Cheng Yue, Zhang Fan, Zhu Jun, Wang Tao, Wei Meng, Guo Dongyang, Mo Liweng, Zhu Changliang, Wang Xia
Clin Hemorheol Microcirc. 2016;62(2):129-37. doi: 10.3233/CH-151959.
Although numerous risk factors for arteriovenous fistulae (AVF) dysfunction have been identified, these risk factors do not explain all cases of AVF dysfunction. Because of the importance of blood pressure variability (BPV) in vascular injury, the predictive value of BPV for AVF dysfunction, was evaluated in this prospective cohort study.
Twenty-four-hour BP monitoring at the intervals of dialysis was recorded every 3 months in 137 patients. The expression of smooth muscle actin (SMA) and the infiltration of mononuclear cells and T lymphocytes were determined by immunohistochemistry on the specimens of fistula vessels.
Eighteen patients developed AVF dysfunction. Cox proportional hazards multivariate analysis revealed a significant relationship between fistula dysfunction and daytime systolic-BPV (d-SBPV), nighttime systolic-BPV (n-SBPV), diabetes mellitus, and initial venous diameter. Patients with AVF dysfunction were observed to have increased SMA expression and more infiltration of inflammatory cells in venous walls compared with the controls. A significant correlation between SBPV and the infiltration of CD68-positive cells was observed.
Our study showed that the degrees of SBPV were significantly associated with the risk of AVF dysfunction. Potentially, the increase of SBPV will aggravate venous wall inflammation and may play a role in AVF dysfunction.
尽管已确定动静脉内瘘（AVF）功能障碍的众多危险因素，但这些危险因素并不能解释所有AVF功能障碍病例。鉴于血压变异性（BPV）在血管损伤中的重要性，本前瞻性队列研究评估了BPV对AVF功能障碍的预测价值。
对137例患者每3个月记录一次透析间隔期的24小时血压监测情况。通过免疫组织化学法测定瘘管血管标本中平滑肌肌动蛋白（SMA）的表达以及单核细胞和T淋巴细胞的浸润情况。
18例患者发生AVF功能障碍。Cox比例风险多因素分析显示，瘘管功能障碍与日间收缩压变异性（d-SBPV）、夜间收缩压变异性（n-SBPV）、糖尿病和初始静脉直径之间存在显著关联。与对照组相比，AVF功能障碍患者的静脉壁SMA表达增加，炎症细胞浸润更多。观察到SBPV与CD68阳性细胞浸润之间存在显著相关性。
我们的研究表明，SBPV程度与AVF功能障碍风险显著相关。SBPV升高可能会加重静脉壁炎症，并可能在AVF功能障碍中起作用。
