细菌性脑膜炎患儿血清、脑脊液基质金属蛋白酶水平变化及其临床意义

Changes of Matrix Metalloproteinase in Serum and Cerebrospinal Fluid of Children with Purulent Meningitis and Those Clinical Significances

目的观察细菌性脑膜炎(PM)患儿血清和脑脊液(CSF)基质金属蛋白酶(MMP-2、MMP-9)水平的变化,分析其相关性,并结合CSF清蛋白指数(AQ),探讨MMP-2、MMP-9在PM患儿血脑脊液屏障(BBB)损伤中的作用机制,并分析其临床意义。方法采用ELISA法检测32例PM患儿(PM组)急性期、恢复期血清和CSF中MMP-2、MMP-9水平,采用溴甲酚绿法测定其血清清蛋白,免疫比浊法测定其CSF清蛋白。采用相同方法检测非神经系统疾病患儿(对照组,n=15)血清和脑脊液中MMP-2、MMP-9水平及清蛋白水平。结果PM组急性期AQ明显高于恢复期和对照组,差异均有统计学意义(Pa<0.001)。PM组急性期血清和CSF中MMP-2、MMP-9水平显著高于恢复期和对照组,差异均有统计学意义(Pa<0.001);PM组恢复期血清和CSF中MMP-2、MMP-9水平与对照组比较差异均无统计学意义(Pa>0.05)。PM组急性期、恢复期,血清MMP-2水平与CSF中MMP-2水平均无相关性(r=0.334、0.042,Pa>0.05);PM组急性期、恢复期,血清MMP-9水平与CSF中MMP-9水平呈正相关(r=0.686,P<0.01;r=0.492,P<0.05)。结论MMP-2、MMP-9可能参与PM的病理过程,MMP-9对PM患儿BBB的破坏作用更加突出,也为PM患儿估计病情和判断预后提供了新的检测指标。

Objective To observe the changes of matrix metalloproteinase（MMP-2 and MMP-9）levels in serum and cerebrospinal fluid（CSF）of children with purulent meningitis（PM）,and analyze the relevance.And according to CSF albumin index（AQ）,to explore the damage mechanism of MMP-2 and MMP-9 in blood-brain barrier（BBB）and those clinical significances.Methods The MMP-2 and MMP-9 levels in serum and CSF at acute phase and recovery phase of 32 children with PM（PM group）were detected by enzyme-linked immunosorbent assay,and CSF albumin was detected by immunoturbidimetric determination,while serum albumin was detected by bromocresol green method.The levels of MMP-2,MMP-9 and albumin in serum and CSF of patients with non-neurological disease（control group,n=15）were detected with the same methods.Results In the PM group,the AQ,MMP-2 and MMP-9 levels in serum and CSF at acute phase were all higher than those at recovery phase and those in the control group,which had shown significant difference（Pa〈0.001）.Ho-wever,compared with the control group,the MMP-2 and MMP-9 levels of serum and CSF at recovery phase had not shown significant differences（Pa〉0.05）.MMP-2 level had no relevance between serum and CSF（r=0.334,0.042,Pa〉0.05,respectively）.But most inte-restingly,the MMP-9 showed a positive relevance（r=0.686,P〈0.01;r=0.492,P〈0.05,respectively）.Conclusions MMP-2 and MMP-9 may be involved in the pathological process of PM in children,and the damage of MMP-9 to BBB becomes more obvious,which might provide a new basis for the estimation of the brain condition and prognosis in PM children.