下肢动脉硬化闭塞症介入治疗效果及其影响因素分析  

Long-term role of endovascular intervention in patients with peripheral arterial disease and its influencing factors

作　　者：李英莎[1] 赵志钢[1] 何洪波[1] 倪银星[1] 孙芳[1] 钟健[1] 孙倩倩[1] 胡勤锦[1] 闫振成[1] 祝之明[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所高血压内分泌科、全军高血压代谢病中心、重庆市高血压研究所,重庆400042

出　　处：《第三军医大学学报》2013年第8期789-792,共4页Journal of Third Military Medical University

基　　金：国家重点基础研究发展计划(973计划,2012CB517805);国家自然科学基金重点项目(81130006)~~

摘　　要：目的通过比较下肢动脉硬化闭塞症患者行介入治疗及保守治疗的截肢率、死亡率等差异,分析介入治疗效果及其影响因素。方法入选2007年11月至2012年6月于我科住院的251例下肢动脉硬化闭塞症患者,分为介入治疗组(n=94)和常规治疗组(n=157),常规治疗组行药物治疗,介入治疗组在常规药物治疗基础上行下肢动脉球囊扩张和/或支架植入术。随访脑梗死、脑出血、急性心血管事件发生率、截肢率及病死率。于出院后1、3、6个月、1、2年检测踝肱指数(ABI)、血压、血糖、糖化血红蛋白、血脂、血肌酐、高敏-C反应蛋白(hs-CRP)。结果常规治疗组病死率、截肢率、脑梗死发生率显著高于介入治疗组(17.20%vs 7.45%,P<0.05;9.55%vs 3.19%,P<0.05;10.83%vs 3.19%,P<0.05)。介入治疗组术前ABI为0.62±0.25,术后3 d、1、3、6个月ABI显著高于术前(分别为0.88±0.19、0.90±0.11、0.82±0.23、0.79±0.20;P<0.01,P<0.05),而常规治疗组ABI呈现继续下降趋势。进一步对相关危险因素行Logistic回归分析,结果显示年龄是影响术后疗效的危险因素(r=0.892,P=0.037),而hs-CRP是影响术后再狭窄发生率的危险因素(r=2.096,P=0.035)。结论下肢介入治疗能有效改善下肢动脉硬化闭塞症患者下肢血供,降低脑梗死发生率、截肢率及病死率。年龄越大,手术效果越差,术前hs-CRP越高,术后发生再狭窄的危险越大。Objective To compare the incidence of major amputation and mortality in patients with peripheral arterial disease who were given interventional therapy or conservative treatment,and to evaluate the efficacy of interventional therapy and its influencing factors.Methods We enrolled 251 in-patients with diagnosed peripheral arterial disease from November 2007 to June 2012 in Daping Hospital,Chongqing.Ninety-four patients had a lower extremity arterial balloon dilatation and/or stent implantation,while another 157 patients referred to conservative treatment.All the patients were followed up for mortality and the incidence of cerebral infarction,coronary heart disease and amputation.Ankle-brachial index（ABI）,blood pressure,blood glucose,glycosylated hemoglobin,blood lipids,serum creatinine,and high-sensitivity C-reactive protein（hs-CRP） were measured in 3 d,1,3 and 6 months,and 1,2 years after interventional therapy.Results The two groups showed significant differences in mortality,the incidence of amputation and cerebral infarction（17.20% vs 7.45%,9.55% vs 3.19% and 10.83% vs 3.19%,P0.05）.The average ABI in the interventional therapy group,which was 0.62±0.25 before operation,showed significant decrease on 3 d,and 1,3,and 6 months after operation（0.88±0.19,0.90±0.11,0.82±0.23 and 0.79±0.20,P0.01,P0.05）.The results of Logistic regression analysis showed that age was an independent risk factor for the validity of the interventional therapy（r=0.892,P=0.037）,while hs-CRP was an independent risk factor for the rate of restenosis（r=2.096,P=0.035）.Conclusion Lower limb interventional therapy can effectively improve lower limb blood supply in patients with peripheral arterial disease,and decrease the mortality and the incidence of amputation and cerebral infarction.The elder patients may have worse outcome.A high hs-CRP level indicates a high risk of restenosis.

关 键 词：外周血管病 介入治疗 疗效 影响因素 

分 类 号：R540.46[医药卫生—心血管疾病] R543.5[医药卫生—内科学]