| Backgroud: Arterial changes in patients with uremia, as important factors for cardiovascular disease, its mechanism and influence factors have also been widespread concerned. When forming in action fistula surgery, we often find in the cephalic vein segmentally harden, the lumen narrowed, or even completely occluded,but from the naked eye the arteries with similar caliber can not be found out the abnormity . From the clinical phenomena we get two enlightments: First, the pathological change of the small veins is earlier than that in arteries with the same caliber ; second, the early changes of small vein is mainly happened on fibrosis. The paper on Veins of patients with uremia, especially medium and small veins in the early stage has't been reported in the literature. From the theoretical speculation :Uremic small veins in patients with pathological changes can lead to organ congestion, lack of oxygen and other pathophysiological changes caused by venous reflux disorder. These changes also affect the survival rate of chronic kidney disease . Therefore, we put forward hypothesis according to the clinical phenomena: the pathological change of the small veins is earlier than that in small arteries, and mainly happened on fibrosis ,which is different from the calcification of small arteries. The paper aims to approve this hypothesis, observe the pathological changes and possible mechanism of small vein in the early stage of uremia.Objective: To observe the pathological changes of small arteries in the early stage of uremia, and discuss the possible mechanism.Methods1. Randomly selected 40 patients who operated the first time Fistula in both artery and vein in our hospital from October 2007 to June 2008. The primary affections: 30 chronic , 2 unclear reasons, except the diabetes。When doing the operation, choose 0.5-1.0 cm radial artery and cephalic vein, fixed by Bouin。Among these 40 patient, 22 are men and 18 are women, 40±17 years old, Scr>707 mmol/L. compared by the arteries and veins of 4 patients who did the hand blood vessel operation, three men and one woman, 35±15 years old, their kidney functions are normal, can exclude other blood vessel diseases.2. Use Alizarin Bordeaux, HE and Mason trichrome staining to observe the fibrosis and calcification of small artery and small vein.3. Use Immunohistochemisty to check anti-α-SMA(Actinalpha ,smooth muscleaort), BMP-2 (bone morphology protein-2) , BMP-7 (bone morphology protein-7), Bcl-2 and Bax.Results1,Alizarin Bordeaux, HE and Mason trichrome staining indicates the change in the vein of uremic patients is mainly the fibrosis, but the change of artery is not obviously , has no obvious fibrosis and calcification.2,Immunohistochemistry and immunofluorescence show thatα-SMA and BMP-2 increased in the small vein of CKD patient, it is different from the small vein of normal people.( P<0.05). But there is no obvious difference between its accompanied artery and the normal one.3,Immunohistochemistry and immunofluorescence show that bcl-2 increased in the small vein of CKD patient , it is different from the small vein of normal people.( P<0.05). But there is no obvious difference between its accompanied artery and the normal one.Conclusion1. The change of the small veins in patients with uremia is earlier than that of the accompanied small-artery.2. The change of small veins of the Uremic patients is mainly the fibrosis at early stage, rather than calcification.3 According to these pathological changes , it should be closely related to cardiovascular disease in uremic patients, or involved in the occurrence and the development of cardiovascular disease in patients with uremia.
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