论文部分内容阅读
目的:探讨血浆β2微球蛋白(β2-MG)及同型半胱氨酸(HCY)对下肢动脉粥样硬化病(LEAD)患者病变的风险分级和预后评估的价值。方法:收集136例明确诊断的LEAD患者,按Fontaine分期标准分为:I期组(n=27),II期组(n=39),Ⅲ期组(n=38),IV期组(n=32),或以ABI值分为:低风险组(0.7≤ABI<0.9,n=36),中风险组(0.4≤ABI<0.7,n=60)和高风险组(ABI<0.4,n=40),均以同期35例健康检查者作为对照。比较各组血浆β2-MG和HCY浓度,并进行相关性分析和生存分析。患者每3个月随访1次,随访期为2年。因截肢或心脑血管疾病死亡作为终点事件,并以此进行预后判断。结果:血浆β2-MG和HCY水平均随着Fontaine分期的进展或风险分级的增加而升高(均P<0.05),且ABI值与β2-MG和HCY水平均呈负相关(r=-0.867,r=-0.846);HCY水平用于判断LEAD患者预后的ROC曲线下面积为0.831,以36.085μmol/L作为截断点,其预测终点事件发生的灵敏度为86.0%,特异度为68.6%,Youden指数为0.546;COX回归分析提示ABI值及HCY水平可作为预测LEAD终点事件发生的独立因素(P=0.018,P=0.001)。结论:LEAD随病情的进展,血浆β2-MG,HCY浓度逐渐升高;HCY水平是预测LEAD发生和预后的良好指标;HCY和ABI风险分级相结合方法有助于更好地判断LEAD患者的预后。
Objective: To investigate the value of plasma β2-microglobulin (β2-MG) and homocysteine (HCY) in the risk stratification and prognosis evaluation of patients with lower extremity atherosclerosis (LEAD). Methods: Thirteen patients with definite diagnosis of LEAD were collected and divided into three groups according to Fontaine staging: stage I (n = 27), stage II (n = 39), stage III (n = 38), stage IV = 32), or were divided by ABI into low risk group (0.4≤ABI <0.7, n = 60) and high risk group (ABI <0.4, n = 36) = 40), all in the same period 35 cases of health check as a control. Plasma concentrations of β2-MG and HCY in each group were compared, and correlation analysis and survival analysis were performed. Patients were followed up every 3 months, the follow-up period was 2 years. Death due to amputation or cardiovascular and cerebrovascular diseases as the end point and prognosis. Results: Plasma levels of β2-MG and HCY increased with the progression of Fontaine staging or risk stratification (all P <0.05), and the ABI values were negatively correlated with the levels of β2-MG and HCY (r = -0.867 , r = -0.846). The area under the ROC curve for determining the prognosis of patients with LEAD was 0.831. The cutoff point of 36.085μmol / L for HCY was 86.0%, the specificity was 68.6%, and Youden The index was 0.546. COX regression analysis suggested that ABI and HCY levels could be used as independent predictors of the end point of LEAD (P = 0.018, P = 0.001). CONCLUSION: LEAD gradually increases with the progress of the disease, and the concentration of plasma β2-MG and HCY gradually increases. HCY level is a good predictor of the occurrence and prognosis of LEAD. The combination of HCY and ABI risk classification can help to better predict the prognosis of patients with LEAD .