尿毒症患者桡动脉上炎症因子表达和氧化脂质沉积对内瘘寿命影响的COX分析

Impact of ox-LDL,MCP-1,CD68 on the survival of arteriovenous fistula in radial arteries of uremic patients

目的研究氧化低密度脂蛋白(ox-LDL)、单核细胞趋化因子1(MCP-1)及巨噬细胞表面抗原(CD68)在尿毒症患者桡动脉壁上的沉积和表达对内瘘使用寿命的影响。方法对23例年龄为29～68岁尿毒症患者在初次手术行桡动脉-头静脉端端吻合建立动静脉内瘘时,保留其手术中因修剪而去除的桡动脉组织。采用免疫组化法测定桡动脉血管壁ox-LDL、MCP-1及CD68的表达。随访内瘘使用寿命,进行内瘘生存分析。失效事件定义为动静脉内瘘非外伤原因引起的堵塞。失访、终止观察为截尾事件。结果用ox-LDL、MCP-1及CD68分别建立COX风险比例模型时,3者的表达每增加1个单位,内瘘寿命缩短的风险比将分别增加1,008(P= 0．008,95%CI∶1．002064～1．014104)、1．007(P=0．000,95%CI∶1．003853～1．010966)及1．098(P= 0．000,95%CI∶1．047909～1．151526)。若3者同时进入COX风险比例模型,整个模型成立(决定系数为52．7,P=0．000)。整个模型中,ox-LDL、MCP-1及CD68 3者缩短内瘘寿命的风险比分别为0．997(P=0．414)、1．006(P=0．025)及1．113(P=0．001)。结论ox-LDL、MCP-1及CD68在尿毒症患者桡动脉壁上的表达增加将缩短内瘘使用寿命,尤其是尿毒症患者炎症因素的影响更大。

Objective To explore the effect of ox-LDL, MCP-1, CD68 on the survival of arteriovenous fistula in radial arteries of uremic patients. Methods Segments of radial arteries were obtained from 23 uremic subjects （29-68 years old） in the initial operation of arteriovenous fistula prior to hemodialysis. The deposit of ox-LDL and the expression of MCP-1,CD68 on the vascular wall were measured by immunohistochemistry. The survival time of arteriovenous fistula was followed by survival analysis. Results COX regression revealed that each of these risk factors, ox-LDL, MCP-1, CD68, played an important role in the survival time of arteriovenous fistula when they entered the model independendy. The hazard ratios were 1.008 （P=0.008,95% CI： 1.002064-1.014104）, 1.007（P=0.000, 95%CI： 1.003853-1.010966）, and 1.098496 （P=0.000, 95%CI： 1.047909- 1.151526）respectively. When all the three factors entered the COX regression model, the whole model was still founded. MCP-1 and CD68 still played important roles in the survival of arteriovenous fistula. The hazard ratios were 1.006（P=0.025） and 1.113（P=0.001） respectively. With the hazard ratio of 0.997, ox-LDL did not reach the statistic significance （P=0.414）. Conclusions The more deposit of ox-LDL and the more expression of MCP-1, CD68 on the vascular wall, the more shortened survival time of arteriovenous fistula. Particularly, the inflammation is the independent risk factor for the prognosis of arteriovenous fistula in uremic patients.