不同时机行血管介入栓塞术对颅内动脉瘤患者疗效及炎症细胞因子的影响
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摘要
目的探讨不同时机行血管介入栓塞术治疗对颅内动脉瘤患者的疗效及炎症细胞因子的影响。方法选取在我院神经外科接受治疗的20例颅内动脉瘤患者作为研究对象,根据不同治疗时机分为两组,72h内行血管介入栓塞术进行治疗的10例患者为早期组,72h后行血管介入栓塞术进行治疗的10例患者为延期组。比较两组患者手术前后的临床疗效及机体炎症细胞因子水平。结果治疗后早期组患者完全栓塞率为90.00%(9/10),明显高于延期组的40.00%(4/10),差异具有统计学意义(P<0.05);早期组与延期组患者NIHSS评分均明显低于治疗前,MBI评分均明显高于治疗前,且早期组患者NIHSS评分明显低于延期组,MBI评分明显高于延期组;早期组患者术后炎症细胞因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6 (IL-6)、白细胞介素-10(IL-10)和血清单核细胞趋化蛋白-1(MCP-1)改善程度均优于延期组,差异均有统计学意义(P<0.05)。结论早期行血管介入栓塞术对患者神经功能以及预后情况的改善效果明显,且能够更有效地改善炎症细胞因子水平,减少炎性反应,有利于患者的恢复,值得临床参考推广。
Objective To investigate the effect of the operation time of vascular interventional embolization therapy on clinical effect and inflammatory cytokine level of the patients with intracranial aneurysms.Methods 20 patients with intracranial aneurysms treated in the department of neurosurgery in our hospital were divided into two groups according to different operation time.10 patients treated with vascular interventional embolization therapy within 72 hours were defined as the early group,while 10 patients treated with vascular interventional embolization therapy over 72 hours were defined as the delayed group.The clinical effect and inflammatory cytokine level before and after surgery were compared between the two groups.Results After treatment,the complete embolism rate in the early group was 90.00%(9/10),which was significantly higher than that in the delayed group(40.00% 4/10),there were statistically significance(P<0.05).NIHSS scores of patients in the early group and delayed group were significantly lower than those before treatment,and MBI scores were significantly higher than those before treatment.NIHSS score of patients in the early group was significantly lower than that in the delayed group,and MBI score was significantly higher than that in the delayed group.The improvement of inflammatory cytokines(TNF-α,IL-6,IL-10 and MCP-1)in the early group was better than that in the delayed group,there were statistically significance(P<0.05).Conclusion Early vascular interventional embolization therapy can significantly improve the neurological function and prognosis of patients,ameliorate the level of inflammatory cytokines more effectively,leading to reduce the inflammatory response,and benefit the recovery of patients,which is worthy of reference and wide application in clinic.
Objective To investigate the effect of the operation time of vascular interventional embolization therapy on clinical effect and inflammatory cytokine level of the patients with intracranial aneurysms.Methods 20 patients with intracranial aneurysms treated in the department of neurosurgery in our hospital were divided into two groups according to different operation time.10 patients treated with vascular interventional embolization therapy within 72 hours were defined as the early group,while 10 patients treated with vascular interventional embolization therapy over 72 hours were defined as the delayed group.The clinical effect and inflammatory cytokine level before and after surgery were compared between the two groups.Results After treatment,the complete embolism rate in the early group was 90.00%(9/10),which was significantly higher than that in the delayed group(40.00% 4/10),there were statistically significance(P<0.05).NIHSS scores of patients in the early group and delayed group were significantly lower than those before treatment,and MBI scores were significantly higher than those before treatment.NIHSS score of patients in the early group was significantly lower than that in the delayed group,and MBI score was significantly higher than that in the delayed group.The improvement of inflammatory cytokines(TNF-α,IL-6,IL-10 and MCP-1)in the early group was better than that in the delayed group,there were statistically significance(P<0.05).Conclusion Early vascular interventional embolization therapy can significantly improve the neurological function and prognosis of patients,ameliorate the level of inflammatory cytokines more effectively,leading to reduce the inflammatory response,and benefit the recovery of patients,which is worthy of reference and wide application in clinic.
引文
[1]游潮.不断挑战复杂难治性颅内动脉瘤[J].中华神经外科杂志,2018,34(5):433~436.
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[4]林宇佳,张国栋,廖政贤,等.双容积图像融合技术在颅内动脉瘤介入血管内栓塞术中的作用[J].实用医学杂志,2017,33(10):1685~1688.
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[15]王宁.血管内介入栓塞术与开颅术治疗脑动脉瘤对比观察[J].陕西医学杂志,2018,47(1):56~58.
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[17]邵云,孙蓉,浦毅,等.不同时机血管介入栓塞对脑动脉瘤破裂致蛛网膜下腔出血患者MCP-1水平及预后的影响[J].医学临床研究,2017,34(12):2371~2373.
[18]刘小飞.炎症反应在颅内动脉瘤发病机制中的研究进展[J].国际神经病学神经外科学杂志,2016,43(4):375~379.
[19]梁华平,王正国,朱佩芳.针对SIRS的新型抗炎靶点及抗炎策略研究进展-从炎症介质到核因子-κB[J].中华危重病急救医学,2001,13(11):649~652.
[20]Kondo Y,Suzuki K,Inoue Y,et al.Significant association between joint ultrasonographic parameters and synovial inflammatory factors in rheumatoid arthritis[J].Arthritis Research&Therapy,2019,21(1):14.
[2]Hofman M,Jamróz T,Jakutowicz I,et al.Endovascular treatment of complex intracranial aneurysms[J].Polish Journal of Radiology,2018,83:e109~e114.
[3]Laukka D,Pan E,Fordell T,et al.317Prevalence of Thoracic Aneurysms or Dilatations in Patients With the Intracranial Aneurysms[J].Neurosurgery,2018,65(CN_suppl_1):128~128.
[4]林宇佳,张国栋,廖政贤,等.双容积图像融合技术在颅内动脉瘤介入血管内栓塞术中的作用[J].实用医学杂志,2017,33(10):1685~1688.
[5]胡鑫渝,向立权,宁琳,等.选择性血管造影与介入栓塞术治疗急性创伤出血1例[J].重庆医学,2017,46(26):3743~3744.
[6]Jalal S,Mustapha J A,Rosman H S,et al.Distal Cuff Occlusion:A Novel,Simple Approach for Distal Embolic Protection in Peripheral Vascular Intervention.[J].Journal of Invasive Cardiology,2017,29(9):297.
[7]张艳萍,申延琴,李妍芳,等.血管性介入栓塞治疗产科出血时机选择的临床研究[J].医学信息,2013,26(30):166.
[8]张淇,胡志源.不同手术时机血管内介入栓塞治疗颅内动脉瘤临床疗效及预后相关因素分析[J].临床荟萃,2016,31(9):990~993.
[9]姚鹏飞,程刚,高晨.炎症在颅内动脉瘤形成和破裂中的作用和机制[J].国际脑血管病杂志,2016,24(3):275~278.
[10]吕艳霞,李安荣,杨朋磊,等.炎症反应在颅内动脉瘤发生中作用的研究进展[J].中国临床神经外科杂志,2017(5):363~365.
[11]Zhang F,Li P,Zhang C,et al.The Prognosis Factors for Endovascular Coiling of Aneurysm in Patients With Ruptured Intracranial Aneurysm[J].Journal of Craniofacial Surgery,2017,28:1.
[12]Bhardwaj A,Sharma G,Raina S K,et al.Advanced Age and Higher National Institutes of Health Stroke Scale Score as Predictors of Poor Outcome in Ischemic Stroke Patients Treated with Alteplase:A Study from a Tertiary Care Centre in Rural North-west India[J].J Neurosci Rural Pract,2017,8(2):236~240.
[13]Hong I,Lim Y,Han HS,et al.Application ofthe Korean version of the modified barthel index:Development of a keyform for use in clinical practice[J].Hong Kong Journal of Occupational Therapy,2017(29):39~46.
[14]Qiu T L,Jin G L,Bao W Q,et al.Morphological Effect on Wall Shear Stress in Intracranial Aneurysms[J].JNeurol Surg A Cent Eur Neurosurg,2018,79(2):108~115.
[15]王宁.血管内介入栓塞术与开颅术治疗脑动脉瘤对比观察[J].陕西医学杂志,2018,47(1):56~58.
[16]陈健龙,于沛涛.血管内介入栓塞术治疗脑动脉瘤的临床疗效观察[J].中西医结合心脑血管病杂志,2018,16(11):1620~1622.
[17]邵云,孙蓉,浦毅,等.不同时机血管介入栓塞对脑动脉瘤破裂致蛛网膜下腔出血患者MCP-1水平及预后的影响[J].医学临床研究,2017,34(12):2371~2373.
[18]刘小飞.炎症反应在颅内动脉瘤发病机制中的研究进展[J].国际神经病学神经外科学杂志,2016,43(4):375~379.
[19]梁华平,王正国,朱佩芳.针对SIRS的新型抗炎靶点及抗炎策略研究进展-从炎症介质到核因子-κB[J].中华危重病急救医学,2001,13(11):649~652.
[20]Kondo Y,Suzuki K,Inoue Y,et al.Significant association between joint ultrasonographic parameters and synovial inflammatory factors in rheumatoid arthritis[J].Arthritis Research&Therapy,2019,21(1):14.