脑出血患者血清MMP-9、IL-6、TNF-α变化及其与灶周水肿的关系

Change of Matrix Metallo Proteinase-9,Interleukin-6,Tumor necrosis factor-a dynamic and its relationship with peripheral edema after cerebral hemorrhage

目的探讨脑出血患者不同时间的血清基质金属蛋白酶9(MMP-9)、IL-6、TNF-α变化及其与灶周水肿的关系。方法采用放免法检测80例脑出血患者(观察组)出血后24 h、72 h、7 d和14 d时的血清MMP-9、IL-6、TNF-α水平,测量其相应时间的灶周水肿体积;并与50例体检正常者(对照组)进行比较。结果观察组脑水肿在发病72 h达高峰,之后缓慢下降。观察组血清MMP-9、IL-6在发病24 h内明显升高,72 h达高峰,与脑水肿高峰一致;7 d后明显下降,14 d接近正常水平,与对照组比较均明显升高(P均<0.01)。血清TNF-α在发病后24 h达高峰,之后逐渐下降;与对照组比较24、72 h均明显升高(P均<0.01)。发病后24、72 h的血清MMP-9水平与IL-6、TNF-α、血肿体积、水肿体积、水肿比值、病情严重程度均呈正相关(P均<0.01)。结论脑出血后血清MMP-9、IL-6、TNF-α均过度表达,并随时间动态变化;MMP-9与灶周水肿体积及病情严重相关,与相对水肿体积相关性更强;MMP-9、IL-6、TNF-α共同参与脑出血后灶周水肿形成,并相互影响。

Objective To study the changes of serum matrix metalloproteinase-9（ MMP-9）, IL-6, TNF-α at different times and its relation with lesion edema in the cerebral hemorrhage patients. Methods Serum MMP-9, IL-6, TNF-α levels in 80 cases of cerebral hemorrhage patients （observation group） 24 h, 72 h, 7 d and 14 d after eerehral hemorrhage were measured by radioimmunity methods, and their respective focal edema volumes at the corresponding time were detected, and compared with 50 cases with normal physical examination（ control group）. Results Hydrocephalus of patients in observation group peaked at 72 h, followed by a slow decline. Serum MMP-9, IL-6 levels within 24 h were signifieandy increased, reached the peak at 72 h after morbidity, accorded with the peak of cerebral edema, decreased significantly after 7 d, dosed to normal levels at 14 d, and were significantly higher than that of control group（P 〈0.01 ）. TNF-α reached to the peak level 24 h after morbidity and then gradually declined, were significantly higher at 24 h, 72 h than that of the control group（ P 〈0.01 ）. MMP-9 was positively correlation with IL-6, TNF-α, hematoma volume, edema volume, edema ratio, the degree of deterioration of the conditions at 24 h and 72 h （ P 〈 0.01 ）. Condusions Serum MMP-9, eytokines （ IL-6, TNF-α） are over-expressed and have the dynamic changes over time after cerebral hemorrhage, MMP-9 is correlated with the edema volume and deteriorated condition and has more stronger correlation with relative size of edema. MMP- 9, IL-6, TNF-α involve in the formation of edema and influence each other.