颈动脉支架植入(CAS)与颈动脉内膜切除手术(CEA)的效果对比及血清MMP-9及TIMP-1的变化

Comparison of effects of carotid artery stenting(CAS) and carotid endarterectomy(CEA) and changes of serum MMP-9 and TIMP-1

目的比较颈动脉支架植入(Carotid artery stent,CAS)与颈动脉内膜切除手术(Carotid endarterectomy,CEA)效果及血清基质金属蛋白酶-9(Matrix metalloproteinase-9,MMP-9)及选择性抑制剂-1(Tissue inhibitor of metalloproteinase-1,TIMP-1)变化。方法选择我院于2016年1月~2019年1月收治的颈动脉狭窄患者86例,按照不同手术方法分为CAS组43例与CEA组43例,CEA组采用颈动脉内膜切除术,CAS组采用颈动脉支架植入,比较两组术后并发症,术前、术后1个月和术后3个月蒙特利尔认知评估(Montreal cognitive assessment,MoCA)量表和简易智力状态量表(Mini-Mental state examinatlon,MMSE)、血清MMP-9和TIMP-1水平变化。结果CEA组并发症发生率(9.30%)低于CAS组(25.58%)(P<0.05)。两组术后1个月和术后3个月MoCA评分和MMSE评分较术前增加(P<0.05);两组术后1个月和术后3个月MoCA评分和MMSE评分比较差异无统计学意义(P>0.05)。两组术后1个月和术后3个月血清MMP-9和TIMP-1水平较术前降低(P<0.05);CEA组术后1个月和术后3个月血清MMP-9和TIMP-1水平低于CAS组(P<0.05)。结论颈动脉内膜切除手术治疗颈动脉狭窄患者效果优于颈动脉支架植入,术后并发症少,且减低MMP-9和TIMP-1水平明显,值得临床借鉴。

Objective To compare the effects of carotid artery stent(CAS)and carotid endarterectomy(CEA)and the changes of serum matrix metalloproteinase-9(MMP-9)and Tissue inhibitor of metalloproteinase-1(TIMP-1).Methods Eighty-six patients with carotid stenosis admitted to our hospital from January 2016 to January 2019 were enrolled and divided into the CAS group with 43 patients and the CEA group with 43 patients according to different surgical methods.Carotid endarterectomy was performed in the CEA group and carotid artery stenting was used in the CAS group.The postoperative complications,preoperative and postoperative 1-month and 3-month Montreal cognitive assessment(MoCA)scale and Mini-Mental State Examinatlon(MMSE),and serum MMP-9 and TIMP-1 levels were compared.Results The incidence of complications in the CEA group(9.30%)was lower than that(25.58%)in the CAS group(P<0.05).The MoCA score and MMSE score 1 month and 3 months after surgery in the two groups were increased compared to those before surgery(P<0.05).There were no differences in the MoCA score and MMSE score between 1 month and 3 months after surgery in the two groups(P>0.05).The serum MMP-9 and TIMP-1 levels 1 month and 3 months after surgery were decreased compared to those before surgery in the two groups(P<0.05).The serum MMP-9 and TIMP-1 levels 1 month and 3 months after surgery in the CEA group were lower than those in the CAS group(P<0.05).Conclusion Carotid endarterectomy is superior to carotid artery stenting in the treatment of carotid stenosis,causes less postoperative complications and reduces the levels of MMP-9 and TIMP-1 significantly,thereby worthy of clinical reference.