药物涂层球囊扩张术治疗膝下动脉粥样硬化病变的疗效及无复流现象  

Efficacy and the no-reflow phenomenon of drug-coated balloon dilatation in the treatment of below-knee lesions

作　　者：司鹏宇 王浙宇 杨硕菲[1] 郭相江[1] 倪其泓[1] 陈佳佺[1] 叶猛[1] 张岚[1] 薛冠华[1] Si Pengyu;Wang Zheyu;Yang Shuofei;Guo Xiangjiang;Ni Qihong;Chen Jiaquan;Ye Meng;Zhang Lan;Xue Guanhua(Department of Vascular Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院血管外科,上海200127

出　　处：《血管与腔内血管外科杂志》2022年第6期645-650,M0002,共7页Journal of Vascular and Endovascular Surgery

基　　金：国家自然科学基金资助项目(81873526)。

摘　　要：目的探讨药物涂层球囊扩张术(DCBA)治疗膝下动脉粥样硬化病变的疗效、安全性及无复流现象发生情况。方法收集2018年5月至2020年9月上海交通大学医学院附属仁济医院收治的98例膝下动脉粥样硬化病变患者的临床资料,根据治疗方法的不同将其分为DCBA组(n=48)和普通球囊扩张术(POBA)组(n=50)。比较两组患者术后安全性指标、有效性指标、术中及术后并发症发生情况,观察无复流现象发生情况,并分析发生无复流现象的危险因素、血小板计数(PLT)、D-二聚体(D-D)水平、凝血功能指标。结果DCBA组患者的球囊直径大于POBA组患者,差异有统计学意义(P<0.05)。两组患者球囊长度比较,差异无统计学意义(P>0.05)。术后3个月,两组患者安全性指标比较,差异均无统计学意义(P>0.05)。生存曲线分析结果显示,术后6、12、24个月DCBA组患者免于临床驱动的靶病变血运重建(CD-TLR)率分别为0.908、0.908、0.718,均高于POBA组患者的0.834、0.713、0.469,差异均有统计学意义(P<0.05)。术后,两组患者ABI均高于本组术前,差异均有统计学意义(P<0.05);但两组患者术后ABI比较,差异无统计学意义(P>0.05)。DCBA组术后出现无复流现象患者5例(慢/无复流组),未出现无复流现象患者43例(正常血流组),慢/无复流组与正常血流组患者冠心病发生率比较,差异有统计学意义(P<0.05);慢/无复流组与正常血流组患者其他危险因素、PLT、D-D水平、凝血功能指标比较,差异均无统计学意义(P>0.05)。结论DCBA治疗膝下动脉粥样硬化病变安全有效,且无复流现象未造成不良临床结果,值得临床推广应用。Objective To investigate the efficacy, safety, and occurrence of the no-reflow phenomenon of drugcoated balloon angioplasty(DCBA) in the treatment of below-the-knee atherosclerotic lesions. Method The clinical data of 98 patients with below-knee atherosclerotic lesions admitted to Renji Hospital, Shanghai Jiaotong University School of Medicine from May 2018 to September 2020 were collected. They were divided into DCBA group(n=48)and plain old balloon angioplasty(POBA) group(n=50) according to different treatment methods. The postoperative safety indicators, efficacy indicators, and intraoperative and postoperative complications were compared between the two groups. The occurrence of the no-reflow phenomenon was observed. The risk factors for the no-reflow phenomenon, platelet count(PLT), D-dimer(D-D) level, and coagulation function indexes were also analyzed. Result The balloon diameter of the DCBA group was larger than that of the POBA group, and the difference was statistically significant(P<0.05). There was no significant difference in balloon length between the two groups(P>0.05). At 3months after the operation, there was no significant difference in the safety indicators between the two groups(P>0.05). The results of the survival curve analysis indicated that the free clinically driven-target lesion revascularization(CD-TLR) rates at 6, 12, and 24 months in the DCBA group were 0.908, 0.908, and 0.718, respectively, which were higher than those in the POBA group of 0.834, 0.713, and 0.469, the differences were statistically significant(P<0.05). After the operation, the ABI of the two groups was higher than that before the operation in the same group,and the differences were statistically significant(P<0.05). There were 5 patients with no-reflow phenomenon after the operation in the DCBA group(slow/no-reflow group), and 43 patients without(normal blood flow group). There was a statistically significant difference in the incidence of coronary heart disease between the slow/no-reflow group and the normal blood f

关 键 词：药物涂层球囊 动脉粥样硬化 膝下病变 无复流现象 

分 类 号：R543[医药卫生—心血管疾病]