小肠黏膜下层血管外支架对动静脉内瘘近吻合口静脉内膜增生的影响  

Effect of small intestinal submucosa external scaffold on juxta-anastomotic venous intimal hyperplasia of arteriovenous fistula

作　　者：孙静 焦自钊 李丹 付海霞 安传国 李凤楼 范晴 王洪娟 Sun Jing;Jiao Zizhao;Li Dan;Fu Haixia;An Chuanguo;Li Fenglou;Fan Qing;Wang Hongjuan(Department of Outpatient Operating Room,Rizhao People’s Hospital,Jining Medical College,Rizhao 276826,China;不详)

机构地区：[1]济宁医学院附属日照市人民医院门诊手术室,日照276826 [2]济宁医学院附属日照市人民医院血液净化科,日照276826

出　　处：《国际移植与血液净化杂志》2021年第3期23-26,10,共5页International Journal of Transplantation and Hemopurification

基　　金：济宁医学院教师科研扶持基金(JYFC2019FKJ221);日照市科技研发专项基金(KJYF2019289)。

摘　　要：目的探讨小肠黏膜下层(SIS)血管外支架对动静脉内瘘(AVF)近吻合口静脉内膜增生的影响。方法选取20只雄性成年家兔,随机分为2组,每组各10只。对照组家兔左侧颈总动脉、颈总静脉端端吻合建立AVF。SIS组家兔左侧颈总AVF建立后,应用SIS包敷近吻合口静脉外周表面建立血管外支架。术后第21天取AVF近吻合口静脉作如下检测:HE染色测量内膜厚度、内中膜厚度比值,免疫组化法检测内膜增殖细胞核抗原(PCNA)表达水平,Western印迹法检测核因子-κB p65(NF-κB p65)及低氧诱导因子-1α(HIF-1α)表达水平。组间比较采用独立样本t检验。结果对照组AVF近吻合口静脉内膜厚度、内中膜厚度比值较SIS组明显增加(t值分别为3.510和3.139,均P<0.01);对照组AVF近吻合口静脉内膜细胞PCNA阳性表达率明显高于SIS组(t=3.619,P<0.01),对照组AVF近吻合口静脉NF-κB p65、HIF-1α的相对表达量均明显高于SIS组(t值分别为12.050和15.077,均P<0.01)。结论小肠黏膜下层血管外支架能够减轻家兔颈总动静脉内瘘近吻合口静脉内膜增生,可能与促进受损静脉修复以减轻静脉损伤后炎症反应及缺氧等有关。Objective To investigate the effect of small intestinal submucosa(SIS)external scaffold on juxta-anastomotic venous intimal hyperplasia of arteriovenous fistula(AVF).Methods A total of 20 adult male rabbits were randomly divided into the control group and the SIS group with 10 rabbits in each group.AVF was created by end-to-end anastomosis of common carotid artery and common jugular vein in the control group.The external scaffold was established by using SIS around the peripheral surface of the juxta-anastomotic vein after the creation of AVF in the SIS group.On the 21st day post-operatively,the juxta-anastomotic veins were collected.The intimal thickness and the ratio of intima-media thickness were measured by hematoxylin-eosin(HE)staining,the expression of proliferating cell nuclear antigen(PCNA)in the intima was detected by immunohistochemistry,and the expression of nuclear factor-κB p65(NF-κB p65)and hypoxia inducible factor-1α(HIF-1α)in the vein were tested by Western blot.Results The intimal thickness and intima-media thickness ratio of juxta-anastomotic veins in the control group were significantly higher than those in the SIS group(t values were 3.510 and 3.139,respectively;P<0.01).The positive expression rate of PCNA in the intimal cells of juxta-anastomotic veins in the control group was significantly higher than that in the SIS group(t=3.619,P<0.01),and the relative expression levels of NF-κB p65 and HIF-1αof juxta-anastomotic veins in the control group were also significantly higher than those in the SIS group on the 21st day post-operatively(t values were 12.050 and 15.077,respectively;P<0.01).Conclusion Small intestinal submucosa external scaffold can mitigate juxta-anastomotic venous intimal hyperplasia of arteriovenous fistula in rabbits,and its mechanism may be related to the alleviation of inflammatory reaction and hypoxia after vein injury by promoting the repair of damaged vein.

关 键 词：小肠黏膜下层 血管外支架 动静脉内瘘 近吻合口静脉 内膜增生 

分 类 号：R654.4[医药卫生—外科学]