巴曲酶联合阿司匹林预防糖尿病下肢缺血病变介入术后再狭窄的疗效分析  

Application of batroxobin plus aspirin in preventing post-intervention re-stenosis in patients with diabetic lower-limb ischemia:analysis of therapeutic effects

作　　者：李菁[1] 王珏[1] 朱悦琦[1] 张培蕾[1] 

机构地区：[1]上海交通大学附属第六人民医院介入影像科,200233

出　　处：《介入放射学杂志》2014年第10期865-869,共5页Journal of Interventional Radiology

摘　　要：目的探讨巴曲酶联合阿司匹林预防糖尿病下肢缺血病变介入术后再狭窄的疗效。方法110例症状性血管闭塞的糖尿病患者随机分为实验组50例和对照组60例。实验组患者接受阿司匹林(100 mg/d)联合巴曲酶治疗(5 u/d×6次,隔天应用),对照组单独应用阿司匹林。以12个月为随访终点,通过下肢磁共振血管成像(MRA)或者血管超声来评估血管再狭窄或者再闭塞的情况。统计踝以上截肢、死亡人数,以及截肢或死亡累积发生率,运用Kaplan-Meier生存曲线来评估保肢率和存活率。结果 12个月后,实验组再狭窄发生率为28.9%,对照组为42.8%(P=0.002)。MRA及血管超声显示膝下动脉(P=0.003)和长度>10 cm(P=0.001)再狭窄发生率高。Kaplan-Meier生存曲线显示血管成形术12个月后,对照组和实验组保肢/存活率分别为78.2%和93.5%(log-rank检验,P=0.032 4)。结论巴曲酶联合阿司匹林可以有效减少血管成形术后再狭窄发生率,尤其针对膝下病变>10 cm者,有着更好的临床疗效,并且可以提高患者的肢体挽救率。Objective To assess the clinical value of batroxobin plus aspirin therapy in reducing the incidence of arterial re-stenosis or re-occlusion in diabetic patients with lower-limb ischemia after receiving angioplasty. Methods A total of 110 diabetic patients with symptomatic arterial obstructions were randomly divided into study group （n=50） and control group （n=60）. Aspirin 100 mg/d plus batroxobin 5 IU every other day for six times was used in patients of the study group, while only aspirin 100 mg/d was used in patients of the control group. The follow-up finishing point was the end of 12 months. The arterial re-stenosis or re-occlusion was evaluated with magnetic resonance angiography （MRA） and/or vascular sonography. Amputation above the ankle, death, and the cumulative rate of amputation or death were determined, and the limb salvage and survival rates were assessed by using Kaplan-Meier analysis method. Results Twelve months after the treatment, the occurrence of restenosis in the study group and the control groups was 42.8%and 28.9% respectively （P = 0.002）. MR angiography and color- duplex sonography revealed that the restenosis occurrence was much higher in infrapopliteal artery （P = 0.003） and in longer （length 〉 10 cm） diseased artery （P = 0.001）. Twelve months after angioplasty Kaplan-Meier analysis showed that the limb salvage-survival rates of the study group and the control group were 78.2%and 93.5%respectively （log-rank test, P = 0.032 4）. Conclusion Combination use of batroxobin and aspirin can effectively reduce the occurrence of restenosis after arterial angioplasty, and the clinical effect is particularly better for the artery distal to the knee and the artery with longer lesion （length 〉 10 cm）, besides this treatment can also improve limb salvage rate.

关 键 词：巴曲酶 阿司匹林 血管成形术 再狭窄 

分 类 号：R587.2[医药卫生—内分泌]