颈动脉支架植入术对症状性颈动脉狭窄患者血清炎症因子及认知功能影响的临床研究

Effects of carotid artery stenting on serum inflammatory factors and cognitive function in patients with symptomatic carotid stenosis

目的:研究了颈动脉支架置入术(CAS)对症状性颈动脉狭窄患者血清炎症因子、认知功能的影响。方法:纳入症状性颈动脉狭窄患者96例,按照手术方法的不同分为颈动脉内膜剥脱术(CEA)组和CAS组,各48例。比较两组的治疗效果,治疗前后的炎症因子水平变化以及不同治疗时间的认知功能。结果:CEA组术后5例(10.42%)患者出现切口血肿,3例(6.25%)出现神经损伤,不良反应发生率16.67%(8/48)。CAS组术后2例(4.17%)患者出现切口血肿,3例(6.25%)发生高灌注综合征,不良反应发生率10.42%(5/48)。两组围术期不良反应发生率、病死率、术后随访结果等比较,差异均无统计意义(P>0.05)。治疗后,CAS组和CEA组肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和高敏C反应蛋白(hs-CRP)水平均明显增高(P<0.05),其中CAS组TNF-α、IL-6和hs-CRP水平均明显低于CEA组(P<0.05)。治疗后不同时间,与治疗前相比,两组MMSE评分均明显增加(P<0.05),其中CAS组和CEA组治疗后不同时间的MMSE评分相比,差异无统计学意义(P>0.05)。结论:CEA和CAS治疗症状性颈动脉狭窄的疗效和安全性相当,且均能有效改善术后患者的认知功能。然而CAS属于微创手术,操作简单,适应证广泛,且治疗后与CEA相比,对机体炎征反证影响更小。

Objective:To study the effects of carotid artery stenting(CAS)on serum inflammatory factors and cognitive function in patients with symptomatic carotid stenosis.Methods:A total of 96 patients with symptomatic carotid stenosis were enrolled and divided into CEA group and CAS group according to different surgical methods,with 48 cases in each group.The CEA group was treated with carotid endarterectomy(CEA),and the CAS group was treated with CAS.The treatment effects,changes in inflammatory factors levels before and after treatment,and cognitive function at different treatment periods were compared between the two groups.Results:In the CEA group,5 patients(10.42%)had incisional hematomas,and 3 patients(6.25%)had nerve damage,and the incidence of adverse complications was 16.67%(8/48).In the CAS group,2 cases(4.17%)had incisional hematomas,3 patients(6.25%)had hyperperfusion syndrome,and the incidence of adverse complications was 10.42%(5/48).There were no significant differences in perioperative adverse complications,mortality and postoperative follow-up results between the two groups(P>0.05).After treatment,the levels of TNF-α,IL-6 and hs-CRP in the CAS group and CEA group were significantly increased(P<0.05),and the levels of TNF-α,IL-6 and hs-CRP in the CAS group were significantly lower than those in the CEA group(P<0.05).At different time after treatment,the MMSE scores of the two groups were significantly increased than those before treatment(P<0.05),but there was no significant difference in the MMSE scores between the two groups(P>0.05).Conclusion:CEA and CAS are effective and safe in the treatment of symptomatic carotid stenosis,and both can effectively improve the cognitive function of post operative patients.However,CAS is a minimally invasive surgery with simple operation and wide indications.Compared with CEA,CAS has less effect on the body’s inflammation response.