介入联合保守治疗下肢动脉硬化闭塞症的临床疗效及预后危险因素分析

Effect of interventional therapy and conservative therapy on arteriosclerosis obliterans of lower limbs and prognostic risk factors analysis

摘要:

目的 分析比较介入治疗与保守治疗下肢动脉硬化闭塞症的临床疗效，并分析影响患者预后的危险因素。方法 选取2016年7月—2018年10月湖北省天门市第一人民医院接受治疗的98例下肢动脉硬化闭塞症患者。根据治疗方法的不同分为实验组（50例）和对照组（48例）。实验组在保守治疗基础上联合介入治疗，对照组仅采取保守治疗。收集患者年龄、性别构成、病程、吸烟史、饮酒史、合并症，以及实验室指标等一般资料；记录并比较患者住院时间、治疗费用、跛行距离、踝肱指数（ABI）、血管畅通率、总有效率、Rutherford分级，以及不良事件发生情况。所有患者根据预后情况，分为预后不良组31例和预后良好组67例，采用多因素Logistic回归分析影响患者预后的危险因素。结果 与对照组比较，实验组住院时间缩短，但治疗费用增加（P <0.05）。相比对照组，实验组Rutherford分级改善，血管畅通率和总有效率提高（P <0.05）。实验组的跛行距离和ABI大于对照组（P <0.05）。实验组心脑血管事件、截肢及死亡发生率低于对照组（P <0.05）。预后不良组和预后良好组在年龄、病程、住院时间、ABI、纤维蛋白原、治疗方法、吸烟史、血小板升高、淋巴细胞降低、畅通与病变动脉构成、高血压、糖尿病、高脂血症方面的差异均有统计学意义（P <0.05）。多因素Logistic回归分析显示，年龄、保守治疗、吸烟、高血压、糖尿病、高脂血症及纤维蛋白原是下肢动脉硬化闭塞症预后不良的独立危险因素（P <0.05）。年龄> 70岁、纤维蛋白原> 4 g/L对下肢动脉硬化闭塞症预后的影响更大。结论 对下肢动脉硬化闭塞症采用介入联合保守治疗，具有安全性高、疗效好、易恢复，并发症少的优势。年龄增加、保守治疗、吸烟、高血压、糖尿病、高脂血症及纤维蛋白原升高可导致下肢动脉硬化闭塞症预后不良。

Abstract:

Objective To compare the effect of interventional therapy combined with conservative treatment on the lower limb arteriosclerosis obliterans, and to analyze the risk factors that affect the prognosis of the patients.Methods From July 2016 to October 2018, 98 patients with lower limb arteriosclerosis obliterans, who received treatment in our hospital, were selected and divided into experimental group (50 cases) and control group (48 cases), according to different treatment methods. The experimental group received interventional therapy on the basis of conservative treatment, while the control group only received conservative treatment. The patient's age, sex, course of disease, drinking history, smoking history, comorbidity and laboratory indicators were recorded. The length of hospital stay, distance to lameness, Rutherford stage, ankle-brachial index (ABI) before and after treatment, clinical outcome, and adverse events were recorded. According to the prognosis, the patients were divided into the group with poor prognosis (n = 31) and the group with good prognosis (n = 67), and the risk factors influencing the prognosis were analyzed by single and multiple factors.Results Compared with the control group, the length of hospitalization was reduced, but the treatment cost was increased in the experimental group (P < 0.05). After treatment, compared with the control group, Rutherford stage was improved, and the vascular unblocked rate and the total effective rate were increased in the experimental group (P < 0.05). The claudication distance and ABI after treatment were higher in both groups than before treatment (P < 0.05), and the experimental group was better than the control group (P < 0.05). The incidence of cardiovascular and cerebrovascular events, amputation and death were lower in the experimental group than in the control group (P < 0.05). There were statistically significant differences in age, course of disease, length of hospital stay, treatment, ABI, vascular unclotting rate, fibrinogen, smoking, hypertension, diabetes, hyperlipidemia, platelet elevation, and lymphocyte lowering between the poor and good prognostic groups (P < 0.05). Multivariate analysis showed that age, conservative treatment, smoking, hypertension, diabetes, hyperlipidemia and fibrinogen were independent risk factors for poor prognosis of lower limb arteriosclerosis obliterans (P < 0.05). Age > 70 years, and fibrinogen > 4 g/L had a greater effect on the prognosis of lower limb arteriosclerosis obliterans.Conclusion Interventional treatment of arteriosclerosis obliterans of lower limbs has the advantages of high safety, good curative effect, easy recovery, and less complications. Increased age, conservative treatment, smoking, hypertension, diabetes, hyperlipidemia, and elevated fibrinogen can lead to poor prognosis in arteriosclerosis obliterans of lower limbs.