Changes and significance of plasma Lp-PLA₂ levels in hemodialysis patients with autologous arteriovenous fistula

Objective To investigate the changes and its clinical significance of plasma lipoprotein-associated phospholipase A₂ (Lp-PLA₂) levels in patients with autonomic arteriovenous fistula (AVF) with hemodialysis. Methods Forty patients with uremia who underwent regular hemodialysis through radial artery-cephalic anastomosis were selected, including 19 patients with vascular access failure (failure group) and 21 patients with vascular access patency (patency group). The patients in the failure group received percutaneous transluminal angioplasty (PTA) treatment, with 16 cases of AVF patency after operation. Plasma Lp-PLA₂, fibrinogen (FIB), white blood cell count (WBC) and neutrophil-lymphocyte ratio (N/L) were measured before operation and 1 month after operation in the failure group, and before dialysis in the patency group. The relationships between plasma Lp-PLA₂ and FIB, and between WBC and N/L were analyzed in patients with vascular access failure. Results (1)The plasma levels of Lp-PLA₂ and N/L in the failure group were higher than those in the patency group (P<0.05). There was no significant difference in plasma FIB level and WBC count between the two groups (P>0.05). (2)The plasma levels of Lp-PLA₂ and FIB were significantly lower after PTA treatment than those before treatment (P<0.05) in the failure group. There was no statistically significant difference in plasma N/L before and after PTA treatment (P>0.05). (3)There was a positive correlation between plasma Lp-PLA₂ and N/L in the failure group (r=0.360, P<0.05), and no correlation with FIB and WBC (P>0.05). Conclusions Our study indicated that the level of plasma Lp-PLA₂ increased after treatment in hemodialysis AVF patients with dysfunction, the level change may be involved in the formation of vascular access failure; mediating inflammatory response, promoting vascular plaque formation, and then plaque formation may be the mechanism of action.