急性脑梗死患者血清基质金属蛋白酶-9的变化研究

Dynamic changes of serum concentrations of MMP-9 in patients with acute cerebral infarction and their clinical significance

目的探讨急性脑梗死患者血清中基质金属蛋白酶-9(MMP-9)浓度的动态变化及其临床意义。方法选取首次发病的48h以内的颈内动脉系统急性脑梗死患者80例,采用酶联免疫吸附双抗体夹心法测定其入院时以及发病后第3、5、7、14天时的血清MMP-9浓度,与健康对照者50例结果比较。结果急性脑梗死患者入院时血清MMP-9浓度为(260±105)ng/ml较对照组(150±88)ng/ml明显升高,差异有统计学意义(t=6.17,P<0.01)。在发病后第3、5、7、14天时分别为(381±128)ng/ml、(300±115)ng/ml、(281±98)ng/ml、(214±90)ng/ml,呈现先增高后逐渐降低的趋势,以发病后第3天MMP-9浓度升高最明显。神经功能缺损评分减少值与发病后第3天之血清MMP-9浓度呈直线负相关(r=-0.586,P<0.01)。预后不良组1周内血清MMP-9浓度各时间点均高于预后良好组,之后2组之间比较差异无统计学意义(P>0.05)。结论血清MMP-9水平的高低与老年急性脑梗死的临床病程有关,是判断脑梗死近期预后的重要指标。

Objective To investigate the dynamic changes of serum concentrations of matrix metalloproteinase-9（MMP-9） in elderly patients with acute cerebral infarction （ACI） and evaluate their clinical significance. Methods Eighty patients with ACI in the internal carotid artery system within 48 hours after stroke onset were enrolled into this study. The blood samples were collected on admission,at the 3rd ,5th ,7th and 14th day after stroke onset. Serum concentrations of MMP-9 were measured by enzyme-linked immunosorbent assay. Results The serum concentration of MMP-9 in patient group were （ 259.5 ±105.1 ） ng,/ml on admission, and it was significantly higher than that in the control group（ 149.7 ± 87.6 ）ng/ml. At the 3rd ,5th ,7th and 14th day after stroke onset ,the serum concentrations of MMP-9 in patient group were （380.6 ± 128.3 ）ng/ml, （300.5± 115.1 ） ng/ml, （281.3 ± 98.0 ）ng/ml and （214.4 ±89.6）ng/ml respectively, it reached a peak point at the 3rd day after stroke onset. MMP-9 level in the large infarction group was higher than in the medium or the small infarction group （ F = 14. 67 ,P 〈 0. 01 ） . The decreased scores of clinical neurological deficit were negatively correlated with levels of MMP-9 at the 3rd day after stroke onset （r = -0. 586 ,P 〈 0. 01 ） . Patients with bad prognosis had higher levels of MMP-9 than those with good prognosis within 1 week. Conclusions MMP-9 was involved in the acute phase of ischemic infarction and the serum level of MMP-9 might have prognostic value to the cerebral ischemic infarction.