Application of buried auricular point combined with Wenjing Sanhan prescription in arteriosclerosis obliterans patients with resting pain

BACKGROUND Research on the combined use of ear acupoint embedding beans and warming meridians with cold-dispersing formulas for alleviating resting pain in patients with arteriosclerosis obliterans(ASO)remains limited.AIM To explore the therapeutic efficacy of auricular point embedding beans combined with Wenjing Sanhan prescription in alleviating resting pain in patients with lower-limb ASO.METHODS A total of 100 patients with ASO experiencing resting pain who were treated at our hospital from January 2022 to January 2023 were enrolled.They were randomly allocated into two groups using a double-blind approach.The control group was treated using a warming meridian with a cold-dispersing formula,while the study group received additional treatment with ear acupoint embedding beans.The clinical efficacy,ankle-brachial artery pressure ratio,hemorheological indicators,and traditional Chinese medicine symptom scores were compared between the two groups.RESULTS The clinical efficacy rate in the study group was significantly higher(94.00%)than that in the control group(72.00%,P<0.05).Moreover,the ankle-brachial artery pressure ratio was significantly higher in the study group after treatment(P<0.05).Hemorheological parameters,including whole blood viscosity,plasma viscosity(1.83±0.11)mPa/s,fibrinogen levels(3.30±0.21)g/L,platelet adhesion rate(49.87%±10.51%),and erythrocyte aggregation index(1.79±0)were improved in the study group compared to the control group.In addition,the scores for decreased skin temperature(1.41±0.26),intermittent claudication(1.30±0.20),and resting pain(1.23±0.31)were significantly lower in the study group than those in the control group(all P<0.05).The level of oxidative stress in the study group also exhibited significant improvement(P<0.05),and the levels of inflammatory factors were considerably lower than those in the control group.CONCLUSION The combination of ear point embedding beans and Wenjing Sanhan prescription demonstrates promising clinical efficacy in alleviating resting pain associated with ASO.

Analysis of the Effect of Problem-Oriented Nursing Intervention on Patients with Lower Extremity Arteriosclerosis Obliterans in Vascular Surgery

Objective: To analyze the effect of problem-oriented nursing intervention on patients with lower extremity arteriosclerosis obliterans (ASO) in vascular surgery. Methods: The clinical data of 128 patients with lower extremity ASO in vascular surgery were selected and randomly divided into groups A and B, with 64 cases each. Group A is the control group, and Group B is the observation group. Group A received the routine nursing intervention, and Group B received the problem-oriented nursing intervention. The compliance, self-care ability, psychological state, quality of life, and nursing satisfaction of the two groups of patients were evaluated based on various indicators. Results: After the intervention, the evaluation of self-care ability (ESCA) score of the patients in Group B was higher than that of Group A, and the symptom checklist-90 (SCL-90) score was lower than that of Group A. The differences were significant (t = 10.019, t = 3.118, P < 0.01). After the intervention, the World Health Organization Quality of Life Brief (WHOQOL-BREF) index scores of the two groups increased and the increase in Group B was significantly higher than Group A (P < 0.001). The compliance rate of Group B (62/ 96.88%) was higher than that of Group A (52/ 81.25%), and the difference was extremely significant (χ2 = 8.020, P < 0.01). Conclusion: Problem-oriented nursing intervention for patients with lower extremity ASO in vascular surgery improved the patient’s self-care ability, and quality of life, reduced the patient’s negative emotions, and enhanced their overall satisfaction.

Advances in the management of arteriosclerosis of the lower extremity:Integrating Western and Chinese medicine approaches

This editorial provides a commentary on the recent article.The paper reviews current literature and explores innovative treatment strategies for lower extremity arteriosclerosis obliterans(LEASO)through an integrative approach.It highlights the effectiveness of combination therapies that merge traditional Chinese medicine(TCM)with Western medical practices,suggesting that such integrative methods may improve patient compliance and outcomes through personalized care.This paper stresses the importance of rigorous clinical trials to evaluate the efficacy and safety of TCM interventions within LEASO treatment protocols,advocating for evidence-based validation of these combined therapies.Our recommendations emphasize accurate diagnosis,appropriate pharmacological in-terventions,the use of advanced surgical and endovascular techniques,and the inclusion of TCM to address underlying dysfunctions.Additionally,continuous monitoring,patient education,and lifestyle modifications are essential to slow disease progression and achieve optimal patient outcomes.The paper concludes by calling for further research to develop standardized treatment protocols that effectively integrate both Western and Chinese medical approaches in managing LEASO.

Clinical and prognostic features in asymptomatic and symptomatic patients with arteriosclerosis obliterans

Background: Patients with arteriosclerosis obliterans (ASO) often have co-existing atherosclerotic diseases. The purpose of this study was to examine the clinical features of patients with ASO, including the overlap of atherosclerotic risk factors, characteristics of car-diovascular events, and clinical prognosis. Method: We enrolled 205 consecutive patients who had ankle brachial index (ABI) of ?0.9 between January 2008 and December 2009. Fontaine (F) classification and clinical background were evaluated and clinical events including mortality and major adverse cardiocerebro-vascular events (MACCEs) were determined. Results: There was a high prevalence of each risk factor. Sixty- five percent of subjects had three or more of the four overlapping risk factors, including hypertension, dia- betes, dyslipidemia, and smoking. After a maximum follow-up of 800 days, the incidence of MACCEs and mortality was 46% and 10%, respectively. We divided the patients into two groups according to the presence of ASO symptoms (F1 and F2-4) and compared the incidence of events. The incidence of MACCEs and mortality in the F2-4 group was significantly higher than that in the F1 group (P = 0.048, P = 0.044, respectively). After excluding lower extremity revascularization, coronary artery disease was a common cause of MACCEs, and the mortality rates after MACCEs increased in a stepwise manner according to F classification severity (P = 0.028). Conclusion: Patients with ASO had overlapping coronary risk factors and a high incidence rate of cardiovascular events. The incidence of coronary events was common, especially in symptomatic patients, and the mortality rates after MACCEs were high in accordance with F classification severity.

Mechanism of Simiao Yongan decoction in the treatment of arteriosclerosis obliterans of lower extremity through JAK/STAT signaling pathway

Objective:To predict the effective components,potential targets and pathways of Simiao Yong’an Decoction in the treatment of lower extremity arteriosclerosis obliterans(ASO)based on the method of network pharmacology,and to explore the mechanism of Simiao Yong’an Decoction in treating ASO combined with cell experiment.Methods:TCMSP database was used to screen the active components and targets of Simiao Yong’an decoction,and Genecards and OMIM databases were used to obtain ASO related proteins;PPI network of drug disease target proteins was constructed by string platform;go function and KEGG pathway enrichment of Simiao Yong’an Decoction ASO target were analyzed by David database.The drug target pathway with high correlation with ASO was selected.The model of vascular smooth muscle cell injury(VSMCs)induced by ox LDL was used,and Simiao Yong’an decoction containing pharmaceutical Qing was given to verify the therapeutic effect of Simiao Yong’an Decoction on ox LDL induced VSMCs and its regulation on highly correlated target pathway.Results:A total of 126 active components of Simiao Yong'an Decoction were screened,40 targets of Simiao Yong’an Decoction ASO were selected,99 go biological processes and 48 related signal pathways were related to ASO;the experimental results showed that with the passage of time,Simiao Yongan decoction could significantly inhibit the proliferation of VSMCs(P<0.05);compared with the model group,the percentage of BrdU positive cells in each dose group of Simiao Yong’an decoction was significantly higher than that in the model group In addition,Simiao Yong’an decoction could significantly inhibit the proliferation of VSMCs(P<0.05);in addition,Simiao Yongan decoction could inhibit the levels of IL-6 and IL-1β(P<0.05);significantly inhibit the expression of PCNA,JAK2 and STAT3 mRNA(P<0.05);Conclusions:Simiao Yong’an decoction has the effect of"multi-component,multi-target and multi-channel"in the treatment of ASO.It can inhibit the activation of JAK/STAT signaling pathway,play an anti-inflammatory role and inhibit the proliferation of vascular smooth muscle cells.

Efficacy and safety of Danhong injection in the treatment of arteriosclerosis obliterans:a meta-analysis of randomized controlled trials

Aims:To systematically evaluate the clinical efficacy and safety of danhong injection in the treatment of arteriosclerotic occlusion.Methods:Computer retrieval China knowledge network(CNKI),and Wiper Chinese journal database(VIP),and Wanfang data knowledge service platform,the Chinese biomedical literature database(CBM),Pubmed,science citation index(SCI)database,the Cochrane Library,including eight Chinese English database,to conform to the criteria for the two researchers use the recommended bias risk assessment method to evaluate the Cochrane bias risk,extracted data,and apply the Review Manager software Meta analysis and system evaluation.Results:Finally,13 studies were included,with a total number of 884 cases.The results showed that the clinical efficacy of danhong injection in the treatment of arteriosclerotic occlusion was higher than that of conventional treatment,and the difference was statistically significant[OR=3.08,95%CI(2.07,4.60),P<0.00001].The improvement of arteriosclerosis was more obvious[OR=0.15,95%CI(0.12,0.19),P<0.00001].The improvement of hemodynamics was more obvious[OR=-0.19,95%CI(-0.33,-0.04),P=0.01].No adverse reactions occurred.Conclusions:Danhong injection has higher clinical efficacy in the treatment of atherosclerotic occlusion,more obvious improvement in arteriosclerosis degree and hemodynamics,and higher safety.However,due to the low quality of literature research,more high-quality,large samples and randomized controlled double-blind clinical trials are needed to provide high-level evidence to further verify the efficacy and safety of danhong injection in the treatment of atherosclerotic occlusion.

Potential Mechanisms of Yanghe Decoction in the Treatment of Soft Tissue Sarcoma and Arteriosclerosis Obliterans Based on Network Pharmacology

Objective The objective of this study was to investigate potential mechanisms of Yanghe Decoction(YHD)in treating soft tissue sarcoma(STS)and arteriosclerosis obliterans(ASO)based on the use of network pharmacology.Methods Candidate compounds and potential targets were identifed through the TCM Systems Pharmacology database and a comprehensive literature search.Related targets of STS and ASO were collected in the GeneCards database,DisGeNET database,and Drugbank database.Furthermore,The STRING 11.0 database was used to determine protein-protein interaction(PPI)networks;common targets were obtained and imported into Cytoscape 3.7.2.Then,a PPI network comprising common targets was drawn,and network topology analysis was performed to screen for key shared targets.Gene ontology functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis of key shared targets were performed by using Metascape software.Subsequently.a compound-target-pathway network was constructed via Cytoscape 3.7.2.Results The following signaling pathways were found to be associated with the mechanisms of YHD in treating STS and ASO:AGE-RAGE signaling pathway,IL-17 signaling pathway;HIF-1 signaling pathway,TNF signaling pathway,interactions between cytokines and cytokine receptors,Th17 cell differentiation,and NOD-like receptor signaling pathway.Among the compounds and targets involved in these pathways,quercetin,luteolin,and kaempferol were found to be core compounds,and TNF,IL-6,and MAPK1 were found to be core targets.Conclusion Taken together,our findings elucidated that potential mechanisms of YHD in treating STS and ASO involved cellular proliferation/differentiation,angiogen-esis,inflammation,immune responses,oxidative stress,and other related signaling pathways.

Application of Big Data Deep Learning in Auxiliary Diagnosis of Lower Extremity Arteriosclerosis Obliterans

At present,the incidence rate of arteriosclerosis obliterans(LEASO)of the lower extremities is significantly increased by aging and lifestyle changes.It is of great importance to predict the LEASO effectively and accurately by analyzing the imaging data of the lower extremities⑴.At this stage,China has entered the era of big data and artificial intelligence.Medical institutions at all levels can produce a large number of lower limb vascular image data every day.Using big data deep learning technology to intelligently analyze a large number of image data,and then carry out auxiliary diagnosis,so as to improve the diagnosis and treatment effect of LEASO is the focus of clinical research.

NRG1、VASH-1水平对ASO患者介入治疗后再狭窄的预测价值

目的探讨血清神经调节蛋白1(NRG1)、血管生成抑制蛋白-1(VASH-1)对下肢动脉硬化闭塞症(ASO)患者介入治疗后再狭窄的预测价值,以期为临床治疗提供参考。方法选取选取2021年9月—2023年8月宝鸡市中医医院收治的112例ASO患者作为本次研究对象。根据介入治疗6个月后患者是否发生再狭窄分为再狭窄组(n=29)和非再狭窄组(n=83)。比较2组患者血清NRG1、VASH-1水平;采用受试者工作特性(ROC)曲线评估血清NRG1、VASH-1对ASO患者介入治疗后再狭窄的预测价值;采用二分类Logistic逐步回归分析探讨ASO患者介入治疗后再狭窄的影响因素。结果再狭窄组患者NRG1水平低于非再狭窄组,VASH-1水平高于非再狭窄组,差异均有统计学意义(P<0.05)。ROC曲线显示,血清NRG1联合VASH-1预测ASO患者介入治疗后再狭窄的曲线下面积(AUC)(95%CI)为0.903(0.852~0.954),特异度为87.11%,灵敏度为86.05%,其预测效能较高。2组患者性别构成、年龄、体质量指数、合并症、病变部位、总胆固醇水平、甘油三酯水平、高密度脂蛋白胆固醇(HDL-C)水平比较,差异均无统计学意义(P>0.05);再狭窄组患者吸烟占比、血管完全闭塞占比、血管病变长度、C反应蛋白(CRP)水平、糖化血红蛋白水平、低密度脂蛋白胆固醇(LDL-C)水平均大于非再狭窄组,差异均有统计学意义(P<0.05)。二分类Logistic逐步回归分析结果显示,CRP≥18.74 mg/L、LDL-C≥3.69 mmol/L、NRG1≤16.98 pg/mL、VASH-1≥553.49 ng/L是ASO患者介入治疗后再狭窄的独立危险因素(P<0.05)。结论血清NRG1水平降低、VASH-1水平升高与ASO患者介入治疗后再狭窄之间关系密切,且这2项指标可作为ASO患者介入治疗后再狭窄的重要预测因子。

LEASO患者血清miR-21、miR-126水平与HMGB1/TLR4信号通路活性和术后复发的关系

目的 探讨股腘型下肢动脉硬化闭塞症(LEASO)患者血清微小核糖核酸(miR)-21、miR-126水平与高迁移率族蛋白B1(HMGB1)/Toll样受体4(TLR4)信号通路活性和术后复发的关系。方法 选取行介入手术的股腘型LEASO患者120例,根据术后是否复发将股腘型LEASO患者分为复发组和未复发组。RF-qPCR剂检测血清miR-21、miR-126表达和外周血单个核细胞HMGB1 mRNA、TLR4 mRNA表达。采用Pearson相关性分析法分析股腘型LEASO患者血清miR-21、miR-126与外周血单个核细胞HMGB1 mRNA、TLR4 mRNA表达的相关性。多因素Logistic回归分析股腘型LEASO患者介入术后复发的影响因素。结果 120例股腘型LEASO患者随访2年,术后复发率为34.17%。与未复发组比较,复发组血清miR-21和外周血单个核细胞HMGB1 mRNA、TLR4 mRNA表达升高,血清miR-126表达降低(P均<0.05)。Pearson相关性分析显示,股腘型LEASO患者血清miR-21与外周血单个核细胞HMGB1 mRNA、TLR4 mRNA表达呈正相关(r分别为0.660、0.649,P均<0.05),miR-126与外周血单个核细胞HMGB1 mRNA、TLR4 mRNA表达呈负相关(r分别为-0.632、-0.641,P均<0.05),外周血单个核细胞HMGB1mRNA与TLR4 mRNA表达呈正相关(r=0.742,P<0.05)。多因素Logistic回归分析显示,高血压、糖尿病和miR-21、HMGB1 mRNA、TLR4 mRNA升高为股腘型LEASO患者介入术后复发的独立危险因素,miR-126升高为独立保护因素(P均<0.05)。结论 股腘型LEASO患者血清miR-21高表达和miR-126低表达与HMGB1/TLR4信号通路激活有关,是股腘型LEASO患者术后复发的独立影响因素。

普通球囊与药物涂层球囊治疗ASO支架内再狭窄的近期疗效对照

目的探讨普通球囊与药物涂层球囊(drug coated balloon,DCB)治疗下肢动脉硬化闭塞症(arteriosclerosis obliterans,ASO)支架内再狭窄的近期疗效对照。方法选择2021年1月至2022年12月我院收治的下肢动脉硬化闭塞症支架再狭窄患者90例作为研究对象,按照不同治疗方案分为普通组(45例,非顺应性后扩球囊普通球囊治疗)与药物涂层组(45例,药物涂层球囊治疗),观察两组术前、术后12 h、7 d时血管内皮功能[P选择素、一氧化氮(nitric oxide,NO)、内皮素-1(endothelin-1,ET-1)]水平;比较两组术前、术后6个月、术后12个月Rutherford分级及踝肱指数(ankle brachial index,ABI)及术后6个月、12个月靶向血管畅通情况。结果术后12 h、7 d,两组P选择素、ET-1水平高于术前,NO水平低于术前(P<0.05);而药物涂层组P选择素、ET-1水平低于普通组(P<0.05),而NO水平低于普通组(P<0.05);术后6个月、12个月Ruthweford分级低于术前(P<0.05);而药物涂层组Rutherford分级低于普通组,差异有统计学意义(P<0.05);术后3d、术后6个月、12个月两组ABI值高于术前(P<0.05);术后6个月、12个月药物涂层组ABI值高于普通组,差异有统计学意义(P<0.05);术后6个月、12个月药物涂层组靶向血管通畅率高于普通组(P<0.05),药物涂层组CD-TLR低于普通组,差异有统计学意义(P<0.05)。结论药物涂层球囊治疗可减少对患者血管内皮功能的损伤,改善患者下肢缺血症,维持靶向血管通畅。

Mechanism of Danggui Sini Decoction(当归四逆汤)for Atherosclerosis Obliterans Based on Network Pharmacology and Molecular Docking

Objective:Based on network pharmacology and molecular docking,we want to explore the pharmacological effects and mechanism of Danggui Sini Decoction in the treatment of lower extremity arteriosclerosis obliterans.Methods:Using TCMSP database to search the main active components of Danggui Sini Decoction(当归四逆汤,DSD)and their related targets,Cytoscape3.8.1 software was used to construct a"component-disease-target"interaction network.Meanwhile,DAVID database was used to enrich the key target genes with GO and KEGG functions.And we used Auto Dock Tools 1.5.6 for molecular docking.Results:A total of 45 candidate active molecules and 250 potential target proteins related to ASO were screened.Key genes such as TNF,IL6,VEGFA,MMP9,IL1B,CCL2,CXCL8,ICAM1,VCAM1,and IL10 are mainly through TNF signaling pathway,HIF-1 signaling pathway,cytokine-cytokine receptor interaction,Toll-like receptor signaling pathway,NF-kappa B signaling pathway,MAPK signaling pathway and other biological pathways exert their effects.The results of molecular docking showed that 5UUI-sesamin,5UUI-paeoniflorin,4XCT-sesamin,and 4XCT-sesamin have extremely strong binding ability.Conclusion:Danggui Sini Decoction(当归四逆汤,DSD)can synergistically exert pharmacological effects through multiple components,multiple targets,and multiple pathways.On the basis of regulating immunity and inhibiting smooth muscle proliferation,it can prevent the occurrence and development of ASO.

精准医学指导在ASO介入术后运动康复中的应用研究

目的观察精准医学指导下的运动康复训练对动脉硬化闭塞症(ASO)介入术后患者血管内皮功能及预后的影响。方法本文为前瞻性研究。选取2020年1月至2022年3月南阳市第一人民医院收治的123例ASO患者为研究对象,以随机数字表法分为常规组(61例)和康复组(62例)。常规组男33例、女28例,年龄45~75(61.36±5.25)岁,实施常规康复锻炼;康复组男32例、女30例,年龄43~77(60.45±5.13)岁,实施基于精准医学的运动康复训练,对入组患者开展为期1年随访。对比两组患者干预前后自我管理能力、血管内皮功能及相关并发症发生情况。采用t检验、χ^(2)检验。结果干预后,康复组自我护理能力量表(ESCA)、一般自我效能感量表(GSES)评分[(125.44±20.61)分、(2.66±0.25)分]均高于常规组[(110.33±20.47)分、(1.92±0.61)分],差异均有统计学意义(t=4.079、8.829,均P<0.001)。随访结束时,康复组血流介导下管壁切应力引发的血管舒张功能(FMD)、硝酸甘油介导下管壁切应力引发的血管舒张功能(NMD)[(12.25±3.14)%、(9.85±2.41)%]均高于常规组[(10.11±3.47)%、(8.22±2.16)%],脉搏波传导速度(PWV)[(10.24±3.45)m/s]低于常规组[(12.41±3.12)m/s],差异均有统计学意义(t=3.588、3.948、3.657,均P<0.001)。随访结束时,康复组并发症发生率为6.45%(4/62),低于常规组[18.03%(11/61)],差异有统计学意义(χ^(2)=6.242,P<0.05)。结论精准医学指导下的运动康复训练能有效改善ASO介入术后患者的健康认知水平,提升自我管理能力,促进患者血管内皮功能恢复,对降低相关并发症发生风险有积极作用。

sTWEAK、sCD163水平与ASO介入治疗术后再狭窄的相关性分析

目的 探讨血浆可溶性TWEAK(soluble TWEAK,s TWEAK)、可溶性CD163(soluble CD163,sCD163)水平与下肢动脉硬化闭塞症(arteriosclerosis obliterans,ASO)介入治疗术后再狭窄(in-stent restenosis,ISR)的关系。方法 选择2018年1月至2019年12月在浙江省湖州市长兴县中医院就诊的263例ASO患者作为研究对象,根据1年内是否发生ISR将患者分为ISR组(n=81)和非ISR组(n=182)。观察两组患者sTWEAK、sCD163、sTWEAK/sCD163及其他临床资料差异,采用多因素分析sTWEAK、sCD163、sTWEAK/sCD163对ISR的影响,采用受试者操作特征(receiver operator characteristic,ROC)曲线计算有关指标对ISR的预测价值。结果 ISR发生率为26.60%。ISR组患者sTWEAK、sTWEAK/sCD163水平低于非ISR组患者,sCD163水平和hs-CRP水平高于非ISR患者,差异均有统计学意义(P<0.05)。ISR组和非ISR组患者吸烟、收缩压(systolic blood pressure,SBP)、糖化血红蛋白(glycated hemoglobin,HbA1c)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、Rutherford分级、病变长度、完全闭塞、最小管腔直径、管腔狭窄率相比较,差异存在统计学意义(P<0.05)。多因素分析显示,s TWEAK/sCD163是ISR的保护性因素(P<0.05),吸烟、HbA1c、病变长度、完全闭塞是ISR的风险因素(P<0.05)。ROC曲线结果显示s TWEAK/sCD163预测ISR的敏感度为80.25%,特异性为88.46%,曲线下面积为0.898,95%CI:0.855~0.932。结论 基线sTWEAK/sCD163水平是ASO介入治疗术后的保护性因素,基线水平对术后1年内ISR具有一定预测价值。

下肢动脉硬化闭塞症患者生活质量及影响因素分析

目的:分析下肢动脉硬化闭塞症患者生活质量及影响因素,为改善患者生活质量提供依据。方法:采用便利抽样法,选取2022年6月—11月重庆市某三级甲等医院下肢动脉硬化闭塞症患者302例为调查对象,采用疼痛程度数字评分量表、生活自理能力评分量表和中文修订版外周动脉疾病生活质量量表评估其生活质量。应用SPSS22.0统计学软件,采用ANOVA方差分析及多元逐步回归分析等方法进行统计、分析。结果:下肢动脉硬化闭塞症患者生活质量评分为(57.22±13.69)分。不同居住地、个人平均月收入、医疗费用支付方式、步行距离、疼痛分级、生活自理能力评定结果、吸烟年限患者的生活质量得分比较,差异具有统计学差异(P<0.05)。多元逐步回归分析结果显示,生活质量的3个影响因素为疼痛分级、生活自理能力评定结果、步行距离。结论:下肢动脉硬化闭塞症患者总体生活质量差,其主要影响因素为疼痛、生活自理能力和步行距离。提示临床应加强对高危人群的早期筛查,早诊断、早治疗,从而改善下肢动脉硬化闭塞症患者生活质量。

iFlow彩色血流编码成像技术在下肢动脉硬化闭塞症诊断中的应用价值

目的研究iFlow彩色血流编码成像技术在下肢动脉硬化闭塞症(LEASO)诊断中的应用价值。方法选择2022年3月至2023年10月期间确诊的106例LEASO患者作为本研究的LEASO组,以一般资料与LEASO组匹配且无动脉病变的80例志愿者作为对照组。两组受试者均进行数字减影血管造影(DSA)并采用iFlow彩色血流编码成像技术检测股骨头区域和踝关节区域达峰时间(TTP)、计算踝关节区域与股骨头区域TTP的差值,测量踝肱指数(ABI)。结果两组研究对象年龄、性别、体质量指数、吸烟史、高血压病史、糖尿病史、冠心病史、股骨头区域TTP的比较,差异无统计学意义(P>0.05);LEASO组踝关节区域TTP及TTP差值均高于对照组,差异有统计学意义(P<0.05);LEASO组中不同Rutherford分类患者股骨头区域TTP的比较以及左侧病变患者与右侧病变患者股骨头区域TTP、踝关节区域TTP、TTP差值的比较,差异无统计学意义(P>0.05),Rutherford分类越高,踝关节区域TTP及TTP差值越低(P<0.05);经Pearson检验,LEASO患者的踝关节区域TTP、TTP差值与ABI呈负相关(P<0.05);经受试者工作特征(ROC)曲线分析,踝关节区域TTP、TTP差值对LEASO具有诊断效能;经Delong检验,TTP差值诊断的ROC曲线下面积高于踝关节区域TTP(P<0.05)。结论iFlow彩色血流编码成像技术测定踝关节区TTP及TTP差值是诊断LEASO的量化指标。

中医耳穴压豆在下肢动脉硬化闭塞症患者中的护理效果及对疼痛的影响

目的:探讨中医耳穴压豆在下肢动脉硬化闭塞症患者中的护理效果及对疼痛的影响。方法:选取2019年1月至2022年3月本院接受治疗的130例下肢动脉硬化闭塞症患者为研究对象,采用随机数字表法将患者分为实验组(n=65)以及参考组(n=65);参考组给予常规疼痛护理干预,实验组给予中医耳穴压豆干预;比较两组患者临床疗效、临床症状消失时间及护理前后疼痛(VAS)评分。结果:实验组治疗有效率明显高于参考组(P<0.05);实验组溃疡、斑块以及坏疽消失时间低于参考组(P<0.01);护理后,两组VAS评分较护理前明显降低,且实验组显著低于参考组(P<0.01);两组ADL评分明显提高,且实验组大于参考组(P<0.01);两组不良反应发生率比较无显著差异(P>0.05)。结论:耳穴压豆在下肢动脉硬化闭塞症护理中的应用效果良好,能有效改善患者临床症状,降低疼痛,提高其日常生活能力,推广价值高。

下肢动脉硬化闭塞症患者自我管理能力的潜在剖面分析及影响因素研究

目的分析下肢动脉硬化闭塞症患者自我管理潜在类别及影响因素。方法采用一般资料问卷、下肢动脉硬化闭塞症患者自我管理能力量表、社会支持评定量表、医院焦虑抑郁量表对470例下肢动脉硬化闭塞症患者进行调查,采用潜在剖面分析建立了4个下肢动脉硬化闭塞症患者自我管理能力潜在类别模型,采用无序多分类Logistic回归分析探讨下肢动脉硬化闭塞症患者自我管理能力潜在类别的影响因素。结果下肢动脉硬化闭塞症患者自我管理能力分为“情绪改进型”(21.28%)、“日常生活改进型”(25.53%)、“全面改进型”(36.17%)和“全面保持型”(17.02%)4种潜在类别。文化程度、家庭人均月收入、吸烟、饮酒、居住地、体质指数、社会支持、焦虑为下肢动脉硬化闭塞症患者自我管理潜在类别的影响因素。结论下肢动脉硬化闭塞症患者自我管理能力处于中等水平,且具有明显的分类特征,医护人员可以根据患者不同自我管理类别特征,制订针对性的干预措施,以提高患者自我管理能力。

CT血管造影对下肢动脉硬化闭塞症介入治疗效果评价及术后复发预测价值研究

目的探讨CT血管造影(CTA)对下肢动脉硬化闭塞症(ASO)介入治疗效果评估及术后复发预测价值。方法选择130例ASO患者,其中男性81例,女性49例;年龄50~67岁,平均年龄58.92岁(标准差5.04岁);身体质量指数(BMI)21~27 kg/m^(2),平均BMI 24.28 kg/m^(2)(标准差1.33 kg/m^(2));高血压51例,糖尿病56例,冠心病57例;吸烟85例。均给予介入手术治疗及CTA检查,比较手术前后下肢动脉狭窄程度、斑块参数[斑块负荷(PB)、斑块面积(PA)、最小管腔面积(MLA)]。对所有患者进行为期1年的随访,根据ASO是否复发,分为复发组和未复发组,比较两组斑块参数,绘制受试者工作特性(ROC)曲线,计算曲线下面积(AUC),分析PB、PA、MLA对ASO复发的预测价值。Logistic回归分析ASO复发的危险因素。结果术后中度狭窄(23.08%)、重度狭窄(19.23%)、完全闭塞率(3.08%)均低于术前(30.77%、46.15%、13.85%)(P<0.05)。术后PB、PA、MLA均低于术前[(29.82±4.11)%vs(62.82±8.16)%、(4.26±0.26)mm^(2)vs(9.26±1.33)mm^(2)、(3.01±0.17)mm^(2)vs(7.16±1.05)mm^(2)。P<0.05]。随访1年后,根据复发情况分为复发组28例和未复发组102例。复发组PB(57.63±4.28)%、PA(9.02±1.27)mm^(2)、MLA(6.96±1.01)mm^(2)均高于未复发组[(28.11±3.85)%、(4.07±1.07)mm^(2)、(2.85±0.12)mm^(2)。t=35.077、20.805、40.474,P<0.05]。PB、PA、MLA联合检测预测ASO复发的AUC是0.792[95%可信区间(CI)0.716~0.954],灵敏度、特异度分别是93.08%、91.13%,均高于单一检测(P<0.05)。高血压、糖尿病、血管闭塞长度、术后用药不规律、C反应蛋白(CRP)是ASO复发的危险因素(P<0.05)(OR=1.268、1.216、1.134、1.329、1.226;95%CI=1.135~1.438、1.128~1.395、1.034~1.296、1.162~1.468、1.133~1.429)。结论CTA可准确评估ASO患者下肢动脉狭窄程度,辅助临床评估治疗效果,提高对疾病复发的预测灵敏度及特异度,ASO的复发与多种因素有关,应当引起临床重视与关注。

下肢动脉硬化闭塞动物模型辅助性T细胞17/调节性T细胞平衡及巨噬细胞极化比率的研究

目的探讨下肢动脉硬化闭塞(arteriosclerosis obliteran,ASO)动物模型外周血辅助性T细胞17(helper T cell type 17,Th17)/调节性T细胞(regulatory T cell,Treg)比值平衡及M1巨噬细胞和M2巨噬细胞极化比率。方法20只SD大鼠随机分为ASO组和对照组,每组10只,其中ASO组构建ASO模型并在90d取材获得血液样本,检测血清中促炎因子白细胞介素(interleukin,IL)-6、IL-17和抑炎因子IL-10的分泌情况、Th17和Treg、M1和M2型巨噬细胞的含量及比率,以及淋巴细胞中叉头状/翼状螺旋转录因子3(forkhead or winged helix transcription 3,Foxp3)、IL-6、IL-10、IL-17的表达情况。结果ASO组大鼠血清IL-6、IL-17显著升高,而IL-10显著降低,差异有统计学意义(P<0.05)。ASO组Th17/Treg比例和M1/M2巨噬细胞比例均显著升高,差异有统计学意义(P<0.05)。在大鼠淋巴细胞中,ASO组的Foxp3和IL-10的mRNA及蛋白含量显著低于对照组,而IL-6和IL-17的mRNA及蛋白水平显著高于对照组,差异有统计学意义(P<0.05)。结论Th17/Treg平衡、M1/M2比例以及血液及淋巴细胞炎症因子表达可能与下肢ASO的炎症反应趋势变化有关。