关键词: 下肢动脉硬化闭塞症, 缺血性坏疽感染, 介入治疗, 踝肱指数, 血管内皮生长因子

Abstract:

Objective To explore the predictive value of the combination of ankle brachial index （ABI）， vascular endothelial growth factor （VEGF）， neutrophil and lymphocyte ratio （NLR）， serum amyloid A （SAA）， and soluble triggering receptor expressed on human myeloid cells-1 （sTREM-1） in predicting the prognosis of endovascular interventional therapy （EVT） in patients with lower extremity arteriosclerosis obliterans （ASO） complicated with ischemic gangrene infection. Methods A total of 304 patients with ASO complicated by ischemic gangrene infection， who underwent EVT in the hospital from March 2019 to March 2024， were selected for the study. The long-term patency rate of the surgical site was analyzed. The patients were divided into a restenosis group （n = 102） and a patency group （n = 202） based on whether restenosis occurred within 2 years after the surgery. The clinical data， preoperative ABI， VEGF， NLR， SAA， and sTREM-1 levels were compared between the two groups. Spearman correlation analysis was employed to analyze the correlation between preoperative ABI， VEGF， NLR， SAA， and sTREM-1 levels and restenosis after interventional therapy in patients with ASO. Binary logistic regression analysis was utilized to analyze the influencing factors affecting the prognosis of EVT in patients with ASO complicated by ischemic gangrene infection. The receiver operating characteristic （ROC） curve was used to analyze the predictive value of preoperative ABI， VEGF， NLR， SAA， and sTREM-1 for the prognosis of EVT. Results The proportions of complete occlusion， TASC grade B， vascular lesion length， neutrophil count （NEUT）， serum C-reactive protein （CRP）， procalcitonin （PCT）， VEGF， NLR， SAA， and （sTREM-1） in the restenosis group were significantly higher than those in the patency group （P 0.05）， whereas the lymphocyte count （LYM） and ABI value were significantly lower （P 0.05）. Spearman correlation analysis indicated that the levels of VEGF， NLR， SAA， and sTREM-1 were significantly positively correlated with restenosis after interventional therapy （P 0.05）， and ABI was significantly negatively correlated with restenosis after interventional therapy （P 0.05）. Binary logistic regression analysis demonstrated that an increase in the length of vascular lesions， elevated preoperative levels of PCT， VEGF， NLR， SAA， and sTREM-1 were risk factors for restenosis after EVT in patients with ASO complicated with ischemic gangrene infection， and an increase in ABI was a protective factor （P 0.05）. ROC curve analysis showed that the sensitivities of preoperative ABI， VEGF， NLR， SAA， and sTREM-1， either alone or in combination， for predicting the prognosis of EVT were 79.41%， 81.37%， 82.35%， 80.39%， 83.33%， and 92.15%， respectively； the specificities were 75.25%， 71.78%， 70.79%， 71.29%， 69.31%， and 68.31%， respectively； and the areas under the curve （AUCs） were 0.815， 0.794， 0.785， 0.773， 0.784， and 0.984， respectively. The combined diagnosis showed a higher value. Conclusions ABI， VEGF， NLR， SAA， and sTREM-1 are influencing factors for restenosis after EVT in patients with ASO complicated by ischemic gangrene infection. These factors can effectively predict the risk of postoperative restenosis.

Key words: lower extremity arteriosclerosis obliterans, ischemic gangrene infection, interventional therapy, ankle brachial index, vascular endothelial growth factor