球囊扩张术与支架植入术治疗大脑中动脉狭窄对脑灌注认知功能及神经炎症的影响  

Effect of balloon dilatation and stent implantation in the treatment of middle cerebral artery stenosis on cerebral perfusion,cognitive function and neuroinflannation

作　　者：张继伟[1] 李亮[1] 齐宝柱 孙文浩[1] 于淼[1] 李东 田宇 王广[1] ZHANG Jiwei;LI Liang;QI Baozhu;SUN Wenhao;YU Miao;LI Dong;TIAN Yu;WANG Guang(Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院,河北承德067000

出　　处：《中国实用神经疾病杂志》2023年第9期1131-1136,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河北省卫生健康委员会医学科学研究课题计划(编号:20200381)。

摘　　要：目的探讨球囊扩张术与支架植入术对大脑中动脉(MCA)狭窄患者成功率、脑灌注、认知功能及NOD样受体热蛋白结构域相关蛋白3(NLRP3)、白细胞计数-1β(IL-1β)和IL-8的影响。方法选取2020-01—2022-12承德医学院附属医院MCA狭窄患者60例,依据简单随机数字表法分为球囊组及支架组各30例。球囊组采取球囊扩张术,支架组采取支架植入术。统计2组治疗成功率、动脉狭窄程度、手术前后脑灌注指标、认知功能(NIHSS、MoCA)、日常生活能力(ADL)评分、血清NLRP3、IL-1β、IL-8水平及术后6个月不良脑血管事件发生率。结果术后支架组动脉狭窄程度低于球囊组(P<0.05);支架组治疗成功率(93.33%)高于球囊组(83.33%),但组间比较无统计学差异(P>0.05);术后1周支架组脑血流量、脑血容量大于球囊组,平均通过时间、达峰时间短于球囊组(P<0.05);术后1个月支架组NIHSS及ADL评分低于球囊组,MoCA评分高于球囊组(P<0.05);术后1 d、1周支架组血清NLRP3、IL-1β、IL-8水平低于球囊组(P<0.05);支架组并发症发生率、不良脑血管事件发生率低于球囊组,但无统计学差异(P>0.05)。结论与球囊扩张术相比,支架植入术治疗MCA狭窄患者,可改善脑灌注,降低动脉狭窄程度,改善患者认知功能、日常生活能力,且可能通过降低血清NLRP3、IL-1β、IL-8表达而减轻再灌注损伤。Objective To investigate the effects of balloon dilatation and stent implantation on the suc⁃cess rate,cerebral perfusion,cognitive function,nod-like receptor pyrin domain-containing protein3(NLRP3),in⁃terleukin-1β(IL-1β),and IL-8 in patients with middle cerebral artery(MCA)stenosis.Methods From January 2020 to December 202260 patients with MCA stenosis in our hospital were selected and divided into balloon group and stent group according to a simple random number table,30 cases in each group.Balloon dilation was performed in the balloon group and stent implantation in the stent group.The treatment success rate,degree of ar⁃terial stenosis,brain perfusion indexes before and after surgery,cognitive function(NIHSS,MoCA),and ability of daily living(ADL)scores,the levels of serum NLRP3,IL-1β,and IL-8,and the incidence of adverse cerebrovas⁃cular events 6 months after surgery were counted in the two groups.Results The degree of arterial stenosis in the stent group was lower than that of the balloon group(P<0.05);the success rate of the stent group(93.33%)was higher than that of the balloon group(83.33%),but there was no significant difference between the groups(P>0.05).The cerebral blood flow and cerebral blood volume of the stent group were greater than those of the balloon group,and the average transit time and peak time were shorter than those of the balloon group(P<0.05).NIHSS and ADL scores of the stent group were lower than those of the balloon group,and the MoCA scores were higher than that of the balloon group(P<0.05).Serum levels of NLRP3,IL-1βand IL-8 in the stent group were lower than those in the balloon group at 1 day and 1 week after operation(P<0.05).The incidence of complica⁃tions and adverse cerebrovascular events in the stent group was lower than that in the balloon group,but there was no significant difference(P>0.05).Conclusion Compared with balloon dilatation,stent implantation in the treatment of MCA stenosis can improve cerebral perfusion,reduce the degree of arterial stenosis,impr

关 键 词：球囊扩张术 支架植入术 大脑中动脉狭窄 脑灌注 认知功能 NLRP3 白细胞计数 

分 类 号：R651.11[医药卫生—外科学]