颈动脉支架置入后炎症因子与大脑缺血性损伤的研究

摘要

Objective To explore the relationship between inflammatory factors and new ischemic injury in the patients undertook carotid artery stenting( CAS ) after operation. Methods Forty two patients with severe carotid stenosis( 48 arteries ) undertook CAS. Blood samples were obtained from the root of aorta( whole-body blood ) and carotid plaque site( local blood ) before and after operation, and to detect the levels of interleukin-6( IL-6 ), interleukin-18 ( IL-18 ),matrix metalloproteinase-2( MMP-2 ),tissue inhibitor of MMP-l( TIMP-1 ),MRI was performed in the patients to determine whether they had the new cerebral ischemic lesions or not. Results After CAS,IL-6 level of lcx:al blood samples ranged from 1.84 pg/ml to 6.78 pg/ml,which was significantly higher than that of whole-bcxly blood samples( ranged from 1.02 pg/ml to 3.41 pg/ml,P <0.01 ),there was no significant difference in the levels of IL-18,TIMP-1,MMP-2 between local blcxxl samples and whole-bcxly blcxxl samples( P >0.05 ). IL-6 levels of local blcxxl samples of 19 patients with symptomatic: stenosis lesions were significantly higher than that of whole-body blood samples[ 4. 6( 2.7-11.2 ) pg/ml vs2.4(1.1-5.5) pg/ml,P < 0. 01 ]. Increased local IL-6 levels had a significant association with new ischemic injury( P = 0. 02 ). Conclusion IL-6 released from plaque might be the important factor of the occurrence of periprocedural complications associated to CAS.%目的 探讨颈动脉支架置入(CAS)后炎症因子及其与术后新发缺血性损伤的关系.方法 42例(共48条)颈动脉严重狭窄患者,施行CAS前后分别检测主动脉根部血样(全身血)与颈动脉粥样斑块处血(局部血)白介素-6(IL-6)、IL-18、基质金属蛋白酶(MMP-2)及MMP组织抑制因子(TIMP-1)水平,术后行MRI扫描检查有无大脑缺血性损伤.结果 CAS术后,局部血样IL-6水平为1.84～6.78 pg/ml,明显高于全身血样的1.02～3.41 pg/ml(P＜0.01),局部血样与全身血样中的IL-18、TIMP-1、MMP-2水平比较,差异均无统计学意义(P＞0.05).19例症状性狭窄患者局部血IL-6水平为4.6(2.7～11.2)pg/ml,明显高于全身样本的2.4(1.1～5.5)pg/ml(P＜0.01).局部IL-6高水平与新发缺血性血管损伤密切相关(P=0.02).结论 由粥样斑块释放的IL-6极有可能是CAS术后并发症发生的重要因子.