骨髓单个核细胞联合颅内外血管搭桥术治疗烟雾病的疗效观察
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摘要
目的研究骨髓单个核细胞联合颅内外血管搭桥治疗烟雾病的临床效果,以及对血清炎症因子C反应蛋白(CRP)、白介素-10(IL-10)的影响。方法收集2015-05—2017-05河南大学第一附属医院收治的烟雾病患者84例,按照数字表法将其随机分为对照组与研究组各42例,对照组实施直接颅内外血管搭桥手术,研究组在对照组基础上加用骨髓单个核细胞治疗,其他综合治疗相同,分别记录治疗前后2组的NIHSS评分、脑血流变化情况、血清CRP与IL-10水平及术后并发症情况。比较2组治疗前后NIHSS评分、脑血流、血清CRP与IL-10水平变化及并发症情况。结果治疗前,2组NIHSS评分比较、血清CRP与IL-10水平无明显差异(P>0.05);治疗后,研究组NIHSS(28.42±1.53)分,脑脉压差(31.13±0.78)、血流量(13.97±1.34),以及血流峰值(157.45±2.76)、血清CRP(37.05±3.12),IL-10(56.33±8.72),对照组NIHSS(28.42±1.53)分,脑脉压差(31.04±0.98)、血流量(13.23±0.99),以及血流峰值(156.28±1.27),血清CRP(44.62±4.21),IL-10(68.03±7.84)。研究组NIHSS评分明显低于对照组(P<0.05),研究组CRP和IL-10水平均显著低于对照组(P<0.05);研究组治疗后的脑脉压(灌注)差、血流量以及血流峰值与对照组无明显差异(P>0.05),研究组的并发症发生率为7.14%,明显低于对照组并发症发生率21.43%(P<0.05)。结论对烟雾病患者采用骨髓单个核细胞联合颅内外血管搭桥治疗效果优于颅内外血管搭桥,可有效改善患者神经功能缺损及脑血流供应,降低血清CRP、IL-10炎症因子的表达,不良反应少,值得推广。
Objective To study the clinical effect of bone marrow mononuclear cells combined with extracranial-intracranial bypass surgery in the treatment of moyamoya disease and the impact on serum inflammatory factor C-reactive protein(CRP)and interleukin-10(IL-10).Methods 84 patients with moyamoya disease from May 2015 to May 2017 admitted in our hospital were enrolled and randomly divided into two groups:control group(n=42)and control group(n=42).The control group was treated with extracranial-intracranial bypass surgery,and the study group was treated with bone marrow mononuclear cells on the basis of the control group.The neurological deficit(NIHSS)scores,complications,changes of cerebral blood flow and serum levels of CRP and IL-10 before and after treatment were recorded between the two groups.We compared the NIHSS score,cerebral blood flow,serum CRP and IL-10 levels and complications between the two groups before and after treatment.Results There was no significant difference in NIHSS scores,serum CRP and IL-10 levelsbetween the two groups before treatment(P>0.05),but after treatment,NIHSS(28.42±1.53),cerebral pulse pressure(31.13±0.78)and blood flow(13.97±1.34),blood flow peak(157.45±2.76),serum CRP(37.05±3.12),IL-10(56.33±8.72)were measured in the study group.In the control group,NIHSS(28.42±1.53),cerebral pulse pressure difference(31.04±0.98)and blood flow(13.23±0.99)and blood flow peak(156.28±1.27),serum CRP(44.62±4.21),IL-10(68.03±7.84)were measured.The scores of NIHSS and the levels of CRP and IL-10 in the study group were significantly lower than those in the control group(P<0.05).There was no significant difference in cerebral pulse pressure(perfusion),blood flow and peak blood flow between the study group and the control group(P>0.05).The incidence of complications in the study group was 7.14%,which was significantly lower than that in the control group(21.43%)(P<0.05).Conclusion Bone marrow mononuclear cells combined with extracranial-intracranial bypass surgery effective in the treatment of Moyamoya disease.It can effectively improve the neurological function and cerebral blood supply of patients and reduce the expression of serum CRP and IL-10 inflammatory factors.This therapy is safe and reliable with few complications,and is worth clinical promotion.
Objective To study the clinical effect of bone marrow mononuclear cells combined with extracranial-intracranial bypass surgery in the treatment of moyamoya disease and the impact on serum inflammatory factor C-reactive protein(CRP)and interleukin-10(IL-10).Methods 84 patients with moyamoya disease from May 2015 to May 2017 admitted in our hospital were enrolled and randomly divided into two groups:control group(n=42)and control group(n=42).The control group was treated with extracranial-intracranial bypass surgery,and the study group was treated with bone marrow mononuclear cells on the basis of the control group.The neurological deficit(NIHSS)scores,complications,changes of cerebral blood flow and serum levels of CRP and IL-10 before and after treatment were recorded between the two groups.We compared the NIHSS score,cerebral blood flow,serum CRP and IL-10 levels and complications between the two groups before and after treatment.Results There was no significant difference in NIHSS scores,serum CRP and IL-10 levelsbetween the two groups before treatment(P>0.05),but after treatment,NIHSS(28.42±1.53),cerebral pulse pressure(31.13±0.78)and blood flow(13.97±1.34),blood flow peak(157.45±2.76),serum CRP(37.05±3.12),IL-10(56.33±8.72)were measured in the study group.In the control group,NIHSS(28.42±1.53),cerebral pulse pressure difference(31.04±0.98)and blood flow(13.23±0.99)and blood flow peak(156.28±1.27),serum CRP(44.62±4.21),IL-10(68.03±7.84)were measured.The scores of NIHSS and the levels of CRP and IL-10 in the study group were significantly lower than those in the control group(P<0.05).There was no significant difference in cerebral pulse pressure(perfusion),blood flow and peak blood flow between the study group and the control group(P>0.05).The incidence of complications in the study group was 7.14%,which was significantly lower than that in the control group(21.43%)(P<0.05).Conclusion Bone marrow mononuclear cells combined with extracranial-intracranial bypass surgery effective in the treatment of Moyamoya disease.It can effectively improve the neurological function and cerebral blood supply of patients and reduce the expression of serum CRP and IL-10 inflammatory factors.This therapy is safe and reliable with few complications,and is worth clinical promotion.
引文
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[2]ACKER G,FEKONJA L,VAJKOCZY P.Surgical Management of Moyamoya Disease[J].Stroke,2018,49(2):476.
[3]WEINBERG D G,RAHME R J,AOUN S G,et al.Moyamoya disease:Func-tional and neurocognitive outcomes in the pediatric and adult popu-lations[J].Neurosurg Focus,2011,30:21.
[4]王刚,冯文峰,张国忠,等.颞浅动脉-大脑中动脉搭桥术早期治疗动脉瘤或烟雾病出血5例报告[J].中国神经精神疾病杂志,2017,43(09):554-556.
[5]李琛,曹旭华,马志昭,等.颞肌贴敷与颅内外血管搭桥联合治疗烟雾病疗效观察[J].海南医学,2017,28(22):3734-3 735.
[6]FUJIMURA M,TOMINAGA T.Significance of cerebral blood flow analy-sis in the acute stage after revascularization surgery for moyamoyadisease[J].Neurol Med Chir(Tokyo),2015,55(10):775-781.
[7]黄启化,李冬梅,高天,等.颅内外血管搭桥结合间接血运重建治疗成人烟雾病的疗效观察[J].武警医学,2013,24(6):494-497.
[8]王飞.颞肌贴敷联合颅内外血管吻合术治疗烟雾病的临床疗效[J].江苏医药,2014,40(6):677-678.
[9]马菲韩,胡娜,陈劲草,等.经颅多普勒联合mRS评分在颅内外血管重建术治疗烟雾病疗效评价中的应用[J].临床外科杂志,2015,23(9):705-707.
[10]蒋泳,孙荣君,王少兵.小儿烟雾病颅内外血管搭桥术后脑-硬膜-动脉融合1例[J].中国临床神经外科杂志,2010,15(9):562-562.
[11]HOSHINO S,TSUDA E,MIYAZAKI A.Vasospastic angina and asymptomatic moyamoya disease in a 14-year-old girl[J].Pediatr Int,2018,60(3):296-297.
[12]朱卫国,陈华群,王嵘,等.颅内外动脉搭桥术治疗出血型烟雾病53例临床分析[J].江苏医药,2014,40(18):2188-2 189.
[13]武传华,张志国,辛军.CT灌注成像对烟雾病术后桥血管再通及手术前后脑血流变化的评价[J].医学影像学杂志,2014,24(3):351-354.
[14]李国胜,胡福广,梁朝辉,等.颞浅动脉-大脑中动脉搭桥术治疗成人缺血性烟雾病的疗效分析[J].脑与神经疾病杂志,2016,24(6):346-349.
[15]牛纪杰,相寿长,许鹏,等.颞肌贴敷并颅内外血管吻合治疗烟雾病的临床疗效观察[J].中外医疗,2012,31(2):73-73.
[16]徐斌,宋冬雷,毛颖,等.颅内外血管吻合结合间接血管重建治疗烟雾病[J].中华神经外科杂志,2009,25(2):102-105.
[17]杨彦昊,李宏宇,关振斌.颞浅动脉-大脑中动脉搭桥联合颞肌贴敷术治疗成人烟雾病的临床分析[J].临床神经外科杂志,2014,11(1):61-63.
[18]杨洪宽,赵亚军,陈如东,等.烟雾病合并颅内动脉瘤的临床特点及血管内治疗(附七例报告)[J].中华神经外科杂志,2015,31(6):568-571.
[19]桂国精,朱健明,沈晓黎.颞肌贴敷与颅内外血管搭桥联合治疗烟雾病的效果分析[J].中国当代医,2016,23(25):53-55.
[20]LANTERNA L A,GALLIANI S,ZANGARI R,et al.Thyroid Autoantibodies and the Clinical Presentation of Moyamoya Disease:A Prospective Study[J].J Stroke Cerebrovasc Dis,2018,27(5):1 194-1 199.
[21]YAMAMOTO T,OKADA T,FUSHIMI Y,et al.Magnetic resonance angiography with compressed sensing:An evaluation of moyamoya disease[J].Plos One,2018,13(1):e0189493.
[22]陈谦,倪玲,周长圣,等.双源CT血管成像评价颅内外血管重建术治疗烟雾病[J].中国介入影像与治疗学,2013,10(9):547-550.
[23]GE P,ZHANG Q,YE X,et al.Clinical Features,Surgical Treatment,and Long-Term Outcome in Children with Hemorrhagic Moyamoya Disease[J].J Stroke Cerebrovasc Dis\,2018,27(6):1 517-1 523.
[24]YAO Z,YOU C.Effect of surgery on the long-term functional outcome of moyamoya disease:a metaanalysis[J].Turk Neurosurg,2018,6.DOI:10.5137/1019-5149.JTN.22598-18.3.[Epub ahead of print]
[25]CHEN L,XU B,WANG Y,et al.Preoperative evaluation of moyamoya spontaneous anastomosis of combined revascularization donor vessels in adults by duplex ultrasonography[J].Br J Neurosurg,2017,30:1-6.
[26]KAZUMATA K,ITO M,UCHINO H,et al.Proposal for a Prospective Registry for Moyamoya Disease in Japan[J].Neurologia Med Chir(Tokyo),2017,57(2):66-72.
[27]REIS C,SAFAVI-ABBASI S,ZABRAMSKI J,et al.The history of neurosurgical procedures formoyamoyadisease[J].Neurosurg Focus,2006,20(6):E7.
[28]戴冬伟,赵文元,许奕,等.烟雾病颅内血流相关性动脉瘤的血管内治疗[J].中华神经外科疾病研究杂志,2011,10(5):446-449.
[29]MIKAMI T,KURIBARA T,KOMATSU K,et al.Meandering flow void around the splenium in moyamoya disease[J].Neurol Res,2017,39(8):1.
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