溶栓治疗急性脑梗死患者血浆基质金属蛋白酶-9含量变化及临床意义

Changes of plasma MMP-9 in patients with acute cerebral infarction before and after thrombolytic therapy by urokinase

目的探讨急性脑梗死患者尿激酶动脉溶栓治疗后血浆基质金属蛋白酶-9(Matrix metalloproteinases-9,MMP-9)的变化及临床意义。方法对20例尿激酶动脉溶栓治疗的急性脑梗死患者MMP-9基础值和溶栓后水平进行测定,比较溶栓前后以及与健康对照组血浆MMP-9水平。结果急性脑梗死患者溶栓后MMP-9水平比对照组和基础值显著升高(P<0.05);溶栓后发生出血性转化的患者MMP-9水平较溶栓前有显著增加(P<0.05),与无出血患者相比有增高趋势但无统计学差异;溶栓后完全再通患者MMP-9较基础值明显升高(P<0.05)。结论尿激酶溶栓可能激活了MMP-9,增加溶栓后出血的风险,并且MMP-9可能参与了脑组织缺血再灌注损伤。

Objective To explore the changes of plasma MMP-9 in patients with acute cerebral infarction before and after thrombolytic therapy by urokinase. Methods The levels of MMP-9 were determined in 20 patients with acute cerebral infarction before and after thrombolytic therapy, and 15 healthy individuals served as control. Results As compared with the controls ,the levels of plasma MMP-9 before thrombolytic therapy were not significantly increased（ P 〉 0.05 ）. Nevertheless, MMP-9 values were significantly increased after thrombolytic therapy using urokinase than either before or control group（ P 〈 0.05 ）. MMP-9 values were significantly higher in patients with haemorrhage after thrombolytic therapy compared with before treatment and the controls （ P 〈 0.05 ）, and the values of MMP-9 were higher than those of patients without haemorrhage, but there was no statistical difference （ P 〉 0.05 ）. In completely reperfusion patients, after thrombolytic therapy, MMP-9 level was markedly higher than in no-reperfusion patients （ P 〈 0.05 ）. Conclusions MMP-9 might participate in reperfusion injury of acute cerebral infarction and the mechanisms of hemorrhagic complications in thrombolysis.