椎动脉支架置入术后sICAM-1、hs-CRP和TNF-α血清浓度的变化及其临床意义

Serum concentration changes of sICAM-1, hs-CRP and TNF-α after vertebral artery stenting and its clinical significance

目的观察椎动脉支架置入术后血清炎性细胞因子的动态变化并探讨其临床意义。方法纳入48例椎动脉支架置入术患者，以48例单纯接受脑血管造影的患者作为对照组，在支架置入（血管造影）前以及支架置人后24h、48h、3d、1周和3周时检测血清可溶性细胞间黏附分子－1（soluble intercellul aradhension molecule－1，sICAM-1）、高敏C-反应蛋白（high—sensitivity C—reactive protein．hs—CRP）和肿瘤坏死因子-α（tumor necrosis factor-α，TNF—α）水平。结果与支架置入前相比，支架置入组支架置入后24h时血清hs—CRP[（4．85±0．53）mg／L对（2．57±0．36）mg／L，P〈0．05]、TNF—α（2．42±0．34）μg/L对（1．08±0．37）μg/L，P〈0．05]和sICAM－1[（449．43±47．16）μg/L对（269．15±37．46）μg/L，P〈0．05]水平均显著增高。hs—CRP水平在支架置人后48h时达高峰[（6．24±0．59）mg／L]，3周时[（2．51±0．29）mg／L]恢复至支架置入前水平[（2．57±0．36）mg／L]；TNF-α水平支架置入后3d时[（2．30±0．25）μg/L]达高峰，3周时[（1．89±0．13）μg/L]仍维持在较高水平；sICAM－1水平则持续升高至3周时[（296．95±59．72）μg/L]。支架置人组支架置入后24h血清hs-CRP、TNF—α和sICAM-1水平分别显著高于对照组造影后24h时的（3．25±0．40）mg/L、（1.18±0．19）μg/L和（336．57±50．18）μg/L（P均〈0．05）。结论椎动脉支架置入术后血清hs—CRP、TNF-α和sICAM-1水平显著增高，提示支架置入引起了持续时间较长的炎症反应。

Objective To observe the dynamic changes of serum inflammatory factors after vertebral artery stenting and to investigate its clinical significance. Methods A total of 48 patients treated with vertebral artery stenting were included, and 48 patients only received cerebral angiography were used as a control group. The levels of soluble intercellular adhesion molecule-1 （sICAM-1）, high-sensitivity C-reactive protein （hs-CRP） and tumor-necrosis factor- α（TNF-α） were detected before procedure （angiography）, at 24 h, 48 h, 3 d, and 1 and 3 weeks after procedure （angiography）. Results The serum levels of hs-CRP （4. 85 ± 0. 53 mg/L vs. 2. 57 ±0. 36 mg/L,P 〈0. 05）, TNF-α （2. 42 ±0. 34 μg/L vs. 1.08±0. 37μg/L,P 〈0. 05） and sICAM-1 （449. 43 ± 47. 16 μg/L vs. 269. 15 ± 37. 46 μg/L, P 〈 0. 05） at 24 hours after procedure in the stenting group were significantly elevated compared with those before procedure. The Hs-CRP level （6. 24 ±0. 59 mg/L） reached the peak at 48 hours after procedure. At week 3 （2. 51±0. 29 mg/L）, it returned to the level before procedure （2.57 ±0. 36 mg/L）; TNF- α level reached the peak at day 3 （2. 30 ± 0. 25 μg/L）, and it remained higher level at week 3 （1.89 ± 0. 13 μg/L）; the slCAM-1 level continued to rise at week 3 （296. 95 ± 59. 72 μg/L）. The serum hs-CRP, TNF-α and sICAM-1 levels at 24 hours after procedure in the stenting group were significantly higher than those （3.25 ±0. 40 mg/L,1.18 ±0. 19 μg/L and 336. 57± 50. 18 μg/L） in the control group （all P 〈 0. 05）. Conclusions The serum hs-CRP, TNF-α, sICAM-1 levels were significantly elevated after vertebral artery stenting. It was suggested that the stenting caused a longer duration of inflammatory response.