颈动脉支架置入术后血浆P－选择素和内皮功能的变化及意义

Changes and the clinical relevance of plasma p-selectin and vascular endothelial cell function after carotid artery stenting.

目的探讨颈动脉支架置入术后P－选择素和内皮功能的变化及意义。方法测定67例短暂性脑缺血发作需颈动脉支架置入术患者（治疗组）和54例全脑血管造影阴性短暂性脑缺血发作患者（对照组）术前，术后1、6、24h，2周肘静脉血浆P-选择素、血管性假性血友病因子（vWF）、内皮素－1（ET－1），根据手术复杂程度将治疗组患者分为A组、B组，并进行比较。其中P－选择素、vWF采用酶联免疫吸附测定法，ET－1采用放射免疫测定法。结果所有患者术后P．选择素、vwF、ET－1水平均升高，治疗组P－选择素术后1h[（29．23±6．98）ng／mi]达到高峰，vWF、ET－1术后6h[（119．63±16．75）％、（79．71±9．78）ng／L]达到高峰。与术前比较，治疗组P-选择素、ET-1术后各时间点差异有统计学意义（P〈0．05或P〈0．01），vWF术后1、6、24h差异有统计学意义（P〈0．05或P〈0．01）。与对照组比较，治疗组P-选择素术后1h、ET-1术后6h差异有统计学意义（P〈0．05），vWF术后1、6h差异有统计学意义（P〈0．01）。与A组比较，B组vWF术后各时间点差异有统计学意义（P〈0．05或P〈0．01），ET-1术后1、6、24h差异有统计学意义（P〈0．05或P〈0．01）。结论P-选择素、vWF、ET-1在颈动脉支架置入术后有一定程度的激活，并与病变程度、手术复杂程度有关；术后监测以上生物指标，对患者的危险分层、临床治疗及判断预后可能有重要价值。

Objective To explore the changes and the clinical relevance of plasma p-selectin （PS） and vascular endothelial cell function in patients with carotid stenosis （CS） before and after carotid artery stenting （CAS）. Methods The plasma levels of PS,von willebrand （vWF） and endothelin-1 （ET-1） before CAS and 1 hour,6 hours,24 hours,2 months after CAS in 67 patients with carotid stenosis and 54 cases of TIA with negative result from cerebral angiography were measured. The patients of the therapy group were further divided into group A and group B according to complexity of CAS. The plasma levels of PS and vWF were determined by enzyme linked immunosorbent assay, and the level of ET-1 was measured by radioimmunoassay. Results The plasma levels of PS, vWF and ET-1 all increased in the patients group after CAS. In the therapy group,the level of PS reached peak value （29.23 ± 6. 98） ng/ml 1 hour after CAS, and the levels of vWF and ET-1 reached peak value （119.63± 16. 75 ） % , （79.71 ± 9.78 ） ng/L 6 hour after CAS. In therapy group, there was significant difference in the levels of PS and ET-1 between each time points after CAS and before CAS （ P 〈 0. 05, P 〈 0. 01 respectively）. There was significant difference in the level of vWF between 1 hour,6 hours,24 hours after CAS and before CAS（ P 〈 0. 05 or P 〈 0.01 ）. There was significant difference in the levels of PS 1 hour after CAS and ET-1 at 6 hours after CAS （ P 〈 0. 05） ,and in the level of vWF at 1 hour,5 hours after CAS between control group and therapy group （P 〈0. 01 ）. There was significant difference in the level of vWF at every time point after CAS （ P 〈 0. 05 or P 〈 0. 01 ）, and in the level of ET-1 at 1 hour,6 hours ,24 hours between A group and B group（ P 〈 0. 05 or P 〈 0. 01 ）. Conclusions PS,vWF and ET-1 were activated to some extent and related to pathological changes degree and complexity of CAS. Monitoring these biological indexes after CAS maybe of great value in predicting risk, evaluating clinical therapy and judging prognosis.