在Best-CLI试验中,胰岛素治疗和慢性肢体威胁性缺血的再血管化程序的结果
Dana Alameddine1, Mohammed Hamouda2, Gheorghe Doros3
1Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT.
Journal of vascular surgery
|August 31, 2025
概括
在下肢再血管化之前,需要胰岛素的糖尿病患者 (IRDM) 血糖控制较差,肢体威胁性缺血症 (CLTI) 更为发达. 对所有糖尿病患者来说,开放的再血管化比内血管治疗更能改善结果.
科学领域:
- 血管外科
- 糖尿病学
- 缺血症研究
背景情况:
- 糖尿病 (DM) 是患有慢性肢体威胁性缺血症 (CLTI) 的患者下肢再血管化 (LER) 的重要危险因素.
- 目前对需要胰岛素的DM (IRDM) 和不需要胰岛素的DM (NIRDM) 患者的结局结果进行的研究已产生不一致的结果.
- 需要高质量的前性数据来澄清这些差异.
研究的目的:
- 将IRDM患者的临床特征和复血管化结果与NIRDM患者进行比较.
- 在患有CLTI的糖尿病患者中确定与重血管化成功相关的因素.
- 在该人群中评估开放式与内血管再血管化策略的比较有效性.
主要方法:
- 来自BEST- CLI试验的前性数据分析,比较IRDM和NIRDM患者.
- 使用考克斯回归模型评估胰岛素需求与患者结果之间的关联.
- 基线特征,血糖控制 (HbA1c),CLTI严重程度 (WIfI阶段) 和再血管化结果的比较.
主要成果:
- 这项研究包括1,229名患有DM的患者;67. 7%的患者患有IRDM,血糖控制较差 (HbA1c<7:19. 2%对44%) 和更先进的CLTI.
- 患有IRDM的患者年轻,患有脏疾病和先前截肢的可能性更高,但吸烟的可能性更低.
- 与内血管治疗相比,不论是胰岛素治疗还是基线HbA1c,开放式再血管化与重大截肢,再干预和重大不良事件或死亡的风险显著降低.
结论:
- 与NIRDM患者相比,IRDM患者接受CLTI的LER患者的血糖控制较差,疾病更严重.
- 胰岛素需求与CLTI分辨率的降低有轻微的关联.
- 在DM患者中,无论胰岛素依赖程度或血糖控制水平如何,开放式再血管化疗法都被证明优于内血管治疗.
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