药物涂层球囊经皮腔内血管成形术对下肢动脉长段闭塞病人临床指标及预后的影响

Effect of drug-coated balloon PTA on clinical indicators and prognosis of patients with long-segment occlusion of lower extremity arteries

目的 探讨药物涂层球囊(DCB)经皮腔内血管成形术(PTA)对下肢动脉长段闭塞病人临床指标及预后的影响。方法 2020年10月~2022年10月医院收治的下肢动脉长段闭塞病人91例,均行PTA治疗。按术中释放球囊不同分为DCB组(46例)和普通球囊(POB)组(45例)。POB组行POB-PTA,DCB组行DCB-PTA。比较两组术前、术后6小时、术后2周血管内皮功能指标[一氧化氮(NO)、内皮素-1(ET-1)、P选择素],术后随访1年,比较两组一期通畅率、再狭窄率、靶病变处血运重建率、术后并发症发生率与术前、术后6个月、12个月靶血管狭窄程度、靶血管最小管腔直径(MLD)、踝肱指数(ABI)、卢瑟福血管外科(Rutherford)分级。结果 DCB组术后6小时、2周血清NO水平分别为(30.83±3.95)pg/ml、(33.62±4.20)pg/ml,高于POB组的(26.70±3.58)pg/ml、(29.96±3.82)pg/ml, ET-1、P选择素水平分别为(70.25±7.24)pg/ml、(67.29±7.05)pg/ml、(30.12±3.68)μg/L、(25.61±3.32)μg/L,低于POB组的(75.98±7.63)pg/ml、(70.73±7.31)pg/ml、(37.03±3.90)μg/L、(27.29±3.50)μg/L(P<0.05);DCB组一期通畅率(82.61%)高于POB组(55.56%),再狭窄率(10.87%)低于POB组(31.11%),两组比较差异有统计学意义(P<0.05);两组靶病变处血运重建率比较,差异无统计学意义(P>0.05);DCB组术后6个月、12个月的靶血管狭窄程度、Rutherford分级为(18.07±5.25)%、(25.68±4.35)%、(2.05±0.64)级、(2.24±0.81)级,低于POB组的(41.20±5.86)%、(57.36±5.18)%、(2.60±0.72)级、(2.75±0.94)级,MLD、ABI分别为为(3.37±0.68)mm、(3.02±0.59)mm、(0.85±0.19)、(0.82±0.15),高于POB组的(1.59±0.41)mm、(1.46±0.38)mm、(0.65±0.15)、(0.62±0.11),两组比较差异有统计学意义(P<0.05);两组术后并发症情况比较,差异无统计学意义(P>0.05)。结论 应用DCB-PTA可显著减轻血管内皮损伤,提升一期通畅率,增加血管直径,缓解下肢缺血症状,降低再狭窄率,且安全性好。

Objective To investigate the effect of drug-coated balloon(DCB)percutaneous transluminal angioplasty(PTA)on clinical indicators and prognosis of patients with long-segment occlusion of lower extremity arteries.Methods A total of 91 patients with long-segment occlusion of lower extremity arteries admitted to the hospital from October 2020 to October 2022 were selected and divided into DCB group(n=46)and ordinary balloon(POB)group(n=45)according to different treatment methods.POB group underwent POB-PTA,DCB group underwent DCB-PTA.The vascular endothelial function indexes[nitric oxide(NO),endothelin-1(ET-1),P-selectin]were compared between the two groups before operation,6 h and 2 weeks after operation.The patients were followed up for 1 year.The primary patency rate,restenosis rate,target lesion revascularization rate,incidence of postoperative complications and the degree of target vessel stenosis,minimum lumen diameter(MLD),ankle brachial index(ABI),Rutherford vascular surgery(Rutherford)classification were measured before operation,6 months,12 months after operation were compared between the two groups.Results The serum NO levels at 6 h and 2 weeks after operation in the DCB group were(30.83±3.95)pg/ml and(33.62±4.20)pg/ml,which were higher than(26.70±3.58)pg/ml and(29.96±3.82)pg/ml in the POB group.The levels of ET-1 and P-selectin were(70.25±7.24)pg/ml,(67.29±7.05)pg/ml,(30.12±3.68)μg/L and(25.61±3.32)μg/L,which were lower than(75.98±7.63)pg/ml,(70.73±7.31)pg/ml,(37.03±3.90)μg/L and(27.29±3.50)(P<0.05).The primary patency rate of the DCB group(82.61%)was higher than that of the POB group(55.56%),and the restenosis rate(10.87%)was lower than that of the POB group(31.11%)(P<0.05).There was no difference in the rate of target lesion revascularization between the two groups(P>0.05).The degree of target vessel stenosis and Rutherford grade in DCB group were(18.07±5.25)%,(25.68±4.35)%,(2.05±0.64)grade and(2.24±0.81)grade at 6 months and 12 months after operation,which were lower than those in POB group(41.20±5.86)%,(57.36±5.18)%,(2.60±0.72)grade and(2.75±0.94)grade.MLD and ABI were(3.37±0.68)mm,(3.02±0.59)mm,(0.85±0.19)grade,(0.82±0.15)grade,which were higher than those in POB group(1.59±0.41)mm,(1.46±0.38)mm,(0.65±0.15)grade,(0.62±0.11)grade(P<0.05).There was no difference in postoperative complications between the two groups(P>0.05).Conclusion The application of DCB-PTA can significantly reduce vascular endothelial injury,improve primary patency rate,increase vascular diameter,relieve lower limb ischemia symptoms,reduce restenosis rate,and has good safety.