摘要目的 探讨短暂性脑缺血发作(TIA)患者行颈动脉支架置入术(CAS)前后白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)的水平变化及其与再狭窄的关系.方法 根据病变情况、手术复杂程度将67例TIA患者分为A组(单支单处病变,置入1个支架,处理1处病变,38例)和B组(单支弥漫性病变或多支多处病变,置入2个支架,处理2处病变,29例),术后1年常规进行头颈血管CTA检查,并根据结果分为再狭窄组(14例)和无狭窄组(48例).检测患者在CAS术前,术后1 h、2周、1个月、6个月、1年血浆IL-6、TNF-α及血清CRP水平,其中CRP检测采用免疫透射比浊法,IL-6、TNF-α检测采用放射免疫测定法.结果随访中1例死亡,4例失访,有14例存在不同程度的狭窄,其中3例再狭窄≥50%.与术前比较,术后1 h、2周、6个月CRP、IL-6水平明显升高,术后1 h、2周、1个月、6个月TNE-α水平明显升高,差异均有统计学意义(P<0.05).与A组比较,B组术后1 h、2周、6个月CRP水平明显升高,术后1 h、2周、1年TNF-α水平明显升高,差异均有统计学意义(P<0.05).与无狭窄组比较,再狭窄组术后1 h、2周、6个月CRP水平明显升高,术后1 h、2周、1个月、6个月IL-6水平明显升高,术后各时间点TNF-α水平明显升高,差异均有统计学意义(P<0.05).结论 IL-6、TNF-α、CRP在CAS后迅速升高,之后逐渐回落,在术后6个月再次出现升高,尤以再狭窄者为著,其可作为预测早期再狭窄的参考指标.

abstractsObjective To explore the changes of the levels of Interleukin-6 (IL-6), tumor necrosis factor a (TNF-α) and c-reactive protein (CRP) after carotid artery stenting (CAS) and their relation to restenosis in patients with transient ischemic attack. Methods The patients were divided into group A (with 1 stenting and 1 lesion, n=38) and group B (with 2 stenting and 2 lesions, n=29) according to the pathologic changes and complicated degrees of CAS, and all the patients were divided into restenosis group (n=14) and non-restenosis group (n=48) according to the examination results of cervical CTA 1 y after CAS. The levels of EL-6, TNF-α and CRP were measured before CAS and 1 h, 2 w, 1 and 6 mon, and 1 y after stents. The level of CRP was measured by enhanced immunoturbidirnetic assay, and the levels of IL-6 and TNF-a were measured by radioimmunoassay. Results to the follow-up survey, 1 died and 4 were lost. Fourteen had restenosis of different degrees. The restenosis rate more than 50 percent was noted in 3 patients. Compared to those before CAS, the levels of CRP, IL-6 and TNF-α were increased rapidly after CAS (P<0.05). Compared to those in the group A, the levels of CRP, IL-6 and TNF-α in the group B 1 h, 2 w and 6 mon after CAS were obviously increased (P<0.05). Compared to those in the non-restenosis group, the levels of CRP, IL-6 and TNF-α in the restenosis group 1 h, 2 w and 6 mon after CAS were obviously increased (P<0.05). Conclusion The levels of IL-6, TNF-α and CRP increased rapidly after CAS, then reduced gradually and increased once again 6 months after CAS, which was notable in restenosis group. They can be the reference indexes of the forecast for early restenosis.