高压氧对脑出血患者血清基质金属蛋白酶-9、细胞间黏附分子-1及脑水肿的影响

The effects of hyperbaric oxygen on serum matrix metalloproteinase-9, intercellular adhesion molecule-1 and brain edema in patients with intracerebral hemorrhage

目的探讨高压氧（HBO）治疗对急性脑出血患者血清基质金属蛋白酶-9（MMP-9）、细胞间黏附分子-1（ICAM-1）和脑水肿的影响及其相互关系。方法选取脑出血患者76例（常规治疗组40例，HBO治疗组36例）及正常对照组30例，分别观察治疗前、后血清MMP-9及ICAM-1含量的动态变化，并于病程第5～7天和第25天进行头颅MRI检查，T2WI图像观测脑水肿的范围，计算脑水肿绝对体积和相对体积。结果（1）常规治疗组和HBO治疗组入院当日血清MMP-9及ICAM-1含量明显高于正常对照组（P〈0．01），人院后第5天达到高峰，2组间差异无统计学意义（P〉0．05）；第15天和第25天HBO治疗组（HBO分别治疗1、2个疗程）血清MMP-9及ICAM-1含量明显低于常规治疗组，2组相比差异有统计学意义（P〈0．01）。（2）病程第5～7天、第25天HBO治疗组的绝对脑水肿体积和相对脑水肿体积均小于常规治疗组（P〈0．05，P〈0．01）。（3）血清MMP-9和ICAM-1含量与脑水肿体积呈正相关，美国国立卫生研究院卒中量表评分（NIH—SS）的差值与血清MMP-9和ICAM—1水平（病程5天时）呈负相关。结论HBO治疗能降低脑出血患者血清MMP-9和ICAM-1浓度，减轻脑水肿程度和范围，有利于神经功能恢复。早期、连续多次HBO治疗可使患者受益。

Objective To investigate the effects of hyperbaric oxygen （HBO） therapy on serum matrix metalloproteinase-9 （MMP-9） and intercellular adhesion molecule-1 （ICAM-1） levels, and on brain edema in patients with intracerebral hemorrhage. Methods Seventy-six subjects with intracerebral hemorrhage were divided into a routine treatment group （40 cases） and a.HBO treatment group （36 cases）. 30 healthy persons served as a control group. Serum MMP-9 and ICAM-1 levels were measured before and after treatment. MRI images of the subjects＇ brains were prepared at the 5 -7 th and 25th days. Absolute edema volumes and relative edema volumes were measured on T2-weighted images. Results （1）The serum MMP-9 and ICAM-1 levels in the routine therapy and HBO groups were higher than those in the control group at the outset （P ≤0. 01 ）. Both indices peaked on the 5th day, but there was no significant difference between the two treated groups. At the 15th and 25th day （ after 10 and 20 HBO treatments） , the serum MMP-9 and ICAM-1 levels in the HBO group had decreased remarkably and were significantly lower than those in the routine therapy group （P ≤〈 0.01 ）. （2）At the 5 - 7th and 25th days, both absolute edema volumes and relative edema volumes in the HBO group were significantly smaller than those in the routine therapy group （P≤〈 0.05, P ≤ 0.01 ）. （3）Serum M MP-9 and ICAM-1 levels were positively correlated with the brain edema volumes, and negatively correlated with decreased NIHSS scores （between pre- and post-treatment）. Conclusions HBO therapy may reduce serum MMP-9 and ICAM-1 levels in patients with intracerebral hemorrhage, and lessen the severity and range of brain edema. HBO is helpful for restoring nerve function. Early and repeated multiple HBO treatments are beneficial for patients.