糖尿病患者膝下流出道病变程度与股腘动脉支架通畅率的相关性研究  

Study on the relationship between the extent of runoff lesions under the knee and the patency of femoropopliteal artery stent in patients with diabetes

作　　者：高明杰[1] 华扬[1] 赵新宇[1] 侯伟红[1] 王力力[1] 凌晨[1] Gao Mingjie;Hua Yang;Zhao Xinyu;Hou Weihong;Wang Lili;Ling Chen(Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053

出　　处：《中华超声影像学杂志》2020年第2期153-157,共5页Chinese Journal of Ultrasonography

基　　金：北京市属医院科研培育计划项目(PX2018032)。

摘　　要：目的观察糖尿病患者膝下流出道动脉病变程度对股腘动脉支架置入术通畅率的影响。方法回顾性连续纳入首都医科大学宣武医院2016年1月至2018年7月期间行单侧股腘动脉支架置入术的糖尿病患者127例(127条患肢),记录动脉硬化危险因素,通过彩色多普勒超声(CDU)评价股腘动脉及膝下流出道(胫前动脉、胫后动脉、腓动脉)病变,依据北美血管外科协会(SVS)标准对膝下流出道病变评分。CDU随访并通过Kaplan-Meier法计算术后3个月、6个月、12个月、24个月的支架通畅率,应用Cox回归分析影响预后的危险因素。结果随访时间1~24个月,术后3个月、6个月、12个月、24个月的总体通畅率分别为91.5%、70.9%、45.7%、31.7%。术后流出道评分及分布:1~3分45条,3.5~5分37条,5.5~7分34条,7.5~10分11条,中位数为4分。根据流出道评分将患者分为评分≤4分与>4分两组,两组间通畅率差异有统计学意义(χ^2=10.825,P=0.001)。Cox回归分析发现,术后高流出道评分是支架通畅率的独立危险因素(RR=1.155,P=0.006,95%CI:1.042~1.281)。结论股腘动脉流出道条件差是影响糖尿病患者支架置入术预后的主要危险因素,超声定期随访对评价及预测疗效具有重要的临床价值。Objective To evaluate the impact of runoff score on the patency of femoropopliteal artery(FPA)stent in patients with type 2 diabetes mellitus with ultrasonography.Methods A retrospective review of a database of 127 patients with type 2 diabetes mellitus(127 limbs)undergoing femoropopliteal stents in Xuanwu Hospital from January 2016 to July 2018 was made.Demographic characteristics and possible related risk factors were recorded.The extent of FPA disease and the runoff lesions below the knee(anterior tibial artery,posterior tibial artery,and peroneal artery)were preoperative evaluated and regular followed-up by color Doppler ultrasonography(CDU).Femoropopliteal artery lesions were graded according to the Trans-Atlantic Inter-Society Consensus(TASCII),and the runoff lesions below the knee were scored according to the Society for Vascular Surgery(SVS).The patency and the predictors for in-stent restenosis were assessed using a Kaplan-Meier and Cox proportional hazards model.Results Follow up period ranged from 1 month to 24 months.The total patency rates at the 3,6,12,24 months were 91.5%,70.9%,45.7%and 31.7%,respectively.Post-procedural runoff score according to SVS criteria:1-3 scores in 45 limbs,3.5-5 scores in 37 limbs,5.5-7 scores in 34 limbs,7.5-10 scores in 11 limbs.The median runoff score was 4.Patients were stratified according to runoff scores(score≤4 and>4 groups),and the difference of the patency rates between the two groups was statistically significant by Kaplan-Meier analysis and Log-rank test(χ^2=10.825,P=0.001).The runoff score affected patency significantly on COX analysis(RR=1.155,P=0.006,95%CI:1.042-1.281).Conclusions Compromised runoff negatively affects the patency of FPA stent.High post-procedural runoff score is a main risk factor related to loss of patency.CDU is a reliable method for monitoring patients with femoropopliteal stenting.

关 键 词：超声检查 糖尿病 股腘动脉 流出道评分 支架置入术 

分 类 号：R587[医药卫生—内分泌]