糖尿病肾病CKD5期患者内瘘成形术血管的病理变化

Pathological Changes in Patients with Fistula Stage Diabetic Nephropathy CKD5 Plasty of Blood Vessels

目的观察糖尿病肾病CKD5期内瘘成形术患者桡动脉、头静脉血管的病理变化。方法选择64例糖尿病肾病CKD5期患者非优势手行桡动脉-头静脉吻合术,术中留取吻合处血管进行病理学送检(实验组);另外选择26例年龄相仿的上肢截肢患者,手腕部相当于内瘘位置,取动、静脉血管进行病理学送检(对照组)。结果 HE染色结果显示64例糖尿病肾病CKD5期患者,其中桡动脉2例炎细胞浸润、粘液样变性,12例纤维组织增生,28例内膜分层、增厚、硬化,11例粥样斑块形成;头静脉3例炎细胞浸润、粘液样变性,5例纤维组织增生,12例内膜增厚、分层,5例钙化灶形成。实验组桡动脉38例(59.4%)及头静脉25例(39.1%)有不同程度病理学变化。对照组仅有2例(7.69%)表现为纤维组织增生,差异有显著性(P<0.05)。结论糖尿病肾病CKD5期患者血管均有不同程度的病理学变化,故提早行内瘘手术及选择合适的吻合方式是内瘘成功的关键。

Objective To observe the pathological changes of the radial artery and the head vein in the pa- tients with diabetic nephropathy stage CKD5. Methods The non dominant hand,radial artery and head vein anastomosis was performed in the selected 64 patients with diabetic nephropathy stage CKD5. The anastomotie vascular was preserved for pathological examination（ experimental group） ;Another 26 age-matched patients with upper limb amputation, whose wrist was equivalent to the fistula location, were taken vascular pathological examination （ control group ）. Results HE staining showed that 64 cases of diabetic nephropathy stage CKD5 patients, the radialartery in 2 eases of inflammatory cell infiltration, mucoid degeneration, 12 cases of fibrous tissue hyperplasia, 28 cases of endometrial thickening, stratified, hardening, 11 cases of atherosclerotic plaque formation ; cephalic vein in 3 cases of inflammatoL＇y cell infihration, mueoid degeneration ,5 cases of fibrous tissue hyperplasia, 12 cases of intimal thickening,stratified,5 cases with calcification fi）ci formation. The experimental group of radial artery and cephalic vein were 38 eases （ 59.4% ）, 25 cases （ 39. 1% ） with different degree of pathological changes. While in the control group were 2 cases（7.69% ） only showed fibrous tissue hy- perplasia. Conclusion Pathological changes of diabetic nephropathy in patients with stage CKD5 vessel in varying de- grees,the fistula operation and suitable early treatment is key to the success of internal fistula.