支架机械取栓与动脉溶栓对急性大脑中动脉栓塞患者神经功能恢复影响的差异研究

The different effects of mechanical embolus removal and intra-arterial thrombolysis on neural functional recovery in patients with acute middle cerebral artery occlusion

目的:研究支架机械取栓与动脉溶栓对急性大脑中动脉栓塞患者神经功能恢复影响的差异。方法:选择2013年9月~2017年10月期间榆林市第一医院收治的急性大脑中动脉栓塞患者进行回顾性研究,根据病史资料中再灌注治疗手段的差异分为研究A组与研究B组,分别接受支架机械取栓与动脉溶栓治疗。治疗前及治疗后24h,测定血清中神经细胞损害标志物、凋亡及应激标志物的含量以及外周血中Wnt通路分子的表达量。结果:与组内治疗前比较,两组患者治疗后血清中NSE、S100B、VILIP1、sFas、sFasL、ET-1、MDA的含量以及外周血中GSK3β、LC3-II、Beclin1的表达强度呈降低趋势,血清中BDNF、NTF、sLivin、SOD的含量以及外周血中β-catenin、mTOR的表达强度呈升高趋势且研究A组患者治疗后血清中NSE、S100B、VILIP1、sFas、sFasL、ET-1、MDA的含量以及外周血中GSK3β、LC3-II、Beclin1的表达强度低于研究B组,血清中BDNF、NTF、sLivin、SOD的含量以及外周血中β-catenin、mTOR的表达强度高于研究B组。结论:支架机械取栓用于急性大脑中动脉栓塞的治疗能够较动脉溶栓更为有效的减轻神经功能损害及相应的氧化应激及细胞凋亡程度。

Objective：To study the different effects of mechanical embolus removal and intra-arterial thrombolysis on neural functional recovery in patients with acute middle cerebral artery occlusion.Methods：Patients with acute middle cerebral artery occlusion who were treated in the First Hospital of Yulin between September 2013 and October 2017 were selected and retrospectively studied,and the differences in reperfusion therapies in history data were referred to divide them into study group A and study group B who underwent mechanical embolus removal and intra-arterial thrombolysis respectively.The levels of neurocyte damage markers,apoptosis markers and stress markers in serum as well as the expression of Wnt pathway molecules in peripheral blood were determined before treatment and 24 hours after treatment.Results：Compared with those of same group before treatment,serum NSE,S100 B,VILIP1,sFas,sFasL,ET-1 and MDA levels as well as peripheral blood GSK3β,LC3-II and Beclin1 expression intensity of both groups were decreasing whereas serum BDNF,NTF,sLivin and SOD levels as well as peripheral bloodβ-catenin and mTOR expression intensity were increasing,and serum NSE,S100 B,VILIP1,sFas,sFasL,ET-1 and MDA levels as well as peripheral blood GSK3β,LC3-II and Beclin1 expression intensity of study group A after treatment were lower than those of study group B whereas serum BDNF,NTF,sLivin and SOD levels as well as peripheral bloodβ-catenin and mTOR expression intensity were higher than those of study group B.Conclusion：Mechanical embolus removal for acute middle cerebral artery occlusion can be more effective than intra-arterial thrombolysis to reduce the nerve function damage as well as the corresponding oxidative stress and apoptosis.