背景:慢性威胁肢体缺血(CLTI),外周动脉疾病的晚期,被诊断为缺血性静息疼痛,不愈合的溃疡,或者坏疽.一些研究已经证明炎症和内皮功能障碍是CLTI的一些主要底物。
方法:根据PRISMA指南进行叙述性综述并报告。搜索了三个数据库-WebofScience,Medline,和EMBASE-用于评估CLTI及其相关生物学标志物的研究。
结果:我们纳入了22项研究,和所有鉴定的标记(C反应蛋白,D-二聚体,纤维蛋白原,细胞因子,IL-6,TNF-α,ICAM-1(细胞内粘附分子-1),VCAM-1(血管细胞粘附分子-1),中性粒细胞与淋巴细胞比率(NLR),IL-8,Pentraxin-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,高迁移率组Box-1蛋白(HGMB-1),骨保护素(OPG)和Sortilin)与晚期CLTI呈正相关,这些患者的主要肢体或主要心血管事件。
结论:所有研究的标志物在CLTI患者中都有升高的值,尤其是当与糖尿病有关时,在这些患者中,证明糖尿病与主要肢体或心血管事件之间存在非常重要的关联。需要更多的研究来验证这些标志物在CLTI患者的诊断或预后方面以及试图寻找针对这些患者的炎症或内皮功能障碍的新的医学策略。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.