经颈动脉溶栓治疗脑静脉窦血栓的影像学及组织病理学研究

An imaging and histopathological study of cerebral venous sinus thrombosis treated with transcarotid thrombolytic therapy

目的观察经颈动脉溶栓治疗兔脑静脉窦血栓的影像学及组织病理学变化,以为临床应用提供依据。方法39只新西兰兔随机分为对照组(15只)、抗凝组(12只)和溶栓组(12只),建立兔脑静脉窦血栓模型,施行经颈动脉溶栓治疗。脑血管造影检查计算脑循环时间,免疫组织化学检测和血管分析方法检测CD31表达水平,并计数微血管密度。结果经颈动脉溶栓治疗后,溶栓组动物脑循环时间[(4.78±0.54)s]低于抗凝组[(6.75±0.46)s]和对照组[(7.00±0.50)s](均P<0.05);溶栓组动物微血管密度[(4.55±0.20)%]明显高于抗凝组[(3.55±0.23)%]和对照组[(2.28±0.70)%](均P<0.01)。结论经颈动脉溶栓治疗脑静脉窦血栓的临床疗效肯定,即使治疗后静脉窦仍呈闭塞状态,仍可使患者脑循环时间明显下降、微血管密度明显增加。

Objective To observe the imaging and histopathological changes of rabbit cerebral venous sinus thrombosis treated by transcarotid thrombolytic therapy for the evidence of clinical application. Methods Thirty-nine New Zealand white rabbit models of cerebral venous sinus thrombosis were prepared by ligation according to the procedure described by Nakase, and were randomly divided into three groups： control group （n = 15）, anticoagulation group （n = 12） and thrombolysis group （n = 12）. Cerebral circulation time was determined by cerebral angiography, hnmunohistochemistry and vascular analysis were used to detect CD31 expression level and calculate the microvascular density （MVD）. Results After transcarotid thrombolytic therapy, the cerebral circulation time in thrombolysis group [（4.78 ± 0.54） s] was lower than that in anticoagulation group [（6.75 ± 0.46） s] and control group [（7.00 ± 0.50） s] （P〈 0.05, for all）, while MVD in thrombolysis group [（4.55 ±0.20）%] was significantly higher than that in anticoagulation group [（3.55 ± 0.23）%] and control group [（2.28 ± 0.70）%] （P〈 0.01, for all）. Conclusion Transcarotid thrombolytic therapy is definitely effective for cerebral venous sinus thrombosis. Even though cerebral venous sinus is occluded, the cerebral circulation time will decrease significantly and the microvascular density will increase obviously after treatment.