發(fā)布時(shí)間：2018-06-15 17:23

  本文選題：微炎癥狀態(tài) + 堿性成纖維細(xì)胞生長因子　； 參考：《石河子大學(xué)》2015年碩士論文

【摘要】：目的:自體動(dòng)靜脈內(nèi)瘺的通暢率隨透析月齡的增加而逐漸降低,其發(fā)病機(jī)理可能是血管內(nèi)皮功能損傷、血管通透性性改變導(dǎo)致動(dòng)靜脈內(nèi)瘺的血管內(nèi)皮細(xì)胞、平滑肌細(xì)胞失控性增生,造成自體動(dòng)靜脈內(nèi)瘺靜脈段血管加速動(dòng)脈硬化,靜脈段血管管腔狹窄,最終導(dǎo)致動(dòng)靜脈內(nèi)瘺功能喪失。堿性成纖維細(xì)胞生長因子、血管內(nèi)皮生長因子具有能促進(jìn)血管內(nèi)皮細(xì)胞及平滑肌細(xì)胞生長、增殖和分化。本研究探討透析患者外周血堿性成纖維細(xì)胞生長因子水平與動(dòng)靜脈內(nèi)瘺靜脈段動(dòng)脈硬化樣病變、血管狹窄、血栓形成等因素造成動(dòng)靜脈內(nèi)瘺功能異常的相關(guān)性,為早期預(yù)防自體內(nèi)瘺功能異常的發(fā)生提供理論依據(jù)。方法:選擇新疆石河子大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院血液凈化中心維持血液透析的患者24例,分為2組:(1)內(nèi)瘺功能正常組:男9例,女7例,平均透析年齡(49.58±11.6)歲,平均使用自體動(dòng)靜脈內(nèi)瘺透析月齡(34±6.69)個(gè)月,16例患者基礎(chǔ)病變分別是慢性腎炎8例,高血壓腎損傷6例,多囊腎2例;(2)內(nèi)瘺功能異常組:男3例,女5例,平均年齡(57.75±9.91)歲,平均使用自體動(dòng)靜脈內(nèi)瘺透析月齡(56.5±14.36)月,8例患者基礎(chǔ)病變是慢性腎炎6例,高血壓腎損傷1例,多囊腎1例;選擇門診體檢患者16例為正常對(duì)照組,晨起空腹抽血檢測(cè)入組對(duì)象血紅蛋白(Hemoglobin)、白蛋白(Alb)、電解質(zhì)、全段甲狀旁腺激素(intact parathyroid hormone),ELISA方法檢測(cè)檢測(cè)兩組堿性成纖維細(xì)胞生長因子(basic fibroblast growth factor,b FGF),血管內(nèi)皮細(xì)胞生長因子(vascular endothelial growthfactor,VEGF)、白介素-1β(Interleukin-1β,IL-1β)水平,比較各組之間生化指標(biāo)、FGF、VEGF、IL-1β的差異性及相關(guān)性。結(jié)果:(1)各組間性別、年齡、血鈣差異無統(tǒng)計(jì)學(xué)意義(P0.05),與內(nèi)瘺功能正常組相比,內(nèi)瘺功能異常組透析月齡長,差異有統(tǒng)計(jì)學(xué)意義(P0.05);內(nèi)瘺功能異常組與內(nèi)瘺正常組間血鈣、血磷、尿素氮、血肌酐、低密度脂蛋白、膽固醇、甘油三脂、全段甲狀旁腺、血紅蛋白差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(2)各組b-FGF、VEGF、IL-1β結(jié)果顯示:與正常組相比,維持血液透析患者血清b-FGF、VEGF、IL-1β水平較正常組顯著偏高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);維持血液透析患者內(nèi)瘺功能正常組與內(nèi)瘺功能異常組血清b-FGF、VEGF、IL-1β水平差異無統(tǒng)計(jì)學(xué)意義;(3)單因素相關(guān)分析:血清b-FGF與透析月齡、磷、IL-1β、VEGF、全段甲狀旁腺激素、低密度脂蛋白、收縮壓呈正相關(guān)(r=0.836、0.459、0.52、0.527、0.711、0.427、0.472,P0.01),與舒張壓呈正相關(guān)(r=0.371,P0.05)。結(jié)論:1)維持透析患者外周血b FGF水平與內(nèi)瘺功能異常無明顯相關(guān)性。2)改善微炎癥狀態(tài),血脂代謝紊亂,控制透析患者血壓對(duì)延長內(nèi)瘺使用壽命有一定的獲益。
[Abstract]:Objective: the patency rate of autologous arteriovenous fistula decreases with the increase of dialysis age. The pathogenesis of arteriovenous fistula may be the injury of vascular endothelial function and the change of vascular permeability leading to vascular endothelial cells of arteriovenous fistula. The proliferation of smooth muscle cells was out of control, which resulted in arteriosclerosis, stenosis of vascular lumen, and loss of arteriovenous fistula function in autologous arteriovenous fistula. Basic fibroblast growth factor, vascular endothelial growth factor can promote the growth, proliferation and differentiation of vascular endothelial cells and smooth muscle cells. The purpose of this study was to investigate the correlation between the level of basic fibroblast growth factor in peripheral blood of dialysis patients and arteriosclerotic lesions of arteriovenous fistula segment, vascular stenosis, thrombosis and other factors, which resulted in abnormal function of arteriovenous fistula. To provide a theoretical basis for early prevention of spontaneous fistula dysfunction. Methods: Twenty-four patients with normal internal fistula function were divided into two groups: male 9, female 7, mean dialysis age 49.58 鹵11.6 years. The average age of autologous arteriovenous fistula was 34 鹵6.69 months (n = 16): chronic nephritis (n = 8), hypertensive renal injury (n = 6) and polycystic kidney (n = 2). In the group of abnormal internal fistula, there were 3 males and 5 females with an average age of 57.75 鹵9.91 years. The average age of autologous arteriovenous fistula for dialysis months was 56.5 鹵14.36 months. The basic pathological changes were chronic nephritis in 6 cases, hypertensive kidney injury in 1 case and polycystic kidney in 1 case. In the morning, fasting blood samples were used to detect hemoglobin hemoglobinine, albumin Albbumin, electrolytes, hemoglobinins, and electrolytes. Total parathyroid hormone intact parathyroid hormoneine Elisa was used to detect the levels of basic fibroblast growth factor (parathyroid), vascular endothelial cell growth factor (VEGF) and interleukin-1 尾 -Interleukin-1 尾 (IL-1 尾) in two groups, and to compare the difference and correlation of biochemical index FGFVEGF-1 尾 between the two groups. Results there was no significant difference in sex, age, blood calcium between groups (P 0.05). Compared with normal internal fistula group, the age of dialysis was longer in the group with abnormal internal fistula function and the difference was statistically significant (P 0.05), the blood calcium and phosphorus in the group with abnormal internal fistula function and normal group of internal fistula were higher than those in the group with normal internal fistula function. Urea nitrogen, serum creatinine, low density lipoprotein, cholesterol, triglyceride, whole parathyroid gland and hemoglobin had no significant difference. The serum levels of b-FGFV VEGF IL-1 尾 in hemodialysis patients were significantly higher than those in normal controls. There was no significant difference in serum b-FGFV FG IL-1 尾 levels between patients with normal fistula function and those with abnormal internal fistula function in hemodialysis patients. There was no significant correlation analysis between serum b-FGF and dialysis age, phospho-IL-1 尾 VEGF, whole parathyroid hormone. Low density lipoprotein (LDL) was positively correlated with systolic blood pressure (SBP) (0.836 ~ 0.459) and 0.527 ~ (0.711) ~ (0.427) ~ (0.427) ~ (0.472) P _ (0.01), and was positively correlated with diastolic blood pressure (P ~ (0.05) and diastolic blood pressure (P _ (0.371g) ~ (-1). Conclusion: (1) there is no significant correlation between the level of bFGF in peripheral blood and the function of internal fistula in dialysis patients. 2) improving the state of microinflammation, disorder of blood lipid metabolism, and controlling blood pressure of dialysis patients have certain benefits in prolonging the service life of internal fistula.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R459.5

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本文編號(hào)：2022827