血液透析血管通路狹窄的機轉

Mechanisms of Hemodialysis Vascular Access Stenosis

翁宏嘉(Hung-Chia Weng) ； 黎思源(Szu-Yuan Li)

《腎臟與透析》 31卷2期 (2019/06) Pp. 58-62

https://doi.org/10.6340/KD.201906_31(2).0003

摘要

血管新生內膜增生導致靜脈端阻塞，是造成透析通路功能障礙最常見的原因。雖然洗腎管路阻塞在臨床上產生重大影響，但目前仍缺乏有效的治療方法。對比之下，近年來冠狀動脈血管成形術蓬勃發展，連帶也牽動動脈內膜增生介入治療的進展。會造成兩種疾病治療發展出現差異原因主要有二，其一是靜脈內膜增生並沒有已被証實的致病機轉；其二是因為無法將分子研究的最新發展，轉化為實際臨床的血管通路治療方法。這一篇文章將深入探討血液透析血管通路功能障礙的病理機制和治療方法。

關鍵字

血管通路功能障礙 ； 靜脈阻塞 ； 新生內膜增生

並列摘要

Venous stenosis, as the result of neointimal hyperplasia, is the major cause of hemodialysis vascular access dysfunction, and there has been a paucity of novel therapeutic interventions in this field. This is in marked contrast to a recent plethora of targeted interventions for the treatment of arterial neointimal hyperplasia after coronary angioplasty. There has been a relative lack of cellular and molecular research that focuses on venous neointimal hyperplasia in the specific setting of hemodialysis vascular access. In addition, there have been inadequate efforts by the nephrology community to translate the recent advances in molecular and interventional cardiology into therapies for hemodialysis vascular access. This article reviews recent concepts in the pathogenesis of vascular stenosis that could potentially be applied in the setting of hemodialysis vascular access dysfunction.

並列關鍵字

vascular access dysfunction ； venous stenosis ； neointimal hyperplasia