下肢动脉硬化闭塞症患者外周血单核细胞围术期变化研究

Perioperative changes of peripheral monocyte cells in patients with atherosclerosis obliteration

目的探讨下肢动脉粥样硬化闭塞症（ASO）患者围术期外周血单核细胞计数变化及其临床意义。方法回顾性分析2014年5月至2017年5月北京石景山医院76例成功行腔内治疗的ASO患者的临床资料，按Fontaine分期分为对照组（Fontaine Ⅱ期）44例和严重肢体缺血（CLI）组（Fontaine分期Ⅲ、Ⅳ期）32例，对比两组患者性别、年龄、吸烟指数、合并糖尿病、合并高血压、围术期单核细胞计数情况。结果与对照组相比，CLI组入院时单核细胞计数显著升高[（0.850±0.183）×10^9/L比（0.478±0.091）×10^9/L，P〈0.001]，且合并糖尿病比例较对照组明显升高（P=0.009）；二组患者血运重建术后单核细胞计数均较术前显著下降（P〈0.001），在年龄、吸烟指数、合并高血压等方面比较，差异无统计学意义。多因素回归分析表明外周血单核细胞计数是ASO患者肢体缺血严重程度的唯一独立预测因子（P〈0.001）。结论CLI患者外周血单核细胞计数显著升高，行腔内治疗后缺血改善，单核细胞计数下降；外周血单核细胞在ASO患者的临床诊断与治疗具有重要意义，术后单核细胞的次级动员＂二级波＂可能是血管修复与重建的关键。

ObjectiveTo evaluate the perioperative changes of peripheral monocyte cells in patients with atherosclerosis obliteration.MethodsThe study was a retrospective, single-center study that enrolled 76 patients with lower limb arteriosclerosis obliterans from May 2014 to May 2017, receiving endovascular treatment in our hospital. Patients were divided into control group （Fontaine stage Ⅱ with intermittent claudication group） or critical limb ischemia （CLI） group （Fontaine stage Ⅲ-Ⅳ with rest pain, ulceration or necrosis） , who were successfully treated with endovascular surgery. The observed values included gender, age, smoking index, diabetes, hypertension, peripheral monocyte count （on admission, 24 h post-operation, 72 h postoperation, 2 weeks to 2 months after surgery） .ResultsPatients with CLI （n=32） had elevated preoperative peripheral monocyte counts compared with control patients （n=44） [ （0.850±0.183） ×10^9/L vs （0.478±0.091） ×10^9/L, P〈0.001], which all decreased after endovascular treatment. The prevalence of type 2 diabetes for the difference in other observed values. Multivariable logistic regression analysis demonstrated that CLI group was significantly higher than the control group （24/32 vs 20/44, P=0.009） . There was no peripheral monocyte count was the only independent predictor for the severity of limb ischemia in patients with lower extremity atherosclerotic occlusion （P〈0.001） .ConclusionsThe peripheral monocyte count of the patients with CLI was significantly increased before treatment, and decreased after tissue perfusion improved. We believed that the peripheral monocyte may be a clinically useful maker in the diagnosis and treatment for the patients with atherosclerosis obliterans, and the postoperative ＂secondary mobilization＂ may be the key to revascularization and angiogenesis.