尿毒症患者自体动静脉内瘘I型狭窄的临床病理研究

Clinicopathological analysis of type I stenosis of autogenous arteriovenous fistula in uremia patients

目的探讨尿毒症患者自体动静脉内瘘(autologous arteriovenous fistula,AVF)I型狭窄的临床病理特点。方法选取因I型狭窄而行AVF重建手术的患者为研究对象,收集入组患者临床资料。手术中留取废弃狭窄静脉组织与初次行内瘘手术的静脉血管组织做对照,做病理学分析,包括HE染色、Masson染色、免疫组化。结果共入组39例患者,平均年龄为(52.7±4.4)岁,62%为男性,糖尿病肾病为首位病因,占43.6%。Pearson相关分析显示:静脉内膜增生(neointimal hyperplasia,NIH)与血磷(r=0.381,P=0.026)呈正相关,与中性粒细胞计数(r=-0.360,P=0.031)呈负相关,与血钙(r=-0.269,P=0.097)和甲状旁腺激素(r=0.007,P=0.971)无相关性。功能不良的内瘘组织HE及Masson染色表现为典型的偏心性NIH。免疫组化提示NIH中内皮细胞标记物CD31、内皮祖细胞标记物CD133、M1巨噬细胞标记物CD68及INOS、M2巨噬细胞标记物CD68及CD206、自然杀伤细胞标记物CD56染色阳性。结论对于I型狭窄导致的AVF功能不良,组织病理染色表现为偏心性的NIH,且内膜厚度与血磷和中性粒细胞水平相关。免疫组化提示NIH中除了排列紊乱的内皮细胞,还出现了内皮祖细胞、M1和M2型巨噬细胞及自然杀伤细胞。

Objective To investigate the clinicopathological characteristics of type I autologous arteriovenous fistula(AVF)stenosis in uremic patients.Methods A total of 39 patients who underwent AVF reconstructive surgery for type I stenosis were enrolled in this study.Their clinical data were collected.The stenotic venous tissue cut during the reconstructive surgery and the venous tissue stored during the first AVF constructive surgery were pathologically compared,including HE and masson staining,and immunohistochemistry using antibodies against CD133,CD31,CD68,CD206,iNOS and CD56 to identify the cell types.Results The mean age of the 39 patients was 52.7±4.4 years old,62%were male,and diabetic kidney disease accounted for 43.6%of the patients.HE and Masson staining of the stenotic venous tissues demonstrated typical neointimal hyperplasia(NIH).Pearson correlation analysis showed that NIH was positively correlated with serum phosphorus(r=0.381,P=0.026)and negative correlated with neutrophil count(r=-0.360,P=0.031),but not with serum calcium(r=-0.269,P=0.097)and parathyroid hormone(r=0.007,P=0.971).Immunohistochemical staining showed that positive staining of CD31,CD133,CD206,iNOS,CD68 and CD56 were found in the NIH area in stenotic venous tissues.Conclusions Histopathological staining showed an eccentric NIH in the venous tissues from type I AVF stenosis.The thickness of the intimal layer correlated with serum phosphorus level and neutrophil count.Immunohistochemistry showed the presence of abnormally arranged intimal cells,endothelial progenitor cells,M1 and M2 macrophages,and NK cells in NIH areas.