尿毒症患者桡动脉病变影响因素及临床意义

Radial artery pathology in uremia:an analysis of 27 cases

目的 :观察尿毒症患者血管病变的临床与病理联系 ,探讨导致血管病变的各种危险因素。 方法 :对 2 7例尿毒症患者的临床检测指标以及桡动脉病理改变 (按病变程度分为轻、中、重组 )进行了观察和分析。 结果 :尿毒症患者与正常对照组 (n =5 0 )比较 ,存在血浆胰岛素 (INS)、C肽、甲状旁腺激素 (PTH)、皮质醇、血清脂蛋白(a) [Lp(a) ]、三酰甘油和平均动脉压 (MAP)增高 (P <0 0 1) ,同时存在血清高密度脂蛋白胆固醇 (HDL -C)、胰岛素敏感指数 (IAI)等降低 (P <0 0 1) ,其中 ,重度血管病变组的INS、PTH显著增高 (与另两组比较P <0 0 1) ,血浆皮质醇增高也较明显 (与中度组比较P <0 0 5 )。Lp(a)水平有随血管病变程度加重而逐渐升高的趋势。此外 ,血管病变程度与临床心血管检查指标异常的发生率之间呈正相关 (P <0 0 5 ) ,其中超声心动图 (UCG)与血管病变程度关系最为密切 (P <0 0 1)。 结论 :高胰岛素血症、胰岛素抵抗 (IR)和LP(a)、PTH、皮质醇增高是导致尿毒症患者血管病变的危险因素。

Objective:In this study,the biopsy specimen of radial artery of 27 uremic patients were examined in order to investigate the pathology of uremic radial artery and to analyze the correlated risk factors. Methodology:Biopsy specimen of radial artery were obtained during the operation for establishment of arterio venous fistula for maintenance hemodialysis.The lesion of the artery was classified into three degrees:minimal,medium and severe.Clinical data were analyzed for correlated risk factor analysis. Results:Eight patients were classified as minimal lesion with mild thickness of artery wall and changes of internal elastic lamina,11 patients as medium with moderate thickness of artery wall and elastic lamina broken down and foam cell infiltration,8 as severe with significant hyalinosis of artery wall and elastic lamina broken down and appearance of clots or plates within the artery wall.Significantly increased levels of serum insulin,PTH and plasma level of cortisol were found in these patients,and correlated with the severity of the lesion of radial artery.Correlation was also found between the severity of the radial artery and cardiovascular events in these patients.Ultrasound cardiograph parameters correlated well with the degree of the artery lesion. Conclusion:Pathology of radial artery correlated with cardiovascular events and also its risk factors as lipoprotein(a),PTH and plasma cortisol in uremic patients.