介入治疗对老年下肢动脉硬化闭塞症病人血流动力学、动脉硬化指标及血小板活化因子的影响
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摘要
目的探讨介入治疗对老年下肢动脉硬化闭塞症病人血流动力学、动脉硬化指标及血小板活化因子的影响。方法选取2015年6月至2018年1月我院收治的下肢动脉硬化闭塞症病人102例,采用随机数字表法分为对照组(51例)和观察组(51例)。对照组采用常规药物治疗,观察组在此基础上行肢动脉球囊扩张或支架植入术。比较2组临床疗效,同时比较2组治疗前后动脉硬化指标[颈动脉-股动脉脉搏传导速度(PWV)、踝肱指数(ABI)及颈动脉内膜中层厚度(IMT)],血流动力学指标[血浆黏度(ηp)、全血黏度(ηb)、纤维蛋白原(Fib)、红细胞电泳(EEP)、血沉(ESR)],血小板活化因子[静脉血可溶性CD40配体(sCD40L)、sP选择素]水平。结果观察组总有效率为96. 08%,显著高于对照组(80. 39%),2组差异具有统计学意义(P<0. 05)。治疗后观察组IMT、ABI、PWV水平均显著优于对照组,ηp、ηb、Fib、EEP及ESR水平均显著低于对照组,差异均具有统计学意义(P<0. 05)。治疗7 d后,观察组sCD40L和sP选择素水平均显著高于对照组,差异具有统计学意义(P<0. 05)。治疗14 d后,2组sCD40L和s P选择素水平差异无统计学意义(P>0. 05)。结论介入治疗可有效抑制老年下肢动脉硬化闭塞症病人动脉硬化,改善血流动力学,但术后早期可出现血小板活化因子水平的升高,因此需注意抗凝治疗,后期水平可恢复。
Objective To investigate the effects of interventional therapy on hemodynamics,arteriosclerosis indexes and platelet activating factors in the patients with arteriosclerosis obliterans in lower extremity. Methods A total of 102 patients with arteriosclerosis obliterans in lower extremity admitted to our hospital from June 2015 to January 2018 were enrolled. All patients were divided into control group( n = 51) and observation group( n = 51). The control group was treated with routine medicine,and the observation group was treated with balloon dilatation or stent implantation on the basis of control group. The levels of atherosclerosis indexs including intima-media thickness( IMT),anklebrachial index( ABI),pulse wave velocity( PWV) and hemodynamics[plasma viscosity( ηp),blood viscosity( ηb),fibrinogen( Fib),erythrocyte electrophoresis( EEP),erythrocyte sedimentation rate( ESR) ]were compared between two groups before and 4 weeks after treatment,and the levels of platelet activating factors( sCD40 L,s P selection) were compared between the two groups before and 1 week and2 weeks after treatment. Results The total effective rate of the observation group( 96. 08%) was significantly higher than that of the control group( 80. 39%)( P< 0. 05). After treatment,the levels of IMT,ABI,PWV in the observation group were significantly better than those in the control group. The levels of ηp,ηb,Fib,EEP and ESR in the observation group were significantly lower than those in the control group( P<0. 05).The levels of sCD40L and sP selectin in the observation group were significantly higher than those in the control group 7 d after treatment( P<0. 05). There were no significant differences in the levels of sCD40L and sP selectin between the two groups 14 d after treatment( P> 0. 05).Conclusions Interventional therapy can effectively inhibit arteriosclerosis and improve hemodynamics in the elderly patients with arteriosclerosis obliterans of lower extremity. However,the levels of platelet activating factors maybe increase early after operation,so we need to pay attention to anticoagulant therapy.
Objective To investigate the effects of interventional therapy on hemodynamics,arteriosclerosis indexes and platelet activating factors in the patients with arteriosclerosis obliterans in lower extremity. Methods A total of 102 patients with arteriosclerosis obliterans in lower extremity admitted to our hospital from June 2015 to January 2018 were enrolled. All patients were divided into control group( n = 51) and observation group( n = 51). The control group was treated with routine medicine,and the observation group was treated with balloon dilatation or stent implantation on the basis of control group. The levels of atherosclerosis indexs including intima-media thickness( IMT),anklebrachial index( ABI),pulse wave velocity( PWV) and hemodynamics[plasma viscosity( ηp),blood viscosity( ηb),fibrinogen( Fib),erythrocyte electrophoresis( EEP),erythrocyte sedimentation rate( ESR) ]were compared between two groups before and 4 weeks after treatment,and the levels of platelet activating factors( sCD40 L,s P selection) were compared between the two groups before and 1 week and2 weeks after treatment. Results The total effective rate of the observation group( 96. 08%) was significantly higher than that of the control group( 80. 39%)( P< 0. 05). After treatment,the levels of IMT,ABI,PWV in the observation group were significantly better than those in the control group. The levels of ηp,ηb,Fib,EEP and ESR in the observation group were significantly lower than those in the control group( P<0. 05).The levels of sCD40L and sP selectin in the observation group were significantly higher than those in the control group 7 d after treatment( P<0. 05). There were no significant differences in the levels of sCD40L and sP selectin between the two groups 14 d after treatment( P> 0. 05).Conclusions Interventional therapy can effectively inhibit arteriosclerosis and improve hemodynamics in the elderly patients with arteriosclerosis obliterans of lower extremity. However,the levels of platelet activating factors maybe increase early after operation,so we need to pay attention to anticoagulant therapy.
引文
[1]尹智明.下肢动脉硬化闭塞症腔内介入治疗的研究进展[J].中国普通外科杂志,2017,26(6):789-794.
[2]杨俊,史文风,杨旸,等.奥马哈系统在下肢动脉硬化闭塞症介入治疗中的应用价值[J].新乡医学院学报,2015,32(10):951-953.
[3]郭上玮.介入治疗在下肢动脉硬化闭塞症中的应用价值[J].河北医药,2015,37(14):2127-2129.
[4]邢娜,王富军,齐会卿,等. sCD40L及sP选择素在糖尿病下肢动脉病变介入治疗前后的变化及其意义[J].中国介入影像与治疗学,2016,13(9):535-539.
[5]中华医学会外科学分会血管外科学组.下肢动脉硬化闭塞症诊治指南[J].中华医学杂志,2015,95(24):145-151.
[6]王云鹏,姚野,孙庆峰,等.老年下肢动脉硬化闭塞症相关危险因素分析及介入手术应用[J].中华老年多器官疾病杂志,2017,16(10):766-769.
[7]黄剑,周大勇,沈利明,等.二氧化碳造影在下肢动脉腔内治疗中的应用[J].介入放射学杂志,2018,27(3):314-317.
[8]陈波,马军,王海涛,等.介入技术在下肢动脉硬化闭塞症合并血栓形成中的应用[J].现代生物医学进展,2016,22(7):414-417.
[9]张瑞鹏,戴维.血管介入联合外科手术治疗下肢动脉硬化闭塞症临床观察[J].湖南中医药大学学报,2016,43(A02):696-696.
[10]姚玉红.参芪与脉络宁注射液联用对35例糖尿病下肢动脉硬化闭塞症患者动脉硬化、血流动力学及炎症的影响[J].华西药学杂志,2015,30(4):523-524.
[11]吴元兵,朱云峰,葛红卫,等.下肢动脉硬化闭塞症腔内治疗后支架内再狭窄的治疗[J].中国普通外科杂志,2015,24(12):1687-1690.
[12]俞志强,龚亦群,洪彪,等.下肢动脉硬化闭塞症介入治疗的临床疗效及其影响因素研究[J].现代生物医学进展,2015,15(32):6275-6278.
[13]许永乐,贾鑫,郭伟,等.紫杉醇药物涂层球囊治疗症状性下肢动脉硬化闭塞症的早中期结果[J].中华外科杂志,2016,54(8):617-619.
[14]张天华,迟德财,姜维良.药物涂层球囊治疗下肢动脉硬化闭塞症的疗效[J].中国普通外科杂志,2016,25(12):1719-1724.
[2]杨俊,史文风,杨旸,等.奥马哈系统在下肢动脉硬化闭塞症介入治疗中的应用价值[J].新乡医学院学报,2015,32(10):951-953.
[3]郭上玮.介入治疗在下肢动脉硬化闭塞症中的应用价值[J].河北医药,2015,37(14):2127-2129.
[4]邢娜,王富军,齐会卿,等. sCD40L及sP选择素在糖尿病下肢动脉病变介入治疗前后的变化及其意义[J].中国介入影像与治疗学,2016,13(9):535-539.
[5]中华医学会外科学分会血管外科学组.下肢动脉硬化闭塞症诊治指南[J].中华医学杂志,2015,95(24):145-151.
[6]王云鹏,姚野,孙庆峰,等.老年下肢动脉硬化闭塞症相关危险因素分析及介入手术应用[J].中华老年多器官疾病杂志,2017,16(10):766-769.
[7]黄剑,周大勇,沈利明,等.二氧化碳造影在下肢动脉腔内治疗中的应用[J].介入放射学杂志,2018,27(3):314-317.
[8]陈波,马军,王海涛,等.介入技术在下肢动脉硬化闭塞症合并血栓形成中的应用[J].现代生物医学进展,2016,22(7):414-417.
[9]张瑞鹏,戴维.血管介入联合外科手术治疗下肢动脉硬化闭塞症临床观察[J].湖南中医药大学学报,2016,43(A02):696-696.
[10]姚玉红.参芪与脉络宁注射液联用对35例糖尿病下肢动脉硬化闭塞症患者动脉硬化、血流动力学及炎症的影响[J].华西药学杂志,2015,30(4):523-524.
[11]吴元兵,朱云峰,葛红卫,等.下肢动脉硬化闭塞症腔内治疗后支架内再狭窄的治疗[J].中国普通外科杂志,2015,24(12):1687-1690.
[12]俞志强,龚亦群,洪彪,等.下肢动脉硬化闭塞症介入治疗的临床疗效及其影响因素研究[J].现代生物医学进展,2015,15(32):6275-6278.
[13]许永乐,贾鑫,郭伟,等.紫杉醇药物涂层球囊治疗症状性下肢动脉硬化闭塞症的早中期结果[J].中华外科杂志,2016,54(8):617-619.
[14]张天华,迟德财,姜维良.药物涂层球囊治疗下肢动脉硬化闭塞症的疗效[J].中国普通外科杂志,2016,25(12):1719-1724.