2型糖尿病膝下动脉病变患者介入治疗前后缺血动脉内氧化应激标志物的变化及意义
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(华中科技大学同济医学院附属武汉中心医院内分泌科,湖北省武汉市 430012)

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段纬喆,硕士研究生,主治医师,主要研究方向为糖尿病周围血管病及糖尿病足的综合治疗,尤其擅长腔内介入治疗下肢动脉硬化闭塞症,E-mail为duanweizhe@zxhospital.com。

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华中科技大学同济医学院附属武汉中心医院科研基金(2017Y17)


Changes and significance of oxidative stress markers in knee artery disease before and after interventional therapy in patients with type 2 diabetes mellitus
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Department of Endocrinology, The Central Hospital of Wuhan Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430012, Hubei, China)

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    摘要:

    目的 观察2型糖尿病(T2DM)下肢动脉硬化闭塞症(ASO)患者下肢动脉介入治疗前后病变动脉内氧化应激标志物的变化,探讨T2DM合并ASO患者体内氧化应激水平及介入治疗对动脉内氧化应激标志物的影响。 方法 选择接受介入治疗的T2DM合并膝下动脉(胫腓动脉)病变的患者30例,入组患者均行下肢动脉造影检查(DSA),部分患者还需要行经皮腔内血管成形术(PTA)。单纯行DAS患者为14例(造影组),DSA+PTA患者为16例(治疗组)。造影组和治疗组患者均在介入手术前行常规检查并抽取静脉血测血脂、糖化血红蛋白(HbA1c)和氧化应激标志物水平,包括超氧化物歧化酶(SOD)以及脂质过氧化物终产物丙二醛(MDA)。造影组、治疗组还需取介入治疗前动脉血3 mL,此外治疗组在缺血动脉远端同一部位取PTA术前术后动脉血。上述标本均测SOD、MDA水平。 结果 造影组患者下肢动脉造影未见明显狭窄。治疗组术前动静脉血SOD水平低于造影组,MDA水平高于造影组(P<0.05)。造影组、治疗组各组内介入术前静脉血与动脉血SOD、MDA比较差异无统计学意义(P>0.05)。治疗组介入术前缺血部位SOD水平较介入治疗前动脉血水平低(P<0.05),MDA水平较介入治疗前动脉血水平高(P<0.05)。治疗组介入术后缺血部位SOD水平较介入术前缺血部位及介入术前动脉血SOD均降低(P<0.05),MDA水平较介入术前缺血部位及介入术前动脉血中水平均升高(P<0.05)。 结论 介入术前后患者使用抗氧化应激药物可能会改善处理病变的远期预后,减少血管再狭窄发生。

    Abstract:

    Aim To observe the changes of intraarterial oxidative stress markers in patients with type 2 diabetes mellitus (T2DM) combined with arteriosclerosis obliterans (ASO) before and after treatment of lower extremity arteries, and to investigate the effect of oxidative stress in patients with T2DM combined with ASO and the effect of interventional therapy on intraarterial oxidative stress markers. Methods Thirty patients with T2DM complicated with subendocardial artery (tibiofibular artery) who underwent interventional therapy were enrolled in the study. All patients underwent lower extremity digital subtraction angiography (DSA), some patients also underwent percutaneoius transluminal angioplasty (PTA). 14 patients were treated with DSA alone (control group), and 16 patients in DSA+PTA (treatment group). In the control group and the treatment group, routine examinations were performed before interventional operation, and venous blood was taken to measure blood lipid, hemoglobin A1c(HbA1c) and oxidative stress markers, including serum superoxide dismutase (SOD), and the lipid peroxides final product malondialdehyde (MDA). The control group and the treatment group were also required to take 3 mL of the arterial blood before the intervention. In addition, the arterial blood of the treatment group was taken before and after PTA in the same part of the distal artery of the ischemic artery. SOD, MDA levels were measured in the above samples. Results There was no obvious stenosis in the arteriography of the lower extremity in the control group. Preoperative SOD level in arterial and venous blood was lower in the treatment group than that in the control group, MDA level was higher than that in the control group(P<0.05). There was no significant difference in the levels of SOD and MDA between venous blood and arterial blood before the intervention in the control group and the treatment group(P>0.05). The SOD level of the treatment group was lower in the ischemic area before the intervention than that of the arterial blood(P<0.05), but the MDA level was higher (P<0.05). The SOD level of the treatment group were lower in the ischemic area after intervention than that of the ischemic area and the arterial blood before intervention(P<0.05), but the MDA level was higher(P<0.05). Conclusion The use of antioxidation stress drugs before and after intervention may improve the long-term prognosis of treatment and reduce the incidence of restenosis.

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段纬喆,赵湜,毛红.2型糖尿病膝下动脉病变患者介入治疗前后缺血动脉内氧化应激标志物的变化及意义[J].中国动脉硬化杂志,2018,26(2):176~180.

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  • 收稿日期:2017-08-20
  • 最后修改日期:2017-10-05
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  • 在线发布日期: 2018-03-07