外周血25-羟基维生素D水平对下肢动脉硬化闭塞症支架植入术后血管再狭窄的预测价值

Value of peripheral blood 25-hydroxy vitamin D level predicts vascular restenosis after stent implantation in lower extremity arteriosclerosis obliterans

目的探讨外周血25-羟基维生素D[25-(OH)D]水平对下肢动脉硬化闭塞症(LASO)患者支架植入术后发生血管再狭窄的预测价值。方法收集2018年1月至2019年9月于安徽医科大学附属合肥医院行支架植入术的84例LASO患者的临床资料,对患者均进行了为期2年的随访,根据支架植入术后是否发生血管再狭窄将患者分为再狭窄组(n=38)和无再狭窄组(n=46)。比较两组患者的临床特征及外周血25-(OH)D水平;分析再狭窄LASO患者临床特征与外周血25-(OH)D水平的相关性,以及外周血25-(OH)D水平对LASO患者术后发生血管再狭窄的预测价值。结果84例LASO患者中,支架植入术后血管再狭窄的发生率为45.24%(38/84),平均发生时间为术后(18.15±4.84)个月。再狭窄组有吸烟史、有糖尿病史、发生下肢双侧病变、发生下肢完全闭塞的患者比例均高于无再狭窄组,下肢血管病变长度长于无再狭窄组,而外周血25-(OH)D水平低于无再狭窄组,差异均有统计学意义(P<0.05)。Pearson相关性分析结果显示,再狭窄组患者的外周血25-(OH)D水平与糖尿病史、下肢血管病变长度、下肢双侧病变情况、下肢完全闭塞情况均呈负相关(P<0.05),与吸烟史无相关性(P>0.05)。多因素分析结果显示,下肢血管病变长度、下肢完全闭塞是LASO患者术后发生血管再狭窄的独立危险因素,而25-(OH)D水平是LASO患者术后发生血管再狭窄的独立保护因素(P<0.05)。受试者操作特征(ROC)曲线分析结果显示,外周血25-(OH)D水平早期评估LASO患者术后发生血管再狭窄的曲线下面积为0.823(95%CI:0.744~0.972),最佳临界值为9.00 ng/ml,约登指数为0.619,灵敏度为86.05%,特异度为78.96%。结论LASO患者支架植入术后血管再狭窄的发生与外周血25-(OH)D水平密切相关,外周血25-(OH)D可作为预测LASO患者支架植入术后发生血管再狭窄的可靠血清标志物。

Objective To investigate the value of peripheral blood 25-hydroxyvitamin D[25-(OH)D]levels in predicting vascular restenosis after lower extremity arteriosclerosis obliterans(LASO)stent implantation.Method The clinical data of 84 LASO patients who underwent stent implantation in Hefei Hospital Affiliated to Anhui Medical University from January 2018 to September 2019 were collected.All patients were followed up for a period of 2 year,and according to whether vascular restenosis occurred after stent implantation,they were divided into restenosis group(n=38)and no restenosis group(n=46).The clinical characteristics and peripheral blood 25-(OH)D levels of the two groups were compared;the correlation between clinical characteristics and peripheral blood 25-(OH)D level in patients with restenosis LASO,and the predictive value of peripheral blood 25-(OH)D level in postoperative vascular restenosis in patients with LASO were analyzed.Result In 84 patients with LASO,the incidence of vascular restenosis after stent implantation was 45.24%(38/84),and the average time was(18.15±4.84)months after operation.In the restenosis group,the proportion of patients with smoking history,history of diabetes,bilateral lesions of lower extremity and complete occlusion of lower extremity was higher than that in the non-restenosis group,the length of vascular lesions of lower extremity was longer than that in the non-restenosis group,and the level of 25-(OH)D was lower than that in the non-restenosis group,the difference was statistically significant(P<0.05).Pearson correlation analysis showed that the level of 25-(OH)D in peripheral blood of patients with restenosis was negatively correlated with the history of diabetes,the length of lower extremity vascular lesion,bilateral lesions of lower extremity and complete occlusion of lower extremity(P<0.05),but not with the history of smoking(P>0.05).The results of regression analysis showed that the length of lower extremity vascular lesion and complete occlusion of lower extremity were independent risk factors for postoperative restenosis in patients with LASO,while the level of 25-(OH)D was an independent protective factor for postoperative restenosis in patients with LASO.Receiver operating characteristic(ROC)curve analysis showed that the area under the curve for early evaluation of 25-(OH)D level in peripheral blood in patients with postoperative vascular restenosis was 0.823(95%CI:0.744-0.972).When the optimal critical value was 9.00 ng/ml,the Youden index was 0.619.At this time,the sensitivity was 86.05%and the specificity was 78.96%.Conclusion The occurrence of restenosis after stent implantation in LASO patients are closely related to changes in peripheral blood 25-(OH)D levels.25-(OH)D in peripheral blood can be used as a reliable blood marker to predict restenosis in LASO patients after stent implantation.