CAS和CEA治疗颈内动脉重度狭窄疗效及对脑血流量、血清miR-145、IGF1R的影响  

Effects of CAS and CEA on Cerebral Blood Flow,Serum miR-145 and IGF1R in Treatment of Severe Internal Carotid Artery Stenosis

作　　者：胡晨 董瑞芳[1] 史方堃[1] 刘红梅[1] 姜东红[1] 张文高[1] 台立稳[2] HU Chen;DONG Rui-fang;SHI Fang-kun;LIU Hong-mei;JIANG Dong-hong;ZHANG Wen-gao;TAI Li-wen(Cangzhou City Central Hospital Department of Neurology,Cangzhou,Hebei,061000,China;Department of Neurology,Second Affiliated Hospital of Hebei Medical University,Shijiazhuang,Hebei,050000,China)

机构地区：[1]沧州市中心医院神经内一科,河北沧州061000 [2]河北医科大学附属第二医院神经内科,河北石家庄050000

出　　处：《现代生物医学进展》2021年第6期1182-1186,共5页Progress in Modern Biomedicine

基　　金：河北省自然科学基金项目(H201320125);沧州市重点研发计划指导项目(172302141)。

摘　　要：目的:探讨颈动脉支架植入术(CAS)和颈动脉内膜剥脱术(CEA)治疗颈内动脉重度狭窄疗效及对脑血流量、血清miR-145、胰岛素样生长因子1受体(IGF1R)的影响。方法:回顾性分析2018年1月至2019年12月我院收治的100例颈动脉重度狭窄患者的临床资料,按照手术方式不同分为A组和B组,每组50例,A组给予CAS治疗,B组给予CEA治疗。比较两组围术期情况、脑血流量、血清miR-145、IGF1R、简易精神状态检查表(MMSE)量表、蒙特利尔认知评估量表(MoCA)的变化,并比较术后并发症、再狭窄率及死亡率。结果:两组患者手术时间、术中失血量、术后机械通气时间、ICU停留时间、住院时间比较,差异无统计学意义(P>0.05);术后3个月时,两组脑血流量指标相对达峰时间(rTTP)、相对平均通过时间(rMTT)、相对脑血容量(rCBV)、相对脑血流量(rCBE)、血清miR-145、IGF1R、MMSE量表、MoCA量表评分比较差异均无统计学意义(P>0.05);术后30 d内,两组心动过缓、心肌酶谱升高、高灌注综合征、局部血肿、颈动脉急性闭塞比较差异无统计学意义(P>0.05),A组脑卒中、低血压发生率明显高于B组,B组高血压发生率明显高于A组(P<0.05);术后1年时,两组患者死亡率、再狭窄率比较差异无统计学意义(P>0.05)。结论:CAS和CEA治疗颈内动脉重度狭窄患者的疗效相似,均可有效改善脑血流量,调节血清miR-145、IGF1R水平的表达,促进认知功能恢复,但CAS术后脑卒中、低血压发生率更高,CEA术后高血压发生率更高。Objective:To study the effects of carotid artery stenting(CAS)and carotid endarterectomy(CEA)on cerebral blood flow,serum miR-145 and insulin-like growth factor 1 receptor(IGF1R)in treatment of severe internal carotid artery stenosis.Methods:The clinical data of 100 patients with severe carotid stenosis admitted to our hospital from January 2018 to December 2019 were retrospectively analyzed,they were divided into A group and B group according to different operative methods,50 cases in each group,the A group was given CAS treatment,and the B group received CEA treatment.The perioperative conditions,cerebral blood flow,serum miR-145,IGF1R,Mini Mental State Examination(MMSE)and Montreal Cognitive Assessment Scale(MoCA)were compared between the two groups,and the postoperative complications,restenosis rate and mortality rate were compared.Results:There was no significant difference in operation time,intraoperative blood loss,postoperative mechanical ventilation time,ICU stay time and hospitalization time between the two groups(P>0.05);at postoperative 30 days,there were no significant differences in the relative time to peak(RTTP),relative mean transit time(rmtt),relative cerebral blood volume(rCBV),relative cerebral blood flow(rcbe),serum miR-145,IGF1R,MMSE scale and MOCA scale scores between the two groups(P>0.05);within postoperative 30 days,there was no significant difference in bradycardia,myocardial enzyme spectrum increased,hyperperfusion syndrome,local hematoma and acute carotid artery occlusion between the two groups(P>0.05);the incidence of stroke and hypotension in A group were significantly higher than that in B group,the incidence of hypertension in the B group was significantly higher than that in A group(P<0.05);at postoperative1 year,there was no significant difference in mortality and restenosis rate between the two groups(P>0.05).Conclusion:CAS and CEA have similar effects in the treatment of patients with severe internal carotid artery stenosis,they are can effectively improve cerebral blood flow,

关 键 词：颈内动脉重度狭窄 颈动脉支架植入术 颈动脉内膜剥脱术 脑血流量 MIR-145 胰岛素样生长因子1受体 并发症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]