Popescu Alexandra Ioana, Rata Andreea Luciana, Barac Sorin, Popescu Roxana, Onofrei Roxana Ramona, Vlad Cristian, Vlad Daliborca
Pharmacology Department, Doctoral School, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Surgical Emergencies Department, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Biomedicines. 2024 Apr 3;12(4):798. doi: 10.3390/biomedicines12040798.
Chronic limb-threatening ischemia (CLTI), the advanced stage of peripheral arterial disease, is diagnosed in the presence of ischemic rest pain, non-healing ulcers, or gangrene. Several studies have demonstrated that inflammation and endothelial dysfunction are some of the main substrates of CLTI.
A narrative review was conducted and reported according to PRISMA guidelines. Three databases were searched-Web of Science, Medline, and EMBASE-for the studies assessing CLTI and the biological markers related to it.
We included 22 studies, and all the markers identified (C-reactive protein, D-dimers, fibrinogen, cytokines, IL-6, TNF-α, ICAM-1 (Intracellular Adhesion Molecule-1), VCAM-1 (Vascular Cell Adhesion Molecule-1), neutrophile-to-lymphocytes ratio (NLR), IL-8, Pentraxin-3, neutrophil gelatinase-associated lipocalin (NGAL), calprotectin, E-selectin, P-selectin, neopterin, High-Mobility Group Box-1 protein (HGMB-1), Osteoprotegerin (OPG) and Sortilin) were positively associated with advanced CLTI, with major limb or major cardiovascular events in these patients.
All the studied markers had increased values in patients with CLTI, especially when associated with diabetes mellitus, proving a very important association between diabetes and major limb or cardiovascular events in these patients. There is a need for more studies to validate these markers in terms of diagnosis or prognosis in CLTI patients and in trying to find new medical strategies that target inflammation or endothelial dysfunction in these patients.
慢性肢体威胁性缺血（CLTI）是外周动脉疾病的晚期阶段，在存在缺血性静息痛、不愈合溃疡或坏疽时被诊断出来。多项研究表明，炎症和内皮功能障碍是CLTI的一些主要病理基础。
根据PRISMA指南进行叙述性综述并报告。检索了三个数据库——科学网、医学索引和荷兰医学文摘数据库，以查找评估CLTI及其相关生物标志物的研究。
我们纳入了22项研究，所有鉴定出的标志物（C反应蛋白、D-二聚体、纤维蛋白原、细胞因子、白细胞介素-6、肿瘤坏死因子-α、细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）、中性粒细胞与淋巴细胞比值（NLR）、白细胞介素-8、五聚素-3、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、钙卫蛋白、E-选择素、P-选择素、新蝶呤、高迁移率族蛋白B1（HGMB-1）、骨保护素（OPG）和sortilin）均与晚期CLTI、这些患者的主要肢体或主要心血管事件呈正相关。
所有研究的标志物在CLTI患者中值均升高，尤其是与糖尿病相关时，这证明了糖尿病与这些患者的主要肢体或心血管事件之间存在非常重要的关联。需要更多研究来验证这些标志物在CLTI患者诊断或预后方面的作用，并尝试寻找针对这些患者炎症或内皮功能障碍的新医学策略。
