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纸质出版:2013
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李英莎,赵志钢,何洪波,倪银星,孙芳,钟健,孙倩倩,胡勤锦,闫振成,祝之明.下肢动脉硬化闭塞症介入治疗效果及其影响因素分析[J].陆军军医大学学报(原第三军医大学学报),2013,35(08):789-792.
Li Yingsha,Zhao Zhigang,He Hongbo,Ni Yinxing,Sun Fang,Zhong Jian,Sun Qianqian,Hu Qinjin,Yan Zhencheng,Zhu Zhiming.Long-term role of endovascular intervention in patients with peripheral arterial disease and its influencing factors[J].J Amry Med Univ (J Third Mil Med Univ),2013,35(08):789-792.
李英莎,赵志钢,何洪波,倪银星,孙芳,钟健,孙倩倩,胡勤锦,闫振成,祝之明.下肢动脉硬化闭塞症介入治疗效果及其影响因素分析[J].陆军军医大学学报(原第三军医大学学报),2013,35(08):789-792. DOI:
Li Yingsha,Zhao Zhigang,He Hongbo,Ni Yinxing,Sun Fang,Zhong Jian,Sun Qianqian,Hu Qinjin,Yan Zhencheng,Zhu Zhiming.Long-term role of endovascular intervention in patients with peripheral arterial disease and its influencing factors[J].J Amry Med Univ (J Third Mil Med Univ),2013,35(08):789-792. DOI:
目的 通过比较下肢动脉硬化闭塞症患者行介入治疗及保守治疗的截肢率、死亡率等差异,分析介入治疗效果及其影响因素。 方法 入选2007年11月至2012年6月于我科住院的251例下肢动脉硬化闭塞症患者,分为介入治疗组(n=94)和常规治疗组(n=157),常规治疗组行药物治疗,介入治疗组在常规药物治疗基础上行下肢动脉球囊扩张和/或支架植入术。随访脑梗死、脑出血、急性心血管事件发生率、截肢率及病死率。于出院后1、3、6个月、1、2年检测踝肱指数(ABI)、血压、血糖、糖化血红蛋白、血脂、血肌酐、高敏-C反应蛋白(hs-CRP)。 结果 常规治疗组病死率、截肢率、脑梗死发生率显著高于介入治疗组(17.20% vs 7.45%,P0.05;9.55% vs 3.19%,P0.05;10.83% vs 3.19%,P0.05)。介入治疗组术前ABI为0.62±0.25
术后3 d、1、3、6个月ABI显著高于术前(分别为0.88±0.19、0.90±0.11、0.82±0.23、0.79±0.20; P0.01
P0.05),而常规治疗组ABI呈现继续下降趋势。进一步对相关危险因素行Logistic回归分析,结果显示年龄是影响术后疗效的危险因素(r=2.096
P=0.035),而hs-CRP是影响术后再狭窄发生率的危险因素(r=1.678
P=0.037)。 结论 下肢介入治疗能有效改善下肢动脉硬化闭塞症患者下肢血供,降低脑梗死发生率、截肢率及病死率。年龄越大,手术效果越差,术前hs-CRP越高,术后发生再狭窄的危险越大。
Objective To compare the incidence of major amputation and mortality in patients with peripheral arterial disease who were given interventional therapy or conservative treatment
and to evaluate the efficacy of interventional therapy and its influencing factors. Methods We enrolled 251 in-patients with diagnosed peripheral arterial disease from November 2007
to June 2012 in Daping Hospital
Chongqing. Ninety-four patients had a lower extremity arterial balloon dilatation and/or stent implantation
while another 157 patients referred to conservative treatment. All the patients were followed up for mortality and the incidence of cerebral infarction
coronary heart disease and amputation. Ankle-brachial index (ABI)
blood pressure
blood glucose
glycosylated hemoglobin
blood lipids
serum creatinine
and high-sensitivity C-reactive protein (hs-CRP) were measured in 3 d
1
3 and 6 months
and 1
2 years after interventional therapy. Results The two groups showed significant differences in mortality
the incidence of amputation and cerebral infarction (17.20% vs 7.45%
9.55%
vs
3.19% and 10.83%
vs
3.19%
P0.05). The average ABI in the interventional therapy group
which was 0.62±0.25 before operation
showed significant decrease on 3 d
and 1
3
and 6 months after operation (0.88±0.19
0.90±0.11
0.82±0.23 and 0.79±0.20
P
0.01
P
0.05). The results of Logistic regression analysis showed that age was an independent risk factor for the validity of the interventional therapy (
r
=1.678
P
=0.037)
while hs-CRP was an independent risk factor for the rate of restenosis (r=2.096
P
=0.035). Conclusion Lower limb interventional therapy can effectively improve lower limb blood supply in patients with peripheral arterial disease
and decrease the mortality and the incidence of amputation and cerebral infarction. The elder patients may have worse outcome. A high hs-CRP level indicates a high risk of restenosis.
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