中青年脑梗死患者颈动脉粥样硬化及其血清基质金属蛋白酶-9、组织基质金属蛋白酶抑制剂-1、超敏C反应蛋白水平的改变

Carotid atherosclerosis and change of serum levels of matrix metalloproteinase-9,tissue inhibitor of matrix metalloproteinase-1 and high-sensitivity C-reactive protein in middle-aged and young patients with cerebral infarction

目的研究中青年脑梗死患者颈动脉粥样硬化及其血清基质金属蛋白酶-9(MMP-9)、组织基质金属蛋白酶抑制剂-1(TIMP-1)、超敏C反应蛋白(hs-CRP)水平的改变。方法应用彩色多普勒超声仪探测42例急性脑梗死患者(ACI组)、29例无症状颈动脉硬化患者(ACA组)及17名健康体检者(NC组)的双侧颈动脉粥样硬化的情况。采用酶联免疫吸附法检测各组血清MMP-9和TIMP-1水平,免疫散射比浊法检测血清hs-CRP水平。结果 NC组均未检出颈动脉粥样硬化斑块。ACI组易损斑块的比例(69.2%)及检出率(47.6%)均明显高于ACA组(46.4%,20.7%)(均P<0.05)。ACI组血清MMP-9、TIMP-1、hs-CRP水平及MMP-9/TIMP-1比值均明显高于ACA组(均P<0.05);ACA组血清MMP-9、TIMP-1、hs-CRP水平均明显高于NC组(均P<0.05)。ACI组中,易损斑块亚组血清MMP-9、TIMP-1、hs-CRP水平及MMP-9/TIMP-1比值均明显高于稳定斑块亚组(均P<0.05);稳定斑块亚组血清MMP-9、TIMP-1、hs-CRP水平均明显高于无斑块亚组(均P<0.05)。结论血清MMP-9、TIMP-1、hs-CRP可作为反映颈动脉粥样硬化及斑块稳定性的血清学指标。MMP-9/TIMP-1比值增高及颈动脉易损斑块可能提示中青年脑梗死的风险。

Objective To study the carotid atherosclerosis and change of serum levels of matrix metalloproteinase-9（MMP-9）,tissue inhibitor of matrix metalloproteinase-1（TIMP-1） and high-sensitivity C-reactive protein（hs-CRP） in middle-aged and young patients with cerebral infarction.Methods The bilateral carotid atherosclerosis of 42 acute cerebral infarction patients（ACI group）,29 asymptomatic carotid atherosclerosis patients（ACA group） and 17 normal controls（NC group） were examined by color doppler.The serum levels of MMP-9 and TIMP-1 in all the groups were measured by enzyme linked immunosorbent assay,and the serum levels of hs-CRP were measured by immunonephelometry.Results Carotid atherosclerosis plaque was not found in NC group.The percentage（69.2%） and positive rate（47.6%） of vulnerable plaque in ACI group were significantly higher than that in ACA group（46.4%,20.7%）（all P0.05）.The serum levels of MMP-9,TIMP-1 and hs-CRP and the ratio of MMP-9/TIMP-1 in ACI group were significantly higher than that in ACA group（all P0.05）,and the serum levels of MMP-9,TIMP-1 and hs-CRP in ACA group were significantly higher than that in NC group（all P0.05）.In ACI group,the serum levels of MMP-9,TIMP-1 and hs-CRP and the ratio of MMP-9/TIMP-1 in vulnerable plaque subgroup were significantly higher than that in stabled plaque subgroup（all P0.05）,and the serum levels of MMP-9,TIMP-1 and hs-CRP in stabled plaque subgroup were significantly higher than that in no plaque subgroup（all P0.05）.Conclusions The serum levels of MMP-9,TIMP-1 and hs-CRP can be serum markers of carotid atherosclerosis plaque and its stability.The increase of the ratio of MMP-9/TIMP-1 and carotid vulnerable plaque might indicate high risk of cerebral infarction in middle-aged and young persons.