不同TOAST分型脑梗死患者血清基质金属蛋白酶-2和基质金属蛋白酶-9水平的研究

Levels of matrix metaUoproteinase-2 and matrix metaUoproteinase-9 in serum of cerebral infarc-tion patients with the different cIassification of TOAST

目的探讨血清基质金属蛋白酶（MMP）-2和MMP-9与脑梗死TOAST分型和预后的关系。方法应用ELISA法检测60例脑梗死患者（CI组）和30例对照者（NC组）血清MMP-2和MMP-9水平，根据TOAST分型，CI组又分为心源性脑栓塞组（20例）、大动脉粥样硬化性脑梗死组（20例）和腔隙性脑梗死组（20例），比较各组血清MMP-2和MMP-9水平的变化。结果CI组患者脑梗死后第1天血清MMP-2水平较NC组明显降低，差异有统计学意义（P〈0．01），血清MMP-9水平较NC组明显升高，差异有统计学意义（P〈0．01）；心源性脑栓塞组和大动脉粥样硬化性脑梗死组患者脑梗死后第1天血清MMP-9水平明显高于腔隙性脑梗死组，差异均有统计学意义（P均〈0．01）；血清MMP-9水平与美国国立卫生院卒中量表（NIHSS）评分呈正相关，预后良好患者发病12d内血清MMP-9水平明显低于预后不良患者，差异有统计学意义（P〈0．01）。结论脑梗死后血清MMP-9水平升高，升高幅度和变化规律在TOAST各亚型不尽相同，心源性脑栓塞患者和大动脉粥样硬化性脑梗死患者MMP-9水平高于腔隙性脑梗死患者；血清MMP-9水平可作为评价脑梗死病情的可靠指标；脑梗死后第1天的血清MMP-9水平是预后的独立预测因素。

Objective To determine and compare the levels of serum matrix metalloproteinase （MMP）-2 and MMP-9 in acute stage of cerebral infarction and the relationship and prognosis between them and the classification of TOAST. Methods The levels of MMP-2 and MMP-9 were detected by ELISA in 60 cerebral infarction patients （CI group） while 30 healthy donors were served as control group （NC group） . Results The level of MMP-2 in CI group was significantly lower than that in NC group （P 〈 0.01 ） and the level of MMP-9 was significantly higher than that in NC group （P 〈 0.01 ）. Compared with lacunar infarction （LI） group, the level of MMP-9 was significantly higher in cardiogenic cerebral embolism group（ CCE group） and large artery arteriosclerosis cerebral infarction group（LAA group）; The serum level of MMP-9 was related to NIHSS.The serum level of MMP-9 in good prognosis patients was significantly lower than that in poor prognosis patients （P 〈 0.01 ）. Conclusions The serum level of MMP-9 is increased after cerebral infarc- tion. The serum level of MMP-9 in the CCE group and LAA group is significantly higher than that in LI group. The level of MMP-9 is a reliable parameter in evaluating the disabilities in cerebral infarction. The level of serum MMP-9 within 24 hours of onset can predict the prognosis of cerebral infarction independently.