慢性肾脏病5期患者内瘘成形术血管的病理学变化

Pathological changes of blood vessels near internal fistula in chronic kidney disease patients at stage 5

目的探讨慢性肾脏病(chronic kidney disease,CKD)5期动静脉内瘘成形术患者桡动脉、头静脉血管的病理学变化。方法选取32例CKD5期患者行桡动脉、头静脉钛轮钉吻合手术,术中留取吻合处血管进行病理学检查(CKD组);另外选择10例年龄匹配的上肢截肢患者的手腕部相当于内瘘位置血管同期进行病理学检查(对照组)。结果 HE染色结果显示32例CKD5期患者桡动脉4例纤维组织增生,11例斑块形成,7例钙化灶形成,CKD组桡动脉(22/32)及头静脉(20/32)有不同程度病理改变,对照组仅有1/10例表现为纤维组织增生,2组比较?2=8.376和?2=9.557,P=0.003和P=0.002,均具有统计学意义。结论 CKD5期患者桡动脉、头静脉已经出现明显的病理学变化,动脉以钙化为主,而静脉以纤维增生管腔狭窄为主,提早进行内瘘手术可能会提高手术成功率。

Objective To study the pathological changes of radial artery and cephalic vein in patients with chronic kidney disease at stage 5 （CKD5）. Method We took samples of radial artery and cephalic vein for pathological study from 32 CKD5 cases （CKD group） during the internal fistula surgery. We also took ‘normal’ blood vessel samples at the same site from amputated limbs of 10 cases （control group） with the age comparable to the CKD patients. Result In CKD group, radial arteries showed fibrosis in 4 cases, plaque formation in 11 cases, and calcification foci in 7 cases, and cephalic veins were found to have fibrosis in 10 case, plaque formation in 8 cases, and calcification foci in 2 cases. In contrast in control group, there were no abnormalities in intimal, medial and adventitial layers in radial arteries and cephalic veins （？ 2 =8.376,？ 2 =9.557,P=0.003,P=0.002）. Conclusion Apparent pathological changes in radial artery and cephalic vein existed in CKD group. The main pathological change was calcification in radial arteries, and was fibrosis and stenosis in cephalic veins. Therefore, internal fistula surgery should be carried out earlier to obtain an internal fistula of high quality for blood access.