目的: 观察尿毒症患者在行动静脉内瘘手术时的桡动脉壁单核细胞趋化因子-1(monocyte chemoattractant protein-1, MCP-1)及高敏 C 反应蛋白（high sensitivity C-reactive protein,hsCRP）表达情况,分析其对患者发生钝针穿刺部位狭窄的预测价值。方法: 连续纳入23例慢性肾脏病5期接受动静脉内瘘手术的患者,按桡动脉壁MCP-1表达的强弱分为低表达组和高表达组。钝针穿刺制造动静脉内瘘后随访48个月,对2组穿刺部位的狭窄事件及相关危险因素进行分析。结果: MCP-1低表达组在560个患者月共发生了5次穿刺部位狭窄,MCP-1高表达组209个患者月发生了8次穿刺部位狭窄（u=-2.080,P均<0.01）。与低表达组相比,高表达组穿刺部位狭窄的风险比（hazard ratio,HR）值为0.08（95% CI为0.02~0.32,P<0.01）。COX分析发现,MCP-1高表达和hsCRP高水平是穿刺部位发生狭窄的高危因素,两者的HR值分别为1.008和17.84（P均<0.05）。结论: 桡动脉壁MCP-1的高表达和hsCRP高水平可预示动静脉内瘘钝针穿刺部位狭窄。
Objective: To investigate whether the existed local inflammation and general micro-inflammation during arteriovenous fistula operation would predict the stenosis of arteriovenous fistula(AVF) in site of cannulation with buttonhole technique thereafter. Methods: Twenty-three patients with chronic kidney disease(CKD) stage 5 were allocated into 2 groups according to the expression of MCP-1 on the wall of radial artery during the operation of constructing AVF: low MCP-1 expression group and high MCP-1 expression group. All of the AVF were cannulated with buttonhole technique and followed up for 48 months. Results: The stenosis rate of cannulation site was 5 per 560 patient-month in low MCP-1 expression group, 8 per 209 patient-month in high MCP-1 expression group (u=-2.080, P<0.05). Compared with low MCP-1 expression group, the Hazzar ratio for high MCP-1 expression group to develop cannulation site stenosis was 0.08 (95% CI: 0.02-0.32, P<0.01). COX analysis revealed that high MCP-1 expression on radial artery and high level of hsCRP were the risk factors for cannulation site stenosis and the HR were 1.008 and 17.84, respectively(P<0.05). Conclusions: The expression of MCP-1 on radial artery and the level of hsCRP could predict the stenosis of the cannulation site of AVF with buttonhole.
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