介入栓塞术与开颅夹闭术治疗颅内动脉瘤对照研究

Comparative study of endovascular interventional embolization in the treatment of patients with intracranial aneurysms

目的探讨血管内介入栓塞术对颅内动脉瘤患者术后血清基质金属蛋白酶-9(MMP-9)、可溶性细胞间黏附分子-1(sICAM-1)水平变化及并发症发生率的影响。方法选取2013-07—2016-07郑州大学附属南阳医院颅内动脉瘤患者98例,依照术式不同分为观察组与对照组各49例。对照组予以开颅夹闭术,观察组采取血管内介入栓塞术。比较2组术前、术后4周神经功能缺损评分(NIHSS)、日常生活能力评分(BI)与血清MMP-9、sICAM-1水平,并观察2组术后并发症发生情况及术后1a预后情况。结果术前2组NIHSS与BI评分差异无统计学意义(P>0.05),术后4周与对照组比较,观察组NIHSS评分降低,BI评分提高,差异有统计学意义(P<0.05);术前2组血清MMP-9、sICAM-1水平差异无统计学意义(P>0.05),术后4周与对照组比较,观察组血清MMP-9、sICAM-1水平均降低,差异有统计学意义(P<0.05);观察组术后并发症发生率6.12%(3/49),低于对照组的22.45%(11/49),差异有统计学意义(P<0.05);术后1a观察组预后情况优于对照组,差异有统计学意义(P<0.05)。结论颅内动脉瘤予以血管内介入栓塞术可显著降低患者术后血清MMP-9、sICAM-1水平,减少并发症,减轻神经功能损伤,改善预后。

Objective To explore the effects of endovascular interventional embolization on serum matrix metalloproteinase- 9 （MMP-9） and soluble intercellular adhesion molecule-1 （sICAM-1） levels changes and incidence rate of complications in patients with intraeranial aneurysms after operation. Methods Ninety-eight patients with intracranial aneurysm in our hospital from July 2013 to July 2016 were selected. The patients were divided into observation group and control group according to different meth- ods, each with 49 cases. The control group received craniotomy and the observation group received endovascular interventional embolization. The neurological deficit score （NIHSS）, daily living ability score （BI） and serum MMP-9 and sICAM-1 levels were compared between the two groups at 4 weeks before and after operation. The postoperative complications and prognosis after 1 year were observed between the two groups. Results There were no significant differences in NIHSS and BI scores between the two groups （P〈0.05）. Compared with the control group at 4 weeks after operation, the NIHSS score of the observation group was decreased, and the BI score was improved, the difference were statistically significant （P 〈0. 05）. There was no significant difference in serum MMP-9 and slCAM-1 levels between the two groups （P〈0. 05）. Compared with the control group at 4 weeks after operation, the levels of serum MMP-9 and sICAM-1 in the observation group were decreased, the difference was statistically significant （P 〈0. 05）. The postoperative complication incidence rate of the observation group was 6.12 % （3/49）, which was lower than that of the control group 22.45 % （11/49）, the difference was statistically significant （Pal0.05）. The prognosis of the observation group was better than that of the control group at 1 year after operation, the difference was statistically significant （P〈 0. 05）. Conclusion The treatment of endovaseular interventional embolization can reduce the serum levels of MMP-9 and sICAM- 1 in patients with intracranial aneurysms. It can reduce complications incidence situation and neurological impairment, improve their daily living ability and prognosis.