| Objective: This study aims to explore the risk factors affecting RCAVF maturity by prospectively investigating the indices of preoperative vascular ultrasound examination and indices of preoperative pathological examination for cephalic vein in patients with MHD in our centre,as well as the correlation betweenα-SMA,VEGF-An and RCAVF maturity.It is hoped to provide a basis for preoperative targeted intervention treatment,reasonable treatment selection for patients and improvement of maturity.Methods:(1)Patients who came to the Department of Nephrology,Affiliated Hospital of You Jiang Medical University for Nationalities from April 2022 to October 2022 for maintenance hemodialysis treatment for their first carpal arteriovenous endovascular fistuloplasty were collected.The study subjects were physically examined by a clinically experienced dialysis nurse and the surgical operator himself at 8 to 12 weeks after the procedure,and the ultrasonographer performed vascular ultrasound testing,and those who met the maturity criteria were performed internal fistula puncture.Patients were divided into mature and immature groups based on the availability of RCAVF and hemodialysis.(2)28patients in the mature group,12 patients in the immature group and 30 healthy people in our physical examination center during the same period were collected,and serum enzyme-linked immunosorbent assay was used to detect the levels of α-SMA and VEGF-A factors and to analyze their correlation with endovascular maturation.(3)Intraoperative ligated veins from patients undergoing AVF angioplasty were retained and the intima and fibrosis of the veins were analyzed by Masson staining,and the expression levels of α-SMA and VEGF-A factors in the vessel wall of each group were detected by immunofluorescence and flow cytometry,and the correlation between the expression levels of these factors and the maturation of the endovascular fistula was analyzed.(4)The experimental data were statistically analyzed using SPSS 26.0,and the results were expressed as mean ± standard deviation,with P < 0.05 representing a statistically significant difference.Results:(1)There were statistically significant differences in primary disease,cephalic vein internal diameter,radial artery internal diameter,brachial artery internal diameter,and brachial artery flow between the mature and immature groups(P < 0.05).There were no statistically significant differences in gender,BMI,education,and HGB,ALB,Ca,P,LDL-C,TG,PTH,and CRP between the mature and immature groups(P > 0.05).(2)Serum ELISA:(1)α-SMA: the results of healthy control,mature and immature groups were 0.14±0.41,7.69±25.16 and 0.13±0.16,respectively,with no statistically significant difference between the three groups(F=1.877,P=0.161);(2)VEGF-A: the results of healthy control,mature and immature groups were: 0.00±0.00,616.08±614.80,172.52±217.05,with statistical differences between the three groups(F=17.657,P=0.000).(3)Masson staining showed that both endothelial and mesothelial tissues in the immature group were observed to be thickened to varying degrees under light microscopy,with more collagenous fibrous tissue.In the mature group,no significant thickening was observed in both the endothelium and the mesothelium,and there was less collagen fibrous tissue.(4)Immunofluorescence staining results:(1)α-SMA: The expression in the mature group(846.50±152.80)was higher than that in the immature group(425.75±112.31),and the difference was statistically significant(t=8.571,P=0.000).(2)VEGF-A: the expression in the mature group(926.61±256.03)was higher than that in the immature group(454.00±136.40),and the difference was statistically significant(t=6.009,P=0.000).(5)Flow cytometry results:(1)α-SMA: the expression in the mature group(881.92±221.93)was higher than that in the immature group(433.25±84.04),and the difference was statistically significant(t=7.231,P=0.000).(2)VEGF-A: expression in the mature group(835.80±195.95)was higher than that in the immature group(440.46±103.27),and the difference was statistically significant(t=6.993,P=0.000).Conclusion:(1)VEGF-A was higher in the serum of the AVF mature group.α-SMA and VEGF-A expression were significantly increased in the venous tissue of the AVF mature group.(2)AVF maturation was negatively correlated with diabetic nephropathy,and AVF maturation was positively correlated with cephalic vein internal diameter,radial artery internal diameter,brachial artery internal diameter,and brachial artery flow. |
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