Taber T E, Maikranz P S, Haag B W, Gaylord G M, Dilley R S, Ehrman K O, Brown P B, Nelson D R, Kay D C, Roberts T L
Department of Nephrology, Methodist Hospital of Indiana, Community Hospitals of Indiana, Indianapolis, USA.
ASAIO J. 1995 Oct-Dec;41(4):842-6.
The maintenance of adequate hemodialysis vascular access is frequently complicated in the patient with polytetrafluoroethylene (PTFE) A-V hemodialysis grafts by venous anastomotic stenosis. This stenosis is caused by neointimal hyperplasia (NIH), a response to vascular injury. In this study, the authors prospectively analyzed the effect of a short-term regimen consisting of administration of two medications, heparin and low molecular weight dextran, on the development of NIH at the venous anastomosis in 79 patients with PTFE A-V hemodialysis grafts. In addition, they evaluated other parameters' effects on the development of NIH. In comparison with control subjects, heparin had some effect in minimizing the development of NIH in the PTFE grafts when evaluated radiologically at 3 months, although this effect was not statistically significant. Low molecular weight dextran, however, had no trend or statistically significant effect on this venous anastomotic narrowing. Interestingly, patient age, use of calcium channel blockers, and presence of diabetes mellitus (DM) all appeared to affect the development of NIH. Increasing age and use of calcium channel blockers was associated with decreased development of NIH; conversely, DM was associated with worsened NIH. In evaluation of access survival (time to first access failure), degree of venous anastomosis stenosis at 3 months was not predictive. Patient time on dialysis pre graft placement was the only measured parameter related to access failure. The method of dialysis pre graft placement (hemodialysis versus peritoneal dialysis) was not a significant factor in early access failure. Pharmacologic treatment of venous anastomotic narrowing in PTFE hemodialysis grafts due to NIH continues to be difficult. Short-term treatment with the tested medication failed to statistically affect NIH. Patient age, use of calcium channel blockers, and presence of DM were all factors in the development of NIH. Of measured parameters, time on dialysis pre graft placement was the only factor correlated with early access failure. In future treatment regimens, one should consider more prolonged treatment. In addition, noted risk factors should be considered when determining type of renal replacement therapy.
对于使用聚四氟乙烯（PTFE）动静脉血液透析移植物的患者，维持充足的血液透析血管通路常常因静脉吻合口狭窄而变得复杂。这种狭窄是由新生内膜增生（NIH）引起的，是对血管损伤的一种反应。在本研究中，作者前瞻性分析了由肝素和低分子右旋糖酐两种药物组成的短期治疗方案对79例使用PTFE动静脉血液透析移植物患者静脉吻合口处NIH发生情况的影响。此外，他们还评估了其他参数对NIH发生的影响。与对照组相比，在3个月时进行放射学评估，肝素在使PTFE移植物中NIH的发生最小化方面有一定作用，尽管这种作用无统计学意义。然而，低分子右旋糖酐对这种静脉吻合口狭窄没有趋势性或统计学上的显著影响。有趣的是，患者年龄、钙通道阻滞剂的使用以及糖尿病（DM）的存在似乎都影响NIH的发生。年龄增加和钙通道阻滞剂的使用与NIH发生减少有关；相反，DM与NIH恶化有关。在评估通路存活时间（首次通路失败的时间）时，3个月时的静脉吻合口狭窄程度并无预测性。移植前患者的透析时间是唯一与通路失败相关的测量参数。移植前的透析方式（血液透析与腹膜透析）不是早期通路失败的重要因素。因NIH导致的PTFE血液透析移植物静脉吻合口狭窄的药物治疗仍然困难。所测试药物的短期治疗未能在统计学上影响NIH。患者年龄、钙通道阻滞剂的使用以及DM的存在都是NIH发生的因素。在所测量的参数中，移植前的透析时间是唯一与早期通路失败相关的因素。在未来的治疗方案中，应考虑更长期的治疗。此外，在确定肾脏替代治疗类型时应考虑已指出的危险因素。
