혈액투석 환자의 동정맥루 폐쇄에 대한 MCP-1/IL-6의 의의

Abstract

Dysfunction of vascular access remains a leading cause of morbidity in patients receiving maintenance hemodialysis, accounting for 10-25% of their hospitalization. The main cause of vascular access dysfunction is thrombosis which is related to venous stenosis. The pathogenetic mechanism of venous stenosis includes cytokines, coagulation factors, growth factors and adhesion molecules. Two such cytokines, monocyte chemoattractant protein-1(MCP-1) and interleukin-6(IL-6), are known to be important in vascular smooth muscle cell proliferation. MCP-1 secreted by vascular endothelial cells, suppresses vascular smooth muscle cell proliferation. In contrast, IL-6 is secreted by monocytes, and it stimulates vascular smooth muscle cell proliferation. The followings are the results of our investigation into the plasma levels of MCP-1 and IL-6, as well as the clinical features of 70 patients currently receiving hemodialysis. 1) The patients were divided into two groups, a group with a history of vascular access obstruction (obstructed group) and a group with no such history (non-obstructed group). The mean age of the patients in the obstructed group was 48.1+/-14.2 years and that of the non-obstructed group, 53.2+/-13.7 yerars. The male-to-female ratios were 12 : 8 and 25 : 25 respectively. The average number of obstructions was 1.5+/-0.7. 2) The average duration of dialysis treatment was 17.2+/-42.2 months for the obstructed group and 28.5+/-35.2 months for the non-obstructed group. The dosage of heparin and erythropoietin given during dialysis, the amount of ultrafiltration, average blood pressure, hematocrit, platelet count, and the levels of albumin, total cholesterol, triglyceride, calcium, phosphorus, glucose, iPTH and creatinine were analysed, but there was no meaningful statistical difference between the two groups, There was, however, a statistically significant(p<0.05) difference in the levels of HDL-cholesterol between the two groups : In the obstructed group, an average level of HDL-cholesterol was 34.4+/-8.5 mg/dL whereas in the non-obstructed group, was 41.3+/-13.7 mg/dL. 3) The obstructed group had a MCP-1 level of 403.2+/-233.9 pg/mL and the non-obstructed group had a level of 271.8+/-124.1pg/ml, which is a meaningful statistical difference(p<0.01). Although the IL- 6 level was 10.3+/-24.3 pg/mL in the obstructed group and 5.0+/-8.1 pg/mL in the non-obstructed group, there is not significant difference because the distri bution of the sample values was widely scattered. In conclusion, MCP-1 levels showed higher levels in the group that had a history of vascular access obstruction perhaps as a result of over-secretion stimulated by A-V fistula obstruction. The higher IL-6 levels(without statistical meaning) in the same group may have relevance to vasclar access obstruction, but additional studies with a larger population are needed to clarify any relationship.