脑动脉瘤介入栓塞术患者血清可溶性细胞间黏附分子-1、白细胞介素-6水平与脑血管痉挛的关系

Relationship between serum soluble intercellular adhesion molecule-1, interleukin-6 levels and cerebral vasospasm in patients with cerebral aneurysm undergoing interventional embolization

目的探讨行脑动脉瘤介入栓塞术患者血清可溶性细胞间黏附分子-1(SICAM-1)、白细胞介素-6(IL-6)水平与脑血管痉挛(CVS)的关系。方法回顾性选取2018年10月至2021年5月在海南医学院第二附属医院接受介入栓塞术治疗的86例脑动脉瘤破裂患者,术后3~5 d采用全脑数字减影血管造影术观察CVS发生情况。观察无CVS和不同程度CVS患者手术前后血清SICAM-1、IL-6变化,分析术后血清SICAM-1、IL-6与脑血管直径减少度的相关性,绘制受试者工作特征(ROC)曲线分析术后血清SICAM-1、IL-6对CVS的诊断价值。结果CVS发生率39.53%(34/86),轻度、中度和重度CVS分别11、14和9例。无CVS患者手术前后血清SICAM-1、IL-6水平比较,差异均无统计学意义(P>0.05)。CVS患者术后3 d血清SICAM-1、IL-6水平较术前明显升高,也显著高于无CVS患者,差异均有统计学意义(P<0.05)。CVS患者随CVS程度加重,术后3 d血清SICAM-1、IL-6水平呈明显升高趋势(P<0.05)。CVS患者术后3 d血清SICAM-1、IL-6水平与脑血管直径减少度均呈正相关(r=0.783、0.790,P<0.05),二者及其联合诊断CVS的曲线下面积(AUC)为0.826、0.731、0.893,敏感度为81.82%、69.70%、84.85%,特异度为80.77%、88.46%、84.62%,且联合诊断的AUC高于单一指标诊断,差异有统计学意义(P<0.05)。结论脑动脉瘤介入栓塞术后血清SICAM-1、IL-6水平与CVS发生及严重程度紧密相关,二者联合检测对CVS具有较好诊断价值。

Objective To investigate the relationship between serum soluble intercellular adhesion molecule-1(sICAM-1)and interleukin-6(IL-6)levels and cerebral vasospasm(CVS)in patients with cerebral aneurysm undergoing interventional embolization.Methods From October 2018 to May 2021,86 patients with ruptured cerebral aneurysms were treated by interventional embolization in Second Affiliated Hospital of Hainan Medical College.The occurrence of CVS was observed by whole brain digital subtraction angiography 3-5 days after operation.The changes of serum sICAM-1 and IL-6 in patients without CVs and with different degrees of CVS before and after operation were observed,the correlation between postoperative serum sICAM-1,IL-6 and cerebral vascular diameter reduction was analyzed.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of postoperative serum sICAM-1,IL-6 for CVS.Results The incidence of CVS was 39.53%(34/86).Mild,moderate and severe CVS occurred in 11,14 and 9 cases respectively.There was no statistically significant change in serum sICAM-1 and IL-6 levels before and after operation in patients without CVS(P>0.05).The serum levels of sICAM-1 and IL-6 in patients with CVs at 3 days after operation were significantly higher than those before operation,and were also significantly higher than those without CVS(P<0.05).The serum levels of sICAM-1 and IL-6 in CVS patients increased with the severity of CVS(P<0.05).The serum sICAM-1 and IL-6 levels were positively correlated with the decrease of cerebral vascular diameter in CVS patients at 3 days after operation(r=0.783,0.790,P<0.05).The area under the curve(AUC)of the two and their combined diagnosis of CVs were 0.826,0.731,0.893,the sensitivity was 81.82%,69.70%,84.85%,the specificity was 80.77%,88.46%,84.62%,and the AUC of combined diagnosis was higher than that of single index diagnosis,the difference was statistically significant(P<0.05).Conclusion Serum sICAM-1 and IL-6 levels are closely related to the occurrence and severity of CVS after interventional embolization of cerebral aneurysms.