血清基质金属蛋白酶 9水平与脑梗死病灶大小及近期预后的关系

背景动物实验表明基质金属蛋白酶( matrix metalloproteinases,MMPs)参与了缺血性脑卒中的病理过程并起着重要的作用,在临床上血清基质金属蛋白酶 9( MMP-9)是否可作为反应脑梗死患者梗死体积大小及近期预后的一个重要指标. 目的探讨 MMP-9水平与脑梗死体积大小,预后关系以及相关影响因素. 设计以诊断为依据的非随机对照研究. 地点和对象选自 2002-01/ 2003-04暨南大学第二附属医院神经科住院的、经临床诊断为颈内动脉系统急性脑梗死或腔隙性脑梗死患者 124例,男 88例,女 36例,平均年龄为 (62.34± 14.32)岁.所有病例均符合 1995年第四届脑血管疾病会议修订的各类脑血管疾病诊断要点,根据影像学检查结果将患者分为脑梗死组 74例,腔隙性脑梗死组 50例. 干预起病后 24 h抽取肘静脉血,用酶联免疫吸附法( ELISA法)测定血清 MMP-9水平,采用免疫比浊法测定 C反应蛋白( C-reactive protein, CRP )水平.根据脑卒中患者临床神经功能缺损程度评分标准 (CNFDS)对患者入院以及发病两周后进行评分. 主要观察指标血清 MMP-9, CRP水平, 白细胞计数,血脂,脑梗死体积,预后. 结果 脑梗死组 MMP-9水平 (731.55± 226.18) mg/L], CRP 水平 (8.65± 3.77) mg/L],三酰甘油水平 (1.91± 0.96) mmol/L]及白细胞计数 (9.17± 1.99)× 109 L-1]明显高于腔隙性脑梗死组 622.64± 196.72) mg/L,( 6.97± 4.36 ) mg/L,( 1.52± 0.85) mmol/L,( 8.38± 1.84)× 109 L-1],差异有显著性意义( P=0.006, 0.024, 0.023, 0.027); MMP9水平与 CRP水平、白细胞计数呈直线正相关( r=0.224, P=0.013; r=0.289,P=0.001),与预后呈等级正相关( r=0.180,P=0.046). 结论 脑梗死急性期血清 MMP-9水平可作为反应脑梗死患者梗死体积大小以及近期预后的一个重要指标.

Correlations of the level of serum matrix metalloproteinases-9 with the focus size of cerebral infarction and its short-term prognosis

BACKGROUND:Matrix metalloproteinases( MMPs) has been proved involving and playing key role in the pathogenesis of ischemic stroke by researches on animals,whether its serum level can be used as an important index for infarct volume of cerebral infarction and short-term prognosis are warmly discussed. OBJECTIVE:To explore the correlations of MMPs with infarct volume and prognosis,as well as its correlative factors. DESIGN:Nonrandomised and case-controlled study based on diagnosis. SETTING and PARTICIPANTS:A total of 124 patients, with diagnosis of acute cerebral infarction of inner-carotid system or lacunal cerebral infarction,were hospitalized in neurological section of the Second Affiliated Hospital of Ji'nan University from January,2002 to April,2003,including 88 males and 36 females with the average age of(62.34± 14.32) years old. All patients accorded with the diagnostic standard by the fourth Cerebravascular Disease Conference in 1995 and divided into cerebral infarction group(CIG,n=74) and lacunal infarction group(LIG,n=50) according to their image results. INTERVENTIONS:Blood samples were collected within 24 hours from the occurrence of stroke for determining the serum level of MMP-9 by enzymelinked immunosorbent assay,meanwhile,C-reactive protein( CRP) was also assessed by immune nephelometry.Scores for clinical nerve functional defect was made at patients entering hospital and two weeks later. MAIN OUTCOME MEASURES:Serum MMP-9,CRP,white blood cell(WBC) counting,blood lipid,infarction volume and prognosis. RESULTS:In cerebral infarction group,the level of MMP-9,CRP,triglyceride and WBC in CIG were(731.55± 226.18) mg/L],(8.65± 3.77) mg/L,(1.91± 0.96) mmol/L and(9.17± 1.99)× 109 L-1,respectively],obviously higher than corresponding(622.64± 196.72) mg/L,( 6.97± 4.36 ) mg/L,( 1.52± 0.85) mmol/L,( 8.38± 1.84)× 109 L-1] of LIG, in lacunal infarction group,difference was statistically significant( P=0.006, 0.024, 0.023, 0.027) ;MMP-9 was found linearly positive correlated with CRP and the number of WBC( r=0.224, P=0.013;r=0.289,P=0.001),and positively correlated with prognosis grades( r=0.180,P=0.046) . CONCLUSION:Serum MMP9 can be used as an important index for infarction volume and shortterm prognosis of stroke in acute phase.