急性脑出血患者中基质金属蛋白酶-9的临床意义

Clinical Research of Serum Metalloproteinase-9 in Patients with Acute Intracerebral Hemorrhage

目的 探讨急性自发性脑出血患者的血肿周围水肿形成及继发性神经损伤的机制.方法 用ELISA方法测定29例急性脑出血患者出血后24～72h及10～14d血清中基质金属蛋白酶-9的含量.依据头颅CT结果,计算血肿体积和水肿体积.同时采用美国国立卫生研究院脑卒中量表（ NIHSS评分）进行神经功能缺损评分.结果 1.脑出血患者血清基质金属蛋白酶-9的含量显著高于正常对照组,并且呈动态变化,发病3d内升高最明显,随后下降,在血肿吸收期基质金属蛋白酶-9的含量仍高于正常水平.2.血清基质金属蛋白酶-9水平与血肿体积无关,但与血肿周围水肿体积呈正相关.3.急性期血清基质金属蛋白酶-9的水平与急性期NIHSS评分无相关;但是与血肿吸收期的NIHSS评分呈正相关.结论 脑出血诱发基质金属蛋白酶-9的过度表达;基质金属蛋白酶-9参与出血后血肿周围水肿的发生、发展过程,参与脑出血继发性损伤中脑水肿的形成.

Objective The study was designed to observe the temporal profile of matrix metalloproteinase-9 （MMP-9） and to investigate the relationship between the level of serum MMP-9 and the perihematomal edema volume and the neurologic impairment in patients with ICH. Methods The level of serum MMP-9 in 29 patients with ICH was determined by enzyme-linked immunosorbent assay（ELISA） for at 24 - 72h and 10 - 14d after onset. The volumes of hematoma and its peripheral edema were measured according to CT scan,the neurologic impairment score was evaluated by the National Institutes Health Stroke Scale（NIHSS） at the two times,respectively. Results 1. Levels of serum MMP-9 were significantly higher in the ICH group at each time point after onset than those in the normal control group.2. Levels of serum MMP-9 were not related with hematoma volume and the first NIHSS scores. On the other hand, levels of serum MMP-9 were positively correlated with the perihematomal edema volume.There was positive correlation between the hematoma volume and the first neurologic impairment scores. Conclusions 1. MMP-9 expression is activated after ICH.The increased expression of MMP-9 may be the index of predicting nervous function injury at the early stage after ICH. 2. The changes of the contents of MMP-9 in serum of patients with ICH are closely related with perihematomal edema volume.lt is postulated that MMP-9 enhance development of perihematomal edema through degrading of the blood brain barrier component substances.