颈动脉粥样斑块稳定性与急性脑梗死发病机制关系的临床研究

The stability of carotid plaque in the pathogenesis of acute ischemic stroke

目的探讨颈动脉粥样斑块稳定性及炎症反应与急性脑梗死之间的关系。方法对71例急性脑梗死患者(A组)、44例无症状颈动脉硬化患者(B组)和21例健康对照者(C组)进行研究,ELISA测定基质金属蛋白酶-9(MMP-9)、组织型基质金属蛋白酶抑制剂-1(TIMP-1)含量,免疫透射比浊法测定高敏C反应蛋白(hs-CRP)含量,应用彩色多普勒超声仪观测颈动脉内中膜厚度(IMT)、斑块类型及斑块形态。结果A组颈动脉IMT[(1.11±0.29)mm]和B组IMT[(1.14±0.26)mm]与C组[(0.77±0.15)mm]比较差异有统计学意义(P<0.05);A组颈动脉斑块以脂质型斑块(59.2%)为主,B组以纤维型斑块(32.9%)为主,A组斑块表面多呈不规则型。hs-CRP、MMP-9含量在A组[分别为(5.47±2.26)mg/L、(250.64±89.65)ng/ml]、B组[分别为(1.80±0.34)mg/L、(144.67±34.40)ng/ml]、C组[分别为(0.59±0.12)mg/L、(64.49±18.26)ng/ml]之间差异有统计学意义;TIMP-1含量在A组[(59.64±15.87)ng/ml]、B组[(73.48±21.22)ng/ml]和C组[(57.95±7.86)ng/ml]之间差异有统计学意义,但A组和C组间差异无统计学意义;A组hs-CRP与MMP-9(r=0.241,P=0.043)呈正相关。结论颈动脉粥样斑块稳定性与急性脑梗死有关,MMP-9、TIMP-1参与的炎症反应是影响颈动脉粥样斑块由结构性不稳定向功能性不稳定进展的重要机制。

Objective To explore the role of inflammation and plaque stability in the pathogenesis of acute ischemic stroke. Methods Seventy one patients with acute anterior circulation cerebral infarction （group A） ,44 patients with asyptomatic carotid atherosclerosis （group B） and 21 normal controls （group C） were investigated. Serum levels of matrix metalloproteinase-9 （MMP-9）, tissue inhibitor of metalloproteinase-1 （TIMP-1） were measured by ELISA,the levels of high sensitive C-reactive protein （hs-CRP） were measured by latex turbidimetric immunoassay. The intima-media thickness （IMT）, plaque echogenicity and morphology were evaluated bilaterally with a 7-12 MHz linear array transducer. Results IMT were larger in group A [（1.11 ± 0.29）mm] and group B [（1.14± 0. 26）mm] as compared to group C [（0.77±0. 15）mm]. The distribution of plaque＇s echogenicity type were significant difference between group A and group B. Fatty plaque （59. 2%） was the main type of plaque in group A, fibrous （32.9%） and fatty plaques （28.0%） were the main types of plaque in group B. The plaque surface was major irregularity in group A. There were significant difference in the levels of hs-CRP among group A [（5.47 ± 2. 26） mg/L], group B [（1.80 ± 0.34）mg/L] and group C [（0.59 ± 0.12）mg/L]. There were significant difference in the levels of MMP-9 among group A [（250.64 ± 89.65）ng/ml], group B [（ 144.67 ± 34. 40）ng/ml] and group C [（64.49 ±18.26）ng/ml] ,too. Hs-CRP was positively correlated with MMP-9 （ r = 0. 241, P = 0.043） in group A. Levels of TIMP-1 was higher in group B [（73.48 ± 21.22）ng/ml] as compared to group A [（59.64± 15.87）ng/ml] and group C [（57.95 ± 7.86）ng/ml] ,but there was no statistically significant difference between group A and group C. Conclusions Increased hs-CRP levels may be related to the presence of inflammation in carotid plaque, which MMP-9 and TIMP-1 play a key role in plaque＇s destabilization and development of ischemic stroke.