Abstract: Objective To study the correlation of high mobility group box protein 1/toll-like receptor 4 (HMGB1/TLR4) signaling pathway with the risk of recurrence after interventional therapy for lower extremity arteriosclerosis obliterans (ASO) in the elderly.〖WTHZ〗Methods A total of 84 patients (96 vessels) with ASO who underwent interventional treatment from January 2020 to January 2021 were enrolled.One week after operation,the levels of HMGB1 and TLR4 mRNA in peripheral blood mononuclear cells (PBMCs) were detected by Real-time Reverse Transcription-Polymerase Chain Reaction (qRT-PCR),and the levels of serum endothelin-1 (ET-1) and high-sensitivity C-reactive protein (hs-CRP) were detected by radioimmunoassay and immunoturbidimetry.The patients were followed up for 12 months,and the restenosis of target vessels was counted.Patients were classified into recurrence group and control group according to the presence or absence of restenosis.The levels of HMGB1 and TLR4 mRNA in peripheral blood PBMCs and the levels of hs-CRP and ET-1 in serum were compared between groups,and the relationship between the above indexes and vascular restenosis in ASO patients after interventional therapy was discussed.Results Postoperative examination showed recanalization in 96 diseased vessels of 84 patients after interventional therapy.All patients completed a 12 months follow-up,and 16 patients (18 vessels) had restenosis (recurrence group) as indicated by ultrasound and CTA of both lower limbs.The levels of HMGB1 and TLR4 mRNA in peripheral blood PBMCs and the levels of hs-CRP and ET-1 in serum were remarkably elevated in recurrence group compared with control group,with statistical difference (all P＜0.05).Correlation analysis denoted that HMGB1 and TLR4 mRNA expression in peripheral blood PBMCs of patients in recurrence group were positively correlated with serum ET-1 and hs-CRP levels (r=0.393,0.378,0.411,0.407,P＜0.05).Conclusion The HMGB1/TLR4 signaling pathway may be involved in post-interventional recurrence in ASO patients by activating the release of inflammatory factors and promoting vascular injury.

Key words: high mobility protein 1/toll like receptor 4 signaling pathway, arteriosclerosis obliterans of lower limbs, interventional surgery, vascular restenosis, high sensitivity C-reactive protein, endothelin-1