颅内动脉瘤患者手术前后血清Hcy、SICAM-1及MMP-9变化与脑血管痉挛的相关性研究

Correlation between changes of serum Hcy,SICAM-1 and MMP-9 in patients with intracranial aneurysms before and after operation and cerebral vasospasm

目的研究颅内动脉瘤患者手术前后血清同型半胱氨酸(Hcy)、可溶性细胞间黏附分子-1(SICAM-1)及基质金属蛋白酶-9(MMP-9)变化与脑血管痉挛(CVS)的关系。方法回顾性选取2015年9月至2018年4月海口市人民医院行开颅动脉瘤夹闭手术的80例颅内动脉瘤患者作为研究对象,根据术后是否发生CVS分组,其中29例发生CVS为CVS组,并根据脑血管直径缩短程度评估CVS严重程度,其中轻度CVS组12例,中度CVS组10例,重度CVS组7例;另51例未发生CVS为nCVS组。术前、术后1、3、7 d采血,依次检测所有患者血清Hcy、SICAM-1及MMP-9浓度,并进行统计分析。并分析血清Hcy、SICAM-1及MMP-9与CVS严重程度的相关性。结果nCVS组术前、术后1、3、7 d血清Hcy、SICAM-1及MMP-9均逐渐降低,差异均有统计学意义(P<0.05);CVS组术后3、7 d血清Hcy、SICAM-1及MMP-9较术后1 d升高,但均低于术前,差异均有统计学意义(P<0.05);CVS组术后3、7 d血清Hcy、SICAM-1及MMP-9显著高于nCVS组,差异均有统计学意义(P<0.05)。脑血管直径缩短程度及血清Hcy、SICAM-1及MMP-9水平比较,无CVS<轻度CVS<中度CVS<重度CVS,差异均有统计学意义(P<0.05)。颅内动脉瘤患者术后脑血管直径缩短程度与术后3 d血清Hcy、SICAM-1及MMP-9呈正相关(r=0.421、0.375、0.500,P<0.05)。结论颅内动脉瘤患者手术前后血清Hcy、SICAM-1及MMP-9水平变化与CVS的发生密切相关,建议围术期动态监测此3项指标,尤其是术后下降不明显或明显升高时及时采取针对性干预。

Objective To investigate the relationship between changes of serum homocysteine(Hcy),soluble intercellular adhesion molecule-1(SICAM-1)and matrix metalloproteinase-9(MMP-9)in patients with intracranial aneurysms before and after operation and cerebral vasospasm(CVS).Methods Eighty patients with intracranial aneurysm who underwent craniotomy and clipping surgery in Haikou People's Hospital from September 2015 to April 2018 were retrospectively selected as the research subjects.According to the occurrence of CVS after operation,29 cases of CVS occurred in the CVS group,and the severity of CVS was evaluated according to the degree of cerebral vessel diameter shortening,among them,there were 12 cases in the mild CVS group,10 cases in the moderate CVS group,and 7 cases in the severe CVS group;the other 51 cases without CVS were in the nCVS group.Blood samples were collected before operation,at 1 day,3 days and 7 days after operation to detect levels of serum Hcy,SICAM-1 and MMP-9 and statistical analysis was performed.The correlation between serum Hcy,SICAM-1 and MMP-9 and the severity of CVS was analyzed.Results Serum Hcy,SICAM-1 and MMP-9 in nCVS group were gradually decreased before operation and at 1 day,3 days and 7 days after operation,the differences were statistically significant(P<0.05).The levels of serum Hcy,SICAM-1 and MMP-9 in the CVS group were higher than those on the 1st day after operation,but they were all lower than those before operation,and the differences were statistically significant(P<0.05).The levels of serum Hcy,SICAM-1 and MMP-9 in the CVS group were significantly higher than those in the nCVS group at 3 and 7 days after operation,and the differences were statistically significant(P<0.05).The shortening of cerebrovascular diameter and serum Ccy,SICAM-1 and MMP-9 levels showed CVS<mild CVS<moderate CVS<severe CVS,and the differences were statistically significant(P<0.05).The degree of shortening of cerebrovascular diameter in patients with intracranial aneurysms was positively correlated with serum Hcy,SICAM-1 and MMP-9 at 3 days after operation(r=0.421,0.375,0.500,P<0.05).Conclusion Changes of serum Hcy,SICAM-1 and MMP-9 in patients with intracranial aneurysms before and after operation are closely related to the occurrence of CVS.It is recommended to monitor these three indicators dynamically during the perioperative period,and targeted intervention should be taken when the decrease or increase is not obvious after operation.