内皮细胞标记物及间充质细胞/肌成纤维细胞标记物在动静脉内瘘狭窄血管中的表达

摘要

Objective To study the clinical expression of endothelial cell markers and mesenchymal cells/myo-fibroblast marker in the veins with arteriovenous internal fistula stenosis. Methods Veins with arteriovenous internal fistula stenosiscollected in the reconstruction of internal fistula from 60 patients with uremia treated in Department of Ne-phrology in the Third People's Hospital of Dongguan from January 2015 to December 2016 were enrolled as stenotic group.Normal venous vessels collected from 40 patients with uremia treated in the hospital or newly discovered during the same period were used as normal group.The vessels in the two groups were treated with double immunofluorescence staining with alpha-SMA and CD31/vWF,and the cells expressing both the two antibodies were observed.Results In the stenotic group,immunofluorescence staining showed expression of alpha-SMA in media smooth muscle cells and in-tima proliferative myofibroblast, CD31/vWF expression in endothelial cells, and expression of both alpha-SMA and vWF in endothelial cells of 3 cases but without CD31 expression.In normal group,immunofluorescence staining of 27 specimens expression of alpha-SMA in media smooth muscle cells and intima proliferative myofibroblast,expression of CD31/vWF in endothelial cells,with no cells having both alpha-SMA and CD31/vWF expression.Conclusion Muscle fiber cells are mainly from the endothelial cells-mesenchymal transdifferentiation. Long-term uremia patients may al-ready have neointimal hyperplasia in the vein.%目的 研究内皮细胞标记物及间充质细胞/肌成纤维细胞标记物在动静脉内瘘狭窄血管中的表达情况.方法 选取2015年1月至2016年12月间在东莞市第三人民医院肾内科接受治疗的尿毒症患者60例,在重建内瘘手术中截取狭窄内瘘静脉血管作为狭窄血管组,选取同期在本院就诊治疗或者新发现尿毒症患者40例,在内瘘成形手术中截取正常静脉血管作为正常血管组;两组分别进行α-SMA与CD31/vWF免疫荧光双染,寻找两个抗体同时表达细胞.结果 狭窄血管组免疫荧光的染色显示中膜的平滑肌细胞和内膜下的增生肌成纤维细胞内均有α-SMA表达,内皮细胞内有CD31/vWF表达,有3例显示内皮细胞同时有α-SMA与vWF表达,但却未见CD31表达;正常血管组中27例标本免疫染色显示中膜的平滑肌细胞和已有内膜下的增生肌成纤维细胞内有α-SMA表达,内皮细胞有CD31/vWF表达,但没有发现α-SMA与CD31/vWF同时表达细胞.结论 肌肉纤维细胞主要来源为内皮细胞-间充质细胞的转分化,长期尿毒症患者本身静脉血管内可能已有新生内膜增生存在.