血液透析患者自体动静脉内瘘狭窄处VEGF-A、趋化因子表达及与b-FGF的相关性  

Expression of vascular endothelial growth factor-A and chemokine in stenosis of autologous arteriovenous fistula in hemodialysis patients and their correlation with b-fibroblast growth factor

作　　者：徐皖东 黄丽丹 张树超[3] Xu Wandong;Huang Lidan;Zhang Shuchao(Department of Nephrology,Kangning Hospital Affiliated to Wenzhou Medical University,Wenzhou 325000,China;Department of Nephrology,Yongjia People's Hospital,Wenzhou 325100,China;Department of Nephrology,Shao Yifu Hospital Affiliated to Zhejiang University Medical College,Hangzhou 310016,China)

机构地区：[1]温州医科大学附属康宁医院肾内科,325000 [2]浙江省永嘉县人民医院肾内科,3251OO [3]浙江大学医学院附属邵逸夫医院肾内科,杭州310016

出　　处：《中国医师杂志》2020年第5期709-713,共5页Journal of Chinese Physician

基　　金：浙江省温州市科技计划经费自筹项目(Y20180679)。

摘　　要：目的探讨血液透析患者自体动静脉内瘘(AVF)狭窄处内皮生长因子-A(VEGF-A)、趋化因子[单核细胞趋化蛋白-1(MCP-1)和RANTES]表达情况及与碱性成纤维细胞生长因子(b-FGF)的相关性。方法选取2018年3月至2019年4月温州康宁医院肾内科的终末期肾脏病患者,共纳入90例,所有患者均给予第一次自体AVF手术,其中45例AVF失功患者为Ⅰ组,术中切取废弃的完整增生肥厚的静脉组织约1 cm;45例AVF正常患者为Ⅱ组,术中将头静脉结扎切断后,于近心端切取0.5~1 cm的完整静脉。测量两组静脉的内膜、中膜厚度和面积,免疫组化法检测静脉组织中VEGF-A、MCP-1和RANTES表达情况,ELISA法检测两组血清b-FGF、VEGF、MCP-1、RANTES水平,分析血清b-FGF与VEGF-A、MCP-1、RANTES表达的相关性。结果Ⅰ组静脉内膜/中膜厚度比、内膜/中膜面积比均大于Ⅱ组,差异有统计学意义(P<0.05)。Ⅰ组静脉组织中VEGF-A、MCP-1和RANTES呈强阳性表达,而Ⅱ组均呈弱阳性表达,差异有统计学意义(P<0.05)。Ⅰ组血清b-FGF、VEGF-A、MCP-1和RANTES表达水平均显著高于Ⅱ组,差异有统计学意义(P<0.05)。Ⅰ组血清b-FGF水平与VEGF-A、MCP-1、RANTES呈正相关(r=0.794,0.523,0.576,P<0.05),Ⅱ组血清b-FGF水平与VEGF-A、MCP-1、RANTES无明显线性关系(P>0.05)。结论血清b-FGF可能通过介导VEGF-A、MCP-1和RANTES高表达,在静脉内膜增生中发挥重要作用。Objective The expression of endothelial growth factor-A(VEGF-A),chemokine[monocyte chemoattractant protein-1(MCP-1)and RANTES]in stenosis of autologous arteriovenous fistula(AVF)in hemodialysis patients and their correlation with basic fibroblast growth factor(b-FGF).Methods From March 2018 to April 2019,90 patients with end-stage renal disease were enrolled in this study.All patients were given the first autologous AVF surgery,and 45 patients with AVF loss were in groupⅠ,45 patients with normal AVF were in groupⅡ.The thickness and area of intima and media were measured.The expression of growth factors was detected by immunohistochemistry.The correlation between serum b-FGF and the expression of growth factors was analyzed.Results The thickness ratio and area ratio of intima to media in groupⅠwere larger than those in groupⅡ(P<0.05).VEGF-A,MCP-1 and RANTES were strongly positive in groupⅠand weakly positive in groupⅡ.The expression levels of serum b-FGF,serum and tissue VEGF-A,MCP-1 and RANTES in groupⅠwere significantly higher than those in groupⅡ(P<0.05).Serum b-FGF levels in groupⅠwere positively correlated with serum levels of VEGF-A,MCP-1 and RANTES(r=0.794,0.523,0.576,P<0.05),while serum b-FGF levels in groupⅡwere not significantly correlated with serum levels of VEGF-A,MCP-1 and RANTES(P>0.05).Conclusions Serum b-FGF may play an important role in venous intimal hyperplasia by mediating the over expression of VEGF-A,MCP-1 and RANTES.

关 键 词：静脉瘘 血液透析 血管内皮生长因子A 趋化因子类 碱性成纤维细胞生长因子 

分 类 号：R692.5[医药卫生—泌尿科学]