| objective: To observe the changes of hemoglobin Oxygenase 1(heme oxygenase-1,HO-1)level and neutrophils-lymphocyte ratio(neutrophil lymphocyte RATIO,NLR)before and after stent implantation in patients with severe carotid artery stenosis.To analyze the possible causes and mechanisms of the changes and explore the role of HO-1 in the improvement of cerebral blood flow in patients with severe carotid artery stenosis.Methods: This study was a prospective study.The patients with severe carotid artery stenosis admitted to Sichuan Provincial People’s Hospital from December 2017 to April2018 were selected as the observation group.The people without carotid artery stenosis treated in the Department of Neurology of our hospital during the same period were selected as the control group.The patients in the observation group were treated with operation and conventional anti aggregation,lipid regulation and blood pressure control,DSA was used to evaluate intracranial blood supply before and after operation.The baseline data of all the subjects were recorded,DSA was used to evaluate intracranial blood supply before and after operationcluding,Hematological parameters of admission were: WBC,NEU,LYM,HbA1 c,TC,TG,LDL,DBIL,IBIL,TBIL.ELISA were used to detect levels of HO-1 in control group,observation group(preoperative,postoperative1 d,postoperative 3d),and neutrophil(lymphocyte)and lymphocyte count were observed in the observation group after operation,then calculate the ratio(NLR).SPSS22.0 software was used to complete statistical analysis.Quantitative data:normal distribution was expressed by(x±s),t test(groups),repeated measurement analysis of variance(inner Group),rank sum test was used in skewness distribution with(M,Qu-QL),and count data: the number of frequency,percentage,using the χ2 test(groups),P<0.05 was statistically significant.Result:1.44 cases of observation group(36 male and 8 female),age range 46-81,the average(65.05± 9.53)years of age,and the numbers and partsof cases are severe stenosis of internal carotid artery(33),subclavian artery(6),vertebral artery(4),common carotid arteries(1).hypertension 32(72.73%),diabetes 22(50%),hyperlipidemia 20(45.45%),coronary heart disease 12(27.27%),smoking 27(61.36%),cerebral infarction history 10(22.73%);Control group with 30 cases(male 20,female 10),aged 57-74,the average(64.25 ±6.21)years of age,diabetes 17(56.67%),hypertension 12(40.00%),hyperlipidemia 15(50%),coronary heart disease 12(40.00%),smoking 12(40%),two groups in diabetes,hypertension,hyperlipidemia,coronary heart disease,smoking,history of cerebral infarction,glycosylated hemoglobin,TG,TC and LDL were no statistical significance.2.Severe carotid artery stenosis leads to insufficient intracranial blood supply.According to the assessment of intracranial blood flow by DSA,CAS can significantly improve intracranial blood supply and restore blood flow reperfusion.3.The preoperative ho-1 level of the observation group was(52.75±26.78)ng/ mL,while that of the control group was(56.27±15.72)ng/ mL.The difference was not statistically significant(t=0.58,P=0.566).4.Serum ho-1 levels in the observation group were52.75±26.78ng/mL,80.18±43.01ng/mL,and 100.36 ±45.23ng/mL before surgery,1 day after surgery,and 3 days after surgery,respectively,with statistically significant differences(F=30.952,P <0.001).And that ho-1 in 1 day after surgery was higher than before surgery(95% confidence interval:13.903-40.952ng/mL,P <0.001),ho-1 in 3 day after surgery was higher than before surgery(95% confidence interval: 30.163-65.071ng/mL,P <0.001),and ho-1 in 3 days after surgery was higher than 1 day after surgery(95%confidence interval: 6.059-34.319 ng/mL,P=0.003).5.The preoperative white blood cell(7.11±2.37)g/L and lymphocyte(1.55±0.64)g/L,the observation group were respectively(7.39 ±2.39)g/L and(1.45±0.64)g/L,with no statistical difference(t=-0.814,p=0.42);t=1.407,p=0.167).Postoperative neutrophil(4.26,2.50)g/L was higher than preoperative(4.24,2.46)g/L(z=-2.007,p=0.045),postoperative NLR(3.07,2.18)was higher than preoperative(2.78,2.21)(z=-2.836,p=0.005).conclusion:1.For patients with severe carotid artery stenosis,DSA assessment showed that stent implantation could improve intracranial artery blood supply,restore blood flow reperfusion.2.While carotid artery stenting improves cerebral reperfusion,it also increases the level of protective factor heme oxygenase 1(ho-1),which may be one of the indicators reflecting postoperative ischemia reperfusion.3.Increased NEU and NLR after stent implantation indicated an inflammatory response during ischemia reperfusion,which may be a contributing factor to the increase of ho-1. |
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