慢性下肢缺血旁路术后早期再狭窄相关因素的研究

Analysis of relative factors of restenosis after artificially grafting bypasses on chronic ischemia of lower extremities

目的探讨慢性下肢缺血行人工血管旁路术后早期发生再狭窄的相关因素。方法回顾性分析2006年1月至2007年9月40例行单侧股胭动脉人工血管旁路术的慢性下肢缺血患者，其中男性36例，女性4例，年龄（66±9）岁。于术前、术后2周行血脂、纤维蛋白原及超敏C反应蛋白检测，术后6个月根据吻合口再狭窄程度分为轻、中、重度狭窄组，分析三组间伴随疾病、高危因素，比较3组血脂、纤维蛋白原、超敏c反应蛋白、同型半胱氨酸、IL-6及转化生长因子β1水平。结果糖尿病和吸烟的患者旁路术后再狭窄程度更严重，相对危险度分别为6．47和7．92。三组术前的各项生化指标差异无统计学意义，术后6个月二组问总胆固醇、低密度脂蛋白、纤维蛋白原、超敏C反应蛋白、IL-6及转化生长因子β1差异有统计学意义。多元线性回归分析示，纤维蛋白原、转化生长因子β1增高与术后内膜增牛程度相关。结论吸烟、伴随糖尿病及纤维蛋白原增高是人工血管旁路术后内膜增生及吻合口再狭窄的临床危险因素。

Objective To analyze the relative factors of early-term restenosis after artificially grafting bypasses on chronic ischemia of lower extremities. Methods From January 2006 to September 2007, 40 cases suffered from chronic ischemia of lower extremities were treated by single side femoropopliteal bypass were followed up during 6 months after operation. There were 36 male and 4 ease female with a mean age of （66±9） years old. Lipid, fibrinogen （FIB） and hypersensitive C reactive protein （hsCRP） were chemical examined during peri-operation. Basing on the degree of restenosis in vascular anastomosis by Color Doppler graft scan, all the patients were derided into light, moderate and severe groups, respectively. Biochemical indictors and cytokines were investigated such as lipid, FIB, hsCRP, IL-6, transforming growing factor betal （TGF-β1） . Possible risk factors resulting in restenosis were compared statistically among three groups with SPSS 15. 0. Results Restenosis were more severe among the patients with concomitance disease such as diabetes mellitus and smoking after operation. Relative risk were 6.47 and 7.92, respectively. There are significant difference in total cholesterin, low density lipoprotein, FIB, hsCRP, IL-6 and TGF-β1 among three groups during six months after operation （P 〈 0. 05）. Multiple linear regression showed that FIB and TGF-β1 may be the risk factors to intimal hyperplasia. Conclusion Diabetes mellitus, smoking and higher levels of FIB may be the major high risk factors resulting in neointima hyperplasia and anastomosis restenosis.