血清基质金属蛋白酶9和组织基质金属蛋白酶抑制剂1与急性脑梗死的临床关系

Relationship between the levels of serum MMP-9,TIMP-1 and clinical cerebral infarction

目的探讨脑梗死患者血清基质金属蛋白酶9(MMP-9)和组织基质金属蛋白酶抑制剂1(TIMP-1)的动态变化及对临床预后的影响。方法选择急性脑梗死患者60例,按照TOAST分型方法将脑梗死患者分为3组,心源性脑栓塞(CE)组,大动脉粥样硬化性卒中(LAA)组,腔隙性脑梗死(SA)组,每组20例;另选健康体检者20例作为对照组,分别测定急性脑梗死患者发病24 h内,第5、10天的血清MMP-9、TIMP-1含量,记录患者入院时的美国国立卫生研究所脑卒中量表(NIHSS)评分;记录发病1、6个月时的Barthal指数(BI)来评价顸后。结果发病后24 h内,脑梗死各组患者血清MMP-9、TIMP-1含量较对照组均明显升高(P<0.05),其中,CE组和LAA组MMP-9、TIMP-1含量持续至第5天仍未下降.而SA组已逐渐降至正常水平。发病后24 h内血清MMP-9含量与相应时间段NIHSS评分呈正相关。近期预后较好患者发病24 h内血清MMP-9含量明显低于预后较差患者(P<0.05)。结论MMP-9与病情的严重程度有关。脑梗死后24 h内的血清MMIP-9含量是预后的独立预测因素。

Objective To investigate the changes of serum MMP-9 and TIMP-1 levels in patients with acute cerebral infarction and to evaluate the effect of changes of MMP-9 and TIMP-1 levels on prognosis. Methods Sixty patients with cerebral infarction were included in this study, and 20 healthy people served as the control group. According to TOAST typing, the patients were divided into three groups：cardiogenic embolism（CE, 20 patients）, large artery atherosclerosis（LAA, 20 patients） and lacunar infarction （SA, 20 patients）. The serum specimens were collected for MMP-9 and TIMP-1 determination with ELISA on admission and on 5th and 10th days of onset. All patients were scored according to the NIHSS on admission and Barthal Index was recorded at 1St and 6th months after onset. Results The serum levels of MMP9 and TIMP-1 increased after cerebral infarction, and were significantly higher than those in the control group （P 〈 0.05）. MMP-9 and TIMP-1 in CE and LAA groups were significantly higher than those in SA group （P 〈 0.05）. MMP-9 and TIMP-1 in SA group gradually decreased to normal while they were still high in CE and LAA group on the 5th day after onset. Correlation analysis showed that there was a positive correlation between MMP-9 and NIHSS within 24 hours after onset （r = 0. 883,P 0.01）. The serum level of MMP-9 within 24 hours after onset was significantly lower in the cases with better prognosis than in those with worse prognosis. Conclusions Serum level of MMP-9 was related to NIHSS and can reflect the severity of cerebral infarction. Its level within 24 hours after onset can predict prognosis of cerebral infarction independently.