糖尿病对股腘动脉支架患者预后影响的临床研究

Impact of diabetes mellitus on outcomes of patients with femoropopliteal artery stenting

目的 探讨糖尿病对下肢动脉硬化闭塞症患者行股腘动脉支架置入术后支架通畅率及临床预后的影响.方法 回顾性总结2006年1月至2012年12月在首都医科大学宣武医院血管外科成功接受股腘动脉支架成形术治疗的下肢动脉硬化闭塞症患者的临床资料,分成糖尿病组和非糖尿病组,对比分析2组患者术后的支架一期通畅率、辅助通畅率、保肢率和生存率.结果 本研究入组患者291例（332条肢体）,糖尿病组患者193例（214条肢体）,非糖尿病组患者98例（118条肢体）.平均随访（34±18）个月.患者术后5年的支架总体一期通畅率、辅助通畅率、保肢率及生存率分别为23.2％、35.3％、89.2％和69.6％.单因素分析显示,糖尿病患者术后5年的支架一期通畅率、保肢率及生存率均低于非糖尿病患者,但2组患者支架的辅助通畅率差异无统计学意义.Cox多因素回归分析证实,女性患者支架的一期通畅率低于男性,严重膝下血管病变和高血压与保肢率降低有关,而年龄则是影响患者生存率的唯一独立因素.结论 糖尿病是影响股腘动脉支架一期通畅率、保肢率和生存率的危险因素,但不是独立危险因素.

Objective To analyze the influence of diabetes mellitus （DM） on the outcomes of percutaneous transluminal angioplasty （PTA） with stenting of femoropopliteal artery,in patients with atherosclerotic occlusive disease （ASO）.Method Clinical data of inpatients who successfully received PTA with stenting procedures of femoropopliteal artery in Xuanwu Hospital from January 2006 to December 2012 were analyzed retrospectively.Patients were stratified into DM and non-DM groups.Results were compared between the two groups including primary patency （PP）,assisted patency （AP）,limb salvage and survival using Kaplan-Meier life table and Cox regression analyses.Result Totally 291 patients underwent 332 procedures.There were 214 DM and 118 non-DM limbs.Mean follow-up was 34 months.The 5-year PP was 23.2％,AP was 35.3％,limb salvage was 89.2％,and survival was 69.6％.DM was associated with lower 5-year PP,limb salvage,and survival than non-DM.But there were no significant difference in AP between the two groups.Females were associated with decreased PP than males on Cox multivariate analysis.Hypertension and below tibial diseases were associated with lower limb salvage rate and age is the only predictor of survival rate.Conclusions DM is a risk factor for poor outcomes after PTA with stenting procedures.