TNF-α和MMP-9在格林-巴利综合征发病机制中的作用

目的探讨肿瘤坏死因子-α（TNF—α）和基质金属蛋白酶-9（MMP-9）在格林-巴利综合征（GBS）发病机制中的作用。方法（1）采用ELISA双夹心法检测24例GBS患者和19例健康人TNF—α和MMP-9血浆浓度。（2）用免疫组化方法分别检测GBS组（7例）和对照组（7例具有遗传性神经病患者）腓肠神经中TNF-α和MMP-9的表达。结果（1）TNF—α和MMP-9浓度在GBS组明显高于对照组（均P〈0．001），且其浓度与临床分级间有显著相关关系（r值分别为0．712和0．724）。（2）在GBS腓肠神经中，MMP-9表达于血管内皮细胞、T淋巴细胞和神经纤维上；TNF-α表达于神经纤维上。结论在GBS中，MMP-9可能对白细胞渗出、血-神经屏障（BNB）和髓鞘结构的破坏起重要作用，TNF—α可能在免疫介导的脱髓鞘和轴索损伤中起重要作用。

Explore the role of matrix metalloproteinase-9 and tumor necrosis factor alpha in the pathogenesis of Guillain-Barre syndrome

Objective To explore the role of tumor necrosis factor alpha(TNF-α)and matrix metalloproteinase-9(MMP-9) in the pathogenesis of Guillain-Barre syndrome(GBS).Methods(1) The serum TNF-a and MMP-9 concentrations were measured by a sandwich enzyme-linked immunosorbent assay(ELISA) in 24 patients with GBS and contro(l19 cases).(2) we detected the expression of TNF-αand MMP9 in sural nerve from the patients(7 cases) with GBS and the patients(7 cases) with hereditary neuropathies using immunohistochemistry.Resealts(1) The concentrations of TNF-αand MMP-9 were raised in GBS group than control group(all p<0.001).Elevated serum concentrations of TNF-αand MMP-9 showed a positive correlation with the disease severity in patients with GBS(r=0.712 and r=0.724).(2) Immunohistochemical findings of seven sural nerves biopsies of patients with GBS disclosed an immunoreactivity of MMP-9 on endothelial cells,T lymphocytes and nerve fibers,and TNF-α on nerve fibers.Conclusion Our findings imply an important role for MMP-9 in transmigration of inflammatory cells,the degradation of blood-nerve barrier,and demyelination of peripheral nerve,and for TNF-αin the cascade of events leading to immune-mediated demyelination and axonal damage in GBS.