无水乙醇介入栓塞治疗对脑动静脉畸形患儿神经功能的影响

doi:10.3969/j.issn.1006-6233.2022.01.021

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摘要 目的:探讨无水乙醇介入栓塞治疗对脑动静脉畸形(bAVM)患儿神经功能的影响。方法:选取2018年12月至2020年12月我院bAVM患儿62例进行,随机数字表法分为栓塞组(n=31)、开颅组(n=31)。开颅组采取微创开颅手术,栓塞组采取全脑血管造影下无水乙醇介入栓塞。比较两组治愈率、并发症、术前、术后7d、术后1个月NIHSS评分、血清神经功能指标[脑源性神经营养因子(BDNF)、EF手型钙结合蛋白(S100B蛋白)、神经元特异性烯醇化酶(NSE)]、基质金属蛋白酶-9(MMP-9)、组织基质金属蛋白酶抑制剂-1(TIMP-1)水平、术后6个月预后情况,BDNF、S100B蛋白、NSE、MMP-9、TIMP-1均采用酶联免疫吸附实验测定。结果:术后1个月复查DSA显示两组畸形团均完全消失,治愈率达100%;两组并发症发生率比较,差异无统计学意义(P>0.05);术后7d栓塞组NIHSS评分低于开颅组(P<0.05),术后1个月两组NIHSS评分比较,差异无统计学意义(P>0.05);术后7d栓塞组血清BDNF水平高于开颅组,血清S100B蛋白、NSE、MMP-9、TIMP-1水平低于开颅组(P<0.05);术后3个月两组血清BDNF水平高于术前,血清S100B蛋白、NSE、MMP-9、TIMP-1水平低于术前(P<0.05),但组间比较,差异无统计学意义(P>0.05);两组预后情况比较,差异无统计学意义(P>0.05)。结论:全脑血管造影下无水乙醇介入栓塞治疗儿童bAVM可取得微创开颅手术相当的疗效,且安全性可接受,无水乙醇介入栓塞可早期改善局部病理环境,并避免开颅手术所致脑组织损伤,利于早期神经功能恢复。

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	何霜霜
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	孙燕宁

关键词 ：全脑血管造影, 无水乙醇, 介入栓塞, 微创开颅手术, 脑动静脉畸形

Abstract：Objective: To explore the effects of absolute ethanol interventional embolization under total cerebral angiography and minimally invasive craniotomy on neurological function of children with cerebral arteriovenous malformation (bAVM). Methods: A prospective study was conducted on 62 children with bAVM in our hospital from December 2018 to December 2020. The patients were divided into embolization group (n=31) and craniotomy group (n=31) with the random number table. The craniotomy group was treated with minimally invasive craniotomy, and the embolization group was treated with absolute ethanol intervention embolization under total cerebral angiography. The two groups were compared on cure rate, complications, NIHSS score, serum neurological function indexes [brain-derived neurotrophic factor (BDNF), EF hand-calcineurin (S100B protein), neuron-specific enolase (NSE)], matrix metalloproteinase-9 (MMP-9), tissue matrix metalloproteinase inhibitor-1 (TIMP-1) levels before operation, 7 days after operation, and 1 month after operation. Prognosis 6 months after surgery was compared as well. Results: Re-examination of DSA 1 month after operation showed that both groups of malformations disappeared completely, and the cure rate was 100%. There was no statistically significant difference in the incidence of complications between the two groups (P>0.05). The NIHSS score of the embolization group was lower than that of the craniotomy group 7 days after the operation (P<0.05), there was no statistically significant difference in NIHSS scores between the two groups at 1 month after operation (P>0.05). The level of serum BDNF in the embolization group was higher than that in the craniotomy group at 7 days postoperatively, and the levels of serum S100B protein, NSE, MMP-9 and TIMP-1 were lower than those in the preoperative and craniotomy groups (P<0.05). There were no significant difference in the levels of serum BDNF, S100B protein, NSE, MMP-9 and TIMP-1 between the two groups at 1 month after operation (P>0.05); there was no statistically significant difference in the prognosis of the two groups (P>0.05). Conclusion: Interventional embolization with absolute ethanol under total cerebral angiography for the treatment of bAVM in children can achieve comparable results in minimally invasive craniotomy, and the security is acceptable, Interventional embolization with absolute ethanol can improve the local pathological environment early and avoid brain tissue damage caused by craniotomy, which is conducive to early recovery of nerve function.

Key words： Total cerebral angiography Absolute ethanol Interventional embolization Minimally invasive craniotomy Cerebral arteriovenous malformations

基金资助:江苏省自然科学基金项目,(编号:BK20191088)

引用本文:

何霜霜, 吉沥, 孙燕宁. 无水乙醇介入栓塞治疗对脑动静脉畸形患儿神经功能的影响[J]. 河北医学, 2022, 28(1): 102-106.
HE Shuangshuang, JI Li, SUN Yanning. Effect of Absolute Ethanol Interventional Embolization Under Total Cerebral Angiography and Minimally Invasive Craniotomy on Neurological Function of Children with Cerebral Arteriovenous Malformation. HeBei Med, 2022, 28(1): 102-106.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.01.021 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I1/102

[1] 王雪,仇爱珍,柏青.颅内动静脉畸形患儿血管内栓塞术后出血的危险因素分析[J].局解手术学杂志,2020,29(2):150~153.
[2] Pezeshkpour P,Dmytriw AA,Phan K,et al.Treatment strategies and related outcomes for brain arteriovenous malformations in children:a systematic review and meta-analysis[J].AJR Am Roentgenol,2020,215(2):472~487.
[3] 杨涛,杨新宇,任新亮,等.同期介入栓塞联合显微外科手术治疗颅内复杂动静脉畸形患儿1例报告[J].中国医师进修杂志,2019,42(11):1041~1043.
[4] 杨艳芳,郭晓慧.11例应用乙醇消融术治疗脑动静脉畸形患者的护理体会[J].天津护理,2020,28(5):597~598.
[5] Derdeyn CP,Zipfel GJ,Albuquerque FC,et al.Management of brain arteriovenous malformations:a scientific statement for healthcare professionals from the american heart association/american stroke association[J].Stroke,2017,48(8):e200~e224.
[6] Cenzato M,Boccardi E,Beghi E,et al.European consensus conference on unruptured brain AVMs treatment (Supported by EANS,ESMINT,EGKS,and SINCH)[J].Acta Neurochirurgica(Wien),2017,159(2):1059~1064.
[7] 白卫星,贺迎坤,李天晓,等.乙醇消融治疗颅内动静脉畸形的初步研究[J].介入放射学杂志,2019,28(2):109~113.
[8] 许斌,白卫星,贺迎坤,等.无水乙醇治疗脑动静脉畸形的疗效评价[J].中华放射学杂志,2020,54(12):1202~1206.
[9] 李德康,李洪,杨晓滨,等.脑动静脉畸形术后神经功能障碍的影响因素分析[J].脑与神经疾病杂志,2018,26(6):331~335.
[10] Morais V,Tourino M,Almeida A,et al.A single session of moderate intensity walking increases brain-derived neurotrophic factor (BDNF) in the chronic post-stroke patients[J].Top Stroke Rehabil,2018,25(1):1~5.
[11] Wu L,Luo Z,Zheng J,et al.IL-33 can promote the process of pulmonary fibrosis by inducing the imbalance between MMP-9 and TIMP-1[J].Inflammation,2018,41(3):878~885.