血液透析自体动静脉内瘘失功患者血浆Lp-PLA2水平变化及意义

目的探讨血液透析自体动静脉内瘘(arteriovenous fistula,AVF)失功患者血浆脂蛋白相关磷脂酶A 2(lipoprotein-associated phospholipase A 2,Lp-PLA 2)水平变化及其临床意义。方法选择经桡动脉-头静脉吻合内瘘行规律血液透析治疗的尿毒症患者40例,其中内瘘失功19例(失功组)、内瘘通畅21例(通畅组);失功组均给予内瘘经皮腔内血管成形术治疗,术后16例AVF通畅。失功组术前及术后1个月、通畅组于透析前分别检测血浆Lp-PLA 2、纤维蛋白原(fibrinogen,FIB)、白细胞计数(white blood cell count,WBC)及中性粒细胞/淋巴细胞比值(neutrophil-lymphocyte ratio,N/L),分析内瘘失功者血浆Lp-PLA 2与FIB、WBC、N/L的关系。结果(1)失功组血浆Lp-PLA 2、N/L水平均高于通畅组,差异有统计学意义(P<0.05),两组血浆FIB水平及WBC计数比较,差异均无统计学意义(P>0.05)。(2)失功组内瘘治疗成功者治疗后血浆Lp-PLA 2、FIB水平均较治疗前明显降低(P<0.05),治疗前后血浆N/L比较差异无统计学意义(P>0.05)。(3)失功组血浆Lp-PLA 2与N/L呈正相关关系(r=0.360,P<0.05),与FIB、WBC均无相关性(均P>0.05)。结论血液透析AVF失功者血浆Lp-PLA 2水平升高,其水平变化可能参与内瘘失功的形成。

Changes and significance of plasma Lp-PLA2 levels in hemodialysis patients with autologous arteriovenous fistula

Objective To investigate the changes and its clinical significance of plasma lipoprotein-associated phospholipase A 2(Lp-PLA 2)levels in patients with autonomic arteriovenous fistula(AVF)with hemodialysis.Methods Forty patients with uremia who underwent regular hemodialysis through radial artery-cephalic anastomosis were selected,including 19 patients with vascular access failure(failure group)and 21 patients with vascular access patency(patency group).The patients in the failure group received percutaneous transluminal angioplasty(PTA)treatment,with 16 cases of AVF patency after operation.Plasma Lp-PLA 2,fibrinogen(FIB),white blood cell count(WBC)and neutrophil-lymphocyte ratio(N/L)were measured before operation and 1 month after operation in the failure group,and before dialysis in the patency group.The relationships between plasma Lp-PLA 2 and FIB,and between WBC and N/L were analyzed in patients with vascular access failure.Results(1)The plasma levels of Lp-PLA 2 and N/L in the failure group were higher than those in the patency group(P<0.05).There was no significant difference in plasma FIB level and WBC count between the two groups(P>0.05).(2)The plasma levels of Lp-PLA 2 and FIB were significantly lower after PTA treatment than those before treatment(P<0.05)in the failure group.There was no statistically significant difference in plasma N/L before and after PTA treatment(P>0.05).(3)There was a positive correlation between plasma Lp-PLA 2 and N/L in the failure group(r=0.360,P<0.05),and no correlation with FIB and WBC(P>0.05).Conclusions Our study indicated that the level of plasma Lp-PLA 2 increased after treatment in hemodialysis AVF patients with dysfunction,the level change may be involved in the formation of vascular access failure;mediating inflammatory response,promoting vascular plaque formation,and then plaque formation may be the mechanism of action.