血管介入栓塞术和显微外科夹闭术对颅内动脉瘤的临床疗效及血清MCP-1水平的影响

Effect of Vascular Embolization and Microsurgical Clipping on Clinical Efficacy and Serum MCP-1 Level of Patients with Intracranial Aneurysms

目的探讨血管介入栓塞术和显微外科夹闭术对颅内动脉瘤患者的临床疗效及血清单核细胞趋化蛋白-1(MCP-1)水平的影响。方法回顾性分析2017年6月至2019年12月于安徽医科大学附属六安医院神经外科就诊的81例颅内动脉瘤患者的临床资料,按照手术方式不同分为两组,其中血管介入栓塞术组(n=39)手术方式选用血管介入栓塞术;显微外科夹闭术组(n=42)选用显微外科夹闭术。记录两组患者的手术时间和住院时间,比较两组患者手术前后美国国立卫生研究院卒中量表(NIHSS)评分、改良Barthel指数(MBI)量表评分及血清MCP-1水平变化,术后并发症发生率及随访3个月的格拉斯哥预后量表(GOS)评估结果。结果血管介入栓塞术组的手术时间和住院时间均短于显微外科夹闭术组[(2.1±0.5)h比(3.0±0.6)h,(11.5±2.1)d比(18.6±2.5)d](P<0.05)。NIHSS评分组间和时点间存在交互作用(P<0.05),不同时点间两组患者NIHSS评分的变化趋势不同,均呈下降趋势,但血管介入栓塞术组下降幅度更大。MBI评分组间和时点间存在交互作用(P<0.05),不同时点间两组患者MBI评分的变化趋势不同,均呈上升趋势,但血管介入栓塞术组上升幅度更大。血清MCP-1水平组间和时点间存在交互作用(P<0.05),不同时点间两组血清MCP-1水平的变化趋势不同,均呈下降趋势,但血管介入栓塞术组降低幅度更大。血管介入栓塞术组的并发症发生率低于显微外科夹闭术组[15.38%(6/39)比35.71%(15/42)](P<0.05)。血管介入栓塞术组的恢复良好率显著高于显微外科夹闭术组[69.23%(27/39)比47.62%(20/42)](P<0.05)。结论血管介入栓塞术治疗颅内动脉瘤的临床疗效优于显微外科夹闭术,且采用血管介入栓塞术治疗的术后并发症发生率较低且远期疗效更加突出,可能与该术式对脑组织的损伤较轻有关。

Objective To investigate the effect of vascular embolization and microsurgical clipping on clinical efficacy and serum monocyte chemotactic protein 1(MCP-1)level of patients with intracranial aneurysms.Methods The clinical data of 81 patients with intracranial aneurysms admitted to the Department of Neurosurgery in Lu′an Hospital Affiliated to Anhui Medical University from Jun.2017 to Dec.2019 were retrospectively analyzed.According to the different surgical methods,they were divided into two groups:a vascular embolization group(n=39)treated by vascular embolization;a microsurgical clipping group(n=42)treated by microsurgical clipping.The operation time and hospital stays of the two groups were recorded.National Institutes of Health stroke scale(NIHSS)scores,modified Barthel index(MBI)scores and the change of serum MCP-1 levels before and after surgery,the rate of postoperative complications and the results of the Glasgow outcome scale(GOS)during three months follow-up were compared between the two groups.Results The operative time and hospital stays of the vascular embolization group were shorter than those of the microsurgical clipping group[(2.1±0.5)h vs(3.0±0.6)h,(11.5±2.1)d vs(18.6±2.5)d](P<0.05).There were interactions between groups and time points in NIHSS scores(P<0.05),the variation trends of NIHSS scores of the two groups were different at different time points,and both showed a downward trend,but the decline was greater in the vascular embolization group.There were interactions between groups and time points in MBI scores(P<0.05),the variation trends of MBI scale scores of the two groups were different at different time points,and both showed an upward trend,but the increase was greater in the vascular embolization group.There were interactions between groups and time points in serum MCP-1 levels(P<0.05),the variation trends of serum MCP-1 levels of the two groups were different at different time points,and both showed a downward trend,but the decline was greater in the vascular embolization group.The postoperative complication rate of the vascular embolization group was lower than that of the microsurgical clipping group[15.38%(6/39)vs 35.71%(15/42)](P<0.05).The good recovery rate of the vascular embolization group was significantly higher than that of the microsurgical clipping group[69.23%(27/39)vs 47.62%(20/42)](P<0.05).Conclusion The clinical efficacy of vascular embolization treatment for intracranial aneurysm is better than that of microsurgical clipping treatment,the rate of postoperative complications is lower and the long-term efficacy is more prominent,which may be related to the less damage to brain tissue caused by vascular embolization.