Allon Michael, Litovsky Silvio H, Tey Jason Chieh Sheng, Sundberg Chad A, Zhang Yingying, Chen Zhen, Fang Yun, Cheung Alfred K, Shiu Yan-Ting
1 Division of Nephrology, The University of Alabama at Birmingham, Birmingham, AL, USA.
2 Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA.
J Vasc Access. 2019 Jan;20(1):31-40. doi: 10.1177/1129729818773305. Epub 2018 May 9.
: Several histologic features have been identified in the upper-extremity arteries and veins of patients with advanced chronic kidney disease, which may affect arteriovenous fistula maturation. However, it is unclear whether these chronic kidney disease vascular features are abnormal.
: We obtained upper-extremity arterial and venous specimens from 125 advanced chronic kidney disease patients undergoing arteriovenous fistula creation and from 15 control subjects. We quantified medial fibrosis, micro-calcification, and intimal hyperplasia with appropriate histology stains. We characterized medial collagen fiber configuration in second-harmonic-generation microscopy images for the fiber anisotropy index and the dominant fiber direction.
: The advanced chronic kidney disease patients were significantly younger than control subjects (53 ± 14 years vs 76 ± 11 years, p < 0.001). After controlling for age, the chronic kidney disease patients had greater arterial medial fibrosis (69% ± 14% vs 51% ± 10%, p < 0.001) and greater arterial micro-calcification (3.03% ± 5.17% vs 0.01% ± 0.03%, p = 0.02), but less arterial intimal thickness (30 ± 25 µm vs 63 ± 25 µm, p < 0.001), as compared to control subjects. The anisotropy index of medial collagen fibers was lower in both arteries (0.24 ± 0.10 vs 0.44 ± 0.04, p < 0.001) and veins (0.28 ± 0.09 vs 0.53 ± 0.10, p < 0.001) in chronic kidney disease patients, indicating that orientation of the fibers was more disordered. The dominant direction of medial collagen fibers in chronic kidney disease patients was greater in the arteries (49.3° ± 23.6° vs 4.0° ± 2.0°, p < 0.001) and the veins (30.0° ± 19.6° vs 3.9° ± 2.1°, p < 0.001), indicating that the fibers in general were aligned more perpendicular to the lumen.
: Advanced chronic kidney disease is associated with several abnormalities in vascular histology and collagen fiber configuration. Future research is needed to investigate whether these abnormalities affect the maturation outcomes of arteriovenous fistulas.
在晚期慢性肾病患者的上肢动脉和静脉中已发现多种组织学特征，这些特征可能会影响动静脉内瘘的成熟。然而，尚不清楚这些慢性肾病的血管特征是否异常。
我们从125例接受动静脉内瘘创建手术的晚期慢性肾病患者及15名对照受试者身上获取了上肢动脉和静脉标本。我们使用适当的组织学染色方法对中层纤维化、微钙化和内膜增生进行了量化。我们在二次谐波产生显微镜图像中对中层胶原纤维结构进行了表征，以获取纤维各向异性指数和主要纤维方向。
晚期慢性肾病患者比对照受试者显著年轻（53±14岁 vs 76±11岁，p<0.001）。在对年龄进行校正后，与对照受试者相比，慢性肾病患者的动脉中层纤维化程度更高（69%±14% vs 51%±10%，p<0.001），动脉微钙化程度更高（3.03%±5.17% vs 0.01%±0.03%，p=0.02），但动脉内膜厚度更薄（30±25μm vs 63±25μm，p<0.001）。慢性肾病患者动脉和静脉中层胶原纤维的各向异性指数均较低（0.24±0.10 vs 0.44±0.04，p<0.001；0.28±0.09 vs 0.53±0.10，p<0.001），表明纤维的排列更紊乱。慢性肾病患者动脉和静脉中层胶原纤维的主要方向更大（49.3°±23.6° vs 4.0°±2.0°，p<0.001；30.0°±19.6° vs 3.9°±2.1°，p<0.001），表明纤维总体上更垂直于管腔排列。
晚期慢性肾病与血管组织学和胶原纤维结构的多种异常有关。未来需要进行研究以调查这些异常是否会影响动静脉内瘘的成熟结果。
