纤维蛋白原水平、踝肱指数与外周血管支架治疗下肢动脉硬化闭塞症后再狭窄的关系  

Relationship of fibrinogen levels and ankle-brachial index with in-stent restenosis after peripheral vascular stenting for lower extremity arterial occlusive disease

作　　者：赵峰[1] 邓默[2] Feng Zhao;Mo Deng(Department of Interventional Vascular Surgery,Affiliated Hospital of Hebei University,Baoding 071000,China;Department of Anesthesiology,Affiliated Hospital of Hebei University,Baoding 071000,China)

机构地区：[1]河北大学附属医院介入血管外科,河北保定071000 [2]河北大学附属医院麻醉科,河北保定071000

出　　处：《中华临床医师杂志（电子版）》2024年第2期144-151,共8页Chinese Journal of Clinicians(Electronic Edition)

基　　金：河北省2023年度医学科学研究课题计划(20231475)。

摘　　要：目的探究影响外周血管支架治疗下下肢动脉硬化闭塞症(LEASO)后发生支架内再狭窄(ISR)的危险因素,分析纤维蛋白原(FIB)水平、踝肱指数(ABI)与ISR的关系。方法选取2021年1月~2022年10月于河北大学附属医院就诊的LEASO患者121例,根据术后ISR是否发生将患者分为ISR组(n=48)和非ISR组(n=73)2组。采用受试者工作特征(ROC)曲线评价模型区分度并确定FIB和ABI的最佳切点,采用Kaplan-Meier生存分析模型分析分别以ABI、FIB最佳切点评价组间ISR发生率,并采用log-rank检验评价组间差异。构建多因素Logistic回归模型,通过调整混杂因素分别分析ABI、FIB对ISR的独立预测价值,构建非条件多因素Logistic回归模型分析ISR危险因素。构建ISR预测模型,Hosmer-Lemeshow检验模型的准确性;利用相加模型和相乘模型分析ABI与FIB的交互作用类型。结果调整混杂因素前和调整混杂因素后不论ABI、FIB作为名义变量还是连续变量高水平的FIB和低水平ABI是ISR独立风险预测因素(P<0.05),ROC曲线确定FIB和ABI的最佳切点,分别统计高水平FIB患者和低水平ABI患者ISR发生率(38.89%,48.08%),较低水平FIB患者和高水平ABI患者(18.52%,17.31%)明显升高(P<0.05)。ABI、白蛋白为ISR风险预测保护因素(P<0.05)。C反应蛋白(CRP)、C反应蛋白/白蛋白比值(CAR)、FIB、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)为危险因素(P<0.05)。构建的预测模型经Hosmer-Lemeshow检验和ROC曲线校验后显示准确度和区分度均较高,当P值切点为0.65时,预测一致率达到最高,认为当P值大于0.65时,该患者被判定ISR患者;而P值小于或等于0.65的患者,被判定为非ISR患者。模型的准确性检验结果显示一致率为81.82%,误判率为18.18%。FIB与ABI具有相加交互效应,当ABI<0.69与FIB≥3.41时提示ISR发生风险升高(OR=2.413,95%CI:1.345~2.890,P<0.05)。结论ABI、白蛋白是预测ISR风险的保护因素,CRP、CAR、FIB�Objective To identify the risk factors for in-stent restenosis(ISR)after peripheral vascular stenting for lower extremity arterial occlusive disease(LEASO),and to analyze the relationship of fibrinogen(FIB)level and ankle-brachial index(ABI)with ISR.Methods A total of 121 LEASO patients who were treated at the Affiliated Hospital of Hebei University from January 2021 to October 2022 were selected and divided into either an ISR group(n=48)or a non-ISR group(n=73)according to the occurrence of ISR or not after the procedure.Receiver operating characteristic(ROC)curve analysis was performed to determine the optimal cut-off points for FIB and ABI.Kaplan-Meier survival analysis was perform to analyze the ISR incidence rates between the two groups based on the optimal cut-off points for ABI and FIB,and the log-rank test was used to evaluate the differences between the groups.A multivariable logistic regression model was constructed to assess the independent predictive value of ABI and FIB for ISR by adjusting for confounding factors.The Hosmer-Lemeshow test was conducted to assess the accuracy of the ISR prediction model.The interaction types between ABI and FIB were analyzed using both additive and multiplicative models.Results Before and after adjusting for confounding factors,both high levels of FIB and low levels of ABI were independent risk predictors of ISR(P<0.05).ROC curve analysis identified the optimal cut-off points for FIB and ABI,and the incidence rates of ISR were significantly higher in patients with high FIB(38.89%)and low ABI(48.08%),compared to those with low FIB(18.52%)and high ABI(17.31%)(P<0.05).ABI and albumin were identified as protective factors for ISR(P<0.05),while C-reactive protein(CRP),CRP/albumin ratio(CAR),FIB,neutrophil-to-lymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR)were identified as risk factors(P<0.05).The constructed prediction model showed high accuracy and discriminative ability according to the Hosmer-Lemeshow test and ROC curve validation.When the P value threshold

关 键 词：纤维蛋白原 踝肱指数 下肢动脉硬化闭塞症 外周血管支架治疗 支架内再狭窄 

分 类 号：R541.4[医药卫生—心血管疾病]