血清结缔组织生长因子、可溶性髓系细胞触发受体1对第二代斑块切除系统联合药物涂层球囊治疗下肢动脉硬化患者预后的诊断价值

Diagnostic value of serum connective tissue growth factor and soluble triggering receptor expressed on myeloid cells-1 in prognosis of patients with lower extremity arteriosclerosis treated by second-generation plaque excision system combined with drug-coated balloon

目的探讨血清结缔组织生长因子(CTGF)、可溶性髓系细胞触发受体1(sTREM-1)对行第二代斑块切除系统联合药物涂层球囊(DCB)治疗的下肢动脉硬化(ASO)患者预后情况的诊断价值。方法选取2019年8月至2021年6月徐州医科大学第二附属医院收治的120例下肢ASO患者为研究对象,均接受第二代斑块切除系统联合DCB治疗,出院后接受为期1年的随访,记录患者术后1年内的血管再狭窄发生情况,以此作为预后的评估标准。设计问卷,记录患者的基线资料,检测患者治疗前的实验室指标,重点分析血清CTGF、sTREM-1与下肢ASO患者预后情况的关系。结果120例接受第二代斑块切除系统联合DCB治疗的ASO患者中,术后预后不良组20例,预后良好组100例。预后不良组患者的低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、CTGF及sTREM-1水平均高于预后良好组患者,差异均有统计学意义(P<0.05);其他实验室指标比较,差异均无统计学意义(P>0.05)。Logistic回归模型分析结果显示,高水平LDL-C、FBG、CTGF及sTREM-1均是ASO患者预后不良的独立危险因素(P<0.05)。受试者工作特征(ROC)曲线结果显示,ASO患者治疗前的血清CTGF、sTREM-1水平单独及联合评估ASO患者预后不良发生风险的曲线下面积(AUC)均>0.7,有一定预测价值,但联合预测价值最高。决策曲线显示,在0.18~0.44、0.53~0.58、0.62~0.92高风险阈值范围内,血清CTGF联合sTREM-1的预测模型评估ASO患者预后情况的净收益率均高于血清CTGF、sTREM-1单独检测。结论血清CTGF、sTREM-1与ASO患者预后情况密切相关,可早期联合检测CTGF、sTREM-1水平以评估ASO患者预后情况,尽早采取针对性干预措施,以降低预后不良的发生风险,从而改善患者的预后情况。

Objective To investigate the value of serum connective tissue growth factor(CTGF)and soluble triggering receptor expressed on myeloid cells-1(sTREM-1)in diagnosing prognosis of patients with lower extremity arteriosclerosis obliterans(ASO)treated by second generation plaque removal system combined with drug-coated balloon(DCB).Method A total of 120 patients with lower extremity arteriosclerosis obliterans treated in the Second Affiliated Hospital of Xuzhou Medical University from August 2019 to June 2021 were selected,all patients were treated with the second generation plaque removal system combined with DCB.After discharge,the patients were followed up for 1 year,the occurrence of vascular restenosis within 1 year after operation was recorded and set as the evaluation standard of prognosis.Baseline data questionnaire was designed to record the laboratory parameters before treatment,and the correlation of serum CTGF and sTREM-1 prognosis of ASO patients were mainly analyzed.Result Among 120 ASO patients treated with the second generation plaque removal system combined with DCB,100 patients had good postoperative prognosis and 20 patients had poor prognosis,accounting for 16.67%.The levels of low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FBG),CTGF and sTREM-1 in the poor prognosis group were higher than those in the good prognosis group(P<0.05).There were no statistical significant differences in other laboratory indexes between groups(P>0.05).Logistic regression analysis showed that,the high levels of LDL-C,FBG,CTGF and sTREM-1 in ASO patients were the influencing factors for poor prognosis(P<0.05).The receiver operating characteristic(ROC)curve result showed that the area under the curve(AUC)of single or combined serum CTGF and sTREM-1 levels before treatment for evaluating prognostic risk in patients with ASO were>0.7,which had certain predictive value,but the best predictive value was the combined detection.The decision curve showed that the combined prediction model of serum CTGF and sTREM-1 was better than the single detection of serum CTGF and sTREM-1 in evaluating the net benefit rate of therapeutic prognosis of ASO patients in the range of threshold 0.18-0.44,0.53-0.58 and 0.62-0.92.Conclusion Serum CTGF and sTREM-1 are closely related to the prognosis of ASO patients.Early combined detection of CTGF and sTREM-1 levels can be used to evaluate the prognosis of ASO patients,and targeted interventions can be taken as soon as possible to reduce the risk of poor prognosis and improve the prognosis of patients.