血管介入与动脉瘤夹闭治疗颅内动脉瘤的临床效果及对患者NF-κB、MMP-9水平的影响
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摘要
目的 探讨血管介入手术和动脉瘤夹闭术治疗颅内动脉瘤的临床效果以及对患者体内核因子κB(Nuclear FactorκB,NF-κB)、基质金属蛋白酶-9(Matrix metalloproteinases-9,MMP-9)水平的影响。方法 选取2010年1月-2018年3月在本院收治的颅内动脉瘤患者120例,采用数字随机法分为介入组和夹闭组,每组各60例;对夹闭组患者采用动脉瘤夹闭术进行治疗,对介入组患者采用血管介入术进行治疗,记录2组患者治疗期间的手术时间、术中出血量和住院时间,对2组患者手术后的神经功能情况作出评价,同时对2组患者的手术治疗效果进行评定,检测2组患者手术前后的NF-κB、MMP-9水平,最后观察2组患者治疗期间的并发症发生情况。结果 介入组患者手术时间、术中出血量和住院时间三项手术相关指标均优于夹闭组患者(P<0.05);介入组患者手术后的神经功能显著优于夹闭组患者术后的神经功能(P<0.05);介入组患者手术后的疗效分级显著优于夹闭组患者手术后的疗效分级(P<0.05),且介入组患者手术后的NF-κB、MMP-9水平明显低于夹闭组患者手术后(P<0.05);介入组患者手术后的并发症发生率低于夹闭组患者(P<0.05)。结论 血管介入手术治疗颅内动脉瘤的用时短、创少小,能够提高患者的神经功能,改善NF-κB、MMP-9的水平,总体效果显著且安全性较高。
Objective To study the clinical effect of interventional angioplasty and clipping of aneurysms on intracranial aneurysms and the expression level influences of nuclear factor κB(NF-κB) and matrix metalloproteinases-9(MMP-9) on patients with intracranial aneurysms.Methods 120 patients with intracranial aneurysms admitted to our hospital from January 2010 to March 2018 were selected and randomly divided into interventional group and clipping group with 60 cases in each group. The patients in clipping group were treated with aneurysm clipping and the patients in interventional group were treated with vascular intervention. The operation time, intraoperative bleeding volume and hospitalization time of the two groups were counted. The neurological function of the two groups after operation was evaluated. At the same time, the surgical treatment of the two groups was also evaluated. The curative effect was evaluated, and the levels of NF-κB and MMP-9 before and after operation were detected and compared between the two groups. Finally, the incidence of complications during the treatment of the two groups was counted.Results The operation time, intraoperative bleeding volume and hospitalization time of the interventional group were better than those of the clipping group(P<0.05), the neurological function of the interventional group was significantly better than that of the clipping group(P<0.05), the curative effect of the interventional group was graded after the operation, it was significantly better than the clipping group(P<0.05), and the levels of NF-κB and MMP-9 in the interventional group were significantly lower than those in the clipping group(P<0.05), and the incidence of complications in the interventional group was lower than that in the clipping operation group(P<0.05).Conclusion Vascular interventional surgery for intracranial aneurysms could improve the neurological function and the expression level of NF-κB and MMP-9. The overall effect was remarkable and the safety was high.
Objective To study the clinical effect of interventional angioplasty and clipping of aneurysms on intracranial aneurysms and the expression level influences of nuclear factor κB(NF-κB) and matrix metalloproteinases-9(MMP-9) on patients with intracranial aneurysms.Methods 120 patients with intracranial aneurysms admitted to our hospital from January 2010 to March 2018 were selected and randomly divided into interventional group and clipping group with 60 cases in each group. The patients in clipping group were treated with aneurysm clipping and the patients in interventional group were treated with vascular intervention. The operation time, intraoperative bleeding volume and hospitalization time of the two groups were counted. The neurological function of the two groups after operation was evaluated. At the same time, the surgical treatment of the two groups was also evaluated. The curative effect was evaluated, and the levels of NF-κB and MMP-9 before and after operation were detected and compared between the two groups. Finally, the incidence of complications during the treatment of the two groups was counted.Results The operation time, intraoperative bleeding volume and hospitalization time of the interventional group were better than those of the clipping group(P<0.05), the neurological function of the interventional group was significantly better than that of the clipping group(P<0.05), the curative effect of the interventional group was graded after the operation, it was significantly better than the clipping group(P<0.05), and the levels of NF-κB and MMP-9 in the interventional group were significantly lower than those in the clipping group(P<0.05), and the incidence of complications in the interventional group was lower than that in the clipping operation group(P<0.05).Conclusion Vascular interventional surgery for intracranial aneurysms could improve the neurological function and the expression level of NF-κB and MMP-9. The overall effect was remarkable and the safety was high.
引文
[1] 翟晓东,于嘉兴,马永杰,等.他汀类药物治疗未破裂颅内动脉瘤的研究进展[J].中国脑血管病杂志,2018,15(5):256-258.
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[4] Pawlowska E,Szczepanska J,Wisniewski K,et al.NF-κB-Mediated Inflammation in the Pathogenesis of Intracranial Aneurysm and Subarachnoid Hemorrhage.Does Autophagy Play a Role[J].Int J Mol Sci,2018,19(4):E1245.
[5] 呼铁民,田甜,王昆鹏,等.开颅夹闭术与血管内介入动脉瘤栓塞术治疗中青年高危颅内动脉瘤破裂效果的比较研究[J].实用心脑肺血管病杂志,2015(7):81-84.
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[9] 王驰,曹伟,左乔,等.颅内动脉瘤血管内栓塞术后复发的影响因素分析[J].中国脑血管病杂志,2016,13(3):113-117.
[10] 梁明礼,何海勇,秦峰,等.颅内动脉瘤破裂并颅内血肿形成的早期显微外科手术治疗[J].中华神经医学杂志,2015,14(6):572-575.
[11] 史明旭,李萌,刘京平.显微外科夹闭和介入栓塞治疗颅内动脉瘤的比较研究[J].医学综述,2015,21(16):3014-3015.
[12] 程树来,钟朋标,张欣瑜,等.颅内动脉瘤血管内介入栓塞治疗术中破裂出血的处理[J].广东医学,2016,37(z1):99-100.
[13] 李伦,黄昌仁.动脉瘤介入栓塞术与颅内动脉瘤夹闭术治疗高分级动脉瘤性蛛网膜下腔出血的效果比较[J].中国医学前沿杂志:电子版,2017,9(4):44-47.
[14] 郭吉卫.血管内介入与传统开颅手术治疗颅内动脉瘤的临床比较[J].神经损伤与功能重建,2015,10(4):350-351.
[15] 刘秋成,廖华,高峰,等.急诊超早期介入栓塞治疗破裂颅内动脉瘤的临床研究[J].河北医药,2018,40(6):853-856.
[16] 刘小雷,王海波.显微外科夹闭术与血管内介入术治疗中青年颅内动脉瘤的疗效评价[J].西部医学,2017,29(2):245-248.
[17] 王俊凯.Toll样受体4和核因子-κB在颅内动脉瘤组织中的表达及作用机制[J].中国老年学杂志,2017,37(14):3427-3429.
[18] 贾禄,吉宏明,任少华,等.Toll样受体4/核因子-кB信号通路在人颅内动脉瘤形成和破裂过程中的激活[J].中国药物与临床,2016,16(9):1274-1277.
[19] 张兴祥,马玉德,娄永利,等.脑室镜辅助颅内动脉瘤夹闭术联合高容量血液稀释对早期脑动脉瘤手术患者血清S100B蛋白及MMP-9水平的影响[J].临床心身疾病杂志,2018,24(4):5-8.
[20] 刘明辉.MMP-9在颅内动脉瘤组织中的表达变化及其对血管平滑肌细胞凋亡的影响[J].山东医药,2017,57(28):88-90.
[2] Wang Y,Emeto TI,Lee J,et al.Mouse models of intracranial aneurysm J[J].Brain Pathology,2015,25(3):237-247.
[3] 鲁晓花,王洪生.血清 MMP-9水平与颅内动脉瘤的相关性研究[J].河北医学,2015,21(7):1161-1162.
[4] Pawlowska E,Szczepanska J,Wisniewski K,et al.NF-κB-Mediated Inflammation in the Pathogenesis of Intracranial Aneurysm and Subarachnoid Hemorrhage.Does Autophagy Play a Role[J].Int J Mol Sci,2018,19(4):E1245.
[5] 呼铁民,田甜,王昆鹏,等.开颅夹闭术与血管内介入动脉瘤栓塞术治疗中青年高危颅内动脉瘤破裂效果的比较研究[J].实用心脑肺血管病杂志,2015(7):81-84.
[6] 郑津,胡学斌,赵洪洋,等.血管介入栓塞治疗时机对颅内动脉瘤患者并发症及神经功能的影响[J].中国医药,2018,13(2):219-223.
[7] 江峰,吴淼经,邓军,等.Hunt-Hess Ⅲ-Ⅴ级前循环动脉瘤超早期显微外科手术治疗效果分析[J].中华神经医学杂志,2015,14(10):1062-1064.
[8] 夏熙双,牛光明,张鹏远.显微外科手术在颅内动脉瘤治疗中的应用价值[J].中华老年医学杂志,2015,34(4):362-364.
[9] 王驰,曹伟,左乔,等.颅内动脉瘤血管内栓塞术后复发的影响因素分析[J].中国脑血管病杂志,2016,13(3):113-117.
[10] 梁明礼,何海勇,秦峰,等.颅内动脉瘤破裂并颅内血肿形成的早期显微外科手术治疗[J].中华神经医学杂志,2015,14(6):572-575.
[11] 史明旭,李萌,刘京平.显微外科夹闭和介入栓塞治疗颅内动脉瘤的比较研究[J].医学综述,2015,21(16):3014-3015.
[12] 程树来,钟朋标,张欣瑜,等.颅内动脉瘤血管内介入栓塞治疗术中破裂出血的处理[J].广东医学,2016,37(z1):99-100.
[13] 李伦,黄昌仁.动脉瘤介入栓塞术与颅内动脉瘤夹闭术治疗高分级动脉瘤性蛛网膜下腔出血的效果比较[J].中国医学前沿杂志:电子版,2017,9(4):44-47.
[14] 郭吉卫.血管内介入与传统开颅手术治疗颅内动脉瘤的临床比较[J].神经损伤与功能重建,2015,10(4):350-351.
[15] 刘秋成,廖华,高峰,等.急诊超早期介入栓塞治疗破裂颅内动脉瘤的临床研究[J].河北医药,2018,40(6):853-856.
[16] 刘小雷,王海波.显微外科夹闭术与血管内介入术治疗中青年颅内动脉瘤的疗效评价[J].西部医学,2017,29(2):245-248.
[17] 王俊凯.Toll样受体4和核因子-κB在颅内动脉瘤组织中的表达及作用机制[J].中国老年学杂志,2017,37(14):3427-3429.
[18] 贾禄,吉宏明,任少华,等.Toll样受体4/核因子-кB信号通路在人颅内动脉瘤形成和破裂过程中的激活[J].中国药物与临床,2016,16(9):1274-1277.
[19] 张兴祥,马玉德,娄永利,等.脑室镜辅助颅内动脉瘤夹闭术联合高容量血液稀释对早期脑动脉瘤手术患者血清S100B蛋白及MMP-9水平的影响[J].临床心身疾病杂志,2018,24(4):5-8.
[20] 刘明辉.MMP-9在颅内动脉瘤组织中的表达变化及其对血管平滑肌细胞凋亡的影响[J].山东医药,2017,57(28):88-90.