下肢动脉硬化性闭塞症患者sVCAM-1水平变化及临床诊断价值研究

Study on the Changes of sVCAM-1 Level and Clinical Diagnostic Value in Patients with Lower Extremity Arteriosclerosis Obliterans

摘要: 目的：通过检测LEASO患者血清中sVCAM-1的表达水平探讨sVACM-1在LEASO中的临床诊断价值。方法：纳入82例自2023年12月至2024年7月在青岛市市立医院就诊并确诊为LEASO的患者(将其定义为下肢动脉硬化闭塞症组(LEASO组)，并根据病变部位及Fontaine分期将其分组。随机纳入同期40名来我院体检的健康者，定义为健康对照组。用酶联免疫吸附法(ELISA)检测各组患者血清sVCAM-1的表达量，计算各组间sVCAM-1表达水平差异；将sVCAM-1与实验室检查结果进行LEASO的影响因素logistic回归分析；并用sVCAM-1联合实验室检查指标对LEASO进行诊断预测。结果：LEASO患者组sVCAM-1表达量高于健康对照组(P < 0.05)。在LEASO组中，单侧下肢组和双侧下肢组sVCAM-1的表达无显著性差异(P > 0.05)。而在根据病变涉及的下肢血管部位的分组中，膝上动脉病变组sVCAM-1的表达量最高，且膝上膝下动脉病变合并组sVCAM-1的表达量高于膝下动脉病变组(P < 0.05)。在LEASO组中，随着Fontaine分期的升高，sVCAM-1的表达量也在逐步升高，但Fontaine IV期sVCAM-1的表达量较III期有所下降。影响因素logistic回归分析结果显示TC (OR = 2.222, 95%CI: 1.323~3.730)、LDL-C (OR = 1.802, 95%CI: 1.232~2.637)、sVCAM-1 (OR = 1.003, 95%CI: 1.001~1.005)是发生LEASO的独立危险因素。最后，利用受试者工作曲线将sVCAM-1联合有意义的实验室指标对LEASO进行诊断预测，ROC曲线灵敏度较强。结论：sVCAM-1可能参与LEASO的发生和发展，通过检测血清sVCAM-1的表达量，或许可以为LEASO的诊断和治疗提供新的思路和方法。

Abstract: Objective: To explore the clinical diagnostic value of sVACM-1 in LEASO by detecting the expression level of sVCAM-1 in serum of LEASO patients. Methods: Eighty-two patients who visited Qingdao Municipal Hospital from December 2023 to July 2024 and were diagnosed with LEASO (defined as the lower extremity atherosclerotic occlusive disease group (LEASO group)) were included and grouped according to the lesion site and Fontaine staging. Forty healthy individuals who came to our hospital for physical examination during the same period were randomly included and defined as the healthy control group. The expression of serum sVCAM-1 was detected by enzyme-linked immunosorbent assay (ELISA) in each group of patients, and the difference of sVCAM-1 expression level between the groups was calculated; logistic regression analysis of the influencing factors of LEASO was carried out by combining sVCAM-1 with the laboratory examination results; and diagnostic prediction of LEASO was carried out by using sVCAM-1 in combination with laboratory examination indexes. Results: The expression of sVCAM-1 in the LEASO patient group was higher than that in the healthy control group (P < 0.05). In the LEASO group, there was no significant difference in sVCAM-1 expression between the unilateral lower limb group and the bilateral lower limb group (P > 0.05). In contrast, in the grouping according to the vascular site of the lower limb involved in the lesion, the expression of sVCAM-1 was highest in the supra-knee artery lesion group, and the expression of sVCAM-1 in the combined supra-knee infra-knee artery lesion group was higher than that of the infra-knee artery lesion group (P < 0.05). sVCAM-1 expression was also progressively higher with the elevation of Fontaine’s stage in the LEASO group, but the expression of Fontaine stage IV sVCAM-1 expression decreased compared with stage III. The results of logistic regression analysis of the influencing factors showed that TC (OR = 2.222, 95%CI: 1.323~3.730), LDL-C (OR = 1.802, 95%CI: 1.232~2.637), and sVCAM-1 (OR = 1.003, 95%CI: 1.001~1.005) were the independent risk factors. Finally, sVCAM-1 was combined with meaningful laboratory indicators for the diagnostic prediction of LEASO using the subject’s working curve, and the ROC curve was sensitive. Conclusion: sVCAM-1 may be involved in the occurrence and development of LEASO, and by detecting the expression of serum sVCAM-1, it may provide new ideas and methods for the diagnosis and treatment of LEASO.