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.

Th17/Treg balance and macrophage polarization ratio in lower extremity arteriosclerosis obliterans

Objective:To explore the balance of peripheral blood T helper 17 cells/regulatory T cell(Th17/Treg)ratio and the polarization ratio of M1 and M2 macrophages in lower extremity arteriosclerosis obliterans(ASO).Methods:A rat model of lower extremity ASO was established,and blood samples from patients with lower extremity ASO before and after surgery were obtained.ELISA was used to detect interleukin 6(IL-6),IL-10,and IL-17.Real-time RCR and Western blot analyses were used to detect Foxp3,IL-6,IL-10,and IL-17 expression.Moreover,flow cytometry was applied to detect the Th17/Treg ratio and M1/M2 ratio.Results:Compared with the control group,the iliac artery wall of ASO rats showed significant hyperplasia,and the concentrations of cholesterol and triglyceride were significantly increased(P<0.01),indicating the successful establishment of ASO.Moreover,the levels of IL-6 and IL-17 in ASO rats were pronouncedly increased(P<0.05),while the IL-10 level was significantly decreased(P<0.05).In addition to increased IL-6 and IL-17 levels,the mRNA and protein levels of Foxp3 and IL-10 in ASO rats were significantly decreased compared with the control group.The Th17/Treg and M1/M2 ratios in the ASO group were markedly increased(P<0.05).These alternations were also observed in ASO patients.After endovascular surgery(such as percutaneous transluminal angioplasty and arterial stenting),all these changes were significantly improved(P<0.05).Conclusions:The Th17/Treg and M1/M2 ratios were significantly increased in ASO,and surgery can effectively improve the balance of Th17/Treg,and reduce the ratio of M1/M2,and the expression of inflammatory factors.

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.

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.

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.

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.

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.

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。

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。

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。

下肢动脉硬化闭塞症患者术后糖代谢及脂代谢指标对支架内再狭窄的预测价值

目的探讨下肢动脉硬化闭塞症(ASO)患者术后糖代谢、脂代谢指标对支架内再狭窄(ISR)的预测价值。方法选择2018年1月至2021年10月郑州大学第二附属医院及上海交通大学医学院附属第九人民医院收治的160例下肢ASO患者为研究对象。患者均接受经皮腔内血管成形术联合支架植入术治疗,术后随访1 a,根据随访期间ISR发生情况将患者分为ISR组(n=59)和非ISR组(n=101)。收集2组患者的临床一般资料,采用单因素分析初步筛选出发生支架内再狭窄的影响因素,将筛选出的指标进一步行多因素logistic回归分析,分析下肢ASO患者术后发生ISR的影响因素。应用受试者操作特征(ROC)曲线分析出院前1 d糖代谢、脂代谢指标单独及联合预测下肢ASO患者术后发生ISR的价值,绘制决策曲线分析出院前1 d糖代谢、脂代谢指标单独及联合预测下肢ASO患者术后发生ISR的净受益率。结果160例患者中59例发生ISR,发生率为36.88%。ISR组与非ISR组患者的年龄、性别、饮酒、合并症、患侧、Fontaine分期、外周血空腹血糖、血清三酰甘油水平比较差异无统计学意义(P>0.05);ISR组吸烟者占比及外周血糖化血红蛋白(HbA1c)、血清低密度脂蛋白(LDL)水平显著高于非ISR组,血清高密度脂蛋白(HDL)水平显著低于非ISR组(P<0.05)。多因素logistic回归分析结果显示,外周血HbA1c、血清LDL水平升高是下肢ASO患者术后发生ISR的危险因素(比值比>1.00,P<0.05),血清HDL水平升高是下肢ASO患者术后发生ISR的保护因素(比值比<1.00,P<0.05)。ROC曲线结果显示,外周血HbA1c、血清LDL、HDL水平单独及联合预测下肢ASO患者术后发生ISR的曲线下面积分别为0.717、0.761、0.654、0.824,特异度分别为0.861、0.792、0.851、0.663,灵敏度分别为0.525、0.678、0.424、0.864。决策曲线分析结果显示,下肢ASO患者术后出院前1 d外周血HbA1c、血清LDL、血清HDL联合预测ISR发生的净受益率高于三者单独预测。结论下肢ASO患者术后糖代谢指标外周血HbA1c、脂代谢指标血清LDL及HDL对ISR的发生均有一定预测价值,且三者联合检测的预测价值及获得的净受益率更高。

吕培文应用鸡血藤治疗下肢动脉硬化闭塞症经验

下肢动脉硬化闭塞症可导致的肢体疼痛及致残等情况,给人们健康及经济带来极大负担,中医药在其治疗上有一定的优势。吕培文教授认为“络脉瘀滞”是下肢动脉硬化闭塞症主要病理改变,提出了“络以通为用”的观念,从而形成以“活血通络”为主的治法。鸡血藤具有补血活血、舒筋通络之功效,为补血活血类常用传统中药。临床上吕培文教授将其广泛应用于下肢动脉硬化闭塞症的治疗,切实针对“络脉瘀滞”的病因病机,辨证配伍补气、补血养阴、温经散寒、清热、活血化瘀、化痰祛湿、理气类药物,可达到活血通络之功效。

下肢动脉硬化闭塞症支架置入术后支架内再狭窄的危险因素分析

目的探究下肢动脉硬化闭塞症支架置入术后支架内再狭窄的危险因素。方法选取62例下肢动脉硬化闭塞症支架置入术后支架内再狭窄患者(再狭窄组)为研究对象,另选取本院下肢动脉硬化闭塞症支架置入术后未发生狭窄患者62例(未狭窄组)进行病例对照研究,分析再狭窄组与未再狭窄组相关资料,通过二元logistic回归分析下肢动脉硬化闭塞症支架置入术后支架内再狭窄影响因素。结果单因素分析结果显示,2组在年龄、身体质量指数(BMI)、性别、Fontaine分类、高血压、冠心病、高脂血症、病程、血管病变长度、病变侧别、置入支架数量、低密度脂蛋白、高密度脂蛋白、甘油三酯、血小板、单核细胞计数、淋巴细胞计数、中性粒细胞计数、肾小球滤过率比较,差异无统计学意义(P>0.05),但在长期吸烟、糖尿病、术后规律服药、血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞比值(NLR)、TIMI评分、HEART评分、ABI值比较,差异有统计学意义(P<0.05)。二元logistic回归分析显示,长期吸烟、糖尿病、术后规律服药、PLR、NLR、TIMI评分、HEART评分、ABI评分均是下肢动脉硬化闭塞症支架置入术后支架内再狭窄影响因素(P<0.05)。结论长期吸烟、糖尿病、术后规律服药、PLR、NLR、TIMI评分、HEART评分、ABI评分均是下肢动脉硬化闭塞症支架置入术后支架内再狭窄影响因素。

下肢动脉钙化与下肢动脉硬化闭塞症患者血流动力学及外周血管支架联合巴曲酶治疗效果的关系

目的探讨下肢动脉钙化与下肢动脉硬化闭塞症(ASO)患者血流动力学及外周血管支架联合巴曲酶治疗效果的关系。方法筛选2022年2月至2024年2月于河北大学附属医院接受外周血管支架联合巴曲酶治疗的120例ASO患者作为观察组,另选取60例踝肱指数≥0.9的患者纳入对照组(非ASO患者)。根据治疗后6个月再狭窄是否>50%的情况将ASO患者分为预后良好组(62例,再狭窄程度≤50%)和预后不良组(58例,再狭窄程度>50%)。比较观察组与对照组的临床资料,分层回归分析血流动力学参数与股浅动脉钙化评分(SFACS)、膝下动脉钙化评分(BKACS)的关系;比较预后良好组与预后不良组的临床资料及治疗前后的踝肱指数、趾肱指数;Cox回归分析评估SFACS、BKACS与患者预后不良的关系;多元线性回归分析SFACS、BKACS与踝肱指数、趾肱指数的关系;限制性立方样条模型分析SFACS、BKACS与ASO患者预后不良风险的剂量-效应关系。结果观察组年龄、男性比例、吸烟史比例、胫后动脉收缩期血流速度峰值(Vs)、足背动脉Vs、SFACS、BKACS明显高于对照组,胫后动脉血管内径、足背动脉血管内径明显低于对照组(均P<0.05)。胫后动脉血管内径、足背动脉血管内径均对SFACS、BKACS产生显著的负向影响,胫后动脉Vs、足背动脉Vs均对SFACS、BKACS产生显著的正向影响(均P<0.05)。预后良好组和预后不良组C反应蛋白、白蛋白、纤维蛋白原、SFACS[2282(856,3259)分比4236(1547,6325)分]和BKACS[1024(526,1730)分比1951(1157,2968)分]比较差异均有统计学意义(均P<0.05)。预后良好组治疗后6个月和治疗后1、2年踝肱指数和趾肱指数均明显高于预后不良组(均P<0.05)。调整混杂因素前后,SFACS、BKACS均与患者预后不良风险呈正相关,与踝肱指数、趾肱指数呈负相关(均P<0.05)。ASO患者预后不良风险随SFACS、BKACS增加而增加(非线性P值分别为0.762和0.395)。结论下肢动脉钙化水平与ASO患者血流动力学有关,在一定程度上能够评估外周血管支架联合巴曲酶的治疗效果,因此在ASO的治疗过程中,可将其作为临床治疗的检查标志之一,用以及时优化治疗方案。

下肢动脉硬化闭塞病人介入术后并发DVT的风险预测列线图模型构建及验证

目的探讨下肢动脉硬化闭塞病人介入术后并发深静脉血栓(DVT)的风险因素,并构建DVT风险预测列线图模型及进行验证。方法回顾性分析2018年6月至2022年5月在漯河市中心医院进行经皮腔内介入术治疗的374例下肢动脉硬化闭塞病人的临床资料,根据术后是否并发DVT而将病人分为并发DVT组与未并发DVT组。对比两组一般资料,采用多因素logistic回归分析法分析下肢动脉硬化闭塞介入术后并发DVT的危险因素,并利用R软件与rms程序构建DVT风险预测列线图模型,且应用caret程序包通过Bootstrap法对其进行内部验证,计算模型一致性指数(C-index),并绘制受试者操作特征(ROC)曲线评价该模型的预测效能。结果374例下肢动脉硬化闭塞病人介入术后3个月内,DVT并发率为9.63%(36/374);并发DVT组年龄≥60岁占比、完全闭塞占比、术后卧床时间≥3 d占比及总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDLC)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数(PLT)均高于未并发DVT组[69.44%(25/36)比50.59%(171/338)、41.67%(15/36)比25.44%(86/338)、58.33%(21/36)比22.19%(75/338)、(4.96±1.02)mmol/L比(4.63±0.94)mmol/L、(2.09±0.26)mmol/L比(1.81±0.31)mmol/L、(3.65±0.54)mmol/L比(3.47±0.51)mmol/L、(3.45±0.62)g/L比(3.11±0.54)g/L、(0.67±0.11)mg/L比(0.38±0.06)mg/L、(246.85±42.74)×10^(9)/L比(205.16±39.68)×10^(9)/L](P<0.05),凝血酶时间(TT)低于未并发DVT组[(15.16±3.11)s比(16.33±3.14)s](P<0.05);多因素logistic回归分析结果显示年龄≥60岁、术后卧床时间≥3 d、TG、FIB、D-D、PLT均是下肢动脉硬化闭塞介入术后并发DVT的危险因素(P<0.05);基于多因素logistic回归分析结果而构建下肢动脉硬化闭塞介入术后并发DVT的风险预测列线图模型,其校正曲线结果显示标准曲线与校准预测曲线具有良好的贴合度;该模型C-index为0.88(0.81~0.89),ROC曲线下面积为0.85[95%CI:(0.78,0.91),Z=9.54,P<0.001]。结论基于年龄、术后卧床时间、TG、FIB、D-D、PLT构建的下肢动脉硬化闭塞病人介入术后并发DVT风险预测列线图模型具有较好的预测能力与区分能力,对临床筛选高风险人群具有较高的指导价值。

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。

回阳通脉汤治疗寒湿阻络型下肢动脉粥样硬化闭塞症的临床研究

目的:探讨回阳通脉汤治疗寒湿阻络型下肢动脉粥样硬化闭塞症(LEASO)的临床疗效。方法:将80例脾肾阳虚的LEASO患者按照随机数字表法分为两组,对照组给予贝前列素钠口服(40μg,3次/d),治疗组在对照组基础上联合回阳通脉汤加减治疗,以3个月为观察终点。比较两组患者中医证候评分,血液内皮素-1(ET-1)、一氧化氮(NO)水平,踝肱指数(ABI),经皮氧分压(TcPO_(2))及足背动脉血流动力学指标。结果:治疗组临床总有效率(90.00%)高于对照组(75.00%,P<0.05),两组患者治疗后中医证候各项评分均较治疗前降低(P<0.05),且治疗组优于对照组(P<0.05);两组患者治疗后ET-1水平均较治疗前降低(P<0.05),且治疗组优于对照组(P<0.05);两组患者治疗后NO水平、ABI、TcPO_(2)、足背动脉血流动力学指标均升高(P<0.05),且治疗组优于对照组(P<0.05)。结论:回阳通脉汤干预寒湿阻络型LEASO能够减轻患者缺血肢体症状,缓解间歇性跛行,提高ABI及TcPO_(2),改善足部血供。