Research on the progression mechanism in arteriosclerotic lesion at the cervical and cerebral artery

目的：大约20%至30%的接受颈动脉内膜切除术（CEA）的患者随后发展为认知障碍。本研究的目的是确定CFA期间颈静脉球中丙二醛（MDA）修饰的低密度脂蛋白（LDL）（氧化损伤的生化标志物）浓度是否与术后认知障碍的发展相关。方法：55例接受CEA的患者在手术前和手术后1个月进行了一系列神经心理学测试。在以下时间点从插入同侧颈静脉球的静脉导管获得用于测量MDA-LDL浓度的血清样品：颈内动脉（伊卡）夹闭前即刻、伊卡夹闭后10分钟和伊卡松开后5分钟和20分钟。伊卡开放后5分钟和20分钟的MDA-LDL浓度均显著高于IC前浓度 ...更多信息 夹闭（P < 0.0001）。在术后神经心理学评估中，55例患者中有6例（11%）出现术后认知功能障碍，Logistic回归分析显示，MDA-LDL值升高伊卡开放后5分钟或20分钟时的脑电活动（计算为夹闭前值的百分比）与术后认知功能障碍的发生显著相关（95%置信区间，0.787-0.981; P = 0.0209）。结论：背景和目的：本研究的目的是确定颈动脉内膜切除术（CEA）过程中产生的术前脑血流动力学损害和活性氧是否与术后脑过度灌注的发生相关。方法：在90例因同侧伊卡狭窄（>70%）而接受CEA的患者的血清样本中测定了丙二醛修饰的低密度脂蛋白（MDA-LDL）（氧化损伤的生化标志物）的浓度。在颈内动脉（伊卡）夹闭前、伊卡夹闭后10分钟以及伊卡开放后5分钟和20分钟，从插入同侧颈静脉球的静脉导管中采集血清样本。CEA前用单光子发射计算机断层扫描测定脑血流量（CBF）和脑血管对乙酰唑胺的反应性（CVR）。结果：12名患者（13%）在CEA后立即观察到高灌注（CBF增加>100%，与术前值相比）。Logistic回归分析显示术前CVR降低（95%CI，1.053 ~ 1.453; P=0.0097），术后MDA-LDL升高（计算为术前值的百分比）。伊卡开放（95%Cis，0.862 - 0.980; P=0.0098）与受试变量中术后脑过度灌注的发生显著相关。11例术前CVR降低和伊卡开放后MDA-LDL升高的患者中有10例发生了CEA后高灌注，其中2例发生了脑高灌注综合征。结论：术前脑血流动力学损伤和术中产生的活性氧与CEA术后脑灌注过度有关。少

OBJECTIVE: Approximately 20 to 30% of patients undergoing carotid endarterectomy (CEA) subsequently develop cognitive impairment The purpose of the present study is to determine whether or not malondialdehyde (MDA)-modified low-density lipoprotein (LDL), a biochemical marker of oxidative damage, concentrations in the jugular bulb during CFA correlates with development of postoperative cognitive impairment. METHODS: Fifty-five patients undergoing CEA were assessed with a battery of neuropsychological tests before and 1 month after surgery. Serum samples for measurement of MDA-LDL concentration were obtained from a venous catheter inserted into the ipsilateral jugular bulb at the following time points: immediately before clamping of the internal carotid artery (ICA), 10 minutes after clamping of the ICA, and 5 and 20 minutes after declamping of the ICA RESULTS: The MDA-LDL concentrations at 5 and 20 minutes after ICA declamping were both significantly higher than concentrations before IC … More Aclamping (P < 0.0001). At the postoperative neuropsychological assessment, six (11%) out of 55 patients showed postoperative cognitive impairment Logistic regression analysis demonstrated that higher values of MDA-LDL increase (calculated as a percentage of the preclamp values)at either 5 or 20 minutes after ICA declamping were significantly associated with the development of postoperative cognitive impairment(95% confidence interval, 0.787-0.981; P = 0.0209)among the variables tested. CONCLUSION: MDA-LDL concentration in the jugular bulb during CEA correlates with development of postoperative cognitive impairmentBACKGROUND AND PURPOSE: The purpose of the present study was to determine whether preoperative cerebral hemodynamic impairment and reactive oxygen species produced during carotid endarterectomy (CEA) correlate with development of postoperative cerebral hyperperfusion. METHODS: Concentrations of malondialdehyde-modified low-density lipoprotein (MDA-LDL), a biochemical marker of oxidative damage, were measured in serum samples obtained from 90 patients undergoing CEA for ipsilateral ICA stenosis (>70%). Serum samples were obtained from a venous catheter inserted into the ipsilateral jugular bulb before clamping of the internal carotid artery (ICA), 10 minutes after clamping of the ICA, and 5 and 20 minutes after declamping of the ICA. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to acetazolamide were also measured using single-photon emission computed-tomography before CEA In addition, CBF was measured postoperatively. RESULTS: Hyperperfusion (CBF increase >100% compared with preoperative values)was observed immediately after CEA in 12 patients (13%). logistic regression analysis demonstrated that reduced preoperative CVR (95% CIs, 1.053 to 1.453; P=0.0097) and an increase in MDA-LDL (calculated as a percentage of the preclamp values) after. ICA declamping (95% Cis, 0.862 to 0.980; P=0.0098) were significantly associated with development of postoperative cerebral hyperperfusion among the variables tested. Ten of 11 patients with reduced preoperative CVR and increased MDA-LDL after ICA declamping developed post-CEA hyperperfusion, and 2 of these patients developed cerebral hyperperfusion syndrome. CONCLUSIONS: Both preparative cerebral hemodynamic impairment and reactive oxygen species produced during surgery correlate with development of cerebral hyperperfusion after CEA. Less