Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania.
Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania.
Int J Environ Res Public Health. 2022 Oct 26;19(21):13934. doi: 10.3390/ijerph192113934.
Carotid endarterectomy (CEA) is the first-line surgical intervention for cases of severe carotid stenoses. Unfortunately, the restenosis rate is high after CEA. This study aims to demonstrate the predictive role of carotid plaque features and inflammatory biomarkers (monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)) in carotid restenosis and mortality at 12 months following CEA.
The present study was designed as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with a minimum of 70% carotid stenosis and surgical indications for CEA admitted to the Vascular Surgery Clinic, Emergency County Hospital of Targu Mures, Romania between 2018 and 2021.
According to our results, the high pre-operative values of inflammatory biomarkers-MLR (OR: 10.37 and OR: 6.11; < 0.001), NLR (OR: 34.22 and OR: 37.62; < 0.001), PLR (OR: 12.02 and OR: 16.06; < 0.001), SII (OR: 18.11 and OR: 31.70; < 0.001), SIRI (OR: 16.64 and OR: 9.89; < 0.001), and AISI (OR: 16.80 and OR: 8.24; < 0.001)-are strong independent factors predicting the risk of 12-month restenosis and mortality following CEA. Moreover, unstable plaque (OR: 2.83, < 0.001 and OR: 2.40, = 0.04) and MI (OR: 3.16, < 0.001 and OR: 2.83, = 0.005) were independent predictors of all outcomes. Furthermore, AH (OR: 2.30; = 0.006), AF (OR: 1.74; = 0.02), tobacco (OR: 2.25; < 0.001), obesity (OR: 1.90; = 0.02), and thrombotic plaques (OR: 2.77; < 0.001) were all independent predictors of restenosis, but not for mortality in all patients. In contrast, antiplatelet (OR: 0.46; = 0.004), statin (OR: 0.59; = 0.04), and ezetimibe (OR:0.45; = 0.03) therapy were protective factors against restenosis, but not for mortality.
Our data revealed that higher preoperative inflammatory biomarker values highly predict 12-month restenosis and mortality following CEA. Furthermore, age above 70, unstable plaque, cardiovascular disease, and dyslipidemia were risk factors for all outcomes. Additionally, AH, AF, smoking, and obesity were all independent predictors of restenosis but not of mortality in all patients. Antiplatelet and statin medication, on the other hand, were protective against restenosis but not against mortality.
颈动脉内膜切除术（CEA）是治疗严重颈动脉狭窄的一线手术干预措施。不幸的是，CEA 后再狭窄率很高。本研究旨在证明颈动脉斑块特征和炎症生物标志物（单核细胞与淋巴细胞比值（MLR）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、全身性炎症指数（SII）、全身性炎症反应指数（SIRI）和全身性炎症综合指数（AISI））在 CEA 后 12 个月内颈动脉再狭窄和死亡率的预测作用。
本研究设计为观察性、分析性、回顾性队列研究，纳入了 2018 年至 2021 年期间罗马尼亚特尔古穆列什县急症县立医院血管外科诊所因至少 70%颈动脉狭窄和 CEA 手术适应证而入院的所有年龄在 18 岁以上的患者。
根据我们的结果，术前炎症生物标志物-MLR（OR：10.37 和 OR：6.11； < 0.001）、NLR（OR：34.22 和 OR：37.62； < 0.001）、PLR（OR：12.02 和 OR：16.06； < 0.001）、SII（OR：18.11 和 OR：31.70； < 0.001）、SIRI（OR：16.64 和 OR：9.89； < 0.001）和 AISI（OR：16.80 和 OR：8.24； < 0.001）的高术前值是预测 CEA 后 12 个月再狭窄和死亡率的强烈独立因素。此外，不稳定斑块（OR：2.83， < 0.001 和 OR：2.40， = 0.04）和 MI（OR：3.16， < 0.001 和 OR：2.83， = 0.005）是所有结局的独立预测因子。此外，AH（OR：2.30； = 0.006）、AF（OR：1.74； = 0.02）、吸烟（OR：2.25； < 0.001）、肥胖（OR：1.90； = 0.02）和血栓性斑块（OR：2.77； < 0.001）是所有患者再狭窄的独立预测因子，但不是死亡率的独立预测因子。相反，抗血小板（OR：0.46； = 0.004）、他汀类药物（OR：0.59； = 0.04）和依折麦布（OR：0.45； = 0.03）治疗是预防再狭窄的保护因素，但不是预防死亡率的保护因素。
我们的数据表明，较高的术前炎症生物标志物值高度预测 CEA 后 12 个月的再狭窄和死亡率。此外，年龄大于 70 岁、不稳定斑块、心血管疾病和血脂异常是所有结局的危险因素。此外，AH、AF、吸烟和肥胖是所有患者再狭窄的独立预测因子，但不是死亡率的独立预测因子。另一方面，抗血小板和他汀类药物治疗是预防再狭窄的保护因素，但不是预防死亡率的保护因素。
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