Abstract: Objective  To explore the dynamic changes over time in serum levels of neutrophil extracellular traps (NETs) markers—citrullinated histone 3 (cit-H3) and myeloperoxidase (MPO)—after head and neck arterial stent implantation. 
Methods  Patients with atherosclerotic stenosis of the head and neck arteries who underwent stent implantation were prospectively and consecutively enrolled. Venous blood samples were collected from the patients within 24 hours of fasting before surgery, and at 6, 12, 24, and 48 hours after surgery to measure serum cit-H3 and MPO levels. One-way repeated measures analysis of variance with Greenhouse-Geisser correction was used to compare the dynamic changes in serum cit-H3 and MPO levels across different perioperative time points. Subgroup analyses of the changes in serum cit-H3 and MPO levels were conducted based on stent implantation site (intracranial vs. extracranial), number of stents implanted (1 vs. 2), whether the responsible vessel had symptomatic stenosis, and whether cerebral infarction was in the acute phase (disease duration≤14 days) at the time of surgery. 
Results  A total of 48 patients were enrolled in this study with a mean age of (61.8±8.4) years, including 42 males (87.5%). Among all patients, the serum cit-H3 levels before surgery and at 6, 12, 24, and 48 hours after surgery were (54.50±6.48) ng/mL, (56.73±6.50) ng/mL, (71.27±7.35) ng/mL, (53.53±17.35) ng/mL, and (52.22±5.45) ng/mL, respectively. The serum MPO levels at the corresponding time points were (25.45±6.67) ng/mL, (26.29±6.75) ng/mL, (28.28±7.68) ng/mL, (31.55±9.09) ng/mL, and (28.68±7.61) ng/mL, respectively. Both markers showed a trend of increasing first and then decreasing, with statistically significant overall differences (P=0.002 for cit-H3; P=0.022 for MPO). In the extracranial and intracranial stent subgroups, the single and double stent subgroups, the symptomatic stenosis subgroup, and the non-acute phase subgroup, the serum cit-H3 levels peaked at 12 hours after surgery. The serum MPO levels peaked at 12 hours after surgery in the intracranial stent subgroup. However, in the double stent subgroup, the symptomatic stenosis subgroup, and the non-acute phase subgroup, the serum MPO levels peaked at 24 hours after surgery.
Conclusions  Within 48 hours after head and neck artery stent implantation, the serum levels of NETs markers cit-H3 and MPO showed an initial increase followed by a gradual return to preoperative levels. This trend was more pronounced in patients with symptomatic arterial stenosis.

Key words: Head and neck artery stent implantation; Myeloperoxidase; Citrullinated histone 3

摘要： 目的 探讨头颈部动脉支架植入后血清中性粒细胞外陷阱（neutrophil extracellular traps，NETs）标志物瓜氨酸化组蛋白3（citrullinated histone 3，cit-H3）及髓过氧化物酶（myeloperoxidase，MPO）水平随时间变化的规律。
方法 前瞻性连续纳入因头颈部动脉粥样硬化性大动脉狭窄行支架植入术的患者，分别于术前空腹24 h内，术后6、12、24、48 h采集患者静脉血，测定血清cit-H3及MPO水平。采用经Greenhouse-Geisser校正的单因素重复测量方差分析，比较患者围手术期不同时间点血清cit-H3及MPO水平的动态变化趋势。根据支架植入部位（颅内 vs. 颅外）、支架植入数目（1个 vs. 2个）、责任血管是否为症状性狭窄，以及手术时脑梗死是否处于急性期（病程≤14 d），对血清cit-H3及MPO水平的变化进行亚组分析。
结果 本研究共纳入48例患者，平均年龄为（61.8±8.4）岁，男性42例（87.5%）。在整体患者中，血清cit-H3在术前及术后6、12、24、48 h的水平分别为（54.50±6.48）ng/mL、（56.73±6.50）ng/mL、（71.27±7.35）ng/mL、（53.53±17.35）ng/mL和（52.22±5.45）ng/mL；血清MPO在术前及术后6、12、24、48 h的水平分别为（25.45±6.67）ng/mL、（26.29±6.75）ng/mL、（28.28±7.68）ng/mL、（31.55±9.09）ng/mL和（28.68±7.61）ng/mL，两者术后水平均呈现先升高后降低趋势，整体差异均具有统计学意义（P=0.002；P=0.022）。颅外及颅内支架亚组、1个及2个支架亚组、症状性狭窄亚组及非急性期亚组的血清cit-H3水平均于术后12 h达到峰值。颅内支架亚组的血清MPO水平于术后12 h达到峰值，2个支架亚组、症状性狭窄亚组及非急性期亚组的血清MPO水平均于术后24 h达到峰值。
结论 头颈部动脉支架植入术后48 h内，血清NETs标志物cit-H3和MPO水平呈现先升高后恢复至术前水平的变化趋势，这种趋势在症状性狭窄患者中更显著。

关键词: 头颈部动脉支架植入; 髓过氧化物酶; 瓜氨酸化组蛋白3