2型糖尿病下肢动脉硬化闭塞症患者血清VCAM-1与支架植入术后再狭窄的相关性

The relationship between VCAM-1 and restenosis after stent implantation in patients with type 2 diabetes mellitus and lower extremity arteriosclerosis obliterans

目的探讨2型糖尿病下肢动脉硬化闭塞症(lower extremity arteriosclerosis obliterans,LASO)患者血清血管细胞黏附分子-1(vascular cell adhesion molecule-1,VCAM-1)水平与支架植入术后再狭窄的相关性。方法选择2015年3月至2017年3月在中国医学科学院北京协和医学院北京协和医院接受支架植入术的2型糖尿病LASO患者82例,其中男47例,女35例,年龄42~72岁,平均(54.6±10.0)岁。所有患者入院后均检测血清VCAM-1水平,并记录相关临床资料,根据术后2年随访时是否发生再狭窄分为再狭窄组和未再狭窄组,分析再狭窄的相关因素及VCAM-1对再狭窄的预测价值。结果术后2年随访时,共36例患者发生再狭窄,其余46例患者未发生再狭窄。单因素分析显示,再狭窄组患者的血清VCAM-1水平、吸烟率、糖化血红蛋白水平、下肢动脉病变长度、下肢动脉完全闭塞率均明显高于未再狭窄组,差异有显著性(P<0.05)。多因素logistic回归分析显示,VCAM-1水平、吸烟、下肢动脉病变长度、下肢动脉完全闭塞是支架植入术后发生再狭窄的危险因素(P<0.05)。ROC曲线分析显示,血清VCAM-1水平预测再狭窄的最佳截点值为100.6ng/ml,敏感性和特异性分别为67.39%和52.78%。结论 2型糖尿病LASO患者血清VCAM-1水平升高与支架植入术后再狭窄的发生有关,且对再狭窄具有一定的预测价值。

Objective To study the relationship between vascular cell adhesion molecule-1(VCAM-1) in serum and restenosis in patients with type 2 diabetes mellitus and lower extremity arteriosclerosis obliterans(LASO) after stent implantation. Method Eighty-two cases of patients with type 2 diabetes and LASO who underwent stent implantation in Peking Union Medical College Hospital from March 2015 to March 2017 were enrolled, including male 47 cases and female 35 cases, aged 42-72 years old, average(54.6±10.0) years old. The VCAM-1 level in serum was measured, the clinical data were recorded, and divided into restenosis group and non-restenosis group according to whether restenosis occurs at 2-year follow-up. The related factors of restenosis and the predictive value of VCAM-1 on restenosis were analyzed. Result At 2 years follow-up, 36 cases of patients occurred restenosis, and other 46 cases of patients did not occurred restenosis. Single factor analysis showed that the levels of VCAM-1, smoking rate, glycosylated hemoglobin, the length of lower extremity artery lesion and the rate of complete occlusion of lower extremity artery in the restenosis group were significantly higher than those in the non restenosis group(P<0.05). Multivariate logistic regression analysis showed that VCAM-1 level, smoking, length of lower extremity artery lesion and complete occlusion of lower extremity artery were risk factors for restenosis after stent implantation(P<0.05). ROC curve analysis showed that the best cut-off point of VCAM-1 in predicting restenosis was 100.6 ng/ml, sensitivity and specificity were 67.39% and 52.78%. Conclusion Serum VCAM-1 content increase in type 2 diabetic patients with LASO relate to the occurrence of restenosis after stent implantation and has predictive value for restenosis.