2型糖尿病患者下肢血管病变介入治疗远期再狭窄及影响因素分析  

Interventional therapy for lower extremity vascular diseases in type 2 diabetic patients: long-term vascular restenosis and risk factors

作　　者：贾梦潇 李强[1] 何洪波[1] 赵志钢[1] 张和轩[1] 李英莎[1] 孙芳[1] 祝之明[1] 闫振成[1] JIA Mengxiao;LI Qiang;HE Hongbo;ZHAO Zhigang;ZHANG Hexuan;LI Yingsha;SUN Fang;ZHU Zhiming;YAN Zhencheng(Department of Hypertension and Endocrinology,Center for Hypertension and Metabolic Diseases,Chongqing Institute of Hypertension,Daping Hospital,Army Medical University(Third Military Medical University)Chongqing,400042,China)

机构地区：[1]陆军军医大学(第三军医大学)大坪医院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

出　　处：《第三军医大学学报》2020年第2期162-167,共6页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81870614)~~

摘　　要：目的探讨2型糖尿病患者下肢血管病变不同部位介入治疗远期再狭窄率及影响因素。方法入选2008年1月至2018年3月我科收治随访1年以上且资料完整的糖尿病下肢血管病变患者138例(154条患肢),根据下肢动脉数字血管造影检查(DSA)明确介入治疗方式,采用下肢动脉球囊扩张和/或支架植入术进行治疗。观察手术成功率、症状改善、踝肱指数(ABI)、趾肱指数(TBI)、再狭窄率等,分别于术后3 d,1、3、6个月、1年检测糖化血红蛋白(HbA1c)、肝功、肾功、血脂、高敏C反应蛋白(hs-CRP),部分患者行CTA或彩超检测下肢血管。结果 138例患者共154条患肢行介入治疗。术后HDL-C、LDL-C、hs-CRP、HbA1c均较术前明显改善(P<0.05)。术后1、 3、 6个月、1年ABI及TBI显著高于术前(P<0.05 or P<0.01)。术后1、 3、 6个月、1年总再狭窄率分别为17.6%、17.8%、20%、20.9%。其中,膝上组术后1、 3、 6个月、1年再狭窄率分别为8.3%、7.7%、5.6%、23.1%;膝下组术后1、 3、 6个月、1年再狭窄率分别为37.5%、30%、37.5%、30.8%;混合组术后1、 3、 6个月、1年再狭窄率分别为7.9%、15.0%、14.0%、10.7%。多因素Logistic回归分析提示,术前TC是影响手术疗效的危险因素(R=0.356,P=0.026),术前HbA1c是影响术后再狭窄发生率的危险因素(R=1.348,P=0.040)。在膝下组中,未狭窄组较再狭窄组术后TC、LDL-C下降更为明显。结论糖尿病下肢血管介入治疗使患者下肢血管灌注得到明显改善。手术部位不同,再狭窄存在差异,膝下组术后再狭窄率显著高于膝上组和混合组。控制血糖、血脂等代谢指标有助于提高手术疗效、降低术后再狭窄率。Objective To evaluate the rate of vascular restenosis following interventional therapy for lower extremity vascular disease and the factors contributing to its occurrence in type 2 diabetic patients. Methods We collected the data from 138 diabetic patients with lower extremity arterial disease(involving 154 limbs) undergoing interventional therapy in our department between January, 2008 and March, 2018. The patients received balloon dilatation and/or stent implantation according to the findings by digital angiography(DSA) of the lower extremity arteries. All the patients were followed up for more than 1 year to assess the surgical success rate, symptom improvement, ankle brachial index(ABI), toe brachial index(TBI), and restenosis rate. Glycosylated hemoglobin(HbA1 c) level, liver function, renal function, blood lipids, and high-sensitivity C-reactive protein(hs-CRP) level were measured at 3 days and 1, 3, 6 and 12 months after the interventional therapy. Some of the patients underwent computed tomographic angiography(CTA) or ultrasound examination for assessment of the lower extremity blood vessels. Results The abnormalities in HDL-C, LDL-C, hs-CRP, and HbA1 c levels were significantly improved in these patients after interventional therapy(P<0.05). At 1, 3, 6, and 12 months after the operation, the ABI and TBI showed significant improvements(P<0.05 or 0.01) and the restenosis rates were 17.6%, 17.8%, 20%, and 20.9% in these patients, respectively. In patients with diseased vessels above the knee, the restenosis rate was 8.3%, 7.7%, 5.6%, and 23.1% at 1, 3, 6 and 12 months after the operation, respectively, as compared with 37.5%, 30%, 37.5%, and 30.8% in patients with diseased vessels below the knee and with 7.9%, 15%, 14.0%, 10.7% in those with diseased vessels both below and above the knee. Multivariate logistic regression analysis suggested that preoperative total cholesterol(TC) level was a risk factor that affected the outcome of interventional therapy(R=0.356, P=0.026), and preoperative HbA1 c was a risk

关 键 词：2型糖尿病 下肢动脉粥样硬化性病变 介入治疗 再狭窄 影响因素 

分 类 号：R181.32[医药卫生—流行病学] R543.5[医药卫生—公共卫生与预防医学]