紫杉醇涂层球囊治疗2型糖尿病膝下动脉严重病变患者发生远期再狭窄预测模型的构建

doi:10.11958/20240057

天津医药 ›› 2024, Vol. 52 ›› Issue (8): 830-834.doi: 10.11958/20240057

紫杉醇涂层球囊治疗2型糖尿病膝下动脉严重病变患者发生远期再狭窄预测模型的构建

林峰¹(), 陈铃雄¹, 刘羽²^,^△(), 张旭明¹, 尹志达¹, 林坛辉¹, 刘尊荣¹

1 福建医科大学附属闽东医院介入血管外科（邮编355000）
2 超声医学科

收稿日期:2024-01-09 修回日期:2024-03-02 出版日期:2024-08-15 发布日期:2024-08-16
通讯作者: △E-mail：460208260@qq.com
作者简介:林峰（1982），男，副主任医师，主要从事外周血管疾病方面研究。E-mail：wws79101@126.com
基金资助:
福建省自然科学基金资助项目(2022J011512)

Construction of long term restenosis prediction model for patients with severe subpatellar artery lesions in type 2 diabetes treated with paclitaxel coated balloon

LIN Feng¹(), CHEN Lingxiong¹, LIU Yu²^,^△(), ZHANG Xuming¹, YIN Zhida¹, LIN Tanhui¹, LIU Zunrong¹

1 Interventional Vascular Surgery
2 Department of Ultrasound, Fujian Medical University Affiliated Mindong Hospital, Fu'an 355000, China

Received:2024-01-09 Revised:2024-03-02 Published:2024-08-15 Online:2024-08-16
Contact: △E-mail：460208260@qq.com

林峰, 陈铃雄, 刘羽, 张旭明, 尹志达, 林坛辉, 刘尊荣. 紫杉醇涂层球囊治疗2型糖尿病膝下动脉严重病变患者发生远期再狭窄预测模型的构建[J]. 天津医药, 2024, 52(8): 830-834.

LIN Feng, CHEN Lingxiong, LIU Yu, ZHANG Xuming, YIN Zhida, LIN Tanhui, LIU Zunrong. Construction of long term restenosis prediction model for patients with severe subpatellar artery lesions in type 2 diabetes treated with paclitaxel coated balloon[J]. Tianjin Medical Journal, 2024, 52(8): 830-834.

摘要/Abstract

摘要：

目的分析紫杉醇涂层球囊（PCB）治疗2型糖尿病（T2DM）膝下动脉严重病变患者发生远期再狭窄的影响因素，并构建预测模型。方法选取接受PCB治疗的T2DM膝下动脉严重病变患者268例。治疗后随访1年，将出现靶血管再狭窄的患者纳入观察组，其余纳入对照组。统计2组临床资料，多因素Logistic回归分析T2DM膝下动脉严重病变患者发生远期再狭窄的影响因素，并构建列线图预测模型。结果 260例（97.00%）患者完成随访，再狭窄发生率为13.85%（36/260）。单因素和多因素Logistic回归分析显示年龄、合并冠心病、泛大西洋协作组织（TASC）Ⅱ分级、Fontaine分期、糖化血红蛋白（HbA1c）、低密度脂蛋白胆固醇（LDL-C）为T2DM膝下动脉严重病变患者发生远期再狭窄的独立影响因素（P<0.05）。构建的列线图预测模型中得分最高的风险因素为HbA1c，其后依次为年龄、LDL-C、TASCⅡ分级、Fontaine分期、合并冠心病; 根据列线图计算各项影响因素的总分为210分时，远期再狭窄的概率达90%。列线图模型的区分度为0.866，Brier得分为0.081，校准斜率为0.733。当风险阈值为0.15~1.0时预测模型评估T2DM膝下动脉严重病变患者发生远期再狭窄的净受益率大于单独评估，且当风险阈值越小时净受益率越大，在阈值达0.23时受益最佳。结论 PCB治疗T2DM膝下动脉严重病变患者发生远期再狭窄的影响因素包括年龄、合并冠心病、TASCⅡ分级、Fontaine分期、HbA1c、LDL-C，根据以上影响因素构建的预测模型在预测患者远期再狭窄方面具有重要价值。

关键词: 糖尿病, 2型, 紫杉醇涂层球囊, 膝下动脉病变, 远期再狭窄, 预测模型

Abstract:

Objective To analyze influencing factors of paclitaxel coated ballon (PCB) on long-term restenosis in patients with severe subpatellar artery lesions in type 2 diabetes mellitus (T2DM), and to construct a prediction model. Methods A total of 268 T2DM patients with severe infra-popliteal artery disease and received PCB treatment were selected. Patients were followed up for 1 year after treatment. Patients with target vessel restenosis were included in the observation group, and the other patients were included in the control group. Clinical data of two groups were analyzed.Multivariable Logistic regression analysis was used to analyze influencing factors of long-term restenosis in T2DM patients with severe infra-knee arterial disease, and a nomogram prediction model was constructed. Results A total of 260 patients (97.00%) completed the follow-up, and the incidence of restenosis was 13.85% (36/260). Both univariate and multivariate Logistic regression analysis showed that age, coexisting coronary heart disease, Trans-Atlantic Inter-Society Consensus (TASC) Ⅱ classification, Fontaine staging, glycosylated hemoglobin (HbA1c) and low density lipoprotein cholesterol (LDL-C) were independent influencing factors for the occurrence of long-term restenosis in T2DM patients with severe infra-popliteal artery disease (P < 0.05). The risk factor with the highest score in the constructed nomogram prediction model was HbA1c, followed by age, LDL-C, TASCⅡ classification, Fontaine stage and coronary heart disease. According to the column chart, the total score was 210 points, and the probability of long-term restenosis was 90%. The discrimination of the nomogram model was 0.866, with a Brier score of 0.081 and a calibration slope of 0.733. When the risk threshold was 0.15 to 1.0, the net benefit rate of long-term restenosis in T2DM patients with severe infra-popliteal artery disease was greater than that of individual evaluation. The smaller the risk threshold, the greater the net benefit rate. The benefit was the best when the threshold reached 0.23. Conclusion The influencing factors for long-term restenosis in T2DM patients with severe subknee artery disease treated by PCB include age, combined coronary heart disease, TASCⅡ grade, Fontaine stage, HbA1c and LDL-C. The prediction model based on the above influencing factors has important value in predicting long-term restenosis in patients.

Key words: diabetes mellitus, type 2, paclitaxel coated balloon, severe lesion of subpatellar artery, long-term restenosis, prediction model

中图分类号:

R587.2，R654.4

图/表 7

参考文献 21

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组别	n	性别（男/女）		年龄/岁		BMI/（kg/m²）		合并高血压		合并冠心病		吸烟史		饮酒史		糖尿病病程/年		主要临床表现（A/B/C）^▲
对照组	224	126/98		65.37±4.50		25.04±2.08		133（59.38）		40（17.86）		95（42.41）		103（45.98）		8.16±2.28		195/17/12
观察组	36	24/12		68.69±4.21		25.31±2.15		23（63.89）		12（33.33）		19（52.78）		22（61.11）		8.30±2.41		31/3/2
χ²或t		1.379		4.144^＊＊		0.720		0.263		4.643^＊		1.354		2.844		0.339		0.028
组别	ABI （<0.5/≥0.5）		TASCⅡ分级（A/B/C/D）		Fontaine分期（Ⅱ/Ⅲ/Ⅳ）		HbA1c/%		FPG/ （mmol/L）		2 hPG/ （mmol/L）		TC/ （mmol/L）		TG/ （mmol/L）		LDL-C/（mmol/L）		HDL-C/（mmol/L）
对照组	125/99		57/70/51/46		90/73/61		8.20±0.97		9.24±1.22		11.73±2.85		4.16±0.61		1.48±0.37		2.49±0.49		1.13±0.20
观察组	20/16		2/10/16/8		7/15/14		8.93±1.02		9.52±1.31		12.12±2.67		4.32±0.57		1.55±0.34		2.78±0.45		1.08±0.22
χ²、t或Z	0.001		2.376^＊		2.128^＊		4.162^＊＊		1.265		0.769		1.474		1.065		3.332^＊＊		1.373

组别	n	性别（男/女）		年龄/岁		BMI/（kg/m²）		合并高血压		合并冠心病		吸烟史		饮酒史		糖尿病病程/年		主要临床表现（A/B/C）^▲
对照组	224	126/98		65.37±4.50		25.04±2.08		133（59.38）		40（17.86）		95（42.41）		103（45.98）		8.16±2.28		195/17/12
观察组	36	24/12		68.69±4.21		25.31±2.15		23（63.89）		12（33.33）		19（52.78）		22（61.11）		8.30±2.41		31/3/2
χ²或t		1.379		4.144^＊＊		0.720		0.263		4.643^＊		1.354		2.844		0.339		0.028
组别	ABI （<0.5/≥0.5）		TASCⅡ分级（A/B/C/D）		Fontaine分期（Ⅱ/Ⅲ/Ⅳ）		HbA1c/%		FPG/ （mmol/L）		2 hPG/ （mmol/L）		TC/ （mmol/L）		TG/ （mmol/L）		LDL-C/（mmol/L）		HDL-C/（mmol/L）
对照组	125/99		57/70/51/46		90/73/61		8.20±0.97		9.24±1.22		11.73±2.85		4.16±0.61		1.48±0.37		2.49±0.49		1.13±0.20
观察组	20/16		2/10/16/8		7/15/14		8.93±1.02		9.52±1.31		12.12±2.67		4.32±0.57		1.55±0.34		2.78±0.45		1.08±0.22
χ²、t或Z	0.001		2.376^＊		2.128^＊		4.162^＊＊		1.265		0.769		1.474		1.065		3.332^＊＊		1.373

因素	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.192	0.053	13.207	<0.001	1.212（1.093~1.345）
合并冠心病	1.569	0.563	7.755	0.005	4.802（1.592~14.490）
TASCⅡ分级			12.732	0.005
B级vs. A级	1.758	0.892	3.887	0.049	5.803（1.010~33.332）
C级vs. A级	3.094	0.921	11.273	0.001	22.055（3.625~134.207）
D级vs. A级	2.500	0.949	6.935	0.008	12.184（1.895~78.328）
Fontaine分期			6.789	0.009
Ⅲ期vs. Ⅱ期	1.556	0.464	11.239	0.001	4.742（1.909~11.780）
Ⅳ期vs. Ⅱ期	1.387	0.613	5.118	0.024	4.003（1.204~13.312）
HbA1c	1.099	0.268	16.817	<0.001	3.002（1.775~5.076）
LDL-C	1.756	0.523	11.293	0.001	5.791（2.079~16.130）

因素	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.192	0.053	13.207	<0.001	1.212（1.093~1.345）
合并冠心病	1.569	0.563	7.755	0.005	4.802（1.592~14.490）
TASCⅡ分级			12.732	0.005
B级vs. A级	1.758	0.892	3.887	0.049	5.803（1.010~33.332）
C级vs. A级	3.094	0.921	11.273	0.001	22.055（3.625~134.207）
D级vs. A级	2.500	0.949	6.935	0.008	12.184（1.895~78.328）
Fontaine分期			6.789	0.009
Ⅲ期vs. Ⅱ期	1.556	0.464	11.239	0.001	4.742（1.909~11.780）
Ⅳ期vs. Ⅱ期	1.387	0.613	5.118	0.024	4.003（1.204~13.312）
HbA1c	1.099	0.268	16.817	<0.001	3.002（1.775~5.076）
LDL-C	1.756	0.523	11.293	0.001	5.791（2.079~16.130）

紫杉醇涂层球囊治疗2型糖尿病膝下动脉严重病变患者发生远期再狭窄预测模型的构建

Construction of long term restenosis prediction model for patients with severe subpatellar artery lesions in type 2 diabetes treated with paclitaxel coated balloon

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