2型糖尿病下肢动脉病变介入治疗对缺血动脉内血管性血友病因子、纤维蛋白原的影响及其意义

Effects of von Willebrand factor and fibrinogen of lower extremity artery in patients with type 2 diabetic lower extremity arterial diseases by percutaneous lower extremity arterial intervention

目的观察2型糖尿病合并下肢动脉病变患者介入治疗对下肢动脉内血管性血友病因子(vonWillebrand factor,vWF)、血浆纤维蛋白原(fibrinogen,Fb)的影响。方法选择2型糖尿病合并下肢动脉病变(Fontaine分级Ⅱb～Ⅳ级)患者66例,术前常规检查并取静脉血检测vWF、Fb水平。行介入手术时于动脉鞘植入成功后动脉鞘内、介入前缺血部位动脉血和介入后病变动脉以远段、介入前和术后1天、2天、7天、14天分别取静脉血检测vWF、Fb水平。观察内皮功能、凝血指标的变化,同时观察其他临床指标。结果介入组介入前动脉鞘内、介入前缺血部位动脉和介入后病变动脉以远段的vWF、Fb水平逐渐升高;vWF(147.6±17.3)%、(231.3±32.6)%、(299.2±35.2)%,Fb(3.91±0.26)g/L、(4.97±0.29)g/L、(5.69±0.28)g/L(均P<0.01);静脉血vWF、Fb水平于术后1天达高峰,术后7天恢复至术前水平,术后14天vWF、Fb水平低于治疗前。静脉血介入前、介入1天、2天、7天、14天vWF(148.3±16.4)%、(199.3±18.6)%、(176.5±18.1)%、(144.1±15.3)%、(128.5±11.4)%、Fib(3.88±0.23)g/L、(4.96±0.30)g/L、(4.59±0.25)g/L、(3.96±0.32)g/L、(3.11±0.19)g/L(均P<0.01)。结论缺血可引起内皮功能的损伤和凝血指标的变化,介入治疗可进一步增加动脉内皮功能的损伤和高凝状态,应早期进行内皮功能保护和抗凝治疗,介入后下肢血流改善,动脉内膜修复后,其内皮功能改善,高凝状态缓解。

Objective To observe the effects of von Willebrand factor（vWF） and fibrinogen（Fb） of lower extremity artery in patients with type 2 diabetic lower extremity artery disease by percutaneous lower extremity arteries intervention. Methods Sixty-six type 2 diabetes patients with lower extremity arterial diseases （Fontaine degree ]] b- I~） were examined routinely and their levels of vWF and Fb were tested. In percutaneous lower extremity arteries intervention, the arterial blood specimens were collected after the arterial sheath placement completed by arterial sheath successfully, after the catheter guide wire passed through the arterial segment of stenosis or occlusion by distal artery of stenosis or occlusion site, after balloon dilatation or stent implantation by distal artery of stenosis or occlusion site, respectively. The vein blood specimens were collected before interventional operation and one day, two days, seven days, fourteen days after interventional operation,respectively. The vein blood specimens were collected before interventional operation and 24 hours, 48 hours, 1 week,2 weeks after interventional operation, respectively. Levels of vWF and Fb were tested with all artery and vein blood specimens. The changes of endothelial function, blood coagulation index and other clinical indexes at the same time were observed. Results Blood specimens of arterial sheath and diseased arteries distal segment artery （ ischemia in artery） before interventional therapy, blood specimens of diseased arteries distal segment artery after interventional therapy, the levels of vWF were （ 147.6 ±17.3） %, （ 231.3 ± 32.6 ）%, （ 299.2 ±35. 2）%,the levels of Fb were （3.91±0.26） g/L,（4.97±0.29） g/L,（5.69±0.28） g/L. So,levels of vWF,Fb in diseased artery distal segment artery （ isehemia artery ） were significantly increased before interventional therapy（ P G 0.01） ,and the indexes further increased after interventional therapy（ P 〈0.01）. Before interventional therapy and one day, two days, seven days, fourteen days after interventional therapy, the vein blood levels of vWF, Fb were （148.3± 16.4）%,（3.88±0.23） g/L,（199.3±18.6）%,（4.96±0.30） g/L,（176.5±18.1）%,（4.59±0.25） g/L,（144.1± 15.3） %,（3.96±0.32） g/L,（144.1±15.3）%,（3.96±0.32） g/L. So,the vein blood levels of vWF,Fb reached peaks in 24 hours after interventional therapy （ P〈0.01）, dropped to the level before interventional therapy at 1 week and the levels were lower at 2 weeks compared with those before interventional therapy. Conclusion Isehemia can induce endothelial function injury and hypercoagulable states, interventional therapy can further increase arterial endothelial function injury and hypercoagulable states, early protection of endothelial function and anticoagulant therapy are necessary after interventional therapy, because of improvement of blood flow of lower extremity after interventional therapy. When arterial endomembrane is repaired,its endothelial function will be improved and hypercoagulable states will be eased.