股浅动脉支架植入术后血清内皮素-1、内脂素水平变化与支架内再狭窄的关系

Changes of serum endothelin-1 and visfatin level after superficial femoral artery stenting and their correlations with in-stent restenosis

目的探讨股浅动脉支架植入术(SFAS)后下肢股浅动脉粥样硬化闭塞症患者血清内皮素-1(ET-1)、内脂素水平变化与支架内再狭窄(ISR)的关系。方法选取2017年3月至2020年7月合肥市第二人民医院招募的297例接受SFAS治疗的下肢股浅动脉粥样硬化闭塞症患者。术后随访9个月,根据随访期间是否发生ISR将患者分为ISR组和非ISR组。采用酶联免疫吸附试验测定术前(入院后24 h内)及术后6 h、3 d、7 d、1个月、3个月时的血清ET-1、内脂素水平。分析术后9个月下肢股浅动脉粥样硬化闭塞症患者SFAS后发生ISR的独立危险因素,以及血清ET-1、内脂素水平对SFAS后ISR发生风险的预测价值。结果297例下肢股浅动脉粥样硬化闭塞症患者中,ISR组患者80例,非ISR组患者217例。ISR组患者的糖尿病患者比例高于非ISR组患者(P<0.05)。非ISR组患者术后6 h时的血清ET-1和内脂素水平明显上升且达到峰值。ISR组患者术后7 d、1个月和3个月时的血清ET-1水平均高于非ISR组患者,术后3 d、7 d、1个月和3个月时的内脂素水平均高于非ISR组患者,差异均有统计学意义(P<0.05)。多因素分析结果显示,术后3 d、7 d和1个月时的血清ET-1和内脂素水平升高均是下肢股浅动脉粥样硬化闭塞症患者SFAS后发生ISR的独立危险因素(P<0.05)。术后7 d,血清ET-1联合内脂素预测下肢股浅动脉粥样硬化闭塞症患者SFAS后9个月ISR发生风险的AUC高于术后3 d的AUC值(P<0.05)。结论SFAS后发生ISR的下肢股浅动脉粥样硬化闭塞症患者血清ET-1和内脂素水平均较高,ET-1和内脂素可作为预测该类患者预后的潜在生物标志物。

Objective To investigate the changes of serum endothelin-1(ET-1)and visfatin level after superficial femoral artery stenting(SFAS)and their relationship with in-stent restenosis(ISR)in lower extremity patients with superficial femoral artery occlusion disease.Method A total of 297 patients with superficial femoral artery occlusion disease of the lower extremity who received SFAS treatment were recruited from Hefei Second People’s Hospital from March 2017 to July 2020.After 9 months follow-up postoperatively,ISR patients were assigned to the ISR group and the remaining patients were assigned to the non-ISR group.The levels of ET-1 and visfatin were measured by enzymelinked immunosorbent assay before operation(within 24 h after admission),or 6 h,3 d,7 days,1 month and 3 months after operation.To analyze the independent risk factors of SFAS for ISR in patients with superficial femoral artery occlusion disease of the lower extremity 9 months after operation,and the predictive value of serum ET-1 and visfatin level for the risk of ISR after SFAS.Result Among 297 patients with superficial femoral artery occlusion disease of the lower extremity,80 patients in the ISR group and 217 patients in the non-ISR group.The proportion of diabetic patients in the ISR group was higher than that in non-ISR group(P<0.05).The serum levels of ET-1 and visfatin increased significantly in non-ISR group and reached a peak at 6 h postoperatively.The serum ET-1 and visfatin levels in ISR group were significantly higher than those in non-ISR group at 7 d,1 month or 3 months postoperatively,and the serum visfatin level at 3 d,7 d,1 month and 3 months after operation were higher than those in non-ISR group,the differences were statistically significant(P<0.05).Multivariate analysis showed that the elevated levels of serum ET-1and visfatin at 3 days,7 days and 1 month after operation were independent risk factors for ISR after SFAS in patients with superficial femoral artery occlusion disease of the lower extremity(P<0.05).Conclusion The levels of serum ET-1and visfatin in patients with superficial femoral artery occlusion disease of the lower extremity with ISR after SFAS were higher,and they could be used as potential biomarkers to predict the prognosis of these patients.