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目的研究尿毒症患者桡动脉钙化与腕部动静脉内瘘术中血栓形成的关系;并探讨尿毒症患者血管病变的各种危险因素。方法 35例尿毒症患者,初次行腕部动静脉内瘘吻合术,采用端-端吻合的方法于术中取小段桡动脉。并对35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)进行观察和分析。结果 35例桡动脉中20例血管有钙化(57.14%),18例管腔内见不同程度的新鲜血栓形成,其中16例患者伴发桡动脉钙化(88.89%),主要定位于桡动脉的平滑肌层和弹力板下方,在未形成血栓的患者中桡动脉钙化的发生率为22.22%,二者差异有统计学意义(P﹤0.05);尿毒症患者与正常对照组(n=40)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﹤0.05),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)降低(P﹤0.05),其中重度血管病变组的INS、PTH显著增高(与另两组比较P﹤0.05),血浆皮质醇增高也较明显(与中度组比较P﹤0.05)。Lp(a)水平有随血管病变程度加重而逐渐升高的趋势。结论尿毒症血管钙化是导致血栓形成的重要原因之一;血栓形成可能与患者的内瘘手术有一定关联。
Objective To study the relationship between radial artery calcification and arterial-venous fistula thrombosis in patients with uremia and explore the various risk factors of vascular disease in uremic patients. Methods 35 cases of uremic patients, the first line of wrist anastomosis of arteriovenous fistula, the use of end-to-end anastomosis to take a short segment of the radial artery. 35 cases of uremia in patients with clinical testing indicators and pathological changes of radial artery (according to the severity of the disease was divided into light, medium and recombinant) were observed and analyzed. Results Twenty of the 35 patients with radial artery had calcification (57.14%) and 18 patients with different degree of thrombosis. Among them, 16 patients had radial artery calcification (88.89%), mainly located in the radial artery smooth muscle (P <0.05). The incidence of radial artery calcification in patients without thrombus was 22.22%, which was significantly lower than that in control group (n = 40) The levels of INS, C, PTH, Cortisol, serum Lp (a) [Lp (a)], triglyceride and mean arterial pressure (MAP) (P <0.05). Serum high density lipoprotein cholesterol (HDL-C) and insulin sensitivity index (IAI) were lower in severe angiopathy group (P <0.05) Plasma cortisol increased more significantly (compared with the moderate group P <0.05). The level of Lp (a) increased gradually with the severity of vascular disease. Conclusion Vascular calcification of uremia is one of the most important causes of thrombosis. Thrombosis may be related to the operation of fistula in patients.