Objective: To analyze the correlation between iliac artery calcification score and restenosis of lower extremity arteries in patients with lower extremity atherosclerotic occlusive disease (LEASO) who underwent drug-coated balloon (DCB) combined with stenting, and to assess the predictive value. Methods: A total of 105 patients with LEASO at Nanjing Drum Tower Hospital, Nanjing University Medicine School, from January 2018 to June 2023 were retrospectively included, and the patients were divided into 2 groups according to whether restenosis of the original lower limb arteries had occurred during follow-up after DCB combined stent implantation: the restenosis group (n=64) and the patency group (n=41). The clinical information of the study subjects was collected through the electronic case system, and all patients underwent CTA examination of both lower limb arteries before the operation, and the calcification scores of common iliac arteries and external iliac arteries of patients' bilateral and stenotic sides were calculated according to the results of the CTA examination. The follow-up time [M (Q1, Q3)] was 9.15 (5.67, 15.60) months in the patency group and 9.20 (6.85, 19.65) months in the restenosis group. Univariate and multivariate logistic regression models were used to analyze the factors associated with restenosis after DCB combined with stent implantation in LEASO patients. The predictive value of iliac artery calcification score for postoperative restenosis was assessed using the receiver operating characteristic (ROC) curves. Results: There were 44 males and 20 females in the restenosis group, aged (73±9) years; 31 males and 10 females in the patency group, aged (73±10) years. Compared with the patency group, the restenosis group had higher neutrophil counts, platelet counts, lymphocyte counts, neutrophil-to-lymphocyte ratios (NLR), platelet-to-lymphocyte ratios (PLR), C-reactive protein, fibrinogen, stent lengths, stent numbers, common iliac artery calcification scores (bilateral and stenotic side), and external iliac artery calcification scores (bilateral and stenotic side) (all P<0.05). Multifactorial logistic regression analysis showed that higher external iliac artery calcification score on the stenotic side (OR=1.480, 95%CI: 1.130-1.939, P=0.004) was an associated factor for restenosis of the lower extremity arteries after DCB combined with stenting.ROC curve analysis showed that the cut-off value of the external iliac artery calcification score on the stenotic side was 5.5 score, the area under the curve (AUC) for predicting restenosis of lower extremity arteries after DCB combined stent implantation in LEASO patients was 0.818 (95%CI: 0.731-0.904, P<0.001), with a sensitivity of 85.4% and a specificity of 68.8%. Conclusions: An elevated calcification score of the external iliac artery on the stenotic side is a correlate of restenosis of the lower extremity arteries after DCB combined stenting in patients with LEASO. With a cut-off value of 5.5 points, its sensitivity for predicting restenosis of the lower extremity arteries after DCB combined stenting is 85.4%, and its specificity is 68.8%.
目的： 分析髂动脉钙化评分与下肢动脉硬化闭塞症（LEASO）患者行药物涂层球囊（DCB）联合支架植入术后下肢动脉再狭窄的相关性，并评估其预测价值。 方法： 回顾性纳入2018年1月至2023年6月南京大学医学院附属鼓楼医院LEASO患者105例，根据患者DCB联合支架植入术后随访过程中原下肢动脉是否发生再狭窄分为2组：再狭窄组（n=64例）和通畅组（n=41）。通过电子病历系统收集研究对象的临床信息，所有患者术前均行双下肢动脉CT血管造影（CTA）检查，根据CTA检查结果计算患者双侧及狭窄侧髂总动脉、髂外动脉钙化评分。通畅组随访时间［M（Q1，Q3）］为9.15（5.67，15.60）个月，再狭窄组随访时间为9.20（6.85，19.65）个月。采用单因素和多因素logistic回归模型分析LEASO患者DCB联合支架植入术后再狭窄的相关因素。采用受试者工作特征（ROC）曲线评估髂动脉钙化评分对术后再狭窄的预测价值。 结果： 再狭窄组男44例，女20例，年龄（73±9）岁；通畅组男31例，女10例，年龄（73±10）岁。与通畅组相比，再狭窄组中性粒细胞计数、血小板计数、淋巴细胞计数、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、C反应蛋白、纤维蛋白原、支架长度、支架数目、髂总动脉钙化评分（双侧及狭窄侧）、髂外动脉钙化评分（双侧及狭窄侧）更高（均P<0.05）。多因素logistic回归分析结果显示，狭窄侧髂外动脉钙化评分升高（OR=1.480，95%CI：1.130~1.939，P=0.004）是DCB联合支架植入术后下肢动脉再狭窄的相关因素。ROC曲线分析结果显示，狭窄侧髂外动脉钙化评分cut-off值为5.5分时，预测LEASO患者行DCB联合支架植入术后下肢动脉再狭窄的曲线下面积（AUC）为0.818（95%CI：0.731~0.904，P<0.001），灵敏度为85.4%，特异度为68.8%。 结论： 狭窄侧髂外动脉钙化评分升高是LEASO患者DCB联合支架植入术后下肢动脉再狭窄的相关因素；cut-off值为5.5分时，其预测DCB联合支架植入术后下肢动脉再狭窄的灵敏度为85.4%，特异度为68.8%。.