基质金属蛋白酶-9在短暂性脑缺血发作预后判断中的作用

The effect of matrix metalloproteinase-9 on the prognosis of transient ischemic attack

目的 探讨血清基质金属蛋白酶-9（MMP-9）水平与短暂性脑缺血发作（TIA）预后的关系.方法 选择64例TIA患者（TIA组）,同时选择与其性别、年龄等匹配的非脑血管病的体检者64例作为对照组,采用ELISA法检测两组MMP-9水平,并进行比较.对入选者随访4年,分析MMP-9水平与TIA预后的关系.结果 TIA组MMP-9水平[（5.25±0.51）μg/L]显著高于对照组[（3.25±0.39）μg/L]（t=7.830,P〈0.05）;TIA组在4年随访中发生一级终点事件患者MMP-9水平显著高于未发生一级终点事件患者[（5.78±0.48）μg/L比（3.15±0.29）μg/L,t=3.250,P〈0.05].TIA患者中,高MMP-9水平者（〉4.5μg/L）较低MMP-9水平者（〈2.5 μg/L）发生一级终点事件的相对危险度为2.612（95% CI 1.557～5.463,P〈0.01）.在排除年龄、性别、体重指数、血脂水平、吸烟史以及高血压、糖尿病病史影响后,高MMP-9水平者发生一级终点事件的危险度显著高于低MMP-9水平者（OR=2.346,95% CI 1.418～5.216,P=0.006）.结论 MMP-9水平与TIA患者的预后有关,提示炎性反应在TIA发病中起重要作用,可能成为评估TIA预后的标志物之一.

Objective To investigate the effect of matrix metalloproteinase-9 （MMP-9） on the prognosis of transient ischemic attack（TIA）. Methods Sixty-four patients with first-onset TIA（TIA group）and 64 age and sex matched cases without any cerebrovascular disease （control group） were involved in this study. The level of MMP-9 was measured by ELISA method,and the subsequent vascular events and death rate were determined in both groups over 4 years. Results The level of MMP-9 in TIA group was significantly higher than that in control group [（5.25 ± 0.51 ） μg/L vs. （3.25 ± 0.39 ） μg/L, t = 7.830, P 〈0.05]. Furthermore, in TIA group, the level of MMP-9 was significantly higher in patients with primary endpoint events than that in the patients without primary endpoint events [（5.78 ± 0.48） μg/L vs. （3.15 ±0.29） μg/L, t = 3.250, P 〈 0.05]. Compared with the patients with lower MMP-9 level （ 〈 2.5 μg/L）, the relative risk of primary endpoint events in higher MMP-9 level patients （ 〉 4.5 μg/L） was 2.612 （95% CI 1.557-5.463 ,P 〈 0.01 ） in TIA group. This increased relative risk for primary endpoint events in TIA group persisted after the adjustment for age, sex, body mass index, blood fat level and other cardiovascular risk factors such as hypertension, diabetes and smoking （OR =2.346,95% CI 1.418-5.216,P =0.006）.Conclusions The level of MMP-9 in TIA patients has relationship with prognosis and inflammation may play an important role in TIA. MMP-9 may be a marker in predicting prognosis.