CAJ | 학술논문

目的探讨颈动脉支架置入术(carotid artery stenting CAS)后血清超敏C-反应蛋白(high-sensitive C-reactive protein,hs-CRP)的动态变化及其与支架内再狭窄的相关性.方法在南京军区南京总医院神经内科行CAS治疗的患者,分别在术前、术后12h、7d、3个月和6个月时检测血清hs-CRP水平,并在6个月后复查脑血管造影,观察有无支架内再狭窄.结果纳入84例行CAS治疗的患者,15例(24％)患者在CAS术后出现支架再狭窄,其中3例狭窄程度＞50％,12例狭窄程度为30％～50％.所有患者术后12 h时血清hs-CRP水平均显著高于治疗前(P均＜0.01),而术后6个月时较治疗前显著降低(P均＜0.01).单变量分析显示,再狭窄组糖尿病比例显著高于无再狭窄组(P＜0.01).再狭窄组术后7 d[(8.83±1.94) mg/L对(6.77±1.63) mg/L,t=14.398,P=0.044]、术后3个月[(8.26±1.32) mg/L对(4.58± 1.45) mg/L,t=17.569,P=0.008]和术后6个月[(7.04±1.07)mg/L对(3.12±1.28) mg/L,t=21.867,P=0.003]血清hs-CRP水平显著高于无再狭窄组,而术前与术后6个月时血清hs-CRP水平的差值(△hs-CRP)显著低于无再狭窄组[(0.85±0.13) mg/L对(4.89±0.94)mg/L,t=16.987,P=0.000].多变量logistic回归分析显示,△hs-CRP(优势比2.392,95％可信区间1.538 ～3.513,P=0.009)和糖尿病(优势比1.840,95％可信区间1.372 ～2.241,P=0.023)是支架再狭窄的独立危险因素.结论 CAS术后12h时血清hs-CRP水平显著升高,随后持续下降.术后6个月时血清hs-CRP下降程度越明显,发生支架内再狭窄的风险越低.
목적 탐토경동맥지가치입술(carotid artery stenting CAS)후혈청초민C-반응단백(high-sensitive C-reactive protein,hs-CRP)적동태변화급기여지가내재협착적상관성.방법 재남경군구남경총의원신경내과행CAS치료적환자,분별재술전、술후12h、7d、3개월화6개월시검측혈청hs-CRP수평,병재6개월후복사뇌혈관조영,관찰유무지가내재협착.결과 납입84례행CAS치료적환자,15례(24％)환자재CAS술후출현지가재협착,기중3례협착정도＞50％,12례협착정도위30％～50％.소유환자술후12 h시혈청hs-CRP수평균현저고우치료전(P균＜0.01),이술후6개월시교치료전현저강저(P균＜0.01).단변량분석현시,재협착조당뇨병비례현저고우무재협착조(P＜0.01).재협착조술후7 d[(8.83±1.94) mg/L대(6.77±1.63) mg/L,t=14.398,P=0.044]、술후3개월[(8.26±1.32) mg/L대(4.58± 1.45) mg/L,t=17.569,P=0.008]화술후6개월[(7.04±1.07)mg/L대(3.12±1.28) mg/L,t=21.867,P=0.003]혈청hs-CRP수평현저고우무재협착조,이술전여술후6개월시혈청hs-CRP수평적차치(△hs-CRP)현저저우무재협착조[(0.85±0.13) mg/L대(4.89±0.94)mg/L,t=16.987,P=0.000].다변량logistic회귀분석현시,△hs-CRP(우세비2.392,95％가신구간1.538 ～3.513,P=0.009)화당뇨병(우세비1.840,95％가신구간1.372 ～2.241,P=0.023)시지가재협착적독립위험인소.결론 CAS술후12h시혈청hs-CRP수평현저승고,수후지속하강.술후6개월시혈청hs-CRP하강정도월명현,발생지가내재협착적풍험월저.
Objective To investigate the dynamic change of serum high sensitive C-reactive protein (hsCRP) after carotid artery stenting (CAS) and its correlation with in-stent restenosis.Methods The serum hsCRP levels were determined before procedure,at 12 hours,7 days,3 and 6 months after procedure in patients who underwent CAS in the Department of Neurology,Jinling Hospital,Nanjing Their cerebral angiography was reexamined and whether there was in-stent restenosis after 6 months was observed.Results Eighty-four patients treated with CAS were included in the study.Fifteen (24％) had in-stent restenosis after CAS.The stenosis in 3 of them was ＞ 50％,and the stenosis m 12 of them was 30％ to 50％.The serum hs-CRP levels in all patients after procedure were significantly higher than those before treatment (all P ＜ 0.01 ),and they were significantly lower at 6 months after procedure than before treatment (all P ＜0.01).Univariate analysis showed that the proportion of diabetes in the restenosis group was significantly higher than that in the non-restenosis group (P＜0.01).At 7 days (8.83 ± 1.94 mg/L vs.6.77 ± 1.63 mg/L,t =14.398,P=0.044),3 months after procedure (8.26 ± 1.32 mg/L vs.4.58 ± 1.45 mg/L,t =17.569,P =0.008) and 6 months after procedure (7.04 ± i.07 mg/L vs.3.12 ± 1.28 mg/L,t =21.867,P =0.003),the serum hs-CRP levels in the restenosis group were significantly higher than those in the non-restenosis group,and the difference of the serum hs-CRP level (△ hs-CRP) before procedure and at 6 month after procedure was significantly lower than that in the nonrestenosis group (0.85 ± 0.13 mg/L vs.4.89 ± 0.94 mg/L,t =16.987,P =0.000).Multivariate logistic regression analysis showed that /hs-CRP (odds ratio [ OR] 2.392,95％ confidence interval [ CI] 1.538 -3.513; P =0.009) and diabetes (OR 1.840,95％ CI 1.372 -2.241; P =0.023) were the risk factors for instent restenosis.Conclusions The serum hs-CRP level increased significantly at 12 hours after CAS procedure,and then decreased continuously.At 6 months after procedure,the more decrease of the serum hs-CRP level,the lower risk of occurring in-stent restenosis was.