CT血管成像分析下肢动脉硬化闭塞症患者主-髂动脉和肠系膜上动脉狭窄的相关性

Correlation between the stenosis degree of aorto-iliac artery and superior mesenteric artery in patients withlower extremity atherosclerotic occlusive disease by CT angiography]

目的观察下肢动脉硬化闭塞症（LEAOD）患者肠系膜上动脉（SMA）和主-髂动脉范围内各条动脉狭窄程度的相关性。方法收集2017年1月至12月天津市天津医院70例因间歇性跛行或静息痛而进行主-髂-股动脉CT血管成像（CTA）检查并确诊为LEAOD患者的图像。采用曲面重建对主-髂动脉范围内各条动脉进行高级血管分析（AVA）并结合原始图像进行分析〔包括SMA主干、腹主动脉（AA）、左侧和右侧髂总动脉（LCIA、RCIA）、左侧和右侧髂内动脉（LIIA、RIIA）、左侧和右侧髂外动脉（LEIA、REIA）〕，选取正常值参考层面和最大狭窄层面，应用软件自动计算重建范围内每条动脉的狭窄率。将患者的影像资料按两种方式分组：①根据SMA狭窄程度，将患者分为Ⅰ组（狭窄程度≤70%）和Ⅱ组（狭窄程度〉70%）；②将不同性别LEAOD患者分别分为中年期组（45～59岁）、老年前期组（60～74岁）和老年期组（75～89岁）。SMA和主-髂动脉范围内各条动脉狭窄程度的相关性采用Pearson简单相关分析。结果70例LEAOD患者的SMA狭窄发生率为100%。相关性分析显示，狭窄Ⅰ组（64例）和Ⅱ组（6例）的SMA与AA、LCIA、RCIA、LIIA、RIIA、LEIA、REIA的狭窄程度均不具有相关性（Ⅰ组r值分别为-0.021、0.023、0.023、-0.137、0.182、-0.113、0.141，Ⅱ组r值分别为0.020、-0.560、0.010、0.306、-0.204、-0.381、0.393，均P〉0.05）。在52例男性患者中，中年期组（16例）、老年前期组（27例）和老年期组（9例）SMA与AA、LCIA、RCIA、LIIA、RIIA、LEIA、REIA的狭窄程度均不具有相关性（中年期组r值分别为-0.032、0.024、0.324、0.146、0.312、0.008、0.344，老年前期组r值分别为-0.108、-0.116、-0.040、-0.249、-0.082、-0.052、0.096，老年期组r值分别为0.182、0.311、0.400、0.360、0.688、0.498、0.406，均P〉0.05）；在18例女性患者中，老年前期组（11例）和老年期组（6例）SMA与主-髂动脉范围内上述动脉的狭窄程度也不具有相关性（老年前期组r值分别为-0.170、0.040、-0.019、0.152、0.508、0.042、0.456，老年期组r值分别为-0.660、0.008、-0.055、-0.056、-0.213、0.344、0.011，均P〉0.05）；中年期组仅1例患者，故未予统计。结论LEAOD患者动脉粥样硬化性改变可同时累及SMA与主-髂动脉，但SMA与主-髂动脉范围内各条动脉的狭窄程度不具有相关性，其原因可能与不同动脉间的管壁组织学结构差异及血流动力学差异有关。SMA粥样硬化性狭窄和闭塞相对于LEAOD是一个独立的疾病进程。

ObjectiveTo investigate the correlation between the stenosis degree of superior mesenteric artery （SMA） and each artery within the scope of aorto-iliac artery in patients with lower extremity atherosclerotic occlusive disease （LEAOD）.MethodsImages of 70 patients who had undergone the aorta-iliac-femoral arteries CT angiography （CTA） examination and had a definite diagnosis of LEAOD due to intermittent claudication or resting pain admitted to Tianjin Hospital from January to December in 2017 were enrolled. The arteries in the aorta as well as iliac were surface-reconstructed, which were analyzed by advanced vascular analysis （AVA） combined with the original images, including SMA trunk, abdominal aorta （AA）, left and right common iliac artery （LCIA, RCIA）, left and right internal iliac artery （LIIA, RIIA）, left and right external iliac artery （LEIA, REIA）. The normal reference plane and the maximal stenosis plane were selected, and the stenosis rate of each artery in the reconstruction range was automatically calculated with software. The patient＇s imaging data were divided into groups with two methods： ① according to the degree of SMA stenosis, the patients were divided into group Ⅰ （stenosis degree ≤70%） and groupⅡ （stenosis degree 〉 70%）; ② LEAOD patients with different gender were respectively divided into three groups： middle-aged group （45-59 years old）, pre-elderly group （60-74 years old） and elderly group （75-89 years old）. The comparison between the stenosis degree of SMA and each artery within the scope of aorto-iliac artery was analyzed with Pearson simple correlation analysis.ResultsThe incidence of SMA stenosis in all LEAOD patients was 100%. Correlation analysis showed that there was no correlation between the stenosis degree of SMA and AA, LCIA, RCIA, LIIA, RIIA, LEIA, or REIA in group Ⅰ （n = 64） and group Ⅱ （n = 6）, respectively （r value was -0.021, 0.023, 0.023, -0.137, 0.182, -0.113, 0.141, respectively, in group Ⅰ, and it was 0.020, -0.560, 0.010, 0.306, -0.204, -0.381, 0.393, respectively, in group Ⅱ, all P 〉 0.05）. In 52 male patients, there was no correlation between the stenosis degree of SMA and AA, LCIA, RCIA, LIIA, RIIA, LEIA, or REIA in middle-aged group （n = 16）, pre-elderly group （n = 27） and elderly group （n = 9）, respectively （r value was -0.032, 0.024, 0.324, 0.146, 0.312, 0.008, 0.344, respectively, in middle-aged group, it was -0.108, -0.116, -0.040, -0.249, -0.082, -0.052, 0.096, respectively, in pre-elderly group, and it was 0.182, 0.311, 0.400, 0.360, 0.688, 0.498, 0.406, respectively, in elderly group, all P 〉 0.05）. In 18 female patients, there was also no correlation between the stenosis degree of SMA and above each artery within the scope of aorto-iliac artery in pre-elderly group （n = 11） and elderly group （n = 6）, respectively （the r value was -0.170, 0.040, -0.019, 0.152, 0.508, 0.042, 0.456, respectively, in pre-elderly group, and it was -0.660, 0.008, -0.055, -0.056, -0.213, 0.344, 0.011, respectively, in elderly group, all P 〉 0.05）. The correlation in middle-aged group was not analyzed because there was only 1 patient.ConclusionsAlthough the atherosclerotic changes in LEAOD patients can affect SMA and aorto-iliac artery at the same time, there was no correlation between the stenosis degree of SMA and each artery within the scope of aorto-iliac artery which may due to the differences in the histological structure and hemodynamics among different arteries. SMA atherosclerotic stenosis and occlusion is a relatively independent disease process for LEAOD.