| Objective:The main cause of arteriovenous fistula(AVF)dysfunction is vascular stenosis caused by intravascular neointimal hyperplasia.Inflammation is one of the causes of AVF stenosis,Lipoprotein-associated phospholipase A2(Lp-PLA2)has been demonstrated in various studies as a specific vascular inflammation marker.The aim of this study was to discuss the related factors of AVF failure,and to focus on the level of Lp-PLA2 in hemodialysis patients and its relationship with AVF failure.Method:Of the 321 AVF patients admitted to Wuhan Central Hospital from October 2018 to June2019,a total of 142 patients meeting the appropriate criteria were included in this study.All patients were assessed with color Doppler ultrasonography of intravenous fistulas,34 patients were classified as patients with AVF preoperative(group 1),44 patients without AVF failure(group 2)and 66 patients with AVF failure(group 3).In addition,Ultrasound-guided percutaneous transluminal angioplasty was performed on 19 patients in the dysfunctional group.Patients with successful PTA operation were divided into pre-treatment group before PTA operation,and were divided into post-treatment group 1 month after PTA operation.Plasma Lp-PLA2,blood biochemistry,and complete blood count were measured in the group 1,group2 and group 3.The differences between the indicators in each group and the correlation between the group 3Lp-PLA2 and the neutrophil count and lymphocyte count ratio(NLR)were analyzed.The pre-treatment group and the post-treatment group were tested for Lp-PLA2 and NLR respectively,and the differences between the two groups before and after treatment were analyzed.Results:1.The level of Lp-PLA2 was lower in group 1 than in group 2(1316.11±230.93ng/ml vs.1435.48±203.54ng/ml;P<0.05);There was no significant difference in age,white blood cells,hemoglobin,blood creatinine,blood uric acid,blood potassium,blood calcium,blood phosphorus,plasma albumin,and parathyroid hormone between the two groups(P> 0.05).2.Lp-PLA2(1406.68±212.34 vs.1598.65±270.33;P<0.05),NLR(3.53(3.02~4.38)vs.4.42(4.00~5.12);P<0.05),hemoglobin(93.19±20.72 vs.103.88±20.88;P<0.05)and calcium(2.17±0.30 vs.2.43±0.41;P<0.05)were lower in group2 than in group3,and the difference was statistically significant(P<0.05).There were no significant differences in gender,age,prevalence of hypertension,prevalence of diabetes,white blood cells,blood creatinine,blood uric acid,blood potassium,blood phosphorus,plasma albumin,and parathyroid hormone in the two groups(P> 0.05).3.There was no correlation between Lp-PLA2 and NLR in group 3(r=0.065,P=0.506).4.Binary Logistic regression analysis showed that Lp-PLA2(OR=1.003;95% CI:1.000-1.006;P=0.021)and NLR(OR=1.800;95% CI: 1.036-3.126;P=0.037)may be independent risk factors of AVF failure in hemodialysis patients.5.Plasma Lp-PLA2 levels in group 3 patients with successful fistula PTA treatment were significantly lower after treatment than before treatment(P <0.05),and there was no significant difference in plasma NLR before and after treatment(P> 0.05).Conclusion:1.Hemodialysis can aggravate the micro-inflammatory state in patients;2.Lp-PLA2,NLR and calcium ions are risk factors for fistula failure in maintenance hemodialysis patients;3.The level of Lp-PLA2 decreases after successful PTA treatment,and its changes may be involved in the pathogenesis of AVF dysfunction. |
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