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目的探讨尿毒症患者早期小动静脉的纤维化改变。方法选择40例慢性肾脏病(chronic kidney disease,CKD)V期患者在行动静脉瘘手术时留取桡动脉及头静脉各0.5～1cm。对照组选取4例行手部血管手术患者头静脉,用茜素红、HE及Masson染色三色法判断血管纤维化及钙化程度。同时采用免疫组织化学的方法检测α-平滑肌肌动蛋白(actinalpha,smoothmuscleaorta,α-SMA)、骨形成蛋白-2(bone morphology protein-2,BMP-2)、骨形成蛋白-7(bone morphology protein-7,BMP-7)表达。结果免疫组化α-SMA、BMP-2在CKD患者静脉的表达有明显的升高,与正常人群的静脉有显著性差异(P<0.05),Masson染色、HE、茜素红染色提示尿毒症患者静脉改变以纤维化为主,而在尿毒症早期动脉改变不明显。结论尿毒症患者静脉的改变早于动脉的改变,而且以纤维化为主。提示静脉的改变同样可能与尿毒症患者心血管疾病密切相关。
Objective To investigate the early arteriovenous fibrosis in patients with uremia. Methods Forty patients with chronic kidney disease (CKD) stage V were admitted to the radial artery and the cephalic vein for 0.5 ~ 1 cm during arteriovenous fistula operation. In the control group, 4 patients undergoing hand-operated vascular surgery were selected to determine the degree of vascular fibrosis and calcification using alizarin red, HE and Masson staining. At the same time, immunohistochemistry was used to detect the expression of α-smooth muscle actin (α-SMA), bone morphological protein-2 (BMP-2), bone morphogenic protein-7 -7, BMP-7). Results The immunohistochemical expression of α-SMA and BMP-2 in the vein of CKD patients was significantly increased (P <0.05). Masson staining, HE and alizarin red staining showed uremia Patients with fibrosis to change the main vein, uremia in the early arterial changes were not obvious. Conclusions The change of venous in uremic patients is earlier than the change of arteries, and the main one is fibrosis. Tip vein changes may also be closely related to cardiovascular disease in patients with uremia.