Josip Juraj Strossmayer University of Osijek. Faculty of Medicine.
Abstract
Cilj istraživanja: Istražiti postoji li povezanost između preproceduralne razine te postproceduralnog porasta serumske razine CRP-a i fibrinogena ovisno o stadiju periferne arterijske bolesti, tipu tretirane lezije i čimbenicima ateroskleroze. Ispitati postoji li povezanost porasta CRP-a i fibrinogena o mjeri periproceduralnog oštećenja arterijske stijenke. Nacrt studije: Ova prospektivna kohortna studija provedena je na Kliničkom zavodu za dijagnostičku i intervencijsku radiologiju, Kliničkoga bolničkoga centra Osijek, u razdoblju od lipnja 2014. godine do veljače 2017. godine. Ispitanici i metode: U istraživanje je uključeno 155 ispitanika. Ispitanici kojima je učinjena samo dijagnostička angiografija (84 ispitanika) činili su kontrolnu skupinu, a ispitanici kojima je učinjena endovaskularna intervencija na perifernim arterijama (71 ispitanika) činili su eksperimentalnu skupinu. Svakom ispitaniku su prije zahvata te 8 sati, 24 sata i 48 sati nakon zahvata uzeti uzorci venske iz koje su određeni CRP i fibrinogen. Za svakog su ispitanika bilježeni tip i duljina tretirane lezije, vrijeme inflacije balona te duljina stentiranog segmenta. Rezultati: U prvih 48 sati nakon intervencije uočen je značajan porast serumske razine CRP- a i fibrinogena (P<0.001). Nije bilo značajne razlike u porastu CRP-a i fibrinogena između različitih tipova lezija. U skupini bolesnika kojima je postavljen stent, 48 sati nakon intervencije uočen je značajan porast razine CRP-a, usporedno sa ispitanicima kojima je učinjena angioplastika balonom. Nađena je dobra pozitivna povezanost između porasta CRP-a između 8 sati i 24 sata nakon intervencije i duljine balonom tretiranog segmenta (r=0.313, P=0.02), kao i vremena inflacije balona (r=0.270, P=0.03). Uočena je dobra pozitivna povezanost porasta CRP-a u prvih 8 sati nakon intervencije i duljine stentiranog segmenta (r=0.535, P=0.01). Zaključak: Ovo je istraživanje pokazalo utjecaj periproceduralne lezije arterijske stijenke na postproceduralni porast upalnih biomarkera. Zbog složenosti vaskularne biologije, daljna istraživanja su potrebna kako bi se pojasnio opaženi vaskualrni upalni odgovor.Objectives: This study aimed to examine whether baseline and postprocedural levels of C-reactive protein (CRP) and fibrinogen correlate with the severity of peripheral arterial disease, lesion complexity, atherosclerosis risk factors and the extent of periprocedural arterial injury. Study design: This observational cohort study was conducted at the Department od diagnostic and interventional radiology, Osijek University Hospital between June 2014 and February 2017. Participants and methods: This study recruited seventy-one patients who underwent PTA with or without stent implantation. Eighty-four patients who underwent diagnostic angiography of the lower limbs during the same period served as a control group. C-reactive protein (CRP) and fibrinogen were measured at baseline, and 8 hours, 24 hours and 48 hours following angiography or endovascular intervention (EVT). For all patients in the study group, complexity of the lesion, PTA treated segment length, balloon inflation time and stented segment length were recorded. Results: There was significant increase in both plasma CRP and fibrinogen levels in the first 48 hours following EVT (P<0.001). No significant difference in CRP and fibrinogen levels was found at examined time points following EVT between different lesion complexities. CRP levels were significantly higher in stent subgroup compared to PTA subgroup 48 hours following EVT. Significant positive correlation was found between PTA treated segment length and CRP increase between 8 hours and 24 hours following EVT (r=0.313, P=0.02), balloon inflation time and CRP increase in the aforementioned time frame (r=0.270, P=0.03), as well as between CRP increase in the first 8 hours following stented and the stented segment length (r=0.535, P=0.01). Conclusion: This study has shown that the arterial injury caused by EVT reflects on the level of inflammatory biomarkers. Due to the complexity of vascular biology, future studies are warranted to clarify the observed inflammatory reactions
