下肢动脉硬化闭塞症支架植入术后支架内再狭窄的危险因素分析  

Analysis of risk factors for in-stent restenosis after stent implantation in lower extremity arteriosclerosis obliterans

作　　者：张文洁 张曼 林孟如 曲莹莹 贾伟 Zhang Wenjie;Zhang Man;Lin Mengru;Qu Yingying;Jia Wei(Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院血管外科,北京100035

出　　处：《血管与腔内血管外科杂志》2024年第12期1423-1427,1442,共6页Journal of Vascular and Endovascular Surgery

基　　金：首都卫生发展科研专项(首发2024-2-2079)。

摘　　要：目的探讨下肢动脉硬化闭塞症支架植入术后随访期间发生支架内再狭窄的危险因素。方法收集2019年2月至2022年12月于首都医科大学附属北京积水潭医院进行支架植入术的197例下肢动脉硬化闭塞症患者的临床资料,根据术后随访期间(术后1年内)支架内再狭窄发生情况的不同将患者分为再狭窄组(n=36)和对照组(n=161)。比较两组患者的临床特征、支架植入术和术后管理情况,分析下肢动脉硬化闭塞症支架植入术后随访期间发生支架内再狭窄的危险因素。结果再狭窄组患者年龄≥65岁、长期大量吸烟、糖尿病、术前C反应蛋白水平﹥5 mg/L及支架数量≥2个的比例均高于对照组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,老年(年龄≥65岁)、长期大量吸烟、糖尿病、术前C反应蛋白水平升高(﹥5 mg/L)、植入多个支架(≥2个)均是下肢动脉硬化闭塞症支架植入术后随访期间发生支架内再狭窄的独立危险因素(P﹤0.05)。结论下肢动脉硬化闭塞症支架植入术后随访期间支架内再狭窄的发生率较高,与老年、长期大量吸烟、糖尿病、术前C反应蛋白水平升高以及植入多个支架均有关,临床应根据这些危险因素及时识别高危患者,强化治疗并定期复诊。Objective To explore the risk factors of in-stent restenosis during follow-up after stent implantation for lower extremity arteriosclerosis obliterans.Method The clinical data of 197 patients with lower extremity arteriosclerosis obliterans who underwent stent implantation at Beijing Jishuitan Hospital,Capital Medical University from February 2019 to December 2022 were collected.The patients were divided into restenosis group(n=36)and control group(n=161)based on the occurrence of in-stent restenosis during the postoperative follow-up period(within 1 year after surgery).The clinical characteristics,stent implantation procedures,and postoperative management of two groups of patients were compared,and the risk factors for in-stent restenosis during follow-up after stent implantation for lower extremity arteriosclerosis obliterans were analyzed.Result In the restenosis group,the proportion of patients with age≥65 years old,long-term heavy smoking,diabetes mellitus,preoperative C-reactive protein>5 mg/L and stent number≥2 were significantly higher than those in the control group(P<0.05).The results of multivariate analysis showed that the elderly age(age≥65 years old),long-term heavy smoking,diabetes mellitus,preoperative C-reactive protein elevation(>5 mg/L),and implantation of multiple stents(stent number≥2)were independent risk factors for in-stent restenosis during follow-up after stent implantation for lower extremity arteriosclerosis obliterans(P<0.05).Conclusion The rate of in-stent restenosis during follow-up after stent implantation is high in patients with lower extremity arteriosclerosis obliterans,with the elderly,long-term heavy smoking,diabetes mellitus,preoperative C-reactive protein elevation and implantation of multiple stents,the high-risk patients should be identified in time based on these risk factors,,and these patients need to receive intensive treatment and regular follow-up.

关 键 词：下肢动脉硬化闭塞症 支架植入术 支架内再狭窄 危险因素 

分 类 号：R543[医药卫生—心血管疾病]