2024 年第 10 期 第 0 卷

下肢动脉钙化与下肢动脉硬化闭塞症患者血流动力学及外周血管支架联合巴曲酶治疗效果的关系

The relationship between lower extremity arterial calcification and hemodynamics and the effect of peripheral vascular stent combined with batroxobin in patients with lower extremity arteriosclerosis obliterans

作者：赵峰1邓默2

英文作者：Zhao Feng1 Deng Mo2

单位：1河北大学附属医院介入血管外科，保定071000；2河北大学附属医院麻醉科，保定071000

英文单位：1Department of Interventional Vascular Surgery Affiliated Hospital of Hebei University Baoding 071000 China; 2Department of Anesthesiology Affiliated Hospital of Hebei University Baoding 071000 China

关键词：下肢动脉硬化闭塞症；下肢动脉钙化；外周血管支架；巴曲酶

英文关键词：Lowerlimbarteriosclerosisobliterans;Lowerlimbarterycalcificationlevel;Peripheralvascularstent;Batroxobin

• 摘要：

• 目的 探讨下肢动脉钙化与下肢动脉硬化闭塞症（ASO）患者血流动力学及外周血管支架联合巴曲酶治疗效果的关系。方法 筛选2022年2月至2024年2月于河北大学附属医院接受外周血管支架联合巴曲酶治疗的120例ASO患者作为观察组，另选取60例踝肱指数≥0.9的患者纳入对照组（非ASO患者）。根据治疗后6个月再狭窄是否＞50%的情况将ASO患者分为预后良好组(62例，再狭窄程度≤50%)和预后不良组(58例，再狭窄程度＞50%)。比较观察组与对照组的临床资料，分层回归分析血流动力学参数与股浅动脉钙化评分(SFACS)、膝下动脉钙化评分(BKACS)的关系；比较预后良好组与预后不良组的临床资料及治疗前后的踝肱指数、趾肱指数；Cox回归分析评估SFACS、BKACS与患者预后不良的关系；多元线性回归分析SFACS、BKACS与踝肱指数、趾肱指数的关系；限制性立方样条模型分析SFACS、BKACS与ASO患者预后不良风险的剂量-效应关系。结果观察组年龄、男性比例、吸烟史比例、胫后动脉收缩期血流速度峰值（Vs）、足背动脉Vs、SFACS、BKACS明显高于对照组，胫后动脉血管内径、足背动脉血管内径明显低于对照组（均P＜0.05）。胫后动脉血管内径、足背动脉血管内径均对SFACS、BKACS产生显著的负向影响，胫后动脉Vs、足背动脉Vs均对SFACS、BKACS产生显著的正向影响（均P＜0.05）。预后良好组和预后不良组C反应蛋白、白蛋白、纤维蛋白原、SFACS［2 282（856，3 259）分比4 236（1 547，6 325）分］和BKACS［1 024（526，1 730）分比1 951（1 157，2 968）分］比较差异均有统计学意义(均P＜0.05)。预后良好组治疗后6个月和治疗后1、2年踝肱指数和趾肱指数均明显高于预后不良组（均P＜0.05）。调整混杂因素前后，SFACS、BKACS均与患者预后不良风险呈正相关，与踝肱指数、趾肱指数呈负相关（均P＜0.05）。ASO患者预后不良风险随SFACS、BKACS增加而增加（非线性P值分别为0.762和0.395）。结论 下肢动脉钙化水平与ASO患者血流动力学有关，在一定程度上能够评估外周血管支架联合巴曲酶的治疗效果，因此在ASO的治疗过程中，可将其作为临床治疗的检查标志之一，用以及时优化治疗方案。

• Objective To investigate the relationship between lower extremity arterial calcification and hemodynamics and the effect of peripheral vascular stent combined with batroxobin in patients with lower extremity arteriosclerosis obliterans (ASO). Methods A total of 120 patients with ASO who received peripheral vascular stent combined with batroxobin in the Affiliated Hospital of Hebei University from February 2022 to February 2024 were selected as the observation group, and 60 patients with ankle brachial index ≥0.9 were selected as the control group (non-ASO patients). The patients were divided into the good prognosis group (62 cases, the degree of restenosis ≤50%) and the poor prognosis group (58 cases, the degree of restenosis > 50%) according to whether the restenosis was > 50% at 6 months after treatment. The clinical data of the observation group and the control group were compared, and the hierarchical regression analysis was used to analyze the relationship between hemodynamic parameters and superficial femoral artery calcification score (SFACS) and inferior genicular artery calcification score (BKACS). The clinical data, ankle-brachial index (ABI) and toe-brachial index (TBI) before and after treatment were compared between the good prognosis group and the poor prognosis group. Cox regression analysis was used to evaluate the relationship between SFACS, BKACS and poor prognosis of patients. Multiple linear regression analysis was used to analyze the relationship between SFACS, BKACS and ABI, TBI. Restricted cubic spline model was used to analyze the dose-effect relationship between SFACS, BKACS and the risk of poor prognosis in ASO patients. Results The age, proportion of males, proportion of smoking history, peak systolic blood flow velocity (Vs) of posterior tibial artery, Vs of dorsalis pedis artery, SFACS and BKACS of the observation group were significantly higher than those of the control group, and the diameter of posterior tibial artery and dorsalis pedis artery were significantly lower than those of the control group (all P＜0.05). The internal diameter of posterior tibial artery and dorsalis pedis artery had a significant negative effect on SFACS and BKACS, and the posterior tibial artery Vs and dorsalis pedis artery Vs had a significant positive effect on SFACS and BKACS (all P＜0.05). There were significant differences in C-reactive protein, albumin, fibrinogen, SFACS ［2 282（856，3 259） vs 4 236（1 547，6 325）］ and BKACS ［1 024（526，1 730） vs 1 951（1 157，2 968）］ between the good prognosis group and the poor prognosis group (all P＜0.05). The ABI and TBI of the good prognosis group were significantly higher than those of the poor prognosis group at 6 months, 1 year and 2 years after treatment (all P＜0.05). Before and after adjusting for confounding factors, SFACS and BKACS were positively correlated with the risk of poor prognosis, and were negatively correlated with ABI and TBI (all P＜0.05). The risk of poor prognosis in ASO patients increased with the increase of SFACS and BKACS (non-linear P=0.762, 0.395). Conclusion The level of lower extremity arterial calcification is related to the hemodynamics of patients with ASO, and it can evaluate the therapeutic effect of peripheral vascular stent combined with batroxobin to a certain extent. Therefore, in the treatment of ASO, it can be used as one of the examination marks for clinical treatment to optimize the treatment plan in time.