DCBA与POBA治疗孤立性腘动脉CTO的短期效果及术后一期通畅的影响因素  

Comparison of short-term efficacy of drug-coated balloon angioplasty and plain old balloon angioplasty in the treatment of isolated popliteal artery chronic total occlusion and the influencing factors of primary patency rate

作　　者：杜旭 杜和坤 杨秀林 李双男 聂中林 余朝文 卢冉 Du Xu;Du Hekun;Yang Xiulin;Li Shuangnan;Nie Zhonglin;Yu Chaowen;Lu Ran(Department of Vascular Surgery,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233000,China)

机构地区：[1]蚌埠医科大学第一附属医院血管外科,蚌埠233000

出　　处：《中国综合临床》2025年第2期140-146,共7页Clinical Medicine of China

基　　金：安徽省教育厅科学研究项目(2022AH051422)。

摘　　要：目的探讨药物涂层球囊血管成形术(drug coated balloon angioplasty,DCBA)与普通球囊血管成形术(plain old balloon angioplasty,POBA)治疗孤立性腘动脉慢性完全闭塞病变(chronic total occlusion,CTO)的短期效果,分析其术后一期通畅的影响因素。方法本研究采用回顾性队列研究方法。选取蚌埠医科大学第一附属医院2020年1月至2022年6月收治的孤立性腘动脉CTO患者42例,根据其应用的球囊不同分为两组,其中行POBA 24例(POBA组),行DCBA 18例(DCBA组)。比较两组患者术后12个月的靶病变累积一期通畅率、累积免于临床驱动靶病变重建(clinically-driven target lesion revascularization,CD-TLR)率、截肢和截趾率,以及术后6、12个月踝-肱指数(ankle-brachial index,ABI)和Rutherford分级的改善情况,分析孤立性腘动脉CTO患者血管成形术后12个月一期通畅的影响因素。计量资料以x¯±s表示,两组间比较采用独立样本t检验;计数资料以例(%)表示,组间比较采用χ^(2)检验或Fisher确切概率法。应用Kaplan-Meier法绘制术后12个月一期通畅率和免于CD-TLR率的生存曲线,组间差异比较采用Log-rank检验。应用单因素Log-rank检验和多因素Cox回归模型筛选孤立性腘动脉CTO患者血管成形术后12个月一期通畅的影响因素。结果术后12个月,DCBA组4例患者出现管腔再狭窄或闭塞,POBA组12例,DCBA组靶病变累积一期通畅率高于POBA组(Log-rankχ^(2)=4.03,P=0.045)。DCBA组术后6、12个月的ABI均大于POBA组[(0.91±0.11)比(0.83±0.09),(0.84±0.11)比(0.70±0.12),t=2.40、P=0.021,t=3.64、P=0.001]。两组患者术后12个月累积免于CD-TLR率、截肢和截趾率,以及术后6、12个月的Rutherford分级比较差异均无统计学意义(均P>0.05)。多因素Cox回归分析结果表明,采用DCBA的手术方式为孤立性腘动脉CTO患者术后12个月一期通畅的保护因素(比值比=0.31,95%CI:0.10~0.87,P=0.038),而高血压则为其独立危险因素(比值比=5.63,95%CObjectiveTo explore the short-term effect of drug-coated balloon angioplasty(DCBA)and common plain old balloon angioplasty(POBA)in the isolated popliteal artery chronic total occlusion(CTO),and to analyze the factors affecting the postoperative primary patency rate.MethodsA retrospective cohort study approach was used in this study.A total of 42 isolated popliteal CTO patients admitted to the First Affiliated Hospital of Bengbu Medical University from January 2020 to June 2022 were divided into two groups according to their different balloons:24 as POBA group and 18 as DCBA group.The primary patency rate of target lesions,the clinically-driven target lesion revascularization(CD-TLR)rate,amputation and toe amputation rate,and the improvement of ankle-brachial index(ABI)and Rutherford grade at 6 and 12 months after surgery were compared.Measurement data with normal distribution was expressed as x¯±s and means between two groups were compared using independent samples t-test.The percentage of counting data was calculated,and the rate between groups was compared byχ^(2) test or Fisher's exact probability method.Kaplan-Meier survival curve method was used to plot the survival curves of primary patency rate and CD-TLR free rate at 12 months after surgery,and Log rank test was used to compare the differences between groups.Univariate log rank test and multivariate Cox regression was used to analyze the factors affecting the primary patency rate at 12 months in patients with isolated popliteal CTO.Results12 months after surgery,4 patients in the DCBA group experienced lumen restenosis or occlusion while 12 patients in the POBA group experienced lumen restenosis or occlusion.The cumulative primary patency rate of target lesions in the DCBA group was higher than that in the POBA group(Log-rankχ^(2)=4.03,P=0.045).ABI in the DCBA group at 6 and 12 months was greater than that in the POBA group[(0.91±0.11)vs(0.83±0.09),(0.84±0.11)vs(0.70±0.12),t=2.40,P=0.021,t=3.64 and P=0.001].There were no significant difference in

关 键 词：下肢动脉硬化闭塞症 腘动脉 药物涂层球囊 普通球囊 

分 类 号：R654.3[医药卫生—外科学]