Tachtsi M, Pitoulias G, Kostoglou C, Papadimitriou D
Aristoteleion University of Thessaloniki, School Medicine, 2nd Department of Surgery-Division of Vascular Surgery G. Gennimatas Hospital, Thessaloniki, Greece.
Int Angiol. 2011 Oct;30(5):429-33.
The aim of the study was to determine the quantity of produced mediators of inflammation (cytokines and eicosanoids), during carotid endarterectomy (CEA), which are factors of ischemic damage of the brain.
Two groups (A and B) of 15 patients each, with internal carotid backpressure >30 mmHg were operated in our institution. We did not use a shunt in Group A during CEA and group B was operated upon with a shunt. Plasma concentrations of Interleukin-1b (IL-1b), Thromboxane B2 (TXB2), Prostaglandin E2 (PGE2) and tumor necrosis factor-a (TNFa) were measured by enzyme-linked immunosorbent assay (ELISA) technique.
We measured gradual increase of levels of IL-1b and TXB2 during cross-clamping and during reperfusion in group A (P<0.05). The levels of TNFa increased only during reperfusion (P<0.05). The concentration of IL-1b and TNFa remained almost stable in group B, whereas the concentration of TXB2 reduced but not significantly (P>0.05). The levels of PGE2 remained stable in both groups.
We should consider the increase of proinflammatory mediators during carotid cross-clamping when no shunt is used. The critical concentration of these mediators that threaten the brain's vitality is not yet detected. However, the clinical significance of this is unclear, since there were no perioperative strokes.
本研究的目的是确定在颈动脉内膜切除术（CEA）过程中产生的炎症介质（细胞因子和类花生酸）的数量，这些介质是脑缺血损伤的因素。
在我们机构对两组（A组和B组）各15例患者进行手术，这些患者的颈内动脉背压>30 mmHg。A组在CEA期间未使用分流器，B组在手术时使用了分流器。采用酶联免疫吸附测定（ELISA）技术测量白细胞介素-1β（IL-1β）、血栓素B2（TXB2）、前列腺素E2（PGE2）和肿瘤坏死因子-α（TNFα）的血浆浓度。
我们测量到A组在交叉钳夹期间和再灌注期间IL-1β和TXB2水平逐渐升高（P<0.05）。TNFα水平仅在再灌注期间升高（P<0.05）。B组中IL-1β和TNFα的浓度几乎保持稳定，而TXB2的浓度降低但不显著（P>0.05）。两组中PGE2的水平均保持稳定。
当不使用分流器时，我们应考虑在颈动脉交叉钳夹期间促炎介质的增加。尚未检测到威胁脑活力的这些介质的临界浓度。然而，由于围手术期没有中风，其临床意义尚不清楚。
