不同血管内介入手术时机对颅内动脉瘤破裂出血患者血清髓鞘碱性蛋白、神经元特异性烯醇化酶及内皮素-1水平的影响

EFFECTS OF DIFFERENT TIMING OF ENDOVASCULAR INTERVENTION ON SERUM MBP,NSE AND ET-1 LEVELS IN PATIENTS WITH RUPTURED INTRACRANIAL ANEURYSMS

目的探讨不同血管内介入手术时机对颅内动脉瘤破裂出血患者血清髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)及内皮素-1(ET-1)水平的影响。方法回顾性分析四川省乐山市人民医院155例颅内动脉瘤破裂出血患者的病例资料,根据接受血管内介入栓塞手术时间分为超早期组(47例,发病48 h内接受治疗)、早期组(53例,发病48~72 h内接受治疗)及延期组(55例,发病72 h后接受治疗)。对比三组栓塞效果及并发症情况,观察术前、术后1周和1月时血清MBP、NSE及ET-1水平变化。结果超早期组和早期组栓塞成功率均显著高于延期组,差异均有统计学意义(均P<0.05)。术后1周及术后1月,三组患者血清MBP、NSE及ET-1水平呈明显降低趋势,其中超早期组显著低于同期早期组,早期组又低于延期组,差异均有统计学意义(P<0.05)。超早期组术后并发症发生率显著低于延期组,差异均有统计学意义(均P<0.05)。结论血管内介入栓塞术治疗颅内动脉瘤破裂出血具有良好效果,超早期或早期手术能显著提高栓塞成功率。

Objective To investigate the effects of endovascular intervention at different time points for intracranial aneurysm rupture and hemorrhage and its effect on serum myelin basic protein(MBP),neuron-specific enolase(NSE) and endothelin-1(ET-1) levels.Methods One hundred and fifty-five patients with intracranial aneurysm rupture and hemorrhage in Leshan people’s Hospital, Sichuan province were selected and divided into super-early group(n=47,treated within 48 h),early group(n=53,treated within 48 h-72 h) and delayed group(n=55,treated 72 hours after onset) according to the time of embolization.The embolization effect and complications of the three groups were compared.The serum MBP,NSE and ET-1 levels were observed before, 1 week and 1 month after surgery.Results The success rate of embolization in the super-early group and the early group was significantly higher than that in the delayed group(P<0.05).1 week and 1 month after the operation, the serum of MBP,NSE,ET-1 in the 3 groups were significantly decreased, while the super-early group was significantly lower than the early-stage group and the early-stage group was lower than the delayed group(P<0.05).The incidence of postoperative complications in the super-early group was significantly lower than that in the delayed group.The differences was statistically significant(all P<0.05).Conclusion Endovascular embolization has a good effect in the treatment of intracranial aneurysm rupture and hemorrhage.Super early or early operation can significantly improve the success rate of embolization.