| 胡 晨,董瑞芳,史方堃,刘红梅,姜东红,张文高,台立稳.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[J].,2021,(6):1182-1186 |
| 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 |
| 投稿时间：2020-09-26 修订日期：2020-10-21 |
| DOI：10.13241/j.cnki.pmb.2021.06.041 |
| 中文关键词: 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 |
| 英文关键词: Severe internal carotid artery stenosis Carotid artery stenting Carotid endarterectomy Cerebral blood flow miR-145 Insulin-like growth factor 1 receptor Complications |
| 基金项目: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） |
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| 中文摘要: |
| 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。 |
| 英文摘要: |
| ABSTRACT 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, regulate the expression of serum miR-145 and IGF1R, and promote the recovery of cognitive function. However, the incidence of stroke and hypotension after CAS is higher, and the incidence of hypertension after CEA is higher. |
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