自体动静脉内瘘狭窄患者行经皮血管内成形术治疗效果及血清MCP-1、VEGF-A变化
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摘要
目的观察自体动静脉内瘘狭窄患者行经皮血管内成形术治疗的效果,并分析其单核细胞趋化蛋白-1(MCP-1)、血管内皮生长因子-A(VEGF-A)水平变化。方法收集2015年3月—2018年3月重庆市第五人民医院肾内科治疗血液透析自体动静脉内瘘狭窄患者60例。根据治疗方法不同分成2组:观察组(30例,行经皮血管内成形术)、对照组(30例,行内瘘切除重建术)。比较2组疗效、内瘘狭窄部位血管指标、MCP-1、VEGF-A、炎性介质水平以及并发症情况。结果 2组患者术后血管内瘘通畅率比较差异无统计学意义(P>0.05);观察组内瘘狭窄部位血管内径、血管横断面积、血管峰值流速等血管指标明显优于对照组(t/P=2.038/0.046、2.096/0.040、3.836/0.000);2组血清MCP-1、VEGF-A水平明显低于治疗前,且观察组明显低于对照组(t/P=2.151/0.036、2.015/0.048);2组hs-CRP、IL-6水平明显低于治疗前,且观察组明显低于对照组(t/P=3.286/0.002、3.438/0.001);2组并发症比较差异无统计学意义(P>0.05)。结论自体动静脉内瘘狭窄患者行经皮血管内成形术治疗效果良好,内瘘通畅情况改善明显,且其血清MCP-1、VEGF-A、炎性介质水平下降显著,并发症少。
Objective To observe the effect of percutaneous transluminal angioplasty( PTA) for stenosis of autologous arteriovenous fistula( AVF), and to analyze the changes of monocyte chemoattractant protein 1( MCP-1) and vascular endothelial growth factor A(VEGF-A). Methods From March 2015 to March 2018, 60 patients with stenosis of autologous arteriovenous fistula in hemodialysis were treated by nephrology department of Chongqing Fifth People's Hospital. According to different treatment methods, the patients were divided into two groups: observation group(30 cases underwent percutaneous endovascular angioplasty) and control group(30 cases underwent internal fistula resection and reconstruction). The curative effect, vascular index of stenosis site of internal fistula, MCP-1, vascular endothelial growth factor A, levels of inflammatory mediators and complications were compared between the two groups. Results There was no significant difference in postoperative patency rate between the two groups(P>0.05). The vascular indexes such as vascular diameter, vascular cross-sectional area and peak blood flow velocity were significantly better in the observation group than in the control group(t/P =2.038/0.046, t/P =2.096/0.040, t/P = 3. 836/0.000); the levels of serum MCP-1 and VEGF-A in the two groups were significantly lower than those before treatment, and the observation group was significantly lower than the control group(t/P =2.151/0.036, t/P =2.015/0.048); 2 groups of hs CRP, IL-6 levels were significantly lower than before treatment, and the observation group was significantly lower than the control group(t/P = 3.286/0.002,t/P = 3.438/0.001) There was no significant difference in the complications between the two groups(P > 0.05). Conclusion Percutaneous transluminal angioplasty for stenosis of autologous arteriovenous fistula has a good therapeutic effect. The patency of internal fistula has been improved significantly. The levels of serum MCP-1, vascular endothelial growth factor A and inflammatory mediators have decreased significantly, with fewer complications.
Objective To observe the effect of percutaneous transluminal angioplasty( PTA) for stenosis of autologous arteriovenous fistula( AVF), and to analyze the changes of monocyte chemoattractant protein 1( MCP-1) and vascular endothelial growth factor A(VEGF-A). Methods From March 2015 to March 2018, 60 patients with stenosis of autologous arteriovenous fistula in hemodialysis were treated by nephrology department of Chongqing Fifth People's Hospital. According to different treatment methods, the patients were divided into two groups: observation group(30 cases underwent percutaneous endovascular angioplasty) and control group(30 cases underwent internal fistula resection and reconstruction). The curative effect, vascular index of stenosis site of internal fistula, MCP-1, vascular endothelial growth factor A, levels of inflammatory mediators and complications were compared between the two groups. Results There was no significant difference in postoperative patency rate between the two groups(P>0.05). The vascular indexes such as vascular diameter, vascular cross-sectional area and peak blood flow velocity were significantly better in the observation group than in the control group(t/P =2.038/0.046, t/P =2.096/0.040, t/P = 3. 836/0.000); the levels of serum MCP-1 and VEGF-A in the two groups were significantly lower than those before treatment, and the observation group was significantly lower than the control group(t/P =2.151/0.036, t/P =2.015/0.048); 2 groups of hs CRP, IL-6 levels were significantly lower than before treatment, and the observation group was significantly lower than the control group(t/P = 3.286/0.002,t/P = 3.438/0.001) There was no significant difference in the complications between the two groups(P > 0.05). Conclusion Percutaneous transluminal angioplasty for stenosis of autologous arteriovenous fistula has a good therapeutic effect. The patency of internal fistula has been improved significantly. The levels of serum MCP-1, vascular endothelial growth factor A and inflammatory mediators have decreased significantly, with fewer complications.
引文
[1]徐元恺,甄景琴,张文云,等.内瘘静脉最小内径可作为判断自体动静脉内瘘狭窄的指标[J].中华肾脏病杂志,2017,33(3):187-190. DOI:10. 3760/cma. j. issn. 1001-7097. 2017.03.005.
[2]范晶娴,庄峰,卢建新,等.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[J].上海交通大学学报医学版,2017,37(2):212-217. DOI:10.3969/j. issn. 1674-8115.2017.02.016.
[3]张家庆,刘萍,王业梅,等.支架植人与球囊扩张治疗自体动静脉内瘘狭窄疗效比较[J].安徽医学,2017,38(6):720-722. DOI:10.3969/j. issn. 1000-0399.2017.06.012.
[4]郑全,杨建泉,罗建方,等.影响经皮穿刺腔内血管成形术治疗动静脉内瘘狭窄术后通畅率的因素分析[J].岭南心血管病杂志,2018,24(5):561-566. DOI:10.3969/j. issn. 1007-9688.2018.05.17.
[5]王墨扬,宋光远,裴汉军,等.过渡性经皮球囊主动脉瓣成形术在治疗危重主动脉瓣狭窄患者的临床应用——单中心经验[J].中国循环杂志,2018,33(4):336-340. DOI:10.3969/j. issn. 1000-3614.2018.04.006.
[6] Mustapha JA, Finton SM, Diazsandoval LJ. Percutaneous Transluminal Angioplasty in Patients With Infrapopliteal Arterial Disease Systematic Review and Meta-Analysis[J]. J Vasc Surg,2016,64(4):1170-1171. DOI:10. 1016/j. jvs. 2016.08.072.
[7]范晶娴,庄峰,卢建新,等.动静脉内瘘成形术前静脉内膜增生机制的探讨[J].中国血液净化,2017,16(3):183-187. DOI:10.3969/j. issn. 1671-4091.2017.03.010.
[8]王秀莲,焦军东.自体动静脉内瘘内膜增生的研究进展[J].中华老年多器官疾病杂志,2017,16(6):477-480. DOI:10. 11915/j.issn. 1671-5403.2017.06. 112.
[9]宁海欢,卓华钦,荣光,等.内皮细胞标记物及间充质细胞/肌成纤维细胞标记物在动静脉内瘘狭窄血管中的表达[J].海南医学,2018,29(7):898-900. D01:10.3969/j. issn. 1003-6350. 2018.07.004.
[10] Cheung AK, Imrey PB, Alpers CE, et al. Intimal Hyperplasia, Stenosis, and Arteriovenous Fistula Maturation Failure in the Hemodialysis Fistula Maturation Study[J].J Am Soc Nephrol,2017,28(10):3005-3013. DOI:10.1681/ASN.2016121355.
[11]何玉霞.hs-CRP、MCP-1、RANTES和HDL2-C、HDL3-C的水平与冠状动脉粥样硬化性心脏病严重程度相关性分析[J].国际检验医学杂志,2017,38(8):1117-1119. DOI:10. 3969/j. issn. 1673-4130.2017.08.044.
[12]王春雪.VEGF-A、MCP-1及RANTES在血液透析患者自体动静脉内瘘狭窄部位表达的研究[D].河北医科大学,2017.
[13]赵治,孙晓东.关注OCT血管成像检测的CNV血管形态特征动态变化对抗VECF治疗后新生血管性AMD应答反应的预测作用[J].中华实验眼科杂志,2018,36(1):1-4. DOI:10.3760/cma.j. issn. 2095-0160.2018.01.001.
[14]黄纪卫,蒋毅,肖勇强,等.血清hs-CRP、TNF-α及VEGF水平对冠心病严重程度的预测价值[J].疑难病杂志,2017,16(12):1205-1208. DOI:10. 3969/j. issn. 1671-6450.2017. 12.005.
[15] Duque JC, Tabbara M, Martinez L, et al. Dialysis Arteriovenous Fistula Failure and Angioplasty:Intimal Hyperplasia and Other Causes of Access Failure[J]. Am J Kidney Dis,2017,69(1):147-151.DOI:10.1053/j.ajkd.2016.08.025.
[2]范晶娴,庄峰,卢建新,等.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[J].上海交通大学学报医学版,2017,37(2):212-217. DOI:10.3969/j. issn. 1674-8115.2017.02.016.
[3]张家庆,刘萍,王业梅,等.支架植人与球囊扩张治疗自体动静脉内瘘狭窄疗效比较[J].安徽医学,2017,38(6):720-722. DOI:10.3969/j. issn. 1000-0399.2017.06.012.
[4]郑全,杨建泉,罗建方,等.影响经皮穿刺腔内血管成形术治疗动静脉内瘘狭窄术后通畅率的因素分析[J].岭南心血管病杂志,2018,24(5):561-566. DOI:10.3969/j. issn. 1007-9688.2018.05.17.
[5]王墨扬,宋光远,裴汉军,等.过渡性经皮球囊主动脉瓣成形术在治疗危重主动脉瓣狭窄患者的临床应用——单中心经验[J].中国循环杂志,2018,33(4):336-340. DOI:10.3969/j. issn. 1000-3614.2018.04.006.
[6] Mustapha JA, Finton SM, Diazsandoval LJ. Percutaneous Transluminal Angioplasty in Patients With Infrapopliteal Arterial Disease Systematic Review and Meta-Analysis[J]. J Vasc Surg,2016,64(4):1170-1171. DOI:10. 1016/j. jvs. 2016.08.072.
[7]范晶娴,庄峰,卢建新,等.动静脉内瘘成形术前静脉内膜增生机制的探讨[J].中国血液净化,2017,16(3):183-187. DOI:10.3969/j. issn. 1671-4091.2017.03.010.
[8]王秀莲,焦军东.自体动静脉内瘘内膜增生的研究进展[J].中华老年多器官疾病杂志,2017,16(6):477-480. DOI:10. 11915/j.issn. 1671-5403.2017.06. 112.
[9]宁海欢,卓华钦,荣光,等.内皮细胞标记物及间充质细胞/肌成纤维细胞标记物在动静脉内瘘狭窄血管中的表达[J].海南医学,2018,29(7):898-900. D01:10.3969/j. issn. 1003-6350. 2018.07.004.
[10] Cheung AK, Imrey PB, Alpers CE, et al. Intimal Hyperplasia, Stenosis, and Arteriovenous Fistula Maturation Failure in the Hemodialysis Fistula Maturation Study[J].J Am Soc Nephrol,2017,28(10):3005-3013. DOI:10.1681/ASN.2016121355.
[11]何玉霞.hs-CRP、MCP-1、RANTES和HDL2-C、HDL3-C的水平与冠状动脉粥样硬化性心脏病严重程度相关性分析[J].国际检验医学杂志,2017,38(8):1117-1119. DOI:10. 3969/j. issn. 1673-4130.2017.08.044.
[12]王春雪.VEGF-A、MCP-1及RANTES在血液透析患者自体动静脉内瘘狭窄部位表达的研究[D].河北医科大学,2017.
[13]赵治,孙晓东.关注OCT血管成像检测的CNV血管形态特征动态变化对抗VECF治疗后新生血管性AMD应答反应的预测作用[J].中华实验眼科杂志,2018,36(1):1-4. DOI:10.3760/cma.j. issn. 2095-0160.2018.01.001.
[14]黄纪卫,蒋毅,肖勇强,等.血清hs-CRP、TNF-α及VEGF水平对冠心病严重程度的预测价值[J].疑难病杂志,2017,16(12):1205-1208. DOI:10. 3969/j. issn. 1671-6450.2017. 12.005.
[15] Duque JC, Tabbara M, Martinez L, et al. Dialysis Arteriovenous Fistula Failure and Angioplasty:Intimal Hyperplasia and Other Causes of Access Failure[J]. Am J Kidney Dis,2017,69(1):147-151.DOI:10.1053/j.ajkd.2016.08.025.