股腘动脉经皮腔内血管成形术及择期支架植入术后再狭窄：单核细胞计数的预测价值

Restenosis after femoropopliteal PTA and elective stent implantation: predictive value of monocyte counts.

作者信息

Schillinger Martin, Exner Markus, Mlekusch Wolfgang, Haumer Markus, Sabeti Schila, Ahmadi Ramazanali, Schwarzinger Ilse, Wagner Oswald, Minar Erich

机构信息

Departments of Angiology, University of Vienna, Medical Faculty, Vienna, Austria.

出版信息

J Endovasc Ther. 2003 Jun;10(3):557-65. doi: 10.1177/152660280301000322.

DOI:10.1177/152660280301000322

PMID:12932168

Abstract

PURPOSE

To investigate the association of baseline peripheral blood monocyte counts and restenosis after femoropopliteal percutaneous transluminal angioplasty (PTA) and PTA plus elective stent implantation.

METHODS

Three hundred thirty consecutive patients (170 men; median age 71 years, interquartile range 61-78) with peripheral artery disease underwent femoropopliteal PTA (n=258) or PTA plus elective stent implantation (n=72). Multivariate Cox regression analysis was used to determine the predictive value of baseline peripheral blood monocyte counts on the rate of restenosis (> or =50% luminal reduction) in follow-up.

RESULTS

Cumulative patency at 6 and 12 months was 55% and 39% after PTA and 70% and 41% after elective stenting, respectively (p=0.19). Pretreatment monocyte counts (in tertiles) were associated with restenosis after PTA (p=0.002) and stent implantation (p=0.02). Compared to patients with monocyte counts <0.3x10(9)/L (lower tertile, n=128), patients with monocytes from 0.3 to 0.4x10(9)/L (middle tertile, n=91) had a 1.8-fold increased adjusted risk for restenosis (95% CI 1.1 to 2.8, p=0.01). Patients with monocytes >0.4x10(9)/L (upper tertile, n=87) had a 2.3-fold increased adjusted risk (95% CI 1.4 to 3.5, p<0.0001).

CONCLUSIONS

Baseline monocyte counts were associated with restenosis after femoropopliteal PTA and elective stent implantation, suggesting that circulating monocytes play a pivotal role in the development of recurrent lumen narrowing.

摘要

目的

探讨股腘动脉经皮腔内血管成形术（PTA）及PTA联合选择性支架植入术后基线外周血单核细胞计数与再狭窄的相关性。

方法

330例连续的外周动脉疾病患者（170例男性；中位年龄71岁，四分位间距61 - 78岁）接受了股腘动脉PTA（n = 258）或PTA联合选择性支架植入术（n = 72）。采用多因素Cox回归分析确定基线外周血单核细胞计数对随访期间再狭窄率（管腔狭窄≥50%）的预测价值。

结果

PTA术后6个月和12个月的累积通畅率分别为55%和39%，选择性支架植入术后分别为70%和41%（p = 0.19）。术前单核细胞计数（三分位数分组）与PTA术后（p = 0.002）及支架植入术后（p = 0.02）的再狭窄相关。与单核细胞计数<0.3×10⁹/L（低三分位数组，n = 128）的患者相比，单核细胞计数为0.3至0.4×10⁹/L（中三分位数组，n = 91）的患者再狭窄校正风险增加1.8倍（95%CI 1.1至2.8，p = 0.01）。单核细胞计数>0.4×10⁹/L（高三分位数组，n = 87）的患者再狭窄校正风险增加2.3倍（95%CI 1.4至3.5，p<0.0001）。