中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (08): 680-684.doi: 10.3969/j.issn.1671-4091.2025.08.012

• 血管通路 • 上一篇    下一篇

DSA引导下经皮腔内血管成形术对血液透析并发动静脉内瘘狭窄患者血清sVCAM-1、Apelin-13及康复效果的影响

耿 超    陈坤前    朱恩全    田芳艳    周宇辉    刘诗潞   

  1. 655000 曲靖，云南省曲靖市第一人民医院1心脏血管外科 2肾内科
  • 收稿日期:2024-07-02 修回日期:2025-05-15 出版日期:2025-08-12 发布日期:2025-08-12
  • 通讯作者: 刘诗潞 E-mail:pcqkcj@163.com
  • 作者简介:suoyu57@163.com

The effect of DSA-guided percutaneous transluminal angioplasty on serum sVCAM-1, apelin-13 and rehabilitation in hemodialysis patients with arteriovenous fistula stenosis

GENG Chao, CHEN Kun-qian, ZHU En-quan, TIAN Fang-yan, ZHOU Yu-hui, LIU Shi-lu   

  1. Department of Cardiovascular Surgery and 2Department of Nephrology, The First People's Hospital of Qujing City, Qujing 655000, China
  • Received:2024-07-02 Revised:2025-05-15 Online:2025-08-12 Published:2025-08-12
  • Contact: 655000 曲靖，云南省曲靖市第一人民医院2肾内科 E-mail:pcqkcj@163.com

摘要： 目的  探讨DSA引导下经皮腔内血管成形术(percutaneous transluminal angioplasty，PTA)对血液透析并发动静脉内瘘(arteriovenous Fistula，AVF)狭窄患者血清人可溶性血管黏附因子1(soluble vasccular cell adhension molecule-1,sVCAM-1)、血管紧张素Ⅱ受体样1受体内源性配体13(angiotensin Ⅱ receptor-like 1 endogenous ligand 13,Apelin-13)及康复效果的影响。 方法  纳入云南省曲靖市第一人民医院2020年7月─2024年2月接受血液透析且并发AVF狭窄的120例患者进行观察，根据治疗方法的不同，将患者分为对照组(行AVF切除与重建术)和试验组(实施PTA疗法)，每组患者60例。比较2组患者AVF功能、血清sVCAM-1、Apelin-13、手术成功情况、舒适度以及并发症。 结果  组内比较，治疗后对照组和试验组患者的AVF直径、透析血流量、AVF血流量、Apelin-13水平分别高于治疗前(对照组：t=2.864、3.691、5.803、2.284，均P＜0.001；试验组：t=6.043、6.594、9.043、5.319，均P＜0.001)，血清sVCAM-1水平低于治疗前(对照组：t=3.753，P＜0.001；试验组：t=7.507，P＜0.001)。组间比较，治疗后试验组患者的AVF直径、透析血流量、AVF血流量、Apelin-13水平高于对照组(t=2.681、3.522、3.481、2.389，P＜0.001、＜0.001、＜0.001、0.019)，试验组患者的血清sVCAM-1水平低于对照组(t=3.841，P＜0.001)。2组间手术技术成功率(χ2=0.209，P =0.648)、临床成功率(χ2=1.008，P =0.315)无统计学差异。试验组患者的并发症发生率低于对照组(χ2=8.107，P=0.004)。 结论  PTA在血液透析并发AVF狭窄治疗中显示出良好的治疗效果和安全性，通过降低血清sVCAM-1水平、升高Apelin-13水平，改善患者的血管功能和内皮细胞功能，提高患者的舒适度和康复效果。

关键词: 经皮腔内血管成形术, 血液透析, 动静脉内瘘狭窄, sVCAM-1, Apelin-13, 康复效果

Abstract:  Objective To investigate the effect of DSA-guided PTA on serum sVCAM-1, apelin-13 and rehabilitation in hemodialysis patients with AVF stenosis.  Methods  A total of 120 patients who received hemodialysis and had AVF stenosis during July 2020 to February 2024 at the First People's Hospital of Qujing City, Yunnan Province were retrospectively analyzed. According to the treatment methods, the 120 patients were divided into a control group (undergoing AVF resection and reconstruction surgery) and an experimental group (implementing PTA therapy), with 60 patients in each group. AVF function, serum sVCAM-1 and apelin-13 levels, surgical success, comfort level, and complications were compared between the two groups.  Results  Before treatment, the internal fistula diameter, dialysis blood flow and internal fistula blood flow were similar in the two groups (t=0.237, 0.477 and 0.157 respectively; P=0.813, 0.634 and 0.875 respectively); after treatment, the internal fistula diameter, dialysis blood flow and internal fistula blood flow were improved in both groups (control group: t=2.864, 3.691 and 5.803 respectively; P＜0.001. experimental group: t=6.043, 6.594 and 9.043 respectively; P＜0.001). The improvement of internal fistula diameter, dialysis blood flow and internal fistula blood flow were better in experimental group than in control group (t=2.681, 3.522 and 3.481 respectively; P＜0.001). Before treatment, serum levels of sVCAM-1 and apelin-13 were similar in the two groups (t=0.354, and 0.656; P=0.724 and 0.513); after treatment, serum sVCAM-1 decreased and serum apelin-13 increased in the two groups (control group: t=3.753 and 2.284, P＜0.05. experimental group: t=7.507 and 5.319, P＜0.05). The decrease of serum sVCAM-1 and increase of serum apelin-13 were more in experimental group than in control group (t=3.841 and 2.389; P＜0.05). There were no differences in success rate of surgical technique (χ²=0.209, P=0.648) and clinical success rate (χ²=1.008, P=0.315) between experimental group and control group. The incidence of complications was lower in experimental group than in control group (1.67% vs. 16.67%; χ²=8.107, P=0.004).  Conclusion  PTA under ultrasound shows better therapeutic effect and safety in the treatment of AVF stenosis in hemodialysis patients. By reducing serum sVCAM-1, increasing serum apelin-13 and improvement of vascular function and endothelial cell function, patients’ comfort and rehabilitation are enhanced.

Key words: Percutaneous transluminal angioplasty, Hemodialysis, AVF stenosis, sVCAM-1, Apelin-13, Rehabilitation effect

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