下肢动脉硬化闭塞症介入治疗后的累积代谢指标及再狭窄的危险因素分析

Cumulative metabolic indicators and risk factors for restenosis after intervention of lower limb arteriosclerosis occlusion disease

目的探讨下肢动脉硬化闭塞症(LEASO)介入治疗后的累积代谢指标及再狭窄的相关危险因素。方法收集2007年1月-2021年7月陆军军医大学陆军特色医学中心高血压内分泌科收治的符合标准的110例LEASO患者的临床资料。所有患者均行下肢介入手术,且随访2年以上,术后2年行双下肢CT血管成像(CTA)和双下肢动脉超声明确是否发生血管再狭窄,根据CTA和超声结果分为再狭窄组(n=37)与非再狭窄组(n=73)。收集患者基本信息,以及术前,术后6个月、1年、2年的血液学指标,对比分析再狭窄组与非再狭窄组患者的基本临床资料、代谢指标的基线值(X_(基线))及累积暴露值(X_(累积))的差异,并采用二元logistic回归模型分析LEASO患者介入术后血管再狭窄的危险因素。结果LEASO患者介入术后2年再狭窄发生率为33.6%。再狭窄组吸烟患者占比、股腘动脉病变的泛大西洋协作组(TASC)Ⅱ分型(以下简称TASCⅡ分型)为C或D型的患者占比、超敏C反应蛋白(hs-CRP)、累积超敏C反应蛋白(hs-CRP_(累积))、累积低密度脂蛋白胆固醇(LDL-C_(累积))、累积三酰甘油(TG_(累积))均明显高于非再狭窄组(P<0.05),而术后规律使用抗血小板药物的患者占比、踝肱指数(ABI)均明显低于非再狭窄组(P<0.05)。二元logistic回归分析结果显示,吸烟(OR=4.158,P=0.040)、TASCⅡ分型(OR=4.3,P=0.036)、hs-CRP_(累积)(OR=1.160,P=0.013)、LDL-C_(累积)(OR=2.313,P=0.003)、TG_(累积)(OR=1.668,P=0.015)是术后2年血管再狭窄的危险因素,术后规律使用抗血小板药物为其保护因素(OR=0.038,P=0.000)。结论吸烟、TASCⅡ分型、hs-CRP_(累积)、LDL-C_(累积)、TG_(累积)为LEASO患者介入术后血管发生再狭窄的危险因素,而术后规律使用抗血小板药物为其保护因素。持续戒烟、强化降脂、抗炎是减少术后血管再狭窄的关键因素,早期干预血管病变(TASCⅡ分型为A或B)的远期效果更佳。

Objective To explore the cumulative metabolic indicators and the related risk factors for restenosis after intervention of lower extremity arteriosclerosis obliterans(LEASO).Methods Data were collected of 110 patients with arterial occlusive symptoms of low limbs who admitted to the Department of Hypertension and Endocrinology,Army Characteristic Medical Center,Army Medical University from January 2007 to July 2021 and met the criteria.All patients underwent low limbs interventional surgery and were followed up for more than 2 years.CT angiography(CTA)and ultrasound of both low limbs arteries were performed 2 years after surgery to clarify whether restenosis occurred and,based on the results of CTA and ultrasound,patients were divided into restenosis group(n=37)and non-restenosis group(n=73).The patients'basic information,pre-and post-operative hematological indices at 6 months,1 year and 2 years were collected to compare and analyze the differences in basic clinical information,baseline values of metabolic indices(X_(baseline))and cumulative exposure values(X_(cum))between patients in the restenosis group and non-restenosis group,and binary logistic regression models were used to analyze the risk factors for post-interventional revascularization in patients with LEASO.Results The incidence was 33.6%of restenosis 2 years after intervention in patients with lower extremity arterial occlusive disease.The percentage of patients with smoking,the percentage of patients with Pan Atlantic Collaborative Group(TASC)typeⅡ(hereafter referred to as TASC typeⅡ)C or D femoropopliteal artery lesions(hereafter referred to as TASC typeⅡ),hypersensitive C-reactive protein(hs-CRP),cumulative hypersensitive C-reactive protein(hs-CRP_(Cum)),cumulative low-density lipoprotein cholesterol(LDL-C_(Cum)),and cumulative triacylglycerol(TG_(Cum))were significantly higher in restenosis group than those in non-restenosis group(P<0.05).The percentage of patients with regular postoperative use of antiplatelet agents and ankle-brachial index(ABI)were significantly lower than those in non-restenosis group(P<0.05).Binary logistic regression analysis showed that smoking(OR=4.158,P=0.040),TASCⅡtyping(OR=4.3,P=0.036),hs-CRP_(Cum)(OR=1.160,P=0.013),LDL-C_(Cum)(OR=2.313,P=0.003),and TG_(Cum)(OR=1.668,P=0.015)were the risk factors for restenosis 2 years after surgery,and regular postoperative use of antiplatelet drugs was a protective factor(OR=0.038,P=0.000).Conclusions Smoking,TASCⅡtyping,hs-CRP_(Cum),LDL-C_(Cum),and TG_(Cum) were the risk factors for restenosis of blood vessels after intervention in patients with lower extremity atherosclerotic occlusive disease.The regular use of postoperative antiplatelet drugs was a protective factor.Continuous smoking cessation,intensive lipid lowering,and anti-inflammation are the key factors to reduce the occurrence of postoperative restenosis,and early intervention of vascular lesions(TASC A-B)has better long-term effects.