短暂性脑缺血发作病人的脑缺血耐受作用及血清MMP-9水平的变化

The Study on Transient Cerebral Ischemic Attack and its Tolerance Associated with the Change of Level for Serum MMP-9 in the Patients with Cerebral Infarction

目的评价短暂脑缺血发作(TIA)是否具有脑保护作用并探讨其机制。方法选择2000～2004年142例脑梗死病人。脑梗死前有 TIA 病史者分为3组,A 组30例,TIA 持续时间10 min;B 组30例,TIA 持续时间10～20min;C 组30例,TIA 持续时间20min;52例无 TIA 病史者列为 D 组。采用欧洲脑卒中神经功能缺损评分标准(ESS),对各组患者人院后24 h、21d 及发病后3个月进行神经功能评分;应用 Pullicino 等公式对各组病人发病21d 时进行脑梗死体积计算;应用酶联免疫吸附法测定各组病人发病12、24、48、72、96 h 时血清 MMP-9的水平。结果 A、B、C 3组病人神经功能评分明显高于 D 组,B 组病人明显高于 A、c两组;发病21 d 时,A、B、C 3组病人梗死体积明显小于 D 组,B 组最明显;每组患者血清 MMP-9的水平呈动态变化即发病12 h 开始增高,48 h 达到高峰,96 h 时恢复到正常水平。B 组病人在不同时间点血清 MMP-9的含量明显低于 A、C 两组,且明显低于 D组。结论缺血耐受在脑梗死前合并 TIA 的患者可能发挥作用。其作用可以与 MMP-9的表达减少有关。

Objective The study on transient earebral ischemic attack and its tolerance associated with the changes of the level for serum MMP-9 in the patients with cerebral infarction. This explored the potential mechanism for TIA to make cerebral ischemic tolerance. Methods One hundred and 42 patients stroke were included in the study and the blood samples from their cubital vein were collectet after onset 12,24,48 and 96 h. Expression of MMP-9 was measured by two - layers antibady sandwich enzyme - linked immunosorbent assay （ELISA） in 142 patients. These divided into A group 30 cases（TIA maintaining time 〈 10 min） ,B group 30 cases （TIA maintaining time 〈 10 -20 min） ,C group 30 cases （TIA maintaining time 〉20 min） and D group 52 patients no TIA history of infarction. All patients were identified by CT/MRI,and all patient＇s neurological defects were scored by ESS at 24 h,21 d and 3 months after onset. At the same time,the infarction was measure at 21 days after onset by the way the pullicino put forth. Results The score of neurological defect in A,B,C groups were higher than of D group and the score of neurological defects of B group were higher than that of A and C groups. The infarction volume of A, B, C groups were lower than which of D group at 21d after onset. The level of serum MMP-9 in patients increased after 12 h, were markedly increased at 24 h,and at peak of 48 h. Then decreasd from 72 h and returned to normal level after 96 h. The expresion levels of MMP-9 in B group was lower than A, C groups and much lower than D group. Conclusion TIA may allow the brain to develop endogenous protective mechanism against a subseguent ipsilateral cerebral ishcemia. Ischemia tolerance might occur in haman brain through decreasing the expression level of MMP-9.