【摘要】 目的 探讨血管钙化程度与药物涂层球囊(drug-coated balloon, DCB)治疗下肢动脉支架内再狭窄(in-stent restenosis, ISR)后再狭窄的相关性。方法 采用回顾性队列研究，最终纳入2019年1月～2023年3月北京大学第三医院DCB治疗126例ISR。结局指标为1年随访期内影像学复查定义的再狭窄。采用外周动脉钙化评分系统(Peripheral Artery Calcification Scoring System, PACSS)评估ISR病变部位血管钙化程度，采用Spearman秩相关分析ISR患者钙化程度与再狭窄的相关性，采用单因素及多因素logistic回归分析筛选发生再狭窄的预后因素。结果 DCB术后1年总体再狭窄率31.0%(39/126)。再狭窄率与PACSS分级呈正相关(r=0.560,P<0.001)。多因素logistic回归分析表明，病变部位累及腘动脉(OR=2.820,95%CI:1.025～7.758),PACSS分级3或4级(OR=15.872,95%CI:5.093～49.468)是DCB治疗ISR后再狭窄的独立影响因素(P<0.05)。无钙化组(PACSS 0级，n=47)、轻中度钙化组(PACSS 1、2级，n=43)与重度钙化组(PACSS 3、4级，n=36)比较，重度钙化组年龄最大[3组分别为(67.7±8.9)、(68.7±7.4)、(72.5±8.8)岁，P=0.031],病变最长(3组中位数分别为70.4、123.6、134.7 mm,P<0.001),再狭窄率最高[3组分别为10.6%(5/47)、14.0%(6/43)、77.8%(28/36),P<0.001]。结论 ISR血管钙化程度越重，再狭窄风险越高。除钙化程度外，病变部位累及腘动脉也是DCB治疗ISR后发生再狭窄的独立预后因素。更多还原

【Abstract】 Objective To investigate the correlation between vascular calcification degree and restenosis after drug-coated balloon(DCB) treatment for in-stent restenosis(ISR) of lower extremity arteries. Methods A retrospective cohort study was adopted, ultimately including 126 patients with ISR treated with DCB in this hospital from January 2019 to March 2023. The outcome indicator was restenosis defined by imaging review during 1-year follow-up. The Peripheral Artery Calcification Scoring System(PACSS) was applied to evaluate vascular calcification at the ISR lesion site. Spearman rank correlation analysis was used to assess the correlation between calcification degree and restenosis. Univariate and multivariate logistic regression analyses were performed to screen prognosis factors for restenosis. Results The overall restenosis rate at 1 year post-DCB was 31.0%(39/126), and it was positively correlated with PACSS classification(r=0.560, P<0.001). Multivariate logistic regression analysis indicated that lesion involving the popliteal artery(OR=2.820, 95%CI: 1.025-7.758) and PACSS classification of grade 3 or 4(OR=15.872, 95%CI: 5.093-49.468) were independent influence factors for restenosis after DCB treatment for ISR(P<0.05). Comparing the non-calcification group(PACSS grade 0, n=47), mild-to-moderate calcification group(PACSS grades 1-2, n=43), and severe calcification group(PACSS grades 3-4, n=36), the severe calcification group had the oldest age [the three groups were(67.7±8.9),(68.7±7.4), and(72.5±8.8) years old, respectively, P=0.031], longest lesion length(the median values of the three groups were 70.4, 123.6, and 134.7 mm, respectively, P<0.001), and highest restenosis rate [the three groups were 10.6%(5/47), 14.0%(6/43), and 77.8%(28/36), respectively, P<0.001]. Conclusions The more severe the ISR vascular calcification, the higher the risk of restenosis. In addition to calcification degree, lesion involving the popliteal artery is also an independent prognostic factor for restenosis after DCB treatment for ISR.更多还原