全身炎症反应指数对下肢股腘动脉闭塞介入术后的预后评估价值

Systemic inflammatory response index for predicting outcomes of interventional surgery in patients with femoral popliteal artery occlusion

关键词:  全身炎症反应指数  下肢动脉硬化闭塞症  股腘动脉闭塞  腔内介入治疗  预后

Key words:  systemic inflammatory response index  lower extremity arteriosclerosis obliterans  femoropopliteal arteryocclusion  intracavitary interventional therapy  prognosis

摘要:

目的探讨术前全身炎症反应指数（systemic inflammatory response index, SIRI）在评估下肢股腘动脉闭塞腔内介入治疗术后患者预后方面的有效性。 方法本研究共纳入2019年1月—2022年12月两中心入组的227例股腘动脉闭塞的患者,计算每位患者的全身炎症反应指数（SIRI）。根据SIRI三分位数将患者分为三组，分别为低、中、高三组，主要观察终点是患者临床驱动的非计划再干预，次要观察终点为复合不良事件（患者的全因死亡和手术患肢截肢）。分析SIRI是否为临床驱动再干预的独立危险因素。 结果研究结果显示在随访365d期间，有60例患者出现了临床驱动再干预，有85例患者出现复合不良事件终点（包括截肢、全因死亡），Kaplan-Meier生存分析表明，第三组高SIRI患者发生临床驱动再干预和复合不良事件在随访期间的1年发生率明显升高（P＜0.01），并且SIRI无论作为连续变量还是分类变量，单因素COX分析和多因素COX分析均显示SIRI与临床驱动的再干预有显著相关性（HR=1.278,95%Cl: 1.0811.511,P=0.04；HR=2.849,95%CI: 1.4305.678,P=0.030）。 结论SIRI是股腘动脉闭塞患者腔内介入手术临床驱动再干预的独立危险因素。

Abstract:

ObjectiveTo explore preoperative systemic inflammatory response index(SIRI) in predicting outcomes of intraluminal surgery in patients with femoral popliteal artery occlusion of the lower limbs. MethodsA total of 227 patients with femoral popliteal artery occlusion who underwent intraluminal interventional surgery in two medical centers from January 2019 to December 2022 were enrolled. Preoperative SIRI values were calculated and patients were stratified into three groups according to SIRI tertiles. The primary endpoint of the study was unplanned reintervention and the secondary endpoint was compound adverse events, including all-cause death and surgical amputation of the affected limb. ResultsPatients were followed up for one year after surgical intervention. During the follow-up period the unplanned reintervention was performed in 60 cases, and adverse events occurred in 85 cases. Kaplan-Meier analysis demonstrated that patients with upper tirtile SIRI exhibited significantly higher rates of unplanned reintervention and incidence of compound adverse events(P<0.01). Univariate and multivariate COX analyses showed that higher SIRI value as a continuous variable or categorical variable was an independent risk factor for unplanned reintervention(HR=1.278, 95%CI: 1.081-1.511, P=0.04; HR=2.849, 95%CI: 1.430-5.678,P=0.03). ConclusionSIRI is an independent risk factor for clinical reintervention, which may serve as a predictor for outcomes of interventional surgery in patients with femoral popliteal artery occlusion.