿毒症维持性血液透析患者，男35例，女12例，观察期间无急性炎症及其它活动性疾病。实验分组：第1组(15例)，终末期肾衰竭患者首次作动静脉内瘘术，并继而行血液透析治疗；第2组(18例)，患者行血液透析未发生血管通路失功；第3组(14例)患者行血液透析，发生血管通路失功并需再次手术。观察3组患者血生化指标，ELISA法检测肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及单核细胞趋化蛋白-1(MCP-1)，并留取第1组和第3组患者桡动脉标本，行常规病理组织学染色，观察血管病理改变，测量血管内膜平均厚度。采用免疫组化观察血管单核巨噬细胞表面抗原CD68、单核细胞趋化蛋白-1的表达。 结果 第3组患者血清hs-CRP、TNF-α及IL-6明显高于第1、2组，第3组患者血管内膜明显增厚、其血管壁上CD68、MCP-1表达均明显高于第1组(P＜0.01)，血浆hs-CRP水平与桡动脉血管壁内膜厚度及CD68、MCP-1在血管壁上的表达呈显著正相关(P＜0.01)。 结论 尿毒症维持性血液透析患者体内微炎症状态可能参与血管通路失功的发生。

关键词: 微炎症, 尿毒症, 血管通路, 血液透析

Abstract: Objective Vascular access (VA) dysfunction is a major clinical complication in maintenance hemodialysis(HD)patients, and is closely related to the outcome of dialysis. Here we evaluated the role of microinflammation in VA dysfunction in HD patients. Methods Forty-seven HD patients(male 35, female12) without acute inflammatory reaction in the observation period were enrolled in this study. They were divided into three groups: group 1 (N=15), patients beginning hemodialysis using an arteriovenous fistula; group 2 (N=18), patients having been treated with HD for a period of time with functional VA; group 3 (N=14), patients having been treated with HD for a period of time with dysfunctional VA. Biochemical parameters were observed in the three groups. Serum TNF-α, IL-6 and MCP-1 were determined by ELISA. High-sensitivity C-reactive protein (hs-CRP) was determined by latex-enhanced immuno-nephelometric method. Tissues of radial artery were taken from patients of group 1 and group 3 for histological study. Expression of CD68 and MCP-1 in the radial arteries was determined by immunohistochemistry. Results Serum hs-CRP, TNF-α and IL-6 were significantly higher in group 3 than in group 1 and 2. Intimal thickness of radial arteries and the expression of CD68 and MCP-1 in arterial walls were also significantly increased in group 3 as compared with those of group1. Moreover, serum hs-CRP was significan-tly correlated to intimal thickness and the expression of CD68 and MCP-1 in arterial walls (P＜0.01). However, there were no differences in age, blood pressure and lipid level among the three groups. Conclusion This study suggests that microinflammation may be involved in the VA dysfunction in HD patients.

Key words: Uremia, Vascular access, Hemodialysis

中图分类号: