Arterial Occlusive Diseases

动脉闭塞性疾病
  • 文章类型: Journal Article
    严重的威胁肢体缺血(CLTI)是一种严重的疾病,其特征是静息疼痛和缺血性组织丢失,影响5%至10%的外周动脉疾病患者。在美国,很少有美国食品和药物管理局批准的用于膝关节以下动脉(BTK)主要治疗的设备。不幸的是,所有人都因内膜增生而遭受高再狭窄率,弹性反冲,和未经处理的解剖,因为缺乏脚手架。EspritBTK系统是一种可吸收的,药物洗脱支架装置有可能解决由于膝下动脉粥样硬化而患有CLTI的人的未满足的需求。LIFE-BTK(膝关节以下药物洗脱可吸收支架治疗的安全性和功效调查)随机对照试验(RCT)是对EspritBTK药物洗脱可吸收支架的前瞻性设计的上市前评估用于治疗这些患者。
    LIFE-BTK试验招募了261名CLTI受试者进行RCT,另外7名受试者进行了药代动力学亚研究。RCT的目的是评估EspritBTK支架与经皮腔内血管成形术相比的安全性和有效性。主要疗效终点是12个月时保肢和主要通畅的复合终点。主要的安全终点是在6个月和30天没有重大的不良肢体事件和围手术期死亡。分别。临床随访计划为5年。
    如果我们要改善这一具有挑战性的患者组的预后,必须在随机对照试验中测试新型设备,以评估其安全性和有效性,与护理标准相比。
    UNASSIGNED: Critical limb-threatening ischemia (CLTI) is a severe condition characterized by rest pain and ischemic tissue loss that affects 5% to 10% of people with peripheral artery disease. In the United States, there are few Food and Drug Administration-approved devices for the primary treatment of arteries below-the-knee (BTK). Unfortunately, all suffer from high restenosis rates due to intimal hyperplasia, elastic recoil, and untreated dissection because of a lack of scaffolding. The Esprit BTK system is a resorbable, drug-eluting scaffold device with the potential to address an unmet need in people suffering from CLTI because of infrapopliteal atherosclerosis. The LIFE-BTK (pivotaL Investigation of saFety and Efficacy of drug-eluting resorbable scaffold treatment-Below The Knee) randomized controlled trial (RCT) is a prospectively designed premarket evaluation of the Esprit BTK drug-eluting resorbable scaffold used in the treatment of those patients.
    UNASSIGNED: The LIFE-BTK trial enrolled 261 subjects with CLTI for the RCT and a further 7 subjects for a pharmacokinetic substudy. The objective of the RCT was to evaluate the safety and efficacy of the Esprit BTK scaffold compared to percutaneous transluminal angioplasty. The primary efficacy end point was a composite of limb salvage and primary patency at 12 months. The primary safety end point is freedom from major adverse limb events and peri-operative death at 6 months and 30 days, respectively. Clinical follow-up care is planned for 5 years.
    UNASSIGNED: Novel devices must be tested in RCTs to evaluate their safety and efficacy compared to the standard of care if we are to improve outcomes for this challenging group of patients.
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  • 文章类型: Case Reports
    背景技术脑血管闭塞是与中风相关的关键健康问题。世界范围内的主要死亡原因。大血管闭塞,构成急性缺血性中风的重要部分,呈现严重的患者结果。涉及多个颅外血管的阻塞很少见,但由于可能没有明显的症状,因此在早期发现方面存在挑战。病例报告:一名65岁的男性,有明显的吸烟史,没有高血压或心血管疾病史,表现为每天4至5次复发性全身强直性癫痫发作。尽管神经系统检查正常,颈部超声检查提示颈动脉和椎动脉有潜在的阻塞.常规血管造影显示轻度冠状动脉斑块,但来自主动脉的所有颅分支完全闭塞。在瓷主动脉旁边.颈部CT血管造影证实主动脉主动脉上分支完全闭塞,右颈内动脉缺失,左侧颈内动脉近端闭塞的证据。由于患者病情稳定,因此无需手术干预即可进行医疗管理。他的药物治疗方案包括抗血小板治疗和他汀类药物出院。四个月的随访显示症状明显改善,CT显示脑血流循环变化最小。结论该案例强调了大脑在承受严重血管挑战方面的显着适应能力。罕见的多发颅外血管闭塞和瓷主动脉的存在进一步使病例复杂化。利用先进的成像技术和个性化治疗方法对于管理复杂的血管状况至关重要。在这种情况下,持续的研究和仔细的监测对于促进理解和管理至关重要。
    BACKGROUND Cerebrovascular occlusion is a critical health concern associated with strokes, a leading cause of mortality worldwide. Large vessel occlusion, constituting a significant portion of acute ischemic strokes, presents serious patient outcomes. Occlusions involving multiple extracranial vessels are rare but pose challenges in early detection due to potential absence of overt symptoms. CASE REPORT A 65-year-old man with a significant smoking history and no prior history of hypertension or cardiovascular disease presented with recurrent generalized tonic seizures occurring 4 to 5 times daily. Despite normal neurological examinations, neck sonography indicated potential obstruction in the carotid and vertebral arteries. Conventional angiography revealed mild coronary artery plaques but complete occlusion of all cranial branches originating from the aorta, alongside porcelain aorta. Neck CT angiography confirmed complete occlusion of the supra-aortic branches of the aorta and absence of the right internal carotid artery, with evidence of proximal occlusion of the left internal carotid artery. Medical management without surgical intervention was pursued due to the patient\'s stable condition. He was discharged with a medication regimen including antiplatelet therapy and statins. Four-month follow-up showed significant symptom improvement, with minimal changes in brain blood flow circulation noted on CT. CONCLUSIONS This case underscores the brain\'s remarkable adaptive capacity in withstanding severe vascular challenges. The rarity of multiple extracranial vessel occlusions and presence of porcelain aorta further complicated the case. Utilizing advanced imaging techniques and personalized treatment approaches are crucial in managing complex vascular conditions. Ongoing research and careful monitoring are essential to advance understanding and management in such cases.
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  • 文章类型: Journal Article
    目的:机械血栓切除术(MT),我们调查了主动脉弓钙化(AoAC)和颈动脉窦钙化(CaSC)对有症状的脑出血(sICH)和急性大动脉闭塞(LAO)预后不良的重要性.
    方法:在这项回顾性观察研究中,我们使用AoAC分级量表评分加Woodcock视觉评分计算了颅前动脉钙化负荷(PACB)评分(AoAC和CaSC的负荷评分).根据欧洲合作急性中风研究III的定义,结果测量为sICH。3个月改良的Rankin量表评分3-6被指定为不良结果。
    结果:与PACB<3的患者相比,PACB≥3的患者发生sICH的风险显著增高(比值比[OR]=2.567,95%置信区间[CI]=1.187-5.550),预后不良(OR=4.777,95%CI=1.659-13.756)。根据接收器工作特性(ROC)曲线,将PACB添加到回归模型中可增强不良结局的预测值(ROC曲线下面积[AUC]:0.718vs.0.519,Z=2.340)和接受MT的患者(AUC:0.714vs.0.584,Z=2.021),独立。
    结论:与PACB相关的因素与全身动脉粥样硬化的常见危险因素一致。低PACB评分提示预后较好。在MT后患有LAO的患者中,PACB可用于预测sICH和不良临床结局。
    OBJECTIVE: With mechanical thrombectomy (MT), we investigated the prognostic importance of aortic arch calcification (AoAC) and carotid sinus calcification (CaSC) for symptomatic intracerebral hemorrhage (sICH) and poor outcome in acute large artery occlusion (LAO).
    METHODS: In this retrospective observational study, we calculated pre-cranial artery calcification burden (PACB) scores (burden score of AoAC and CaSC) using the AoAC grading scale score plus Woodcock visual score. The outcome measure was sICH per the European Cooperative Acute Stroke Study III definition. A 3-month modified Rankin scale score 3-6 was designated as poor outcome.
    RESULTS: Compared with patients who had PACB <3, those with PACB ≥3 showed substantially higher risks of sICH (odds ratio [OR] = 2.567, 95% confidence interval [CI] = 1.187-5.550) and poor outcome (OR = 4.777, 95% CI = 1.659-13.756). According to receiver operating characteristic (ROC) curves, adding PACB to the regression model enhanced the predictive value for poor outcome (area under the ROC curve [AUC]: 0.718 vs. 0.519, Z = 2.340) and in patients receiving MT (AUC: 0.714 vs. 0.584, Z = 2.021), independently.
    CONCLUSIONS: Factors related to PACB were consistent with common risk factors of systemic atherosclerosis. Low PACB scores indicated better prognosis. In patients with LAO following MT, PACB was useful in predicting sICH and poor clinical outcome.
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  • 文章类型: Journal Article
    方法:前瞻性研究。
    目的:探讨颈椎小关节脱位时椎动脉(VA)闭塞的发生率及脊髓前动脉(ASA)是否闭塞。
    方法:大学医院,中国。
    方法:在2年内,前瞻性纳入21例颈椎小关节脱位的常规患者。所有患者均接受计算机断层扫描血管造影(CTA)以评估VA的通畅性,神经根前动脉(ARAs),和受伤时的ASA。记录了临床数据,包括人口统计,症状性椎基底动脉缺血,美国脊髓损伤协会减损量表(ASIA)等级,ASA和VA放射学特征。
    结果:21例患者中有5例(24%)发生了VA单侧闭塞,其中单侧小关节脱位2例,双侧小关节脱位3例。在所有21例患者中均未发现ASA闭塞,其中5例伴有VA单侧闭塞。没有患者出现症状性椎基底动脉缺血。
    结论:VA闭塞发生在大约四分之一的颈椎关节突脱位中,很少有症状的椎基底动脉缺血。颈椎小关节脱位后ASA未闭塞,即使是单侧VA闭塞。
    METHODS: A prospective study.
    OBJECTIVE: To investigate the incidence of vertebral artery (VA) occlusion and whether anterior spinal artery (ASA) is occluded in cervical facet dislocation.
    METHODS: University hospital, China.
    METHODS: During a 2-year period, 21 conventional patients with cervical facet dislocation were prospectively enrolled. All patients received computed tomography angiography (CTA) to assess the patency of the VA, anterior radiculomedullary arteries (ARAs), and ASA at the time of injury. Clinical data were documented, including demographics, symptomatic vertebrobasilar ischemia, American Spinal Injury Association Impairment Scale (ASIA) grades, and ASA and VA radiological characteristics.
    RESULTS: VA unilateral occlusion occurred in 5 of 21 patients (24%), including 2 with unilateral facet dislocation and 3 with bilateral facet dislocation. No ASA occlusion was found in all 21 patients, including 5 with VA unilateral occlusion. No patients had symptomatic vertebrobasilar ischemia.
    CONCLUSIONS: VA occlusion occurs in approximately one-fourth of cervical facet dislocations, with infrequent symptomatic vertebrobasilar ischemia. ASA is not occluded following cervical facet dislocation, even with unilateral VA occlusion.
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  • 文章类型: Journal Article
    目的:桡动脉闭塞(RAO)是经桡动脉途径(TRA)导管插入术的主要并发症。我们的目的是揭示高敏C反应蛋白(hs-CRP)和全血细胞计数(CBC)成分的能力,是炎症标志物,预测RAO。方法:将患者分为两组:RAO组103例和无RAO组300例。CRP,评价CBC组分和RAO。结果:hs-CRP显著升高,单核细胞,血小板(PLT),TRA后观察血小板分布宽度(PDW)和血小板聚集值,只有PDW的增加,在回归分析中发现PLT和hs-CRP是独立的决定因素。结论:高PDW和PLT和hs-CRP水平升高是RAO发展的新的独立决定因素。
    炎症标志物在桡动脉闭塞发生中的作用,这限制了经桡动脉的心导管插入。
    Aim: Radial artery occlusion (RAO) is a major complication of catheterization via transradial access (TRA). Our aim is to reveal the ability of high-sensitive C-reactive protein (hs-CRP) and complete blood count (CBC) components, which are inflammation markers, to predict RAO. Methods: Patients were divided into two groups: 103 with RAO and 300 without RAO. The relationship between CRP, CBC components and RAO was evaluated. Results: A significant increase in hs-CRP, monocyte, platelet (PLT), platelet distribution width (PDW) and plateletcrit values was observed after TRA, and only the increase in PDW, PLT and hs-CRP was found to be independent determinants in regression analysis. Conclusion: High PDW and PLT and increased hs-CRP levels are new independent determinants of the development of RAO.
    The role of inflammation markers in occurrence of radial artery occlusion that restricts the transradial cardiac catheterization.
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  • 文章类型: Journal Article
    背景技术用于脑血管造影和神经介入治疗的经桡动脉入路(TRA)已获得普及,但是与股动脉穿刺相比,桡动脉的狭窄直径和弱搏动降低了初始穿刺成功率。这项来自单个中心的回顾性研究评估了543例经桡动脉入路(TRA)进行脑血管造影的患者中桡动脉闭塞(RAO)的发生率和相关因素。材料与方法我们纳入了2021年7月至2024年2月接受TRA的543例患者。超声用于确定桡动脉是否闭塞。记录相关临床资料以评估RAO的发生率和影响因素。结果在DSA后24小时,我们进行了超声成像。患者分为RAO组(n=32)和非RAO组(n=511)。结果显示,RAO在没有添加肝素的抗痉挛药的患者中明显更高,他们更有可能需要三次以上的桡动脉穿刺尝试,并且倾向于使用Cordis穿刺针接受11厘米的桡动脉鞘(均P<0.05)。多因素logistic回归分析显示抗痉挛药中加入肝素(OR=0.076,95%CI:0.018~0.321,P<0.001),少于3次桡动脉穿刺尝试(OR=0.245,95%CI:0.111-0.541,P<0.001),使用16厘米的桡动脉鞘(OR=0.195,95%CI:0.067-0.564,P=0.003),使用Terumo穿刺针(OR=0.325,95%CI:0.148-0.717,P=0.005)可以降低桡动脉闭塞的发生率。结论我们的中心发现,在抗痉挛药物中加入肝素可减少桡动脉穿刺尝试的次数,使用16厘米的桡动脉鞘显着降低了经桡动脉脑血管造影后早期RAO的发生率。
    BACKGROUND The transradial approach (TRA) for cerebral angiography and neurointerventional treatment has gained popularity, but the narrow diameter and weak pulsation of the radial artery lower the initial puncture success rate compared to femoral artery puncture. This retrospective study from a single center evaluated the incidence of and factors associated with radial artery occlusion (RAO) in 543 patients who underwent transradial approach (TRA) for cerebral angiography. MATERIAL AND METHODS We included 543 patients who underwent TRA from July 2021 to February 2024. Ultrasound was used to determine whether the radial artery was occluded. Relevant clinical data were recorded to assess the incidence of and factors affecting RAO. RESULTS At 24 h after DSA, we performed ultrasound imaging. The patients were divided into an RAO group (n=32) and a non-RAO group (n=511). Results showed that RAO was significantly higher in patients who did not have add heparin to the antispasmodic agents, and they were more likely to have needed more than 3 radial artery puncture attempts, and tended to have received an 11-cm radial artery sheath with the Cordis puncture needles (all P<0.05). Multiple regression logistic analysis showed that adding heparin to the antispasmodic agents (OR=0.076, 95% CI: 0.018-0.321, P<0.001), having fewer than 3 radial artery puncture attempts (OR=0.245, 95% CI: 0.111-0.541, P<0.001), using a 16-cm radial artery sheath (OR=0.195, 95% CI: 0.067-0.564, P=0.003), and using Terumo puncture needles (OR=0.325, 95% CI: 0.148-0.717, P=0.005) can reduce the incidence of radial artery occlusion. CONCLUSIONS Our center found that adding heparin to the antispasmodic agents reduced the number of radial artery punctures attempts, and using a 16-cm radial artery sheath significantly lowered the incidence of early RAO after transradial cerebral angiography.
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  • 文章类型: Journal Article
    探讨经皮血管内成形术(PEA)联合选择性支架置入术治疗锁骨下动脉严重狭窄或闭塞的疗效和安全性。我们对接受PEA治疗的重度狭窄≥70%或锁骨下动脉闭塞患者进行回顾性研究.对其临床资料进行分析。回顾性研究了222例患者,其中男性151人(68.0%),女性71人(32.0%),年龄48-86(平均63.9±9.0)岁。47例(21.2%)患者有合并症。201例(90.5%)患者存在锁骨下动脉狭窄≥70%,21例(9.5%)患者存在完全锁骨下闭塞。所有(100%)患者均成功进行了血管成形术。190例(85.6%)使用球囊扩张支架,20例(9.0%)患者使用自膨式支架。仅12例(5.4%)仅接受球囊扩张治疗。在接受支架血管成形术治疗的210例患者中,71例(33.8%或71/210例)进行了球囊预扩张,139(66.2%或139/210)直接展开球囊扩张支架,和2(1.0%或2/210)经历了球囊扩张后。5例(2.3%或5/222)使用远端栓塞保护装置。3例(1.4%)患者发生围手术期并发症,其中主动脉夹层2例(0.9%),右侧大脑中动脉栓塞1例(0.5%)。无出血发生。182例(82.0%)患者随访6个月,1例(0.5%)患者发生再狭窄>70%,在接受12个月随访的68例(30.6%)患者中,11例(16.2%)患者发生了>70%的再狭窄。经皮血管内成形术可以安全有效地治疗严重狭窄≥70%或锁骨下动脉闭塞。
    To investigate the effect and safety of percutaneous endovascular angioplasty (PEA) with optional stenting for the treatment of severe stenosis or occlusion of subclavian artery, patients with severe stenosis ≥ 70% or occlusion of subclavian artery treated with PEA were retrospectively enrolled. The clinical data were analyzed. A total of 222 patients were retrospectively enrolled, including 151 males (68.0%) and 71 females (32.0%) aged 48-86 (mean 63.9 ± 9.0) years. Forty-seven (21.2%) patients had comorbidities. Subclavian artery stenosis ≥ 70% was present in 201 (90.5%) patients and complete subclavian occlusion in 21 (9.5%) cases. Angioplasty was successfully performed in all (100%) patients. Balloon-expandable stents were used in 190 (85.6%) cases, and self-expandable stents in 20 (9.0%) cases. Only 12 (5.4%) cases were treated with balloon dilation only. Among 210 patients treated with stent angioplasty, 71 (33.8% or 71/210) cases underwent balloon pre-dilation, 139 (66.2% or 139/210) had direct deployment of balloon-expandable stents, and 2 (1.0% or 2/210) experienced balloon post-dilation. Distal embolization protection devices were used in 5 (2.3% or 5/222) cases. Periprocedural complications occurred in 3 (1.4%) patients, including aortic dissection in 2 (0.9%) cases and right middle cerebral artery embolism in 1 (0.5%). No hemorrhage occurred. Among 182 (82.0%) patients with 6-month follow-up, restenosis > 70% occurred in 1 (0.5%) patient, and among 68 (30.6%) patients with 12-month follow-up, restenosis > 70% took place in 11 (16.2%) patients. Percutaneous endovascular angioplasty can be safely and efficiently performed for the treatment of severe stenosis ≥ 70% or occlusion of subclavian artery.
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  • 文章类型: Journal Article
    背景:椎动脉残端综合征(VASS)是急性卒中的一个原因。由于VASS发病机制的特殊性,VASS的介入治疗是困难的。常见的机械血栓切除术方法包括股动脉和桡动脉方法。然而,传统的方法可能不适合VASS。如果不采取有效措施及时开放违规船只,这可能导致高残疾率。近年来,关于治疗VASS的手术方法尚未达成共识。
    方法:患者就诊于急诊科,有2小时意识障碍史。
    方法:经过神经和磁共振成像检查,患者诊断为急性大血管闭塞性后循环脑梗死。
    方法:患者在当地医院静脉输注阿加曲班(10mg)后症状未缓解。我们首先尝试通过正常方法打开闭塞的椎动脉,但失败了。然后我们刺穿了椎动脉,成功地打开了闭塞的椎动脉,并进行了机械血栓切除术。
    结果:患者成功进行椎动脉穿刺和机械取栓,没有证据表明穿刺部位有术后出血或血管损伤。患者在手术后第二天恢复了意识,但身体活动仍然受损。经过4个月的康复,病人完全康复了。
    结论:当常规方法不能满足机械血栓切除术的要求时,椎动脉反向穿刺是VASS患者可行的手术方法。然而,由于案件数量少,一系列安全问题,如潜在的穿刺失败,穿刺后出血,血管闭塞仍需进一步探讨。
    BACKGROUND: Vertebral artery stump syndrome (VASS) is a cause of acute stroke. Owing to the particularity of the pathogenesis of VASS, interventional treatment of VASS is difficult. Common mechanical thrombectomy approaches include femoral and radial artery approaches. However, conventional approaches may not be suitable for VASS. If effective measures are not taken to open offending vessels in time, this can lead to a high rate of disability. In recent years, no consensus has been reached regarding surgical methods for treating VASS.
    METHODS: The patient presented to the emergency department with a 2-hour history of disturbance of consciousness.
    METHODS: After neurological and magnetic resonance imaging examinations, the patient was diagnosed with acute large vessel occlusive posterior circulation cerebral infarction.
    METHODS: The patient\'s symptoms were not relieved after intravenous infusion of argatroban (10 mg) at a local hospital. We first attempted to open the occluded vertebral artery through normal approaches but failed. We then punctured the vertebral artery, successfully opened the occluded vertebral artery, and performed mechanical thrombectomy.
    RESULTS: The patient underwent successful vertebral artery puncture and mechanical thrombectomy, with no evidence of postoperative bleeding or vascular injury at the puncture site. The patient regained consciousness the day after surgery but remained impaired in physical activity. After 4 months of rehabilitation, the patient recovered completely.
    CONCLUSIONS: When the conventional approach cannot meet the requirements of mechanical thrombectomy, reverse puncture of the vertebral artery is a feasible surgical method for patients with VASS. However, due to the small number of cases, a series of safety problems such as potential puncture failure, hemorrhage after puncture, and vascular occlusion still need to be further explored.
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
    OBJECTIVE: Bone morphogenetic protein-4 (BMP4) has been proved to be an important regulatory factor for the pathological process of atherosclerosis (AS). However, there are few related clinical studies. This study aims to investigate the levels of plasma BMP4 in patients suffering from the arterial occlusive diseases (ACD) characterized by AS, and further to test the relationship between BMP4 and inflammation and vascular injury.
    METHODS: A total of 38 ACD patients (the ACD group) and 38 healthy people for the physical examination (the control group) were enrolled. The plasma in each subject from both groups was obtained to test the levels of BMP4, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-10, and vascular endothelial cadherin (VE-cadherin), and the relationship between BMP4 and the detected indicators above were further analyzed.
    RESULTS: Compared with the control group, the patients in the ACD group displayed significant elevations in the neutrophil to lymphocyte ratio [NLR, 1.63 (1.26, 1.91) vs 3.43 (2.16, 6.61)] and platelet to lymphocyte ratio [PLR, 6.37 (5.26, 7.74) vs 15.79 (7.97, 20.53)], while decrease in the lymphocyte to monocyte ratio [LMR, 5.67 (4.41, 7.14) vs 3.43 (2.07, 3.74)] (all P<0.05). Besides, the ACD patients displayed significant elevations in plasma BMP4 [581.26 (389.85, 735.64) pg/mL vs 653.97(510.95, 890.43) pg/mL], TNF-α [254.16 (182.96, 340.70) pg/mL vs 293.29(238.90, 383.44) pg/mL], and VE-cadherin [1.54 (1.08, 2.13) ng/mL vs 1.85 (1.30, 2.54) ng/mL], and decrease in IL-10 [175.89 (118.39, 219.25) pg/mL vs 135.92 (95.80, 178.04) pg/mL] (all P<0.05). While the levels of IL-1β remained statistically comparable between the 2 groups (P=0.09). Furthermore, the plasma BMP4 levels were further revealed to be positively correlated with the levels of IL-1β (r=0.35), TNF-α (r=0.31) and VE-cadherin (r=0.47), while they were negatively correlated with the levels of IL-10 (r=-0.37; all P<0.01).
    CONCLUSIONS: After ACD occurrence, the patients\' plasma concentrations of BMP4 would be upregulated, which may serve as a candidate to indicate the levels of inflammation and vascular injury.
    目的: 骨形态发生蛋白-4(bone morphogenentic protein-4,BMP4)在动脉粥样硬化(atherosclerosis,AS)的病理过程中具有重要调节作用,但相关的临床研究较少。本研究拟观察以AS为主要病理特点的动脉阻塞性疾病(arterial occlusive disease,ACD)患者血浆BMP4的表达情况,并分析血浆中BMP4与炎症因子和血管损伤标志物之间的相关性。方法: 共招募38名诊断为ACD的患者(ACD组)和38名体检志愿者(对照组),抽取ACD组患者术前和对照组体检时的静脉血,比较2组血常规指标的差异。采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测血浆中BMP4、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素(interleukin,IL)-1β、IL-10及血管内皮钙黏蛋白(vascular endothelial cadherin,VE-cadherin)的表达变化,并进一步分析BMP4与以上各指标之间的相关性。结果: 与对照组相比,ACD组患者血常规结果表现为中性粒细胞-淋巴细胞比值[neutrophil to lymphocyte ratio,NLR;1.63 (1.26,1.91) vs 3.43(2.16,6.61)]和血小板-淋巴细胞比值[platelet to lymphocyte ratio,PLR;6.37(5.26,7.74) vs 15.79(7.97,20.53)]升高、淋巴细胞-单核细胞比值[lymphocyte to monocyte ratio,LMR;5.67(4.41,7.14) vs 3.43(2.07,3.74)]下降(均P<0.05);ACD组患者血浆BMP4[581.26(389.85,735.64) pg/mL vs 653.97(510.95,890.43) pg/mL]、TNF-α[254.16(182.96,340.70) pg/mL vs 293.29(238.90,383.44) pg/mL]及内皮标志物VE-cadherin[1.54 (1.08,2.13) ng/mL vs 1.85 (1.30,2.54) ng/mL]的水平均显著升高,而抗炎因子IL-10的水平显著下降[175.89 (118.39,219.25) pg/mL vs 135.92(95.80,178.04) pg/mL](均P<0.05)。2组间促炎因子IL-1β的差异无统计学意义[300.39(205.39,403.56) pg/mL vs 378.46 (243.20,448.69) pg/mL;P=0.09]。相关分析结果表明:血浆BMP4水平与促炎因子IL-1β(r=0.35)、TNF-α(r=0.31)以及内皮标志物VE-cadherin(r=0.47)呈正相关,与抗炎因子IL-10呈负相关(r=-0.37;均P<0.01)。结论: ACD患者血浆BMP4的水平升高,且与患者的炎症水平和血管损伤程度具有相关性。.
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