他汀类药物治疗与自体股腘动脉旁路移植血管通畅率的提高相关。
Statin therapy is associated with improved patency of autogenous infrainguinal bypass grafts.
作者信息
Abbruzzese Thomas A, Havens Joaquim, Belkin Michael, Donaldson Magruder C, Whittemore Anthony D, Liao James K, Conte Michael S
机构信息
Division of Vascular Surgery, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
出版信息
J Vasc Surg. 2004 Jun;39(6):1178-85. doi: 10.1016/j.jvs.2003.12.027.
OBJECTIVE
HMG-CoA reductase inhibitors (statins) broadly reduce cardiovascular events, effects that are only partly related to cholesterol lowering. Recent studies suggest important anti-inflammatory and antiproliferative properties of these drugs. The purpose of this study was to determine the influence of statin therapy on graft patency after autogenous infrainguinal arterial reconstructions.
METHODS
A retrospective analysis of consecutive patients (1999-2001) who underwent primary autogenous infrainguinal reconstructions with a single segment of greater saphenous vein was performed. Patients were categorized according to concurrent use of a statin. Graft lesions (identified by duplex surveillance) and interventions were tabulated. Comparisons between groups were made by using the Fisher exact test for categorical variables and the Student t test for continuous variables. Patency, limb salvage, and survival were compared by log rank test. A stepwise Cox proportional hazards analysis was then employed to ascertain the relative importance of factors influencing graft patency.
RESULTS
A total of 172 patients underwent 189 primary autogenous infrainguinal arterial reconstructions (94 statin, 95 control) during the study period. The groups were well matched for age, indication, and atherosclerotic risk factors. Procedures were performed primarily for limb salvage (92%), with 65% to an infrapopliteal target. Perioperative mortality (2.6%) and major morbidity (3.2%) were not different between groups. There was no difference in primary patency (74% +/- 5% vs 69% +/- 6%; P =.25), limb salvage (92% +/- 3% vs 90% +/- 4%; P =.37), or survival (69% +/- 5% vs 63% +/- 5%; P =.20) at 2 years. However, patients on statins had higher primary-revised (94% +/- 2% vs 83% +/- 5%; P <.02) and secondary (97% +/- 2% vs 87% +/- 4%; P <.02) graft patency rates at 2 years. Of all factors studied by univariate analysis, only statin use was associated with improved secondary patency (P =.03) at 2 years. This was confirmed by multivariate analysis. The risk of graft failure was 3.2-fold higher (95% confidence interval, 1.04-10.04) for the control group. Perioperative cholesterol levels (available in 47% of patients) were not statistically different between groups.
CONCLUSIONS
Statin therapy is associated with improved graft patency after infrainguinal bypass grafting with saphenous vein.
目的
HMG-CoA还原酶抑制剂（他汀类药物）能广泛降低心血管事件风险，其作用仅部分与降低胆固醇有关。近期研究表明这些药物具有重要的抗炎和抗增殖特性。本研究的目的是确定他汀类药物治疗对自体股下动脉重建术后移植物通畅率的影响。
方法
对1999年至2001年连续行单段大隐静脉自体股下动脉初次重建术的患者进行回顾性分析。根据是否同时使用他汀类药物对患者进行分类。将移植物病变（通过双功超声监测确定）和干预措施制成表格。分类变量采用Fisher精确检验，连续变量采用Student t检验进行组间比较。采用对数秩检验比较通畅率、肢体挽救率和生存率。然后采用逐步Cox比例风险分析来确定影响移植物通畅率的因素的相对重要性。
结果
在研究期间，共有172例患者接受了189次自体股下动脉初次重建术（94例使用他汀类药物，95例为对照组）。两组在年龄、适应证和动脉粥样硬化危险因素方面匹配良好。手术主要是为了挽救肢体（92%），其中65%的目标是腘下动脉。两组围手术期死亡率（2.6%）和主要并发症发生率（3.2%）无差异。2年时，初次通畅率（74%±5%对69%±6%；P = 0.25）、肢体挽救率（92%±3%对90%±4%；P = 0.37）或生存率（69%±5%对63%±5%；P = 0.20）无差异。然而，使用他汀类药物的患者2年时初次修正通畅率（94%±2%对83%±5%；P < 0.02）和二次通畅率（97%±2%对87%±4%；P < 0.02）更高。单因素分析研究的所有因素中，只有使用他汀类药物与2年时二次通畅率改善相关（P = 0.03）。多因素分析证实了这一点。对照组移植物失败风险高3.2倍（95%置信区间，1.04 - 10.04）。两组间围手术期胆固醇水平（47%的患者可获得）无统计学差异。
结论
他汀类药物治疗与大隐静脉股下旁路移植术后移植物通畅率提高有关。
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