中青年颈动脉闭塞的临床特点与外科治疗分析  

Analysis of clinical feature and surgical treatment of young and middle-aged patients with carotid artery occlusion

作　　者：范银星 孙羽东 王宏飞[2] 秦锋[2] 赵志青[2] 景在平[2] 

机构地区：[1]江苏省镇江市解放军第359医院肿瘤科,江苏镇江202001 [2]第二军医大学附属长海医院血管外科,上海200433

出　　处：《外科理论与实践》2015年第4期316-321,共6页Journal of Surgery Concepts & Practice

基　　金：国家自然科学基金(81170299)

摘　　要：目的:探讨中青年颈动脉闭塞的发病机制,为其治疗方法的选择提供依据。方法:回顾2008年1月至2014年6月342例颈动脉闭塞病人的临床资料。结果:<65岁(中青年组)病人226例,≥65岁(老年组)病人116例。中青年组合并高血脂、吸烟、外周动脉疾病等病史的病人显著低于老年组(P<0.001)。血液分析结果表明,与炎症反应相关的C反应蛋白(CRP)、白细胞、红细胞沉降率(ESR)在中青年组中显著高于老年组(P<0.05)。老年组三酰甘油则相反,显著升高(P=0.003)。同时,对病人颈动脉内膜标本组织病理学检测结果提示,中青年组与免疫炎症相关的巨噬细胞、T细胞、肥大细胞数以及转化生长因子β的水平均显著高于老年组(P<0.05)。术后6个月随访结果表明,中青年组病人术后再狭窄与卒中发生率显著高于老年组。预后分析结果提示,CRP与ESR高水平以及颈动脉支架成形术显著增加中青年病人术后主要并发症的发生率。结论:颈动脉内膜免疫炎症反应性增生是中青年人颈动脉闭塞发病的主要机制,颈动脉内膜剥脱术可能是其首选的外科治疗手段。Objective To investigatie the mechanism and surgical management of yound and middle-aged patients with carotid artery occlusion. Methods Clinical records of 342 carotid artery occlusion patients between January 2008 and June 2014 were analyzed retrospectively. Results There were 226 patients less than 65 years old in young and middleaged group and 116 patients 65 and more years old in aged group. Hyperlipidemia, smoking and peripheral vascular di-seases were less significantly in young and middle-aged group than those in aged group（P〈0.001）. It was shown that the amounts of markers of inflammation including C reactive protein（CRP）, white blood cells and erythrocyte sedimentation rate（ESR） were higher significantly in young and middle-aged group than those in aged group（P〈0.05）. However, the amount of triglyceride showed the opposite result, which was lower in young and middle-aged group significantly（P=0.003）.Meanwhile, the pathological examination on the endothelium of carotid artery of patients showed that immune inflamma-tion-related index such as macrophage, T cells, mastocyte and transforming growth factor β were higher in young and middle-aged group than aged group（P〈0.05）. It was indicated with six months follow-up that rate of both postoperative carotid artery restenosis and postoperative stroke were more in young and middle-aged group than those in aged group. The analysis of prognosis showed that the higher levels of CRP and ESR and application of carotid artery stenting could signifi-cantly increase the occurrence of major complications in young and middle-aged group. Conclusions The intimal hyperplasia in carotid artery induced by immune inflammation might be the main mechanism of carotid artery occlusion in young and middle-aged patients. Carotid endarterectomy becomes the preferred surgical procedure.

关 键 词：颈动脉闭塞 免疫炎症 动脉粥样硬化 颈动脉内膜剥脱术 

分 类 号：R653[医药卫生—外科学]