下肢动脉硬化闭塞症介入治疗后再狭窄与氯吡格雷抵抗及血浆内皮素-1的相关性

Correlations between restenosis after interventional treatment of lower extremity atherosclerotic occlu⁃sive disease and clopidogrel resistance,plasma endothelin-1

目的探究下肢动脉硬化闭塞症(lower extremity arteriosclerosis occlusive disease,LEAOD)介入治疗后再狭窄发生与氯吡格雷抵抗(clopidogrel resistance,CR)及血浆内皮素-1(endothelin-1,ET-1)的相关性。方法选取2016年6月广西医科大学附属柳铁中心医院收治的90例LEAOD患者为研究对象,根据术后1年内是否发生再狭窄分为再狭窄组32例和未狭窄组58例。比较两组患者人口学资料、临床特征、CR和ET-1的差异,分析CR和ET-1与再狭窄发生的相关性,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析CR和ET-1在再狭窄发生预测中的作用。结果再狭窄组患者年龄、ET-1和CR发生率均较未狭窄组患者高,差异有统计学意义(P<0.05)。年龄、ET-1和CR发生率与再狭窄发生均呈正相关(P<0.05)。校正混杂因素后,高表达ET-1和CR高发生率是影响LEAOD患者术后再狭窄发生的独立危险因素(P<0.05)。ROC分析结果显示,ET-1、CR和两者联合预测LEAOD患者术后1年内再狭窄发生的曲线下面积分别为0.680、0.629和0.704,联合预测的曲线下面积最高。结论高表达ET-1和CR高发生率是LEAOD患者介入治疗后血管再狭窄发生的独立危险因素,在LEAOD患者术后再狭窄早期评估中具有一定的预测价值。

Objectives To explore the correlations of restenosis with clopidogrel resistance(CR)and plasma endothelin-1(ET-1)after interventional treatment of lower extremity arteriosclerosis occlusive disease(LEAOD).Methods A total of 90 patients with LEAOD admitted to Liutie Central Hospital Affiliated to Guangxi Medical University in June 2016 were selected as the research objects.According to whether restenosis occurred within 1 year after surgery or not,they were divided into restenosis group(n=32)and non-stenosis group(n=58).The differences in demographic data,clinical characteristics,CR and ET-1 between the two groups were compared,and the correlation between CR,ET-1 and the occurrence of restenosis was analyzed.Receiver operating characteristic curve(ROC)was used to analyze the roles of CR and ET-1 in the prediction of restenosis.Results The age,ET-1 and incidence of CR in restenosis group was higher than those in non-stenosis group(P<0.05),and the age,ET-1 and incidence of CR was positively correlated with the occurrence of restenosis(P<0.05).After adjusting for confounding factors,high expression of ET-1 and high incidence of CR were independent risk factors for postoperative restenosis in LEAOD patients(P<0.05).In ROC analysis,the area under the curve(AUC)of ET-1,CR and the combined prediction of restenosis in LEAOD patients within 1 year after surgery were 0.680,0.629 and 0.704,respectively,and the combined prediction had the highest AUC.Conclusions High expression of ET-1 and high incidence of CR are independent risk factors for the occurrence of vascular restenosis in patients with LEAOD after interventional therapy,which has certain predictive value in the early evaluation of postoperative restenosis in patients with LEAOD.