高压氧治疗对脑梗死患者血清基质金属蛋白酶-9的影响

Effects of hyperbaric oxygen therapy on serum concentrations of matrix metalloproteinase-9 for patients with cerebral infarction

目的探讨高压氧(HBO)治疗后急性脑梗死患者血清基质金属蛋白酶-9(MMP-9)水平的动态变化及其与临床疗效的关系。方法选取首次发病的24 h以内的颈内动脉系统急性脑梗死患者76例,分为高压氧治疗组(HBO组,36例)和常规治疗组(常规组,40例)。常规组仅给予常规治疗,HBO组在常规治疗基础上加用HBO治疗。30例年龄、性别与脑梗死患者相匹配的健康人为健康对照组(正常对照组)。采用酶联免疫吸附双抗体夹心法测定脑梗死患者入院时、发病后第3、5、10天以及正常对照组血清MMP-9。所有患者于入院时和治疗后10 d、1个月进行神经功能缺损评分,评价HBO组和常规组之间的疗效差异。结果(1)与正常对照组比较,HBO组和常规组入院时血清MMP-9的浓度均明显增高,差异有统计学意义(P<0.01),但后二者之间差异无统计学意义(P>0.05)。与治疗前相比,常规组和HBO组血清MMP-9水平均呈现先增高后降低的动态变化趋势,3 d时达高峰,在治疗后3、5 d时HBO组血清MMP-9浓度低于同期常规组(P<0.05)。(2)治疗1个月后,神经功能缺失评分HBO组明显低于常规组;HBO组疗效优于常规组(P<0.05)。(3)脑梗死患者神经功能缺损评分减少值与患者发病后第3天之血清MMP-9水平呈显著负相关。结论HBO治疗能降低脑梗死患者升高的血清MMP-9浓度,减轻神经功能缺失程度,其临床疗效可能与降低患者血清MMP-9的浓度有关。

Objective To measure the dynamic changes of matrix metalloproteinase-9 （ MMP-9 ） concentration in patients with cerebral infarction treated with hyperbaric oxygen （HBO） and to investigate the relationship between MMP-9 concentration and the curative effect. Methods Seventy-six patients with acute cerebral infarction in the internal carotid artery system within 24 hours after stroke onset were randomized into two groups. Patients in the routine treatment group （ n = 40 ） were treated with clinical routine treatment only, whereas those in the HBO group （ n = 36 ） were treated with HBO therapy combined with clinical routine treatment. Thirty healthy persons were used as the control. Concentrations of MMP-9 were measured by enzyme- linked immunosorbent assay. The blood samples were collected on admission, at the 3rd , 5th and lOth day after treatment. Neurological deficits were estimated on admission, at the lOth day and one month after treatment, and therapeutic efficacy were evaluated after treatment. Results （ 1 ） There was no significant difference between the HBO group and the routine group in MMP-9 concentration on admission. MMP-9 concentrations in the two patient groups were significantly higher than in the control （ P 〈 O. O1 ）, reaching a peak on the 3rd day. At the 3rd and 5th day after treatment, MMP-9 concentrations in HBO group were significantly lower than in the routine group （ P 〈 O. 05 ）. （2） The scores of neurological deficit in HBO group were lower than in the routine group after one month after treatment. Patients in HBO group showed better functional outcome than in the routine group （ P 〈 O. 05 ）. （ 3 ） The decreased scores of neurological deficit （between pre- and post-treatment） negatively correlated with the levels of MMP-9 at the 3rd day. Conclusions MMP-9 was involved in the formation of cerebral infarction. HBO therapy may decrease the level of MMP-9 in patients with cerebral infarction and improve their outcome of neurological function. Therefore, the better therapeutic efficacy may be correlated with the decreased level of MMP-9. HBO therapy has promise as a treatment for acute cerebral infarction.