血清基质金属蛋白酶-9对脑梗死出血转化的预测意义研究

目的探讨内皮损伤标志物基质金属蛋白酶-9（matrix metalloproteinase-9,MMP-9）对脑梗死出血转化的判定作用。方法连续收集住院150例脑梗死患者为研究组,根据头颅CT检查有无出血情况分为出血转化组（HT）和非出血转化组（non-HT）,用ELISA方法检测患者血MMP-9水平,并结合患者临床症状及头颅CT改变进行分析。结果患者HT组血清MMP-9水平（339.2±192.4 ng/ml）明显高于non-HT组（80.7±44.0 ng/ml）和对照组（75.9±28.1ng/ml）（P〈0.001）。发病不同取样间隔,3 h内、3～6 h、7～12 h、13～24 h HT组血清MMP-9水平高于non-HT组,差异有统计学显著性（P〈0.001）。HT组血清MMP-9水平3 h内即明显升高;出血转化组不同亚型及有无症状性出血转化组血清MMP-9的表达无统计学差异;血清MMP-9预测出血转化的界值是180 ng/ml,当MMP-9≥180 ng/ml时,脑梗死出血转化的灵敏度为78.9%,特异度为95.4%,阳性预测值71.4%,阴性预测值96.9%。结论通过检测MMP-9的水平对脑梗死出血转化进行早期预测作用,增加临床溶栓治疗的安全性,预防出血转化,改善预后有重要意义。

Plasma Metalloproteinase-9 Concentration Predicts Hemorrhagic Transformation in Cerebral Infarction

Objective To evaluate the predicting value of the marker of endothelial injury:plasma matrix metalloproteinase-9(MMP-9) concentration predicts hemorrhagic transformation in cerebral infarction.Methods By ELISA MMP-9 concentration in plasma were measured in 150 patients with cerebral infarction.At the time the clinical characters and cranial CT features of the patients were analysed.Results The serum MMP-9 level in the patients with HT(339.2±192.4 ng/ml) was significantly higher than that in the patients with non-HT(80.7±44.0 ng/ml)and that of control subjects(75.9±28.1 ng/ml)(P<0.001).The serum MMP-9 levels in patients with cerebral infarction were significantly higher than that in the patients with non-HT respectively at 3h,3~6 h,7~12 h,13~24 h after the onset.The serum MMP-9 levels in patients with cerebral infarction is not related to type of HT.The sensitivity and specificity of serum MMP-9≥180 ng/ml to predict hemorrhagic transformation in cerebral infarction were 78.9% and 95.4% respectively.The positive predictive value is 71.4% and the negative predictive value is 96.9%.Conclusion The increased level of plasma MMP-9 may be a predictor to the HT proceeding.