脑出血患者血浆及血肿引流液中基质金属蛋白酶9的动态变化

Expression of matrix metailoproteinase MMP-9 in the plasma and hematoma fluid of intracerebral hemorrhage patients

目的探讨基质金属蛋白酶（MMP）-9在脑出血（ICH）后继发性神经元损伤中的作用。方法收集符合ICH的诊断要点，经外科手术的住院患者60例。正常对照组40名，其中30名取自正常人静脉血；10名取自正常人脑脊液（CSF）。ICH组取发病后第1天、第4天、第7天血肿引流液及同期静脉血。按照NIHSS和GCS评分；根据“多田公式”计算出血量；采用ELISA检测MMP-9含量。结果（1）ICH患者血肿引流液及血浆中MMP-9含量在不同时段均明显高于正常对照组，差异有统计学意义（均P〈0．01）。正常对照组CSF中不含有MMP-9。（2）ICH患者血浆及血肿引流液中MMP-9含量在发病后的第1天即升高，至第4天达高峰，与第1天对比，差异有统计学意义（P〈0．01），至第7天进入平台期，与第4天对比差异无统计学意义（P〉0．05）。通过动态观察发现，ICH患者血浆及血肿引流液中MMP-9的含量，会随着病情的变化而变化，差异有统计学意义（P〈0．01或P〈0．05）。（3）ICH患者血肿引流液中MMP-9含量较相应时限血浆中MMP-9含量高，差异有统计学意义（P〈0．01）。（4）ICH患者血浆及血肿引流液中MMP-9含量与出血量及NIHSS呈正相关；与GCS之间呈负相关，相关性有统计学意义（P〈0．01）。结论MMP-9可能参与了ICH后继发性神经细胞损伤，其变化与ICH患者脑水肿的演变规律相符。ICH患者血浆及血肿引流液中MMP-9含量的动态演变具有一致性，与出血量的大小和病情轻重呈正相关。

Objective To investigate the matrix metalloproteinase （MMP）-9 played in secondary brain injury following intracerebral hemorrhage （ ICH）. Methods Hematoma fluid and peripheral blood samples were collected from 60 ICH patients, 34 males and 26 females, aged 60 ± 13 （37 -81 ） n the days 1,4, and 7 after evacuation of hematoma. Peripheral blood samples were collected form . 30 sex, and agematched healthy adults as normal controls. Cerebrospinal fluid （SCF） samples were collected from 10 sex, and age-matched patients to undergo operation during lumbar anesthesia. ELISA was used to detect the content of MMP-9. Tada formula was used to calculate the perihematomal edema volume. The National Institutes of Health Stroke Scale （NIHHS） and Glasgow Coma Score （GCS） were used to assess the condition of patients. Results （ 1 ） The MMP-9 levels in the plasma and hematoma fluid of the ICH patients at all time points were all significantly higher than those of the normal controls （ all P 〈0. 01 ）. MMP-9 was not found in the normal CSF. （2） The plasma and hematoma fluid MMP-9 levels were increased already in the day 1, peaked in the day 4, and then kept at a high level until the day 7. （3） The MMP-9 levels in hematoma fluid t all time points were all significantly higher than those in the plasma （all P 〈0. 01 ）. （4） The MMP-9 level was positively correlated with the hematoma volume and NIHSS score, and negatively correlated with the GCS score （ both P 〈 0. 01 ）. Conclusions MMP-9 may takes part in the secondary injury after ICH, and its change is correlated with the hydrocephalus of patients. The dynamical change of the plasma MMP-9 level is consistent with the hematoma fluid MMP-9 level after ICH. There is a positive correlation among the MMP-9 level, perihematomal edema volume, and severity of ICH.