前列地尔联合西洛他唑治疗下肢动脉硬化闭塞症介入术后再狭窄的疗效

Efficacy of alprostadil combined with cilostazol on restenosis after interventional therapy for lower limb arteriosclerosis obliterans

目的分析前列地尔联合西洛他唑治疗下肢动脉硬化闭塞症(ASO)介入术后再狭窄的临床效果。方法选取浙江省丽水市人民医院2021年1月至2024年1月收治的ASO介入术后再狭窄的患者,共98例,根据治疗方式的不同,分为单一组(接受前列地尔治疗48例)和联合组(接受前列地尔联合西洛他唑治疗50例)。比较2组的疗效、临床指征[踝肱指数(ABI)、患肢灌注量和患肢经皮氧分压(TcPO_(2))]、血清指标[基质金属蛋白酶-9(MMP-9)和内皮素-1(ET-1)]和不良反应发生情况。结果联合组治疗总有效率为98%,高于单一组的85%(χ^(2)=5.172,P<0.05);治疗前2组ABI、患肢灌注量和患肢TcPO_(2)以及MMP-9和ET-1水平比较,差异均无统计学意义(t=1.581、0.075、0.366、0.321、0.525,P>0.05);治疗后2组ABI、患肢灌注量和患肢TcPO_(2)均升高,且联合组[(0.93±0.23)、(28.29±6.31)PU、(31.2±6.5)mmHg]高于单一组[(0.81±0.21)、(21.46±5.33)PU、(25.2±6.4)mmHg](t=2.694、5.777、4.623,P<0.05),2组的MMP-9和ET-1水平均降低,且联合组[(12.9±2.0)ng/ml、(57±7)pg/ml]低于单一组[(16.5±3.1)ng/ml、(62±8)pg/ml](t=6.878、3.141,P<0.05);联合组不良反应发生率为14%,单一组为8%,2组比较差异无统计学意义(χ^(2)=0.789,P>0.05)。结论前列地尔联合西洛他唑治疗ASO介入术后再狭窄患者临床疗效显著,能有效提高ABI,增加患肢远端血氧含量和血流灌注量,改善下肢缺血情况,促进血管重构和组织修复,且安全性高。

Objective To explore the clinical effect of alprostadil combined with cilostazol in the treat-ment of restenosis after interventional therapy for lower limb arteriosclerosis obliterans(ASO).Methods A total of 98 patients with restenosis after ASO intervention admitted to Lishui People′s Hospital in Zhejiang Province from January 2021 to January 2024 were selected and divided into a single group(treated with alprostadil,48 cases)and a combination group(treated with alprostadil combined with cilostazol,50 cases)according to different treat-ment methods.The efficacy,clinical indications[ankle brachial index(ABI),affected limb perfusion volume and transcutaneous partial pressure of oxygen(TcPO_(2))],serum indexes[matrix metalloproteinase-9(MMP-9)and en-dothelin-1(ET-1)]and occurrence of adverse reactions were compared between groups.Results The total effec-tive rate of treatment in combined group was 98%,which was higher than 85%in single group(χ^(2)=5.172,P<0.05).There was no statistically significant difference in ABI,limb perfusion volume,TcPO_(2),MMP-9,and ET-1 levels be-tween the two groups before treatment(t=1.581,0.075,0.366,0.321,0.525,P>0.05).After treatment,ABI,affected limb perfusion volume and affected limb TcPO_(2)in the two groups were increased,and the indicators in combined group[(0.93±0.23),(28.29±6.31)PU and(31.2±6.5)mmHg]were higher than the single group[(0.81±0.21),(21.46±5.33)PU and(25.2±6.4)mmHg](t=2.694,5.777,4.623,P<0.05).The levels of MMP-9 and ET-1 were de-creased in both groups,and the two levels in combined group[(12.9±2.0)ng/ml and(57±7)pg/ml]were low-er than single group[(16.5±3.1)ng/ml and(62±8)pg/ml](t=6.878,3.141.P<0.05).The total incidence rate of adverse reactions in combined group was 14%,and that in single group was 8%(χ^(2)=0.789,P>0.05).Conclusion Al-prostadil combined with cilostazol has significant clinical efficacy in the treatment of patients with restenosis after ASO interventional therapy.It can effectively enhance ABI,increase blood oxygen content and blood perfusion at the distal end of the affected limb,improve lower limb ischemia,and promote vascular remodeling and tissue re-pair,and has high safety.