介入治疗对老年下肢动脉硬化闭塞症病人血流动力学、动脉硬化指标及血小板活化因子的影响

Effects of interventional therapy on hemodynamics,arteriosclerosis indexes and platelet activating factors in elderly patients with arteriosclerosis obliterans in lower extremity

目的探讨介入治疗对老年下肢动脉硬化闭塞症病人血流动力学、动脉硬化指标及血小板活化因子的影响。方法选取2015年6月至2018年1月我院收治的下肢动脉硬化闭塞症病人102例,采用随机数字表法分为对照组(51例)和观察组(51例)。对照组采用常规药物治疗,观察组在此基础上行肢动脉球囊扩张或支架植入术。比较2组临床疗效,同时比较2组治疗前后动脉硬化指标[颈动脉-股动脉脉搏传导速度(PWV)、踝肱指数(ABI)及颈动脉内膜中层厚度(IMT)],血流动力学指标[血浆黏度(ηp)、全血黏度(ηb)、纤维蛋白原(Fib)、红细胞电泳(EEP)、血沉(ESR)],血小板活化因子[静脉血可溶性CD40配体(sCD40L)、sP选择素]水平。结果观察组总有效率为96. 08%,显著高于对照组(80. 39%),2组差异具有统计学意义(P<0. 05)。治疗后观察组IMT、ABI、PWV水平均显著优于对照组,ηp、ηb、Fib、EEP及ESR水平均显著低于对照组,差异均具有统计学意义(P<0. 05)。治疗7 d后,观察组sCD40L和sP选择素水平均显著高于对照组,差异具有统计学意义(P<0. 05)。治疗14 d后,2组sCD40L和s P选择素水平差异无统计学意义(P>0. 05)。结论介入治疗可有效抑制老年下肢动脉硬化闭塞症病人动脉硬化,改善血流动力学,但术后早期可出现血小板活化因子水平的升高,因此需注意抗凝治疗,后期水平可恢复。

Objective To investigate the effects of interventional therapy on hemodynamics,arteriosclerosis indexes and platelet activating factors in the patients with arteriosclerosis obliterans in lower extremity. Methods A total of 102 patients with arteriosclerosis obliterans in lower extremity admitted to our hospital from June 2015 to January 2018 were enrolled. All patients were divided into control group( n = 51) and observation group( n = 51). The control group was treated with routine medicine,and the observation group was treated with balloon dilatation or stent implantation on the basis of control group. The levels of atherosclerosis indexs including intima-media thickness( IMT),anklebrachial index( ABI),pulse wave velocity( PWV) and hemodynamics[plasma viscosity( ηp),blood viscosity( ηb),fibrinogen( Fib),erythrocyte electrophoresis( EEP),erythrocyte sedimentation rate( ESR) ]were compared between two groups before and 4 weeks after treatment,and the levels of platelet activating factors( sCD40 L,s P selection) were compared between the two groups before and 1 week and2 weeks after treatment. Results The total effective rate of the observation group( 96. 08%) was significantly higher than that of the control group( 80. 39%)( P< 0. 05). After treatment,the levels of IMT,ABI,PWV in the observation group were significantly better than those in the control group. The levels of ηp,ηb,Fib,EEP and ESR in the observation group were significantly lower than those in the control group( P<0. 05).The levels of sCD40L and sP selectin in the observation group were significantly higher than those in the control group 7 d after treatment( P<0. 05). There were no significant differences in the levels of sCD40L and sP selectin between the two groups 14 d after treatment( P> 0. 05).Conclusions Interventional therapy can effectively inhibit arteriosclerosis and improve hemodynamics in the elderly patients with arteriosclerosis obliterans of lower extremity. However,the levels of platelet activating factors maybe increase early after operation,so we need to pay attention to anticoagulant therapy.