Sharma Gaurav, Kuppler Christopher, He Yong, Tao Ming, Ding Kui, Longchamp Alban, Dember Laura M, Ozaki C Keith, Berceli Scott A
Division of Vascular and Endovascular Surgery, Brigham and Women's Heart and Vascular Center/Harvard Medical School, Boston, Massachusetts, USA.
Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida, USA.
Kidney Int Rep. 2018 Mar 2;3(4):970-978. doi: 10.1016/j.ekir.2018.02.008. eCollection 2018 Jul.
Local inflammation is an important regulator of vascular remodeling. We hypothesized that adipose tissue adjacent to hemodialysis arteriovenous fistulae modulates maturation.
During fistula creation, perivenous adipose was collected from 111 participants in the Hemodialysis Fistula Maturation Study. Nine adipose-associated mediators were measured. Duplex ultrasound was performed at 4 time points postoperatively from 1 day to first cannulation (10-26 weeks). Associations between logarithmically transformed biomarker levels and fistula remodeling were evaluated using mixed effects regression.
Elevated interleukin (IL)-6 and monocyte chemoattractant protein (MCP)-1 were associated with a reduction in the fractional vein diameter during the early time frame of 1 day to 2 weeks (diameter change of 26.6% and 20.4% at the 25th and 75th percentile for IL-6, = 0.01; 27.8% and 21.1% at the 25th and 75th percentile for MCP-1, = 0.02), but not in later stages of remodeling. Local leptin levels showed a significant negative correlation with fractional venous flow increase between 2 and 6 weeks (percent flow change 31.4% and 11.3% at the 25th and 75th percentile for leptin, = 0.03).
Thus, impaired fistula vein dilation and reduced capacity for flow augmentation associate with specific local adipose phenotypic signatures in a time-dependent manner. In view of adipose tissue plasticity, these findings raise the possibility of novel adipose-based strategies to facilitate fistula maturation.
局部炎症是血管重塑的重要调节因子。我们推测，与血液透析动静脉内瘘相邻的脂肪组织会调节内瘘成熟。
在建立内瘘过程中，从血液透析内瘘成熟研究的111名参与者中收集静脉周围脂肪。检测了9种与脂肪相关的介质。术后从第1天到首次插管（10 - 26周）的4个时间点进行双功超声检查。使用混合效应回归评估对数转换后的生物标志物水平与内瘘重塑之间的关联。
在术后1天至2周的早期阶段，白细胞介素（IL）-6和单核细胞趋化蛋白（MCP）-1升高与静脉直径分数降低相关（IL-6在第25和第75百分位数时直径变化分别为26.6%和20.4%，P = 0.01；MCP-1在第25和第75百分位数时直径变化分别为27.8%和21.1%，P = 0.02），但在重塑后期阶段则无此关联。局部瘦素水平在术后2至6周与静脉血流分数增加呈显著负相关（瘦素在第25和第75百分位数时血流变化百分比分别为31.4%和11.3%，P = 0.03）。
因此，内瘘静脉扩张受损和血流增加能力降低与特定的局部脂肪表型特征呈时间依赖性相关。鉴于脂肪组织的可塑性，这些发现提出了基于脂肪的新型策略促进内瘘成熟的可能性。
