药物涂层球囊在糖尿病下肢血管病变治疗中的价值

Application of drug-coated balloon in diabetic patients with lower extremity arterial disease

下肢动脉病变在世界范围内的发病率逐年攀升,其在糖尿病患者中更为常见,且往往临床发展、结局更差,尤其发展为下肢截肢的概率较非糖尿病患者提高4~5倍,膝以下的动脉血管病变为主。下肢动脉病变不仅仅是糖尿病足的主要发病原因之一,更贯穿于糖尿病足整个进展过程,并影响其最终结局。在糖尿病下肢动脉病变患者当中,有相当高的比例需要进行血管重建,经皮穿刺血管腔内血管成形术作为一种风险小、创伤小的血管重建技术在近些年得到了长足发展,尽管如此,这项技术在发展过程当中仍需要面对的一个关键问题或者说重要限制就是再狭窄或再堵塞,药物涂层球囊的应用是基于基础的球囊血管成形术结合局部的药物释放,同时避免了永久性的血管内异物植入,从而减低再狭窄或再堵塞发生的概率,提高远期预后效果。本综述综合了大量临床及基础的研究证据,现将药物涂层球囊在临床中的应用及特点总结如下。

Lower extremity arterial disease (LEAD) is a major endemic disease with an increased prevalence worldwide.LEAD is particularly common in diabetic patients with worse outcomes in clinic,especially 4 to 5times risk of lower limb amputation higher than non-diabetic patients.The main artery lesion is below the knee.LEAD is the main cause of diabetic foot.It is involved in whole progression of diabetic foot and affected clinical end point.Revascularization is needed in high proportion of diabetic patients with LEAD.Percutaneous transluminalangiography (PTA) has achieved substantial development because of safety and less damage on tissue in recent years.However,we have to face pivotal issues or important limitations which are restenosis and reocclusion.The concept of drug-coated balloon (DCB) is based on the combination of balloon angioplasty and local drug delivery,without the permanent implantation of any endovascular devices.Application of DCB may reduce prevalence of restenosis and reocclusion which can further affect long-term prognosis.This review summarized clinical characteristics of DCB based on evidence from numerous basic and clinical researches.