Effect of stent-assisted coil intracranial embolization in patients with ruptured intracranial aneurysms
-
摘要:目的
探讨支架辅助弹簧圈颅内栓塞对颅内破裂动脉瘤患者的影响。
方法选取110例颅内破裂动脉瘤患者为研究对象，根据支架辅助方式将其分为对照组（单纯弹簧圈栓塞术，n=55）和研究组（支架辅助弹簧圈栓塞术，n=55）。比较2组患者手术情况及住院时间、神经功能、血清髓磷脂碱性蛋白（MBP）水平、临床疗效以及脑脊液炎症因子水平。
结果术后，2组患者神经生长因子（NGF）和脑源性神经营养因子（BDNF）水平高于术前，且研究组高于对照组，差异有统计学意义（P < 0.05）。术后，2组患者血清MBP和脑脊液白细胞介素-4（IL-4）、肿瘤坏死因子-α（TNF-α）、白细胞介素-8（IL-8）水平高于术前，但研究组低于对照组，差异有统计学意义（P < 0.05）。研究组总有效率为96.36%，高于对照组的83.64%，差异有统计学意义（P < 0.05）。
结论支架辅助弹簧圈颅内栓塞对颅内破裂动脉瘤患者效果较好，可改善患者神经功能，降低其脑脊液炎症水平和血清MBP水平。
-
关键词:
- 支架辅助弹簧圈颅内栓塞 /
- 颅内破裂动脉瘤 /
- 神经功能 /
- 髓磷脂碱性蛋白 /
- 炎症因子
Abstract:ObjectiveTo investigate the effect of stent-assisted coil intracranial embolization in patients with ruptured intracranial aneurysms.
MethodsA total of 110 patients with ruptured intracranial aneurysm were selected as the study objects. The patients were divided into control group (pure embolization with spring coil, n=55) and study group (stent-assisted embolization with spring coil, n=55) according to the stent assisted method. The operation status, length of hospital stay, nerve function, serum myelin basic protein (MBP) level, clinical efficacy and cerebrospinal fluid inflammatory factor level were compared between the two groups.
ResultsAfter surgery, the levels of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) in the two groups were significantly higher than those before surgery, and those in the study group were significantly higher than those in the control group (P < 0.05). After operation, the levels of serum MBP and cerebrospinal fluid interleukin-4 (IL-4), tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) in two groups were significantly higher than those before operation, and those in the study group were significantly lower than those in the control group (P < 0.05). The total effective rate of the study group was 96.36%, which was significantly higher than 83.64% of the control group (P < 0.05).
ConclusionStent assisted coil intracranial embolization has a good effect in patients with ruptured intracranial aneurysm, which can improve the nerve function of patients, reduce the level of cerebrospinal fluid inflammation and serum MBP.
-
-
表 1 2组患者一般资料比较(x±s)
组别 n 性别 年龄/岁 体质量指数/(kg/m2) 瘤体大小/mm 男 女 研究组 55 30 25 58.75±8.64 24.21±1.65 13.54±2.07 对照组 55 27 28 58.51±8.69 24.15±1.61 13.62±2.09 
下载: 导出CSV
表 2 2组患者手术情况及住院时间比较(x±s)[n(%)]
组别 n 手术时间/min 术中出血 住院时间/d 研究组 55 76.87±16.52* 8(14.55)* 8.41±2.13* 对照组 55 100.29±24.32 20(36.36) 18.56±3.31 与对照组比较, * P＜0.05。
下载: 导出CSV
表 3 2组患者神经功能指标比较(x±s)
ng/L 组别 n NGF BDNF 术前 术后3 d 术前 术后3 d 研究组 55 109.98±7.68 122.29±9.82*# 9.75±0.76 12.09±0.98*# 对照组 55 107.95±8.58 118.26±7.93* 9.68±0.86 11.19±0.76* NGF: 神经生长因子; BDNF: 脑源性神经营养因子。与术前相比, * P＜0.05; 与对照组比较, #P＜0.05。
下载: 导出CSV
表 4 2组患者临床疗效比较[n(%)]
组别 n 良好 差 死亡 总有效 研究组 55 53(96.36) 2(3.64) 0 53(96.36)* 对照组 55 46(83.64) 8(14.55) 1(1.82) 46(83.64) 与对照组比较, * P＜0.05。
下载: 导出CSV
表 5 2组患者脑脊液炎症因子水平比较(x±s)
组别 n IL-4/(ng/mL) TNF-α/(ng/mL) IL-8/(pg/mL) 术前 术后3 d 术前 术后3 d 术前 术后3 d 研究组 55 6.59±1.05 10.71±2.46*# 1.65±0.15 2.35±0.49*# 3.26±0.54 5.28±0.29*# 对照组 55 6.38±1.37 16.84±3.59* 1.69±0.18 2.98±0.64* 3.29±0.56 9.12±1.06* IL-4: 白细胞介素-4; TNF-α: 肿瘤坏死因子-α; IL-8: 白细胞介素-8。与术前相比, * P＜0.05; 与对照组比较, #P＜0.05。
下载: 导出CSV
-
[1] 陈振, 张松, 晋亚洲, 等. 支架辅助弹簧圈栓塞与单纯弹簧圈栓塞治疗颅内破裂动脉瘤疗效的对比分析[J]. 中华神经外科杂志, 2020, 36(1): 38-43. https://www.cnki.com.cn/Article/CJFDTOTAL-HNSJ202311006.htm [2] 卢万俊, 韩长鸣, 高峰, 等. 支架辅助栓塞治疗小型颅内宽颈动脉瘤的安全性及有效性[J]. 实用临床医药杂志, 2021, 25(22): 82-86. doi: 10.7619/jcmp.20212008 [3] 江志贤, 黄佳欣, 张晋宁, 等. 多支架重叠辅助弹簧圈栓塞治疗颈内动脉破裂血泡样动脉瘤: 38例回顾性病例系列研究[J]. 国际脑血管病杂志, 2020, 28(7): 516-521. https://www.cnki.com.cn/Article/CJFDTOTAL-ZCYO202123022.htm [4] 潘捷, 吴高远, 倪永丰. LVIS密网支架辅助弹簧圈栓塞介入治疗单发颅内破裂小动脉瘤的近期疗效及其并发症发生情况的研究[J]. 立体定向和功能性神经外科杂志, 2019, 32(3): 157-162. https://www.cnki.com.cn/Article/CJFDTOTAL-NENG201903007.htm [5] 黄蔚文, 赵岳峰. 血管内介入栓塞术治疗前循环破裂颅内动脉瘤临床疗效及预后危险因素分析[J]. 陕西医学杂志, 2020, 49(4): 446-449, 457. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYZ202004015.htm [6] 苏优勒, 张占普, 窦长武, 等. 血管内介入栓塞与开颅手术夹闭治疗破裂颅内动脉瘤的疗效及安全性比较[J]. 疑难病杂志, 2019, 18(5): 455-458, 463. https://www.cnki.com.cn/Article/CJFDTOTAL-YNBZ201905006.htm [7] 武中成, 曲国辉, 徐鹏, 等. 支架辅助弹簧圈栓塞术在颅内复杂动脉瘤治疗中的应用[J]. 中国冶金工业医学杂志, 2018, 35(2): 232-233. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYJ201802093.htm [8] 中华医学会神经外科学分会神经介入学组. 颅内动脉瘤血管内介入治疗中国专家共识(2013)[J]. 中华医学杂志, 2013, 93(39): 3093-3103. https://www.cnki.com.cn/Article/CJFDTOTAL-NXGB201311012.htm [9] KIMURA A, TANAKA N. Reverse shock index multiplied by Glasgow Coma Scale score (rSIG) is a simple measure with high discriminant ability for mortality risk in trauma patients: an analysis of the Japan Trauma Data Bank[J]. Crit Care, 2018, 22(1): 87.
[10] ETMINAN N, CHANG H S, HACKENBERG K, et al. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis[J]. JAMA Neurol, 2019, 76(5): 588-597.
[11] 田向阳, 张岭, 孙来广, 等. 开颅手术与血管内栓塞对颅内后循环动脉瘤患者的疗效及颅脑损伤因子的影响[J]. 中国医药科学, 2019, 9(14): 14-18. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX201914007.htm [12] 康平, 苏龙, 马改平, 等. 支架辅助弹簧圈栓塞术与单纯弹簧圈栓塞术治疗颅内破裂动脉瘤患者的效果比较及对术后出血事件的影响[J]. 临床医学研究与实践, 2022, 7(2): 12-15, 69. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202202004.htm [13] 王辉, 何安邦, 刘珍, 等. 支架辅助栓塞技术治疗颅内动脉瘤的临床观察[J]. 中国医刊, 2018, 53(7): 801-805. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYI201807031.htm [14] 傅西安, 钱苏荣, 王剑刃, 等. 支架辅助弹簧圈栓塞颅内破裂动脉瘤并发症[J]. 昆明医科大学学报, 2018, 39(1): 50-54. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX201801010.htm [15] 冷俊峰, 于小华, 郜宪礼, 等. 急诊支架辅助弹簧圈栓塞颅内破裂宽颈动脉瘤的疗效分析[J]. 心脑血管病防治, 2021, 21(1): 82-83, 86. https://www.cnki.com.cn/Article/CJFDTOTAL-XXFZ202101019.htm [16] 唐少舟, 王成鸿, 邓勇, 等. 脑膜瘤患者手术前后血清ETS-1、MMP-1及MBP水平变化及其临床意义[J]. 湖南师范大学学报: 医学版, 2019, 16(4): 80-83. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYG201904027.htm [17] WASIK N, SOKÓŁB, HOŁYSZ M, et al. Serum myelin basic protein as a marker of brain injury in aneurysmal subarachnoid haemorrhage[J]. Acta Neurochir, 2020, 162(3): 545-552.
[18] 叶海泉, 黄文超. Lvis支架辅助弹簧圈血管内栓塞治疗颅内破裂动脉瘤的临床效果和安全性[J]. 中国医学物理学杂志, 2020, 37(7): 898-902. https://www.cnki.com.cn/Article/CJFDTOTAL-YXWZ202007019.htm [19] 王玉莉, 胡红旗, 郭东才, 等. 腰大池引流速度对颅内动脉瘤性蛛网膜下腔出血患者炎症相关标记物的影响[J]. 广东医学, 2020, 41(1): 77-81. https://www.cnki.com.cn/Article/CJFDTOTAL-GAYX202001017.htm [20] 马修尧, 任超, 刘彬, 等. 比较Lvis支架辅助弹簧圈和Solitaire支架辅助弹簧圈栓塞治疗颅内破裂宽颈动脉瘤的安全性和有效性[J]. 中华全科医学, 2018, 16(8): 1247-1249, 1348. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201808007.htm -
期刊类型引用(1)
1. 张向前，兰堃田，李伟明. 外周血循环肿瘤细胞动态变化与晚期食管癌化疗患者预后的关系. 医药论坛杂志. 2024(21): 2261-2265 . 
百度学术
其他类型引用(2)
计量
- 文章访问数: 131
- HTML全文浏览量: 49
- PDF下载量: 5
- 被引次数: 3
苏公网安备 32100302010246号