Percutaneous Treatment of Claudication: The Role of Diabetes and Inflammation

经皮跛行治疗：糖尿病和炎症的作用

• 批准号: 7485722
• 负责人: Louis Loc Nguyen
• 金额: $ 15.93万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7485722
• 关键词: Accounting; Adoption; Advisory Committees; Affect; Aftercare; American; Anatomy; Angioplasty; Ankle; Arterial Occlusive Diseases; Arteries; Attention; Benefits and Risks; Biological; Biological Markers; Blood Vessels; CD40 Ligand; Cardiovascular Diseases; Cardiovascular system; Caring; Central obesity; Characteristics; Clinical; Clinical Research; Cohort Studies; Complement 2; Complex; Condition; Cost Analysis; Data; Databases; Diabetes Mellitus; Disease; Disease Progression; Distal; Economics; Educational process of instructing; Effectiveness; End Point; Event; Factor Analysis; Failure; Fasting; Fibrinolysis; General Population; Glucose; Glycosylated Hemoglobin; Grant; Health; Health Services Research; High Density Lipoprotein Cholesterol; Hospitals; Hypertension; Hypertriglyceridemia; Impairment; Individual; Inferior; Inflammation; Inflammatory; Inflammatory Response; Institution; Insulin; Insulin Resistance; Interleukin-6; Intermittent Claudication; Intervention; Ischemia; Lesion; Limb structure; Lipids; Lower Extremity; Maintenance; Measures; Medical; Medicine; Metabolic syndrome; Morbidity - disease rate; Neuropathy; Numbers; Obesity; Operative Surgical Procedures; Outcome; Pathway interactions; Patient Care; Patients; Pattern; Performance; Peripheral; Peripheral arterial disease; Personal Satisfaction; Physiologic pulse; Plasminogen Activator Inhibitor 1; Population; Predictive Value; Principal Investigator; Procedures; Process; Public Health; Public Health Schools; Pulse taking; Quality of life; Questionnaires; Rate; Regression Analysis; Rehabilitation therapy; Research; Research Personnel; Resource Development; Risk; Risk Factors; Role; Scanning; Score; Surveys; System; Techniques; Testing; Training; Treadmill Tests; Treatment Failure; Treatment outcome; Universities; Visit; Walking; Woman; abstracting; base; cardiovascular risk factor; career; claudication; cofactor; coping; cost; cysteine rich protein; day; diabetic; disorder risk; experience; follow-up; functional outcomes; glucose metabolism; glycemic control; hemodynamics; impaired glucose tolerance; improved functioning; indexing; instructor; lipid disorder; medical schools; mortality; programs; prospective; response; restenosis; success; trend

DESCRIPTION (provided by applicant): Diabetes (DM) and peripheral artery disease (PAD) are rapidly growing health concerns among Americans. In particular, intermittent claudicatiori (IC) affects walking function, general quality of life (QOL), and can herald worsening ischemia. The use of arterial angioplasty and stenting to treat lower extremity arterial occlusive disease has increased recently. However, clinical outcomes have been mixed and their impact on patient QOL difficult to measure, especially for patients with DM who may have additional biological and functional obstacles to treatment success. Louis Nguyen, MD, MBA, is Instructor of Surgery in the Division of Vascular & Endovascular Surgery and Investigator in the Center for Surgery and Public Health at Brigham & Women's Hospital (BWH), a teaching affiliate of Harvard Medical School. This proposal details a plan to develop Dr. Nguyen into an independent clinical researcher. Because of his unique training and experience in surgery and health services research, Dr. Nguyen intends to study problems in vascular surgery by using a combination of institutionally-based clinical studies with nationally collected databases. The plan proposed in this grant will capitalize on the educational, research, and career development resources of several Harvard University institutions. Drs. Michael Conte (Vascular Surgery), John Ayanian (Medicine and Harvard School of Public Health [HSPH]), and Mark Creager (Cardiovascular Medicine) will comprise the Advisory Committee. Drs. Allison Goldfine (Joslin Diabetes Center) and Myriam Hunink (HSPH) will serve as consultants. All five are internationally recognized clinician-researchers in their fields. The proposed prospective observational cohort study will examine the effects of DM, insulin resistance, and inflammation on outcomes of infrainguinal percutaneous peripheral interventions for IC. The first aim examines hemodynamic outcomes using arterial duplex. The second aim examines functional outcomes using treadmill walking performance and QOL surveys. The third aim combines these findings to examine larger treatment implications with a cost analysis and CMS database analysis specific to the care of DM patients. It is anticipated that this research will contribute to the better clinical and economic understanding of IC treatment outcomes for DM patients with PAD risk factors. (End of Abstract)

描述（由申请人提供）： 糖尿病 (DM) 和外周动脉疾病 (PAD) 是人们日益关注的健康问题 美国人。特别是，间歇性跛行 (IC) 会影响步行功能、总体生活质量 (QOL)，并可能预示着缺血恶化。近年来，越来越多地使用动脉血管成形术和支架置入术来治疗下肢动脉闭塞性疾病。然而，临床结果好坏参半，其对患者生活质量的影响难以衡量，特别是对于可能存在治疗成功的额外生物学和功能障碍的糖尿病患者。 Louis Nguyen，医学博士、工商管理硕士，是哈佛医学院教学附属机构布莱根妇女医院 (BWH) 血管和血管内外科部门的外科讲师和外科和公共卫生中心的研究员。该提案详细介绍了将 Nguyen 博士培养成独立临床研究员的计划。由于他在外科和健康服务研究方面的独特培训和经验， Nguyen 博士打算结合基于机构的临床研究和国家收集的数据库来研究血管外科问题。这笔赠款中提出的计划将利用哈佛大学多个机构的教育、研究和职业发展资源。博士。 Michael Conte（血管外科）、John Ayanian（医学和哈佛大学公共卫生学院 [HSPH]）和 Mark Creager（心血管医学）将组成咨询委员会。博士。 Allison Goldfine（乔斯林糖尿病中心）和 Myriam Hunink（HSPH）将担任顾问。所有五人都是各自领域国际公认的临床医生研究员。 拟议的前瞻性观察队列研究将检查糖尿病、胰岛素抵抗和炎症对腹股沟下经皮外周干预治疗 IC 的结果的影响。第一个目标是使用双工动脉检查血流动力学结果。第二个目标是使用跑步机行走表现和生活质量调查来检查功能结果。第三个目标将这些发现结合起来，通过针对 DM 患者护理的成本分析和 CMS 数据库分析来检验更大的治疗意义。预计这项研究将有助于更好地临床和经济地了解具有 PAD 危险因素的 DM 患者的 IC 治疗结果。 （摘要完）