不同TOAST分型脑梗死患者血清基质金属蛋白酶-2和基质金属蛋白酶-9水平的研究

目的 探讨血清基质金属蛋白酶(MMP)-2和MMP-9与脑梗死TOAST分型和预后的关系.方法 应用ELISA法检测60例脑梗死患者(CI组)和30例对照者(NC组)血清MMP-2和MMP-9水平,根据TOAST分型,CI组又分为心源性脑栓塞组(20例)、大动脉粥样硬化性脑梗死组(20例)和腔隙性脑梗死组(20例),比较各组血清MMP-2和MMP-9水平的变化.结果 CI组患者脑梗死后第1天血清MMP-2水平较NC组明显降低,差异有统计学意义(P＜0.01),血清MMP-9水平较NC组明显升高,差异有统计学意义(P＜0.01);心源性脑栓塞组和大动脉粥样硬化性脑梗死组患者脑梗死后第1天血清MMP-9水平明显高于腔隙性脑梗死组,差异均有统计学意义(P均<0.01);血清MMP-9水平与美国国立卫生院卒中量表(NIHSS)评分呈正相关,预后良好患者发病12 d内血清MMP-9水平明显低于预后不良患者,差异有统计学意义(P＜0.01).结论 脑梗死后血清MMP-9水平升高,升高幅度和变化规律在TOAST各亚型不尽相同,心源性脑栓塞患者和大动脉粥样硬化性脑梗死患者MMP-9水平高于腔隙性脑梗死患者;血清MMP-9水平可作为评价脑梗死病情的可靠指标;脑梗死后第1天的血清MMP-9水平是预后的独立预测因素.

Levels of matrix metalloproteinase-2 and matrix metalloproteinase-9 in serum of cerebral infarction patients with the different classification of TOAST

Objective To determine and compare the levels of serum matrix metalloproteinase (MMP)-2 and MMP-9 in acute stage of cerebral infarction and the relationship and prognosis between them and the classification of TOAST. Methods The levels of MMP-2 and MMP-9 were detected by ELISA in 60 cerebral infarction patients(CI group)while 30 healthy donors were served as control group (NC group).Results The level of MMP-2 in CI group was significantly lower than that in NC group (P＜0.01) and the level of MMP-9 was significantly higher than that in NC group (P＜0.01).Compared with lacunar infarction (LI) group,the level of MMP-9 was significantly higher in cardiogenic cerebral embolism group(CCE group) and large artery arteriosclerosis cerebral infarction group (LAA group);The serum level of MMP-9 was related to NIHSS.The serum level of MMP-9 in good prognosis patients was significantly lower than that in poor prognosis patients (P＜0.01).Conclusions The serum level of MMP-9 is increased after cerebral infarction.The serum level of MMP-9 in the CCE group and LAA group is significantly higher than that in LI group.The level of MMP-9 is a reliable parameter in evaluating the disabilities in cerebral infarction.The level of serum MMP-9 within 24 hours of onset can predict the prognosis of cerebral infarction independently.