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.

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.

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.

Clinical study about the effect of Simiao Yong'an Decoction on preventing in-stent restenosis and regulating inflammation and oxidative stress after lower extremity stent angioplasty stenting

Objective:To study the effect of Simiao Yong'an Decoction on the prevention of in-stent restenosis and the regulation of inflammation and oxidative stress after lower extremity stent angioplasty.Methods:A prospective study was conducted on 60 ASO patients who underwent lower extremity stent angioplasty in our hospital between January 2014 and January 2018.The patients were randomly divided into observation group receiving postoperative Simiao Yong'an Decoction combined with antiplatelet drug treatment and control group receiving postoperative antiplatelet drug treatment.The conditions of in-stent restenosis were followed up,and the indicators of coagulation,inflammation and oxidative stress were detected.Results:The incidence of in-stent restenosis in observation group 1 year after operation was significantly lower than that in control group;6 months and 12 months after operation,the ankle brachial index(ABI)levels,minimal lumen diameter(MLD)levels at the stent and superoxide dismutase(SOD)contents of observation group were significantly higher than those of control group,whereas D-dimer(D-D)and fibrinogen degradation product(FDP)levels as well as P-selectin,C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),malondialdehyde(MDA)and inducible nitric oxide synthase(iNOS)contents were significantly lower than those of control group.Conclusions:Simiao Yong'an Decoction can prevent the in-stent restenosis and inhibit the inflammation and oxidative stress after lower extremity stent angioplasty.

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.

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。

下肢动脉血管重建术后并发淋巴漏的风险预测列线图模型建立及预防指导

目的探讨下肢动脉血管重建术后并发淋巴漏的影响因素,并以此构建风险预测列线图模型,同时提出相对应的预防指导建议。方法回顾性分析于2014年1月至2022年6月在徐州市中心医院行下肢动脉血管重建的879例下肢动脉硬化闭塞症(LEASO)病人的临床资料,根据病人术后有无并发淋巴漏将其分为并发组(31例)和未并发组(848例),比较两组病人的一般资料。采用多因素logistic回归分析法分析下肢动脉血管重建术后并发淋巴漏的影响因素,并基于此采用R 3.4.5软件包绘制列线图模型,且绘制受试者工作特征(ROC)曲线对列线图模型的预测效能进行评估,绘制校准度曲线图并采用Bootstrap法检验预测列线图预测模型的一致性。结果单因素分析显示,两组身体质量指数(BMI)[(26.52±2.01)kg/m^(2)比(25.71±2.13)kg/m^(2)]及Fontaine分期[Ⅳ期38.71%比18.28%]、术中出血量[>100 mL 29.03%比11.20%]、术后血红蛋白(Hb)水平[(95.33±15.25)g/L比(104.57±22.38)g/L]、术后白蛋白(Alb)水平[(25.68±5.59)g/L比(28.28±6.17)g/L]、使用高频电刀(83.87%比55.54%)、腹股沟切口(80.65%比56.25%)差异有统计学意义(均P<0.05)。logistic回归分析可知,BMI[OR=2.52,95%CI:(1.18,3.86)]、Fontaine分期[OR=3.22,95%CI:(2.08,4.36)]、术中出血量>100 mL[OR=3.36,95%CI:(2.23,4.48)]、术后Hb水平[OR=2.97,95%CI:(1.75,4.20)]、术后Alb水平[OR=3.10,95%CI:(2.02,4.19)]、使用高频电刀[OR=3.39,95%CI:(2.20,4.59)]、腹股沟切口[OR=3.31,95%CI:(2.00,4.62)]均是影响LEASO病人下肢动脉血管重建术后并发淋巴漏的独立危险因素(P<0.05)。据此构建预测LEASO病人下肢动脉血管重建术后并发淋巴漏的列线图模型,预测值同实测值基本一致,一致性指数为0.836,模型具有良好的精准度和区分度。结论BMI、Fontaine分期、术中出血量>100 mL、术后Hb水平、术后Alb水平、使用高频电刀、腹股沟切口均为影响LEASO病人下肢动脉血管重建术后并发淋巴漏的影响因素,基于上述因素构建的列线图模型效能高。

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。

系统性炎症指标对下肢动脉硬化闭塞症患者发生肌少症的预测价值

目的:评估全身免疫炎症指数(SII)、血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞比值(NLR)、淋巴细胞/单核细胞比值(LMR)和C反应蛋白(CRP)等系统性炎症指标对下肢动脉硬化闭塞症(ASO)患者发生肌少症的预测价值。方法:本研究纳入江苏大学附属武进医院和南京医科大学附属常州第二人民医院的251例ASO患者。依据第三腰椎腰大肌指数(PMI)将患者分为肌少症组和非肌少症组。收集患者的一般资料和相关血液指标,并计算SII、PLR、NLR和LMR。通过二分类Logistic回归分析确定ASO患者发生肌少症的危险因素,并采用受试者工作特征(ROC)曲线评估相关指标的预测效果。结果:251例ASO患者中,肌少症组和非肌少症组患者数分别为98例(39.0%)和153例(61.0%)。与非肌少症组相比,肌少症组患者年龄明显增加(P<0.001),SII、PLR、NLR和CRP水平明显增高(P<0.01),而BMI和LMR水平明显降低(P<0.01)。多因素Logistic回归分析结果表明,高龄、BMI偏低、SII上升均为ASO患者发生肌少症的独立危险因素。ROC曲线结果显示,年龄、BMI、SII和3项指标联合预测肌少症发生的曲线下面积分别为0.674、0.678、0.644和0.746(P均<0.001)。结论:年龄、BMI及系统性炎症指标中的SII对ASO患者肌少症的发生有一定的预测价值。

介入治疗90岁及以上下肢动脉闭塞症患者的临床疗效

目的探讨90岁以上下肢动脉闭塞症患者经皮下肢动脉腔内成形手术的临床疗效。方法选择2018年1月至2022年12月首都医科大学宣武医院收治的下肢动脉硬化闭塞症患者18例,均采用下肢动脉腔内成形术进行治疗。结果所有患者手术成功。16例患者手术前间歇性跛行距离为(125.56±119.77)m,手术后为(338.89±259.84)m(t=5.09,P<0.05);手术前踝肱指数为0.31±0.20,出院时踝肱指数为0.71±0.16(t=-11.52,P<0.05)。其中15例术后3个月Rutherford分级得到不同程度的提高,血管治疗长度[(250.45±213.50)mm]与Rutherford分级提升无相关性(P=0.703),而术后血管恢复比值(0.82±0.17)与Rutherford分级提升存在相关性(P=0.022)。结论介入治疗90岁及以上下肢动脉闭塞症患者的临床效果显著,能够保留患者部分自理能力,提高生活质量。

1992-2022年中医药治疗下肢动脉硬化闭塞症研究文献可视化分析

目的了解中医药治疗下肢动脉硬化闭塞症研究现状及发展趋势,为相关研究提供参考。方法检索中国知识资源总库(CNKI)、中国学术期刊数据库(万方数据)、中文科技期刊数据库(VIP)收录的1992年9月18日-2022年9月18日中医药治疗下肢动脉硬化闭塞症研究文献。采用NoteExpress3.6.0软件管理、去重,采用Excel2019分析发文量趋势,采用VOSviewer1.6.18.0和CiteSpace6.1.R6软件对纳入文献作者、机构及关键词进行共现、聚类、时间线及突现分析并绘制知识图谱。结果共纳入文献1095篇,发文量总体呈上升趋势;涉及1915位作者,发文最多的为陈柏楠,形成了以奚九一、曹烨民、葛建立等为核心的研究团队;主要研究机构有山东中医药大学、北京中医药大学、黑龙江中医药大学等,但各机构间合作较少;高频关键词有动脉硬化、糖尿病、临床疗效、脱疽、血液流变学等,形成气虚血瘀、四妙勇安汤、血管新生等13个聚类,研究热点为中医外治法、临床疗效、血脉瘀阻证、用药规律、补阳还五汤。结论1992-2022年中医药治疗下肢动脉硬化闭塞症研究热度逐渐升高;基于大数据平台的基因检测、分子生物学等现代研究为该领域研究热点;中医内、外治法联合的中医特色综合治疗,以及结合介入治疗等技术的中西医结合多学科交叉研究为发展趋势。

Comparison of the Safety and Effectiveness of Lower Extremity Artery Bypass Grafting and Endovascular Angioplasty in the Treatment of Lower Extremity Arteriosclerosis Obliterans in the Elderly

Objective:To compare the safety and effectiveness of lower extremity artery bypass grafting and endovascular angioplasty in the treatment of lower extremity arteriosclerosis obliterans in the elderly.Methods:The data of 87 elderly patients with lower extremity arteriosclerosis obliterans treated in our hospital from August 2015 to August 2017 were analyzed retrospectively.According to the different treatment methods,they were divided into angioplasty group(n=45,intravascular angioplasty)and bypass grafting group(n=42,lower extremity artery bypass grafting).The success rate,hemodynamics of dorsalis pedis artery and nerve conduction of lower extremity were compared between the two groups Velocity,VAS score,late target vessel lumen loss(LLL),patency rate,restenosis rate,ankle brachial index(ABI)and clinical adverse events.Results:There was no significant difference between angioplasty group and bypass group(P>0.05).One month after operation,the hemodynamics of dorsalis pedis artery and nerve conduction velocity of lower limbs in the two groups were better than those before operation,the difference was statistically significant(P<0.05),but there was no significant difference between the two groups(P>0.05).The VAS score of the two groups was significantly lower than that of the preoperative group(P<0.05),but there was no significant difference between the two groups(P>0.05).The ABI of the two groups was significantly improved after operation,the difference was statistically significant(P<0.05),but there was no significant difference between the groups at each time point(P>0.05).There was no significant difference in LLL,patency rate and restenosis rate between the two groups(P>0.05).There was statistical difference in the incidence of complications between the two groups(P<0.05).During the follow-up period,no serious adverse events such as death or amputation occurred in both groups.Conclusion:Endovascular angioplasty and lower extremity artery bypass grafting have the same clinical effect in the treatment of elderly patients with lower extremity arteriosclerosis obliterans,which are safe and feasible.

下肢动脉腔内血管成形术联合创面局部应用胰岛素治疗糖尿病足溃疡的临床效果研究

目的:观察下肢动脉腔内血管成形术(PTA)联合创面局部应用胰岛素治疗糖尿病足溃疡的临床效果。方法:选取2020年8月-2023年8月我院收治的糖尿病足溃疡合并下肢动脉硬化闭塞症患者65例,所有患者均接受下肢动脉PTA治疗,根据治疗方法不同,将患者分为对照组35例和观察组30例。对照组采用常规外科换药法,即局部清创、清洁换药;观察组在常规外科换药基础上应用局部注射胰岛素及胰岛素溶液湿敷。对比两组的踝肱指数(ABI)、创面愈合情况及治疗有效率。结果:两组患者性别、年龄、糖尿病足病程、糖化血红蛋白、空腹血糖水平、Wanger分级、Fontaine分期、Rutherford分级、疼痛分级无显著性差异(P <0.05);两组术前及术后ABI指数对比无显著性差异(P <0.05),术后第4周,观察组愈合情况优于对照组(P <0.05);观察组治疗有效率高于对照组,差异有统计学意义(P<0.05);两组组内比较,术后4周ABI指数较术前明显提高,差异有统计学意义(P <0.05),术后创面面积较术前明显缩小,差异有统计学意义(P<0.05)。结论:下肢动脉PTA手术联合创面局部应用胰岛素治疗糖尿病足溃疡,可促进创面愈合,提高创面愈合率,同时下肢PTA手术可改善糖尿病足溃疡患者下肢血供,对创面愈合起到促进作用,临床效果确切。

利伐沙班联合支架植入术治疗下肢动脉硬化闭塞症的疗效及对患者血管内皮功能、血流动力学指标的影响

目的探讨利伐沙班联合支架植入术治疗下肢动脉硬化闭塞症的临床效果,并分析其对患者血管内皮功能、血流动力学指标的影响。方法选取2021年9月至2023年4月青岛大学附属医院收治的108例下肢动脉硬化闭塞症患者,在组间基线特征可比的原则上,随机分为观察组和对照组,每组54例。对照组采取支架置入术进行治疗,术后口服拜阿司匹灵(100 mg/d),观察组在此基础上术后联合利伐沙班(5 mg/d)治疗。比较两组的临床疗效,治疗前和治疗1个月后血管内皮功能指标[硝酸甘油介导的非内皮依赖性舒张功能(NMD)、血流介导的血管扩张功能(FMD)、一氧化氮(NO)、内皮素(ET)]及血流动力学指标(足背动脉内径、血流量和血流速度峰值)的变化,以及术后并发症发生情况。结果观察组治疗总有效率(90.74%)明显高于对照组(75.93%),差异有统计学意义(P<0.05)。治疗前两组NMD、FMD、NO、ET水平比较差异无统计学意义(P>0.05);治疗1个月后两组患者的NMD、FMD、NO水平明显高于治疗前,且观察组高于对照组,而ET水平明显低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗前两组足背动脉内径、血流量和血流速度峰值比较差异无统计学意义(P>0.05);治疗1个月后两组足背动脉内径及血流量明显高于治疗前,且观察组高于对照组,而血流速度峰值明显低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。观察组术后并发症总发生率为5.56%,明显低于对照组的20.37%,差异有统计学意义(P<0.05)。结论利伐沙班联合支架植入可提高下肢动脉硬化闭塞症的治疗效果,并能显著改善患者的血管内皮功能及血流动力学指标,减少术后并发症的发生,值得临床应用。

CTA与DSA评估慢性肢体威胁性缺血患者全球肢体解剖学分期系统分期的一致性分析

目的分析CTA与DSA在评估慢性肢体威胁性缺血(CLTI)患者全球肢体解剖学分期系统(GLASS)分期中的一致性。方法 回顾性分析2017年1月至2020年12月西安交通大学第一附属医院收治的CLTI患者临床资料。以DSA评估结果为金标准,分析CTA与DSA评估GLASS分期的一致性。结果 CTA评估GLASS评分与DSA具很强的一致性,其中两者评估股腘动脉段评分的加权Kappa系数为0.798(95%CI=0.722~0.873,P<0.01),评估膝下动脉段评分的加权Kappa系数为0.785(95%CI=0.725~0.845,P<0.01),评估GLASS整体评分的加权Kappa系数为0.832(95%CI=0.752~0.911,P<0.01),均显示出很强的一致性。结论 下肢动脉CTA检查可准确评估CLTI患者靶病变GLASS评分和分期,有助于下肢动脉硬化闭塞症诊断及血运重建技术难度评估。

数字减影血管造影引导下血管腔内成形术在下肢动脉硬化闭塞症中的疗效及其术后复发的影响因素分析

目的探讨数字减影血管造影(DSA)引导下血管腔内成形术(TA)在下肢动脉硬化闭塞症(ASO)中的疗效及其术后复发的影响因素。方法选取2018年4月至2022年4月河北北方学院附属第一医院收治的180例ASO患者,采用随机数字表法将其分为A组(n=90,采用TA治疗)、B组(n=90,采用下肢动脉旁路移植术)。比较两组患者的临床疗效、视觉模拟评分法(VAS)评分、术后不良事件发生情况及术后复发情况。结果A组患者临床总有效率为92.22%(83/90),高于B组患者的78.89%(71/90)(P=0.011)。术后1 d、术后1个月,A组患者的踝肱指数(ABI)、趾肱指数(TBI)均高于B组患者,两组患者ABI、TBI以时间因素为源、以组别为源、以时间与组别交互为源的主体内效应间比较,差异均有统计学意义(P﹤0.05)。术后1 d、术后1个月,A组患者VAS评分均低于B组患者,两组患者VAS评分以时间因素为源、以组别为源、以时间与组别交互为源的主体内效应间比较,差异均有统计学意义(P﹤0.05)。A组患者不良事件总发生率为3.33%(3/90),低于B组患者的13.33%(12/90)(P=0.015)。术后6个月,共51例患者复发,多因素分析结果显示,高血压史、高脂血症、纤维蛋白原水平升高、手术方式、下肢动脉狭窄程度均是ASO复发的独立危险因素(P﹤0.05)。结论ASO患者在DSA引导下TA治疗效果显著,患者下肢血供状况明显改善,VAS评分及不良事件发生风险降低,高血压史、高脂血症、纤维蛋白原水平升高、手术方式及下肢动脉狭窄程度均是导致ASO复发的独立危险因素。

老年下肢动脉硬化闭塞症患者不同治疗方式的预后分析

目的 探究不同治疗方法对老年下肢动脉闭塞症患者不良预后的影响。方法 回顾性选取2020年5月至2022年5月在西安交通大学第一附属医院周围血管科住院的老年下肢动脉闭塞症患者352例,根据患者意愿和病变特征分为球囊扩张组142例、支架置入组145例及保守治疗组65例,对所有患者进行13~24个月的随访,随访内容:主要不良心血管事件(MACE),包括全因死亡、急性心肌梗死、急性缺血性脑卒中和主要不良下肢事件(MALE),包括下肢静息痛、溃疡或皮肤缺损、坏疽、再闭塞、截肢发生情况,比较分析3组临床资料和预后,绘制Kaplan-Meier生存曲线。结果 支架置入组全因死亡发生率显著低于保守治疗组(9.7%vs 23.1%,P<0.01)。支架置入组和球囊扩张组MALE静息痛发生率明显低于保守治疗组(4.8%、9.2%vs 24.6%,P<0.01)。结论 适合行介入治疗的老年下肢动脉闭塞症患者接受血管腔内治疗可以降低部分患者发生全因死亡和MALE事件风险。

超声微血管成像技术评估下肢动脉硬化闭塞症支架术后再狭窄

目的探讨超声微血管成像(SMI)技术在下肢动脉硬化闭塞症(LEASO)支架术后再狭窄评估中的应用价值。资料与方法回顾性分析大连大学附属新华医院2017年1月—2019年12月LEASO支架植入术后25根血管(20例患者)的常规血管超声、SMI和数字减影血管造影(DSA)检查结果,并进行一致性检验;以DSA为“金标准”,观察SMI对LEASO的诊断价值。结果再狭窄程度评估:DSA显示闭塞7枚(28.0%),重度狭窄14枚(56.0%),中度狭窄4枚(16.0%);常规血管超声显示闭塞13枚(52.0%),重度狭窄9枚(36.0%),中度狭窄3枚(12.0%);SMI显示闭塞9枚(36.0%),重度狭窄12枚(48.0%),中度狭窄4枚(16.0%)。一致性分析:常规血管超声与DSA一致性强度中等(Kappa=0.558),SMI与DSA一致性强度高(Kappa=0.868),SMI与常规血管超声一致性强度中等(Kappa=0.420),差异均有统计学意义(P<0.01)。结论SMI评估再狭窄程度与DSA的一致性强,且优于常规血管超声,或可成为LEASO支架术后随访、判断支架内再狭窄的一种新方法。

基于CiteSpace的国内外下肢动脉硬化闭塞症护理研究的可视化分析

目的:分析国内外下肢动脉硬化闭塞症护理研究的现状、热点及趋势,为国内下肢动脉硬化闭塞症病人的护理研究和管理提供思路。方法:采用计算机检索2000年1月1日—2022年7月30日Web of Science核心合集及中国知网数据库中收录的关于下肢动脉硬化闭塞症护理的文献,运用CiteSpace软件对其发表时间、国家/机构分布、作者分布、关键词等进行可视化分析。结果:共纳入670篇文献,中文文献520篇,英文文献150篇,2000—2022年下肢动脉硬化闭塞症护理研究呈波动上升式发展趋势;中文发文量最多的机构是郑州大学附属洛阳中心医院,国内各研究机构间的合作度不高。英文发文量最多的国家是日本,发文量较多的机构是日本名古屋大学、东京大学等,主要研究机构的合作度较高。病人自我健康管理是下肢动脉硬化闭塞症护理研究的热点及前沿。结论:未来研究中应注重作者、机构以及多学科间的合作,关注下肢动脉硬化闭塞症病人疾病相关危险因素的自我管理,提供智慧化护理,提高病人远期生活质量。

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。