CELL-PROLIFERATION IN HUMAN ARTERIOVENOUS-FISTULAS USED FOR HEMODIALYSIS
CELL-PROLIFERATION IN HUMAN ARTERIOVENOUS-FISTULAS USED FOR HEMODIALYSIS
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DOI：
10.1161/01.atv.13.4.609
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发表时间：
1993-04-01
期刊：
影响因子：
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通讯作者：
GORDON, D
中科院分区：
文献类型：
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作者：
REKHTER, M;NICHOLLS, S;GORDON, D
为肾衰竭患者血液透析建立的动静脉（AV）瘘的长期通畅性通常以月为单位进行测量，特别是当聚四氟乙烯（PTFE）材料插入动脉和静脉之间时。这是由于PTFE移植物材料与静脉的吻合区域内膜增生性病变的快速发展。我们研究了7个人类动静脉瘘在瘘翻修时取出的增殖模式。通过使用增殖细胞核抗原（PCNA）的抗体测定细胞增殖，并通过免疫化学试剂鉴定平滑肌细胞、单核细胞/巨噬细胞、单核细胞、淋巴细胞和内皮细胞的特定细胞类型。所有静脉段均显示内膜明显增生。血管内膜和中膜的血管化被毛细血管大小的血管所发现，内膜的主要细胞成分是平滑肌。通常在微血管周围观察到巨噬细胞，并且许多还存在于外膜的移植物周围区域。与人类动脉粥样硬化病变相反，在这些瘘管中观察到高细胞增殖率。PCNA指数（PCNA阳性细胞百分比[平均值+/-SD]）如下：内膜17.7+/-11.3%，中膜24+/-11.2%，外膜20+/-11.6%。但PCNA阳性细胞的分布并不均匀。相反，含有微血管的内膜区的PCNA指数是无血管内膜区的5 - 6倍（分别为28.9+/-10.6%vs4.9 +/-4.5%，p
The long-term patency of arteriovenous (AV) fistulas created for hemodialysis of renal-failure patients is usually measured in months, particularly when polytetrafluoroethylene (PTFE) material is interposed between the artery and vein. This is due to the rapid development of intimal hyperplastic lesions in the anastomosis region of the PTFE graft material with the vein. We studied the proliferative patterns in seven human AV fistulas removed at the time of fistula revision. Cell proliferation was determined by using an antibody to the proliferating cell nuclear antigen (PCNA), and specific cell types were identified by immunochemical reagents for smooth muscle cells, monocytes/macrophages, monocytes, lymphocytes, and endothelial cells. All venous segments exhibited a markedly hyperplastic intima. Vascularization of the intima and media by capillary-sized vessels was found. The main intimal cellular component was smooth muscle. Macrophages were usually seen around microvessels, and many also populated the perigraft region of the adventitia. In contrast to human atherosclerotic lesions, high rates of cell proliferation were observed in these fistulas. PCNA indices (percentage of cells that were PCNA positive [mean+/-SD]) were as follows: intima 17.7+/-11.3%, media 24+/-11.2%, and adventitia 20+/-11.6%. However, the distribution of PCNA-positive cells was not uniform. Instead, the PCNA index in microvessel-containing intimal fields was five to six times that of avascular fields (28.9+/-10.6% versus 4.9+/-4.5%, respectively, p