CT血管造影对下肢动脉硬化闭塞症介入治疗效果评价及术后复发预测价值研究

Evaluation of CT angiography in interventional treatment of lower extremity arteriosclerotic obliterans and its value in predicting postoperative recurrence

目的探讨CT血管造影(CTA)对下肢动脉硬化闭塞症(ASO)介入治疗效果评估及术后复发预测价值。方法选择130例ASO患者,其中男性81例,女性49例;年龄50~67岁,平均年龄58.92岁(标准差5.04岁);身体质量指数(BMI)21~27 kg/m^(2),平均BMI 24.28 kg/m^(2)(标准差1.33 kg/m^(2));高血压51例,糖尿病56例,冠心病57例;吸烟85例。均给予介入手术治疗及CTA检查,比较手术前后下肢动脉狭窄程度、斑块参数[斑块负荷(PB)、斑块面积(PA)、最小管腔面积(MLA)]。对所有患者进行为期1年的随访,根据ASO是否复发,分为复发组和未复发组,比较两组斑块参数,绘制受试者工作特性(ROC)曲线,计算曲线下面积(AUC),分析PB、PA、MLA对ASO复发的预测价值。Logistic回归分析ASO复发的危险因素。结果术后中度狭窄(23.08%)、重度狭窄(19.23%)、完全闭塞率(3.08%)均低于术前(30.77%、46.15%、13.85%)(P<0.05)。术后PB、PA、MLA均低于术前[(29.82±4.11)%vs(62.82±8.16)%、(4.26±0.26)mm^(2)vs(9.26±1.33)mm^(2)、(3.01±0.17)mm^(2)vs(7.16±1.05)mm^(2)。P<0.05]。随访1年后,根据复发情况分为复发组28例和未复发组102例。复发组PB(57.63±4.28)%、PA(9.02±1.27)mm^(2)、MLA(6.96±1.01)mm^(2)均高于未复发组[(28.11±3.85)%、(4.07±1.07)mm^(2)、(2.85±0.12)mm^(2)。t=35.077、20.805、40.474,P<0.05]。PB、PA、MLA联合检测预测ASO复发的AUC是0.792[95%可信区间(CI)0.716~0.954],灵敏度、特异度分别是93.08%、91.13%,均高于单一检测(P<0.05)。高血压、糖尿病、血管闭塞长度、术后用药不规律、C反应蛋白(CRP)是ASO复发的危险因素(P<0.05)(OR=1.268、1.216、1.134、1.329、1.226;95%CI=1.135~1.438、1.128~1.395、1.034~1.296、1.162~1.468、1.133~1.429)。结论CTA可准确评估ASO患者下肢动脉狭窄程度,辅助临床评估治疗效果,提高对疾病复发的预测灵敏度及特异度,ASO的复发与多种因素有关,应当引起临床重视与关注。

Objective To investigate the value of CT angiography(CTA)in evaluation efficacy of interventional therapy for lower extremity arteriosclerosis obliterans(ASO)and in prediction of postoperative recurrence.Methods A total of 130 ASO patients were enrolled,which included 81 males and 49 female,aged 50-67 years old with mean age of 58.92 years old(standard deviation 5.04 years old);body mass index(BMI)was 21-27 kg/m^(2)with mean BMI of 24.28 kg/m^(2)(standard deviation 1.33 kg/m^(2)).Previous history:hypertension history in 51 cases,diabetes history in 56,coronary heart disease history in57 and smoking history in 85.All of them performed interventional operation and CTA examination,the degree of lower extremity arterial stenosis and plaque parameters[plaque burden(PB),plaque area(PA),minimum lumen area(MLA)]before and after operation were compared.All of them were followed up for 1-year,and divided into recurrence group and non-recurrence group according to ASO recurrence.The plaque parameters between 2 groups were compared,receiver operating char acteristic(ROC)curve was drawn,area under the curve(AUC)was calculated,and the predictive value of PB,PA and MLA for ASO recurrence was analyzed.The risk factors of ASO recurrence were analyzed by Logistic regression.Results The postoperative moderate stenosis(23.08%),severe stenosis(19.23%)and complete occlusion rate(3.08%)were lower than those before operation(30.77%,46.15%,13.85%)(P<0.05).The postoperative PB,PA and MLA were lower than those before operation[(29.82±4.11)%vs(62.82±8.16)%,(4.26±0.26)mm^(2)vs(9.26±1.33)mm^(2),(3.01±0.17)mm^(2)vs(7.16±1.05)mm^(2).P<0.05].After 1-year follow-up,all of them were divided into recurrence group(n=28)and non-recurrence group(n=102)according to recurrence.The PB(57.63±4.28)%,PA(9.02±1.27)mm^(2)and MLA(6.96±1.01)mm^(2)in recurrent group were significantly higher than those in non-recurrent group[(28.11±3.85)%,(4.07±1.07)mm^(2),(2.85±0.12)mm^(2).t=35.077,20.805,40.474,P<0.05].The AUC of PB,PA and MLA combined detection to predicte ASO recurrence was 0.792[95%con fidence interval(CI)0.716-0.954],the sensitivity and specificity were 93.08%and 91.13%,respectively,which were higher than those of single detection(P<0.05).The hypertension,diabetes,vascular occlusion length,irregular postoperative medication,and C-reactive protein(CRP)were risk factors of ASO recurrence(P<0.05)(OR=1.268,1.216,1.134,1.329,1.226;95%CI=1.135-1.438,1.128-1.395,1.034-1.296,1.162-1.468,1.133-1.429).Conclusion It is demonstrated that CTA could accurately assess the degree of lower limb artery stenosis in ASO patient,assist the clinical evaluation of therapeutic effect,and improve the sensitivity and specificity of disease recurrence prediction.The recurrence of ASO is related to various factors,which should be paid attention to in clinic.