血液透析血管通路的基础与临床进展  

Advances in basic and clinical knowledge of vascular access for hemodialysis

作　　者：陈冬平 叶朝阳 CHENDong-ping;YE Chao-yang(Department of Nephrology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Traditional Chinese Medicine Institute of Kidney Disease,Shanghai University of Traditional Chinese Medicine,Key Laboratory of Liver and Kidney Diseases,Ministry of Education,Shanghai University of Traditional Chinese Medicine,Shanghai 200005,China)

机构地区：[1]上海中医药大学附属曙光医院肾病科,上海中医药大学中医肾病研究所,肝肾疾病病证教育部重点实验室(上海中医药大学)

出　　处：《中国血液净化》2018年第12期793-797,共5页Chinese Journal of Blood Purification

基　　金：国家自然科学基金面上项目(81873617)国家自然科学基金青年项目(81400687);上海浦东新区重点学科群建设基金(PWZxq2017-07)

摘　　要：血管通路是血液透析患者的"生命线",近年来其相关基础与临床研究进展迅速。目前认为新生内膜增生是血管通路功能不良最主要的原因,上游事件如血管壁的始动损伤、血流动力学改变、内皮功能障碍等在慢性肾脏病背景下启动一系列下游的病理生理过程,最终新生内膜增生导致血管通路成熟障碍或功能不良。外科手术改良和经皮血管内动静脉内瘘成形术是近期血管通路构建领域的临床热点,血管通路血管内治疗技术如球囊辅助促成熟技术、副静脉闭塞及覆膜支架置入技术正逐渐开创血管通路维护与修复的新局面。多种全身性药物干预和局部血管外套技术在血管通路新生内膜增生的临床防治中取得了一定的疗效,新一代生物人工移植物显示了较好的安全性和通畅率预后,值得进一步临床研究验证。Vascular access is the "lifeline" to hemodialysis patients. The basic and clinical knowledge of vascular access progresses rapidly in recent years. Neointimal hyperplasia is now recognized as the main cause of vascular access dysfunction. Upstream events such as vascular wall injury, hemodynamic changes and endothelial dysfunction trigger a series of downstream pathophysiological processes in the context of chronic kidney disease. Eventually, the secondary neointimal hyperplasia leads to vascular access dysfunction or maturation failure. Surgical modification and percutaneous transluminal plasty of the dysfunctional AVF are the hot spots in the field of vascular access reconstruction. Endovascular technologies such as balloon-assisted maturation, accessory vein occlusion and stent placement are gradually opening up new prospects for maintenance and repair of vascular access. A variety of systemic drug intervention and local vascular wrap technologies have obtained some achievements for the clinical prevention and treatment of neointimal hyperplasia in vascular access. Tissue-engineered blood vessel grafts as vascular access have showed better safety and patency, and are worthy of further clinical study.

关 键 词：血液透析 血管通路 动静脉内瘘 人造血管 内膜增生 

分 类 号：R318.16[医药卫生—生物医学工程]