下肢闭塞性动脉硬化合并颈动脉粥样硬化性狭窄的影响因素分析及治疗策略  

Analysis of influencing factors and treatment strategies of lower extremity arteriosclerotic obliterans combined with carotid atherosclerotic stenosis

作　　者：申嘉陵 张铖 刘润禹 张雷 刘勇 何延政 孙晓磊 Shen Jialing;Zhang Cheng;Liu Runyu;Zhang Lei;Liu Yong;He Yanzheng(Sun Xiaolei11 Department of Vascular Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China;Director Office,the Health Commission of Sichuan Province,C hengdu 610041,Sichuan,China)

机构地区：[1]西南医科大学附属医院血管外科,四川泸州646000 [2]四川省卫生健康委员会主任办公室,四川成都610041

出　　处：《血管与腔内血管外科杂志》2021年第7期821-825,830,共6页Journal of Vascular and Endovascular Surgery

基　　金：四川省卫生计化生育委员会课题普及应用项目(18ZD019);四川省科技厅科技计划项目(2018JY0400);泸州-西南医科大学科技战略合作项目(2017LZXNYD-J19);西南医科大学附属医院科研课题(17124);核医学与分子影像四川省重点实验室开放课题(HYX19007);四川省心血管疾病防治协同创新中心项目(xtcx2019-20);医学电生理学重点实验室(西南医科大学)开放基金项目(KeyME-2018-04)。

摘　　要：目的探讨下肢闭塞性动脉硬化(ASO)合并颈动脉粥样硬化性狭窄的影响因素及治疗策略。方法收集2019年1月至2021年1月西南医科大学附属医院就诊的302例下肢ASO患者临床资料。根据颈动脉粥样硬化性狭窄情况分为颈动脉狭窄(n=211)和非颈动脉狭窄(n=91);根据踝肱指数(ABI)分为轻度异常(n=20)、中度异常(n=132)和重度异常(n=150)。统计患者临床资料、颈动脉影像学资料、治疗方法和围手术期脑血管不良事件发生率等。ASO合并颈动脉粥样硬化性狭窄的影响因素采用Logistic回归分析。结果轻度异常ASO患者合并糖尿病发生率为40.00%,低于中度异常和重度异常ASO患者合并糖尿病发生率的70.45%和74.00%,差异有统计学意义(P<0.05);重度异常ASO患者ABI最低(P<0.01)。合并糖尿病、冠心病、高脂血症及ABI<0.7是ASO合并颈动脉粥样硬化性狭窄的独立危险因素(P<0.05)。151例症状性颈动脉狭窄患者中,101例行颈动脉内膜剥脱术(CEA)或颈动脉支架成形术(CAS)治疗,再2期治疗ASO,围手术期脑梗死发生率0.99%;50例仅治疗ASO,围手术期脑梗死发生率8.00%,脑梗死发生率比较,差异有统计学意义(P<0.05)。结论积极预防和控制ASO合并颈动脉粥样性狭窄的相关危险因素,可以减缓颈动脉粥样硬化的进展,减少脑梗死事件发生。同时应根据患者颈动脉狭窄程度及相关风险合理选择治疗方案。Objective To analysis of influencing factors and treatment strategies of lower extremity arteriosclerotic obliterans(ASO)combined with carotid atherosclerotic stenosis.Method A total 302 patients with lower extremity ASO from January 2019 to January 2021 in Affiliated Hospital of Southwest Medical University were enrolled.According to the degree of carotid atherosclerotic stenosis,there were divided into carotid artery stenosis(n=211)and non-carotid artery stenosis(n=91).According to the ankle brachial index(ABI),the severity of lower extremity ASO was divided into mild abnormality(n=20),moderate abnormality(n=132),and severe abnormality(n=150).Clinical data,carotid artery imaging data,treatment methods and the incidence of cerebrovascular adverse events during perioperative period were analyzed.The influencing factors of ASO combined with carotid atherosclerotic stenosis were analyzed by Logistic regression.Result The incidence of mildly abnormal ASO patients combined with diabetes was 40.00%,which was lower than that of moderately abnormal and severely abnormal ASO patients combined with diabetes(70.45%and 74.00%)(P<0.05).The patients with severe abnormal ASO had the lowest ABI(P<0.01).Diabetes,coronary heart disease,hyperlipidemia and ABI<0.7 were independent risk factors for ASO combined with carotid atherosclerotic stenosis.Among the 151 patients with symptomatic carotid stenosis,101 cases were treated with carotid endarterectomy(CEA)or carotid artery stenting(CAS)first,and the incidence of perioperative cerebral infarction was 0.99%.50 cases were only treated with ASO.The incidence of perioperative infarction was 8.00%.Comparing the incidence of cerebral infarction,the difference was statistically significant(P<0.05).Conclusion Actively preventing and controlling the related risk factors of ASO combined with carotid atherosclerotic stenosis can reduce the progression of carotid atherosclerosis and the occurrence of stroke events,and scientific and personal strategy should be made up to the degree of carotid

关 键 词：糖尿病 闭塞性动脉硬化 动脉粥样硬化 狭窄 脑卒中 

分 类 号：R543[医药卫生—心血管疾病]