症状性颈动脉重度狭窄患者支架成形术后血清炎症因子的变化及临床意义

Changes and Clinical Significance of Serum Inflammatory Factors in Patients with Symptomatic Severe Carotid Artery Stenosis after Stenting

目的:观察症状性颈动脉重度狭窄患者支架成形术后血清IL-6、IL-8、IL-10和TNF-α表达水平的动态变化并探讨其临床意义。方法:选择2018年08月至2022年08月于我院神经介入科住院治疗的112例症状性颈动脉重度狭窄患者作为研究对象。依据手术方式的不同,分为单纯造影组45例;支架成形术组67例。对支架成形术组患者,依据术后3 d颅脑DWI-MRI检查结果判断是否发生颅内微缺血(IMI),分为微缺血组29例和无微缺血组38例。检测所有患者手术前和术后24 h、3 d、30 d血清IL-6、IL-8、IL-10和TNF-α表达水平,观察患者手术前后炎症因子动态变化情况,比较微缺血组与无微缺血组炎症反应的差别。结果:与单纯造影组相比,支架成形术组患者术后24 h、3 d血清IL-6、IL-8、IL-10和TNF-α表达水平均显著增高(P < 0.05)。与术前相比,支架成形术组患者术后24 h血清IL-6、IL-8、IL-10和TNF-α水平显著升高(P < 0.05),并达到高峰,术后30 d血清IL-6、IL-8、IL-10和TNF-α水平恢复至术前水平。微缺血组患者术后24 h、3 d血清IL-6、IL-8、IL-10和TNF-α表达水平显著高于无微缺血组(P < 0.05)。结论:症状性颈动脉重度狭窄患者支架成形术后发生了急性血管炎症反应,术后发生微缺血事件患者的血管炎症反应较未发生者更为强烈。

Objective: To observe the dynamic changes of serum levels of IL-6, IL-8, IL-10 and TNF-α in patients with symptomatic severe carotid artery stenosis after stenting and explore their clinical signifi-cance. Methods: A total of 112 patients with symptomatic severe carotid artery stenosis who were hospitalized in the neurointerventional department of our hospital from August 2018 to August 2022 were selected as the study objects. According to the different surgical methods, 45 cases were divided into angiography group. The stenting group was 67 cases. The patients in the stenting group were divided into 29 patients in the microischemia group and 38 patients without micro-ischemia group according to the results of postoperative 3 d head DWI-MRI examination. The ex-pression levels of IL-6, IL-8, IL-10 and TNF-α in serum were detected before and 24 h, 3 d and 30 d after surgery. The dynamic changes of inflammatory factors were observed before and after surgery, and the difference of inflammatory response between the micro-ischemia group and the non-micro-ischemia group was compared. Results: Compared with angiography group, the expres-sion levels of IL-6, IL-8, IL-10 and TNF-α in serum in stenting group were significantly increased 24 h and 3 d after stenting (P < 0.05). Compared with the preoperative level, the serum levels of IL-6, IL-8, IL-10 and TNF-α in the stent-plasty group were significantly increased 24 h after surgery and reached a peak (P < 0.05), and the serum levels of IL-6, IL-8, IL-10 and TNF-α were restored to the preoperative level 30 days after surgery. The expression levels of IL-6, IL-8, IL-10 and TNF-α in se-rum in the microischemia group were significantly higher than those in the non-microischemia group 24 h and 3 d after surgery (P < 0.05). Conclusions: Acute vascular inflammation occurred in patients with symptomatic severe carotid artery stenosis after stenting, and the vascular inflamma-tion was more intense in patients with postoperative micro ischemia events than those without.