| BachgroundDiabetes limbs artery block is a common disease,caused by arteriosclerosis. Due to lack of effective therapy,disability of diabetes limbs artery block is higher. Baloon pcrcutaneous transluminal angioplasty and stent implantation are effective therapy of diabetes limbs artery block.But restenosis has not been well solved,which is the main obstacle to the development of diabetes limbs artery block intervention.The complex process of RS has not been clearly defined,which is generally thought to be caused by vascular injury,elastic recoil,proliferation endomembrane,vascular remodeling,changes of vacular activity material,high appearance of various growth factor,and cell apoptosis after PCI.Recent studys suggest that the change of endothelium has played a very important role in the development of DLAB and RS after diabetes limbs artery block intervention,but its mechanism has not been study clearly.There are few reports of effect of long balloon percutaneous transluminal angioplasty plus long stent imlplantation on endothelium function in patients with diabetes limbs artery block the operation can not only reduce endothelium injury and rate of RS but also enhance effect in theory.Aims1.To evaluate clinical effects of long balloon percutaneous transluminal angioplasty plus long stent implantation for treating diabetes limbs artery block.2.To investigate the effects of long balloon percutaneous transluminal angioplasty plus long stent implantation on endothelium function in patients with diabetes limbs atery block.3.To find out the mechanism of restenosis in patients with diabetes limbs artery block after long balloon percutaneous transluminal angioplasty plus long stent implantation.MethodsA total of 43 patients with single superficial femoris stenosis were randomly divided into long balloon percutaneous transluminal angioplasty group and ordinary balloon percutaneous transluminal angioplasty group.Long stents were planted in patients after long balloon percutaneous transluminal angioplasty, odinary stents were planted in patients after ordinary balloon precutaneous transluminal angioplasty.We observed the concurrent disease,primary patency, the rate of RS,the ankle brachial index after stent implantation to find difference. Femoral vein blood was collected before angioplasty,immediatly after stent implantation as well as 2h and 7d after stent implantation to measure the content of serum nitric oxide(NO),plasma endothelin(ET-1) and serum vigor of nitric oxide synthase(NOS).The serum level of NO and vigor of NOS were measured by chemical analysis.The plasma level of ET-1 were measured by radioimmunoassay Furthermore,we observed the difference between the two groups in every time point.Results1.The operating time was(40.2±25.6)min in test group and(702±30.6) min in control group(P＜0.05).The rate of dissecting was 4.1%in test group and 19.1%in control group(P＜0.05).The number of implanted stent were(1.1±0.21) in lest group and(2.3±0.17) in control group(P＜0.05).The number of balloon cxpandding were(12±0.24) in test group and(4.6±0.36) in control group(P＜0.01).The ankle brachial index was(0.84±0.13) in test group and (0.72±0.14) in control group in 6 months after stent implantation(P＜0.05). The primary patency was 90.9%in test group and 71.4%in control group in 6 months after stent implantation(P＜0.05).The restenosis rate was 9.1%in test group and 28.6%in control group in 6 months after stent implantation(P＜0.05).2.The serum level of NO was(343.25±35.66)umol/L,in test group and (33825±4033)umol/1 in control group before operation(P＞0.05).The serum level of NO was(223.35±29.68)umol/L in test group and(156.35±29.54)umol/ L in control group immediately after stent implantation(P＜0.05).The serum levelof NO was(215.27±27A8)umol/L in test group and(135.35±27.44)umol/L in control group at 2h after stent implantation(P＜0.05).The serum level of NO was(305.18±33.62)umol/L in test group and(296.31±30.46)umol/L in control group on 7d after stent implantation(P＞0.05).3.The vigor of NOS was(110.32±8.34)u/ml in test group and(113.32±5.29)u/ml in control group before operation(P＞0.05).The vigor of NOS was (83.36±6.41)u/ml in lest group and(5128±730)u/ml in control group immediately after stent implantation(P＜0.05).The vigor of NOS was(75.28±7.33)u/ml in test group and(4736±5.22)u/ml in control group at 2h after stent implantation(P＜0.05).The vigor of NOS was(105.32±5.28)u/ml in test group and(101.29±8.26)u/ml in control group on 7d after stent implantation(P＞0.05).4.The plasma level of ET-1 was(103.18±532)pg/ml in test group and (105.16±5.56)pg/ml in control group before operation(P＞0.05).The plasma level of ET-1 was(124.28±6A5)pg/ml in test group and(133.25±4.52)pg/ml in control group immediately after stent implantation(P＜0.05).The plasma level of ET-1 was(153.62±6.66)pg/ml in test group and(164.53±8.42)pg/ml in control group at 2h after stent implantation(P＜0.05).The plasma level of ET-1 was(11038±7.62)pg/ml in test group and(116.28±7.38)pg/ml in control group on 7d after stent implantation(P＞0.05).Conlusion1.Long balloon percutaneous transluminal angioplasty plus long stent implantation is a s effective and low rate of RS method for treating diabetes limbs artery block.2.Long balloon percutaneous transluminal angioplasty plus long stent implantation can significantly reduce the production of ET-1 and has lower influence on serum level of NO and activity of NOS than that of ordinary balloon percutaneous transluminal angioplasty plus ordinary stent implantation.3.Long balloon percutaneous transluminal angioplasty plus long stent implantation produce less effect on endothelium function in patients with diabetes limbs artery block,which may account for the lower rate of restenosis.
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