早期颈内动脉支架置入对动脉粥样硬化脑梗患者血清Lp-PLA2和Hcy水平的影响

摘要 目的：探讨早期颈内动脉支架置入（carotid artery stenting，CAS）对动脉粥样硬化脑梗死患者血清脂蛋白相关磷脂酶2（lipoprotein-associated phospholipase 2，LP-PLA2）和同型半胱氨酸（Homocysteine，Hcy）水平的影响。方法：选择2018年8月到2021年4月在在西安交通大学第一附属医院诊治的颈动脉重度狭窄性脑梗死患者86例作为研究对象，根据治疗方法将患者分为早期CAS组与对照组各43例，对照组给予药物保守治疗，2周后脑梗死稳定后再给予手术，CAS组在对照组基础上治疗3~5 d后给予颈内动脉支架置入治疗，检测两组患者血清Lp-PLA2和Hcy水平变化情况。结果：CAS组治疗后7 d的总有效率为97.7 %，高于对照组的86.0 %（P<0.05）。CAS组治疗后7 d的高灌注综合征、脑出血、低血压、心动过缓等并发症发生率为4.7 %，对照组无出现高灌注综合征、脑出血、低血压、心动过缓等并发症，对比差异无统计学意义(P>0.05)。两组治疗后7 d的颈内动脉相对脑血流量与脑血容量高于治疗前(P<0.05)，CAS组高于对照组(P<0.05)。两组治疗后7 d的血清Lp-PLA2、Hcy含量低于治疗前（P<0.05），CAS组低于对照组（P<0.05）。结论：早期颈内动脉支架置入在动脉粥样硬化脑梗死患者的应用能抑制Lp-PLA2、Hcy的表达，改善患者的血流动力学变化，从而促进提高治疗效果，在临床上的应用具有很好的安全性。

Effects of Early Internal Carotid Artery Stent Placement on Serum Lp-PLA2 and Hcy Levels in Patients with Atherosclerotic Cerebral Infarction

ABSTRACT Objective: To investigate the effect of early internal carotid artery stenting (CAS) on serum lipoprotein-associated phospholipase 2 (LP-PLA2) and homocysteine (Hcy) levels in patients with atherosclerotic cerebral infarction. Methods: A total of 86 patients with severe carotid artery stenotic cerebral infarction who were diagnosed and treated in the First Affiliated Hospital of Xi''an Jiaotong University from August 2018 to April 2021 were selected as the research subjects. According to the treatment method, the patients were divided into the early CAS group and the control group, 43 cases in each group. The control group were given conservative drug treatment, and after 2 weeks the cerebral infarction was stabilized before surgery. The CAS group was given internal carotid artery stenting after 3-5 days of treatment on the basis of the control group, and the changes of serum Lp-PLA2 and Hcy levels in the two groups were detected. Results: After 7 days of treatment, the total effective rate at 7 days were 97.7 % in the CAS group, which were higher than 86.0 % in the control group (P<0.05). The incidence rates of complications such as hyperperfusion syndrome, cerebral hemorrhage, hypotension, bradycardia in the CAS group were 4.7 % after 7 days of treatment, and there were no cases of hyperperfusion syndrome, cerebral hemorrhage, hypotension, bradycardia ocurred in the control groups that compared were not difference(P<0.05). The internal carotid artery relative cerebral blood flow and cerebral blood volume in the two groups were higher than those before treatment (P<0.05), and the CAS group was higher than the control group (P<0.05). There were no significant difference in the control group before and after treatment (P>0.05). The levels of Lp-PLA2 and Hcy in serum 7 days after treatment in the two groups were lower than those before treatment (P<0.05), and those in the CAS group were lower than those in the control group (P<0.05). Conclusion: The application of early internal carotid artery stenting in patients with atherosclerotic cerebral infarction can inhibit the expression of Lp-PLA2 and Hcy, and improve the hemodynamic changes of patients, thereby promoting the improvement of the therapeutic effect, and having good safety in clinical application.