纤维蛋白原/白蛋白比值联合乳酸脱氢酶预测下肢 动脉硬化闭塞症支架植入术后预后的价值

Pridiction value of fibrinogen/albumin ratio combined with lactate dehydrogenase levels for occurrence of major adverse limb events in patients with lower extremity arteriosclerotic obliterans after stent implantation

关键词:  纤维蛋白原与白蛋白比值  乳酸脱氢酶  预后  下肢动脉硬化闭塞症

Key words:  fibrinogen to albumin ratio  lactate dehydrogenase  prognosis  atherosclerotic occlusive

摘要:

目的探讨纤维蛋白原与白蛋白比值（fibrinogen to albumin ratio, FAR）联合乳酸脱氢酶（lactate dehydrogenase, LDH）对下肢动脉硬化闭塞症（arteriosclerosis obliterans, ASO）患者支架植入术后预后的预测价值。 方法收集2020年1月至2021年12月于海军军医大学第一附属医院血管外科行腔内支架植入术治疗的227例ASO患者的临床资料，根据随访1年内主要肢体不良事件（major adverse limb events, MALE）的发生情况将其分为无MALE组（n=154）和MALE组（n=73）。收集患者相关资料，如性别、就诊年龄、原发性高血压病史、2型糖尿病病史、肾功能不全病史、吸烟史、体质量指数（body mass index, BMI)、术前血常规、血生化、凝血功能、靶血管位置、植入支架情况（类型、数量、长度、平均直径）、术后远端流出道情况、术后用药方案等。分析支架植入术后1年内MALE发生的危险因素。 结果FAR、LDH均为支架植入术后发生MALE的独立危险因素（P<0.05）。受试者工作特征（receiver operating characteristic, ROC）曲线分析结果显示，FAR指标曲线下面积（area under the curve, AUC）为0.618（95%CI： 0.541~0.692；P=0.004），最佳截断值、灵敏度、特异度分别为9.32、59.51%、58.92%。LDH指标AUC为0.608（95%CI： 0.529~0.688；P=0.009），最佳截断值、灵敏度、特异度分别为202.25U/L、61.22%、56.93%。FAR联合LDH指标的AUC为0.645（95%CI： 0.568~0.722；P<0.001），灵敏度、特异度分别为63.06%、64.44%。 结论ASO支架植入术后1年内发生MALE事件与FAR、LDH有关，单一指标均可用于预测支架植入术后1年内MALE发生概率，联合指标可提高其诊断预测效能。

Abstract:

ObjectiveTo investigate the value of fibrinogen to albumin ratio(FAR) combined lactate dehydrogenase(LDH) level in predicting the occurrence of major adverse limb event(MALE) in patients with lower limb atherosclerotic obliterans(ASO) following stent implantation. MethodsClinical data of 227 ASO patients who underwent endoluminal stent implantation in Department of Vascular Surgery, the First Affiliated Hospital of Naval Military Medical University between January 2020 and December 2021 were retrospectively analyzed. MALE occurred within 1 year after stent implantation in 73 cases(MALE group) and did not occur in 154 cases(no-MALE group). The gender, age, history of hypertension, type 2 diabetes mellitus(T2DM), renal insufficiency, smoking history, body mass index(BMI), post-procedure medication regimen, pre-procedure blood counts, blood biochemistry, coagulation function, target vessel location, the type, number, length and mean diameter of implanted stents, and post-procedure distal outflow tract were compared between two groups. The risk factors for MALE within 1 year after stent implantation was analyzed with multivariate logistic regression. ResultsLogistic regression analysis showed that FAR and LDH were independent risk factors for MALE occurrence after stent implantation(P<0.05). Receiver operating characteristic(ROC) curve analysis revealed that the area under the curve(AUC) of FAR and LDH in predicting risk MALE occurrence was 0.618(95%CI： 0.541-0.692; P=0.004) and 0.608(95%CI： 0.529-0.688; P=0.004), with an optimal cut-off value, sensitivity, and specificity of 9.32, 5951%, 58.92%, and 202.25U/L, 61.22%, 56.93%, respectively. The AUC of the combination of FAR and LDH was 0645(95%CI： 0.568-0.722; P<0.001), with a sensitivity and specificity of 63.06% and 64.44%, respectively. ConclusionThe incidence of MALE within 1 year following stent implantation in ASO patients is correlated with FAR and LDH levels, the combination of two indicators has a better predictive value for risk of MALE.